We are very grateful to one of our members who has kindly offered the following account of their experience as the mum of a young adult who is transitioning (for a clinician's view of adult clinics, click here).
Parenting a Young Adult with Gender Dysphoria
If your young adult announces that they are trans out of the blue you will feel shock. The fact that they are technically an adult won’t make much difference. When I stopped crying, I phoned a Charing Cross GIC family helpline where a nurse offered the following reassurance: ‘Well you’d want them to be happy wouldn’t you?’ This was 2013 and my first encounter with the bizarre world of gender. Since then I have probably made every mistake in the book. I’m not a psychologist and, luckily, there’s a lot of excellent advice available. But I thought it might be useful to describe some of the conflicts that might follow this announcement.
We don’t have figures for how many acquire a sudden trans identity between 18 and 25. We know that the peak age for referrals to the GIDS is 15 and that in 2018-9 roughly three quarters of referrals were girls. But the parents of sons who have contacted me have all reported that a trans identity developed suddenly in the years between 17 and 25. It isn’t news that this is a vulnerable age group and we know that this is the age at which serious mental health problems often emerge for the first time. Although a sudden trans identity is not classed as a mental health issue it can present the parent of a young adult with many of the challenges that would face you if your offspring did develop a mental health problem. Only this time, you are on your own.
The key task of this age group, we’re told, is to separate from parents. “Developmental tasks from late teens into early adulthood are about moving away from your family,” according to clinical psychologist Alex Fowke. It’s a stage at which identities are fiercely claimed and swiftly discarded. You cannot stop or shape either the process of separation or that of identity formation. But you can - inadvertently - slow down the process by which identities that don’t work are discarded and replaced. What you don’t want is for your young adult to be cemented in their position by your hostility or fixed in a transient identity by inappropriate medical intervention.
Not a Child
Even though you know that your child is an adult, this is hard to hold on to when you sense upcoming danger: a sudden change of gender identity, accompanied by demands for medication and surgery sets alarm bells ringing. This is doubly the case if it is couched in a brand new vocabulary studded with phrases drawn from online sources. You will be desperate to point out future dangers.
But because your young person is newly adult they will guard their status all the more fiercely. Because they need to live in a world shaped by the values of their own generation, they are programmed to favour peer acceptance over parental approval. Trans culture will prime them to see you as the problem, and will offer a replacement glitter family with none of the flaws of their own family. You will likely be viewed as ignorant of the new gender knowledge, blind to advanced thinking and rigid in your old fashioned certainties. As a family therapist said to me: ‘The one thing we know for sure is that between the ages of 18 and 30 pretty much any pressure you try to exert on your offspring will produce the opposite effect.’
I was thinking about why this sensible advice is so difficult to bear in mind when I came across a picture of a distraught parent in Charles Dickens’ Barnaby Rudge, a novel about social contagion published in 1848, the same year as Charles Mackay’s Extraordinary Popular Delusions and The Madness of Crowds. It was Mackay’s book that provided Douglas Murray with a title for his own recent study of contemporary contagions. In the 1780s (when the novel is set) a psychological trauma was more likely to drive a twenty-year-old son to enlist in the army than announce a cross sex gender identity. Dickens tells the story of a twenty year old who is rebuffed by his long term love and who enlists on the rebound. With no idea of the whereabouts of his fully-grown son, the elderly father drafts a poster which ‘obstinately persisted, despite the advice and entreaties of his friends, in describing his son as a “young boy;” and furthermore as being from eighteen inches to a couple of feet shorter than he really was’. The result is the arrival ‘at various times and at a vast expense, of some five-and forty runaways ranging from six years old to twelve.’ Perhaps the follies of parents don’t really change.
