Imagine you are a parent and your kid has come out to you as transgender. Now imagine you live in Texas. The governor has just instructed the Department of Family and Protective Services to consider any gender-affirming medical treatment child abuse. You are now living in a nightmare scenario where no matter what you do your child is at extreme risk.

If you aren’t the parent of a transgender child your reaction to the news out of Texas and similar anti-transgender actions in other conservative states probably falls into one of three categories:

• Good. It’s about time.
• Absolute horror. This is madness.
• Shrug. What will those silly conservatives think of next? Oh well, it will probably get knocked down in the courts. Not my problem.

You almost certainly come to this question with opinions and assumptions about transgender kids, their parents, current medical advice, and risks. You are probably wrong. Your ignorance is getting kids killed. Please keep reading.

Some kids talk about being or wanting to be the opposite gender but grow up to be cisgender, i.e. identifying as the gender assigned to them at birth on the basis of their genitals. Go to the talking points page of any anti-trans group and they will throw out statistics suggesting most trans kids change their minds after puberty.

The problem with these studies is they don’t differentiate between types of kids who explore gender. Listen to the difference between these statements from a little girl:

• “I wish I was a boy.”
• “I want to be a boy.”
• “I am a boy.”

Many children have fleeting experiences of wondering what it would be like to be the opposite gender. Wise parents don’t make a big deal of it and instead gently push back on society’s gender expectations. “What do you want to do that you think girls can’t do?” they might say.

A little girl may spend her childhood rejecting dresses, preferring short hair and traditionally male toys and hobbies, and grow up perfectly happy to be a woman. This does not make her a trans child who changed her mind yet many studies would consider her such.

On the other hand, a girl who insists, over and over that she is a boy, demands a boy’s name, and needs her family and school to call her a boy, is statistically much more likely to persist in living openly as a trans man.

Myth #2: Puberty blockers are dangerous, untested, and cause irreversible harm to kids who may not want to be trans when they grow up.

Puberty blockers are not a medication developed for transgender children. GnRH, gonadotropin-releasing hormones, have been used since the 1980s to successfully treat precocious puberty and other conditions affected by hormones.

Imagine a five-year-old girl begins to grow breasts and pubic hair. She will probably be given puberty blockers to pause her unnaturally early puberty for both health and social/emotional reasons. When she is old enough, she will stop taking the blockers and natural puberty will resume.

It works exactly the same for transgender children. The medication puts a pause on puberty by blocking the release of estrogen or testosterone which changes a child’s body into that of a sexually developed adult.

You can’t pause puberty forever. An adult body needs estrogen or testosterone to be healthy. So at some point, the child stops puberty blockers and either allows natural puberty to resume or starts taking gender-affirming hormones to begin developing opposite gender characteristics.

Here is what the American Academy of Pediatrics has to say:

Gonadotrophin-releasing hormones have been used to delay puberty since the 1980s for central precocious puberty. These reversible treatments can also be used in adolescents who experience gender dysphoria to prevent development of secondary sex characteristics and provide time up until 16 years of age for the individual and the family to explore gender identity, access psychosocial supports, develop coping skills, and further define appropriate treatment goals. If pubertal suppression treatment is suspended, then endogenous puberty will resume.

Often, pubertal suppression creates an opportunity to reduce distress that may occur with the development of secondary sexual characteristics and allow for gender-affirming care, including mental health support for the adolescent and the family. It reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.

Are there side effects and risks? Yes, absolutely. Every medical intervention has risks but so does not intervening. An AAP study published in 2020 shows a decreased risk of lifelong suicidal ideation in transgender individuals who wished to receive puberty blockers and did versus those who wanted puberty blockers and did not receive them.

If a child uses puberty blockers and decides not to transition, they stop the blockers, allow puberty to begin or resume, and all is well.

If a trans boy does not use puberty blockers and grows unwanted breasts, he will face surgery as an adult to remove them. A trans woman who completes male puberty will have an irremovable adam’s apple, a deep voice she may or may not be able to change with extensive, expensive vocal therapy, and a face she may later wish to surgically change.

