This guide has been produced by FSTB – the Danish Association for the Support of Transgender Children – and is intended as a support resource for family members and relatives of transgender children and teenagers. Its content is based on the findings of recent research, professional experience, and FSTB’s expertise regarding transgender children and teenagers. The original version of this publication was produced with the support of the Danish Health Authority (Sundhedsstyrelsen).
FSTB works with children, teenagers and their families, helping them to find individual strategies and practical solutions for various situations. FSTB counsellors are available to answer questions and provide advice based on their knowledge and experience in supporting transgender children and teenagers.
Contact details for the counsellors can be found on the website www.fstb.dk
Terms and expressions
Gender (social). We are all born into a world where our gender has a significant influence on the expectations and opportunities we face in life. Alongside other factors, gender shapes us and our environment and, in this way, sets the framework for our lives and our relationships with others.
Assigned sex. Infants are assigned a sex based on their external anatomy. The sex assigned to infants determines their legal sex. This means that the child is registered as a boy or a girl with a gender-marked social security number (in Denmark), which is used in public systems, registers, etc.
Gender characteristics. Certain characteristics or features of the human body are traditionally associated with masculinity or femininity (male or female gender): for example, facial hair, breasts, genitals, voice pitch, height/build, etc. None of these characteristics alone determines a person’s gender identity. However, they can influence how a person’s gender is perceived by those around them.
Gender identity. Every person has a gender identity. It is not determined by the body or appearance, but by how we ourselves understand and feel about ourselves. It is an internal sense of self.
Transgender person / Trans person. Transgender people usually experience a mismatch between their gender identity and the sex assigned to them at birth. The sex assigned to transgender people and how others perceive them from birth does not correspond to their internal sense of self.
Gender expression. The ways in which a person expresses their gender through appearance and behaviour. Essentially, things such as clothing, hairstyles, toys and colours have no biological gender. However, many of us have a clear idea of what is considered masculine, feminine or gender-neutral expression in society.
Gender identity in children and adolescents
Transgender children and teenagers are not a new phenomenon. Research shows that approximately 1% of the population are transgender people. In recent years, society has become more open and, consequently, more aware of transgender children and teenagers.
Recent research* shows that the development of gender identity in transgender children and teenagers is very similar to that of their cisgender peers. Research also confirms that if a child or teenager’s sense of gender identity is strong and consistent throughout childhood and adolescence, they are likely to continue to identify with that gender in adulthood. For some people, gender identity may be non-binary or fluid (changing). However, the established gender identity of transgender children and adolescents rarely changes in later life.
* The TransYouth Project is a first-of-its-kind study. It focuses on a group of transgender children and teenagers from the United States and Canada and aims to examine their cognitive, psychological and social development.
References: Olson, K. R. (2016): Prepubescent Transgender Children: What we Do and Do Not Know. Journal of the American Academy of Child & Adolescent Psychiatry, 55 (3). Fast, A. A. & Olson, K. R. (2018): Gender Development in Transgender Preschool Children. Child Development, 89
When can children and adolescents be sure that they are transgender?
Transgender children may show signs of a mismatch between their self-perception and their assigned sex very early on — as young as 2–3 years old. Consequently, some parents become aware of this during their child’s early childhood, whilst for others, this realisation comes later — during adolescence or even in adulthood. There is no ‘right’ or ‘wrong’ age to talk about one’s gender identity.
Family support is of paramount importance for transgender children and teenagers
It is important for transgender children and teenagers to feel that their loved ones understand, accept and love them. Recent research shows that when transgender children are surrounded by a safe and supportive environment, they develop just like their peers. Conversely, a lack of support and acceptance within the family can negatively impact mental health and increase the risk of anxiety, depression and self-harm.
Most often, parents and relatives want the best for the child, but may feel anxious about the changes that accompany the process of gender transition and living in accordance with one’s identity.
