Support for Transgendered Children

Executive Summary
The book entitled Transgender Care defines transgender identity as a term used to
describe a number of groups of people: transvestites, transgenderists, those with androgynous
presentations, or the inter-sexed (Israel & Tarver, 2009, p.8). As society evolves, it is becoming
more important to provide a variety of professional transgender support services to meet the
more multifaceted needs of many different populations. This support must start when a child
initially begins experiencing gender dysphoria. Challenging the concept of the gender binary is
so important in order to allow a group of people freedom from psychologically and emotionally
damaging pressures to be someone they are not. This paper emphasizes the need for increasing
support for transgendered youth and advocates for the implementation of community-based
counseling and support services as well as positive family and community responses.
The Issue in Brief
Children begin identifying with their gender and sense of self from a young age and
many transgender children begin experiencing gender dysphoria long before puberty. In fact, in
Kennedys 2008 study, data from an analysis of an online artifact suggested that the average age
at which a transgendered person becomes aware they were transgender is around 8 years old and
that more than 80% of transgender people became aware they were transgender before they left
primary school (Kennedy and Hellen, 2010, p.27). This means that it is imperative that schools
introduce children to the concept of transgendered people so that transgender children are able
to feel they are not alone and that their gender identity is just as valid as any other (Kennedy
and Hellen, 2010, p.41). This would also promote tolerance as the children enter adulthood.
Shannon Mintor, a lawyer who advocates for transgender children and youth notes during the
past 15 years, public awareness and acceptance of transgender children and youth in the United
States have increased at breathtaking speed (Mintor, 2012, p.422). Also, in the past decade,
many states and localities began to enact legal protections for transgender children and youth in
schools (Mintor, 2012, p.423). These legal safeguards protect transgendered children against
discrimination and bullying in the school setting. Also, some school districts have implemented
comprehensive policies requiring schools to use appropriate names and pronouns for transgender
students, permit them to dress according to their gender identity, and provide them with access to
restrooms and locker rooms based on their own gender identity (Mintor, 2012, p.430). However,

Support for Transgendered Children

as Donna Nebenzahl notes in her article on harassment towards transgender youth, for the
majority of trans youth, being picked on and isolated for their differences is a reoccurring theme
during their school years (Nebenzahl, 2011). In fact, studies show that bullying over gender
identity starts in grade 2 or 3 (Nebenzahl, 2011). A 2009 national school climate study by Egale
Canada suggested that 95% of trans highschool students felt unsafe at school, while 90%
reported being verbally harassed because of their gender expression (Egale, 2009). Even more
shocking, half of the students reported that the staff never intervened when homophobic
comments were made (Egale, 2009). Identifying as a transgender individual is often very
difficult for children and even adults. It is vital that we provide children with information on
transgender individuals and teach acceptance of a variety of sexual and gender identities.
Increasing Expertise in Transgender and Gender Dysphoric Care of Youth
According to Pediatric Endocrinologist Irene N. Sills, the Dutch have been pioneers in
diagnosing and treating these (transgendered) youth. They have developed a protocol for pubertal
suppression of youth with gender dysphoria using the same medication, gonadotropin-releasing
hormone (GnRH) analog, that pediatric endocrinologists have been using to suppress puberty in
children with precocious puberty. The period of pubertal suppression allows for further mental
health exploration in an attempt to ensure that the decision about gender change is made only
after careful consideration of all factors. Studies examining the physical and emotional effects of
such interventions found that the psychological benefit exceeds any negative effect of stopping
puberty (Sills, 2014, p.689). This process and period of pubertal suppression can be extremely
beneficial and telling for gender dysphoric youth. As the United States becomes more accepting
of transgendered populations, guidelines for their medical care have been proposed. In 2009, the
Endocrine Society published guidelines for the treatment of transsexual persons that included
guidelines for management of adolescents (Sills, 2014, p.689). Cross-sex hormone therapy is
being advised for transgendered youth as well. However, researches have yet to learn at what age
or how many years after puberty it is safe to start hormone therapy. Side effects and risks of
hormone therapy are also of concern (Sills, 2014, p.690). Other support tactics include gender
therapy, aesthetic or genital reassignment procedures, tools to navigate societal discrimination
and hostility, work with gender specialists, and family and societal support.

