Gender nonbinary people—who often call themselves enby—do not identify with the male-female gender binary. There are a wide range of gender expressions and identities under the enby umbrella, including agender, gender outlaw, genderqueer, and genderfluid. Gender nonbinary people are not a monolith. Some see gender as a problematic concept to be rejected and fought. Others do not object to gender yet feel they personally do not fit into a specific gender identity. Many enbies identify as trans.

Trans people often report a feeling of gender dysphoria. This is stress, anxiety, and frustration associated with being labeled as a gender with which one does not identify. For example, a trans boy whose parents force him to wear dresses may feel intense gender dysphoria that affects his self-esteem and mental health. Gender dysphoria is highly prevalent among people who are not allowed to express their gender identity.

A person does not have to identify with either the male or female gender to experience dysphoria. Enbies can feel dysphoria, too.

What Gender Dysphoria Looks Like in Nonbinary People

Some of the DSM-5’s diagnostic criteria for gender dysphoria are inclusive of enbies. Common symptoms include:

• Inconsistencies between one’s lived gender identity and assigned gender identity
• Wanting to be treated as a member of a different or alternative gender
• Dislike of or frustration with gender signifiers

However, the DSM-5 also focuses heavily on gender dysphoria as the desire to be the “opposite” gender. Because gender nonbinary people do not wish to be the “opposite” gender, they may not feel included in traditional diagnostic criteria.

Gender dysphoria in nonbinary people may manifest in slightly different ways, including:

• A shifting attitude toward gender signifiers. For example, a person might dislike their breasts one day but feel fine with them on another day.
• Feeling troubled by some gender signifiers but not others. For instance, a person might want to be rid of their chest hair but like their penis.
• Feeling pressured to defend their gender identity. Some enbies report being told that they are adopting a trend, not expressing their identity and lived experience.
• Facing pressure to conform to multiple gender roles. Some enbies present in androgynous ways or embrace signifiers of two or more gender identities. They may face pressure to conform to conflicting gender identities.

Gender Dysphoria in Nonbinary Youth

Binary trans people—those who identify as male or female—and enbies generally report developing gender dysphoria around the same time. For most people dysphoria sets in around puberty, getting progressively more intense as puberty changes the body.

John Sovec, LMFT, a California therapist who works with LGBT clients, says, “Gender dysphoria is often discussed in the treatment of adult nonbinary clients, but it is important to also note its influence on the development of nonbinary adolescents. When you reflect on the pressures to fit in that already exist in a teen’s world, imagine the distress and anxiety that can manifest when gender dysphoria is present.

Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. “Adolescents are already experiencing the myriad changes that are occurring during the onset of puberty, and these changes in the body can magnify the feelings of dysphoria. What was once a generalized feeling of being uncomfortable with their physical sex and/or gender role can be heightened with the onset of puberty and manifest in feelings of depression, anxiety, shame, and self-hatred.

“It is important to assist adolescents in establishing their identity by actively exploring identity-related choices and encouraging identity development in their affirmed identity in a safe and supportive environment.”

Research suggests enbies face significant difficulty accessing gender-affirming health care. This may be because traditional notions of gender dysphoria take the gender binary for granted. A 2018 study of more than 800 trans youth found that just 13% of nonbinary youth sought hormone therapy, compared to 52% of binary trans youth. They were also more likely report encountering barriers to accessing hormone therapy.

The study also found that older enbies (aged 19-25) were significantly more likely than older binary youth to avoid necessary health care. However, younger enbies and binary trans people (aged 14-18) saw no differences in foregoing primary health care. Cultural shifts in attitudes regarding gender may play a role in this. As awareness of enbies increases, so too may the willingness of younger enbies to identify as nonbinary and demand gender-affirming health care.

When Nonbinary People Seek Treatment for Gender Dysphoria

Gender nonbinary people are sometimes reluctant to seek health care for gender dysphoria, as well as for unrelated issues. This may be because doctors commonly believe inaccurate stereotypes about enbies or are unaware of their existence.

A 2017 study of enbies seeking health care found that they often feel misunderstood, stigmatized, disrespected, or pigeonholed into the incorrect gender. Even when enbies seek care at gender-affirming clinics, they may encounter clinicians who are accustomed to relying on a strict gender binary. According to the study, nonbinary people may feel pressure to conform to the gender binary in health care settings.

In some cases, a health care provider may trigger feelings of dysphoria. For example, a doctor might call a chest binder a bra. This can deter enbies from seeking appropriate medical care and make it more difficult to access hormonal therapies and other treatments for dysphoria.