Complex feelings
Parents and loved ones do not always immediately understand what it means to be a transgender person. The news that a child or relative is transgender can cause confusion, uncertainty, fear or a sense of grief.
Parents and relatives may sometimes feel unable to cope with meeting the needs of a child or teenager. A transgender child or teenager may go through a long process of reflection before deciding to disclose their identity to their family. Questions and concerns from parents and relatives can be hurtful to them, and they may feel burdened by having to explain their feelings over and over again. Therefore, seeking information from other sources and discussing questions and concerns with other people can sometimes be a helpful option for parents and relatives.
'We, as parents, both experienced grief. And on top of that, we felt guilty because we had not managed to understand our child and had brushed it off for so long. At the same time, we were worried that we might lock our child into a phase. Everything we thought we knew about gender and identity turned out to be a very simplified version of the truth. We were really did start from scratch'— Parent
References: Olson, K. R., Durwood, L., DeMeules, M., McLaughlin, K. A. (2016): Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). Simons L, Schrager SM, Clark LF, Belzer M. & Olson J. (2013): Parental support and mental health among transgender adolescents. Journal of Adolescent Health; 53, p. 791-793.
Alliance within the family
Setting an example of acceptance and helping relatives adapt is the best way to take an allied stance towards a transgender child or teenager. When loved ones take an active interest, it sends a clear message: you are loved and valued.
Research confirms that a safe home environment significantly reduces the risk of self-harm and suicidal thoughts among transgender children and teenagers.
Practical steps:
- Listen and give them space. More often than not, children know best about their own identity. Don’t pressure them by demanding constant explanations. Approach the situation with positive interest and respect.
- Spread the word. Ignorance is often the cause of misunderstanding. Help others learn more about gender identity to dispel prejudices.
- Use the correct name and pronouns.* Politely correct others if they use the wrong name or pronouns when referring to the child.
- Create a safe environment. Speak out against negative comments or inappropriate questions from those around you.
- Help them find role models. It is important for transgender children to see themselves reflected in other people. Help them find role models and content so they don’t feel alone.
* Pronouns are words that refer to a person without using their name. For example: he/him, she/her, they/them .
Reference: The Trevor Project (2021): National Survey on LGBTQ Youth Mental Health 2021. West Hollywood, California: The Trevor Project.
The gender transition process
Children and teenagers express their gender identity in different ways. Some change their appearance, name or social circle. It is important for a child or teenager to go through this process at their own pace and in a way that feels comfortable for them.
The role of loved ones is to provide a safe environment so that children can express their gender identity in the way that suits them best.
Coming out: when children come out
Some children may tell their parents about their gender identity at a young age. Others do so only during their teenage years or later. There is no single moment when a child ‘must’ come out — it depends on a multitude of personal and external factors.
Some need time to build up the courage, due to a fear of being rejected. For others, it is important first to see or meet people with similar experiences in order to find the words to describe their feelings. Some teenagers, whose bodies begin to change during puberty, may urgently require medical assistance to halt this process, which prompts them to talk to their parents.
References: Durwood, L., McLaughlin, K.A., & Olson, K. R. (2017): Mental health and self-worth in Socially Transitioned Transgender Children. Journal of the American Academy of Child and Adolescent Psychiatry, 56. Pullen Sansfaçon, A., Hébert, W., Lee, E. O. J., Faddoul, M., Tourki, D., Bellot, C. (2018): Digging beneath the surface: Results from stage one of a qualitative analysis of factors influencing the wellbeing of trans youth in Quebec. International Journal of Transgenderism, 19(2).
Social transition and self-expression
Children and adolescents may decide to change their gender expression so that their appearance aligns with their gender identity.
The term ‘social transition’ describes the changes that occur when a child or adolescent alters their appearance (e.g. hairstyle, clothing), as well as their name and pronouns, in order to feel more comfortable. Such changes are fully reversible if the child or adolescent’s gender identity subsequently changes.
