Transcending: Gender-Expansive Children

I’m writing a blog series Transcending: They’ll Know Us By Our Love, about the church and LGBTQ people, beginning with transgender people.

The Situation told why this is personal for me.

Creation looked at what the Bible says about gender and how what transgender people say about themselves matches that.

The Science looked at the considerable scientific research that also matches both what the Bible says and what transgender people say about themselves.

Self-Definition looks at why we should believe people when they tell us who they are.

What Does the Bible Say? looks at what the Bible says about transgender people changing their bodies to match their gender. Spoiler alert: It says nothing against it! And has plenty to say about supporting and accepting who they are.

Not Conforming to the World looks at how transgender people are a marginalized group of outsiders – and the church should not be piling on.

Choice and Non-Choice looks at some evidence that LGBTQ people are born that way.

Interpretation points out that concluding homosexuality is sinful is by no means the only reasonable interpretation of Romans 1 and other New Testament passages.

Today I’m going to look at gender-expansive children and how pediatricians recommend that we respond to them.

In my first Science link, I only referenced one professional organization of doctors. Even though I do not believe that the Endocrine Society has any reason to be biased in favor of offering treatment that is not helpful, I’ve been challenged about this, so have done some research about other professional organizations of medical doctors, psychologists and psychiatrists. It turns out that most national and international organizations of these professionals have some sort of statement, if they interact with transgender people at all. And they offer links to peer-reviewed studies and yet more scientific evidence on the effectiveness and helpfulness of treatment.

I want to look at more of these links, and I’ve decided to look in more detail instead of looking at them as a group – there’s so much information, it can get overwhelming.

It’s interesting to me that random google searches don’t necessarily gather this information, but if you’re looking specifically for professional organizations, you can find them, including those crucial links to research.

I’d like to start with a comprehensive paper compiled by the American Academy of Pediatrics called “Supporting and Caring for Transgender Children.” This paper was prepared in conjunction with the American College of Osteopathic Pediatricians and the Human Rights Campaign Foundation.

I’m going to highlight some statements in the paper, but I do highly recommend reading it fully, if you have any interest at all in understanding transgender children and the things they are dealing with.

Before I go through the paper, I want to make some comments. People who believe that using hormonal therapy or surgery to alter ones bodies is “opposed to God’s design,” and people who think transgender people are “confused” or perverting their sex drive or simply highly suggestible and led astray by counselors – have trouble explaining why young children would ever claim to be transgender.

With children, it’s definitely not about sex. That throws off the idea that being transgender is some kind of sexual perversion. On a child’s level, it’s about who they are and other people calling them the wrong thing.

Most transgender adults who came out as children now tell us that they explained to their parents that the parents were getting their gender wrong, not the other way around. This wasn’t about gender stereotypes or what colors they liked or what they wanted to play with, but was somehow about who they are.

Personally, this fits my belief that God created people “male and female,” and gender identity is something you are born with. Gender identity is biologically located in your brain and won’t always match your external organs, just as chromosomes don’t always match your external organs and internal organs don’t always match your external organs. That even children claim to know their own gender despite what people tell them seems to be strong evidence that gender identity and genitals don’t always have to match.

But let’s look at the American Academy of Pediatrics paper, “Supporting and Caring for Transgender Children.” I’m going to go through it in detail, but do recommend reading it yourself.

They begin with a story, mentioning Jazz Jennings, one of the youngest people to publicly come out as transgender. She is now eighteen years old and has had gender confirmation surgery and is still happy with her journey. But the point of mentioning her is that she testifies that she had a safe and happy childhood.

The purpose of the guide is clearly stated:

This guide is designed for anyone who knows a transgender or gender-expansive child, plans to write about children who transition, or simply wants to learn more. It reviews what medical and education experts know about transgender children, explores some myths about gender transition in childhood, and offers suggestions for adults with a transgender child in their life.

The focus is on children who have not yet reached puberty, approximately ages 5 to 10.

First, they explain terms. They tell about gender-expansive children, who don’t necessarily follow norms for gender expression.

Occasionally, a child consistently asserts a gender identity inconsistent with the sex they were assigned at birth. Jazz, for example, insisted she was “really a girl,” despite being told she was a boy. These children may also express discomfort with their sex, such as a desire to be rid of their genitals or a wish that they’d been “born in a different body.” They will often say “I am…” rather than “I wish I were…” Children and adults who identify with a gender and/or sex different than what they were assigned at birth are known as transgender. Transgender children are a subset of gender-expansive kids.

They cite a study that most gender-expansive children do not grow up to be transgender adults. Being gender-expansive is much more common than being transgender.

The first advice they give is not to pressure children — one way or the other.

Although families and communities may struggle with uncertainty, pressure (either to transition or to stop gender-expansive behaviors) can be harmful, so their patience and support are immensely important.

It is not uncommon for a child to feel pressure — at home, school or elsewhere — to hide their gender-expansive traits. This social pressure, when it exists, can be intense and very painful, leading children to hide their “true gender selves” altogether. Families may even encourage the child to do so, hoping to protect them from bullying. Unfortunately, hiding one’s identity or gender-expansive traits can cause serious problems during childhood and later in life — including depression, anxiety, self-harm and even suicide.

Just like the studies the Endocrine Society linked to, the Pediatricians also assert that gender identity cannot be changed by others (with links).

