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Gender diverse youth
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The term gender identity refers to a child’s inner sense of their gender (as male, female, a blend of genders, etc.). It can be the same or different from a child’s assigned sex at birth. It is normal for young children to express wanting to be another gender or for young children to believe people can change their gender easily.
For the majority of children, their gender identity is the same as their assigned sex at birth (cisgender youth). But for some children, feelings that their gender does not match their sex assigned at birth develop and continue or intensify as they grow older (gender diverse youth). Some of these children experience clinically significant distress when their gender identity does not match their assigned sex at birth – this is called gender dysphoria (American Psychiatric Association’s Diagnostic and Statistical Manual). Gender dysphoria includes a strong and persistent gender identification different than assigned sex at birth that persists for at least 6 months.
The term transgender broadly describes any person whose gender identity or gender expression is different from cultural expectations based on their sex assigned at birth. Currently, it is estimated that approximately 0.5-1% of youth identify as transgender. The term non-binary is used to describe individuals who do not identify exclusively as male or female. Instead, they may identity as being both male and female, somewhere in between, or falling outside of these categories. Some, but not all, non-binary individuals may also identify as transgender. Of note, gender identity is different than sexual orientation. Sexual orientation is related to emotional, romantic or sexual attraction to others. A person’s sexual orientation is independent of their gender identity. Therefore, gender diverse youth may identify as straight, gay, lesbian, bisexual, etc.
At Children’s Wisconsin, we work with many gender diverse children and adolescents. Some may be just starting to explore or understand their gender identity, while others may identify as transgender or may be experiencing gender dysphoria. In addition to individual psychotherapy, there may be opportunities for group counseling, parent support and school liaison work. Some children may also be seen in the Gender Health Clinic if they are interested in learning about medical services such as puberty-suppressing hormone therapy and gender-affirming hormone therapy.
Why is this a concern?
Children and adolescents who are struggling with issues around gender may benefit from additional support. At times, they may feel depressed, isolated, or anxious. They may have experienced discrimination, harassment or lack of support from others. Counseling can help to explore areas of concern and identify coping skills and other interventions to improve well-being.
How are gender concerns diagnosed/evaluated?
Currently, we have psychologists and therapists who work with children and adolescents who may be experiencing questions or concerns related to gender. Most often, an initial intake assessment is completed with the child and family and treatment goals are established collaboratively.
When to seek help
In very young children (4 or younger), exploring gender identity is actually pretty common. If they continue to show signs that their gender identity may not match with their sex assigned at birth, you may want to discuss this with their pediatrician or a mental health provider, particularly if the child seems upset, distressed, or anxious. The focus of care should be on ways to support your child and family. Since gender identity is not a choice, trying to “force” a child to change their gender identity is not helpful and could lead to additional concerns.
What happens next
Some gender diverse youth make steps toward gender transition, a process to match their gender identity more closely with their outward appearance. This may include changing clothes, names or pronouns to fit their gender identity. For some children and adolescents, it may also include medical interventions to help their bodies align more with their gender identity.