Transgender and Gender-Diverse Youth


Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Transgender and Gender-Diverse, which is written for primary care clinicians but also may be of help to parents and family members.

Who are transgender and gender-diverse youth and what causes gender dysphoria?

Some individuals' gender identities may not match their assigned birth gender but rather come from a combination of biological, cultural, and environmental factors. Terms used to identify this select group of individuals include transgender,gender-diverse, and gender non-binary. Gender dysphoria is the distress associated with one's perceived lack of matching of self with regards to gender expression.

What are the symptoms of gender dysphoria?

Transgender children consistently, persistently, and insistently express an opposite-gender identity and feel that their gender is different from their assigned sex. Transgender children may undergo a social transition by adopting preferred pronouns, a new name, and gender-affirming attire. However, making these changes may not completely alleviate gender dysphoria. Persisting gender dyshproia may manifest as symptoms of depression, anxiety, or anger usually related to undesired physical traits related to their biology sex.

How is it diagnosed?

Diagnosis includes assessing for gender nonconforming identity, gender dysphoria, and exploring a detailed social history to find differences in gender identity and sex assigned at birth. Individuals must show multiple characteristics for at least 6 months. Detailed criteria can be found in the Transgender and Gender-Diverse.

What is the prognosis?

Alleviating distress associated with gender dysphoria and early identification and treatment of common related conditions, including HIV, substance abuse, sexually transmitted infections, and mental health disorders, improves outcomes. Youth who identify as transgender often have an underlying mood disorder, anxiety disorder, or post-traumatic stress disorder. Psychosocial support, hormone therapy, and gender focused psychotherapy are helpful for youth and young adults.

What is the risk for other family members or future babies?

The development of gender identity is poorly understood and influenced by central nervous system factors, genes, hormones and hormone receptors, and environmental 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 role(s) of genetics in gender identity, as well as neuroanatomical, environmental, social, cultural, and hormonal factors.

What treatments/therapies/medications are recommended or available?

Gender dysphoria can be decreased with social transition and treatment, including hormone therapy, psychotherapy, and surgery. The purpose of these treatments is to promote gender role and gender expression that is affirming to the individual.

How will my child and our family be impacted?

Families can provide emotional support, support treatment plans including psychological and medication treatments, and assist in transition to adulthood.

What proportion of children who like to dress or play like members of the "opposite" sex end up transgender?

While many children enjoy playing in non-gender conforming ways (e.g. girls playing with trucks) and wearing non-gender conforming clothing (e.g. boys wearing princess dresses), only about 15% of children with gender dysphoria ultimately identify as transgender.


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 in Montana

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Adolescent Medicine

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Child Abuse Counseling

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General Pediatric Surgery

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Nutrition Assessment Services

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Pediatric Cardiology

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Pediatric Endocrinology

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Pediatric Gastroenterology

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Pediatric Hematology/Oncology

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Pediatric Plastic Surgery

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Psychiatrist, Child-18 (MD)

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Psychologist, Child-18 (PhD, PsyD)

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Speech - Language Pathologists

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Authors & Reviewers

Initial publication: March 2018; last update/revision: August 2018
Current Authors and Reviewers:
Author: Adam W. Dell, MD