How Do I Know If My Child Has Gender Dysphoria?

Parental acceptance and support for their children with gender dysphoria is critical for the child’s physical health, mental health and satisfaction with life.

Once considered a disorder, believed by some to be a moral perversion, the American conversation about gender dysphoria has moved out into the open as states and the federal government take actions to protect the civil rights and safety of transgender individuals. Beliefs about sex and gender are deeply entrenched in cultural values and religious tenants. In the past, individuals whose gender identities conflict with their anatomy were forced to conform to societal expectations, causing a host of emotional problems.

What is gender dysphoria?

The American Psychiatric Association (APA) made a terminology change in the May 2013 release of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. DSM-5 replaced “gender identity disorder” with “gender dysphoria,” noting in a fact sheet that failure to identify with your biological gender in itself is not a disorder. Problems arise when a transgender individual is rejected by family and society, and forced to deny their own identity. A diagnosis of gender dysphoria is necessary to protect the individual’s access to care.

Is this just a phase?

Does your son prefer dresses to blue jeans? Is your daughter a tomboy into adolescence? According to the National Association of Social Workers, most people develop their sense of gender identity as preschoolers. It is unlikely that a young child who identifies with one gender will change as they grow. Some may attribute a child’s gender dysphoria to confusion. A study published in the March 2015 issue of Psychological Science compared transgender children with non-transgender children and found no different in how children in each group viewed their gender identity.

Signs your child might be transgender

APA guidelines for diagnosis include a consistent and persistent (at least for six months) marked difference between expressed gender and assigned gender. It is manifested by a strong desire to be treated as the other gender and a distain for one’s own sexual characteristics. Rachael Pepper, co-author of “The Transgender Child,” writes that clinicians look for specific markers when making a gender dysphoria diagnosis.

Children that identify as girls:

  • Wish to pee sitting down;
  • Wear traditional girl clothing
  • Want to grow their hair long
  • Play with traditional girl toys
  • Dislike their boy body parts
  • Insist they are girls (not just express a desire to be a girl)

Children that identify as boys:

  • Are very “tomboyish”
  • Want short hair
  • Play mostly with other boys
  • Pee standing up
  • Are more comfortable in boy clothing
  • Prefer to play with traditional boy toys

If you observe a combination of these markers over a period of more than six months, it may be time to consult a doctor about the possibility your child has gender dysphoria.

Helping your child with gender dysphoria

While society’s views on gender dysphoria are evolving, your child will still be faced with obstacles going forward. It is most important your child feels he or she has the love and support of family. Your child will need your help negotiating the world outside the home. Where you live will make a difference, particularly in school. Some communities are less accepting of transgender children than others. While moving isn’t an option most can afford, you can become an advocate for your child, beginning with your child’s school administrators. Know your child’s legal rights. These vary by state and by school district. Gender Spectrum, an advocacy organization, offers legal help with transgender issues.

Will my transgender child need medical intervention?

When, and how, to transition from birth assigned gender to identified gender depends on the individual. Before the onset of puberty, a child may transition socially by changing his or her name, clothing and hairstyle to better display their interior identity. Once puberty begins, a doctor may prescribe hormonal treatments to delay development of secondary sex characteristics.[ii]

Gender reassignment surgery is an option, although a 2011 survey by the National Center for Transgender Equality found that most people with gender dysphoria do not surgically alter their body to conform to their gender identity.

The World Professional Association for Transgender Health offers this timeline for transitioning:

  • Stage 1 – live in gender role consistent with gender identity
  • Stage 2 – begin use of hormone therapy after 3 months of living in new gender role
  • Stage 3 – gender-affirmation surgery after 12 months of living in new gender role and using hormone therapy

Where to go for help

In addition to resources offered by Gender Spectrum, several organizations offer information and support for transgender individuals and their families.

  • Trans Youth Family Allies: Provides support services and educational outreach for families, educators and healthcare practitioners.
  • Youth Resource: A website for LGBT youth.
  • PFLAG: Offers support, education and advocacy.