How do you discuss gender issues with adolescents?

pixierose, BSN, RN · Mar 25, 2018

I work per diem in a psych ED, and sadly we see lots of adolescents who are transgender... and a lot of parents who aren't happy.

First thing ... how do we help kids get through? By acceptance. There has been some threads started on AN by nurses RE: transgender and nursing care that have left me dismayed. We honor these kids for who they are, not who we think they should be.

Take "adult expectations" out of the equation. I have two teens, 16 and 15. It's not my body, not my future, not my choice.

My understanding on hormone therapy are that there are requirements one must meet to be eligible. One doesn't just decide at age 12 to begin; they must demonstrate a readiness and meet certain criteria? At least this was my understanding.

KelRN215, BSN, RN · Mar 25, 2018

We've got a whole new world opening up to kids. They have to wrap their minds around issues that adults are having trouble with. How can they be expected to make a reasoned knowledgeable decision about their own sexuality with so much peer pressure, adult expectations and societal influences?
Personally I think I would go with "Be who you want to be, but honor the body you are born with even if it's not perfect." In a nutshell, that's my best effort. But tell me about kids that are questioning their identity. I thought for about a year in adolescence that I might be gay...I'm not, but imagine if I had gone through the coming out process, and then had to crawl back in! Mortifying! How do parents and school counselors help kids get though?
Regarding transgender folk, If a kid decides to take hormones, can they change their mind in a year, and have everything go back to normal? Will puberty take place, just delayed for a year? If they put off hormone therapy until they get through adolescence, what are the disadvantages? I hate to have a kid make a life changing decision at 12-13 years old, and have no way to change their minds.

I would not say this as a transgender female may feel very distressed about her member or facial hair, a transgender male may feel the same way about his breast and period and I don't think this comment would be in any way helpful. Transgender individuals feel that their body does not match their true gender.

Also, as pixierose said, transgender children taking hormones is not a decision that is made overnight. The disadvantages of delaying hormone therapy until after puberty are obvious: transgender boys will grow breasts and begin to menstruate, transgender girls will grow facial hair, their voices will drop, their genitalia will grow and they will begin to have erections.

Here's a good article on the subject: Led by the child who simply knew - The Boston Globe

StrwbryblndRN · Mar 25, 2018

I have 2 teenagers. I find that kids in high school are pretty open to sexuality, gender concerns and so forth. Peers are able to discuss issues with each other, and also the opposite sex so much better than my generation. There is still issues of teasing, and close mindedness but overall high kids are willing to listen to each other. With that in mind, any adolescent who is at odds with their sexuality find solace with other kids. Counselors and other adults grew up in a different era and may not be the best resource. A friend of my daughters has recently started transitioning and my daughter has indicated that fellow students have been overall supportive.

I believe it is normal to question your sexuality and gender. (I know I did) I take solace that it is not forbidden like previous generations.

FolksBtrippin, BSN, RN · Mar 26, 2018

We don't really talk to them about gender issues. We listen to them about gender issues. We understand that it is a journey, not a decision. Their gender identity will evolve over time. We don't worry about them coming out of the closet or having to go back in. We just open the closet door really wide and turn the lights on in there and let people walk in and out and around closets as much as they want to.

And we know that they are figuring it all out without us.

That's how we do it.

Rocknurse, MSN, APRN, NP · Mar 26, 2018

I agree with many here that allowing a teen to express themselves is the most important thing. It's not a sudden overnight decision or announcement, but a series of conversations and realizations. Allowing a teen time and space to express how they're feeling is the best avenue, with neither encouraging nor dissuading them. Really, in effect, they would most likely need a professional counselor trained in gender issues to talk with, rather than someone without that experience. Also, teens don't generally start irreversible hormonal therapies until they are at least at the age of 18. They could potentially be given puberty blockers but those can be stopped allowing puberty to continue should the teen suddenly decide they didn't want to transition.

I will say though, that being "mortified" if you came out erroneously is testament to the shame and guilt that is associated with being gay. It shouldn't be something that is seen as shameful or embarrassing which is why it's important to talk with them. Imagine how us gay people feel having to pretend we're straight for years and years because we're too frightened or ashamed to be honest with people in those tender and vulnerable teenage years. That's equally as mortifying. Shame and guilt need to be removed from the equation.

