The powerful emotions behind gender dysphoria cause many trans children to grow up emotionally constricted and deeply ashamed of their difference. Over time, the pervasive societal stigmatization of trans people allows the low self-esteem of these children to grow into the internalized self-hatred of many transgendered adults. While gay and lesbian people, who are far more numerous, have made some tremendous strides in educating the public, trans people are still struggling to present society with more positive, accurate portrayals of who they really are.
Coming out as transgendered is usually difficult for everyone concerned. Consequently, many male teenagers who crossdress do so in secret, never telling their families and friends about it. As adults, most continue to keep their crossdressing private, sometimes seeking support through transgender support groups. Those who tell their families experience a variety of reactions, from loving acceptance to complete rejection.
If a male adolescent's crossdressing is discovered by his parents, it is likely to precipitate an emotional crisis for the entire family. A female-to-male's "crossdressing" may be disguised as a "tomboy" phase that a daughter stubbornly refuses to grow out of, only later causing friction within the family.
However, if a youth is intent on gender transition, major changes are in store for the entire family. Being out about one's sexual orientation is a choice for most gay sons and lesbian daughters, but rarely with those who enter gender transition, since gender is so visible.
Moreover, the changes arising from gender transition will be much more profound than just physical appearances. In a sense, when transsexual youth "come out" and tell their family, their parents are indeed "losing a daughter" and gaining a new son they never knew they had, or vice-versa. Yet the youth remains their child, usually much happier, but with a whole new set of challenges to surmount.
While an increasing number of parents are acknowledging their child's gender struggle, most trans children keep their gender issues secret until they cannot hold them back any longer. Thus their revelation takes most parents by surprise. Moms and dads of these kids then must deal not only with shock, denial, anger, grief, misplaced guilt, and shame, but also many real concerns about the safety, health, surgery, employment, and future love relationships of their child. In addition, they must learn to call their child a new name, and even more difficult, use new pronouns. Thus trans parents need tremendous support. In wondering what changes to expect, one mother found it comforting to anticipate seeing her new son look like her former daughter"s twin brother.
The Risks Faced by Trans Youth
When a trans youth or adult comes out, the ability to pass in their new gender is usually limited. Hormonal therapy can take years to produce a passable appearance, especially with male-to-female trans people, and some may never pass completely. Thus those in gender transition are readily apparent to others, and they are vulnerable to intense harassment, discrimination, and even violence.
Trans youth often feel that their true gender identity is crucial to the survival of self. If their parents refuse to allow their gender transition, or if their families and friends withhold support, these youths incur the same risks faced by gay and lesbian youth with non-accepting families. Some may runaway from home and live on the streets, or they may seek to escape the pain of their lives through substance abuse. Like gay and lesbian youth, trans youth are also at higher risk for suicide.
Due to severe employment discrimination, male-to-female transgendered youth who are homeless, runaways or throwaways often work in the sex industry to survive and to pay for their hormones, electrolysis, cosmetic surgery and genital sex reassignment surgery. These youth are therefore at high risk for HIV/AIDS and other sexually transmitted diseases (STDs), and they should be referred to understanding health care providers for testing and/or treatment. Female-to-male youth may resort to con games or other marginal means to support themselves.
Taking street hormones or high dose hormones without medical supervision is also commonplace, and may result in lethal complications. Hormonal sex reassignment can only be safely done under the supervision of an experienced endocrinologist following the Standards of Care. Some MTF trans persons who are impatient with the slow pace of hormonal sex reassignment may seek silicone injections to immediately improve their body shape, but these have proven to be a health risk later in life.
Referral for Hormonal and Surgical Sex Reassignment
Transsexual people go to extraordinary lengths to obtain relief from their gender dysphoria. The desire to modify the body to conform to one's gender identity cannot be adequately explained by someone who is transsexual, nor can it be fully understood by someone who is not. This self-perceived need becomes a determined drive, a desperate search for relief and release from that ultimate of all oppressors – one's own body. Nor can the urgency itself be easily understood. It is a need to match one's exterior with one's interior, to achieve harmony of spirit and shape, of body and soul. It is a cry to be granted what is a given for all others: a gender identity not to be doubted nor ridiculed, but merely accepted.
Although parents may be alarmed by their teen's desire for physical transformation, they need to recognize the intensity behind it. Referral to a psychotherapist experienced in trans issues who can make a proper diagnosis is the key first step. If a diagnosis of Gender Identity Disorder is made, the doctor and parents should respect and support the child's feelings of who they really are.