What Do I Do: My Daughter Says She is Transgender?

As more teenagers, particularly girls, express feelings of being transgender or experience gender dysphoria, it's essential for parents to navigate these conversations with understanding, care, and a balanced approach. Recent shifts in transgender demographics have revealed that the majority of those identifying as transgender are now teenage girls, which marks a significant change from previous generations. Alongside this shift, there has also been an increase in detransitioning—when individuals reverse their decision to transition.

Transgender Demographics Are Changing

Over the past decade, the transgender population has experienced significant demographic shifts. Historically, the majority of individuals identifying as transgender were middle-aged biological men. However, a noticeable and growing trend has emerged: adolescent girls now represent a substantial portion of the transgender population. Between 2016 and 2020, the percentage of transgender individuals aged 13 to 17 increased from 10% to 18%, with biological females now comprising the overwhelming majority of adolescents undergoing gender-affirming treatments and surgeries (Herman, Flores, & O’Neil, 2022; Leaning & Joseph, 2020; Lagos, 2022; Nolan, Kuhner, & Dy, 2019; Coleman et al., 2022). Particularly striking is the 389% rise in gender-affirming surgeries among adolescents, with a staggering 98.6% of these surgeries being performed on biological females (Coleman et al., 2022; Lagos, 2022). This dramatic shift calls for a closer examination of the factors contributing to the growing number of teenage girls identifying as transgender. It also raises important questions about the long-term impact of irreversible medical interventions, such as hormone therapy and surgeries, and the need for careful, thoughtful consideration before proceeding with such treatments.

The Rise of Detransitioning

As the number of teenagers transitioning has risen, so has the number of individuals who later choose to detransition. Research indicates that between 8% and 24% of transgender individuals eventually detransition, with biological females being more likely to do so than males (Littman, 2021; Irwig, 2022). The most common reason for detransitioning is the realization that their gender dysphoria may have been driven by underlying mental health conditions, such as anxiety, depression, or past trauma, rather than a true mismatch between gender identity and biological sex (Vandenbussche, 2022). This underscores the critical need for a thorough and comprehensive exploration of the root causes of gender dysphoria before making irreversible medical decisions. While gender-affirming care may be beneficial for some adolescents, others may find that their discomfort with their gender is more closely tied to emotional or psychological issues that can be addressed through different forms of therapy or support. Ensuring that these factors are carefully evaluated is essential in providing the most appropriate care for each individual.

Mental Health Considerations and the Importance of Caution

Research indicates that transgender individuals, particularly adolescents, face a heightened risk of mental health challenges, including self-harm, suicidal ideation, and anxiety. While gender-affirming treatments may provide short-term relief for some, studies suggest that long-term mental health outcomes for those who undergo gender reassignment surgery can worsen over time. For instance, one study found that, ten years after surgery, many individuals reported more severe mental health difficulties than they experienced before transitioning (Dhejene et al., 2011; Henk et al., 2011; Levine & Abbruzzese, 2023). This highlights the important reality that transitioning is not a universal solution for gender dysphoria. While it may alleviate distress for some, it may not address the underlying mental health issues contributing to a person's struggles. Consequently, it is essential for parents to approach this complex issue with a balanced perspective—affirming their child's feelings while being cautious about making irreversible decisions, particularly those that are not fully supported by current scientific evidence and research (Dhejene et al., 2011; Henk et al., 2011; Levine & Abbruzzese, 2023).

How Parents Can Support Their Daughters

As your daughter navigates her feelings of gender dysphoria or transgender identity, here are some ways you can provide support while ensuring a thoughtful approach:

Prioritize Mental and Emotional Health

• Focus on Emotional Well-being: Encourage your child to explore their feelings in a safe and supportive environment without rushing into decisions about changing their name, pronouns, or body. Mental health professionals can help your child develop a deeper understanding of their emotions and experiences before making any irreversible changes.

• Address Underlying Mental Health Issues: It's crucial to ensure that gender dysphoria is not being used to mask or avoid addressing other underlying emotional or mental health issues like anxiety, depression, or trauma. Working with a mental health professional who specializes in adolescents can help uncover and treat any deeper concerns.

Help Them Reframe Thought Patterns

• Encourage Self-Acceptance: Help your child work through their feelings of discomfort by encouraging them to accept their current body and self. Guide them toward building self-esteem and self-worth without making changes to their physical appearance.

• Support Cognitive Behavioral Approaches: Cognitive Behavioral Therapy (CBT) can be a valuable tool in helping your child shift unhelpful or negative thought patterns. CBT can help them process feelings of dysphoria by focusing on their thoughts and emotions and finding ways to cope without resorting to physical changes.

Emphasize the Importance of Time

• Give Space for Exploration Without Permanent Changes: Encourage your child to take their time and explore their feelings without making permanent decisions. Let them know it’s okay to not have all the answers immediately and that there are many ways to work through their feelings without rushing into medical or social transitions.

• Highlight the Benefits of Waiting: Explain that transitioning, whether socially or medically, is a significant and potentially irreversible step. Encourage your child to work on building emotional resilience and coping strategies as they take time to understand their gender identity fully.

Foster Open Communication

• Create a Safe Environment for Discussion: Encourage your child to share their thoughts and feelings openly with you. It’s essential that they feel supported and understood while working through their emotions. Be an active listener, showing empathy and patience without immediately suggesting changes to their appearance or identity.

