- We are all hindered by this,
and I want us to understand
that children who are not gender atypical,
children that are totally hetero-normative in terms
of their gender, that they're gender-normative
in their behaviors, are also harmed and also hindered
by the social world that we live in
that limits their gender identity,
their gender expression, their gender play.
So we need to be open to various
resolutions, changes and movements
throughout childhood and adolescence.
And this perhaps is one of the hardest struggles
because children are relatively rigid in their perceptions,
so they're not really interested in having
a more fluid or open view, and often parents,
and I'll talk more about this soon,
who are these parents who are dealing with
gender nonconforming children are under
tremendous pressure and tremendous stress
and like all parents, they sort of
want to resolve the issues as quickly as they can.
So the child is saying, "Mom, I think I'm a boy."
Go to a therapist, talk about it.
Child cuts their hair, child wants male pronouns,
child changes name, and the parent
kind of wants this to be done.
"Can we sort of move on?"
This was a lot of challenging and difficult
work for us to do as a family.
And they're often times not open to that changing,
so I'll tell one other story here.
And I want to again be really clear.
These stories I'm telling are not common.
They're unusual.
But that doesn't mean we can't pay attention,
that we shouldn't pay attention to them.
So I worked with a family who had a
a male-born child who had transitioned
as a third or fourth grader to living as a girl.
I actually was not part of that clinical process.
The family came to me later in the child's development.
Had been living successfully as
a little girl for many, many years.
There actually was a very funny story
that I was at an event and that kid was playing
in childcare, and I guess people in the community
had heard that this child was transgender,
and somebody came up to me and said,
"Hey, look at that girl over there.
"Do you know that she's transgender?"
I guess they didn't know that the child was born a boy,
and said to me, "It's really hard, I know the parents say
"that she's transgendered, but I don't see
"anything masculine about her at all."
Meaning that they thought that the child was
transgender moving from female to male,
but the child was so socialized female
that it had never crossed their mind the child
was actually born male and living as a female.
And of course, being a therapist, I couldn't say anything
except, "Mhm," and moved on.
But what happened was, is this child went
into puberty, and about 11 or 12 years old,
came to their parents and said, "I need to talk to you."
And said, "Would you guys be really mad at me
"if I went back to living as a boy?"
And like I said, these parents go through a lot
to assist children in these transitions, and
sort of like, "Sure, sweetie, great, why?"
And this was the child's answer.
The child said, "As I'm going into puberty,
"I realize that I'm attracted to girls,
"but I don't feel like I'm attracted to girls
"the way a girl would be attracted to girls.
"I feel like I'm attracted to a girl the way
"a boy would be attracted to girls."
Now I want to be clear with you.
I have no idea what that means.
I mean, I don't know what the difference is
between the way a boy likes a girl and a girl likes a girl.
What I accept is that this child understood something about
his sexual orientation and his gender identity
that shifted during the course of his life
and his childhood, and he had parents that were willing
to say, when he said, "I want to be a girl,"
they said, "That's fine, we support you."
And when he said, "I want to be a boy,"
they said, "That's fine and we support you."
So again, we're looking at gender health.
I want to repeat again, that's not a common experience,
but the ability for a parent to live with a little bit
of ambiguity, and maybe all of us as parents
need to learn to live with more ambiguity around gender
and gender expression and gender identity,
and we'd all be healthier for that,
but especially for this population.
Sometimes they actually start to shut down around the
ambiguity because they sort of want to resolve this,
and they don't want to come back to talking about it.
So I think we, as people working with families,
need to be sensitive to that.
Okay, what I want to talk about is
the changing models of working with
gender nonconforming children and transgender youth.
So we talked earlier about these older models
that sort of pathologized the parents,
pathologized the children, are trying to prevent
homosexuality, trying to prevent transgenderism,
and in some kind of crazy way,
trying to prevent peer ostracism.
The medical model that we have worked with
for the last 50 years in this country to work with
adults who are transsexual, and it's important to realize
that the model really is a model working with adults,
was not really designed with children and youth in mind.
It sort of assumes, its very basis, assumes that people
will transition in adulthood, that people will come in
to therapy seeking treatments for gender dysphoria
in their adulthood, and that we sort of proceed from there
in terms of thinking about hormones and surgery.
So the treatment strategy with children
has really been to fix the children, to make
the children, in some way, non-transsexual.
They actually have language that they use,
what they call "pre-homosexual children."
So we want to work with these children before,
it is believed, that their faulty sexual orientation
or gender identity is established,
and we're going to, again, fix them to be
normative, heterosexual, and cisgender adults.
So it assumes pathology, that if gender does not
in some way match one's natal sex, there's a problem
and that problem needs a clinical intervention.
We wait until adulthood to assist them, and
one of, there's many problems associated
with that, which we'll talk about, but one
of the most significant problems is that
for people who are transsexual,
to not receive medical treatments,
and we will talk in a few minutes about
what some of these medical treatments are,
to not receive any kind of medical treatments,
social treatments or medical treatments,
means that they will have gone through puberty
in the, quote unquote, "wrong direction."
So in other words, if somebody is born male
who identifies as female, that their gender identity
is female, and they experience puberty
that would be a normative puberty for a male,
which means that they will...
Anybody here that's ever witnessed
puberty in young people, you know that it's really quite
dramatic, that they go from being
pre-pubescent children, and all of a sudden
there's facial hair, all of a sudden there's skin texture
changes, in a very short period of time they grow in height,
their hands, size of their hands change,
the size of their feet change.
I'm just laughing trying to remember,
remembering my older son sort of tripping over his feet
at about 13 or 14 a lot, because his feet
had grown to a size 12 shoe.
The changes are dramatic in the facial structure,
certainly in the dropping of the voice and in,
in growing facial hair, what some people
call "testosterone poisoning."
If you're a girl, and you have those kinds of changes
happening, you can see how that would be
really frightening and really dramatic, and they're
also irreversible, and that's really an important thing
to sort of be aware of, is that these kinds of changes
that happen to the human body cannot be changed.
They cannot be fixed later.
So a lot of our treatments that we are looking at now
for working with children and youth, are ways of
putting puberty in a kind of stasis until the child
and the adults around them feel confident
that the cross-gender gender identity
is solid and accurate, and we're able to move forward.
The idea of waiting until adulthood really has
potentially negative effects for these children.
So what I want to look at are some of the contemporary
affirmative approaches that we're now using,
and this slide I'm borrowing from my colleague Jean Malpas
who works at the Gender and Family Project,
which is part of the Ackerman Institute
for the Family in New York City.
What Jean says is these are the most important
aspects of affirmative approaches.
So first of all we're looking at the physical
and emotional safety for the child.
We're following the child's lead in terms
of gender roles and identification.
So a child who says, "I feel more comfortable
"with short hair," then we honor that in the child.
That when a child is saying, "I don't want to go to school
"as a boy, I want to go to school as a girl,"
that we are listening and following the child's lead.
That our goal is to help support and build
self-confidence with the child, and helping them
to socially integrate into their communities,
their social environments, and their schools.
Jean, like myself, is a family therapist, and of course
we believe that the real work here is with families.
I often say that there's actually very little work
I have to do with some of these children,
that the children are really doing fine.
The parents are the ones that are struggling,
and I really think when you can help parents to
feel good about their children, and feel good about
how they are parenting, and help them to resolve
some of the struggles or ambiguities that they have,
that they're actually able to be better parents.
They know how to parent their children.
They're the ones who are needing support.
That we want to create safe spaces
to explore gender and emergent identity.
I'll give you an example of what that might look like.
I was working with a young child,
born female, who identified as a boy.
Was very, very nervous, though, to come out about this
at school in fourth grade, fifth grade.
Although he was definitely identified,
he was living as a girl at the time,
that he was definitely identified as different
from the other girls, and a lot of kids would sort of say,
"Are you a boy or are you a girl?"
because of the way that she, at the time, was dressing.
And he really wanted to explore his gender identity,
but it wasn't safe to do that in the home community.
So the family went on sort of the classic American
car trip across the US, and during
this trip, he got to be a boy.
He was very sweet, he got a button,
and he made himself a button that said on it,
"He" in big letters, so every time his parents accidentally,
interestingly enough, his sister never slipped,
but the parents often slipped, and he would take
the button and say, "He."
But he got to explore what it felt like to just
do sort of normal life, to go into a restaurant,
to be camping, to be hiking, and to have people
on the trail, people he was meeting, people in restaurants,
identify him as a boy, and how that felt.
So we create safe spaces for our children to explore
their gender identity, and also often with these children,
there's a tremendous amount of school advocacy.
And I'm talking here not just about
children that have socially transitioned.
That, of course, there's a lot of advocacy.
But even children before transition,
or children who never transition.
That the challenge of being a gender nonconforming
or gender variant child within a school system
is often very difficult, and schools often spend
enormous amounts of time gendering children
in ways that they don't think about,
and that are probably unnecessary.
Boys here and girls here, the girls are going to go
to the gym, the boys are going to go
to the gym, everybody line up here,
boys on one side, girls on the other.
In the younger grades, there's the sort of boy toys
on one side of the room and the girl toys
on the other side of the room.
There are ways that teachers reinforce this
and there are ways that teachers can not reinforce it.
So in terms of diagnostics,
there's a couple of things that
we really have to be clear about.
The first one is that we need to make a distinction
between gender nonconformity and gender dysphoria.
So there are lots of children that are gender nonconforming,
meaning that they don't fit in to the simple
criteria, the simple boxes, that are typical behaviors
for boys and girls, like the child I mentioned earlier,
a little boy who liked to play with Barbie dolls.
There are lots of little girls that are rough and tumble,
and they're not really expressing any distress about it,
nor are they saying the words,
"I'm not a girl," or "I'm not a boy."
They're just needing more space to be exactly who they are.
