Who is the transgender child and what should parents know?

Approximately 50 percent of transgender children and youth have considered suicide by the time they are 20 years old, according to the Youth Suicide Prevention Program. Approximately 25 percent have attempted it. And 41 percent of transgenders of all ages have attempted it at some point in life, according to the American Foundation for Suicide Prevention and the Williams Institute. This compares with 4.6 percent of the general public attempting it.

A portrait of the young transgender child

A 3-year-old boy said to his mother, quoted in Parents Magazine, "I'm a girl. Don't you know I'm a girl? I'm a girl inside. My blood is pink." He also wanted to know why he was a girl inside but not outside. On another occasion, he said he hoped he would be struck by lightning.

In the formative years before school, children pick up from their parents what is expected from them in their gender roles. Boys should not play with dolls, and girls should not be too tomboyish. Boys should engage in rough and tumble, and girls should look feminine, wearing pretty dresses and ribbons and bows. These children soon see that there is much about themselves that they have to hide.

If they are religious, they may feel that God will punish them. Eventually, they may slip into depression and anxiety and become isolated and secretive. There are two paths young transgender children take. They hide their preference and continue to pass as their birth sex. Or, they may feel so strongly about about their preference that they cannot hide it. If they reveal it, huge problems may emerge. Society can be devastating to their emotional development. They may be rejected by family members and playmates. School time may be fraught with bullying, discrimination, harassment and lack of support from teachers and administrators. Even the child who wants to hide his feelings can be stunted in his or her emotional development.

What does transgender mean?

Being transgender is not a "phase." Yes, there are boys who play with dolls for a while, or girls who love "roughhousing," but they never think of themselves as the other sex and return to behavior that is normal for their sex.

Transgender people have been known about in many cultures since antiquity. A transgender person is different than a transsexual person. The latter wants to change physically to the other sex by surgery, hormones or other methods. The transgender may not. They are also not to be confused with heterosexuals or bisexuals.

Help for transgender kids

The mental health of these children depends largely upon the support of their parents. Early intervention is crucial. Parental acceptance and support has been shown to lower the suicide risk. Parents must listen when their child tries to communicate his or her uncertainties and fears.

Parental acceptance can result in problems of its own, however. Parents confiding in others can bring disapproval and rejection by family and acquaintances. It has been reported that parents of transgender children have actually been threatened with harm or death. The controversy over which bathroom the transgender child should use has brought out misguided judgment against the children and their parents.

Puberty is a particularly difficult time. The usual bodily changes are upsetting to transgender children. A child born as female but identifying as male may be disgusted with breast development, and a boy by birth but a girl inside may be horrified with all the hair growth. These children cannot function well in school or in family life without support. If they go through the "wrong" puberty, it can lead to severe problems, including substance abuse, suicidal ideation, cutting and other forms of self-abuse, continuing high levels of stress and anxiety, and eventual poverty. They remain targets of bullies and harassment.

There are medical treatments available to delay puberty. However, the parent must be supportive from an early age and must be on top of the latest advances in this area. With medications and other treatment, they can delay the angst of puberty and function better in school and at home. Parents should seek counselling for their child, if necessary, and perhaps even for themselves.

Religious parents should concentrate on the basic teachings of their faith, which undoubtedly includes love, non-judgment and acceptance.

"The answer is to love your kids as is. Your love and acceptance is the best medicine your kids will ever get," says Dr. Michelle Forcier, Rhode Island pediatrician and expert on transgender kids.