An interview with Dr. Johanna Olson, Adolescent Medicine, Assistant Professor, Children’s Hospital Los Angeles.
Q: How can a parent know if their child is transgender?
A: So much of this depends on the age of the child. In much of the current research about this, there isn’t a clear consensus in the community or among providers. The term “transgender” itself has gone through dynamic shift over time but is generally taken to mean someone who has a gender identity, a gender expression, a gender performance that is outside of the expected cultural norms for their assigned sex at birth.
It’s also true, though, that there are a lot of kids who are prepuberal [in the stage just before puberty] who have gender nonconforming behaviors, who I would not label as transgender. The truth is that we don’t really know whether that child who is gender non-conforming in childhood is going to go on to have a trans identity in adolescence or adulthood. What we do know is that by the time kids reach adolescence, if they have a gender identity that is different from their sex assigned at birth, that it is very likely that they will continue on to have that gender identity. So adolescence is an important time when we talk about treatment.
Q: How do you approach a child who just expresses some gender non-conforming behavior, as opposed to say a kid who persistently, insistently and consistently says “no I’m not a boy, I’m a girl”?
A: I think you have to follow the affirmative approach to care – so what does that child need to feel safest and to feel the most whole in that moment in time? And the biggest question is do you support a child going through a social transition in early childhood. The reality about these kids who are asking to live as a gender different than their assigned sex at birth is that they usually have immense amounts of gender dysphoria. And we do know that kids who are more gender dysphoric in childhood are more likely to have trans identities as adolescents and adults.
Here’s where it gets difficult though. Social transitioning has to be the kid’s need, not the parent’s need. If a parent wants their child to socially transition because it’s easier than just having a kid who is gender non-conforming, that’s a problem. And I have to say – this is very important – having an assigned male at birth who wants to wear girls clothes and paint their nails but is not identifying as a girl is a very hard space. It’s a hard space for parents; it’s a hard space for caregivers; it’s a hard space for relatives; it’s a hard space for the child. So it’s easy to then imagine, “Hey, can’t you just live as a girl full-time?” might seem like an easier solution to a difficult scenario.
Q: What would you say to a parent who comes to you with a 4 or 5 year old kid who they think might be transgender?
I always recommend that the family do a weekend where the child tries out the other gender and see what happens. If you’re nervous about it, go somewhere for a weekend where your kid is able to live in that gender they’re asserting, and see what happens for your kid. See what happens when they’re in the clothing they choose. It can be really illuminating.
I think that it’s really important before people panic about socially transitioning that they stop and ask themselves, “What could be the consequences of this? Is it really that dire?” When we think about giving people the opportunity to walk in both gender roles, we do a great service for society. I’ve never seen an argument that it’s harmful to let kids explore gender. People have such a psychic earthquake about this, but it’s not necessary.
Just because you let your kid grow their hair out and wear dresses and go by a different name – that’s all reversible. This is one of the problems about the whole concept of stealth and being secretive. It adds this ridiculous layer of secrecy that is really becoming archaic in the context of the new ways we’re thinking about gender. It propagates this idea that you can only be one gender your whole life and that gender is determined based on your genitals at birth. I just think that concept is becoming outdated.