How trans youth and their parents decide to start medical transition

Zinnia JonesThe process by which trans adolescents seek out and access medical transition treatment, including puberty blockers and/or cross-sex hormones, is one of the most widely misunderstood subjects in the public imagination. Initiating treatment is frequently depicted as something capricious, a decision made rashly by youth who may simply be experiencing a “phase”, with little or no in-depth consideration of its significance and impact; their parents are portrayed as either going along with this under the coercion of threats of suicide, or swept up in an alleged “trend” themselves; trans-supportive clinicians are in turn maligned as reckless enablers who supposedly allow immediate access to these treatments on the basis of mere adolescent whims. This bizarre caricature is the image of adolescent transition most commonly promoted in alarmist and sensationalist media outlets today.

It should come as no surprise that the reality of trans youth and their families looks nothing like this. In a recent study of 17 transmasculine adolescents aged 14 to 20 (none had previously accessed puberty blockers), along with 13 of their parents, researchers conducted interviews on their experiences of the process of considering the option of HRT and choosing to begin treatment (Daley et al., 2019). This process turns out to be far more complex and protracted than prevailing media images would suggest.

Interviews showed that trans adolescents’ progress toward seeking gender-affirming care began with identifying themselves as trans and coming out to their parent(s) – however, “in cases where parents were less familiar with gender identity or less supportive of their child’s identity, the time to seeking care was often extended by months or years.” These adolescents were already aware of the possibility of receiving HRT, while parents often exhibited reluctance at first:

The typical process described by both adolescents and parents included parental hesitancy about GAHT [gender-affirming hormone therapy] and the adolescent advocating to start treatment. As time passed, the parent became more informed about both gender identity and GAHT. This often led to a partnership in which the parent and adolescent shared the information they knew about GAHT and then came to a final decision to start treatment. Although the information sharing was deemed important, rarely did the ultimate decision hinge on a specific fact or turning point, rather parents grew comfortable over time.

Notably, most of these adolescents accepted their parents as part of this decision-making process, rather than being in conflict with them:

Relatedly, although some adolescents reported they would have preferred a greater proportion of decisional control, all but two continued to want a parent to have a role in the decision. Parent participants were generally satisfied with their role in the decision and the roles of others.

Adolescents also described a process of “information seeking” after learning about the option of HRT, using “blogs, online videos, and discussion forums to learn about individuals’ experiences”, as well as obtaining information from “personal contacts, family members, classmates, or community members with experience with GAHT” and from the gender clinic itself. (It’s worth noting that this study does not depict seeking out information on transitioning as an inherently sinister act or a vector for “contagion”, unlike a certain other notorious paper.)

When discussing desired outcomes of treatment, adolescents were primarily focused on the physical changes, while parents were more broadly concerned with their child’s overall “happiness and self-confidence, with many specifically commenting that such goals were no different than a parent’s goal for any child.” Both adolescents and parents demonstrated an awareness of the possible risks and side effects of HRT – these youth had discussed this with their parents or clinicians. The authors conclude:

The decision-making pattern most evident in this study is slow, steady progress but with differences between families related to the time it takes to progress along the decision path.

In other words: not what you’ll read about in the papers.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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