It is really very different-looking
than children who are dysphoric.
Children who are dysphoric are often depressed.
They're often anxious when they have to do things
that they perceive to be normative for that gender.
If they're going to a family wedding and that
little boy has to put on a suit and tie,
they're often very resistant to doing that.
They hate getting their hair cut.
These are just examples.
They're very uncomfortable on the sports teams,
and again, I'm not trying to reinforce
these arbitrary gender things that boys like sports
and girls don't like sports, I'm just trying to
make the point that in the world that we
live in, the world is very gendered.
I often tell a story that I went into
my son's elementary school when he was in
the fifth grade, and I was walking down the hall
and coming down the hall was a group of second graders.
And again, they were in line.
The boys were on one side, the girls were on the other side.
The boys, the entire line of boys, were wearing
dark blue, dark brown, they were wearing
jeans, they were wearing sneakers.
What color did I miss there?
Black, blue, brown, and one little boy had on
a sort of dark green shirt that was the brightest
of any of the colors that the little boys were wearing.
The little girls looked like we had
entered some Neverland fantasy world.
They were in pinks and purples and blues.
They had things in their hair and things around
their neck and things in their hand.
The pencils that they were holding in their hand
were multi-colored with long strings
on the end of the eraser part of it.
Their backpacks were colorful.
Everything about them was sort of a ballet performance
and they were indeed kind of skipping down the hall
where the boys were kind of trudging down the hall.
These roles are really...
They're taught, they're reinforced,
and stepping out of them are punished.
So sometimes children who are gender nonconforming
are going to feel very oppressed.
I mean, they may not have that word,
but they're going to be feeling very oppressed.
But it's different feeling oppressed because the social
world is limiting you than it is the dysphoria
that some of these children are experiencing,
which is often in their bodies, and they'll say that.
They'll say, "I don't know why God gave me a penis.
"I know that I'm a girl, I don't understand
"why my body looks the way it does."
The dysphoria is exactly what we're talking about here.
It is dysphoric, it is uncomfortable, it is distressful.
Again, gender nonconforming children are often
in various levels of distress too, but it is not
often as focused on their anatomy, this anatomical
dysmorphia, the sense that their body is somehow wrong.
And that is really one of those places
where there is a branching of the road.
That children who are experiencing this dysphoria
in their bodies, in addition to gender nonconforming
behaviors and mannerisms, you are looking more
at a child whose trajectory is more likely
to be a transgender trajectory than children
whose behavior is atypical, but are not expressing
that much distress, and are really not expressing
any distress about their bodies.
Again, I'm not saying that...
I've made the point over and over again
that this is fluid, so the child who is not having
anatomical dysphoria at age seven might have
a lot of anatomical dysphoria at age 14.
But that is one of the ways that we're looking at,
how do we make the decisions of moving from
one stage to another with these children?
The third one is persistence over time,
is the idea that gender dysphoria is not fleeting.
That anatomical dysmorphia is not fleeting.
It's not something that kids feel for a week or two weeks
or three weeks, and then it sort of goes away.
So this idea that this is a phase...
Phases are phases, and what makes a phase a phase is that
it ends, and that for these children, it doesn't end.
It not only doesn't end, it persists,
and it persists more strongly over time.
My son went through a phase where he thought
he was a Power Ranger, and it lasted for quite a long time.
I'd say it lasted about six months.
But at 14, he no longer thinks he's a Power Ranger.
I think, I hope.
So my point is, is that we're looking
at a number of issues here, we're looking at
the physicality, their comfort in their body.
We're looking at their behavior and their mannerisms
in terms of what is expected behavior
and how much they deviate from that, and we're also
looking at this having taken place across time.
So the other distinction I want to make
is between social transitions and medical transitions,
and this is something that the media
gets really confused about often.
And I just actually was having dinner with a very
dear friend of mine who's not a therapist
and does not work in this field, but knows of course
that I do, and said to me over dinner,
"Oh, I wanted to tell you.
"I was talking to a friend of mine and her cousin
"has a kid who is," this was the quote,
"the youngest child to ever have gender surgery."
And I said, "Really, how old was the child?"
And I forgot what she said but it was like
nine or something, and I said, "I assure you."
And we're separating this out from children
with intersex conditions, which as we discussed before,
is very complicated, and we're just looking at children
who are not intersexed, but who are transgender.
I recognize that I'm on film here and you say things
and then you want to eat your words later,
but to my knowledge, there is not a single child
in the world that has had gender confirming surgery
at nine years old, that that is just not something
that anybody would consider, that what we're
talking about when we're talking about
pre-pubescent children are social transitions.
We're talking about a child changing their name.
We're talking about people using pronouns that
connect with their gender, meaning that
even if the child is female-born, if he is living
as a boy, then we use boy pronouns.
That kind of seems logical, doesn't it?
The cut-off process that we're talking about here is age.
The issue here is puberty.
So if we're talking about under the age of puberty,
a child who has persistent gender dysphoria over time,
anatomical dysphoria, is uncomfortable in their body,
is exhibiting cross-gender behaviors, and is saying,
"I want to be, live, be addressed,
"with the pronouns of the other sex.
"Please mommy and daddy, please let me do that."
We're looking at the possibility of
a social transition for that child.
We're not talking about medical transitions
until we go into puberty, and I will
talk about that in just a second.
So age is the cutoff in that place.
So the Tanners Stages, for those of you not
medically oriented, and I would be one of those people,
is a developmental process of looking at a child's body
and the physical development of what puberty does.
So if you will, adults are Tanner Stage Five,
meaning that our bodies have fully matured,
and Tanner Stage One are pre-pubescent children.
So what happens is right at Tanner Stage Two,
when children start developing, so female children
develop breast buds, their bodies start to change,
the shape of their bodies start to change to look more
what we think of as female bodies looking.
We talked earlier about what the process
of testosterone does for male bodies.
When I say male here, XY bodies.
So this process of puberty starts.
Now with this population, puberty
often brings great distress.
And you can imagine that if you're a boy,
if you feel yourself as a boy, if you know yourself
to be a boy, and you suddenly start growing breasts,
generally speaking, you're not going to be happy with that.
That if you see yourself as a girl, and you're
starting to develop facial hair and your voice
is starting to drop, this is really frightening
about what is happening to your body.
One of the things that we can do,
and when I say "we" here I don't mean family therapists
and social workers and psychologists,
but I mean medical doctors, is offer
hormone blockers starting at Tanner Stage Two.
And what these blockers do is they put
the pubescent body in a kind of stasis,
which I want to say has its own problems.
When you are 12 years old and your friends are starting
to develop, and now you're 13 years old or 14 years old
and your friends are now really starting
to move through puberty but you're not,
it's kind of a little awkward, but it is generally
considered a much better alternative for these young people
then to move into what is for them the wrong,
the wrong puberty, the puberty that their body would go into
but one that does not fit how they see
their social and psychological selves.
So this business of distinguishing between
gender nonconforming children and kids who will
become transgendered adolescents is really
one of the key issues, and this is why.
Because for children who are transgender,
who are going to become transgender teens
and who are going to eventually transition
and identify themselves as adults as transgender people,
as transsexuals or, as we said earlier, as men and women
who may have been born in a different body.
Rosalyne Blumenstein refers to,
"I'm a woman of transsexual experience."
A phrase that I just really love.
So for people who are going to move on
in their transition process, the earlier
we can identify them, the more we can give them
the specific support that they need,
which would include social transition,
would include puberty suppression, as well as advocacy,
again, in the schools and in their social world.
For children that are, and I don't really want to use
the word here, "just," but I will,
who are just gender nonconforming,
for children that have fluid gender identities,
for children who are gender atypical
but not necessarily experiencing distress,
social transition would be contraindicated.
That treatment for suppressing puberty
would be contraindicated.
So understanding which of these two groups
we're working with helps us determine
the kind of treatment plans that we develop.
And I also want to be really clear here.
There is no litmus test.
There is no strict assessment.
This is a dialogue that a therapist is having with a client,
with a young person, that the therapist is having with
the parents, that the parents are having with the doctor,
that the team is sitting down together and working on
and it changes over time, of how,
how the child sees it and how the parents see it.
Sometimes parents are very resistant
to the puberty suppression in the beginning,
and then they become very supportive of it.
Sometimes the child really doesn't care,
Sometimes the parents are saying,
"Do you want us to do something to suppress your puberty?"
And the kid's going, "I don't know,
"leave me alone, I don't really care."
And then all of a sudden the body starts developing
in a particular way and they're like, "Whoa, mom,
"you've got to do something about this right away."
This is an ongoing discussion that takes place.
I do want to say something about hormones,
about puberty-blocking hormones.
Of course one of the first questions that parents
raise here is, "Are these dangerous?"
I will say that any time we are putting any substance
in our body, including coffee, it has potential effects
on our body that can be negative.
It's a medication.
However, these medications have been used
for children who have precocious puberty,
meaning girls who are going into puberty
at age six or age seven, and of course we don't
want to do that, so we want to hold off puberty.
We give them these medications and then we stop
giving it to them when they reach an age
where puberty would be more appropriate,
not only physiologically but psychologically and socially.
We have used these for years.
There is a little bit of evidence that it can effect
bone growth, but almost everybody in the field
believes that these children are on these medications
for a short enough period of time
that the effects are negligible.
Because again, we're looking at putting a kid on this
at 11 or 12 years old, and really,
by the time a child is 15 years old,
we're moving into another stage of development.
We would probably be taking the child
off of puberty suppression hormones.
It's also important to be aware
that the way the hormones work, is that
if you stop the hormones at any point...
I want to be clear, I'm talking about
the puberty suppression hormones.
So you put the child on it.
Puberty goes into stasis.
Nothing is happening, not boy,
not girl, nothing is happening.
And then let's say two years down the road,
you stop those hormones.
