Gender Dysphoria in Children

Bruce Jenner, Olympic decathlon gold medalist and sex symbol of the 1970s and 80s, came out publicly last night to Diane Sawyer, indicating that he has always identified as female. In hindsight, the world should really not have been so shocked. For years, Jenner has been undergoing hormone treatments and cosmetic procedures to change his physical appearance from masculine to feminine. He’s been seen wearing nail polish, growing out his hair, and wearing jewelry. The tragedy of this story is not that a once breathtakingly handsome, athletic man is sacrificing his masculinity in order to live the remainder of his life as female, but rather, that it took him this long to embrace his true self.

There are many reasons why persons suffering from gender dysphoria do not transition sooner, and why some do not transition at all. Those reasons may be as varied as the individuals themselves, but among the most common reasons are the fear of being ostracized by family, friends and even strangers, the fear of disappointing loved ones, and the fear of how one’s choice might adversely affect their livelihood.

It is more difficult, by far, to transition after having lived many years in the wrong body. Individuals that have gone through school, have established careers, marriages and who have children, have infinitely more to lose than those that transition at a much younger age. As society comes to understand more about gender dysphoria, more parents are willing to accept that their children may have a physiological reason for identifying as the opposite gender. Most children enjoy playing dress up and experimenting with alternate personas and we encourage active, creative imaginations. Parents are not typically alarmed when their son dresses up as a princess when playing with his sisters, or if a girl pretends to be Batman. But when a child begins to express themselves consistently and passionately as the opposite gender, this might be an indicator that the child is experiencing gender dysphoria. Other indicators include wanting to change their name to a traditionally masculine or feminine name that is the opposite of their born gender; consistently choosing clothing typically associated with the opposite gender; wanting to change their physical appearance (growing out or cutting hair, wearing nail polish or makeup, etc.) or referring to themselves using gender specific pronouns that are opposite of their current pronoun. Children may also express an interest in having genitals of the gender with which they identify; reject toys or games that don’t fit their perceived gender; or even attempt to urinate in the manner of their perceived gender (e.g. girls standing or boys sitting).

It can be difficult for parents to know where the line between imagination, learning and maturation blurs with actual gender identity disorder. Even the most open-minded parents must live in fear of making a mistake if they decide to support their child’s transition. “What if we’re wrong, and this is a passing phase?” “What if our child’s brain is not developed enough to make this life-altering decision?” “What if they change their mind later and it’s too late?” But the lack of support or action on behalf of transgendered persons can be too costly.

According to a 2011 study from the American Foundation for Suicide Prevention and the Williams Institute at UCLA School of Law, the suicide rate among transgender or gender nonconforming persons is nearly nine times the national average, with 41% having attempted suicide at some point in their lives. Factors such as discrimination, lack of available healthcare, sexual assault, physical assaults, and homelessness contribute to this statistic. Another interesting finding from this study reveals that transgender persons who were open about their gender dysphoria or those that felt that others “could tell” they had transitioned, were more likely to have attempted suicide. This finding would seem to support the notion that transition in childhood may be a more prudent approach.

Take the case of five year old Jacob Joseph Lemay, who was born Mia Lemay. His parents recognized very early in his life that he was not the daughter he appeared to be on the outside. Citing his “consistent, persistent and insistent” expressions that he was truly a boy, his parents decided to explore the possibility of allowing him to transition, with the help of a therapist. His expressions included referring to himself as a boy, dressing as a boy, cutting his hair, questioning his gender and wondering aloud why “God made him wrong.” According to his parents, reflecting on his first few years of life, they realized that their son rarely smiled, looked people in the eye or seemed genuinely happy. It wasn’t until they broached the subject of allowing him to transition, that he began to come out of his shell. Choosing a new school in which students only knew him as a boy named Jacob, allowed him to express himself openly as the person he knew himself to be. But for many parents, those agonizing questions still persist.

An increasing number of therapists specializing in gender dysphoria are emerging to help families navigate these delicate waters. In conjunction with medical doctors, the patient and family, therapists are able to help determine a course of treatment for children with gender identity disorder. Such treatment includes counseling, talk therapy, and eventually when agreed upon and appropriate, the use of puberty blockers and hormones. In some cases, persons elect to undergo gender reassignment surgery. The goal of the treatments is to help individual’s body align with their perceptions of self rather than to alter their perceptions of self. For parents grappling with the question of whether their child is going through a “phase,” as opposed to experiencing true gender dysphoria, therapists recommend taking cues from the child. There are cases in which the apparent gender dysphoria has not continued past puberty. However, there are many cases in which the gender dysphoria did persist and at that point was determined to be permanent.

If your child may be experiencing gender dysphoria, ask your primary physician for a referral to a therapist specializing in this type of work.