Parents searching for a safe place for their transgender, gender nonconforming, or nonbinary child usually have a lot of questions. One of the first things parents who reach out to me ask is, “What is gender dysphoria?” This is usually followed by, “How is it affecting my child?”
Understanding gender dysphoria is an important part of the journey to support trans youth. But many parents may not be sure what this concept means. Put simply, gender dysphoria is an internal conflict between the sex a person was assigned at birth and the gender they identify with. It is often described as a feeling of discomfort with the body a person lives in and their deeper sense of gender. This conflict can be seen in many ways. Body dysphoria, depression, anxiety, eating disorders, and self-harming behaviors are a few, but there are others. All of these symptoms can be seen as attempts to manage the deregulation that can occur when a person’s body does not represent their gender.
Gender dysphoria may be first felt in puberty, when physical changes of development begin. Children can experience discomfort before puberty, but these feelings usually become stronger as differences between the physical body and internal sense of gender increase. Imagine knowing you are male, having a masculine sense of self—in a body that begins to develop breasts. This disconnect can cause extreme anguish and anger in adolescents. Many also say they feel trapped.
How Does Dysphoria Manifest?
This internal conflict is different for each person, but it is often seen as depression or anxiety. Looking in the mirror and seeing a body that does not express your internal sense of self can cause pain, unsettled feelings, and disconnect. Psychological pain may show up in a child’s behavior. Many adolescents refuse to attend school and withdraw from social interactions. Your child may drop activities that require physical contact, like sports, and avoid situations where they would need to expose their body, like pool parties.
At its most intense, body dysphoria in teens can lead to suicidal thoughts and attempts, as well as self-harming behaviors and disordered eating. These actions often result from the need to control a body that feels completely out of control and to ease the pain of an internal disconnect. These symptoms are signs that a higher level of care is needed. A therapist trained to offer support to transgender, gender nonconforming, and nonbinary adolescents may be the best person to provide this care.
Help for Gender Dysphoria
A therapist who is well-versed in working with trans youth is vital for creating a safe space for kids and families to address the challenges of gender dysphoria. The goal in therapy is not to change how a person feels or expresses their gender. Rather, it is for children and their parents to explore tools and methods of support for the feelings that surround the distress of not being able to physically express their true self.
It is important for families to develop a dynamic that is informed, supportive, and curious about their child’s journey as they explore their gender. This dynamic can create a space where different expressions of gender can be safely explored. This exploration may help relieve distress that occurs with dysphoria.
It is important for families to develop a dynamic that is informed, supportive, and curious about their child’s journey as they explore their gender.
Some of the first ways this exploration may take place is with social expression. Through social expression, a child or teen can develop their sense of self and affirm their gender identity. Your child may try out different styles of clothing and new hairstyles and ask you to refer to them by pronouns that fit their gender. They may choose a new name or try out several new names before they determine the one that fits best. These expressions can be seen as the first step in aligning themselves with their internal sense of being male, female, some of both, or neither. By supporting your child’s expressions and identity, you can help ease their distress and help them find a deeper and clearer sense of self.
The next step may be medical transition. Medical treatments that help align physical characteristics with gender include:
- Puberty blockers. These help prevent the developmental changes of puberty. They can help reduce distressing changes in trans children who have not yet decided on hormone therapy.
- Hormone therapy. Hormones cause physical changes that support internal gender identity.
- Gender confirmation surgery. Some trans people may pursue surgery to completely match their physical body to their gender, but others may choose certain types of surgery only.
It is important to understand that not all people who identify as transgender, gender nonconforming, or nonbinary are interested in pursuing complete medical transition. They may choose some aspects and reject others. For example, your teen may be interested in hormone therapy but not feel ready for gender confirmation surgery. This personal choice is a part of each person’s transition.
You can help your child by encouraging open discussion and taking their feelings and wishes into account. Ask what your child thinks about medical transition. Do your own research so you can have informed discussions with your child. Careful research can help you help your child make decisions based on accurate information and informed consent.
Exploring these topics can bring up strong emotional reactions. But it is important for both you and your child that you are able to support them during their transition and talk through their options from an informed, caring position instead of a fearful, reactive one.
Some families may need more help and support to explore these feelings and assist a child who is dealing with the painful reality of gender dysphoria. If you are struggling to find the best way to offer support to your child, you may find it helpful to talk through your feelings with your own therapist or counselor.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Rood, B. A., Reisner, S. L., Surace, F. I., Puckett, J. A., Maroney, M. R., & Pantalone, D. W. (2016). Expecting rejection: Understanding the minority stress experiences of transgender and gender nonconforming individuals. Transgender Health, 1(1), 151–164. doi: 10.1089/trgh.2016.0012
- Sherer, I., Baum, J., Ehrensaft, D., & Rosenthal, S. M. (2015, January 1). Affirming gender: Caring for gender-atypical children and adolescents. Contemporary Pediatrics. Retrieved from http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/affirming-gender-caring-gender-atypical-children-and-adolescents?page=full
- Steensma, T. D., McGuire, J. K., Kreukels, B. P., Beekman, A. J., & Cohen-Kettenis, P.T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52(6), 582-90.
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