That child will, at that point, start to develop
in the gender, their puberty development will be
in the gender to which they were natally born.
So if you are an XX child, you will go into female puberty,
if you are an XY child, you'll go into male puberty,
as if we had not stopped the puberty.
So even though you're starting that process two years later,
the development would be completely
a normal process from that point on.
Let's say the child, at that point, decided to not
transition, to not continue on a transgender trajectory.
So I hope that that makes sense.
More commonly, what we do at that point
is then begin to talk about putting the child
on cross-gender hormones, which again,
for them is not really cross-gender
because it is the gender to which they identify.
So again, I want to mention the Standards of Care here.
The Standards of Care make a very strong point
that mental health professionals and schools
should not impose a binary view of gender.
They should give ample room for children to explore
different gender options, and accomodate
the child's gender expression.
That is for gender nonconforming children
as well as transgender children.
Somewhere in here, Toby, I want
to show some of the videos of Jazz.
You have the links on the last page.
I will probably send you slightly different links.
So this clip, these words I'm going to say now,
associate with that piece, and I'm not 100 percent
sure where we're going to put it.
I want to show you what
the process looks like for young children,
because it may be, there's a lot of words here.
It's easy for us as grown-ups,
and perhaps many of us who are not
immersed in transgender community
and transgender politics, who may not have a lot
of close transgender friends, to not really understand.
Actually I was having dinner last night here
at Smith College and was talking to a colleague's husband.
He's not a social worker, and asked me what I did.
I said something, and he said, "Yeah, I don't get that."
He said, "I get the gay thing, but I don't really get,
"what would make someone feel that
"uncomfortable in their body?"
I'm not saying that judgmentally.
It's a hard thing to get.
So what I want to do is I want to show you
what it looks like, even as young as 18 months old,
even as young as five or six years old,
what these children are expressing that would make a parent
want to say, "There's something real going on here.
"That when I tell my little boy,
"'You have to wear boy's clothes,'
"I have a very depressed child.
"When I let my child do what 'he' wants to do,
"what he wants to do is dress in girl's clothing
"and play girl's games and play with other girls
"and do things that, if he had a female body,
"we would consider 100 percent normal
"girl behavior in this culture."
So witnessing your child moving from sort of
a state of depression to a state of happiness, is very
compelling for most of us as parents and as therapists.
So I want to show you Jazz, whose family
has documented her transition.
She's now a teenager, so I'm going to show you
some clips of her now, and I'm also going to show you some,
I'm going to show you some clips of her as a young child,
as a preteen, and as she's moving into the teenage years.
So I'm going to show you some clips of Jazz
as she is now, as she's maturing and getting older.
Okay.
So Jean Malpas, who I mentioned earlier,
this is also a slide of his.
Looking at these three...
I'm going to say kinds of children,
and of course, each of these...
This is a spectrum, but even within each of the labels,
there is a diversity of presentations.
So there are children that are nonconforming,
children that are atypical, children that don't fit
the standard views of what boys and girls should look like.
There are children that are gender dysphoric where,
in addition to usually being gender nonconforming,
they are really uncomfortable in their bodies,
with their anatomy, and I want to say that sometimes
kids can be gender dysphoric and not gender nonconforming,
because that has a lot to do with the freedom
that they've had to explore, and in some families
there is no freedom to explore, so the children
are uncomfortable, but are really not allowed
to ever, ever, ever have the experience
of wearing clothes of the other gender.
And children that are cross-gender identified, okay,
that are actually living, they are socially transitioned,
if they're teens, they're beginning
a medical transition of their gender.
Those are sort of the three groups
of children that we're talking about.
And the three groups of families that we are talking about
are families that are, I'm actually going to start
on the other side, families that are struggling,
that are conflicted, that have children that are gender
nonconforming, it is causing them tremendous pain.
Sometimes the pain is in a heterosexual
family where there are two parents.
Sometimes it's very gender-split,
meaning mom is very supportive, and dad isn't,
and I assume there are families out there
where that is reversed, but I see that much less frequently.
Most of the time it is the mothers who,
and who are often, in our culture, spending more time
with their children, and are witnessing the pain
of what happens when you try to take away
the girl toys from the child who is anatomically a boy.
So these parents are struggling, they're conflicted.
Sometimes there's a cultural fit.
We're dealing with religiosity, we're dealing with immigrant
families who may come from cultures where there's
much stricter gender roles, so we have to really look at...
It's easy, I think, maybe too easy,
for us as social workers to become advocates
for these children, and not really compassionate
for the struggles that the parents are going through
in families where this really does feel
like this is against God, where it feels like they're
going to get into, they're going to get ex-communicated
from their religious families, that they're going to be
ostracized from their cultural and ethnic communities.
So we have to be really sensitive to the struggles
that the parents are going through as well.
There are parents, and this is actually the population
of parents that I see the most common,
parents who are accepting, they're concerned,
they're educated, but I would say that they're still
confused or they're unsure of how to move forward.
That they want very much to respect their children,
they love their children, they can see
that their children are not typical.
In many cases they have other children
in the family that were very typical.
They want to support their children.
They have done a lot of reading.
They have gone on the Internet.
Sometimes they've gone to conferences
and they're trying to figure out
what's the best move for their family.
And I want to say sometimes this population of parents,
there's one of the complications for them.
I talked earlier about the fact that
in their exuberance of supporting their children,
they're sometimes moving faster than their children are.
"Do you want to start hormones, honey?"
"No, mom, I just want to play video games."
They're kind of, they're anxious, because having a child
whose gender is ambiguous in our culture
often makes us want to
make a decision and move forward
and sort of to shut down the options.
So a lot of times, you know, I remember
I got a phone call once from a mom.
I had worked with the family since
the kid was five or six years old,
and during the long years of therapy,
the kid had moved from kind of a gender atypical
presentation to a fairly male presentation.
He was thinking he very much wanted to mature
and live as a boy in his teenage years.
But he was pretty happy as a 9, 10 year old
and not really asking the parents for anything
regarding pronoun change or school change.
Just kind of doing his thing, but at the time,
living as a girl, and they had come to a place
where he was really clear he wanted to live as a boy.
The parents called me up one day, and very anxious
on the phone, the mom is like, "I know you said
"that we have to get him on puberty suppressing hormones
"right away, and that it's, that the window, we have to get,
"we have to do this before the window closes."
The window of Tanner Stage Two, the window of what,
of what puberty looks like.
Again, anybody here that's raised children,
anybody here that works in a school system,
it is not exactly like you go to bed on Monday night
as a pre-pubescent child, and you wake up looking
like a 16 year old child in puberty.
And I said to her, I said, "This is
"a very large bay window here.
"We can make an appointment to see the doctor.
"If it's a week or two before we get in,
"if it's even a month or two, nothing much
"is going to change with your child in a two-month
"period that is life threatening here.
"I'm not telling you to wait two years.
"I'm not even telling you to wait nine months."
But there's a sense sometimes with this population
where they're just very anxious and they
are often times ahead of their children
and they're often times really...
Their concern for their children is so big
that it almost makes it hard for them to think clearly
about the fact that we're talking about young people here
who move through a lot of emotional states
and that because their children are gender-variant,
they're taking concerns, very real concerns,
that the child is having, and sort of amplifying them
in a way that they might not do with all of the
10,000 other concerns that young people might have.
So anyway, this third group here are families
where the children have socially transitioned,
and often they serve as community mentors
for families in the other stages that we were talking about.
And I said earlier in the very beginning
that this is a population that needs a tremendous amount
of support because they're often, they're viewed
in very negative ways sometimes by communities
and families, that they created this, that they are
pushing their children into these identities
that aren't accurate, so they really need a lot of backing
and a lot of support, and they also
sometimes need a little bit of help.
There's one mom that I work with
who comes to a support group that I run,
and she's so, she's marvelous, and she's 100 percent
supportive of her kid, and her kid is doing phenomenal,
but it's sometimes in her enthusiasm and her support
and her sense of wanting to convey to the parents
that the kids are going to be fine, just have their back,
the kids are going to be fine, she sometimes is moving
faster than the folks that are struggling
and conflicted are able to move.
So I kind of have to slow her down because
it sometimes feels intimidating to people
who really are saying, "We're not there yet.
"We're not ready yet."
There's a spectrum of behaviors,
of experiences and behaviors for children and for families.
This is Diane Ehrensaft.
Actually, what are the words that these kids
use to talk about themselves?
I'm using the term "gender nonconforming,"
but children don't very often come into therapy
and say, "Hi, I'm gender nonconforming."
I'll actually tell you what one
young person came into my office and said.
It was actually very sweet.
I had met with the parents first for a couple of sessions,
and then they brought their child,
who was then a girl, into the office.
Little child, six years old, so of course the first
thing that I say to the child is,
"Do you want to come in with your parents?"
Thinking a lot of six year olds do not want
to walk into a therapy office without their parents,
and she looked at me and she said,
"No, I want to go in myself."
I said, "Okay," and she sat down on my couch,
and she looked at me straight in the eyes,
and she says, "The reason that I'm here
"is because my parents are having
"a very hard time accepting my gender."
Six years old.
And then said, she asked me if I knew what a tomboy meant.
And I told her that I thought I did, but I asked her
to tell me what that meant to her and she did,
and then she said, "I just want you to know
"that if your intention," and that was the word she used,
"if your intention is to make me
"wear dresses, this is not going to work."
So these kids are very clear often,
not always, about who they are.
But again, they don't walk in and say,
"I'm gender nonconforming," or often,
young kids, "I'm transgender."
But this is some of what they say.
They say, "I'm gender fluid."
They say, "I'm a gender hybrid."
They say, "I'm a gender smoothie."
They say, "I'm a gender oreo."
They say, "I'm a gender Prius, half girl and half boy."
