Raising a Transgender Child / How parents can help their kids live the lives they always hoped for
Jennifer and Jon Campisi thought their daughter Eva was most likely a tomboy. As a young toddler, the child protested girls’ clothing. “She — we were saying she then — would bring stuff home from day care,” Jennifer says. “And it would be boy toys.”
The Dallas couple explained to her that she could be a girl and still enjoy things like soccer and trucks. They even found toy trucks that were pink to drive home their message.
But they soon realized it was about more than the toys their child wanted to play with.
“We heard him pray to be a boy,” Jennifer says. “He asked questions like, ‘Why did God make me a girl?’”
At around age 4, they heard their child tell Santa that what she wanted for Christmas was to be a boy. “He was asking to be called Adam or Jake,” Jennifer adds.
Like many parents do when we have questions, Jennifer turned to Google, typing in queries like: “My 4-year-old daughter thinks she’s a boy.”
To the Internet’s credit, she found a likely explanation: transgender.
“I had never heard of transgender,” Jennifer says. And it’s no wonder: A very small percentage of the U.S. population identifies as transgender (though the estimates that exist are considered rough at best), and resources for the transgender community have been historically lacking.
But when the Campisis started their journey with EJ, a nickname they came up with until they legally changed his name from Eva to Evan, now 9, they found a supportive community, lots of fellow parents to talk to and ample resources to help them navigate the world of raising a transgender child, all through their counselor, whom they found through an Internet search.
Understanding transgender individuals starts with understanding gender and recognizing that a person’s gender identity doesn’t necessarily correspond with physical biology.
“An individual who is transgender does not agree with the biological sex they were assigned at birth,” explains Dr. Oliver L. Blumer, an advisor to the Transgender Education Network of Texas and an advocate for transgender individuals. In Blumer’s case, for example, he was born a female but identifies as a man.
“I was a boy,” he says. “And I felt that way since I was 3.”
To some parents, 3 might sound young. But these feelings of not being born into the right gender often do start young, because, as Feleshia Porter, a Dallas counselor specializing in gender identity and transition, points out, “Gender is a hard-wired aspect of our self.”
And it’s not just about masculine or feminine traits.
“To some extent you can gauge a person’s masculine or feminine expressions when they’re younger,” says Renee Baker, a counselor in Dallas, who specializes in working with the lesbian, gay, bisexual and transgender (LGBT) community. “But gender identity is different.”
A young girl might have masculine behaviors and typical “boy” interests and identify as a girl, while another might have those same behaviors but identify as a boy.
For some individuals, it’s not a clear choice, says Dr. Ximena Lopez, a pediatric endocrinologist and founder of the Gender Education and Care, Interdisciplinary Support (GENECIS) program at Children’s Health in Dallas.
“This is a spectrum,” she explains. “There are children and adults who don’t identify in this binary form of gender. They don’t identify as one or the other.”
Not identifying as the gender one was assigned to at birth is clinically called gender dysphoria. “This is something we think has existed for a long time,” Lopez says. “The earliest reports are from the 1920s.”
But for many decades, transgender individuals didn’t have the resources to help them understand why they felt the way they did — and to know they weren’t alone. And while the resources are growing, social acceptance of transgender individuals is a work in progress.
“There is no specific diagnostic test to identify someone as transgender — no genetics, no blood test,” Lopez explains.
For the Campisis, EJ was able to express his identity before he had the words to describe it. This is common, Lopez informs, though many children won’t express their identity until adolescence.
“Most psychologists do feel that during early childhood, children fluctuate in how they express their gender,” Lopez says.
The important thing, Porter adds, is giving kids a chance to explore their gender identity.
“Until puberty hits, you don’t have any permanent representation of your gender,” she says. “That’s a perfect time for kids to explore.” And when kids get the message that it’s OK to be who they are, “they’ll stop hiding who they are,” she adds.
And that can have a profound impact. Young people who aren’t able to explore their gender identity may lag behind their peers in their emotional development, Porter notes.
“That’s why we try to create an environment that allows a child to explore how they identify,” she adds.
Coping with the Emotions
Every parent is different, Baker says, and that means everyone will experience emotions that are uniquely theirs, but there are some common themes.
“Parents can be hard on themselves,” she says. “They sometimes blame themselves — like they did something wrong.”
But experts say parents can’t make their child transgender. “There’s no proof that the environment has any effect,” Lopez says. “In our experience here, we see families from every type of environment — conservative, liberal, one parent, two parents, all different religions. And this has been reported in all parts of the world.”
While there’s no real understanding behind a cause, she adds, there is some data to suggest that gender identity happens in the brain.
In one study, published by the Oxford Journals, researchers conducted MRIs of the brains of adults and found that transgender adults have brains that look more like the gender they identify with.
Once they shift away from blaming themselves, parents often have to grieve.
“They need to grieve the image they had for that child and the hopes and dreams they had,” Porter says.
When a child transitions from living as a girl to living as a boy or vice versa, the transition affects the parents too. “They have to transition from the parents of a little girl to the parents of a little boy,” she says.
Baker uses her own experience to inform and talks to parents.
“I know what my parents went through with my own transition,” she says. “I know how hard it is for parents. They have expectations and dreams for their kids. And all of a sudden, there’s a shift.”
For the Campisis, fear was another emotion they had to face.
“I stressed about how he’d be treated at school,” Jon says.
“There was a lot of fear — fear of what other people would think. Would they be accepting?” Jennifer adds. “You want to be protective of your child.”
Working through the emotions as a parent is important, and part of what counseling offers is assistance in finding language for what they’re feeling.
“Being able to have a good dialogue with the child is very important,” says Michael J. Salas, a Dallas-based therapist. “The families that don’t work on that start to build distance and heavy boundaries, and they don’t feel as connected.”
