Transgender and Gender-Diverse Youth


The Questions and Answers that follow aim to provide an introduction to transgender and gender–diverse youth for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
More information about many topics relevant to children with transgender and gender–diverse youth and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Transgender and Gender-Diverse module.

Who are transgender and gender-diverse youth?

Some individuals' gender identities do not match their assigned birth gender; these identities are thought to develop from a combination of genetic, biological, hormonal, cultural, and environmental factors. Some terms used to identify this select group of individuals include transgender, gender-diverse, and gender non-binary.

What is gender dysphoria?

Gender dysphoria is the distress associated with a mis-match between the sex and gender a person was assigned at birth and their personal sense of gender – their gender identity.

What are the symptoms?

Transgender children consistently, persistently, and insistently express a gender identity that is different from their assigned sex. Transgender children may adopt preferred pronouns, a new name, and clothing that matches their gender identity. However, these changes may not resolve their gender dysphoria, which may manifest as symptoms of depression, anxiety, or anger, often related to the undesired physical traits of their biologic sex.

How is it diagnosed?

Diagnosis of gender dysphoria includes assessing for gender non-conforming identity, a detailed social history, and identifying symptoms of dysphoria. Individuals must show multiple characteristics for at least 6 months. Detailed criteria can be found in the Transgender and Gender-Diverse diagnosis module.

What is the expected outcome?

Good outcomes are associated with resolving the distress of gender dysphoria, acceptance by family and a social network, and early identification and treatment of potentially associated conditions, including mental health disorders, traumatic stress, substance use/abuse, HIV, and sexually transmitted infections. Youth who identify as transgender often have a mood disorder, anxiety disorder, or post-traumatic stress disorder. Psychosocial support, hormone therapy, and gender-focused psychotherapy are helpful for youth and young adults.

Will anyone else in the family get gender dysphoria?

The development of gender identity is poorly understood and influenced by a variety of factors. Studies with twins suggest that gender identity may be more of a matter of biology than choice. Ongoing studies aim to better understand the roles of genetics and other factors in gender identity.

What is the treatment?

Gender dysphoria can be decreased with social transition (informing others about their gender identity) and treatment, which may include hormone therapy, psychotherapy, and surgery. The purpose of these treatments is to promote gender roles and gender expression that are affirming to the individual.

How will my family's life be changed?

Families often struggle to understand and accept non-conforming gender identity but doing so may be the most important factor in a healthy outcome for the transgender or gender-diverse youth. Families can support treatment plans including psychological and medication treatments, provide emotional support, and assist with youth development into adulthood.


Information & Support

Transgender Youth and Schools

Schools in Transition: Guide for Supporting Transgender Students in K-12
Considerations and practical tips by age and topic (dress codes, names & pronouns, bullying, sex-separated facilities, etc.) for school teachers and administrators to support safe environments for transgender students (68 pages); by American Civil Liberties Union, Gender Spectrum, and other partners.

LGBT Youth & Schools Resources (ACLU)
A library of resources for school administrations and gender nonconforming students with information about harassment, free speech, privacy, suicide prevention, and more; American Civil Liberties Union.

Know Your Rights! A Guide for LGBT High School Students (ACLU)
A 7-page electronic resource with information for students about Title IX, privacy, freedom of speech, and more; American Civil Liberties Union.

Teaching Transgender Toolkit
Best practices, lesson plans, and resources for those who wish to facilitate trainings about transgender people, identities, and experiences; written by Dr. Eli R. Green, founder of The Transgender Training Institute, available for a fee.

Legal Changes to Identity Documents

Gender Change and ID Documents (NCTE)
Find out how to get a legal name change where you live and update your name/gender on state and federal IDs and records; National Center for Transgender Equality.

How Do I Change My Gender on Social Security Records? (SSA)
Required documents and processes; Social Security Administration.

Gender Designation Change for Passports (U.S. Dept of State)
Requirements and answers to frequently asked questions about gender changes on U.S. passports.

Transgender Parents

Protecting the Rights of Transgender Parents and Their Children
A guide for parents who have transitioned or come out as transgender and are facing challenges to their legal status as parents; American Civil Liberties Union and National Center for Transgender Equality.

For Parents and Patients

Center of Excellence for Transgender Health (CoE)
Information, programs, and services for transgender individuals; Center of Excellence for Transgender Health, University of California, San Francisco.

Facts for Families: Transgender and Gender Diverse Youth (AACAP)
An introduction for families about gender diversity; American Academy of Child & Adolescent Psychiatry.

How I Help Transgender Teens Become Who They Want to Be (TED Talk)
A TED talk (approx. 17 minutes) by Dr. Norman Spack at Boston's Children Hospital about his experience as one of the few doctors in the United States to treat minors with hormone replacement therapy.

Gender Revolution: A Journey with Katie Couric (NGS)
A documentary that explores gender identity; National Geographic Society.

Where's My Book?: A Guide for Transgender and Gender Non-Conforming Youth, Their Parents, & Everyone Else
A 390-page book to help transgender youth through puberty. Explains the basics of gender identity, sexual orientation, puberty, puberty blockers, hormone treatments, and gender-affirming surgeries - by Dr. Linda Gromko (2015).

The Gender Creative Child
A 304-page book for parents and professionals that explains the rapidly changing cultural, medical, and legal landscape of gender and identity - by Diane Ehrensaft, PhD (2016).


The Genderbread Person (PDF Document)
A popular infographic that breaks down gender identity, gender expression, biological sex, and sexual orientation into an easy to understand visual.

Services for Patients & Families in Montana (MT)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: June 2018; last update/revision: June 2019
Current Authors and Reviewers:
Authors: Adam W. Dell, MD
Reviewer: Nicole Mihalopoulos, MD, MPH