The parent of a young adult who enlists in a new gender identity may be tempted to behave as if their young adult is ‘a couple of feet shorter than he really was’. You can still see the child in your young adult and you may be painfully conscious of a childhood which conflicts with the new gender narrative. But the NHS will see an adult and treat them as such. From the age of 17 a young person is eligible to transfer to adult gender services: this post describing the pathway for young people over 17 at Leeds GIDS gives a sense of the superficial nature of the assessment they may undergo. Gender services are unlikely to offer therapy unless it is specifically requested and they may well not explore the possible impact of co-occurring mental or physical conditions. A 2018 ‘Practitioners’ guide to Binary and Non-Binary Trans Patient Care’ by Ben Vincent explains that: ‘There are no medical conditions which are contraindications for referral to a GIC’. (Vincent, 79) One young desister described adult services as ‘a box ticking exercise’. Another, happy in their transition reports that ‘There are no groups’ in adult services:
‘I think some adult services do have them. It’s pretty much: go there, do what you need to do, get what you need to get and leave. But that’s fine for me and how I’ve been doing my transition.’
There may be delay due to pressure of demand and the length of waiting lists. But once in the system, clinicians are trained to accept a statement of gender identity at face value and ask a young person for guidance on how to proceed with medical intervention. At a first visit to an adult gender clinic, your young person will be offered information about how to access toilets that fit their gender identity and may be given tips on choosing a new name.
You cannot, then, rely on the NHS or other medical services to safeguard a young adult bent on rapid physical transition. It is important to be clear about this because non specialists such as GPs and family therapists may make the very reasonable assumption that this major intervention would be dispensed with caution. I was told by our GP that the gender clinic would offer several years’ of gentle dissuasion before medication. The family therapist told me that medication for a 22 year old would in the first instance only be hormone blockers. Neither was correct. Nor was the family therapist correct in her assumption that an autism diagnosis would delay access to medical intervention.
In any case, your young adult now has access to relatively inexpensive private medical intervention. For £300 GenderCare will offer your daughter or son access to cross sex hormones after a one-hour consultation. A gender story derived from study of YouTube, Reddit or Tumblr will be taken as proof of authenticity: this is just the story that the clinic is used to hearing - another ‘straightforward’ case. ‘The Narrative isn’t entirely accurate to my situation but am def going to pull a couple of “early trans memories” to help convince her’ confides one young person preparing to meet a GP. Via Reddit your young person can identify an NHS GP who will prescribe hormones as a ‘bridging prescription’ and that prescription will then be continued by a sympathetic GP.
I realise that this is quite a negative view of the assessments. But I mistakenly assumed that NHS gender services would recognize complexities and context that seemed obvious to me. I was familiar with the cautious way in which other NHS psychological services responded to the strident assertions and claims of young people. I wish I had known that gender services will take statements of gender identity at face value. Perhaps the most important lesson is that your offspring is an adult and the NHS will treat them as such.
Not an Adult
The trouble is that you are also right when you suspect that your young adult is not fully mature.
Outside gender services, the NHS recognises the special vulnerability of this age group: "The idea that suddenly at 18 you're an adult just doesn't quite ring true", says a Tavistock child psychologist. Young people "still need quite a considerable amount of support and help beyond that age." Within mental health services other than gender, ‘Child psychologists are being given a new directive which is that the age range they work with is increasing from 0-18 to 0-25.’ The NHS long term plan recognises that ‘Between the ages of 16-18, young people are more susceptible to mental illness, undergoing physiological change and making important transitions in their lives’ and they are now planning to ‘extend current service models to create a comprehensive offer for 0-25 year olds that reaches across mental health services for children, young people and adults.’
If your kid is on the autistic spectrum they may not only be especially vulnerable to gender dysphoria but they may also be in some senses younger than they appear. You may assume that an autism diagnosis will ensure that gender clinicians proceed with extra caution. Unfortunately this is unlikely to be the case.
Once again Dickens captures the predicament of the parent. Barnaby Rudge is a twenty year old with what we might now call a learning disability or autism, who becomes caught up in the social contagion of anti-Catholic riots. His mother begs the leaders to recognise his vulnerability: ‘“there are reasons why you should hear my earnest, mother’s prayer, and leave my son with me. Oh do! He is not in his right senses, he is not, indeed!”’ But she ‘was thrown to the ground; the whole file was in motion; Barnaby was whirled away into the heart of a dense mass of men, and she saw him no more.’
