When children and adolescents experience gender dysphoria, our aim should be to provide them with treatment of the highest standard of care. We should be attempting to provide assistance that will result in the best outcomes—in the short-term, as well as the long-term. Unfortunately, treatment of childhood dysphoria is an area not yet well understood. The extreme contentiousness around the topic means that research can be difficult to conduct and is often hampered by ideological agendas. (For example, see here.) Without a clear consensus among researchers about the best way to treat gender dysphoric children and teens, input from parents increases in importance when determining course of treatment, since it can be assumed that most parents know their children well and have their best interests at heart.
However, narratives promoted by activists and the media currently undermine the crucial parental role in diagnosing dysphoria and helping to determine the most appropriate treatment. Amid glowing media discussions of brave trans kids and their heroic, supportive parents hangs an ominous specter of ignorant, bigoted parents who coldly turn their child out, or cause him or her to endure torturous conversion therapy to eradicate transgender feelings. Tales of the former abound. These stories are told in detail and with soaring rhetoric. In contrast, the latter kind of parents are always darkly implied, but rarely discussed with specifics. Rather, their influence is frequently invoked to underscore the dangers of not immediately affirming a child’s chosen gender.
There are several problems with this. The foundational assumption seems to be that many, if not most, parents will reject or condemn a child who comes out as transgender. But we have no evidence that this is the case. A 2015 study by the Pew Research Center noted that a majority of American parents report they would not be upset to learn that their child is gay or lesbian, and most gays and lesbians who came out to their parents felt that their relationship with their parents either grew stronger or stayed the same. Parental acceptance rates have been steadily rising since the 1980s and continue to inch up year by year. While the study did not explore parental reactions to having a transgender child, it would be surprising if family acceptance trends for trans kids were found to be moving in starkly divergent directions from those for gay and lesbian kids.
Nevertheless, the media continues to cultivate a narrative of widespread parental rejection and abuse. “To Stop Trans Kids from Killing Themselves, Shocking Study Says ‘Accept Them’” reads one Vice headline. The article makes the rather startling assertion that “in most species it is typically taboo to reject offspring, but something has occurred in our culture that has made it socially acceptable to reject transgender or LGB children.” No evidence is offered to support the claim that parents are rejecting their gender nonconforming children in heretofore unseen numbers against the promptings of parental instincts evolved over the eons. Readers are asked to accept this on faith.
A recent Daily Beast article decrying legislative proposals to keep schools from usurping parental authority in the case of trans kids starts off with this fallacy embedded in its opening sentences:
For transgender kids, home is not always a safe place to be out of the closet.
According to an online resource from the American Academy of Pediatrics (AAP), most kids “have a stable sense of their gender identity” by age 4. But they don’t reach the legal age of majority until at least 14 years later—sometimes longer, depending on the state.
That means many transgender children spend over a decade in the custody of someone who may not support them, and who may try to enroll them in harmful conversion therapy programs to try to change their gender identity.
Merely by virtue of living with parents, the author appears to be implying, trans kids may be at risk.
In another Vice article published a few months later—this one grandiosely titled “How the Mothers of Transgender Children are Changing the World”—we are again asked to believe that rejecting parents are the problem even though scant evidence is offered. “High rates of suicide and homelessness in the transgender population can probably be traced back in part to parental rejection,” the article asserts. In fact, the research linked in support of this statement notes that “the suicide attempt rates among those whose families supported them after coming out as trans was 33 percent.” Evidently then, parental rejection is far from the only issue here.
A further problem with the rejection assumption is that it leaves no room for sensible parental concern. If our starting supposition is that parents who express anything other than effusive enthusiasm are bigoted and rejecting, then the parental voice quickly gets lost, discounted, and even mocked when addressing clinicians. Rather than discerning whether transition might be right for a particular child after a careful evaluation that includes information from many sources including parents, gender therapists tend to assume that transition is the one and only right response, and parents are wrong if they don’t affirm. According to this belief, a questioning parent who wants to slow down on medical intervention is prima facie wrong.
Parents often have crucial information that could be important in making a differential diagnosis. Since children and teens are often poor historians, parental input can be key. Parents may have information about whether the dysphoria was present in childhood and whether there are other psychosocial challenges that may confound diagnosis. Many of the parents I speak with report having had their information and opinions rejected by gender therapists who appear to be distrustful of them. One mother was told by a gender therapist that she needed to enter her own therapy to learn how to support her ‘son’ when she shared information about her daughter’s recent sexual harassment by a boy in the neighborhood. The therapist even scolded the mother, suggesting that the mother’s sadness and concern for her child’s potential transition were inappropriate responses.
