Research shows that children recognize their own gender and gender in others starting when they are very young. You may notice children behaving in ways typical of their gender as early as two or three years old. By the age of five, most children can identify the gender of other people.
Children whose gender identity doesn’t match the gender they were assigned at birth may behave in ways that don’t match their assigned gender. For example, a child who was assigned female at birth might prefer to play with "boy toys" like trucks and tools. This can start when children are toddlers.
By early grade school, children may be able to express that their internal gender is different than the one they were assigned at birth. This is known as gender dysphoria. Gender dysphoria is the distress someone feels when there is a difference between their gender identity and the anatomy of their body. People with gender dysphoria are called transgender.
In a 2020 study of transgender adults, 73% of transgender women and 78% of transgender men reported that they first experienced gender dysphoria by age seven. Typically, gender dysphoria gets more serious if the person continues to live in the gender they were assigned instead of their internal gender identity.
Can gender dysphoria be a phase?
It is not unusual for kids to explore gender, especially when they are very young. Children like to play dress-up or engage in pretend play where they imagine themselves as someone of another gender. For most children, this is simply another kind of experimentation, and they eventually move on to other interests. It is not a symptom of gender dysphoria.
Gender dysphoria is upsetting to children who experience it. It is not a phase and continues indefinitely. Experts say children have diagnosable gender dysphoria if they have experienced significant distress about their gender for at least six months. They also exhibit six or more of the following behaviors:
- Expressing the desire to be the other gender or insisting that they are the other gender
- Strong preference for wearing clothes of the opposite gender
- Strong preference for make-believe play or fantasy play where they role-play the opposite gender
- Consistent preference for toys, games, or activities typically preferred by the opposite gender
- Consistent rejection of toys, games, and activities typically preferred by their assigned gender
- Primarily chooses playmates of the other gender
- Expresses dislike of their sexual anatomy
- Expresses a desire for physical sex characteristics of the opposite gender
In teens, gender dysphoria symptoms must be present for at least six months as well as six or more of the following:
- Able to express a sense of disconnect between their preferred gender and their physical sex characteristics
- Consistent desire to change their sex characteristics to those of their preferred gender
- Consistent desire to be their preferred gender
- Consistent request to be treated as their preferred gender
- Strong conviction that their emotions and thoughts are those of their preferred gender
What gender identities are there?
Some people are assigned one gender at birth but identify as the opposite gender. For example, a baby with typically male anatomy is presumed to be a boy at birth but later says she feels like a girl. This is what you may think of as being transgender or trans. For other people, gender is more nuanced.
More and more experts agree that gender isn’t as simple as male and female. They believe that those two gender identities are the endpoints of a spectrum of possible gender identities. Some people's gender identity falls in the middle of that spectrum. They don’t embrace either the identity of male or female. These individuals may describe themselves with words like non-binary, genderqueer, gender-non-conforming, or androgynous. They may use they/them pronouns or newer pronouns such as “zie”.
Supporting your child
Experts encourage parents to be supportive and loving if a child expresses gender dysphoria. Accepting your child’s identity and listening to their feelings is the most helpful thing you can do. Children with gender dysphoria who have acceptance and support at home have less distress and fewer mental health concerns over the long term.
Families should look for transgender support groups, so they have a community of people with a shared experience. Finding doctors and mental health professionals to guide a family is also very helpful. They can assist with deciding what types of transition care are appropriate. Depending on the child’s feelings, there are different steps your family may take, including:
- Social transition: This is where your child wears their preferred clothes and uses a preferred name and pronouns. You will work with their school and community to navigate this change with them.
- Puberty blockers: In some cases, medicine to delay puberty is appropriate. These medications prevent a child from starting to develop adult sex characteristics that might be upsetting to them.
- Hormone replacement: Older teens may be eligible to get hormone replacement therapy. The teen will start taking prescribed doses of hormones for their preferred gender. This triggers puberty consistent with their gender identity.
- Surgery: Gender confirmation surgery is not typically performed on young children. Once your child is older, they may seek this treatment.
If your child is experiencing gender dysphoria, you can speak with your doctor or mental health professional about resources for your family.
Boston Children's Hospital: "Gender Dysphoria | Diagnosis & Treatment".
Cedars-Sinai: "Most Gender Dysphoria Established by Age 7, Study Finds."
Children's Hospital of Philadelphia "When Do Children Develop Their Gender Identity?"
National Health Service: "When does someone become aware of a gender identity?"
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