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Transgender Teens: A Parent’s Guide

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Adolescence is a time of radical transformation. Teens develop physically, emotionally, intellectually, and socially. They form their own identities, distinct from their parents. They engage in an evolving, instinctive process of trial and error to learn about themselves and find their place in the world. Through a series of successes, failures, and everything in between, they create a vision of who they are, who they want to become, and how they want to live their lives.

One area of adolescent development parents often have difficulty watching and understanding is sexuality. Teens develop an individual sexual identity much the same way they develop other aspects of their personality – through exploration, experimentation, novelty-seeking, and risk-taking. It’s during this period that most teens discover whether they’re gay, lesbian, straight, or bisexual. Or, they may feel most comfortable with a concept of sexuality that’s not bound or connected to one category over another – a fluid or non-binary sexual identity.

The time when teens develop a sexual identity is also when they may begin to question their gender. They may experience a dissonance between their internal sense of self, called their expressed gender, and the gender given them at birth – based on their genitalia – called their assigned gender. An individual born biologically female may develop a male gender identity, and vice-versa. When we say transgender, this is essentially what we’re talking about. Like sexuality, gender identity can be fluid and non-binary. Individuals may embrace each gender at different times and under different circumstances.

This post is designed to help parents with a transgender teen in the home. We’ll talk about what it means to be transgender, the struggles a transgender teen may face, and how to help a transgender teen navigate this time in their life.

Here’s a shortcut: love and accept your teen unconditionally.

What Does Being Transgender Mean? The Fundamentals

Before we define the term, it may be useful to understand the broader context within which it exists. This can help parents place their teenagers on a spectrum of sexuality and gender that may be quite different from the one they grew up with. Also, a word of advice: in order to show a default level of respect for individuals who identify as transgender, it’s important to accept how they identify themselves. Questions like “But what sex are you really?” are signals that the person asking is either new to the idea of gender fluidity or unwilling to part with their own ideas about gender. Often, questions like these are posed with honest intentions.  But parents should know they can be damaging and contribute to the feelings of isolation many transgender teens feel.

Rule of thumb: address and relate to a transgender individual with the name and as the gender by which they introduce themselves. It’s their life and their gender. They get to choose, not anyone else.

With that said, the first thing parents should understand is something most modern teens know already. The concept and experience of being transgender is related to, but not identical to, the concept and experience of sexuality. For instance, a teen with an assigned male gender might develop an expressed female gender. Then, they may show romantic or sexual interest in individuals of assigned or expressed male gender. In most cases, this teen identifies as straight. Their sexuality develops as an aspect of their expressed gender identity, as opposed to their assigned gender identity. Therefore, in this example, sexual identification is a function of expressed gender, not assigned gender. This may initially confuse people whose idea of sexuality is inseparable from their understanding of gender.

Terms to Know if Your Teen is Transgender

Now, we’ll offer a quick glossary of terms, adapted from this article published by the American Psychiatric Association. We’ve already defined two key terms, assigned and expressed gender, above, so those won’t be on this list. If your teen is questioning their gender identity, it’s almost certain they use the following terms the way we define them. It’s important to your teen that you understand and respect their language use, especially in this context, even if that use contradicts everything you think you know about identity, gender, and sexuality.

11 Terms Parents of Trans Teens Need to Know

  1. Gender: The role a boy, girl, man, or woman manifests in their public life. An individual’s gender develops as a function of biological, social, and psychological factors.
  2. Gender Identity: The social category – male, female, or something else – an individual chooses to live. It may or may not correspond to biological sex, but reflects an individual’s innate sense of who they are and how they want to live.
  3. Gender Expression: How individuals manifest their gender externally, by way of behavior, clothing and appearance, or mannerisms.
  4. Transgender: Individuals who temporarily or permanently identify with a gender that’s different than their biological gender.
  5. Transsexual: Individuals who have or plan to transition from one gender to another, in terms of their lived, social identity. Transition may or may not include gender reassignment surgery or hormone treatment.
  6. Gender Fluidity: The characteristic of embracing different gender identities at different times.
  7. Non-binary: An individual who does not conform to distinct female or male gender expressions. This phrase can also mean a worldview that does not recognize male or female gender expressions as the only two choices available to an individual.
  8. Genderqueer: These individuals have no fixed gender or sexual identity and will switch between or embody different gender/sexual identities at different times.
  9. Agendered: An individual who identifies as having no distinct gender.
  10. Cisgendered: An individual whose assigned gender matches their expressed gender.
  11. Gender Dysphoria: A term used by mental health professionals to describe the range of emotions an individual may experience when they’re uncomfortable/feel in conflict with their assigned gender.