A third problem with the belief that parental rejection is the norm is that it makes for bad policy. How can a society function efficiently if it cannot depend on parental good faith toward offspring as a bedrock assumption? This does not mean, of course, that there aren’t truly awful parents who reject and abuse. But they are the exception rather than the rule. To establish guidelines and policies based on these exceptions dangerously arrogates too much authority to the state and institutions for children’s well-being and undermines the role of the parent. This leads to policies that range from the dangerous to the absurd.
In 2016, the National Education Association issued guidance for schools in conjunction with the Human Rights Campaign and other activist groups. The guidance stipulates that when students have parents who don’t agree with immediate affirmation of a trans identity, schools should step in. According to the report, “the school and student should determine how to proceed through the collaborative process of figuring out how the school can support the student and balance the student’s need to be affirmed at school with the reality that the student does not have that support at home.”
In practice, many schools have informal policies whereby any request on the part of a student for a change in name or pronouns is immediately granted without any discussion with parents. In my work consulting with parents of teens who have adopted a trans identity out of the blue without any prior history of gender dysphoria, I hear frequently that the child has been affirmed at school without parental input.
In one case, a family whose daughter was in the midst of gender exploration at home asked me to have a conversation with an administrator at their daughter’s private school. In a phone conversation with the head of the upper school, I shared my concerns about social contagion and poor outcomes in teen girls who appear to have developed rapid onset gender dysphoria (ROGD). I asked whether he might consider having a conversation with parents when a student came to school administrators asking for name and pronoun changes. “We can’t do that,” he responded. “It would put the child at too great a risk for parental abuse and rejection.”
Of course, this is an incoherent and poorly thought-through policy. Keeping parents in the dark to ‘protect’ the child is naïve at best. It appears that most kids suddenly claiming a trans identity are from educated, upper middle-class households. The parents I speak with are deeply engaged in and concerned about their children’s lives. It is very unlikely that a name change at school would escape notice for long in families where parents routinely check homework and are in close contact with teachers and others at the school. Most of the parents I speak with whose child has been affirmed without their knowledge quickly discover what has happened simply by seeing an assignment come home with a different name on it. Far from being rejecting or abusive, these parents are deeply concerned about their children’s struggles and spend considerable time researching the best way to support their child.
But let’s imagine for a moment that the school manages to affirm a child while ensuring that the parents don’t find out. The NEA guidance does, after all, encourage school administrators to address “how to refer to the student when communicating with the student’s parents or caregivers, both in writing and verbally,” as well as “how to refer to the student when communicating with the student’s siblings.” What is at stake if a school’s deliberate deception of parents succeeds? In such a case, parents would lose the opportunity to be alerted to their child’s distress in a timely manner. Perhaps the family has information the school does not that might shed light on underlying issues—histories of depression, eating disorders, or recent traumas, for example. By not informing parents about their child’s struggles, schools may be closing off an important opportunity to get appropriate treatment for comorbid issues.
Moreover, changing a child’s name at school can come with a host of potentially serious problems. One mother I spoke with told me that her child had been affirmed at school with a boy’s name without her knowledge. The mother received a phone call from the school one day stating that there had been and accident, and her son “X” (boy name) had been injured. The mother replied that the school was mistaken, as she did not have a son, nor a child named “X.” Of course, the medical emergency had in fact involved her child, but she only found out later. Another family’s daughter had been quickly affirmed at school without any discussion with the parents. Soon after, the teen was signed up for the SAT under the new, male name. This presented a significant challenge, since ID is required when taking a standardized test. In this case, the teen subsequently changed her name back to her birth name, and the family faced a bureaucratic struggle when it came time to apply for college, since the teen’s scores had been sent to universities under the male name and sex.
But perhaps the most serious problem created by the assumption of parental rejection is that it encourages familial estrangement. Alexis is a young reidentified woman who now feels that the narratives around being transgender encouraged her to distance herself unnecessarily from her parents. “The activists really do separate families,” she told me in an email conversation recently. “I thought I couldn’t trust my own mother.” Alexis says that, although no older trans person ever told her she would have to leave her family, she was given to believe that parental alienation was inevitable. “There was this time in class where my friend who was a transgender boy talked about dealing with his relatives. He said he cut them out of his life completely. He had to, he said. Everyone in the room nodded in agreement, even the teacher seemed to approve. I assumed I would have to do that too.” Alexis’s ‘coming out video’ provides a fascinating account of her experiences and is well worth watching:
Having been in contact with hundreds of families with ROGD teens, I am aware that parental alienation is a not infrequent outcome. Contrary to the scare-mongering in the articles cited above, the family rejection I have seen is almost always initiated by the young person, not his or her parents. I have known multiple families in which trans identified young people cut off all contact with their families simply because the parents suggested to their child that a cautious approach to medical transition might be best or shared some academic journal articles about the side effects of treatment.
