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Dr Mani Pavuluri Blog

Let’s be Kind

Transgender Youth: Let’s Begin to Understand at God Speed

Society is learning about transgender as we speak. Trans means across in Latin, and transgender means “across gender.” Yes, after 30 years of practicing Psychiatry, I am still learning as a sudden wave of new experiences in treating those who are struggling with all issues affecting the trans people seem to emerge. I see children evolving with gender preferences, siblings being confused, peers not knowing how to make it all comfortable for their trans youth friends, parents accepting- yet struggling inside especially with how to connect with their child, and youth in gender transition wearing a bright and brave smile in the community trying to move on.

I do not think Gender Identity Disorder will remain too long in the Diagnostic and Statistical Manual of Psychiatry just as no one remotely thinks being Gay is a Psychiatric issue. While it is impossible to tell all that it entails in a nutshell, I attempted to give a quick overview to bring everyone up-to-speed so that our society as a whole raises the level of empathy and kindness to the transgender youth.

First, get the clarity. What is Transgender?

Know the difference between the three things. (1) Gender identity can be on a spectrum. The central tenet to embrace is ‘gender is not binary.’ It is the gender they naturally and internally feel and identify with, independent of the anatomical assigned sex at birth. You are trans male if you identify as male from assigned sex as female, and trans female if you are identifying as female if assigned sex is male. (2) Assigned sex is natal i.e., what they are born with. (3) Romantic orientation is sexual orientation and different from gender identity or assigned sex. These days, a large number of transgender or gender-variant teens on the spectrum of identity may date with peers with broad preferences. Some may think they may be gay, but later realize it is not actually about the sexual orientation.

Gender expression can be gender-conforming to align with one’s identity with voice and clothes as opposed to gender non- conforming youth who may maintain gender fluid, gender-neutral, agender or non-binary outward expression. Gender expression is the outward expression and not exactly the same as gender identity. Transsexuals are a subgroup of transgender, as not all transgenders are transsexuals.

Psycho-bio-social Aspects:

1. Psychological Issues: The deep distress is caused by at least four groups of things. These issues require careful attention. (1) Marginalized identity in school, community or church, perceptions, bullying and social media attacks, (2) Expectations, reaction, and resistance at home, (3) Internal torture as body changes and discomfort ensues around puberty, and (4) Self-loathing, thinking they are somehow weird, freak, or an outcast.
2. Biological Issues: Most important to note is that there are no known explanations for why this occurs, and the most common view is potential hormonal changes prenatally, even before birth.
3. Social Issues: Practical aspects of transitioning are humongous. While the upside of is rewarding, the downside is petrifying. It requires changes in how others address them, legal name change, change in driving license and passports, and waves and waves of people from friends to coaches to neighbors knowing the news and assimilating the same. This is an overwhelming process to handle for a young person.

What Parent Can Do- The Best Case Scenario:

Imagine I am providing a basic checklist to a parent here: Let’s begin with the Family Acceptance Project’s research finding ( that it is very harmful to force the child to dress and act in a way that causes distress to the child. Know that you will risk losing the child to alcohol, substance abuse or altogether through suicide.

Accept who they want to be with an open heart, appreciate for opening up with you, show them in every way that you love them, and grow together in the process. Know that you did nothing wrong and nor did they. It is a natural occurrence and the only option you have is to embrace it. That said, a few that are gender-variant may return back to being the assigned sex.

Your job now is to simply build their resilience through respect, acceptance, and encouragement. For, you are the most powerful people in their lives as parents.

Here are some things you can do:
• It extremely important how you approach ‘the coming out’ process. Be poised and keep it succinct as a statement, with the positive tone so that others do not dangle with throwing back their own anxiety, misery, doubt, and empathy with lack of depth.
• Regularly acknowledge child’s strengths, talk about things where the focus of the conversation is not them, ask questions but do not interrogate, let them know they are normal, spend time together, actively listen, the problem may be at times you were shunned from their inner circle, but be patient.
• Standup for your child at school or anywhere to stop bullying.
• Ask for forgiveness if you initially were harsh or did not understand the gender issues
• Lack of connectedness and belonging are the hardest things that predict depression, so help them to have the power to manage their emotional strength
• Surrounding yourself and your teen with the gay-straight alliance, joining LGBTQ school club, TransYouth Family Allies will bring comradery, understanding, and reduce isolation. In other words, create the loving community that is gender variant or tolerant. Volunteer with organizations that involve camps or self-help groups with transgender youth. Online support groups can be helpful as there can be instant support from large group powered by collective knowledge and empathy.
• Remind yourself to see the beauty in their expression. You are not alone as a parent and a lot of people are forging this new territory with you.
• If they are gender variant, do not push them to choose and hurry the process.
• Doctors can provide a letter to help them participate in competitive sports with the gender of his or her identity.
• As all issues are heavily complicated, I highly recommend working with therapists or psychiatrists who can help with associated depression, identity crisis and support the family. Anyone who is competent and takes interest is a good fit and does not have to be a specialist clinic for transgender youth.
• Deal with your other children as they go through confusion, the grief of losing what they know and anger at receiving less attention around the crisis.
• If there is no unisex bathroom, it may be preferable to use the bathroom of how they present themselves outwardly regardless of gender identity (they may align eventually) for safety reasons.
• At a later stage when and if your child elects Male to Female (MTF) or Female to Male (FTM) hormonal treatment and surgery, you will need two mental health professionals to provide a referral.
• Read and also provide the school with brilliant books by Nicholas Teich (Transgender 101) or Stephanie Brill and Rachel Pepper (Transgender Child and Teen).

What Society Can Do- Our Responsibility:

It begins with the acceptance that there is NOTHING WRONG with the youth. Enjoy them. They are normal and treat them as you would any other person with compassion and not alienate them. Give them an out as it could be encroaching on their privacy and level of comfort to ask direct questions. If any, be extra kind. You may not think the whole unisex bathroom issue discussed across the school and parent board is after all, not “going overboard.” If you read what it all entails for the individual, I know I can count on you all equipped with these thoughts and be amazing! You will begin to grasp the significance of the rainbow colors of the flag as ‘a spectrum’ on which all humans feel, think, and identify. They have the inherent right to choose, feel, and live how they feel comfortable. Let us make the world a better place for the transgender youth.

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