Gender Identity

• Some people have a gender identity that is different from their gender assigned at birth.  
• Some children, as the American Academy of Pediatrics explains, do not identify with either gender. They may feel like they are somewhere in between or have no gender.  
• It is natural for parents to ask if it is "just a phase”?  But there is no easy answer.

Helpful Definitions 

• Gender Identity: One's internal sense of who one is, based on a combination of biological, developmental, and environmental factors. This may be male, female, somewhere in between, a combination of both or neither. A child’s understanding of their gender identity develops over time, just like their body does.
• Gender Diversity: An over-lapping term to describe changes that kids/teens/adults may use when their gender identity, expression, or even perception does not conform to the norms and stereotypes others expect.
• Gender Expression: How one presents themselves through their behavior, gestures, health and style. This may be the same or change.  
• Transgender: term used when gender diverse traits remain the same over-time.  
• Affirmed Gender: When a person’s true gender identity, or concern about their gender identity, is shared and confirmed by themself and possibly others.  
  • There are stages of Gender Affirmation:
    • Social: this can be seen in how your child dresses, acts and what pronouns they prefer to use, such as him or her and what name they prefer to be called.    
    • Legal: this stage can involve changing gender and names on legal documents to match their affirmed gender.  
    • Medical: this may involve the use of medications such as hormones or surgeries to help transition to the gender they identify with.  

Accepting your child and adolescent’s gender-diverse identity

• Research suggests that gender is something we are born with.
  • It is important that children feel loved and accepted for who they are, for whatever gender they identify with.  
• When disclosing their gender diverse identity, some kids might expect immediate acceptance and understanding.
  • Family members may go through their own process of becoming more comfortable and understanding a child's gender identity, thoughts, and feelings.  
  • For some families, the process may feel like the stages of grief which are: shock, denial, anger, bargaining, and acceptance.  
• Just as gender diverse children do best when they are supported while sharing their thoughts and feelings, some parents may need their own emotional support. They may also have many questions along their child's journey.

What parents and caregivers can do

• When your child shares their gender diverse identity with you, respond in a supportive way. Understand that although gender identity cannot be changed, it often is seen over time as people discover more about themselves. Using the name that your child has chosen and the pronouns (examples: he, she, them) that they prefer shows that you support and accept them as they are.  
• For some people gender identity can be a journey. It can last many years, and the result can be different from where the journey began.  
• Accept and love your child as they are. Try to understand what they are feeling and experiencing. Even if there are disagreements, they need your support and understanding to develop into healthy teens and adults.  
• Stand up for your child when they are mistreated. Do not minimize the social pressure or bullying your child may be facing. See How You Can Help Your Child Avoid & Address Bullying.
• Make it clear that rude statements or jokes based on gender, gender identity, or sexual orientation are not tolerated. Allow your child to see your disapproval when you encounter these jokes or rude statements when in the community or on social media.  
• Be on the lookout for signs that may indicate a need for mental health support, such as anxiety, insecurity, depression, decreased participation with family, changes in eating patterns, low self-esteem, dropping grades in school, lack of interest in preferred activities and/or any emotional problems in your child and others who may not have a source of support otherwise. Children and teens with gender concerns have a higher level of suicidal thoughts than non-LGBTQ teens.  
• Connect your child with LGBTQ organizations, resources, and events. It is important for them to know they are not alone.
• Celebrate diversity in all forms. Provide access to a variety of books, movies, and materials—including those that positively represent gender diverse individuals.  Be sure to look for age-appropriate options.  
• Point out LGBTQ celebrities and role models who stand up for the LGBTQ community, and people in general who demonstrate bravery in the face of social stigma, where you find it appropriate for your child and their age.
• Support your child's self-expression.   It is helpful to have positive conversations with them about their choices of clothing, jewelry, hairstyle, friends, and room decorations.
• Reach out for education, resources, and support if you would like help understanding LGBTQ youth experiences. See Support Resources for Families of Gender Diverse Youth.

Gender affirmative care

• Gender affirmative care is based on the belief that all children benefit from love and support. The goal of gender affirmative care is not treatment; it is to listen to a child and, with the help of parents, families, trusted role models and healthcare providers, build understanding.  
• Sometimes, disagreements can cause frustration. Through strong and supportive teamwork with patients and their families, healthcare providers can create a safe environment in which emotions, questions, and concerns about gender can be. Gender affirmative care is most effective when your child has access to a combination of medical, mental health, and social services, including resources for parents and families.  

Mental health support for gender-diverse youth

• Support or rejection ultimately has little influence on the gender identity of youth; however, it may strongly affect young person's ability to openly share or discuss concerns about their identity and feelings. Gender-diverse identities and expressions are not mental disorders but suppressing gender concerns can harm a child's emotional health and development and contribute to increased rates of depression, anxiety, and other mental health concerns.
• A large proportion of teenage suicide attempts are linked to issues of gender and sexuality, particularly feelings of rejection. Many gay, lesbian, bisexual, and transgender individuals unfortunately attempt suicide during their lifetime.
• As a parent, even when you struggle to understand and may not see eye-to-eye, your most important role is to offer understanding, respect, and unconditional love for your child. This builds trust and puts you in a better position to help them through difficult times. Research has shown that if a transgender teen has even just one supportive person in their life, it greatly reduces their risk of suicide.
• Transgender and gender-diverse children – like all children – need support, love and care from family, school and society. When supported and loved, kids mature into happy and healthy adults. Pediatricians stand ready to assist in the healthy development of transgender and gender-diverse children.

When to talk with your child's pediatrician or health care clinician

• Talk to your child's health care clinician early and often. It is recommended that medical providers start conversations with children as young as preschool about their bodies, feelings, and relationships. Pediatricians can help them understand and appreciate difficult feelings and concerns.
• It is important to recognize that cross-gender preferences and play is a normal part of exploring gender and relationships for children regardless of their future gender identity. Routine conversations about gender create an environment of support and reassurance so that children feel safe bringing up questions. It is also good practice to continue these discussions at home. The best approach, for parents or pediatricians, is to nonjudgmentally ask questions that allow the child to talk about their experience and feelings before applying any labels or assumptions.
• If your child is struggling with symptoms of depression, anxiety, isolation, or other emotional concerns, they may need to see a mental health professional who can offer additional support. If your child mentions any suicidal thinking, please talk with your health care clinician or mental health provider right away.
• For more information or help finding a support group for yourself or your child, please talk with your pediatrician.

More information  

• Parenting a Gender-Diverse Child: Hard Questions Answered
• Support Resources for Families of Gender-Diverse Youth
• Gender Identity Development in Children
• How You Can Help Your Child Avoid & Address Bullying
• Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents (AAP Policy Statement)

Reviewed by:  LGBTQ Committee and TT D.O.  06/2024