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Raising A Transgender Child

“Falling outside of the gender binary isn’t a mental illness that needs treatment,” explains Elizabeth Leen. She spoke Feb. 4 to parents about
raising a transgender child at the LGBT Community Center, Harrisburg.

Called TRANS-ition, the group is a setting for parents and caregivers of gender non-conforming youth that continues March 4 and April 1. Leen is a Licensed Social Worker who is currently the Behavioral Health Administrator and Therapist at Alder Health Services. Since 2011 she has been working to develop and grow Alder’s behavioral health program while providing therapy services for members of the LGBT community. Raising a trans child, or a child who does not identify with gender-normative expectations – like clothing or play activities which, for example, represent a binary is a timely topic. Binary means either or, as in either male or female.

In early February, Lancaster County’s Lampeter-Strasburg school officials ran into difficulty when a guidance counselor read Jacob’s New Dress to a kindergarten class. The teacher had sent a note home to parents after the book was read to the class. That decision drew criticism from parents and a local pastor. Prevention of problems through education and understanding is what Leen advises. She notes that falling outside that either/or construct is not a form of mental illness although ridiculing or bullying a child for being different can lead to mental health problems. Recent research published in the Journal of Adolescent Health indicates non-acceptance of a child’s non-binary nature can lead to mental health problems. The study compares the mental health of transgender youth treated at a community health center with that of their non-transgender peers. Not surprising, it finds that transgender youth face much higher negative mental health outcomes. Researchers looked at electronic health records of 180 transgender patients
age 12-29 years matched with non-transgender patients who were seen for healthcare at the center. Compared with non-transgender youth, transgender youth had a higher probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%). Are these higher measures of mental health problems the result of nonacceptance and/or hostile environments? Non-acceptance and/or hostile environments are certainly antecedents
for depression and anxiety among transgender and gender non-conforming youth,” Leen explains, adding that society still struggles with understanding
and acceptance of gender non-conformity. She says that some individuals report significant depression and anxiety due to one’s gender identity
not matching their physical appearance. “Being mis-gendered by others is a constant reminder that your physical appearance and identity may not be
translating into society’s standards of a binary world and for some this leads to feelings of anxiety and/or depression.”

How early do transgender children show signs of gender identity? Leen says many individuals state they have known since they were very
young or as long as they can remember their gender did not conform to their sex. “It is not uncommon for children as young as three-years-old to start
showing signs of gender dysphoria and discomfort with gender norms,” she points out. If a child shows signs of a fluid gender identity, what can a parent do to be supportive? “Parents play a powerful role in a child’s life and supporting your child to be themselves has been proven to have significant positive outcome in a child’s mental health and self-esteem,” Leen says. “Be patient with your child, just because they are showing gender non-conforming behaviors doesn’t necessary mean they are transgender.” She advises parents to allow children to explore their feelings in the safety of their own home without fear of ridicule or bullying.

“Engage in supportive parenting practices with your child. Creating a supportive family environment and require respect within the family for your child. Express love and support for your child and allow a zero tolerance policy for disrespect and negative comments.” Leen says. “Maintain an open and honest line of communication with your child.” When should supportive counseling begin? For the child? For one or both parents? Falling outside of the gender binary isn’t a mental illness that needs treatment, Leen stresses. “Unfortunately our world does not quite understand gender diversity yet and this can lead to feelings of anxiety and/or depression.” Therapy can help gender non-conforming children process the feelings, concerns that come along
with falling outside of the gender binary. Parents often have a variety of responses to their child coming out. “There is no right or wrong response and there maybe feelings of embarrassment, anger, fear, doubt, grief, denial, worry, acceptance, understanding, pride and joy,” Leen says. This is a difficult road to navigate for parents “and may not be onewe choose for our children but it’s our responsibility to navigate it. No parent is alone in these feelings or experiences and it may be helpful to see support from other parents or a mental health provider.” When finding a therapist it’s important to find a professional who will meet your needs. “By no means are all therapists well informed on issues of gender as they relate to children and youth,” Leen advises. She says when seeking a professional, ask about their experience with transgender individuals or gender non-conforming individuals. “An uneducated therapist can do more harm than good,” Leen says. When does medical help with transitioning begin? Identifying as gender non-conforming does not necessarily mean an individual will completely transition. “Some may choose not to make changes to their bodies while others may feel the need to change in order to feel complete,” Leen explains.

Some families may begin puberty blockers for a child during adolescence to stop the puberty process until they are ready to begin Hormone Replacement
Therapies. “Once a family and physician feel an individual is ready they may begin receiving Hormone Replacement Therapies,” Leen says.
In the end, it’s important to find a medical provider who understands gender and children. “Don’t be afraid to ask what their experience is with working with gender non-conforming or transgender children. Ask other’s about their experience in finding a provider to manage their child’s care. Even if your child will not be making physical changes it is still important to have an affirming provider,” Leen concludes.

Contact: liz@alderhealth.org or 233-7190, ext. 248

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