As a child goes through their transition, Baker says, a lot of parents see their child blossom — becoming happier and more engaged.
“And they really are able to connect at a deeper level. That’s true a lot,” she says. “The transition is a mental and emotional one as much as it is a physical one.”
As a child explores his or her gender identity and families contend with the related emotions, there’s a physical reality we can’t control: puberty. It’s a confusing time for adolescents regardless of gender identity, but for young people who are faced with the idea that they are developing into something they don’t want to be (and with no control over it), it can be particularly distressing.
The good news for parents is there are medical interventions that can help. The Children’s Health GENECIS program, which has grown to more than 210 patients since opening in early 2015, brings together multiple specialties — including psychology, psychiatry, social work, pediatric endocrinology, adolescent medicine and gynecology — to help transgender children (ages 4 to 17) and their families.
Lopez saw a need for the program a few years ago when she was seeing more and more patients with gender dysphoria. She no longer wanted to send patients out of town. Knowing that according to a report of the National Transgender Discrimination Survey, 41 percent of transgender individuals admit to attempting suicide (compared with 1.6 percent of the general population), she wanted families to have this resource in the North Texas.
For the Campisis, GENECIS has been a tremendous blessing.
“It’s one place that knows our child and our family and our story,” Jennifer says. “It’s comforting to know you can go to them.”
The program offers two kinds of hormone therapy for adolescents. The first is a puberty suppression therapy.
“We put puberty on pause,” Lopez explains. “It’s benign and pretty reversible.”
For girls, the therapy delays the development of breasts and a menstrual cycle.
“We can’t imagine how much these kids suffer,” she says. “They go to great lengths to hide their breasts.”
For boys, the therapy prevents physical changes like facial hair, an Adam’s apple and the deepening of the voice.
Looking the way they want to present themselves helps give young people more confidence and can make it easier for their peers to accept them.
“Adolescence is the age where people want to be accepted by everyone else,” Lopez says.
When Melissa Ballard’s daughter was 12, the child told her parents she wanted hormone blockers. The Little Elm mom didn’t know what they were and so wasn’t on board at first, and her daughter interpreted that as a lack of acceptance from her parents.
“But the truth was I just didn’t know what it was,” Ballard says. Meanwhile, her daughter knew that he was a boy. And if he couldn’t live as a boy, he didn’t want to live.
The child — Ashur — was suicidal. Early last year, the family went to GENECIS for an evaluation and started hormone therapy that summer. Today, Ballard says, Ashur is happier and emotionally stronger.
The therapy allows young people the luxury of time. “They have time to continue to explore their gender before anything irreversible is done,” Lopez says.
That time is essential, Baker explains.
“Let them have the time they need. Some parents might want to get the transition over with,” she says. “But that’s not healthy.”
The second therapy is a hormone replacement therapy, also called gender-affirming therapy that helps the teenager develop as the gender he or she identifies as.
This therapy, Lopez notes, does have some irreversible effects and typically isn’t started until around age 16 following the puberty-suppression therapy.
The Role of Support
Perhaps the most helpful thing for the Campisis was connecting with others.
“We’d meet other people with transgender kids, and their story was like our story,” Jennifer says. “It gave us hope that we’re not alone. At first, we didn’t know anybody, and that’s a scary place to be.”
Porter and Baker help bring families with transgender kids together. At the same time Baker runs a biweekly support group for parents, Porter engages the kids and their siblings in play (the counselors share office space).
“Our parents really bond,” Porter says. “They have play dates; they invite each other over.”
The support has helped the Campisis.
“We know now that it’s not a big deal like we once thought it was,” Jennifer says. “It’s not anything we did — or anything we didn’t do.”
Ballard saw a need to connect with parents and families — and for the kids to engage with one another too — beyond support group sessions. So, she started DFWTKF.com (Dallas-Fort Worth Trans Kids and Families) to help families like hers connect socially.
Kids, she says, benefit from being face to face with other kids going through the same things they are. And the parents find comfort in talking to people who truly understand their challenges and needs.
Another source of support can be extended family.
“It’s wonderful when they’re supportive and loving,” Porter says. Some parents expect grandparents and aunts and uncles to have a negative response and might delay telling the extended family.
“Don’t predict how people are going to respond. Allow them to have their own response,” Porter advises. “People will surprise you.”
She says that once a child’s parents start educating family members, things often get smoother. “Families are pretty resilient when you give them a chance,” she says.
And while parents can find solace in support, the person who needs the most support is the child.
“It’s just about simply accepting the child and being there for them — loving them on a daily basis,” Baker says.
When parents reject a child, there’s a high risk of the child becoming isolated from their families, Lopez explains. And that can lead to a higher risk of depression and suicide as well as risky behaviors — running away from home, drugs, alcohol and prostitution.
“The main determinant is parental support,” she says. “What I suggest is to accept each child for who they are. The most important thing for parents is that they support their child.”
Embracing Our Kids
EJ started his transition around the time he started kindergarten. He doesn’t feel like he has to hide who he is, and he knows he has the support of his parents.
Like a lot of third-graders, he plays sports with friends — he’s played basketball with the same team for multiple seasons. He likes science and reading in school, and he has a lot of friends.
“He’s never had any issues in school, no behavioral problems,” Jennifer says.
And kids might be kinder than we think.
“Don’t be scared. You’re still going to have a lot of friends,” EJ advises other kids. “People won’t tease you.”
For Jon and Jennifer, it wasn’t an easy road, but connecting with the right resources made all the difference. And when parents have the right support, they are equipped to care for their kids.
“Love your kids for who they are, and don’t worry about what others think,” Ballard says. “If your kid is healthy and happy and they have your support, they’re going to flourish.”