Part one in a series about LGBTQIA+ youth.

Sometimes I know before the first appointment. A parent may have been the one to reach out, to answer the question when I ask, “So, tell me what’s going on.”

Maybe this is a family where the parents have already wondered about their child’s sexual orientation or gender identity (or both!). 

Perhaps the kid has already come out, to themselves, at school, at home, or nowhere. Sometimes it’s not on anyone’s radar - and anxiety, depression, trouble focusing, or other struggles are front and center.

My first job (and this is my job with any adolescent I’m working with) is to get a full medical, developmental, and social history from the kid and the parents. Then I need to understand what this kid’s life is like right now. I also need to assess for risk. I do this by asking directly about suicidal thoughts, drug use, eating disorders, and other risky behaviors.

These conversations will give me some initial insights. I'll learn how this young person has seen their gender so far. Continuing to go deeper in this exploration means asking kids (and their parents) more questions, many more questions. I'll ask how they experience their gender. I'll ask what it would take for their gender identity to feel affirmed. Do they have gender dysphoria and/or gender euphoria? And, how do they respond to both? We explore what they would like their future to look like and what it would take to get them there. What are the tradeoffs and obstacles they’ll need to navigate in the process.

Some kids have understood this about themselves long before they share it with others. For others, it may be a recent and growing curiosity. For others, it may change again or come and go. None of these is more real than any other. Every path forward is valid. This includes social, medical, or legal transition, or no transition.

And that’s the thing about kids and gender, their experiences are uniquely individual. Some gender expansive kids are acutely aware of their trans identity at a young age. This group includes those who identify as non-binary, transgender, or gender fluid. Others only have a vague feeling. It is fleeting. They feel something is wrong or different about them. Kids may change their minds about how they identify and how they present. They might have short hair one year, wear skirts the next, and maybe both the year after. They may want to use one set of pronouns at home and a different set at school. This can seem uncertain and confusing to parents. Yet, it's a key part of self-understanding.

A teenager is exploring their gender. They need space to do it. They have the chance to try out ways of expressing this identity. They can try out hairstyles, clothing, accessories, pronouns, and a different name. These things are how they engage in that exploration. If you’re questioning your gender, the best test is to try it in a safe, supportive place.

And the great thing about these social experiments? They might stick, but they are also absolutely reversible and can change or update as your child does. They’re also the only gender affirming intervention for kids prior to the onset of puberty.

These conversations, experiments, and explorations take quite some time. In my experience, they take at least 6 months. More often, it's a multi-year process. It lets the teenager continue to grow and explore. It also helps the family learn to support their young person. If, after delving into all of this, a teen and their family is interested in learning more about medical interventions, and I think it’s appropriate, I would then refer them to an adolescent gender clinic.

Learn what happens next in part two, to be published next week!

Don’t feel like you know a lot about gender identity? Confused about gender fluid, non binary, cis, trans? Not sure about the difference between gender identity and sexual orientation?

The Gender Unicorn (https://transstudent.org/gender/) is a great place to start familiarizing yourself with new vocabulary and a new non-binary way of thinking!

The National Center for Transgender Equality (https://transequality.org/about-transgender) has a lot of great resources! GLAAD (https://www.glaad.org/transgender/allies) also has tips for allies.

Look into finding a local chapter of PFLAG (https://pflag.org/), an organization that supports queer and trans folks, as well as their parents, families, and allies.