For parents

The common response is that greater social acceptance and awareness – especially for transgender men – has made it easier for people to realise they are trans. That is a huge factor, but what’s more relevant is that the ones coming out now represent a much broader spectrum of trans identities than before.

Until recently, the stigma of expressing any kind of non-normative gender identity was so high (and dangerous) that many of these people dared not even wonder if they might be trans. Instead, the ones who did transition back then were those who were willing to risk their lives because they simply could not fathom any other way to live. Their gender dysphoria was so severe, or their behaviour so clearly non-normative, that they would not have been able to hide it.

This is also why trans women have historically been criticised as giving in to extreme female stereotypes: it is precisely the extremely feminine trans women who found themselves completely unable to live as men. Others would have still struggled, and some did transition, but most found the risks to far outweigh the rewards.

Today, being trans is less of a death sentence. This is a good thing. We’re thus seeing a rise in masculine trans women and feminine trans men, non-binary people who do not identify as men or women, people who move between gender identities and expressions, non-heterosexual trans people, trans people with mild or no gender dysphoria, and so on.

Many would have previously resigned themselves to lives of quiet misery or resentment. Some are now finding their way out. Some may never transition, or be content with simple changes like their name or the way they dress.

This also means the steep rise in trans identification has not meant an equally steep rise in medical treatments. Many statistics are of those seeking counselling at gender clinics, regardless of what comes after. Even those statistics are creatively presented – such as the shocking claim that the number of natal girls visiting gender clinics in Great Britain has soared by 4,000%. What’s rarely mentioned is that the baseline number was 40 children, which had risen to 1,800 almost a decade later. There were 12.7 million children in Great Britain at that point.

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Transgender identity is not the same as sexuality. A child expressing their gender is not an indication they have been inappropriately sexualised, even if the gender they say they are is not what others expect.

Young children may not yet understand what being trans is, nor have a complex understanding of gender, but they are not too young to know when something feels wrong. A child who does not want to wear a dress is not too young to know that, regardless of whether or not they are trans.

Nonetheless, children are also more susceptible to gender stereotypes and may have immature understandings of sex and gender. A young child might think that having long hair is what makes someone a girl, or express wishes to be another gender because they prefer certain clothes, toys or activities, and believe that those things are only allowed for that gender; or they may think their parents will love them more if they are that gender.

That’s where adult discernment and education comes in. For the most part, those declarations are fleeting and harmless. Studies in the 1980s and 1990s found that the majority of those kids (as many as 80-90%) did not grow up to be trans; many ended up gay, bisexual or lesbian. This has commonly been misrepresented to suggest that most trans children will grow out of it, but most of those children were not considered transgender in the first place, and only exhibited symptoms of gender dysphoria. (Much like how having a cough is not the same as having COVID-19.)

However, a child who expresses persistent, insistent, consistent claims of being or wanting to be another gender, or discomfort around their body’s sexual characteristics – especially if accompanied by worsening signs of distress or depression – is more likely to be transgender. Unlike gender non-conforming children, simply allowing them to pursue the interests they want does not alleviate their distress, which instead centres around how others perceive their gender.

For example, a tomboy may be satisfied at being told that girls can do anything boys can do, and thrive when she’s encouraged to pursue the traditionally masculine activities she loves and excels at. In contrast, a trans boy may only be pursuing those activities because he thinks it will help him be seen as a boy. Telling him that girls can do those things too would not address the source of the pain, and may in fact worsen it because it would undermine his efforts to prove that he’s a boy.

A 2015 study exploring subconscious gender identity in children found that transgender children experienced their gender identities in ways indistinguishable from their non-trans peers – meaning that a transgender girl ‘feels’ like a girl in the exact same way other girls do.

In more extreme cases, children who experience a strong sense of their body being wrong may resort to self-mutilation. Trans girls as young as 4 or 5 have attempted to cut off their genitalia, tearfully insisting they’re not supposed to be there.

If your child is experiencing deep anguish around their gender and how they are perceived, and letting them dress and play as they like has not substantially alleviated that, it might be worth seeking out a professional who works with transgender youths and children. This can help bring clarity to the situation, and assess if social transition would be suitable for them.

Sometimes, just hearing about trans people can be a source of relief for the child, helping them make sense of what they feel, learn that they are not alone, assure them that transition is a possibility, and give them hope for the future.

Transgender children who desire to socially transition and do so have consistently had significantly better mental health compared to their trans peers who wanted to but were unable to transition. A 2022 5-year study of 317 prepubescent trans children who socially transitioned found that only 2.5% eventually ceased identifying as trans and detransitioned, typically those who transitioned prior to age 6. Another 3.5% came to identify as non-binary.

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Social media has heightened the visibility and awareness of transgender issues, especially among youths. This has allowed trans people to find words for how they feel, and find others who feel the same way.

