Transgender Teens

Teen Transgender Issues

What does it mean to be transgender?

We are all born with a biological sex. During childhood, we also develop a gender identity, which is our sense of ourselves as male or female. For most of us, our biological sex matches our gender identity (that’s called being cisgender). But for some of us, it does not. A biological male may feel instead that he is female and vice versa. These individuals are transgender.

Gender dysphoria is the clinical term for what transgender individuals experience. Adolescents with gender dysphoria will express a strong desire to be a different gender and to be treated as such (not fleetingly, but for a significant period of time and likely for life); they are also often deeply distressed by the physical characteristics of their biological sex; and their distress may be so severe that it impairs day-to-day functioning.

How is gender dysphoria treated in adolescence?

The goal is not to change the way an adolescent feels about his or her gender identity. Rather, it’s to relieve the suffering that can occur when a person feels like they’re in the wrong body. This can include taking steps to make a person’s outer appearance match up with his or her gender identity (called transitioning). Experts also recommend therapy, as transgender individuals are at significant risk for a number of mental health issues, including anxiety, self-harm behaviors, and depression.

Isn’t middle school and even high school early to make a decision like this?

Studies show that gender dysphoria in early childhood often does not persist into adolescence. But they also show that gender dysphoria that lasts through adolescence usually does persist into adulthood. Brushing off an adolescent’s feelings with “it’s just a phase” (or worse) is not only not helpful, it can increase the likelihood the adolescent will develop a mental health issue down the road. Instead, experts urge parents with adolescents experiencing gender dysphoria to make an appointment with their pediatrician.

Note to Parents of Transgender Teens

  • The first thing parents in this situation need is a lot of information. This includes the concepts of sex, gender identity, gender expression, and what is meant by transgender and transsexual. They need to know that sexuality is separate but interacts with gender identity and that sexual orientation occurs along a spectrum. Parents also need a thorough understanding of their teen’s specific thoughts, feelings, and desires.
  • Too often a teen will drop the bombshell of coming out transgender and then say nothing more about it to his or her parents. The parents’ first responses are generally to challenge the veracity of what their teen is saying, and then communication breaks down completely.
  • It is essential to explain to these teens that even though it is normal for them to be moving away from parents and toward their peers, in this case, it is important to keep open the line of communication with their parents. I often find it helpful to have a session in which I interview the child in front of the parents to elicit the information that will help the parents understand this particular child.

We must be aware that families, too, must be educated about transgender issues, learn skills for coping with the child’s gender change, and be able to mourn and seek social and emotional support for themselves. The goal of treatment is to arrive at a shared understanding of who the child is, what should happen next, and how to proceed with both safety and authenticity in mind.

How can I support a transgender teenager?

It’s tough to be a transgender teenager. You’re often harassed. You’re discriminated against. You’re at a significantly increased risk for a slew of mental-health issues. In fact, a staggering 41 percent of transgender adults have attempted suicide. This is not an easy path to walk. How parents and other adults respond to transgender teenagers can make all the difference.

Be sensitive and supportive of both the teenager and family. Avoid detailed questions; it’s not your business. Instead simple expressions of support like “How are you doing?”. Perhaps most helpful of all: take time to understand the issues.


The exercise below may help your teen to better understand their own values and story. NewPath has counselors ready to help guide you and your teen through this confusing time.

Deconstructing Gender: Self-Exploration Exercise

  • What is your own gender identity?
  • How old were you when realized you were a “girl” or a “boy?”
  • Who and what made this clear to you?
  • Did you agree with your parents clothing choices for you as a child?
  • What activities did/do you enjoy?
  • Have you expressed your own gender identity differently over the course of your life?
  • How do you feel about your body? Your genitalia?
  • What messages have you received about your gender and from whom (e.g. parents, media, religion etc.)? Were you “policed” by others around your identity, gender roles and social practices or body?
  • How has your gender shaped your beliefs, social engagements and practices?
  • What have you been allowed/encouraged to do because of your gender identity and what limitations have you faced (e.g. social sanctions/promotions)?

At NewPath, we see our client’s as one whole person.

  • We ask about your gender identity and preferred pronoun. Explore internal experience and how it impacts you interpersonally.
  • We foster multiple and integrated identity development: race, ethnicity, gender, class, sexuality, profession etc.
  • Educate parents about the importance of not pathologizing the gender expression of their children.
  • Our treatment interventions include allowing children the space to explore their gender expression, family education and support, as well as parental support to mourn the loss of their fantasies about their birth child’s ascribed gender.
  • Collaborate treatment efforts with all providers involved, e.g., social workers, endocrinologist for hormone blockers and hormone treatment, family therapist, and treatment team staff.
  • We know gender nonconformity is a natural expression of human development and experience.
  • Above all we Do No Harm: If we have questions we seek consultation from a gender specialist. Monitor countertransference and refer out if we are not able to act fully in the best interest of our client.
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