Of course, young adults have always faced dangers. But what I think we are dealing with now is a set of pressures which have evolved too rapidly for doctors, psychologists, governments, parents, lawyers to understand. Gender ideology offers a particularly fraught rite of passage which is (at the present moment) naively reinforced by the NHS and by wider culture.
Return to Childhood?
For some young people, however, a suddenly occurring gender dysphoria can disrupt the normal process of separation from parents and from home. Gender identity can be as much a return to childhood as a means of flying the nest. We know that ‘With independence comes the fear of rejection and humiliation’. But no one would expect a kid who comes out as gay to demand that their parent help them choose new clothes, address them differently and allow them to stay at home after university while they adjust, or be asked to accompany them to appointments where they learn how to manifest their sexual orientation.
A trans identity often seems to require validation from a parent. You may be asked, in effect, to rebirth your child so that they can re-emerge in fantasy as a different adult. It may not be enough to say that you accept that your kid has a belief that you do not share, that you respect it without fully understanding it. Instead you may be told that their happiness and even survival depend on your positive affirmation. You may suspect that this demand comes from a place of fear, that your kid needs you to counteract their own doubts. But if you voice this suspicion you give your kid permission to disown their own fear and to displace it onto you.
This is a genuinely tricky act to manage: if you actively affirm their beliefs, you take over the responsibility for thinking through the choices that they are making. If your young person is - as they and the world claim - an adult, then they need to take any decision themselves.
If you give in to the demand for active affirmation you also allow a double standard which denies your own need to be respected. I believe that that no one has the right to compel others to make statements they do not believe. The respect that you will accord your adult child’s belief must be balanced by respect for your beliefs, whatever they are.
The trouble is that it isn’t just your offspring who is behaving strangely. There’s something about gender dysphoria that makes the NHS behave in a unique way. If your young adult is suicidal or has an eating disorder you should receive fantastic care however difficult the problem. But if your young adult has a sudden gender dysphoria you cannot assume that doctors, psychologists, therapists or experts are your friends. You might expect that your young adult would be encouraged to respect your views and to make up their own mind as they work towards adulthood and self-sufficiency. But instead you may be told that it is your responsibility to house a young adult who refuses to leave home. You may be encouraged to support a young adult who is receiving disability benefit for anxiety whilst a GIC dispenses medication on the basis that they have no mental health issues. Is your young adult ill or well, independent or dependent? What demands do you make of them?
The problem is compounded by the assumption that social transition allows some kind of ‘real life experience’. For if you are compelled to affirm their new gender identity, the young person will not be experiencing a realistic trial of it. Such a managed context may lead instead to a growing anxiety and a need to test their ability to pass, by means of escalating demands for validation. By offering a sheltered space at home to experiment with a new identity you are in effect preventing your adult child from discovering whether this identity is one in which they can live. After all, you will not be around to protect your offspring in the long term.
At the same time, you may sense that the distress driving apparently illogical demands or incoherent beliefs is real. If your young adult behaves like a child, complaining about being left ‘home alone’, you can be sure that they are afraid. Although the language may be hackneyed it may be a means to convey real fear. Az Hakeem’s useful guide, Trans, describes the feelings of something not being right and of body dissociation that can foreshadow a trans identification. It can be hard to understand the power of the beliefs that your young person is gripped by or the bodily nature of the experience. If a kid had an eating disorder (and we know that eating disorders are often associated with gender dysphoria), we would probably know that it won’t solve anything just to tell them that they are not fat. It’s important to recognise that a young person who believes they are the wrong sex may be dealing with feelings and beliefs that are equally powerful and frightening. We do not have to share their beliefs to sympathise with their feelings.
So what can you do?
First of all, remember the general advice:
- Take time and don’t rush to react. Answers like ‘Um,’ or ‘I need to think about that’ can be handy while you give yourself time to think.
- Listen to your kid/young adult. Try to understand how they think. Ask questions. Don’t assume you know the answers.
- Explain what you can’t do. For me this included accompanying my kid to a gender clinic though some parents specifically want to do this.
