Parenting Transgender Children and Youth: What a Dad Needs to Know

Former deputy executive director of New York City’s LGBT Community Center, therapist and transgender author, Elijah C. Nealy, has written the first-ever comprehensive guide to understanding and supporting trans kids, Transgender Children and Youth: Cultivating Pride and Joy With Families in Transition. Here, in the second of three articles for, Elijah explains what it means to be transgender and how fathers can help support their children as they explore their identity…

Image: IngImage.


Navigating a child’s gender transition is uncharted territory for most families. Despite increasing trans visibility in the media, most families do not know transgender individuals within their immediate social networks. In addition, many parents and grandparents came of age when gender identity and biological sex were assumed synonymous. As a result, when children come out as transgender most parents lack the information needed to understand what this means for them and their child, as illustrated by the following vignette.

“Even as a toddler, Sam liked his older sister’s dolls more than trucks or trains,” he told me. “In preschool, he loved playing dress-up in princess gowns and shoes with the girls in the class. His mum and I just kind of rolled with it. We wanted him to be able to be who he was. But last week as I was reading a bedtime story, Sam asked if a “wizard could come and take his penis away.” I asked, “Why?” He said, “I don’t need it anymore. I’m a girl.”

“What does this mean?” Sam’s dad asked. “Is there something wrong with Sam? Is he transgender? How would we know for sure? Isn’t he too young to know? His mum and I are worried.”

The starting point for parents like Sam’s dad often involves understanding the distinctions between the key concepts of sex, gender identity, gender expression and sexual orientation. 

Sex refers to the “sex assigned at birth.” The delivery doctor’s announcement, “She’s a girl!” or “He’s a boy!” is based on the appearance of their genitalia. In the vignette above, Sam was assigned male at birth based on the fact that he was born with a penis.

Gender Identity reflects our internal understanding of who we are as a man or a woman – or both or neither. While sex is about our anatomy, gender identity is about what’s in our mind; it’s who we know ourselves to be, regardless of body parts. When Sam’s dad asked if Sam was transgender, he was asking about Sam’s gender identity – who Sam understands himself to be. Historically, many people understood sex and gender identity as synonymous. Today, we know that while most people’s gender identity aligns with the sex they were assigned at birth (called 'cisgender'), the gender identity of transgender individuals varies in some way from the sex they were assigned at birth. While Sam was assigned male at birth based on his genitalia, his assertion that he is a “girl” can indicate that his gender identity varies from his birth-assigned sex.

Distinct from gender identity or sexual orientation, Gender Expression reflects the ways we express our identities as men or women (or both, or neither) to ourselves and in the world. How we communicate our gender can include choice of clothing; preferred hairstyle; physical mannerisms, such as the way we walk or talk; whether we wear jewellery and, if so, what kind, and on which body part; our career choices and even the leisure activities we prefer. While expectations about gender expression vary across time and place, most cultures have norms for what is “acceptable” or normative gender expression for boys/men and girls/women. In Sam’s case, playing dress up and liking dolls reflects what is typically considered feminine gender expression in today’s white Anglo cultures.

While sexual orientation and gender identity are sometimes conflated, they are two distinct aspects of who we are as human beings. While gender identity reflects who we are, Sexual Orientation is about our physical and emotional attractions to other people. Are we typically attracted to people of the opposite sex or gender, people of the same sex or gender, or people of both/all sexes and genders?

Historically, children whose gender expression varied from what was stereotypically expected of their sex (e.g., boys who like dolls or girls who play with trucks) were labelled Gender Variant and diagnosed with Gender Identity Disorder. Treatment consisted of correcting and/or punishing this behaviour in an effort to redirect these children toward more gender-conforming interests. This approach particularly targeted young boys in an effort to ensure they did not grow up to be homosexual or transsexual (the terms used at that time). The ICD-10 code (F64) for Gender Identity Disorders continues to reflect a psychiatric diagnosis that stigmatises transgender children and adults.

Thanks to more recent understandings of sex and gender identity as distinct aspects of our identities and cultural variation in gender norms, best practices among mental health professions today reject pathologising children like Sam. Today, the World Professional Association for Transgender Health understands these children’s interests and behaviours as gender diverse, creative or expansive. While their creative gender expression may not be the statistical norm, all major medical and mental health associations today agree that there is nothing abnormal about gender diversity. Clinical work will explore with Sam and the family over time whether Sam’s preference for “girl things” is about his gender expression or emerges as reflective of a gender identity as a girl [Transgender]

Parenting Transgender Children and Youth: What a Dad Needs to Know

Transgender children and teens identifying with a gender identity other than the sex assigned at birth often desire to transition to live in their affirmed gender. The first step is social transition, typically changing name and pronoun to match their gender identity, and changes in clothing choices and hair cut/style. It often begins part time with family and then may progress to a child attending school in their affirmed gender identity. It’s critical to understand there are no medical interventions for pre-pubertal youth – only social transitions.

If your child’s trans identity persists over time, best practice today includes the use of Gonadotropin Releasing Hormone (GnRH) analogues at the onset of puberty. Often called “puberty blockers,” these medications simply put puberty on hold. Blocking the development of secondary sex characteristics among transgender youth significantly reduces their gender dysphoria (a condition where a person experiences discomfort or distress because there's a mismatch between their biological sex and gender identity), and naturally associated risk factors. These medications can “buy more time” for dads, other parents and counsellors like me, to ensure the young person’s affirmed gender identity persists.

When your child remains clear about their affirmed gender identity, later adolescence (16 years of age in many countries) typically includes masculinising or feminising hormone therapy. Top surgery can be performed in the UK on the NHS from 18 years of age (chest reconstruction for young trans men and breast augmentation for young trans women). Genital surgeries are only available after the transgender youth reaches the legal age of majority and has lived continuously in their affirmed gender for a reasonable length of time. 

Each of these steps is recommended as medically necessary and appropriate treatment for transgender individuals, and typically reduces dysphoria as their body is brought more into alignment with their gender identity.

When dads comprehend the distinctions between sex, gender expression, gender identity and sexual orientation, as well as the steps involved in social and medical transitions, we can more effectively understand and support our transgender children. This information also empowers us to be their advocates within the extended family and in the outside world when necessary.

Three important ways to embrace your child’s uniqueness


...the Sex we are assigned at birth, the ways we express our Gender, our Gender Identity, and who we are attracted to (Sexual Orientation) are distinct aspects of who we are.


...a safe space for your child to explore their gender expression and identity without judgment. Many of us grew up in a world that told us boys (or girls) could only be interested in certain toys or games, only express certain emotions or only wear certain clothes, but it’s important to teach our children there are many ways to be a boy or a girl.  


...for your child’s wellbeing in the world. Don’t let anyone shame them for being, or expressing, who they are. Our support and advocacy goes a long way to ensuring our children grow up with healthy self-esteem and the confidence to “take on” the world.

For more information on UK services, please check NHS Choices and the Gender Identity Development Service.

Elijah C. Nealy is a therapist and former deputy executive director of New York City’s LGBT Community Centre. A trans man himself, he has written the first-ever comprehensive guide to understanding, supporting, and welcoming trans kids, Transgender Children And Youth: Cultivating Pride And Joy With Families In Transition.

Covering everything from family life to school and mental health issues, as well as the physical, social and emotional aspects of transition, the book is full of best practices to support trans kids. Find out more by watching the video below.

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