This glossary is by no means exhaustive, but for the parent of a transgender teen, it’s essential to know all these terms.

Transgender Teens: Social and Cultural Factors

It’s also important for parents to understand that socially and culturally speaking, although gender identity and sexuality are not identical, transgender teens are part of the sexual minority known as the LGBTQI (Lesbian, Gay, Bisexual, Transgender/Transsexual, Questioning, Intersexed) community. In addition to all the typical pressures of adolescence, transgender teens are vulnerable to significant social, emotional, and behavioral risks. Research shows transgender teens at increased risk of:

  • If your transgender teen comes out, their friends, teachers, and society in general may treat them differently than they treat individuals in the sexual majority:
    • 42% of LGBT youth report their community is not accepting of LGBTQI individuals.
    • 26% report their most significant problems are not feeling accepted by their family.
  • The heteronormative patriarchy is firmly entrenched, and some days your teen will feel like it’s an uphill battle just to be themselves:
    • 92% of LGBTQI youth report hearing negative messages about being LGBTQI at school, from peers, or online.
    • 68% report hearing negative messages about being LGBTQI from elected officials.
Social isolation.
  • Fear of judgment may cause your transgender teen to withdraw from friends, family, and most social situations.
    • LGBTQI youth who are out to their families are more likely to report being happy than those who are not. However, pay close attention to the following bullet points:
      • Only 24% say they can be themselves at home.
      • Just 25% have families who support them by becoming involved in the greater LGBTQI community
      • 67% hear their families make negative remarks about LGBTQI people
  • Being in the sexual or gender minority increases risk of verbal bullying and abuse from peers, teachers, and family:
    • 73% of LGBTQI youth have experience verbal threats because of their identity
    • 48% report being mocked or made to feel bad by family members because of their identity.
Physical and Sexual Assault.
  • Being in the sexual or gender minority increases risk physical and sexual assault:
    • 20% of LGBTQI youth report they were forced to do sexual things against their will in the past year
    • 11% report being sexually attacked or raped because of their LGBTQI identity

LGBTQI Teens: Increased Risk of Emotional and Substance Use Disorders

Studies conducted over the past three decades present contradictory data on rates of emotional and substance use disorders in LGBTQI youth. However, despite the conflicting evidence, there is consensus in the mental health community that LGBTQI youth are at greater risk for developing both emotional and substance use disorders, as compared to their heterosexual peers. In their 2012 publication, “A Providers Introduction to Substance Abuse Treatment for Lesbian, Gay, and Transgender Individuals” the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a logical explanation:

“LGBT youth use alcohol and drugs for many of the same reasons as their heterosexual peers…However, LGBT youth may be more vulnerable as a result of the need to hide their sexual identity and the ensuing social isolation. As a result, they may use alcohol and drugs to deal with stigma and shame, to deny same-sex feelings, or to help them cope with ridicule or antigay violence.”

Here’s the data on alcohol and substance use from the SAMSHA publications:

  • About 20-30% of the LGBTQI population abuse illegal substances
  • Around 25% abuse alcohol

In addition, LGBTQ youth are often forced to navigate a judgmental, negative, and unforgiving environment. As discussed above, they’re at high risk of verbal abuse, violence, and harassment by adults and peers alike. In response, according to the SAMSHA report, they risk developing and experiencing significant internal “…conflict, identity confusion, or even self-hate.” This phenomenon can lead to significant emotional, psychological, or behavioral consequences.

LGBTQI Teens: Mental Health Statistics

Research on emotional and mental health issues in LGBTQI teens shows:

  • 77% of LGBTQI teens report feeling depressed in the past week
  • 95% say they have trouble sleeping at night
  • 70% report having feelings of worthlessness or hopelessness in the past week
  • 85% say their stress level is five or higher on a scale of one through ten.

