Transgender (trans), nonbinary, and other gender-diverse youth often face more significant mental health risks than their peers. Research shows that trans youth have a much higher risk of depression than non-trans (or cisgender) youth. Trans teens also are many times more likely to harm themselves or think about suicide than non-trans teens.
But being gender-diverse or trans does not automatically result in behavioral or mental health problems. One study found that trans children who feel supported in their gender identity have no more depression than cisgender children. Their anxiety is also not much higher than their non-trans peers when they have strong social and family support.
The support of family, friends, and the community can strengthen the mental health and self-esteem of trans and gender-diverse youth. Here’s how you can be a part of that social support system.
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Recognize a Child’s Struggle
The first step to supporting a trans or gender-diverse child or a child exploring their gender identity is recognizing what they are experiencing. Children typically begin to develop a gender identity around age 2. They can begin questioning their gender identity at any age. They may begin feeling confused or distressed about their gender identity before preschool, during puberty, young adulthood, or adulthood. There is no right (or wrong) time and it varies by individual.
Children also may discover they do not have a single-gender identity or that their identity is neither male nor female.
The process of a child trying to understand their gender identity can involve gender dysphoria. Gender dysphoria is significant distress caused by physical, social, and emotional characteristics of an assigned gender that does not match a person’s gender identity. A child feeling gender dysphoria may want to experiment or change the way they dress, talk, or otherwise act or appear.
Signs a child may be struggling with gender dysphoria
Sometimes a child’s struggles may be more obvious, like when they persistently and consistently insist that they have a different gender identity than their sex assigned at birth. But sometimes kids will show other signs, such as:
- Getting upset if called any term related to gender, such as sister or brother.
- Showing signs of anxiety or moodiness, especially during single-gender activities like gym class.
- Asking you to call them by a different name.
- Asking you to use a different pronoun, such as he/him, she/her, they/them, or something else outside of the binary such as xi/xir, fae/faer, etc.
- Asking questions about gender identity or changing gender.
- Feeling disgusted or embarrassed about their body or changes during puberty.
- Expressing a desire to change aspects about their body that cause discomfort or distress, such as breasts or a penis.
How to Support a Gender-Diverse or Transgender Child
The most important way to support a child is to let them know you accept them no matter who they are. Tell them you want to support them if they feel uncertain or confused about their gender identity. Make sure they know you won’t judge or reject them.
Be patient as a child explores their own identity. Sometimes they may want to talk, and other times they may not. When they are ready to talk, listen.
A child who questions their gender identity may or may not be trans or gender-diverse. It can take time for them to figure out who they are, and they need support. Respect the time they need and any boundaries they set.
Ask the child how you can best support them. Ask them what name and pronouns are correct to use. If they want to change their appearance, help them find clothing and accessories that make them feel comfortable.
Supporting the mental health of trans and gender-diverse youth
Trans and gender-diverse youth may face bullying or discrimination from others. Often, this takes the form of misgendering. Misgendering someone means referring to them as being of a gender that’s different from what they consider themselves to be.
For example, if the child’s pronouns are “she” and “her,” it can be painful if someone uses “he” and “him.” Over time, misgendering and negative comments can contribute to depression and anxiety.
Specific ways to help
There are many ways you can help support trans and gender-diverse youth. These include:
- Making sure your child knows they are supported at home.
- Only telling others about a child’s gender identity when the child gives you permission.
- Using your child’s correct pronouns and chosen name.
- Supporting your child when/if someone hurts them.
- Finding a doctor who offers and has experience with gender-affirming care that treats trans and gender-diverse people with dignity and respect.
- Speaking with the school to ensure the environment is safe for trans and gender-diverse children. Welcoming Schools has tips on training and school resources, and Gender Spectrum’s Schools in Transition provides a comprehensive guide.
- If your child would like to meet with a school professional, arrange a meeting and be an advocate for your child’s needs and wants.
If you make a mistake
Sometimes adults make a mistake and use the wrong pronouns or the child’s former name. These mistakes can be harmful, invalidate a child’s identity, or make them feel less safe. Adults can follow these steps when they make mistakes:
- Listen to and affirm the child’s gender identity.
- Apologize for your mistake without justifying, explaining, or defending yourself.
- Move on, try harder, and do better in the future.
Mental Health Resources to Support Transgender and Gender-Diverse Children
Fortunately, there are many community resources to help trans and questioning youth, their families, and others in their lives:
The Trevor Project
The Trevor Project is a national group that works to prevent suicide in LGBTQIA+ youth. LGBTQIA+ stands for lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic people. It has several resources for transgender, gender-diverse, and gender-questioning children:
- TrevorSpace is an affirming social community for LGBTQIA+ people ages 13 to 24.
- The Trevor Project Coming Out Handbook can help youth think through questions about their identity.
- A guide to protecting youth’s space and well-being on Instagram.
Gender Spectrum works to create gender-sensitive and inclusive environments for all children and teens. It offers a wide range of support, including:
- Resources for parents/caregivers, children, professionals, and faith leaders
- Support groups for gender-diverse youth and parents/caregivers.
Community mental health and health care resources
- American Academy of Pediatrics tips for parents of LGBTQIA+ youth.
- National Alliance on Mental Health.
- UPMC Resources for LBGTQIA+ patients and caregivers.
- Resources page for the Gender and Sexual Development Program at UPMC Children’s Hospital of Pittsburgh.
- LGBT Youth Resources at the CDC.
- Trans Youth Equality Foundation.
- Transgender Law Center.
- It Gets Better Project.
- TransYouth Family Allies.
- GLAAD resources.
The UPMC Children’s Gender and Sexual Development Program provides resources and more information about gender-affirming care.
Editor's Note: This article was originally published on , and was last reviewed on .
A Guide to Being an Ally to Transgender and Nonbinary Youth. The Trevor Project. Link
Coming Out: Information for Parents of LGBTQ Teens. Healthy Children. American Academy of Pediatrics. Link
Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics. May 2018. Link
LGBT Youth Resources. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. The Centers for Disease Control and Prevention. Link
LGBTQI. National Alliance on Mental Health. Link
Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics. March 2016. Link
Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health. March 2015. Link
Psychiatric Diagnoses and Comorbidities in a Diverse, Multicity Cohort of Young Transgender Women. JAMA Pediatrics. May 2016. Link
Supporting Your Child with Gender Identity Issues. Young Minds. Link
Connect with UPMC
From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.