As mentioned previously, the Pew Research Center study noted that family relationships often improve after a young gay or lesbian person comes out to parents. Only in a minority of cases did the relationship worsen. According to recent research on ROGD, parental relationships tend to worsen after a young person announces a trans identity, and the relationship continues to deteriorate over time. I believe that this difference is due in part to the belief promulgated by transgender activism that parents are not to be trusted, and should be looked upon with suspicion. Once such a belief has been created, even loving, well-meaning questioning or discussion is usually interpreted as evidence of ‘transphobia.’
Separating young people from their families serves no one, least of all the trans identified person. Young people experiencing gender incongruence are often psychosocially vulnerable and in need of family members who can offer material and emotional support. Stephen Levine is a psychiatrist who has had a long experience in working with transgender patients. He chaired the WPATH committee that developed the fifth version of the standards of care in the 1990s. In a recent academic paper, he shares concerns about family rupture. “The literature laments that some families reject their children, but it does not mention the patients’ rejection of their families,” he writes. He posits an ethical conundrum:
In diminishing our patients’ gender distress, we are enacting the ethical principle of Beneficence. But we are ignoring our empathic concern for those deeply connected to our patients. Perhaps the protocol for these patients ought to include counseling on how not to lose connection to others. By not doing so, it is likely that we are failing to help our patients to understand and preserve their familial and peer bonds.1
As a society, we have decided that there are times when it is appropriate for the state and other institutions to intervene between a child and his parents. Courts have found, for example, that medical providers may overrule parental objection to blood transfusions for their child in the case of Jehovah’s Witnesses. Do parents who don’t immediately affirm their child’s sudden transgender identity fall into the same category as Jehovah’s Witness parents seeking to prevent blood transfusions? Courts justify compulsory medical treatment over parental objection in order to prevent physical harm to the child. There is no robust evidence that immediate affirmation for teens is necessary to avoid harm. Medical intervention for gender dysphoric adolescents remains a controversial subject, about which no clear consensus exists at this time.2 In fact, some anecdotal evidence points to the reverse. Many reidentified young people note that they were less happy when trans identified, and rates of depression and suicidality remain high for adults after transition.3
In some sense, the discussion turns around what we mean by the word ‘support.’ Transgender activists believe that the only way to support a transgender identifying teen is to immediately accede to all requested changes, including potential medical intervention. Parents who support their child in this fashion are signing off on hormones and surgery—treatments that will have irreversible consequences possibly including sterilization and loss of sexual function. They will do so in spite of the fact that there is no consensus as to whether these treatments are indeed effective or prudent. When parents don’t agree with immediate transition, activist clinicians pressure them with misleading references to suicide.
Many parents, however, have a different understanding of the word ‘support.’ The parents I speak with overwhelmingly love their children. They are interested in supporting their children in growing to adulthood with healthy bodies. They want to support their child’s emerging identity by allowing wide-ranging exploration of different orientations and interests. And they want to guide their child in weighing long-term consequences so that he or she can make wise decisions. Many parents who support their child in this way find that their child moves through her period of gender exploration without feeling the need to make permanent changes to her body. Young people with parents who supported their gender nonconformity while encouraging them to accept their bodies often express gratitude for this kind of parental support.
By encouraging teens and young adults to break away from their families due to ostensible ‘lack of support,’ trans activists are alienating kids from their bedrock source of support. Who besides one’s family is always going to be there, and always have one’s best interests at heart? The activist community won’t be on hand to pay college tuition, or set the child up in their first apartment, or help pick up the pieces when life strategies fail. We each only have one set of parents. Encouraging someone to walk away from these unique relationships is breaking up a special and priceless bond.
It should go without saying that, as a society, we acknowledge parents as the authorities when it comes to protecting the well-being of their children except in extreme cases where we have good evidence otherwise. Parental love is overwhelmingly a force for good. Attempts to undermine or discredit a parent’s love and concern for her children are shameful. We shouldn’t stand for it.
Lisa Marchiano is a Jungian analyst in private practice. She has been consulting with parents of teens with rapid onset gender dysphoria since 2016. She blogs at theJungSoul and podcasts at ThisJungianLife. You can follow her on Twitter at @LisaMarchiano
1 Stephen B. Levine (2018) Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria, Journal of Sex & Marital Therapy, 44:1, 29-44, DOI: 10.1080/0092623X.2017.1309482, p. 13.
2 Costa, R., Carmichael, P., & Colizzi, M. (2016). To treat or not to treat: Puberty suppression in childhood-onset gender dysphoria. Nature Reviews Urology,13(8), 456-462. doi:10.1038/nrurol.2016.128
3 Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE,6(2). doi:10.1371/journal.pone.001688