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Transgender & Gender-Diverse Youth

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Answers to questions families often have about caring for their youth who is transgender or gender-diverse

Who are transgender and gender-diverse youth?

Some individuals' gender identities do not match their assigned birth gender; these identities are thought to develop from a combination of genetic, biological, hormonal, cultural, and environmental factors. Some terms used to identify this select group of individuals include transgender, gender-diverse, and gender non-binary.

How does someone know they are transgender?

People can realize that they are transgender at any age. While many transgender children consistently, persistently, and insistently express a gender identity that is different from their assigned sex, some transgender children may be afraid to share these feelings and may try to conform to the accepted standard for their assigned sex. Transgender children may adopt different pronouns, a new name, and clothing that matches their gender identity. However, these changes may not resolve their gender dysphoria, which may include symptoms of depression, anxiety, or anger, often related to the undesired physical traits of their biologic sex.
Additionally, someone may know they are transgender because they feel happier and more like their authentic self as the other gender.

What is gender dysphoria?

For some transgender people, the difference between the gender they were assigned at birth and their personal sense of gender—their gender identity—can lead to serious emotional distress that affects their health and everyday lives if not addressed. Gender dysphoria is the medical diagnosis for someone who experiences this distress.

How is gender dysphoria diagnosed?

Diagnosis of gender dysphoria includes assessing for gender non-conforming identity, a detailed social history, and identifying symptoms of dysphoria. Individuals must show multiple characteristics for at least 6 months. Detailed criteria can be found in the Caring for Transgender & Gender-Diverse Youth diagnosis module.
Not all transgender people have gender dysphoria. On its own, being transgender is not considered a medical condition. Many transgender people do not experience serious anxiety or stress associated with the difference between their gender identity and their gender of birth, and so may not have gender dysphoria.

How is gender dysphoria addressed?

Gender dysphoria can often be relieved by expressing one’s gender in a way that the person is comfortable with. This may include informing others about their gender identity, dressing and grooming in a way that reflects who one knows they are, using a different name or pronoun, and, for some, taking medical steps to physically change their body (such as hormone therapy and surgery). Some people may also seek psychotherapy. The purpose of these steps is to promote gender roles and gender expression that are affirming to the individual. Often, making these changes helps the person to feel like their authentic self. All major medical organizations in the United States recognize that living according to one’s gender identity is an effective, safe and medically necessary treatment for many people who have gender dysphoria.

What is the goal of addressing gender dysphoria?

Each person will have different needs to become their authentic self. The goal of addressing gender dysphoria is to help the person with this process, as well as reducing or removing the distress caused by the dysphoria. Acceptance by family and a social network, as well as access to hormone therapy or surgery may reduce feelings of gender dysphoria.
Early identification and treatment of associated conditions, including mental health disorders, traumatic stress, substance use/abuse, HIV, and sexually transmitted infections may also be needed. It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Youth who identify as transgender often have a mood disorder, anxiety disorder, or post-traumatic stress disorder. Psychosocial support, hormone therapy, gender-focused psychotherapy, and suicide prevention are helpful for youth and young adults.

Will anyone else in the family experience gender dysphoria?

The development of gender identity is not well understood and influenced by a variety of factors. Ongoing studies aim to better understand the roles of genetics and other factors in gender identity.

How will my family's life be changed?

Families often struggle to understand and accept non-conforming gender identity but doing so may be the most important factor in a healthy outcome for the transgender or gender-diverse youth. Families can support treatment plans including psychological and medication treatments, provide emotional support, and assist with youth development into adulthood. Parents can ask their child how they want to be referred to (as a daughter, son, or using gender-neutral language), what pronouns they want to use, and how they would like to dress and groom. Seeing this as a way to grow with your child, get to know them better, and have a closer relationship can help children feel accepted and valued for who they are.