Transgender children and adolescents who change their hairstyle, clothing, name and pronouns to align their outward expression of gender with their inner sense of self often experience a sense of joy and fulfilment. The best way for parents and relatives to ensure the well-being of a transgender child or teenager is to acknowledge and respect their desire to change their gender expression.
‘At this point, it feels completely natural for me to talk about my child using the correct pronouns and gender. At first, we agreed that mistakes were acceptable as long as we corrected them straight away” — Parent
When puberty begins
Puberty causes physical changes that can cause significant distress for transgender teenagers.
Teenagers’ anxiety about their bodies developing in a way that doesn’t align with their sense of self can manifest as low self-esteem, depression, anxiety or self-harm.
‘It was not until I was 15 years old that I discovered that I am transgender. For a long time I was unsure. Was it something | was convincing myself of? Was I masculine enough to be an “actual” boy? Was I prepared to go through a transition, or would it be less complicated to just live my life as a woman? As I learned more about what it means to be transgender and I heard the stories of other transgender persons, it became clear to me that the only right thing was to come out. It was a big relief when I told my parents. They have been a great support and they helped me come out to the rest of the family.' — Transgender teenager
Options for gender-affirming care
Transgender identity is a natural part of human diversity and does not require “treatment”. However, living in a body that does not match one’s sense of self can lead to severe frustration and distress (gender dysphoria).
Gender-affirming care can alleviate this distress and help teenagers align their physical development with their gender.
There is no single right path. Not all transgender people require medical interventions, whilst for others they are vital. The teenager’s wishes and needs must be respected throughout the process.
Medical care and transition
Young transgender people in Denmark who require medical care undergo a comprehensive medical and psychological assessment.
- Puberty blockers: These may be prescribed to temporarily halt puberty. This gives the teenager time to reflect without fear of irreversible physical changes (breast development, voice breaking, etc.). If the teenager stops taking the blockers, puberty resumes. They are usually prescribed once a certain stage of puberty has been reached (Tanner stage 2).
- Hormone therapy: From around the age of 15–16, teenagers may be prescribed gender-affirming hormone therapy (testosterone or oestrogen). Hormones are prescribed to align the adolescent’s physical development with their gender identity.
- Surgery: Individuals under the age of 18 are not eligible for gender-affirming genital surgery in Denmark.
References : ReMedico, D., A. P. Sansfaçon, Zufferey A., Galantino G., Bosom M, Suerich-Gulick F. (2020): Pathways to gender affirmation in trans youth: A qualitative and participative study with youth and their parents. Clinical Child Psychology and Psychiatry, 25(4). Sundhedsstyrelsen (2018): Sundhedsfaglig hjælp ved kønsidentitetsforhold.
Key takeaways
Acknowledge gender identity
- Always let the child or teenager decide for themselves who to tell about their identity and when.
- Use the child’s correct name and pronouns.
- Create an environment where the child feels safe to share their thoughts and feelings.
- Ensure that other family members respect the child’s identity.
- Remember: there is no ‘right’ or ‘wrong’ way to be a trans person. Everyone has different needs and their own journey.
Listen to understand
- Trust what your child tells you about their gender.
- Learn about transgender issues from reliable sources.
- Remember: neither parents nor those around them can ‘create’ or change a child’s gender identity.
- Respect the right of children and teenagers not to take on the role of educating adults.
Practising allyship
- Ensure a safe atmosphere within the family.
- Correct yourself and others if the wrong name or pronoun is used.
- Put a stop to negative comments and bullying, both in private conversations and in public.
- Show positive curiosity, care and respect.
- Make sure the child has someone who understands them.
Why support is important
Family support boosts self-esteem and well-being, and strengthens the social and mental health of transgender children and teenagers. It has a huge impact on their future.
Many transgender adults note that it was the support of their loved ones that helped them gain self-confidence and maintain warm relationships with their parents, friends and partners.