These aren’t easy decisions for either the parents, the doctors, or the children but pressing a pause button medically while they all work together to figure things out is often the choice with the least possibility of lasting harm to the child.

Myth #3: What about Keira Bell? Puberty blockers made her grow facial hair and a deep voice and now she regrets it all.

Maybe you have heard the story of Keira Bell, the current poster child for stopping puberty blockers in the UK. Keira asked for and received puberty blockers at age 16 from the NHS Gender Identity Development Service. A year later she started testosterone. At age 20, she had her breasts surgically removed.

At age 23, she changed her mind and started a legal battle against the NHS claiming they should have challenged her more.

“See!” say anti-trans activists, “Keira’s puberty blockers ruined her life.”

Read her story carefully. Puberty blockers did not deepen her voice, give her facial hair or remove her breasts. She had breasts because she didn’t start blockers until age 16 when her breasts were already grown. Her deep voice and facial hair came when she stopped blockers and started testosterone for the express purpose of developing those male characteristics.

Myth #4: Parents and kids jump into gender-affirming treatment quickly and easily

One day you are at the neighborhood barbeque and your friend has a son. The next week you see a girl in a dress playing in the front yard. “Sam is now Samantha,” your neighbor says cheerfully when you raise an eyebrow in question.

Just because the transition happened overnight in your experience doesn’t mean the parents or child are jumping into anything quickly. Most social transitions — how a child presents to the world via name, dress, facilities used, etc. — are considered for months or years before you see any evidence. You have no idea what steps the family has already gone through.

Reputable doctors don’t hand out treatment like candy. Here’s what the Mayo Clinic says:

To begin using pubertal blockers, a child must:
- Show a long-lasting and intense pattern of gender nonconformity or gender dysphoria
- Have gender dysphoria that began or worsened at the start of puberty
- Address any psychological, medical or social problems that could interfere with treatment
- Have entered the early stage of puberty
- Provide informed consent

Additionally:

parents or other caretakers or guardians must consent to the treatment and support the adolescent through the treatment process.

And that’s just for puberty blockers which are an easily reversible procedure. The hoops to jump through for gender-affirming hormones or surgery are even greater.

Myth #5: People who are transgender know it and show it from a very early age

Some people express a strong transgender identity in early childhood. Many don’t realize until their bodies go through puberty and suddenly everything feels wrong. Others slowly come to awareness/acceptance later in adulthood.

Many trans people wrestle internally for a long time before sharing with their family members. They may go deep on trying to be a girly girl or manly man without even realizing why they are trying so hard to fit societal gender norms.

Parents can be totally blindsided by the coming out of a teenager. The teen has been researching and thinking about this for ages and wants to transition immediately while the parent is still reeling and saying, “Wait, what? But you loved trucks and dinosaurs as a kid. How can you be a girl?”

Myth #6: Being transgender is very popular. Kids are doing it for attention.

The world has changed from the days when same-sex attraction and gender non-conformity were hidden deep in the closet. Kids are aware of an entire rainbow of possibilities beyond boy meets girl. Many of them think and talk about gender and sexual orientation in a way their parents and grandparents never even considered.

But being transgender still carries a huge societal cost. You risk rejection and bullying every day. Adults who are supposed to protect you might not only turn a blind eye but also support your tormentors or torment you themselves. Consider the case of high school vice-principal Lee Livengood who followed a trans boy into the restroom and harassed him, telling the boy to use the urinal in front of him to prove his gender.

A review of 19 different studies of transgender youth found them six times more likely to be bullied than cisgender youth.

According to a recent study, 85% of transgender teens have seriously considered suicide while 50% have attempted it. Lead researcher Dr. Michael Marshall says:

One of the key problems they face is this notion that everyone else in the world can essentially invalidate their identity by just telling them it’s not OK to identify as transgender. Their identities are hidden, and when they’re hidden, it’s easy for other people to discriminate against them. This causes a lot of pain and suffering.

Myth #7: Kids under 18 are too young to consent to life-changing interventions. Parents and doctors should make them wait until age 18.

