Joint Statement Supporting and Care of Transgender Children
Supporting and providing access to gender affirming care for transgender children promotes health and well-being. It is not child abuse. This approach is recommended by the prevailing standards of care, best practices, and guidelines endorsed by national and international professional organizations including the World Professional Association of Transgender Health, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the National Association of Social Workers, and the Australian Professional Association for Transgender Health and is associated with improved mental and physical health outcomes.
The gender affirmative model of care includes obtaining a child’s assent before engaging in any medications or surgical procedures. Until puberty, there are no medical or surgical interventions involved related to gender affirmative care. After the onset of puberty, comprehensive gender health planning — including consideration for medical interventions (e.g., pubertal suppression, hormone therapy, gender affirming surgery) — is completed with interdisciplinary teams, following established guidelines, and only with the assent of the youth.
As signatories to this letter, it is our position that all children should be able to express their gender identity without fear of rejection. Supporting transgender children and children who are expressing a different gender than expected includes providing opportunities for the child to explore their gender identity freely. This can include facilitating a social transition where a child is able to live in the gender role that is most authentic to that child. This usually includes a new name, pronouns, attire, hair length and/or style in order to present as their self-identified gender. Parents are also encouraged to seek gender affirming medical and mental health care services from experienced providers to support their child’s healthy development and wellbeing.
This gender affirming model of care is based on the latest scientific evidence which demonstrates that family acceptance of a child’s gender identity and providing gender-affirming care are associated with improved well-being and mental health including reductions in symptoms of depression, anxiety, and suicidality. Children who experience negative family and caregiver responses of indifference, rejection, and/or attempts to change their gender identity or expression are more likely to experience negative psychological and social outcomes including depression, anxiety, suicidality, substance abuse, as well as heightened risk of lower educational attainment and homelessness.
The signatories of this statement support parents’ rights to support their child’s gender identity and access gender affirming care for their child without fear of Child Protective Services’ (CPS) involvement. It is a CPS mandate that they must act in the best interest of all children, which also means protecting the rights and needs of children including needs of gender expression. We also oppose any efforts to restrict the ability of healthcare professionals to provide care consistent with established standards and best practice guidelines, or the ability of parents to access and consent to such care for their child.
Signatories can be viewed at www.transtexas.org/h
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864.
Anton, B. S. (2009). Proceedings of the American Psychological Association for the legislative year 2008: Minutes of the annual meeting of the Council of Representatives. American Psychologist, 64, 372–453. doi:10.1037/a0015932
Austin, A., Craig, S. L., Alessi, E. J., Wagaman, M. A., Paceley, M. S., Dziengel, L., & Balestrery, J. E. (2016). Guidelines for transgender and gender nonconforming (TGNC) affirmative education: Enhancing the climate for TGNC students, staff and faculty in social work education. Alexandria, VA: Council on Social Work Education.
California Academy of Family Physicians Committee on Health of the Public. (2019). Principles for the Protection and Care of Transgender and Gender-Expansive Patients. https://cafponcloud.egnyte.com/dl/93sD0J8k9J/
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., ... & Monstrey, S. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165-232.
De Vries, A. L. C., McGuire, J. K., Steensma, T. D. , Wagenaar, E., Doreleijers, T., Cohen-Kettenis, P. T. (2014). Prospective young adult outcomes of puberty suppression in transgender adolescents, Pediatrics, 134, 696-704. doi:10.1542/peds.2013-2958
Ehrensaft, D., Giammattei, S. V., Storck, K., Tishelman, A. C., & Keo-Meier, C. (2018). Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. International Journal of Transgenderism,19(2), 251-268.
Gottlieb, A. R., & Lev, A. I. (Eds.). (2019). Families in Transition: Parenting Gender Diverse Children, Adolescents, and Young Adults. Columbia University Press.
Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903.
Hunter, S., & Hickerson, J. (2003). Affirmative practice: Understanding and working with lesbian, gay, bisexual, and transgender persons. NASW Press.
Jacob, J. A. (2015). Conversion therapy ineffective and inappropriate for LGBTQ youth. JAMA,314(20), 2121-2121.
Keo-Meier, C. E., & Ehrensaft, D. E. (2018). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children(pp. xii-226). Washington DC, US: American Psychological Association.
Kuvalanka, K. A., Weiner, J. L., & Mahan, D. (2014). Child, family, and community transformations: Findings from interviews with mothers of transgender girls. Journal of GLBT Family Studies, 10, 354-379. doi: 10.1080/1550428X.2013.834529
National Association of Social Workers National Committee on Lesbian, Gay, Bisexual, and Transgender Issues. (2015). Sexual orientation change efforts (SOCE) and conversion therapy with lesbians, gay men, bisexuals, and transgender persons. https://www.socialworkers.org/LinkClick.aspx?fileticket=IQYALknHU6s%3d&portalid=0
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223
Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267.
Rafferty, J., & Committee on Psychosocial Aspects of Child and Family Health. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4), e20182162.
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health,63(4),503-505.
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791-793.
Telfer, M. M., Tollit, M. A., Pace, C. C., & Pang, K. C. (2018). Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. Medical Journal of Australia, 209(3), 132-136.
Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2019). Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry, 1-9. doi: 10.1001/jamapsychiatry.2019.2285. [Epub ahead of print]