It has also encouraged others to think more deeply about their own gender identities and try out different identities to find what fits best. For teenagers, this is part of the usual adolescent exploration that eventually leads to a firmer sense of who they are. Some may come to realise they are trans or non-binary; others may realise they are not.

Not having access to that exploration and education does more harm than good. For example, a feminine boy with no access to trans spaces might think he must be trans because he loves fashion and makeup and dreams of being able to wear a dress. Conversely, a trans girl may think she can’t be trans because she loves video games and is attracted to girls. A non-binary youth may meanwhile struggle to know where they fit in.

Trans youths may also end up thinking that there is only one way to transition, and feel obliged to pursue medical treatment that they may not actually want. Greater education, awareness and interaction with trans peers can help resolve these problems.

Ultimately, just as how it’s not possible for social media to make a trans person no longer trans, it’s also not possible for social media to make someone trans when they are not. A major source of that belief is the theory of ‘Rapid-Onset Gender Dysphoria’ (ROGD), or “social contagion”. A researcher observed some parents talking about how their teenagers, especially those who were natal females, were coming out as transgender after spending a lot of time on social media. The parents noted that their children were friends with other trans youths online. The parents concluded that those online friends had been influencing them, or that their children were identifying as trans for social approval and belonging.

The study has since been repeatedly debunked, including by this 2022 study of over 200,000 adolescents. It found firstly that the skewed gender ratio was due to a decrease in trans feminine (natal male) youths, rather than an increase in trans masculine youths, whose numbers had remained steady. Secondly, trans youths experienced far more bullying and social ostracism after coming out, countering the notion that they did so for social acceptance. It also found that the number of youths coming out as trans had actually fallen over time – from 2.4% to 1.6% between 2017 and 2019, even though greater and more sensationalised media coverage had given the opposite impression.

The ROGD paper was further criticised for how the parents were recruited from several anti-trans online forums and drew its conclusions based on their speculations, rather than actual statistics. The researcher has since retracted her paper and confirmed that no actual trans youths or clinicians were included in the study.

It is natural for young people to gravitate towards others – both online and offline – who seem to be struggling with the same things they do, including around their gender identity. When one of them then realises they are trans, their friends who feel the same way may come to that same revelation, giving the false impression that they influenced each other into becoming trans. In reality, it was that commonality of experience that drew them together in the first place.

Young people in general are spending a lot more time on social media than before, often to an excessive degree; this applies equally to those who are and are not transgender. Parents who grew up in a different time may end up linking those two concerns, but the evidence does not support one leading to the other.

Nonetheless, social media spaces can often be hostile and psychologically unhealthy. If your teenager seems to be spending too much time online and it is negatively affecting their well-being, consider finding them other ways to obtain the same benefits in a healthier space. If they are trans or are questioning their gender identity, they may wish to check out dedicated support groups for LGBTQ youths.

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No. Trans healthcare providers take a step-by-step, harm-reduction approach when it comes to youths and children. Transition itself comes in many stages, and is not something that children are rushed into when brought to a gender clinic for assessment. The first step is typically counselling to better understand the child’s identity, during which some may come to understand that they are not trans. (As with all healthcare – including children’s healthcare – there are bad actors, but that is a whole separate concern.)

The American Academy of Pediatrics (AAP) has a comprehensive set of guidelines for the care of transgender children and adolescents that lays out this process.

Among parents, even those who do believe their child is trans are very hesitant to allow them to transition, out of fears of social backlash, or how others would treat their child or respond to them as parents. Practical issues are another huge concern. In Singapore, public schools do not accommodate students who are transitioning, pressuring students to pursue private education – which is prohibitively expensive for most families – or to limit their social transition to non-school settings, where living that double life can be psychologically stressful and unsustainable. At the same time, not transitioning can be untenable for trans students with severe gender dysphoria. Many trans students end up dropping out of school as a result.

Parents are especially hesitant about any medical treatment due to fear of the risks involved. All that is exacerbated for those who are not convinced their child is really trans.

However, humans (and parents) are not a monolith. In very rare cases, there are parents who may be very enthusiastic about supporting their trans child and have their whole transition planned out. Sometimes it’s their way of showing how much they love and support their child. But if the child seems less certain than their parents, and it’s primarily the parents driving things, that’s usually a sign to hold back. Healthcare professionals who work with transgender children would be familiar with the red flags and make sure not to rush into anything.

Regardless, all this is largely irrelevant in Singapore, where social transition is near impossible, and transition healthcare unavailable for anyone under 18.

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No. It is common for parents to blame themselves or feel guilty that their child is transgender, wondering what they did ‘wrong’ for their child to end up this way. However, there is no known correlation between parenting styles and gender identity. It might only determine whether or not a child feels safe enough to come out.