KelRN215, BSN, RN · Mar 26, 2018

We don't really talk to them about gender issues. We listen to them about gender issues. We understand that it is a journey, not a decision. Their gender identity will evolve over time. We don't worry about them coming out of the closet or having to go back in. We just open the closet door really wide and turn the lights on in there and let people walk in and out and around closets as much as they want to.
And we know that they are figuring it all out without us.
That's how we do it.

Most excellent advice.

OldDude · Mar 26, 2018

When I got my driver license, seat belts were not required and it wasn't against the law to drink and drive; you could purchase alcohol at 18. There wasn't a such place on land as a "No Smoking" area. All this to give you an idea of how I am a "work in progress" regarding this subject. I've spent many hours riding my "high horse" about the way I think things should be and becoming a parent of 4 boys and 1 girl made me eat that self righteousness. At age 19 my #1 son told me he was gay. I had suspected that over the years but I never broached the subject with him - for whatever rationalized irrelevant reason on my part; maybe simple-minded denial. Anyway, after he told me he was gay, I told him I understood, I was glad he told me, and wanted him to know I loved him; that's all I could stumble through. He hugged me up real big, squeezed me tight, and said "thank you! I thought you would be mad at me!" - GULP - I felt like a complete parental failure for having laid the groundwork for him to think I would be mad at him for being gay.

So, I do so appreciate this thread, and the excellent, to the core, real-world, contributions, information, and advice.

Thank You!!

Horseshoe, BSN, RN · Mar 26, 2018

It can't be stressed enough that gender identity, sexual orientation, and sexuality are not the same things.

Elvish, BSN, DNP, RN, NP · Mar 26, 2018

I do think it's important for primary care providers to discuss this with adolescents at office visits, and I agree with the member who said we mostly need to be listening. But if we don't ask we risk not uncovering what may be a source of great anxiety. "Some teenagers have questions about their gender identity/whether their assigned birth sex matches what their brain tells them/[whatever phrase you want to use], and that's perfectly normal as they're trying to figure out their place in the world. Any questions about it that I can answer for you?" (Or, "Does this sound like you or anyone you know?" might work. Teens sometimes like to ask about 'a friend' when they're seeking info for themselves.)

A 12- or 13-yo is not going to be surgically transitioning, but they may take GnRH blockers to delay the onset of puberty while transitioning socially. Hormones come a little later in adolescence. A lot of trans therapy is close monitoring while weighing risks/benefits; hormones aren't risk-free, but neither is forcing a trans adolescent to live in a body that they don't want. (Let me say now: I fully understand that not every trans person wants to surgically transition, and that decision should be respected in either direction.)

There is a high incidence of mental health issues in transpeople, but it's not because they're defective, it's due to shame and stigma. THAT'S wrong.

If a care provider told my kid (trans or otherwise) to honor the body they were given, I would interpret that as them being told that dysphoria's is not legitimate, and that's inappropriate. Trans kids, especially, are so so vulnerable, and they are almost assuredly going to have a lot of adults in their lives telling them what to do. They're going to need a soft place to land. Based on what we know about sex, gender, and development, it's scientifically sound that we be that for them.

EaglesWings21, ASN, RN · Mar 30, 2018

I read something recently that made perfect sense to me. It said something along the lines of "you are not your sexuality." If your students struggle I would tell them they are not defined by these struggles or urges. They have so much more time for their brain to develop, so much outside influence, and so so many hormones. I would tell them to just try to be themselves. Figure out what is important to them in life. That just because they have one thought or inclinication that doesn't mean to immediately draw a conclusion. If I continued doing everything I did when I was 13 and 14, I would not fit into society like I do today. Teenage brains are complex and ever changing. I would avoid labels and finalities because things change so quickly from one day to the next.

Horseshoe, BSN, RN · Mar 30, 2018

I read something recently that made perfect sense to me. It said something along the lines of "you are not your sexuality." If your students struggle I would tell them they are not defined by these struggles or urges. They have so much more time for their brain to develop, so much outside influence, and so so many hormones. I would tell them to just try to be themselves. Figure out what is important to them in life. That just because they have one thought or inclinication that doesn't mean to immediately draw a conclusion. If I continued doing everything I did when I was 13 and 14, I would not fit into society like I do today. Teenage brains are complex and ever changing. I would avoid labels and finalities because things change so quickly from one day to the next.

This thread is about gender issues, not sexuality.