Support for Transgendered Children

Guidelines for Transgendered Youth
In their book Transgender Care, Gianna Israel and Donald Tarver also propose 9
recommended guidelines for transgendered youth. These guidelines provide the framework for
further development of professional support of transgender individuals (Israel & Tarver, 2009,
p.4). The guidelines endorse the use of Gender Specialists, which is a new term for care
providers who have committed themselves to seeking gender-specialized education, supervision,
and peer consultation (Israel & Tarver, 2009, p.13). The first recommended guideline for
transgendered youth is that hormone administration and genital reassignment procedures should
not be broadly limited by age but evaluated on a case by case basis with the individual, the
physician, and a Senior Gender Specialist. The second is that The decision- making processes
for any gender-confirmation procedure needs to include consideration of the critical factors of
age, maturity, and physical development. The third, A two year wait is recommended for
transgender youth between the initiation of hormone administration and either genital
reassignment surgery or gonad removal. The fourth, Schools, social-service, mental health
systems and churches are all likely to encounter gender-questioning as well as self-identified
transgender and androgynous-identified individuals. These providers and organizations are
advised to make individual counseling and support groups available to these persons. The fifth
guideline is that support services designed for transgender, androgynous and gender-questioning
youth are advised to operate within a sensitive-services structure or model, emphasizing a
confidential atmosphere that doesnt require parental consent. The Sixth, community based
counseling and support services are advised that youth in general do not have the financial
resources to pay for support. Accordingly, these services should be made accessible either by
being free or based upon donations or sliding-scale fees. The seventh guideline states, youth
support services and care providers are advised to make youth-oriented literature containing
information about HIV and AIDS, safe sex and abstinence, alcohol and drug abuse prevention,
and access to mental health and social support. This includes information about telephone
numbers and services of youth support hotlines. The eighth guideline emphasizes that youth
support services and care providers are advised to remind individuals that their search for selfidentity and other processes of inquiry about identification as a transgender or androgynous
person are natural and healthy. And finally, the ninth guidelines states gender specialists are
advised to offer transgender youth a courtesy disclosure letter, primarily because these

Support for Transgendered Children

individuals are at high risk for victimization and frequently interact with persons in authority
(Israel & Tarver, 2009, p.140). These guidelines created in the Transgender Care book are well
developed and cover an array of aspects of support and care of transgendered children and
adolescents. If these guidelines were better observed by community members, educators, parents,
institutions, and organizations, transgendered youth would be given better and more effective
care. Keep in mind; these proposed guidelines are only a framework for support, and they dont
supplement any existing literature or resources. They are a basis of further development for
professional support and constitute a resource that begins by answering basic questions and
continues by covering issues not addressed in current literature (Israel & Tarver, 2009, p.4).
Conclusion
No single group has gone more unnoticed by society or abused and maltreated by
institutional powers, than youth with transgender needs and feelings. Complicating these
concerns are the fact that the most transgender youth remain invisible; most of those
experiencing cross gender feelings are indistinguishable from other youth (Israel & Tarver,
2009, p.132). Many children and adolescents grow up with the notion that gender
nonconformity is wrong, and should be feared or ridiculed. Many transgendered youth are
suppressing their transgender identity rather than face the criticism associated with becoming
who they really are. This is causing an array of social, emotional, and psychological issues. In
fact, approximately 50- 88% of transgendered youth have seriously considered or attempted
suicide (Israel & Tarver, 2009, p.133). That statistic is horrifying and it is clear that proper
support and care for transgendered youth must be carried out in the home, school, community,
and medical sphere. The guidelines noted above outline suitable support tactics for transgendered
youth. In addition to individual support, community education and involvement is key to
promoting acceptance and tolerance towards the transgendered community.

References

Support for Transgendered Children

Egale. (2009). Youth Speak Up About Homophobia and Transphobia, The First National Climate
Survey on Homophobia in Canadian Schools, Phase One Report. Toronto,
Canada.
Israel, Gianna; Tarver, Donald (2009). Transgender Care : Recom Guidelines, Practical Info.
Retrieved from http://www.eblib.com
Kennedy, N., & Hellen, M. (2010). Transgender children: more than a theoretical challenge.
Graduate Journal Of Social Science, 7(2), 25-43.
Nebenzahl, Donna. (2011). Transgender Children Face Harassment from Their Peers. The
Vancouver Sun, C2.
Sills, N. (2014). Increasing Expertise in Caring for the Gender Dysphoric Child and Transgender
Adolescent.The Journal of Pediatrics, Volume 164 Issue 4, Pages 689-690.