Some parents worry that they were too strict in enforcing gender roles, making their child think they had to be another gender in order to freely be themselves. Conversely, other parents worry that they weren’t strict enough in enforcing gender roles, such that their child’s gender-atypical behaviour wasn’t stamped out before it developed into a trans identity – even though this is not possible, and only results in children repressing who they are in order to be accepted by their parents.

For every parenting style, there are parents who did the exact opposite and whose children were still trans. Trans people come from families that are conservative and liberal, religious and non-religious, rich and poor, loving and abusive, across all classes and ethnicities and cultures.

There is some weak evidence that being transgender runs genetically in families. It is not uncommon for more than one sibling to be transgender, or for a parent to eventually come out as transgender after their child does so, admitting that they had been repressing it all these years. Multiple members of an extended family may turn out to be transgender, even those who had no idea the others existed.

The only things parents can determine are whether or not their child feels safe enough to come out to them, or to discuss any struggles around gender they may have. Having a supportive family environment will also enable children to explore any gender-atypical interests and ask questions in a safe, non-judgemental space, rather than feel they have to work things out on their own or with peers who may not have the knowledge or wisdom to provide good advice.

The claim originated from the American College of Pediatricians (ACPeds), a small fringe group that was explicitly established to pursue an anti-LGBTQ agenda. Their president, Quentin van Meter, was invited to do a webinar in Singapore in 2021. We wrote a response to his webinar, which involved numerous contradictions and indicated a fundamental misunderstanding of who trans people are.

ACPeds is not to be confused with the official American Academy of Pediatrics (AAP), a professional association of over 64,000 pediatricians.

Snopes debunked ACPeds’s claims, and included a presentation from the AAP supporting an affirming approach to gender non-conforming children. The AAP emphasises that this does not encourage or push gender transition. Instead, it aims to provide the child with an supportive environment that lets them know they are loved and accepted just as they are – which is the opposite of abuse. Over time, the approach aims to help families differentiate between children with a persistent transgender identity and those who are gender non-conforming or exploring gender atypical interests.

For children who continue to assert a transgender identity, the AAP notes the positive outcomes when they are allowed to socially transition. Quoting the linked study:

This finding is especially significant in light of the high rates of mental health problems historically observed in transgender children and adolescents who are not able to transition until adulthood.

Trans children whose dysphoria was successfully alleviated with social transition but who experience renewed body dysphoria as they approach puberty may be further assessed for puberty blockers. We have written more about that here.

We have worked with other organisations in Singapore to produce a guide for parents of transgender children. It aims to be a companion to parents who may be feeling lost, confused, or distressed about their child’s gender identity. You can download the guide in English here. You can visit this page for versions in Chinese and Bahasa Melayu.

许多人错误地认为性别认同是性行为的副产品。有时这还导致人们断言，任何表现出跨性别身份的孩子都一定是受到性虐待的孩子。这是错误的。性别认同的存在和性倾向毫无关系。孩子们不需要知道性行为或者性倾向是什么就可以告诉您他们是男孩还是女孩，并且通常能够在18岁之前。
跨性别儿童也是如此。唯一的不同的是，他们表达的性别认同可能与典型的体型不同，因此他们可能因为他们的身体感觉到焦虑不安。

人类的性别认同在3岁左右就形成了。许多跨性别成年人从幼儿时代就意识到本身具有非典型的性别认同，即使他们可能没办法表达出这样的感觉。

一项2015年研究儿童潜意识性别认同的研究发现，跨性别儿童以与非跨性别同龄人无异的方式体验其性别认同。换句话说，跨性别女孩“感觉”像一个女孩，就和其他女孩一样。

其他跨性别儿童可能没有严重的性别不安，或者不敢说任何话，或者没有意识到能够作为身体的性别以外的可能性。他们可能过了一段很长的时间才意识到自己是跨性别者，但这不是他们改变性别身份的结果，而是花费更长的时间来发觉自己的性别认同。

无论如何，即使跨性别的孩子可能不知道作为一个性别意味着什么的复杂细微的差别，他们也能够分辨出什么时候感到不对劲或使他们感到痛苦。采取措施减轻这种痛苦是没有害处的，特别是当这种痛苦长期持续发生时；拒绝采取行动通常会导致更糟糕的结果。

但是，这些统计数据的研究来自对80年代和90年代被诊断出患有性别认同障碍（GID）的儿童的小样本研究。当时，诊断标准主要将性别认同障碍的儿童定义为那些表现出强烈的性别非典型游戏和兴趣模式的儿童，而并非要求孩子声称自己是或渴望成为异性。在这些研究中，许多孩子是女性化的男孩和男性化的女孩，他们对性别认同所表示的不满是因为别人因性别而对他们拥有的错误的期望。