Research consistently shows significant health care disparities between trans and cis individuals. There may be similar disparities between binary and nonbinary trans people. This could affect access to all forms of health care, including potentially life-saving treatments that are unrelated to gender.

How Therapy Can Help Nonbinary People with Gender Dysphoria

The right therapist can provide a supportive, affirming environment for enbies with gender dysphoria. In therapy, a nonbinary person can discuss their feelings about gender in general, as well as their own gender identity. Therapy that supports these feelings instead of stigmatizing them can be a powerful antidote to the pressure many nonbinary people face to conform to a gender binary.

A therapist may also:

• Support a nonbinary person in accessing dysphoria treatment options, finding a supportive health care provider, and choosing the treatment most consistent with their identity.
• Help a nonbinary person discuss their identity with friends or family. Not all nonbinary people present as obviously nonbinary. They may need help coming out, discussing their identity, and educating loved ones about what it means to be nonbinary.
• Discuss issues such as self-esteem, body image, depression, and anxiety.
• Help a nonbinary person understand that being nonbinary is not a mental health condition or a personal failing.

In therapy, a nonbinary person can better understand their own identity, become a stronger advocate for their needs, and tackle internalized dysphoria and transphobia.

References:

1. Clark, B. A., Veale, J. F., Townsend, M., Frohard-Dourlent, H., & Saewyc, E. (2018). Non-binary youth: Access to gender-affirming primary health care. International Journal of Transgenderism, 19(2), 158-169. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15532739.2017.1394954
2. LGBTQ 101: terminology and tips. (n.d.) Retrieved from https://www.kenyon.edu/about-kenyon/diversity-at-kenyon/lgbtq-plus/terminology
3. Lykens, J. E., Leblanc, A. J., & Bockting, W. O. (2018). Healthcare experiences among young adults who identify as genderqueer or nonbinary. LGBT Health, 5(3), 191-196. Retrieved from https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6016091&blobtype=pdf
4. Mamone, T. (2017, October 19). Yes, non-binary people experience gender dysphoria. Retrieved from https://theestablishment.co/yes-non-binary-people-experience-gender-dysphoria-c056eb3df3c9
5. Providing affirmative care for patients with non-binary gender identities. (n.d.). Retrieved from https://www.lgbthealtheducation.org/publication/providing-affirmative-care-patients-non-binary-gender-identities

Transgender kids face alarming rates of bullying and abuse. GLSEN’s 2017 National School Climate Survey found 83.7% of trans and 69.9% of gender nonconforming (GNC) students experience bullying at school.

Bullying can erode self-esteem, increase isolation, and make it more difficult for a child to assert their gender identity. Some bullied children become depressed and suicidal. Centers for Disease Control and Prevention (CDC) reports that any involvement with bullying—whether as a victim, bully, or both—raises a child’s risk of suicidal behavior.

Parents, educators, and other adults have significant power to reduce bullying and support trans kids at school.

Transphobia Statistics

Transphobia is animus toward transgender people. It can cause bullying, physical aggression, and other forms of abuse.

Research consistently finds that gender-related discrimination is a problem in schools. GLSEN’s annual National School Climate Survey looked at over 23,000 children in grades 6-12. The study found 42.1% of trans and GNC kids are prevented from using their preferred pronouns. Nearly half of these kids (46.5%) are forced to use the wrong bathrooms.

Other research has found high rates of transphobic bullying.

• Research published in 2017 found trans kids are two to three times more likely than their peers to be bullied.
• A 2016 survey of adult transgender individuals found 60% have avoided public restrooms because they feared confrontation and bullying.
• A 2012 survey found 61% of students have heard peers make negative remarks about gender expression. The same survey found 27% of students face physical abuse because of their gender expression.

Creating a Safe Environment for Trans Kids

Many parents and educators worry that there’s nothing they can do to stop transphobic bullying. Yet research consistently finds that creating an inclusive, gender-affirming environment can greatly reduce bullying. Even when kids are bullied in these environments, they may feel more comfortable reaching out to an adult than they would in less inclusive environments.

According to GLSEN, students at inclusive schools with curricula that feature LGBTQ-affirming content are less likely to experience bullying, hear transphobic remarks, or feel unsafe at school. They are also less likely to be forced to use the wrong bathrooms or the wrong pronouns. Inclusive curricula can also raise self-esteem, reduce the risk of depression, and even improve grades.