Gender Tauruses, who are a girl on top and a boy on bottom.
So they have ways of talking about their gender that are not
necessarily the clinical languages that we would use.
So what are the criteria that we use for social transition?
Social transition before puberty is complex.
It needs to be thought through.
Some of the questions we want to ask,
is, "Is it necessary, is it crucial to the child?
"Has it been crucial?
"Is this child saying, 'I can't go on this way,
"'I can't live this way, I hate what is happening to me,
"'we have to do something'?"
And there are children that are absolutely saying that.
Is it safe?
Is the environment they are living in safe for a transition?
Is their home safe?
I'm talking about their father, I'm talking about
their brothers, I'm talking about their grandparents,
I'm talking about the other siblings in the house.
Is their school safe, and what can
we do to make the school safe?
What is their teacher like?
What is the administration of the school like?
What does the school board say about children like this?
Will they have a place to pee in the school itself?
What is their neighborhood like?
Are they safe leaving the house?
Are they going to get beaten up in the neighborhood?
Is it safe enough, and what do
we have to do to make it safer?
And this is the place where we are advocates,
this is the place that we are trainers.
This is not enough to send the parents out
to go talk to the school systems.
We need to bear, we need to use the weight
of our professional knowledge and expertise
because they will listen to us in a way that they
sometimes will not listen to the families.
So are they ready?
And there's a difference between eligibility and readiness.
This is a language of the World Professional Association
of Transgender Health, and of the Standards of Care.
People can be eligible for certain things,
but they may not be ready.
That's why we have a gap year for some kids
who are graduating high school that are eligible
for college, but they're really not quite ready for college.
So is the family and community ready?
Is there enough support for the child and the parents?
And flexibility, are the parents willing to see this
as an experiment, and be committed
to it while remaining flexible?
Just think about that.
That you're committed to it, you're on board,
you're behind your kid, you're talking to the school,
you're supporting your kid, you're making sure
your kid is safe, you're doing all the work you need to do,
and at the same time, you're okay with
your kid shifting and changing.
And anybody who's parenting children knows that
this is sort of part of the way it is.
That kids are, you know...
really, really, really, really, want to go overseas
and study, and then a week before it's time to go,
they say, "Dad, I can't go, I'm too scared to go."
That we're sort of moving in and out of a lot of shifts
and a lot of changes with this population of young people.
So I want to repeat something I said earlier.
Probably going to repeat it at least
one more before we're done.
Regardless of whether a gender nonconforming child
transitions socially, it is in the best interest
of all children who express gender nonconformity
to have their authentic expressions of gender
supported by peers, parents, teachers,
and other adults in their lives.
So whether the child is gender atypical,
whether the child is gender dysphoric,
whether the child is incredibly gender typical,
our job as parents is to support children's gender identity.
So this what the Standards of Care
have to say about medical treatments.
They talk about three levels of treatments.
Treatments that are fully reversible,
and the puberty suppression hormones that we've talked about
are considered fully reversible.
Like I said earlier, you stop taking the suppressant,
and you go right into the normative puberty
for children of that, who are born of that natal sex.
Partially reversible are considered hormonal therapy.
So generally speaking, we would not
start a child on hormone therapy until
they are at least 15 or 16 years old.
How early we do that really depends on the history.
For example, if a...
12 or 13 year old child comes to my office,
is expressing gender nonconformity,
wants to start on hormones, we put that kid
on a hormone suppressant, we do the work with the family,
do the work with the kid, blah blah blah.
You go through the whole process of doing that,
and the kid is wanting to take hormones,
but you've only really been in therapy, let's say,
for a year or a year and a half,
or maybe there's other issues going on with the kid,
that might be a kid who doesn't start on cross-gender
hormones until they're further along in their puberty.
A child like Jazz, okay, who has been exhibiting
this experience since they were a small child,
who starts living in a cross-gender identity
at five or six or seven or eight years old,
is in school in a cross-gender identity,
has been placed on puberty-blocking hormones
at Tanner Stage 2 and is now 15 years old,
and essentially, has been living a cross-gender identity
for over a decade, and nobody in this child's life,
the child included, is seeing any evidence that this
is changing or abating, it just seems like there's no reason
to not provide cross-gender hormones to support,
to affirm the gender identity that the child
is going to be living in, and the child is now
going to go through their puberty
at the correct time in their lives.
Medical treatments that are considered irreversible
are surgeries, and again, nobody is doing
genital surgery on teenagers.
Certainly nobody is doing them on
anyone younger than teenagers.
Occasionally, a handful of doctors are doing
breast removal and chest reconstruction for older teens.
But in terms of genital surgeries, nobody
is doing those before the age of 18,
and they are considered irreversible surgeries.
That doesn't mean that gender is irreversible.
People can still change their gender if that is
how they come to experience themselves
later down the road, but it does of course
make for major complications in terms of surgery.
So here's the criteria for puberty delaying hormones.
Long-lasting and intense pattern of gender dysphoria.
Again, it can be suppressed or expressed, meaning there are
kids that are sort of underground about their gender,
and kids that are way out there about their gender.
So long-lasting and intense pattern of gender dysphoria.
That the gender dysphoria emerges or worsens with puberty.
And again, this is this big area.
For some kids, they're gender atypical, but they really
don't have a lot of dysphoria, until boom, they hit puberty,
and they're like, "Whoa, what is happening with my body?"
For other kids, they've had the dysphoria all along,
but it gets very, very, very big when they hit puberty.
That any co-existing psychological, medical, or social
problems that could interfere with
treatment have been addressed.
Now this is complicated.
Again, we're dealing with youth, with a particular group
of youth that are often experiencing all kinds of social
ostracism, they're often experiencing social oppression,
their bias, they're struggling with their own identity,
they're struggling with how to fit in psycho-socially
with their peers on a lot of levels.
It's complicated, puberty is complicated,
youth is complicated, adolescence is complicated
without having gender issues, that it is just complicated.
But as much as able, we want to help
deal with any comorbid issues.
Any depression, any anxiety, certainly any kinds
of substance abuse, certainly any kinds of major
mental health issues, that we want to do everything we can
to assist the child in being in the healthiest
and most stable place that we can at the time
that we start administering puberty-delaying hormones.
We want to make sure that the adolescent
has been given informed consent.
Is the adolescent able to, do they have the skills,
to understand what it is that they're doing?
And that parents and caregivers have consented
to the treatment throughout the treatment process.
So one of the things that we examine when we're looking at,
not just puberty-delaying hormones, but also
most specifically cross-gender hormones,
is the effects that this will likely have on fertility.
Now I'm not a medical doctor and I'm not
going to go into a lot of the details about that.
But what I want to say is that part of my job
is to talk to 14 year olds and 15 year olds
and 16 year olds about their future fertility.
Now I think that it is so important that we do this.
I was so supportive of the WPATH Standards of Care
when they put directly into the...
the Standards of Care that fertility needs to be
one of the things that we assess for.
However, it is really hard to talk to a 15 year old
about whether or not they may want
to get pregnant in 10 years or 20 years.
It's really difficult to talk about sperm preservation.
It's really difficult to talk about the quality of your eggs
or how that may effect your ability to carry a child.
The average 15 year old couldn't care less about
those things, and there are exceptions.
I actually once did a consult
with a young, young here being 16 years old,
female who was considered transitioning,
and did three sessions where on her own,
she came in to treatment saying that she really,
that was what she wanted to look at,
was whether or not she could preserve her fertility
because that was really important to her,
and it was so important that she was willing to delay
starting testosterone, if need be,
until she got pregnant and had children.
So there are exceptions to this,
but most of the time, young people, it's just...
It's like talking to them about their retirement fund.
Like they just have no idea what you're talking about.
And I'm not trying to put down young people when I say this.
It is just developmentally, a 15 year old
is really not capable of the kind of informed consent
that we would like them to be able to be responsible for.
They're just not.
They're 15 years old, and, you know,
getting hormones is really important to them.
That's what's really important, not whether
or not they're going to be able...
So the most common answer we get
from children is, "I'm really fine adopting."
Which is great, I'm an adoptive parent,
I think adoption is a marvelous thing
and I support these kids, but I do want to say,
when we talk about some of the ethical concerns,
is I do suspect that some of these young people
might later on have some regrets about that.
The example I want to give to you in thinking about this is,
I understand these are really weighty decisions
that we're making, but if you had a child, a female child,
who came into your office who was pregnant,
and she said, "I'm 16 years old,
"I'm three months pregnant, I don't believe in abortion,
"and I want to have this child."
I suspect that nobody listening to this
would say that we should force her to have an abortion.
I suspect that anybody who's listening to this
that's over 25 or 30 yourself recognizes how difficult
it is to be a parent, period, let alone to be
a 16 year old parent, and we're going to have concerns
about this child moving forward, who I don't think
is capable of understanding, at 16 years old,
what it really means to be responsible for a baby,
let alone that baby for the next 18 years.
And as the mother of an 18-year-old,
it doesn't stop at 18, right?
The responsibility that we have to our children
and our care and our love goes on way past that.
I don't think a 16 year old is capable of that,
but that doesn't mean it's not
her right to make that choice.
We understand that the choice she makes,
if she makes a choice to have an abortion,
I've certainly had numbers of grown women
in my office who are grieving abortions
that they had when they were younger.
That we make choices to the best of our ability.
My somewhat tongue-in-cheek example
is people are allowed to get married even when we think
they're marrying a really stupid, shitty person.
They're allowed to do that.
We don't interfere with people's rights.
What we do is we try to give them all the information
we can about the choices that they can make.
Do birth mothers feel sad sometimes
that they placed children for adoption?
Do birth mothers, I would say, mostly feel sad about it?
Do they sometimes regret it later in life?
That's true.
That doesn't mean birth mothers should not have
the right to place children for adoption.
