WHAT YOU NEED TO KNOW:

What is gender identity? Gender identity is a term used to describe feeling like a boy or like a girl. A child knows if he or she is a boy or a girl by the age of 1 year. By 4 years, a child understands differences between boys and girls. Your child's sex refers to being born as a boy or as a girl. Gender refers to how society expects boys and girls to act and appear. For example, girls may be expected to wear dresses and play with dolls. Boys may be expected to play more roughly, or with toy trucks. Your child may be born as one sex but feel more like the other sex.

What terms are used to describe gender identity? Your child may identify with more than one of the following terms. He or she may feel that none of the terms apply. Try not to label your child. Even if the terms do not apply to your child, they can help you understand your child's exploration of gender identity. The terms can also help you talk with your child's healthcare providers and school officials.

• Gender variant, or gender nonconforming, means not acting the way society dictates for a gender role.
  
  
• Gender expression refers to the way a person dresses and appears to others. Your child can enjoy dressing like the opposite gender and also be comfortable with his or her birth sex.
  
  
• Genderqueer means having a gender identity that is not male or female, or is a combination of both.
  
  
• Transgender means identifying with the opposite gender. The term can also be used to describe a person who does not feel completely male or female.
  
  
• Social transition means expressing gender identity on a regular basis. Your child may start by wearing certain pieces of clothing, or only wearing them at home. He or she may then start to wear the clothing in public. This may be temporary, or it may be the first step toward permanently identifying with the opposite gender.
  
  
• Transsexual means permanently identifying with the opposite gender and showing outward signs. The term can also refer to a person who has had a medical or surgical procedure to change body parts into the opposite sex.
  
  
• Gender affirmation means making a decision to be the opposite gender and making changes in expression in public. For example, your child may change his or her name.
  
  
• MTF or FTM are terms used to describe the change in gender identity. MTF means male to female and is used to describe a person born with the male sex but who has a female gender identity. FTM means female to male and is used to describe a person born with the female sex but who has a male gender identity.
  
  
• Gender dysphoria means not liking to be the sex assigned at birth. Your child may feel distress at having to appear in a way that is expected for his or her birth sex. He or she may feel anxious or depressed when puberty starts to change breasts or sex organs, deepen the voice, or cause facial hair to grow.
  
  
• Sexual orientation refers to being straight, gay, or bisexual. Sexual orientation is not caused by gender identity.

What treatment is available for my child? The goal of treatment is to help your child understand and accept his or her gender identity. Treatment is not meant to change your child or force him or her to act like society expects for his or her birth sex.

• Counseling with an experienced healthcare provider may help your child safely explore gender identity. Counseling may also help all members of the family accept your child's decisions and be supportive. Support groups with other transgender people may also be helpful. Ask your child's healthcare provider for more information.
  
  
• Puberty suppression medicine can help delay the start of puberty. Puberty brings physical changes that can be difficult for a child who has gender dysphoria or is still exploring gender identity. This medicine delays the start of puberty but does not stop it completely. The medicine allows your child to take more time to explore gender identity and decide.
  
  
• Medical alteration can help change your child's body to match his or her gender identity. Medical alteration means the person receives hormones of the opposite sex. A child born male receives the female hormone estrogen. A child born female receives the male hormone testosterone. Ask your child's healthcare provider for more information. This is not a decision your child can make quickly. He or she will need to have counseling, and express the affirmed gender in public.
  
  
• Surgical alteration means using surgery to make physical changes permanent. A person must be at least 18 years old to have surgery. The surgery used to be called gender reassignment. It is currently called gender affirmation.

What can I do to help support my child?

• Learn and use appropriate terms. Listen to the gender identity terms your child uses to describe himself or herself, and practice using those terms. You may need to explain the terms to others or teach them the terms to use with your child. Use the pronouns your child prefers. For example, a child who is born female but identifies as male may want to be referred to with pronouns such as he, him, and his.
  
  
• Be positive and supportive. Do not tell your child that this is just a phase. By the time a child reaches adolescence, gender identity exploration is not just part of playtime and imagination. Do not try to force your child to dress or act in a way that you feel is more appropriate. Your child's gender identity cannot be changed. Remind your child that gender is only one small part of his or her identity. Talk about all of the qualities you enjoy about your child.
  
  
• Make your child feel safe at home. Help all your children and other family members be supportive. Do not allow them to make fun of your child. Name calling and bullying are never acceptable.
  
  
• Be supportive in public. Your child may receive unwanted attention in public. People may stare, point, or laugh when they see your child. This can be embarrassing for your child. You may also feel some embarrassment, but it is important to remain supportive. Encourage your child to be confident in public. Be open and available if your child wants to talk about something that happened.
  
  
• Talk to your child's care providers. Anyone who cares for your child needs to know how to be appropriate. This includes medical professionals and childcare providers. Medical visits may be stressful for your child. Give providers information ahead of time so they know how to speak respectfully with your child.
  
  
• Talk to teachers and officials at your child's school. Bullying can be a problem for a person who is exploring gender identity or is transgender. Your child's school officials will need to make sure that your child can attend school safely.

What are the risks of gender identity problems? Your child may become depressed or anxious if he does not feel accepted in exploring gender identity. He or she may be bullied for dressing or acting a certain way. He or she may feel left out or discriminated against. This may cause him or her to become withdrawn. Gender identity problems increase your child's risk for suicide or self-harm.

Call 911 for any of the following:

• Your child threatens or attempts suicide or self-harm.
  
  

When should I contact my child's healthcare provider?

• Your child is depressed, withdrawn, or anxious.
  
  
• You have questions or concerns about your child's condition or care.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.