Some strategies that promote a safe environment for trans kids include:

• Creating a trans-inclusive curricula. Schools can participate in LGBT History Month, feature notable transgender historic figures, and discuss transgender history and civil rights with students.
• Asking students about their preferred pronouns or names and then using them
• Educating teachers, school counselors, and others who work with students about transgender issues.
• Establishing safe spaces, such as counselor’s offices, where students can safely discuss gender issues and bullying.
• Refusing to tolerate any bullying or transphobia, even from teachers or other adults.

Parents who want to support a transgender child should urge their child’s school to promote an inclusive environment that actively works to prevent transgender discrimination. At home, parents can help by allowing children to assert their own gender identity in a safe, judgment-free zone.

It is important to let the child determine what gender means to them. Parents should avoid reinforcing gender stereotypes or rigid gender ideologies. For example, a trans girl does not need to turn her entire wardrobe pink in order to “prove” she is a girl. No toy or clothing should be off limits to anyone solely because of gender.

Parents can also support their trans or GNC children by introducing them to the wider LGBT community. They may read books with their child that feature people of many gender identities and presentations. They may identify trans or GNC role models for kids to learn about. They may also help their children meet other trans kids through support groups, trans camps, and other communities.

Lastly, parents may wish to educate themselves about transgender history and issues. Children pick up on what parents believe, not just what they say. Parents who are uncomfortable with their child’s gender presentation may inadvertently stigmatize their child. Education can help parents reevaluate their own ideas about gender and become better advocates for their children.

Understanding Your Child’s Rights

Federal, state, and local laws determine a student’s legal rights. Trans students in some states have more protections than students in other states. Individual schools may extend additional rights to trans students.

Many courts have ruled that transgender individuals are protected under Title IX. This federal law forbids schools from discriminating against students based on their sex or gender expression. Under Title IX, transgender and GNC students have the right to:

• Be protected from bullying, harassment, and violence.
• Use restrooms and locker rooms that match their gender identity.
• Be called the correct name and pronouns.
• Dress and present themselves according to their gender identity (so long as they follow the general school dress code).
• Access the same educational opportunities and school events as other students.
• Maintain their medical privacy, including the right not to disclose being transgender.

However, not all states share this interpretation of Title IX. According to the American Civil Liberties Union, only 17 states have laws explicitly protecting transgender students from harassment and discrimination. These include Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Minnesota, New Jersey, New York, North Carolina, Oregon, Vermont, and Washington. The District of Columbia also has anti-discrimination laws.

Even between these states, the extent of civil protections can vary. For example, only California, Connecticut, and Washington currently allow transgender students to join school sports teams consistent with their gender identity. School districts within a state may also vary in their policies.

The rights of transgender students at school are continually evolving. Parents who worry their child is facing discrimination should consider consulting a lawyer who specializes in educational law or who has experience with transgender issues.

How Therapy Can Help Transgender Kids

Therapy can offer immense support to transgender kids and their families. Family counseling can help a family identify strategies for supporting a child’s gender identity and fighting back against bullying. When family members do not fully understand or accept a child’s trans identity, family therapy can educate them and encourage acceptance.

Individual counseling can help transgender kids who struggle with depression, low self-esteem, and anxiety due to bullying. The right therapist can also affirm a child’s gender identity and point them toward trans role models and literature. In therapy, a child can learn that being trans is not a mental health problem or a weakness, but an important component of a person’s identity that should be respected and celebrated.

You can find a therapist here.

References:

1. GLSEN 2017 National School Climate Survey. (2018). Retrieved from https://www.glsen.org/article/2017-national-school-climate-survey-1
2. Know your rights: Transgender people and the law. (n.d.) ACLU. Retrieved from https://www.aclu.org/know-your-rights/transgender-people-and-law
3. McKay, T., Misra, S., & Lindquist, C. (2017). Violence and LGBTQ+ communities: What do we know, and what do we need to know? RTI International. Retrieved from https://www.rti.org/sites/default/files/rti_violence_and_lgbtq_communities.pdf
4. Supporting transgender and gender diverse students in schools [PDF]. (2015). American Psychological Association. Retrieved from https://www.apa.org/pi/lgbt/programs/safe-supportive/lgbt/school-administrators.pdf
5. The relationship between bullying and suicide: What we know and what it means for schools [PDF]. (2014). Chamblee: Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/bullying-suicide-translation-final-a.pdf
6. Trotta, D. (2016, December 08). U.S. transgender people harassed in public restrooms: Landmark survey. Reuters. Retrieved from https://www.reuters.com/article/us-usa-lgbt-survey/u-s-transgender-people-harassed-in-public-restrooms-landmark-survey-idUSKBN13X0BK
7. What are my rights at school? (n.d.). Retrieved from https://transequality.org/know-your-rights/schools

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. [fat_widget_child_counselor_right]

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. [amazon_affiliate]

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.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
2. 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
3. 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
4. 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.