Finally, the stigma and emotional issues related to being among the LGBTQI minority in a majority heterosexual, gender-typical society can lead LGBTQI teens to engage in self-harming behaviors or make suicide attempts. Data from the National Alliance on Mental Illness (NAMI) indicates:

  • Suicide is one of the leading causes of death for LGBTQI individuals age 10-24.
  • LGBTQI youth are four times more likely to engage in self-harm than non-LGBTQI youth
  • LGBTQI youth are three times more likely to engage in suicidal ideation or attempt suicide than non-LGBTQI youth
  • 38-65% of the total transgender population engage in suicidal ideation

If you’re the parent of a transgender teen, it’s time to take a step back and breathe. We get it: all these statistics are a little scary.

How to Help Your Transgender Teen

We want to reiterate something we said above that’s also borne out by research:

Transgender teens with an understanding, loving, non-judgmental support group –  including an open-minded family and compassionate group of peers – are at decreased risk of all the emotional, psychological, and substance use problems experienced by many transgender teens.

We cannot stress enough how important a loving and supportive family environment can be for a transgender teen. In some cases – where the teen is really struggling with their gender identity and the associated emotions – it can be, quite literally, the difference between life and death.

So that’s where you start with your trans teen: unconditional love and support. But since the chances are you’re not a mental health professional, your teen may need additional support managing their emotions and developing practical coping skills that allow them to handle the pressure – however unfair and unjust it may be – placed on them by a society that has yet to completely accept who they are and how they want to live their life.

The good news is that there are dedicated professionals who can help your transgender teen. If they’re experiencing emotions that you, as a parent, aren’t equipped to handle, you can seek support from experts.

LGBTQ-Responsive Treatment Works

LGBTQ youth struggling with emotional, behavioral, or substance use disorders benefit from a compassionate, welcoming, and understanding therapeutic environment. The added issues LGBTQ youth face – isolation, alienation, interpersonal aggression, lack of acceptance, and internal conflicts – can make achieving and sustaining sobriety all the more difficult. Decades of research prove a robust social support network is crucial in helping non-LGBTQ individuals live a life free of drugs and alcohol, and recent studies show targeted interventions – also centered around social support and an inclusive, non-judgmental milieu – are effective in reducing drug use, increasing coping skills, and helping LGBTQ individuals develop the skills necessary for recovery and lifelong sobriety.

How to Find Help for Your Transgender Teen

If your teen identifies as transgender and needs treatment for an emotional, behavioral, or substance use disorder, you have options. They may not necessarily require a program designed exclusively for transgender youth, but they will be best served by one. There are many therapists and counselors experienced in the nuances of transgender identity issues. When seeking treatment for your transgender teen, ask any provider you consider if they have expertise with LGBTQ youth. If you send your teen to a treatment center, make sure it feels safe. It should not only accept LGBTQ teens, but embrace them with warmth, compassion, love, and understanding.

To help begin your search, start with these resources:

  • The LGBT National Help Center is a comprehensive clearinghouse for everything LGBTQ. The site maintains a youth talkline (1-800-246-7743) and online peer-to-peer support. It also has an LGBTQ Teens Online Talk Group, and two weekly Trans Youth Online Talk groups.
  • The Lesbian and Gay Child and Adolescent Psychiatric Association is an affiliate of the American Academy of Child and Adolescent Psychiatry (AACAP) and is committed to serving the mental health needs of sexual minority youth.
  • The Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling (ALGBTIC) maintains this therapist locator for individuals looking for mental health services provided by ALGBTIC members.
  • The Association of LGBTQ Therapists (AGLP) provides fact sheets, newsletters, opinion pieces, and this excellent bibliography for anyone interested in taking a deep dive into LGBTQI issues.
  • The Trevor Project website is another comprehensive clearinghouse for all things LGBTQI, with a focus on youth.
  • The SAMSHA treatment locator allows you to specify your search to identify substance abuse professionals with experience in treating LGBTQI clients.

Our Behavioral Health Content Team

We are an expert team of behavioral health professionals who are united in our commitment to adolescent recovery and well-being.

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