That these decisions are complicated on multiple levels.
We're going to move to the best kind of informed consent
that we can possibly provide, the best kind
of psycho-education for everybody involved,
but then there's a piece here that we have to accept
that there are limitations of knowledge
and limitations of ability to understand.
I think anybody here that has a child
that's listening to this knows that,
prepared as you might have been,
that there's no way to prepare for being a parent.
It's absolutely a different experience.
The map is not the territory, as they say, right?
So we can listen to these young people
talk about their gender and how they experience it.
We can help them make the best choices,
but how they settle with those choices
is going to continuously evolve
over the years and decades to come,
and our job is to support them in those changes
that may happen as they go through this.
Okay, so feminizing and masculinizing hormone therapy.
Adolescents, this is from the Standards of Care,
may be eligible to begin hormone therapy,
preferably with parental consent,
as young as 16, and often 18.
What we say is that it's the laws
of the country that you live in.
In the US, you're an adult at 18.
In other countries you're an adult at younger ages.
We often, again, with young people that have
a persistent history, we often start to make
these decisions at 16 and 17 years old.
Ideally, the treatment is made with the adolescent,
the family, and a treatment team.
I know that some of you are working in clinics
and situations where these children are living,
these young people are living on the streets,
that they don't have connection with their families.
Their families are not supportive,
their families are abandoning, their families
are abusive to them in all kinds of ways,
and these decisions are not made with family involved,
and that when we're making those decisions
without family involved, it behooves us as adults
in these young people's lives, to in some way
replace the kind of love and caring that they should be
having at home with their family, with a treatment team
of adults that are able to help them think through
these decisions, and make the best
possible choices that they can make.
So what are some of the ethics of medical referral?
Some of the pros, that gender dysphoria impacts
self-esteem and interferes with normative development.
So these teens are already struggling
with how they feel about themselves,
and they're struggling with just being able to move through
a normal developmental adolescence
because of their gender dysphoria.
So the puberty blocking treatments, as well as
the later hormonal treatments, help them to move
through a more normative development.
You know, that young people, especially
these days, see transgender adults.
They're getting on YouTube and they're seeing other kids
that are following through on these kind of treatments.
So it's not like they don't know the options.
A lot of times when I work with adults,
they'll say, "I didn't know."
Like "I didn't know that I could have
"done this when I was younger."
And the truth is, when you're 40 years old,
they couldn't have done it when they were younger,
because these options did not exist then.
So they know what can be done.
And I want to remind you of what I said earlier,
which is most transsexuals, most adult transsexuals,
knew from the time they were very young.
So when we're looking at this cohort of kids
who have persistent gender dysphoria over time,
that they exhibited these cross-gender behaviors
from a young age, that have this anatomical dysphoria,
that are in this cohort who are most likely going
to grow up and be transsexual, that we are helping,
we are helping them to be on
the correct developmental path.
Some of the concerns is, hello,
young people do not always make
healthy and sound decisions for themselves.
I am the mother of two delightful young teenage men,
and I can tell you that it is a whirlwind watching...
And I'm not talking about cross-gender hormones here.
I'm talking about, "What did you eat?"
"Well, the last five meals I had pizza."
"Well, that might be why you have a bellyache.
"I'm not a hundred percent sure, honey,
"but that might be why you have a bellyache."
You know, that they make...
Actually my favorite line, I'll share with you.
Years ago a friend of mine's son said to her,
"I figured out, mom, that you don't
"actually have to wash your jeans.
"That if you just put them in the dryer
"they just smell clean."
So young people do not always make
healthy and sound decisions for themselves.
And especially these days, where access to YouTube,
access to communities of transgender youth,
that kids that are disenfranchised, kids that are struggling
with all kinds of other things about their identity,
where being "queer" and being "gender-bending"
is sometimes cool, and where we know that
some of these kids are going to identify as adults
not as transgender, but as gay.
That there's a lot of different decisions that are coming in
when they're coming into our office for assessment.
So we need to be also looking.
It's a balance here.
We want to be advocates, we want to be supporting
these kids, because most people aren't.
Most therapists they're going in to see
are psychoanalyzing them, or thinking,
"Do you think you're transgender
"because your parents are divorced?
"I think that you're transgender because your dads are gay."
All this stuff, all this psycho-babble.
So it is so important for us to listen to their
authentic stories about their gender,
and to be advocates and support them.
But on the other hand, it would be irresponsible for us
to not recognize that we are adults,
and that they are children, they are young people,
who are dealing within a very complicated world
trying to understand their identity.
We know from Erik Erikson's work that
this is a stage, this is a process, so how they...
Any of you that are listening, if you think back
on your 15 year old self, I suggest
that you've probably changed a little bit since that self.
And some of the things that you knew,
that you knew were about yourself,
you knew would never change about yourself,
well guess what, it has changed about who you are.
So again, it's a balance that we're trying to do,
and there's a handful of kids, there's not many,
but there's a handful of kids who
are sort of caught up in more of a
gender celebratory, youthful party,
then they are really experiencing any kind of dysphoria,
and the assessment process of whether
it is appropriate for them to have
puberty suppressing hormones or cross-gender hormones
is a little bit more complicated than the kids
that are clearly experiencing gender dysphoria.
Okay, so let's look at some of the implications of research.
So the good news, and I do think it is good news,
that research has shown that people who medically transition
in adolescence show improved post-surgical
psychological adjustment, as compared
to transsexuals who transition later in life.
So what I'm saying is that kids that have been
assessed and assisted, in either puberty blocking hormones
and later cross-sex hormones, that when we follow
these children over time, that their post-surgical,
post-transition adjustment, how they are doing at age 25,
is better than transsexuals who begin the process
of transition, let's say when they are in their 20s or 30s
or, commonly for male-to-females, in their 40s and 50s.
That their adjustment is more difficult,
and doesn't that make sense?
You're 35 years old, you're married,
you have teenage children yourself,
you're fired from your job when you try to talk about this,
that you have an established life that, generally speaking,
transition is not considered what anybody expected
to be in your trajectory, by your wife, by your kids,
by your job, by your neighborhood,
by your church, etcetera, etcetera.
That when people transition younger,
they have the ability for having successful adult lives,
that their relationship, their education, their career
is all done in their correct, affirmed gender.
So you transition, let's say you transition
socially at age 10, and you start taking
puberty suppressing hormones at age 11 or 12.
You're living now, I'm going to say female-to-male
for no particular reason, but female-to-male,
and you're living now as a boy,
and now you're entering high school and you're a boy,
and you're able to be socially identified as a boy.
You're able to date however you
would, gay or straight, as a boy.
Now you're taking cross-gender hormones,
so you're maturing as a boy.
You're able to make decisions for your life,
the decisions about what college you want to go to,
you're able to make decisions about where...
As a boy, you're able to make your
career decisions as a boy, that the name
on your high school diploma is a boy's name.
So the adjustment is easier.
I also want to ask you to think about
what are the ethical implications
of not assisting these young people?
What happens if we choose to not assist them?
So this quote here by...
These folks, Gooren and de Waal, are some of the early...
They've been doing research in cross-gender hormones
for decades now, so they are really the folks
who all of the, you know, we are the inheritors
of their medical expertise and knowledge.
"It is to be remembered that giving,
"but also withholding, endocrine treatment
"is a momentous and responsible decision."
So it's not just giving, but actually withholding,
is a momentous and responsible decision.
And one cannot sidestep the ethical dilemmas
by merely avoiding them, especially given
the devastating impact puberty can have on this population.
And they mean that endocrinologically,
physiologically, as well as psychologically.
So some other benefits.
Another benefit of early gender reassignment,
gender confirmation, is that these youth
would not need to develop a false sense
in a gender identity and expression that
does not feel authentic to them.
So again, think about that.
You're born a girl, you identify as a boy,
but you can't live as a boy because your family
or school or neighborhood won't allow you to.
You can't even really talk about it,
you can't even really tell anybody, so you're a girl.
And how successful at being a girl
are you going to be socially?
How successful are you going to be dating?
How are, what is your sweet 16 going to look like?
How are you going be able to move through this process?
And you're going to have to create a false sense to do that.
And I think that everybody listening understands
the incredible psychological damage
of what it means to not have an authentic self.
So their socialization as women or men gets to happen
naturally in their pre-pubescent and pubescent years.
They don't have to unlearn their original
gender socialization and then re-learn a new one.
And you know, for those of us that work
with adult transsexuals, you know, again,
I completely recognize all of the stupidity
of gender roles and all of the ways that it is just stupid
that girls can do this and boys can do this
and girls act like this and boys act like this,
and I recognize all the limitations of it.
But when you have been raised as a man
and socialized as a man, and you're trying
to live your life as a woman, the ability to pass,
to move through the world in ways that will
appear to others to be the way they expect women
to look and behave, becomes really important,
and re-learning a new gender socialization
is a tremendous amount of effort and time.
And lastly, the developmental process
would take place during the proper life cycle.
In other words, your teenage years is when
you're supposed to be exploring sex and gender.
That doesn't mean you're not allowed
to explore it for the rest of your life.
But that this is the part of the life cycle
where people are absolutely beginning to figure out
"Am I gay or am I straight?
"Do I like boys or do I like girls?
"Do I want to date or don't I want to date?
"How do I want to present myself?"
Children go through this period of
sort of changing how they look.
They go from sort of Abercrombie to grunge,
from sophomore to junior year of high school.
They're trying on identities to say,
"Where do I fit in to the world?"
And they're doing this in their proper gender identity
when we support them in young transitions.
So some of the challenges working with parents.
Parents main concerns, of course, are fear for their child's
safety, and their hopes for the child's social integration.
Their main experience, and again I'm quoting Jean Malpas,
anxiety on the edge of the unknown.
Now, again, I think that's the main experience
of being a parent, to be really honest with you.