In my practice, I work with many people who are transgender. The ages of those I’ve worked with over the years range from 5 (yes, 5) to 65, and the single most common complaint I have heard from these individuals is that their loved ones have said or done something that leads them to question the validity of their identity.

To illustrate: teenagers I work with will often tell me that when they approached their parents to talk about identifying as trans, nonbinary, gender nonconforming, or any other identity on the spectrum, their parents’ first response was, “Are you sure this isn’t a phase?” While parents may have meant this harmlessly, and only intended to seek information about what was going on with their child, this language is not validating and is likely to leave the child (or adult) feeling unsupported and as if who they are doesn’t matter.

The phrases below are a few examples of what not to say when a child (or anyone you know!) comes out to as trans. I also offer some suggestions to consider that may lead to a more productive conversation and help your child feel validated and supported.

Here are a few things NOT to say in these situations. I also offer, for your consideration, some suggestions that may lead to a more productive conversation. [fat_widget_right]

“Are you sure this isn’t just a phase?”

It’s a good idea to avoid this question because it questions the basic understanding your child or teen has of themselves. When I work with parents, I often suggest we simply meet the child where they are right then, without considering how “sure” or “unsure” they may be of their identity. While a few of the people I have worked with have identified differently on the spectrum throughout their lives, none of them considered any of those identifications as a “phase.” I went through a phase of dying my hair pink and wearing studded bracelets. But I did not go through a phase of identifying as female. I have always been aware of my female identity, just as people who are trans are aware of their own identities.

Gender identity is exactly what it says: identity. It is an intrinsic part of who a person is. Would you question a person’s identity based on race or religion and ask them if it was a “phase”? It may be helpful to view gender identity in the same way. If today your child tells you they are trans, then it’s best to go with that until they tell you otherwise.

“Don’t you think you should date a person of X gender first?”

Gender identity and sexuality are completely different entities. Often, the parents of the people I work with confuse the two. Though they are trying to better understand their child’s disclosure by asking questions like these, they are simultaneously completely misunderstanding what their child is telling them.

Having your child come out to you as transgender or gender nonconforming may be overwhelming, confusing, and emotional, but I implore you to try to see your child’s disclosure as a demonstration of the trust they have in you as a parent.

For example, a transgender man (a person who was assigned female at birth might also identify as FtM (female to male) does not need to have a romantic or sexual relationship with another man in order to know whether he is truly male. Being romantically involved with a man (or person of any gender) does not inform a trans person’s sense of gender identity—in the same way a cisgender woman (person who was assigned female at birth and who identifies as female) would not have to date a man to know she is female, only whether she is sexually attracted to men.

“You are too young.”

To this, I simply say “Wrong.”

I understand a lot of people may struggle with the idea that young children can know their gender identity at such a young age. Sure, preschool and kindergarten years are a relatively gender-fluid time as it is, and gender roles and stereotypes may be more lax—let’s face it, a 5-year-old boy in a princess dress is likely to receive an “aww” because we assume children are just playing and exploring costumes and ideas rather than figuring out who they are.

However, I do strongly believe that children as young as 2 or 3 years of age can be aware of their gender identity. This awareness may present as an aversion to certain clothes or an attraction to a certain type of style that does not align with the gender they were assigned at birth. Rather than assuming your daughter is a tomboy or your son is just curious about your shoes, I encourage you to be open to the idea that your child may be figuring out who they are. Listen to them, hear their concerns or desires, and above all, please remain open-minded. Encourage their style, gender presentation, and expression, whether it turns out to be simple exploration or early expression of gender identity. The sooner our children know we support them regardless of who they are, the healthier and happier they are likely to be in adulthood.

Having your child come out to you as transgender or gender nonconforming may be overwhelming, confusing, and emotional, but I implore you to try to see your child’s disclosure as a demonstration of the trust they have in you as a parent. This act of sharing, which they may have deliberated over for some time, is likely to leave them feeling vulnerable and open. Keep that in mind as you choose your next steps and words, as they can, and likely will, have a lasting impact on your child and may be a touchstone memory for the rest of their lives.

I believe the most essential and key support system for any child is their family, and I encourage you to openly offer as much love and support as you possibly can. If you would like to talk through what you are feeling, or discover ways of opening a conversation or showing your support, I recommend seeking out a compassionate and qualified therapist or counselor who is trained in working with trans individuals and their families.