• Engage in Ongoing Conversations: Let your child know that these feelings can evolve over time, and it's normal to have moments of confusion or uncertainty. Regularly checking in with your child about their emotional well-being is vital.

Explore Therapeutic Support

• Seek Professional Guidance: Working with a therapist who has experience with gender dysphoria and adolescent mental health who but is not going to have tunnel vision for transitioning. Fins a therapist to provide the support and coping skills they need to process their emotions. Therapy can help them explore feelings of gender dysphoria while focusing on self-acceptance, emotional well-being, and mental health.

• Avoid Medical or Social Interventions Early: Be cautious about encouraging your child to make irreversible changes, like hormone treatments or surgeries. Even changing pronouns or names can have longterm and unintended consequences. Instead, focus on helping them understand and improve their emotional and psychological health.

Conclusion: Encourage Inner Growth Over External Changes

Acknowledging the genuine suffering and stress that individuals experiencing gender dysphoria endure is crucial for fostering an environment of understanding and compassion. Parents play a pivotal role in validating their child's feelings and struggles, which can significantly alleviate emotional distress. It’s important to recognize that this suffering is real and can manifest in various ways, impacting mental health and overall well-being. While the instinct may be to pursue immediate medical interventions such as hormone therapy, research suggests that the most effective treatment typically involves evidence-based mental health therapy, possibly supplemented by medications like mood stabilizers or selective serotonin reuptake inhibitors (SSRIs). These therapeutic approaches provide a supportive framework for children to explore their feelings safely and constructively. By emphasizing compassion and understanding, while also grounding their decisions in research and best practices, parents can help their children navigate their journey with both sensitivity and care, ultimately leading to healthier outcomes and improved mental health.

Note: Currently, there is a growing wave of legislation in some states that categorizes the refusal to provide medical interventions, such as hormone therapy, for children experiencing gender dysphoria as a form of child abuse. This alarming trend has resulted in cases where protective services have intervened and removed children from homes that do not support medical transitioning. Consequently, parents must stay informed about the laws in their state, as these regulations can significantly impact their rights and responsibilities regarding their child's care. Moreover, there are reports of schools socially transitioning children—changing their names and pronouns—without parental consent, further complicating the dynamic between parents and their children. Additionally, children are often exposed to pervasive social influences that convey messages suggesting that parents who do not facilitate their child's transition are being abusive. These pressures can create confusion and conflict within families. Given these realities, it is essential for parents to be vigilant about the social influences surrounding their child. Monitoring their child's interactions and the messaging they receive can help ensure that it aligns with the parents' values and goals for their child, fostering a cohesive approach to supporting their child's mental and emotional health while navigating these complex issues.

Resources for parents:

• Lost in Trans Nation: A Child Psychiatrist's Guide Out of the Madness by Dr. Miriam Grossman

• Helena Kerschner's Story

• Irreversible Damage by Abigail Shrier

• The Anxious Generation by Jonathan Haidt

• Bad Therapy: Why Kids Aren't Growing Up by Abigail Shrier

• The Collaps of Parenting by Dr. Leonard Sax

Resources:

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7. Herman, J. L., Flores, A. R., & O’Neil, K. K. (2022). Suicide-related outcomes following gender-affirming treatment: A review. Cureus, 15(3), e36425. https://doi.org/10.7759/cureus.36425

8. Henk Asscheman, Erik J Giltay, Jos A J Megens, W (Pim) de Ronde, Michael A A van Trotsenburg, Louis J G Gooren, A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones, European Journal of Endocrinology, Volume 164, Issue 4, Apr 2011, Pages 635–642, https://doi.org/10.1530/EJE-10-1038

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10. Kaltiala, R., Heino, E., Työläjärvi, M., & Suomalainen, L. (2020). Adolescent development and psychosocial functioning after starting cross-sex hormones for gender dysphoria. Nordic Journal of Psychiatry, 74(3), 213–219. https://doi.org/10.1080/08039488.2019.1691260

11. Kaltiala-Heino, R., Sumia, M., Työläjärvi, M., & Lindberg, N. (2015). Two years of gender identity service for minors: Overrepresentation of natal girls with severe problems in adolescent development. Child and Adolescent Psychiatry and Mental Health, 9(1), 1-10. https://doi.org/10.1186/s13034-015-0040-2

12. Lagos, D. (2022). Has there been a transgender tipping point? Gender identification differences in U.S. cohorts born between 1935 and 2001. American Journal of Sociology, 128(1), 94-143.

13. Leinung, M. C., & Joseph, J. (2020). Changing demographics in transgender individuals seeking hormonal therapy: Are trans women more common than trans men? Transgender Health, 5(4), 241–245. https://doi.org/10.1089/trgh.2019.0070

14. Levine, S. B., Abbruzzese, E., & Mason, J. W. (2022). Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults. Journal of Sex & Marital Therapy, 48(7), 706–727. https://doi.org/10.1080/0092623X.2022.2046221

15. Levine, S.B., Abbruzzese, E. Current Concerns About Gender-Affirming Therapy in Adolescents. Curr Sex Health Rep 15, 113–123 (2023). https://doi.org/10.1007/s11930-023-00358-x

16. Morrison, M., et al. (2017). Transgender Attitudes and Belief Scale and the Transphobia Scale.

17. Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(4), 404-411. https://doi.org/10.1071/SH17067

18. Vandenbussche, E. (2022). Detransition-related needs and support: A cross-sectional online survey. Journal of Homosexuality, 69(9), 1602–1620. https://doi.org/10.1080/00918369.2021.1919479