Chapter 4: Gender development and support for the child/adolescent: How can we support transgender and gender-nonconforming children/adolescents?

As a learning institution and as a teacher, it is important that you are able to discuss gender development and best practice for young transgender children/adolescents with their parents, and the school community at large. At the same time you should know that there is no one set path for all transgender and gender non-conforming people. This Master Class sets out some of the good ways to support transgender and gender non-conforming children/adolescents as they move from birth to adult hood.

Gender development across the continuum

As discussed in the previous Master Class, Chapter 3, some children/adolescents have a gender identity that is different from their sex assigned at birth. Many children/adolescents have interests and hobbies that may align with the other gender, for example boys who like to play with dolls. Some children/adolescents, however, do not identify with either gender. They may feel like they are somewhere in between or have no gender. (Please refer to your glossary for the definition of nonbinary gender). Some teachers, parents and other caregivers ask the question: is it “just a phase?” But, there is no easy answer.

For some young children/adolescents, expressing a wish to be or identifying as another gender may be temporary; for others, it is not. Only time will tell. Some children/adolescents who are gender non-conforming in early childhood grow up to become transgender adults (persistently identifying with a gender that is different from their birth sex), and others do not.

The prevalence rate of transgender people is not known. The incidence of transgender children/adolescents, initially thought to be very low, is increasingly rapidly. This may be because social media allows more visibility of transgender people and encourages others to claim their identity. Many gender non-conforming children/adolescents grow up to identify with a gay, lesbian, or bisexual sexual orientation (i.e. attracted to the same or both genders as opposed to feeling they are a different gender). Others may not.

How can I support the transitioning process?

Firstly you need to understanding the Process (Persistent, consistent and insistent)

Gender identity is typically unalterably established at the age of 3. Research suggests that children who are persistent, consistent, and insistent about their gender identity are the ones who are most likely to become transgender adults. Research suggests that gender is something we are born with; it can’t be changed by any intervention. It is critically important that children are respected and accepted for who they are. It is therefore essential to support and follow the lead of the child. If a teenager has identified as a different gender since early childhood, it is unlikely that they will change their mind.

A 12-year-old male who has consistently asserted, “I am a girl,” since the age of three, will most likely remain transgender throughout life. Sometimes a young child who strongly identifies with another gender does change. The most common time for this to occur is about 9- or 10-years-old.

There is not enough research to know if this change means the child has learned to hide their true self due to social pressures, or if it was indeed “just a childhood phase.”

Puberty is a time when a child’s gender identity can come into question. Sometimes teens who never exhibited anything outside the norm in their gender expression or identity, may start feeling differently as their bodies change. Parents and teachers can be unsure if it is just a “teenage phase” or if their child is really transgender.

It will be helpful to allow the teen to explore their gender identity with support from a counsellor or therapist who has experience in this area.

On the other hand, sometimes in puberty a child who has been asserting themselves as transgender will become comfortable with their birth assigned sex. To date, 80% of pre-adolescent children that identified as transgender will lose the wish to be the opposite sex going through puberty, but afterward, 80% will revert to their transgender identity.

At some point, a child who is persistently gender non-conforming may choose to “transition”, or begin to live as their self-identified gender instead of the gender assigned at birth. Others may not. The transitioning process is different for everyone, and is usually initiated by the child.

Let’s have a look at the different transitioning processes.

Social transitioning

Some children make a transition early in childhood by wearing the clothing for their identified gender and changing their name or pronoun.

It starts with parents allowing their children to socially transition at home and then at school. Please see page 33 for how to support a child to socially transition at school.

Puberty pausing

Medical treatment is available to “pause” the signs of puberty associated with early adolescence.

These are sometimes called “puberty blockers”, which prevent the secondary characteristics associated with puberty from occurring (e.g. voice deepening, facial hair, and height in males; breast development in females).

These medications allow more time for the young teen and their family to make a decision about the next steps in transitioning.

The effects of these medications mimic those of a natural hormone found in the body and are completely reversible when the medications are stopped.On the other hand, for trans women in particular, puberty pausing is important because no amount of oestrogen can reverse some of the effects of testosterone in puberty, e.g. the hardening of the jaw.

This is an especially important issue for those transgender people who want to “pass” as their identified gender later in life, i.e. not have people able to identify them as transgender because they so closely look like their identified gender. For other transgender people, passing may not be so important. Puberty pausing helps with the acute dysphoria that happens amongst some transgender teens leading some to suicide, and depression.

Medications and hormones

Later in adolescence, teens can choose to use medication or hormones to transition and go through the puberty of the gender consistent with their identity. Gender affirming hormones and surgery are only recommended from age 18 onwards.

Surgical transition

Some adults choose to have surgeries, and some do not. If a young person has taken puberty blockers prior to transitioning, they will not require some surgeries to reverse the effects of puberty (i.e. breast removal or facial feminisation).