Although social experiences help to shape a child’s gender identity, neither families nor professionals can change that identity, and trying to do so can be extremely harmful.

Next they discuss gender dysphoria and transgender children. I want to highlight that for children, they are not talking about medical intervention.

Depending on the child’s age and signs of distress, “gender-affirmative” counseling or therapy can help manage gender dysphoria. However, in many cases, the remedy for dysphoria is gender transition: taking steps to affirm the gender that feels comfortable and authentic to the child. It is important to understand that, for children who have not reached puberty, gender transition involves no medical interventions at all: it consists of social changes like name, pronoun and gender expression.

While acceptance and affirmation at home can help a great deal, children do not grow up in a vacuum, so even children with supportive families may experience dysphoria. Nonetheless, families and doctors of transgender children often report that the gender transition process is transformative — even life-saving. Often, parents and clinicians describe remarkable improvements in the child’s psychological well-being.

They mention, as I’ve read other places, that a child who is transgender will be insistent, consistent, and persistent about their gender identity, with little or no ambivalence.

The paper explains that even without medical intervention, transition is not simple, and they’ll need medical, psychological, family, and school support.

I love this paragraph about how that transition typically goes for the child, despite all the challenges:

Despite these difficulties, a child’s gender transition is almost always a positive event. Often, the child’s debilitating gender dysphoria symptoms lift, diminishing difficult behavior that came with them. Dr. Ehrensaft calls this the ex post facto (“after the fact”) test: a dramatic reduction in stress, and blossoming happiness for the child and family, indicate that social transition has been the right choice. Along with joy at this renewed well-being, families are often thrilled to find that gender transition removes the emphasis on gender in a child’s life. With their gender identity no longer in conflict, the child can focus on the important work of learning and growing alongside their peers. Many children feel relief, even euphoria, that the adults in their life have listened and understood them.

(This is exactly what I’ve heard about from so many mothers of transgender children in my Facebook group.)

The article does touch on what’s going to happen when puberty hits. Usually transgender children will take puberty-blockers to give them more time to be sure whether they want to fully transition as a transgender adult. These are fully reversible.

Another important section sums up what we do know with very good evidence at this time (and it’s heavily footnoted):

Experts who work with transgender children, adolescents and adults generally agree on some important points. First, transgender adolescents and adults rarely regret gender transition, and the process (including social and/or medical changes) substantially improves their well-being. Second, some children express a strong transgender identity from a young age and grow into transgender adults who can live happily and healthily in their authentic gender. Third, discouraging or shaming a child’s gender identity or expression harms the child’s social-emotional health and well-being, and may have lifelong consequences.

A very important section follows, where they look at the strong evidence that gender-affirmative therapy (“focusing on what the child says about their own gender identity and expression, and allowing them to determine which forms of gender expression feel comfortable and authentic”) is the best approach, as opposed to reparative therapy, which attempts to “correct” gender-expansive behaviors, or delayed transition, which “prohibits transition until a child reaches adolescence or even older, regardless of their gender dysphoria symptoms.”

While researchers have much to learn about gender-expansive and transgender children, there is evidence that both reparative therapy and delayed transition can have serious negative consequences for children. While some groups promote these strategies in good faith, many use misleading descriptions of research or even outright misinformation.

This section describes the theory and evidence behind each approach. It explains why clinicians have embraced gender-affirmative care, and outlines what we have yet to learn about caring for transgender children.

Right now, my church is considering a policy that says that any “attempt to change ones birth sex” is “opposed to God’s design.” Since that amounts to saying that gender-affirmative therapy is opposed to God’s design, they’re left with reparative therapy. Please, please, take a look at the statistics here which show great harm can come from reparative therapy. Follow the links and look closely before saying that transgender children must use this approach, against the overwhelming consensus of major medical organizations.

There is no scientific evidence that reparative therapy helps with gender dysphoria or prevents children from becoming transgender adults. Instead, experts and professional organizations believe that it inflicts lasting damage on children. In particular, it harms family relationships and makes children feel ashamed of who they are. Sociologist Karl Bryant, who as a young boy underwent therapy designed to make him less stereotypically feminine, wrote in 2007 that “the most enduring residue [of the treatment was] the shame of knowing that those I was closest to disapproved of me in what felt like very profound ways.”

They then look at Delayed Transition and the problems with not treating children individually, but setting rules for all children based on age.

That section has some lovely conclusions:

Gender-affirmative clinicians emphasize considering each child individually — and in terms of their developmental stage, not their age. They advise that transition should take place when the child indicates that they are ready, rather than when adults dictate it.

With affirmation and support, many transgender and gender-expansive children mature into happy, healthy young adults. These young people are remarkably resilient to the challenges they face. Emerging research reports that transgender children whose families affirm their gender identity are as psychologically healthy as their non-transgender peers.

The paper finishes up with advice to parents and with lists of resources (and of course the 98 footnotes). They don’t want anyone to rush to assume their child is transgender (most gender-expansive children aren’t), but they do want parents to assure their children that they are loved unconditionally, “however they express themselves and whoever they grow up to be.”

Growing up transgender or gender-expansive can be difficult. By supporting families, sharing the facts and practicing gender-affirmative attitudes with all children, each of us can make life a little easier for these unique, resilient kids.

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