Resources

Information & Support

Related Portal Content
Caring for Transgender & Gender-Diverse Youth
Assessment and management information for the primary care clinician caring for youth who are transgender and gender-diverse.
Care Notebook
Medical information in one place with fillable templates to help both families and providers. Choose only the pages needed to keep track of the current health care summary, care team, care plan, health coverage, expenses, scheduling, and legal documents. Available in English and Spanish.
Transgender Youth and Schools
Schools in Transition: Guide for Supporting Transgender Students in K-12
Considerations and practical tips by age and topic (dress codes, names & pronouns, bullying, sex-separated facilities, etc.) for school teachers and administrators to support safe environments for transgender students (68 pages); by American Civil Liberties Union, Gender Spectrum, and other partners.
LGBT Youth & Schools Resources (ACLU)
A library of resources for school administrations and gender nonconforming students with information about harassment, free speech, privacy, suicide prevention, and more; American Civil Liberties Union.
Know Your Rights! A Guide for LGBT High School Students (ACLU)
A 7-page electronic resource with information for students about Title IX, privacy, freedom of speech, and more; American Civil Liberties Union.
Teaching Transgender Toolkit
Best practices, lesson plans, and resources for those who wish to facilitate trainings about transgender people, identities, and experiences; written by Dr. Eli R. Green, founder of The Transgender Training Institute, available for a fee.
Annotated Bibliography: LGBTQ Resources (PDF Document 40 KB)
List of LGBTQ+ resources for students and teachers.
Legal Changes to Identity Documents
Gender Change and ID Documents (NCTE)
Find out how to get a legal name change where you live and update your name/gender on state and federal IDs and records; National Center for Transgender Equality.
How Do I Change My Gender on Social Security Records? (SSA)
Required documents and processes; Social Security Administration.
Gender Designation Change for Passports (U.S. Dept of State)
Requirements and answers to frequently asked questions about gender changes on U.S. passports.
Transgender Parents
Protecting the Rights of Transgender Parents and Their Children
A guide for parents who have transitioned or come out as transgender and are facing challenges to their legal status as parents; American Civil Liberties Union and National Center for Transgender Equality.

For Parents and Patients

Center of Excellence for Transgender Health (CoE)
Information, programs, and services for transgender individuals; Center of Excellence for Transgender Health, University of California, San Francisco.

Facts for Families: Transgender and Gender Diverse Youth (AACAP)
An introduction for families about gender diversity; American Academy of Child & Adolescent Psychiatry.

How I Help Transgender Teens Become Who They Want to Be (TED Talk)
A TED talk (approx. 17 minutes) by Dr. Norman Spack at Boston's Children Hospital about his experience as one of the few doctors in the United States to treat minors with hormone replacement therapy.

Gender Revolution: A Journey with Katie Couric (NGS)
A documentary that explores gender identity; National Geographic Society.

Where's My Book?: A Guide for Transgender and Gender Non-Conforming Youth, Their Parents, & Everyone Else
A 390-page book to help transgender youth through puberty. Explains the basics of gender identity, sexual orientation, puberty, puberty blockers, hormone treatments, and gender-affirming surgeries - by Dr. Linda Gromko (2015).

The Gender Creative Child
A 304-page book for parents and professionals that explains the rapidly changing cultural, medical, and legal landscape of gender and identity - by Diane Ehrensaft, PhD (2016).

Tools

The Genderbread Person (PDF Document)
A popular infographic that breaks down gender identity, gender expression, biological sex, and sexual orientation into an easy to understand visual.

Services for Patients & Families Nationwide (NW)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Transgender Youth (ClinicalTrials.gov)
Studies looking at better understanding, diagnosing, and treating this condition; from the National Library of Medicine.

Authors & Reviewers

Initial publication: June 2018; last update/revision: July 2020
Current Authors and Reviewers:
Authors: Nicole Mihalopoulos, MD, MPH
Adam W. Dell, MD
Reviewers: Aiden Green
Dom Bortruex
Authoring history
2019: first version: Adam W. Dell, MDA
AAuthor; CAContributing Author; SASenior Author; RReviewer