- Find out as much as you can about the world (online or in real life) that your kid inhabits. If you can use the terms that make sense to them and show an understanding of their belief structure you may be able to form a bridge which allows you to gently ask questions.
- Show as little interest in gender as possible. You may well have developed a gender obsession to match that of your kid. But to them you need to display interest in just about anything else. What else is your kid interested in, or worried about? What other problems might there be?
- Read about techniques for extracting a family member from a cult. You don’t need to believe that gender ideology is a cult to use these.
- Encourage all the things that enable mental health (both for you and your young person): get outside, exercise, sleep, other interests, good food. Gender identity beliefs encourage body dissociation and grow in a virtual world.
- Pronouns: In every sentence lurks the pronoun test. And in every sentence lurks the possibility of provocation and rage. This is the trickiest of tricky questions and every parent will come to a different answer. Repetition of the proper name is one option. Indirect constructions are another. Some parents may be able to stand firm on this and use correct biological pronouns but if the ultimate aim is to maintain a relationship then it may be better to give in than to provoke a reaction. For my own sanity, even after I gave in, I continue to use correct pronouns outside the home. Just never be overheard!
Looking after yourself
Where your young adult is terrified and exploring a range of forms of emotional manipulation, you need to find some way to stay relatively calm - or at least to pretend to be relatively calm. To do that you will need to find others to talk to, others who can share your obsession and who can listen without judgement.
If things go wrong
And don’t assume that if your kid gets hormones that this is the end of the story. They can obtain hormones very easily, and may well see as the sine qua non of their journey of self-discovery (or their revolt against your values and upbringing). It won’t help to convey a sense that this is an irreversible catastrophe, to provide them with a reaction which reinforces their sense of a dramatic rebirth. It may be that it is only through experience that they will learn whether physical intervention provides the relief that they hope for. It is much more likely that a young adult will change their mind because of their experience within the trans community or in wider society than through listening to the opinions of their parent.
Watching physical changes develop is intensely difficult and this is the time when you need whatever helps you to survive, whether this is exercise, meditation or the support of your friends and peers. I had assumed that physical interventions would force me to give up my own beliefs and accept that my young adult really was the other sex. But I discovered that nothing really changed. My offspring was still the same person though their appearance was slightly different. In practice it isn’t all that different from the irritation our own parents experienced when we adopted ludicrous haircuts or clothes. The mental torment comes from fears about the future that our minds impose on us.
So it helps to remember that there’s a huge amount of negotiation and change to follow. You want to allow a way out if your young person should have doubts or should find that medical interventions do not cure dysphoria. Effects of hormones are gradual and progressive. Some are irreversible but some are not and even those that are will not turn your beloved child into an alien. When we are going through difficult times our own friends help us by holding on to the person they know from the past. We can do this for our young adult: hold on to the identity of the person who may be lost, remember that identity is not defined by gender.
I find a source of hope in the voices of detransitioners: these are young people who display an astonishing courage and self-knowledge, gained through experience and in many cases suffering. They show us that personality is unchanged by physical alteration. Perhaps the most damaging effect of trans identification is not the physical changes that are sought but the belief system that encourages rejection of existing social and familial links.
This is not a fight you have to fight alone. There are now many others and there is an increasing wealth of wisdom you can draw on (not least the mistakes of those who have gone before you). Medical professionals will likely be aware that gender treatment is a contested area. If they don’t know, you will tell them. Lobby for better support for young adults with gender dysphoria. Professor Richard Byng is calling for ‘increased psychological input for the 17-25 year olds who will need a developmental trauma informed services as aspired to in GIDS’. Your friends may be willing to see that this is a difficult issue and may not automatically celebrate the brave and stunning transition of your young adult if you indicate to them that, well, it’s a bit complicated.
I’ll end with a spoiler: John Willets, the son in Dickens' novel who enlisted in the army, returns a few years later missing an arm but ready to live his life. Barnaby is saved from the gallows at the last moment. I hope that the early years when we did have a role as parents has imbued our young adults with resilience. I hope also that the adult world is on its way towards a more nuanced approach to gender problems.