It's a constant, "What does this mean
"and what should I do, and how do I be
"a good parent to my child with what's going on?"
But certainly when a child is dealing with gender
transitions or gender atypical behavior,
the anxiety of the parent of not knowing
what is going to happen is very overwhelming.
That there's a sense of responsibility
and a fear of influence.
They're afraid of their children's peers and how
they're influencing them, they're skeptical of the
therapists and whatever your agenda is about.
They are afraid, they go online and, again,
there are lots of parents who have been advocates
for children that have successfully transitioned.
They're just very leery of everybody, they don't know
who to trust and who to believe.
If they're too accepting of their child,
they're afraid they're going to expose them to violence.
If they're not accepting enough, they're afraid
that they're going to inflict more suffering,
and particularly fears around suicidality.
There's a lot of literature out there saying that
children who have atypical gender identities,
children that are identifying as gay or bisexual,
have much higher risk of so many issues,
but one of them is a higher risk of suicidality.
There are some argument in the research about
whether or not this population is really more suicidal
than other teens are, and there's some critiques
about the research that's been done.
If you ask a kid, "Have you ever thought about suicide?"
I don't know that that is hard science there,
of the kind of answer that a 14 year old would give
and what they mean by, "Yeah, I've thought of suicide,"
might not be what we as clinicians or researchers
think as an answer to that question.
So it's a complicated area, but there is just no question
that this is a vulnerable population and that they are
vulnerable to both hurting themselves and being hurt
by others, and parents are incredibly aware of that
and incredibly protective and frightened about it.
Except of course the parents that are
inflicting that violence themselves.
So parents, working with parents,
you need to work with their loss of expectations
and narratives, their dreams, their fantasies.
I had one family that I worked with where the mom
and her sister were very close, and then she had
two daughters, and she really saw that...
Her hope was that her daughters were going to be
as close to each other as she was to her sister.
And indeed the siblings still remain close,
but they're no longer a daughter and a daughter.
They're a daughter and a son now.
So how do these narratives that we have about...
You know, the father's fantasy of his daughter's wedding
and what that looks like when his daughter is now his son.
So what are our narratives, what are
the expectations we have, what are the dreams?
The sense I talked about earlier of feeling scrutinized
and blamed, of living with this ambiguity.
But I also want to say this last one,
which is maintaining normative parental control.
That when your child, quote unquote,
changes their sex, changes their gender,
that is an enormous amount of power
for a young person, for an eight year old
or 12 year old or 14 year old.
And sometimes what parents need to remember
more than anything is sort of like,
"Okay, you used to be a girl, and now you're a boy.
"You need to go do your homework.
"Okay, now you're a boy.
"Can you please start to do your chores?"
That we need to sort of get back into the dailiness
of life, and not sort of live in a world where everything...
"I can't do the chores, mom, because everyone at school
"is making fun of me because I'm gender variant."
"So sorry everyone's making fun of you
"because you're gender variant.
"I love you very much.
"Can you please go unload the dishwasher?"
That there has to be a way that we maintain
some kind of normative family life and don't allow
these children to kind of get a little too puffed up
about how much power they have.
It is good that they have power over their gender,
and it's good that they have parents that have their backs,
but it's also good that they learn how
to do their chores and their homework.
I want to talk a little bit about Caitlin Ryan
and the Family Acceptance Project.
Caitlin Ryan is a social worker, and the Family Acceptance
Project comes out of San Francisco.
One of the first things I want to say about Caitlin Ryan's
work is that it has a quality to me of "duh."
What I mean by that is, I could have told you this.
What she's saying is so incredibly simple, that when
parents support their children, children do better.
They have more positive outcomes on every issue,
we're going to be going through these issues in just
a second, than parents who don't accept their children.
That if you accept your children and you love your children,
your children do better than if you don't accept them.
Like, duh.
But we also know that my saying that doesn't really
have any power assailants in the world at all.
But having research that shows that helps direct policy.
It helps direct funding.
So Caitlin Ryan's work, although it does have
a "duh" factor to it, has been one of the most important
pieces of research that has come out
in LGBT studies in decades, in my opinion.
So Caitlin Ryan did a study in the San Francisco Bay area
looking at children from diverse ethnic backgrounds.
White kids, African-American kids, Latina, Latino kids,
and Asian-Pacific Island kids.
What her research showed is that across ethnic identities,
that if we look at every area, in every area that we
look at, from drug and alcohol use, suicidality,
HIV infection, homelessness, school leaving,
that the more a parent accepts their child,
the better the child is going to do.
And it also says that if we can move a child...
If we can move a parent from a rejecting, hostile stance,
to a slightly less hostile stance, if we can move them from
a coldness to warmth, if we can move them from
"I'm throwing you out of the house,"
to "You can live in the house,
"but I really don't like your behavior."
If we can move them from, "I don't accept
"what you're saying," to "I don't understand
"what you're saying, but I love you."
That the more we can move the parent, step-by-step,
to a state of acceptance, the better the children do.
And the bar graph just shows us
that the incidents of drug and alcohol use and misuse,
the experience of suicidal ideation and suicidal attempts,
that the dropout rate, that the homelessness rate,
that HIV infection, that every area that we can think of
that is a potential mental and physical danger for children,
that the more accepting the parents' behavior is,
the better the child is doing.
And this also gives us some insight into working with kids
that are runaways, kids that have already left home,
that we are working with in the context
of agencies and social service organizations
where the family is already a shadow, is already in
the past, and the kids are kind of on their own.
Oh, I didn't mention prostitution
before, that's another big issue.
So we're sort of picking up these kids
who have already left home.
In some cases the parents don't
even know where the kids are.
So when we are building programs that
we're helping these kids find shelter,
and we're helping these kids get food,
and we're helping these kids have access to safe sex
and birth control, and we're helping these kids find
other ways of supporting themselves
than survival sex and prostitution, that we're helping
these kids get their GED, that we're helping
these kids get back into school.
All of these things that we're doing,
I want to encourage all of you to not forget the family.
That sometimes what the kids are saying is,
"My family hates me, my family threw me out,
"my family is abusive," and there's no doubt
about it, that families can be abusive.
There's no doubt about it that parents do
sometimes throw their kids away.
But I also know, and again I know this having teenagers,
that sometimes the way they perceive
parents' statements, parents' behavior,
is not necessarily the way...
It's not necessarily what happened.
And of course, you know, there are lots of times that
the child, who now has this cross-gender identity,
has all these friends online, is feeling really good
about being genderqueer, but hasn't talked to the parent
about this at all, because what's happening
in the child's room on the computer is not
something the parent has access to.
We could have a whole other workshop all about
computers and technology and monitoring that
and what parents are doing and what we're not doing
and what we're trying to do, but they're smarter
than we are, and all of that kind of stuff.
But the point is, that by the time the child says
to the parent, "Boom, I'm genderqueer.
"Boom, I'm transgender.
"Boom, I got hormones on the Internet
"and I'm using them and you can't stop me."
That sometimes parents react to that
in really unprepared ways, they say
stupid things, they say judgmental things.
I'm not defending the parents for doing that,
I'm just saying that they're human, too, they make mistakes.
But children, young people, with their frontal lobe
the way it is, may not recognize that.
So the parent who says, "I can't deal with this,
"get the fuck out of the house,"
may not feel that way in two hours or four hours
but the kid's already taken a bus to New York City
and now the parent is desperately searching for the kid
who has now managed to really disappear.
I just want to remind us here that a part of our work
with these gender nonconforming, transgender youth
who are homeless and living on the street that come
into our care is, you may find if you reach out
to the parents, obviously with the kid's support here
or the kid's permission, that they're really glad
to hear from you, that they're terribly worried
about their children, that they might want
to apologize to the child for what they said,
that they might want to support the child,
and that actually the child who appears to be homeless
might not really be homeless at all.
But there might be some need for some serious
family work to have happen to integrate this
child in their confirmed gender with parents who
completely were blindsided by this information.
I don't want to lose the families here,
and I want us to be thinking about
the kinds of policy decisions that we're making,
and the kinds of ways that we are, again,
we're balancing advocacy for these kids,
support for these kids, at the same time that we're
recognizing that they are young people who may not have
the complete, that what they're hearing and what
they're seeing may not be the same thing.
I was just talking to a student the other day
who is the mother of a teenager,
and I was talking about this very issue.
This has nothing to do with gender, she just
shared to me that she told her teenage son
that she was taking away his phone because
he was like playing games on his phone
when he should be doing his homework.
And the kid, and the parents were divorced,
and the kid called up the dad and said,
"Mom threw me out of the house."
And the kid really believed that.
That's what the kid absolutely heard the parent say,
when the parent said, "Give me your phone."
And I could (laughs)
Our phones are really important
to us, I understand all of that.
We just have to remember we're dealing with
a not fully developed pre-frontal cortex
of young people that are dealing with a lot of gender
issues, and the nature of parental and child interactions
in these teenage years, by its nature, is children
are pushing away, they're pushing away,
they desperately want to be independent,
their parents embarrass them, their parents are stupid.
My favorite line my partner said when we entered adolescence
is overnight we became the village idiots.
Which is really hard, you know, when you were
your child's most beloved, that they just thought
you were the best people in the world, and suddenly
overnight you're just a complete and total fool.
And this is developmentally normal,
at least in Western cultures, it's not so much
in other cultures, but in Western cultures this is part
of their developmental bid for independence,
and it is natural for parents to go through all kinds
of places, of being overprotective, of being
under-protective, of feeling rejected, of being,
trying to not let them leave the nest and then
ultimately probably pushing them out of the nest.
This is all normal, and when you confound that
with all of these issues of gender, that by and large
most parents don't understand, and by and large
most parents are really confused about,
and bottom line, they're really concerned about their kids
and they don't know how to make sense
of what, to them, really sounds crazy.