If you have read carefully this far you already know why this is a myth. Waiting until age 18 causes body changes that are irreversible. Many children deterred from transitioning experience extreme mental anguish and take their own lives. Others self-harm or have great difficulty in school.

Gender dysphoria can be deep and prevent a child from living a normal teenage life. Don’t assume you understand what it is like to walk in a transgender’s child’s shoes. You may be asking the impossible. There is a common saying among parents of transgender children, “Do you want an alive daughter or a dead son?”

Myth #8: Transgender people are creepy. I can spot them all a mile away and I don’t want them anywhere near me.

No, you can’t. Half the people you think are transgender are masculine appearing women born female or effeminate men. Meanwhile, that beautiful woman washing hands next to you in the ladies' room was identified as male at birth. The buff man lifting weights on the next bench used to have breasts.

You know what’s creepy? Thinking you have any right to know what is inside any other person’s pants either now or in the past. Unless you are considering a mutually desirable sexual relationship with someone, it is none of your business.

Myth #9: There are only two genders: male and female. That’s just basic science.

What about intersex people? Roughly 1 in 1500 to 2000 children are born with ambiguous genitalia. About half of these children have surgery in infancy to make their genitals look more traditionally male or female. The doctors and parents make that decision without any input from the child. This child will have to live with their choices which can include loss of sexual sensation in adulthood as well as feeling anguish their parents made the wrong gender choice.

Why are we okay with permanently altering infants who can not consent in any way, but not okay with teens, parents, and doctors working together to make the best choices they can?

Myth #10: None of the debate about transgender rights has anything to do with race or socioeconomic status.

Who do you think is hurt most by all the anti-trans laws cropping up? People with financial resources can move or work around the laws. Black parents are already much more likely to be targeted by child protective services. Anyone want to guess who gets attacked first?

Imagine you are a young closeted person of color in Texas right now. You long to tell your parents you are trans but can’t bear the thought of getting them in trouble with the law. One day you step in front of a bus because you can’t face the pain anymore.

Six Black trans women were murdered in the US in the space of nine days in the summer of 2020. According to Harvard Civil Rights, Black trans people face 26% unemployment, twice as high as transgender people in general.

Anti-trans legislation and prejudice hurt us all but like nearly everything in our legal system, it hurts poor people and people of color most.

Imagine being a parent…

Put yourself in a parent’s shoes. Your 14-year-old just told you they are transgender. You’ve done your research. You’ve consulted medical and mental health experts. If you are religious you have maybe even talked to a spiritual leader.

You have the legal responsibility to decide what is best for your child until they turn 18. You have a moral and ethical obligation to make the hard choices even if your child disagrees. Most importantly you love your child more than they could possibly ever imagine.

You wish you had a magic wand to solve the problem but you don’t. You know that living openly as a transgender person will be very hard. Your child is insisting they have been trying to live as the gender you thought they were for years and if they have to keep doing it they are afraid they will kill themselves.

You, on the other hand, remember that they desperately wanted to be a soccer player until you brought all the gear, and then they changed their mind two months in. Or that time they told you if they couldn’t get a cell phone like all their friends they would just die.

How can this person who isn’t mature enough to remember to close the door tightly enough so it latches and the dog doesn’t get out mature enough to make these big decisions?

Maybe you try to force gender compliance. “Boys are boys. Girls are girls. Stop all this nonsense.” Maybe they will manage to bid their time until they can escape and make their own legal choices. Chances are high you will not have much of a relationship with this child once they leave home.

And that’s a best-case scenario. They might run away, possibly supporting themselves with sex work. Or they commit suicide. These risks are real.

Or you can be supportive. “I love you, sweetheart, and we will figure this out together.” You find the best doctors and gender health specialists you can access and afford and you consider carefully all the options to make sure your child has the best future possible.

Puberty blockers may be the closest thing to a magic wand you are going to get while you help your child think about and work through the serious issues of more dramatic gender-affirming treatments.

How dare you call that child abuse Governor Abbott? How dare you?

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