这是经常被引用为证据的研究之一。该研究追踪了25名女孩，其中只有15名符合性别认同障碍的诊断标准。其余10个被视为“亚阈值”案例。在14年后的随访中，发现15个人中只有3个人是跨性别者。但是，大多数（如果不是全部）的这些女孩子们最初都是根据《精神疾病诊断与统计手册》III或IV诊断的，前者描述的是女孩的性别认同障碍如下：

患有这种疾病的女孩经常有男性同龄人群体，对运动和粗鲁的玩耍非常感兴趣，对玩洋娃娃或玩“房子”的兴趣不足。

《精神疾病诊断与统计手册III》（和《精神疾病诊断与统计手册IV》不一样）要求儿童也表达强烈的，持久的成为异性的愿望，很多假小子都会表示愿意成为男孩，这并不奇怪，因为当时的性别刻板印象比较刻板。此文详细介绍了一个年轻女孩的案例研究（第6页），该女孩坚持要成为男孩，并且符合所有《精神疾病诊断与统计手册》IV的性别认同障碍诊断标准。但是当被问到为什么要成为男孩时，她说那是因为她喜欢男孩的内衣。她说女孩不能穿男孩的内裤，所以她想成为男孩。

同样，一个男孩被告知不能玩洋娃娃，因为只有女孩这样做，他可能会做出反应：“那么我想成为女孩！”但是，他在这里的实际愿望是玩洋娃娃，而不是因为本身实际上是女孩，而诊断标准并未区分两者。

其他研究也遵循类似的模式。同时，许多跨性别儿童并不符合诊断条件，因为他们被认为不够男性化或女性化。

为了滤除这些误报，部分诊断标准随后被修订了，以不再强调性别非典型性特征，而将重点放在患者坚持自己是另一个或是想要成为另一个性别上。这是跨性别者身份的决定性特征，尤其是在伴随着持续数月或数年之久的明显困扰的情况下。如果一个女童表现出强烈的想成为男性的愿望，而当被允许与“男孩”玩具一起玩并穿上更多阳刚的衣服时，这种痛苦和欲望减轻了，那么她很可能只是个假小子；但是，如果所有这些行动仍然无法解决困扰，那么她很有可能这是一个变性男孩。

（您可以在这里阅读更多有关此内容的信息。）

父母通常会自责或在得知自己的孩子是变性者后感到内疚。他们可能会尝试弄清楚自己做错了什么，让孩子有这种结果。但是，父母教养方式和性别认同之间没有已知的关联，目前的证据强烈指向产前的生物学影响，尤其是激素影响。

一些父母担心他们在执行性别角色时过于严格，导致孩子觉得自己必须成为另一种性别才能自由地作为为自己。相反的，其他父母担心他们在执行性别角色方面不够严格，导致一个孩子在发展成为跨性别身份之前并未消除其性别非典型行为。对于每种育儿方式，有些父母做的完全相反，但最终还是有了变性孩子。跨性别人士来自各个阶层，种族和文化，家境保守派的也有和自由派也有，宗教派和非宗教派，富人和穷人，充满爱的家庭和从满虐待倾向的家庭都有。

有一些微弱的证据表明，跨性别者在家庭中遗传。不止一个兄弟姐妹成为跨性别人，或者父母在孩子表达自己是跨性别后也声称自己也是跨性别人，并承认他们多年来一直压制它，这些并不少见。一个大家庭的多个成员可能是跨性别者，即使那些不知道其他人存在的人也是如此。跨性别和非异性恋倾向也有联系，跨性别者更可能拥有同性或双性恋的家庭成员。一名跨性别女人发现她先前婚姻中的三个儿子都是同性恋。

听起来很正式的美国儿科学会（ACPeds）的一份声明驳斥了跨性别者身份的合法性，并宣布让变性儿童过渡是虐待儿童。

但是，与拥有64,000多名儿科医生的美国儿科学会不同，ACPeds不是官方的医疗机构。这是一个由大约60-200人组成的小团体，其明确目标是追求反LGBT议程。

您可以在此文中逐点阅读反驳他们的点数。斯诺普斯（Snopes）也对他们的主张进行了揭穿，以及来自实际的美国儿科学会的演讲，支持对性别不符合儿童采取肯定的方法。他们建议父母为孩子提供一个可以被接受的，支持性的环境，无论他们最终是否跨性别，都让他们蓬勃发展。

对于那些仍然坚持跨性别身份并表达过渡愿望的人，美国儿科学会注意到允许跨性别儿童社交上过渡的积极成果：

总而言之，我们提供了新的证据，表明在性别认同上受到支持的年轻跨性别儿童中，他们的心理病内部化率低。这些数据至少表明跨性别的可能性与儿童期的心理病理学不是同义词，也不是其直接的结果。相反的，这些结果提供了明确的证据，表明变性儿童的焦虑和抑郁水平与非变性兄弟姐妹和同龄人没有什么不同。

资料来源：身份得到支持的跨性别儿童的心理健康