Like, "I gave birth to you, I know you're a girl,
"I don't know what you're talking about, you're not a boy."
There's a process for both of them to have to go through.
Okay, so what are our goals?
We want to reduce the anxiety and the reactivity.
We want to be a resource to the child
and we want to be a resource to the parents
so they can be a resource to their child, that's our goal.
We want to identify how reactions to the personal
meaning of gender and gender variance might
complicate relationships with the child.
What I mean by that is,
a mother who was a tomboy, who now
feels comfortable living as a woman,
might not understand that her female child is not a tomboy.
That her female child actually has a male gender identity.
That a father who, and I would say this is true
for almost all men in our culture whether they are
men's men or whether they are, quote unquote, sissy men,
that the way boys and men are treated in this culture
when they step out of traditional male roles
is just horrendous and awful.
So the protection that fathers have to their trans-female,
trans-female, born-male children, is often highly
protective, and it's not just about their child,
but it's about their own memories.
So when you do the therapy work of saying to the dad,
"Well, what happened to you?
"Do you have an experience in your childhood
"where you were treated as being a sissy,
"or you were treated for being too girly?"
And it's a rare man in our culture that doesn't have
painful stories associated with this, in relationship
to their own father, and when they get in touch with that,
when they realize, "I don't want to treat my child
"like this," it's very powerful work.
That we want to facilitate co-parenting
relationships and conflict resolution.
Again, in heterosexual mother-father families,
there is often a conflict between the mother
and the father about that should be treated.
In families where there's divorce, and sometimes there's
new step-parents involved too, there's conflict
between the two families about how this should be treated,
and almost always one side is more
supportive than the other side.
So facilitating these conversations
becomes one of our goals.
And assessing the needs and conditions.
Does this child need to socially transition, and if so,
what is the advocacy work we need to do at the school?
How do we facilitate the conversation with the pediatrician,
who may be on board and may be resistant?
How do we find the best pediatric endocrinologist
or family physician for this family to work with?
That is going to, not just prescribe hormones,
but actually help them psychologically
and support them in understanding what is happening.
So those are some of our goals.
Support, you know...
I think having support groups
for parents is really important.
I think offering family therapy, both with
the parents alone as well as with the children...
I just was working with a kid the other day who
was talking about how he, female-to-male,
how he had come out to some friends,
and then he came out to the school social worker,
and then he came out at school,
but he hadn't yet told his parents.
And I said, "Do you think your parents will be rejecting?"
And he said, "No, no, not at all.
"My parents are really great, they're really quite liberal
"and I think they'll be very supportive."
"Well, why haven't you told your parents?"
"I'm really scared to tell my parents."
"I thought you just said that they're
"really liberal and supportive."
"Oh no, they really are."
The terror of having a parent reject you is so intense,
that even though you know your parent won't reject you,
it doesn't stop you from being terrified.
So sometimes having the kid and the family
in the room together, and facilitating some of these
conversations can be really helpful.
I talked about school advocacy.
Sometimes it's with physicians.
You know, physicians that are really opposed to it,
physicians that won't provide treatment.
This is really a big deal if you're living in
more rural parts of the United States
where you don't have access to pediatric
endocrinologists that are trained in this.
We need to rely on the pediatrician to be able to help,
so there has to be advocacy here.
And again, we want to encourage exploration and expression.
We want to give these children spaces to explore.
So what I want to do is I want to give you
just a couple of really brief cases to kind of look at this.
So this is a child I'm going to call Jayce.
Mom called, and mom almost always does call.
The exception to that is sometimes dads make the phone call
when their trans sons, again female-to-male, are in college.
For some reason I get more calls from dads
of kids of that age, and always female-to-male of that age.
Other than that it's almost always mothers that call.
The family has four children.
The marriage is strained.
The youngest is a five year old
who has always been feminine.
Natal male, always been feminine,
likes to wear women's clothing, girl's clothing,
wears hair long, wants to be called Jayce instead of Jay.
The parents are tolerant but very uncomfortable,
and the child is going to start school in the fall
and is extremely anxious about going as a boy.
And again, this is at the place where I receive
more phone calls from parents of children
between five and seven years old than any other
age group because that is where school comes in.
And school becomes the dividing line between,
at home the child can dress in various ways,
but at school there's limitations.
At school, taking a little Dora backpack
can affect your social relationships.
So some of the ethical questions.
How does a young person know that
their gender is not what it appears to be?
I mean, how does a child know that?
And I think, as grown-ups, we struggle with that.
But I think when you think back and you think of yourself
at five years old, when you think of yourself as six
years old, you knew whether or not you were a boy or a girl.
I think this ability to trust children,
again, not 100 percent,
but that this experience that they're having is not
something that they are pulling out of the ether.
This is something very real and internal.
That we need to start this ethical process of understanding
the difference between gender nonconforming
children and gender dysphoria, what I am
calling here in quotes "sissy boys."
There's a famous research study
called "The Sissy Boy Study."
Sissy boys and trans girls, in other words,
where is the place where this is a boy who is feminine
versus a child who is a girl in a boy's body.
Where's the place where this is a girl who is a tomboy
versus this is a child who is a boy but who
is born into a natal female body.
How do we determine which children are really trans
and which are, again, pre-homosexual?
Who are just tomboys or very girly boys.
How do we determine the difference between
gender role and gender identity?
Between the core sense of gender
and how people dress or present themselves.
Again, within the context of a world
where the children are not allowed to cross those
boundaries without experiencing strong resistance
and reaction from the world around them.
How do we help children and their
families to figure this out?
Is there more plasticity of gender for young children?
In other words, for those people who believe
in reparative therapy, who are not working in affirmative
models, what they would say is gender
at this young age is pretty plastic.
That you can sort of help children mold a sense,
that the sissy boy can develop a sense
of being a boy, and being comfortable being a boy,
even if the child is, quote unquote, "really trans,"
whatever that means, that you can help people,
because if you can help people to fit into their natal body
without having to take hormones and surgery,
is that not a better choice?
Now of course I would say that this kind of
reparative therapy does not work, but these are the kind
of ethical questions that people raise.
Can they express gender discomfort as reactive
to any number of issues in the family?
In other words, are we really looking at gender here,
or are we looking at a whole bunch of other issues
of real pathological stuff going on in the family
or mental health issues that the child
is exhibiting in some way around gender?
And again, I think this is important to explore.
I don't see it a lot.
What I see a lot is children who
really have authentic gender issues.
But I do think it is incumbent upon us
to ask these questions and look at it.
What does it mean to be gender atypical in a sexist world?
What does it mean to be stepping out of gender roles?
So if you are a female child who is more masculine
in your presentation, how do you find yourself
mirrored in the world in a way that you can develop
a strong self-identity as a more masculine female?
And is the desire to say, "I'm a boy,"
because there's not a lot of other models for these kids?
I think we need to be looking at
all of those ethical questions also.
It's also important to be aware that
most gender specialists have worked
with adults, not children.
So what happens is you're a gender specialist,
you work with adult transgender people,
you start to get calls from families of young children.
And even though that's not your expertise,
many of us started to do this work.
So we're gender specialists without specific training
in child and adolescent psychology, and on the other hand,
those people who are child and adolescent specialists
are rarely also trained in gender.
So we have these two populations that are
rarely working together, so I think one of the things
that we need to be looking at is working together
in interdisciplinary teams that include
pediatric endocrinologists as well as child and
adolescent specialists as well as gender specialists.
And the question of how are the parents' behaviors
encouraging, reinforcing, or
limiting the child's expression?
All three of those.
How do parents deal with the gender-variant
behavior of their children?
How do they respond to that behavior?
In some families, it's just not a really big deal.
Your son comes down for dinner wearing
pink nail polish and everybody just says,
"Pass the mashed potatoes."
In other families you get beat up or punished for that.
In other families you get humiliated for that.
How are the parents responding to that,
because I think that that effects how
the child's identity is developing.
The second case I want to talk about is Max.
So Max, you know, received a call from mom.
Max is the middle child, natal female,
is 13 years old, identities as a "trannyboi,"
and is attracted to females, dresses and wears hair
in a male style, seeking to stop female puberty.
Mother is accepting but ambivalent.
Max views hirself outside of the gender binary.
So Max is rejecting male and female pronouns,
is wanting to use neither male nor female pronouns,
often times using plural pronouns like "they,"
sometimes using "hir" or "ze."
So how do we assess gender identities outside of the binary?
I mean, who has...
Anybody out there have an assessment tool for me for that?
How will these decisions affect Max's
gender identity, including fertility issues?
We talked about the fad of gender flexibility,
particularly in urban settings.
The reality is Max can get hormones on the Internet.
Max does not need a therapist,
Max does not need a doctor.
That's just a reality for the world.
So how do we know with this population
when it's right to pursue early transitions?
I remember one client I worked with many years ago,
about 17 years old, female child,
very actually feminine in her presentation.
I would say she was beautiful in a sort of
stereotypical female, culturally approved kind of way.
And "ze" wanted to remove their breasts.
My favorite line during the therapy was when ze said,
"It's not that my breasts are not beautiful.
"They just don't belong on my body."
This raised a lot of ethical questions
and a lot of work with the parents about this.
In the end, wrote a letter to approve,
approve the surgery, and to my knowledge,
I spoke to them about ten years following that,
and they were doing great and happy not to have,
any longer have those breasts that did not
belong on their body, which is great.
Although other than that, the person was
presented fairly female in the world,
but identified as sort of non-gendered or outside of gender.
Is the child feeling pressured to fit in?
Is the child going through, quote unquote, a phase?
Is the child experiencing severe gender dysphoria?
We need to sort of look at, what are the complications
with this, as well as the right to self-determination,
for people to identify themselves as they are
and as they see themselves, and the reality
for us older folks to really get it, that there really are
a lot more options out there available.
