How do you discuss gender issues with adolescents?

Nurses General Nursing

Published

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.

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.

This is really lovely.

Specializes in ER.
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.

What I was worried about was if a kid was questioning their sexuality, what of they decided to take hormones, is that an irreversible decision in any respect? Would they lose fertility?

By honoring the body they have, I guess I wasn't very clear. I would say the same to a medically ill child that was frustrated. I want them to look at what is working in addition to what isn't, and be proud and happy. A trans kid could be dismayed at breast development and getting a period (I certainly was, and didn't have any trans issues) but their body is working as designed, they are starting out healthy, and can make changes medically as they wish in the future. Hope that makes more sense.

Specializes in Hospice, Palliative Care.

I stick with science: DNA and chromosomes. I don't encourage the schizo____ who believes they are the president, I don't encourage the person who is having a panic attack about a bomb in the room that is not there... and I don't encourage the anorexic that her belief (which is not science) that she is fat.

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.

I love this! I would like to share this sentiment at our clinic's next staff meeting. We have received a good amount of staff inservices pertaining to this , but I have never heard it expressed so perfectly.

What I was worried about was if a kid was questioning their sexuality, what of they decided to take hormones, is that an irreversible decision in any respect? Would they lose fertility?

An individual doesn't take hormones because they are questioning their sexuality, they take them because they don't believe their physical body is compatible with their gender identity. Sexuality and gender identity issues are NOT the same thing. It seems even those in the nursing profession don't always understand this.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I do so honestly and compassionately. They ask questions, I give honest and caring answers. For me, it's never been hard to do.

Specializes in ED, med-surg, peri op.

I don't think people on this post get it. In the real world a gay or transgender person is not going to have loving supportive family and friends all the time. They not always going to know what's going on with themselves either. People still get bullied for this, families still struggle with these topics, and the person themselves struggle a lot even if they have support. Surely everyone knows the rate of self harm and suicide is quite high in this group.

I think it's important to talk about how to approach this topic with youth, as someone whose straight and doesn't know anyone who's trans or only met people that are openly gay and don't have problems with it. I wouldn't really know how to comfort someone who was struggling with this. Relying on there peers is awful advice, or telling them they can come out and everything will be fine when you don't know there home life is equally awful advise. (Which I may have read the wrong way, but that's what I got from this post).

It is a sensitive topic that you really need to approach right to maintain that therapeutic relationship and for the pt to keep talking to you. Firstly I wouldn't worry about the hormone treatment, it's not your place to discuss that. Maybe research the process so you know where to send someone if they are wanting the treatment. But you don't need to worry about discussing that to much. And secondly I wouldn't be giving out any cheesy advice like honour you body. Telling them it is ok to feel the way they do and that it's completely normal is a bit better if they are confused. If they are 100% Sure and want to come out then I would asked them about there concerns and see if there's anyway I could help.

We don't live in a perfect world. People still have issues with people being gay and trans. While we may live in a more progressive world, people aren't all going to accept this. We can't send youth out there thinking everything is going to be fine.

Specializes in Community, OB, Nursery.
What I was worried about was if a kid was questioning their sexuality, what of they decided to take hormones, is that an irreversible decision in any respect? Would they lose fertility?

By honoring the body they have, I guess I wasn't very clear. I would say the same to a medically ill child that was frustrated. I want them to look at what is working in addition to what isn't, and be proud and happy. A trans kid could be dismayed at breast development and getting a period (I certainly was, and didn't have any trans issues) but their body is working as designed, they are starting out healthy, and can make changes medically as they wish in the future. Hope that makes more sense.

Thanks for the clarification.

So, if a kid is questioning their sexuality, they're probably not going to be on hormones unless they're also certain their gender identity differs from their assigned sex, and sometimes not even then until they're a certain age. Sexuality is who they're attracted to. Gender identity is who they are. Everyone, us posting here included, gets one from category A, one from category B.

I have found this resource to be extremely helpful with regard to trans health issues, and some of the questions you've got will be answered. I spent hours one night reading through most of this stuff and it was riveting.

Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: Fertility options for transgender persons

Like most people said here I think listening and trying to understand is best. I remember trying to broach these subjects with my parents and it didn't go as I thought it would. My older sister is gay so I thought it would be somewhat "normal" but I was seen as trying to imitate her. And I distinctly remember my mother watching a documentary or something about transgenderism when I was very young and her saying "I just couldn't handle if one of my daughters did that to me. I just wouldn't be able to accept you being my son all of sudden". So needless to say i never even brought up the gender thing. I wish she had been more open. At some point people are going to have to stop blaming it on what they were taught and start learning new things. Everything can't stay the same and no one wants to stay in the dark for the rest of their lives, having to hide themselves. I'm tired of hearing things like "your generation has all these new found gender things/sexualities/every one thinks they're gay now. We never had that in my day." Yes, yes you did. It just wasn't spoken about. (Sorry this comment isn't supposed to sound mean to the people here. In just speaking generally about the people who AREN'T supportive or even who are violent and angry about it. And I don't understand that because it really isn't their decision to make.

You are right. I am one if those "youths" if you call 23 youth. And in north carolina....people are not generally accepting of much "difference" here, so I feel like i came out (to a few people) just to go back into hiding for safety reasons. So now I feel stuck with no support and I can't be myself. (No just with gender or sexuality but everything.) I know this was about adolescents but I felt the same then too and was not comfortable or validated. (Actually when I was adolescent gender was just starting to be publicized on tv but not exactly accepted, more like spectated and probed at. Like Chaz Buno? or My Name Is Jaz..I'm not sure if these are the right spellings but if anyone remembers the shows, thank you . but it was something I didn't want to watch because I was told early that basically that was just unacceptable/not an option. (I also had a time in adolescence where I wore mostly "boyish" clothing and my mother said she would burn them all if I didn't throw them away immediately)

Question: Has anyone ever had a trans patient who didn't have at least anxiety, depression, bipolar or PTSD in their health history? Are the two related? Chicken before the egg kind of thing? Or does the difficulty of being trans cause the aforementioned issues?

Question: Has anyone ever had a trans patient who didn't have at least anxiety, depression, bipolar or PTSD in their health history? Are the two related? Chicken before the egg kind of thing? Or does the difficulty of being trans cause the aforementioned issues?

I've had this question as well. My experience with transgender patients is the same as yours.

+ Add a Comment