All children deserve to feel safe, accepted, and valued at home, at school, and in medical settings. As a parent or guardian of a trans or gender expansive child, it’s up to you to advocate for your child’s care and well-being.

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Illustration by Alyssa Kiefer

Research shows that gender expansive youth who are supported in their identities have similar mental health outcomes to their cisgender peers, including similar levels of depression and only slightly higher levels of anxiety.

Early access to gender affirming care can further reduce the risk of suicidality, depressive disorders, and anxiety.

This article guides parents and guardians through finding gender affirming care and outlines what this care typically entails at each age and stage, from young children to teenagers who may benefit from medical interventions.

Whether you have a deep understanding of gender identity and expression or are at the start of your journey, you might find it helpful to work with a therapist or other mental health professional during this time.

A therapist can help you identify and unlearn any internalized assumptions or negative beliefs about gender. They can also provide support as you navigate your child’s shifting identity, cultural or social expectations, and potential discrimination.

How to find a gender affirming pediatrician

If your child already has a pediatrician with whom they feel comfortable, search their name and credentials in the above directories to see whether they’re recognized as an affirming provider.

You can also look up their professional website, social media, and other digital footprints to help get a sense of their personal and political views.

If you think they will be receptive, have a one-on-one conversation about your child’s evolving sense of self.

Use this opportunity to make sure they’re affirming of your child’s gender, accepting of natural gender diversity, and focused on letting your child determine their gender expressions.

From there, you can determine whether you want to continue care with your child’s current pediatrician or find a new clinician.

Many people find it helpful to contact the doctor’s office before an appointment to confirm the child’s name and pronouns. You might also consider reminding personnel when you and your child arrive for the appointment.

Discuss the appointment with your child before heading to the doctor’s office. Let them know that medical personnel might use the wrong name or pronouns at first, and assure your child you will advocate for them.

If someone misgenders or misnames your child, correct them right away. Doing this in front of your child can help establish their own sense of self-advocacy and innate self-acceptance.

Prepubescent children are usually younger than age 10. Medical interventions aren’t always appropriate for this age group, but positive exploration or social transitioning can be impactful.

This can look like:

  • encouraging your child to pick out and wear the clothes they feel most comfortable in
  • referring to your child by their chosen name and pronouns and telling others to do the same
  • empowering your child to play with toys and participate in activities that strike their interest, regardless of traditional gendered expectations

Displaying openness and acceptance regarding your child’s preferences — which may shift over time — is vital.

Children are especially vulnerable to negative stigmas surrounding gender identity and expression. Younger children, in particular, tend to internalize discriminatory treatment.

Keeping an open line of communication with your child can show them you’re interested in who they are and invested in their happiness. It also establishes you as a person they can come to in times of duress.

Finding support in the years before puberty can be crucial in reducing anxiety, depression, and gender dysphoria.

You may need to educate others regarding your child’s gender identity, including teachers and other parents. Outline acceptable treatment of your child, and be willing to answer questions.

Discussing your child’s gender expression with parents, grandparents, and other family members can be difficult. Offer resources, tell your relatives they’re an important part of your child’s life, and, if necessary, implement boundaries to protect your child’s well-being.

If your child expresses discomfort or shows signs of harm after interacting with specific people, limit or eliminate those interactions.

Puberty usually starts between the ages of 10 and 14. With puberty comes the development of more “feminine” or “masculine” features — including vocal changes, body hair, and breasts — that may be incongruent with your child’s sense of self.

Many gender expansive children benefit from medical intervention to delay these changes until they’re older.

This allows your child the time and space to better understand their gender identity without the anxiety and stress that come from feeling alienated from their body.

Research repeatedly shows that allowing interested youth to take puberty blockers reduces their lifetime risk of suicidal ideation. In other words, puberty blockers can be lifesaving for gender expansive children.

Puberty blockers have been safely used for more than 30 years to delay precocious puberty. They are injected intramuscularly on a prescribed schedule. Their effects are easily reversed by discontinuing the medication.

Although mild irritation at the injection site is possible, there are no substantial side effects.

While some studies have indicated lowered bone density with puberty blockers, there are no definitive conclusions. Your child’s pediatrician may recommend a calcium supplement as a precaution.

Hormone therapy is the leading treatment for gender dysphoria in postpubertal youth. Postpubertal youth are typically over age 15.

If you haven’t already, establishing care with a supportive therapist or psychiatrist can help provide a pathway to accessing gender affirming hormone therapy (GAHT) and other medical interventions.

Depending on your teen’s desired results, GAHT can be used to block or increase the production of estrogen or testosterone.

This can produce physical changes congruent with your teen’s internal sense of self and prevent unwanted or incongruent changes from occurring.

Gender expansive youth who start GAHT early in adolescence generally do not develop physical changes that they may later want to address with surgery.

A 2022 study looked at data collected from a 2020 survey of 34,759 lesbian, gay, bisexual, transgender, queer, and questioning youth ages 13–24, including 11,914 transgender or nonbinary youth.

Youth using GAHT were less likely to report seriously considering suicide or recent depression than youth who wanted GAHT but did not receive it.

Side effects are possible with any hormone therapy, including birth control and treatment for hair loss. Your teen’s clinician can discuss their individual risk of side effects and any precautions they can take.

Breast augmentation, rhinoplasty, and other cosmetic procedures are often performed on gender conforming young people without controversy.

But for gender expansive youth, surgical interventions are rarely performed before age 16. The most common surgical intervention is top surgery.

Your teen will likely be required to have a well-documented case of gender dysphoria and to have used GAHT for at least 1 year to be considered eligible for surgery.

Your individual financial situation and healthcare coverage can further complicate access.

It may be necessary to assess your current health insurance or consider switching insurance providers if your teenager or adult child is a dependent on your health insurance plan.

If you can’t access care through your insurance, you can file a civil rights complaint. You can also advocate for care using these resources.

Multiple wide-ranging studies have indicated positive outcomes for gender expansive people who receive gender affirming surgeries and procedures.

Some of these surgeries, such as facial feminization, are considered cosmetic. But their effects aren’t superficial and can drastically improve quality of life.

Postoperative outcomes in the vast majority of gender expansive people are overwhelmingly positive compared with presurgery.

Trans and gender expansive adolescents deserve to have fulfilling, joyful lives — and it starts at home.

If your child is questioning or exploring their gender, it’s up to you as their caregiver to show up for them with love and support.

Encouraging your child to find what makes them happy and empowering them to do so can make all the difference. So can gender affirming medical care.

Although it may take some vetting and research on your part, it’s worth the time and effort to ensure that your child feels accepted and supported by their doctors.

Anastasia Selby is a graduate of the MFA program at Syracuse University and currently lives in Tallahassee, FL, where they are pursuing their PhD in English. Their writing has been published in High Country News, Boulevard, Vox, The New Ohio Review, Allure, and Tricycle Buddhist Review. Find their newsletter here.