Now how will this translate into, quote unquote,
the real world in 10 or 15 years?
I have a very distinct memory from my own younger days.
I was in my early 20s, I was living in the
San Francisco Bay area, I was hanging out with
a bunch of radical dykes who looked nothing
like my mother thought that women should look like.
And we were all going out to dinner at
an organic restaurant at a time when the word "organic"
didn't exist outside of the San Francisco Bay area really.
I remember my mom saying to my friends in this restaurant,
with her great Brooklyn accent,
"You know, you girls can't live this way."
"Live this way" meant you had to get married to men,
you had to stop looking like boys,
you had to start looking like girls in our culture,
like women are supposed to look.
You had to wear high heels shoes, you had to
go get some kind of decent, real job.
The reality is that all of those women that I was sitting
at that table with, they all have real jobs today.
They're rabbis and physician's assistants and educators
and they're all living lives, but all of them still are
sexual orientation and gender radicals
compared to the world that my mother thought existed,
and my mother's world, what she thought was possible for us,
that we created a different world for ourselves,
and I really trust that this generation of youth
are creating a different world, and that the world
that they are creating, by the time they are 30 and 40
years old, that being genderqueer will just be
one of the options that are available to people
living in the world in the same way that being a lesbian
and a lesbian mom and partnered with a butch partner
is one of the possibilities that's available to me
in this world, and I still get to have a job
and get hired at Smith College and I still get to be
a professional, and I get to do all those things
at the same time that I get to be
the kind of queer self that I have.
They're going to be able to create
a world where that will be true too.
Okay, my last case I want to do is Felisha,
who is a 16 year old male who ran away
from home to live as a girl, so again,
home was not safe, home did not feel safe.
She's been taking estrogen that she got legally,
illegally, I'm sorry, on the Internet.
Has been pumping silicone through a friend,
a very dangerous practice, something to be very aware of
with young people and also not so young people.
The pumping basically means that they're taking silicone
and it is often not the grade of silicone that a doctor
would use to do breast implants, it's an industrial level
of silicone that is pumped literally into the body,
injected into the body, to make the breasts look fuller,
to make the hips look fuller, etcetera, etcetera.
It's extremely dangerous, it migrates around the body.
The health ramifications of this
are horrible, they're extraordinary.
So Felisha's parents do not want to support this decision,
but they want "him" to come home and get therapy.
How do we know when it's right to pursue early transitions?
How do we know how to help parents like this
to support their child, to help them accept
that whether or not they like it or not,
their kid is living as a girl.
That's not going to change.
I shouldn't say that's not going to change.
I don't know what's going to happen in the future,
but what I know is right now this kid is living as a girl
and they either need to get on board or their kid
is going to be doing really, really dangerous stuff.
If the kid is going to be pumping silicone
and getting hormones on the Internet, at this point,
the conversation is over about whether this is healthy
or not healthy or good or bad.
I want to get my kid in to see a doctor
who is going to prescribe hormones in the right dosage
and level for that child, in a way that is healthy.
Can a young person understand the enormity
of these decisions that they're making?
Running away from home, pumping silicone.
Are they able to make an informed decision?
And as I said earlier, I think it is limited,
the kind of informed consent that they are capable of,
but they are capable of and allowed to
make decisions for their lives, and there's a piece of it,
again, if your kid decides to drop out of high school,
you may think that's a bad decision, but at 16 years old,
your kid is allowed to drop out of high school.
So how do you therefore, from that
point on, support your child?
How do we help manage the family's anxiety
and, if you will, the normative family dysfunction.
All of our families are a little crazy.
All of us are doing the best we can.
Most of us are, by the time we get to be parents,
are carrying a lot of baggage with us.
We're doing the best we can to do the right thing.
We're going to make a lot of mistakes along the way.
How do we help families sort out what is really
gender issues in the family, which actually might be
relatively easily treated, and what are all the rest
of the issues that are happening in the family
that actually might be more complicated?
Looking at, is the environment free of coercion?
Is this child really free to be making decisions?
I just had a case I was working on,
an older young person, 20 years old,
who showed up in my office just so angry
and resistant and hostile, and was just like...
When I was like, "Hello," and it was like,
"I don't want to be here and I don't want to do this,
"and this is just stupid and my mother made me come."
"Okay, well what's the problem?"
"What the problem is, is I just want female hormones
"and I'm just so sick of talking to all you stupid people."
"Well, who are us stupid people?"
"Well, the doctor and the therapist and this other
"person and nobody knows anything,
"and all I want to do is live as a girl."
And I said, "So I just want to clarify.
"I want to make sure I understand what you're saying
"is that you perceive yourself to be a girl
"and you want to take female hormones
"and you feel like everybody's really blocking you,
"that they're gatekeeping you."
"Yeah."
"Okay, so let's get it off the table.
"I have the power to get you female hormones,
"and I'm going to say right now
"that I will help you do that.
"So let's take that off the plate,
"that I will help you do that.
"What next?"
Kid looks at me and says, "I just want hormones."
And I said, "I heard you, I just told you that
"I would be happy to help you get hormones.
"So is there anything else you want to talk about?"
"Just like that you're going to let me take hormones?"
"You know, you're 20 years old, you're an adult.
"You're telling me you want to take hormones,
"you're telling me everyone's giving you a hard time.
"I don't want to give you a hard time.
"I mean there's a couple of things I,
"there's some questions I want to ask you,
"there's some things I want to talk to you about,
"but I'm telling you right now that unless
"I come to the conclusion that you are really crazy,
"you're really sort of mentally ill,
"you don't know what you're talking about,
"I will help you do that."
And the second I took that off the plate,
the second this hostile, angry kid,
just weeping in my office, just weeping in my office,
and part of the weeping was, "I don't know
"if I should do this, I don't know if I should go forward.
"I'm scared to go forward.
"What would it look like if I went forward?
"How do I present as a girl?
"I don't know how to do any of this stuff."
So when I'm talking about coercion here...
The coercion can go the other way,
that we're blocking people in.
Take that off the table.
Take it off the table, so that the person has the ability
to really explore what this means for them,
and if they feel like what they have to do
is prove something to us, then they're not
going to feel free to do that.
Do they have the necessary information?
Do they understand the risks and benefits?
Do they understand what hormones will and will not do?
And in my experience, there's lots and lots
of misinformation on the Internet, and among
people that are fairly well-educated about it,
of what they think will happen.
Is there any other alternative course of treatment?
Sometimes just saying to people,
"Well, I just want to wear women's clothes,
"but I don't really want to take hormones."
"Okay."
"That's okay?"
"That's okay."
"You mean that's really okay?"
"No, it's really okay."
"So what would that look like?"
"I don't know, let's talk about, what would it look like?"
So the idea of really opening up options for them.
So some of the youth specific issues.
Kids come in a lot and say, "I hate my body."
Most teenagers hate their body.
Most girls that are getting their period
hate their bodies for doing that.
So again, we have to do a careful assessment
of what is typical teenage body anxiety
and what is really gender dysphoria.
We need to do a complete assessment around
sexual orientation versus gender identity.
So it's a fairly common...
experience that as the female child is experiencing
the early stages of their sexual orientation,
their gender identity, they're liking a girl,
and they're thinking, "Well if I like girls,
"it must be that I am a boy."
And they may not be able to have an image
of what it means to be a female who likes other females,
especially if their gender role, not gender
identity here, gender role, is different.
So in other words, if they're attracted to very
feminine girls, but they see themselves as
a more masculine girl, there may not be many
public images out of there of, what does
it mean to be a masculine female?
There may actually be more images in this
day and age to be a transgender male.
So sorting out, what is sexual
orientation and gender identity?
Recognizing the freedom that young people have
regarding the Internet, the amount of information
they have at their fingertips, their inability to actually
use and discern what is good and bad information.
That's one of the things that I see having teenagers
and also teaching young people in colleges
is that the first thing that pops up on a search engine
is sort of viewed as the gospel truth,
and they have very little good critical thinking skills
of how to sort through what is a good website
and what is a bad website, what is accurate
information and what is not.
We want to look at the distinction between
experimentation versus authenticity.
We want to support our kids in experimenting and
expressing all of these different ways of being
in their youth and their teenage years, and also
helping them to understand what of that is an experience
and what of that is sort of a permanent sense
of authenticity with their identity.
And again, this is really hard because most of us
don't really land in who we are until at least our mid-20s,
so it's hard work to do, and I want to say one more time
to just be really sensitive to the challenges
of frontal lobe development and emotional reactivity
that is just part of what this population is all about.
So I hope that in the last couple of hours
this has been helpful for people to understand
some of the clinical information, some of the clinical
implications, of working with this population,
of understanding the differences between
gender nonconforming behavior and gender dysphoria.
Understanding some of the medical treatments
that are available, the difference between hormone blockers
and cross-gender hormones, the difference between
the treatment of pre-pubescent kids versus teenagers,
the really important need for parental support,
the really important need for education and advocacy
out in the school systems, the need for family
systems work, where we're assisting parents
in accepting their children, because we know
the outcomes are going to be better.
And I just want to end by saying, I work...
I'm tempted to say that awful sentence, so you can all
throw a pillow, nothing harder than a pillow,
at your computer screen right now, but you know,
some of my best friends are.
Some of my best friends are very successful
transgender adults, therapists.
That being transgender...
That people who are transgender can live
successful, happy, and satisfying lives.
And that assisting young people who are transgender,
because we can't make people transgender
or not transgender, we can't, in my opinion,
fix people to be anything other than who we are.
The only thing that we can do, to use Diane Ehrensaft's
words, is assist them and their families
in transgender health, to assist them in this
normative developmental lifestyle process,
but one that's not talked about
in most of our human behavior textbooks at this point.
That to assist people in a process
of how to love and nurture.