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When children express doubts about their gender

June 26, 2018 | UCI Health
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When children and adolescents express doubt about their gender, parents are generally uncertain about what to say and where to turn.

Many parents want to help their children discover their authentic selves and thrive, but don’t know how to do that. They also may be uncertain where to find the right counseling or medical treatment for their child. It can be a confusing new reality for everyone involved.

That’s why about 40 patients a month turn to Dr. Lynn Hunt and the UCI Health Pediatric Gender Diversity Program, the only program of its kind in Orange County that provides a full range of care for children with gender dysphoria, in which their gender identity may differ from what was assumed at birth.

Many of the program’s patients — who range in age from young children to young adults — are referred by community pediatricians who know these issues call for expertise beyond their skills. Other times, supportive parents seek out the program’s services to help their children through a period that can be overwhelming, whether from fear of societal rejection or the need for specialized medical care.

Understanding gender terminology

Even the terminology surrounding gender dysphoria and gender identity is new and nuanced. What’s the difference between gender and sexual identification? What is a transman or transwoman? What is meant by cisgender and nonbinary?

The most important thing parents of gender-diverse children can do, says Hunt, medical director of the gender diversity program, is the same thing every parent should do with their children, provide parental acceptance and support.

“Listen and try to understand,” says Hunt, a professor of pediatrics in the UCI School of Medicine’s Department of Pediatrics.

“Parents need to understand that there are many ways to be in the world. Gender diversity exists. The biggest harm is in not listening and giving them negative messages about themselves.”

Protecting your gender diverse child

Parents also may need to go to bat for their gender-diverse child at school, Hunt says. Because gender-diverse people are a protected class in the state of California, schools are obligated to take action on bullying and to provide appropriate locker room and bathroom accommodations that do not shame students in any way. But sometimes they need a nudge.

One of the first things parents, pediatricians and others who deal with children need to know is that gender identity is different from sexual orientation, Hunt says.

Gender is the identity with which a person connects — male, female, something in between or something outside of gender boundaries. Sexual orientation involves the attraction a person feels toward others, which doesn’t necessarily have much to do the person’s gender, and in any case is something that emerges with puberty.

There are also many ways of identifying and expressing one’s own gender, whether for cisgender people — those who feel they are the gender they were assigned at birth — or someone who opts for medical interventions such as hormone therapy and gender-affirming surgery.

‘Gender is more of a spectrum’

“Gender is more of a spectrum,” says Brit Cervantes, program coordinator for the gender diversity program.

“For example, a transman is someone who is assigned as a female at birth but is transitioning to male. And that can take many forms. There’s medical transitioning, but there’s also just social transitioning – people who get a legal name and legal gender change, and align themselves with that gender, and that’s enough for them.”

Other people might be transmasculine, meaning they present themselves in a more masculine way. But they don’t necessarily identify as male, Cervantes says.

Yet terminology is far less important than realizing gender identity “is very personal” and individual, says Cervantes, who has transitioned to male.

For example, he says, there are children and teenagers who may feel very certain of their gender identity from a young age, and others who may have a vague feeling that they don’t fit into traditional male-female categories, but are uncertain exactly what that means until later in life.

Education and awareness

When such children feel the need for help, their regular pediatricians often refer them to the Pediatric Gender Diversity Program. There, they can find appropriate patient and family counseling, as well as medical advice and evaluation.

“Most pediatricians feel they’re not trained enough to work with these patients,” Hunt says. Gender issues affect an estimated one in every 200 children which doesn’t make it common, but “it’s not like one in a million.”

That’s why education — of medical professionals, as well as parents, teachers and patients — is a key mission of the program.

Hunt says it’s important not to assume that children know exactly what they want gender-wise. For that reason, puberty suppression is one of the most useful medical tools the program has to offer patients. It prevents preteens and teens from developing physical characteristics that don’t necessarily fit their gender identity.

Delaying puberty buys time

“The nice thing about puberty suppression is that it’s reversible, while natural puberty isn’t,” she says. In other words, delaying puberty gives adolescents time to feel comfortable with themselves while they learn more about their gender identity. If they wait until they develop secondary sex characteristics, such as breasts, they might need surgery to reverse those.

The program also provides gender-affirming hormone therapy, as well as connections to community groups and resources that can help patients and families feel less isolated and learn about their options and their rights.

Above all, for gender-diverse children and their parents who feel alone with their questions and worry that they must search for an array of different healthcare providers, the Pediatric Gender Diversity Program is designed specifically for them, a place where they are met with acceptance and support.

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