Supporting Transgender Children: New Legal, Social, and Medical Approaches

Abstract

The author, a lawyer who advocates for transgender children and youth, explores how clinical approaches to transgender children and youth are keeping pace with social and legal changes affecting these young people and with recent evidence suggesting that children are harmed by family and societal rejection as well as by attempts to change their gender identity or gender expression. The author urges providers and legal advocates to work with policymakers and the families of transgender children and youth to create a future in which these young people can reach their full potential and be embraced as fully equal, respected, and participating members of society.

Keywords:

• gender
• gender identity
• gender identity disorder
• gender identity disorder of childhood
• gender identity disorder of adolescence
• gender variance
• legal rights
• transgender
• transsexual
• treatment

Notes

1. Zucker et al. (this issue) describe various scenarios in which gender variance appears to be symptomatic rather than indicative of a child's authentic identity; Ehrensaft (this issue) describes scenarios in which children manifest gender variance “in an attempt to solve some other life or emotional problem” (p. 345).

2. In contrast to the U.S.-based clinicians represented in this volume, the Amsterdam Clinic currently “recommend[s] that young children not yet make a complete social transition (different clothing, a different given name, referring to a boy as “her” instead of “him”) before the very early stages of puberty” (de Vries & Cohen-Kettenis, this issue, p. 307–308).

3. This strong consensus is based in part on a near-universal recognition that “gender dysphoria rarely changes or desists in adolescents who had been gender dysphoric since childhood and remained so after puberty” (de Vries & Cohen-Kettenis, this issue, p. 306). See also Zucker et al. (this issue): “there is much less evidence that GID can remit in adolescents than in children” (p. 392).

4. See, for example, Edwards-Leeper and Spack (this issue) noting the prevalence of “gender fluidity even in our clinic of severely gender dysphoric individuals in terms of the extent which patients feel it necessary to alter their physical bodies in order to feel comfortable in their affirmed gender” (p. 334).

5. See Zucker et al. (this issue) arguing that treatments designed to reduce cross-gender behavior and identification in children are justified in part by avoiding “the attendant social ostracism that can ensue from GID persistence” (p. 390).

6. In addition to this empirical research, there is growing anecdotal evidence that many of the young people touted as success stories by clinicians who claimed to successfully treat GID in children were in fact harmed by those treatments. See, for example, Burroway, 2011.