Advice re non-binary teen

Hi,

My assigned female at birth child has come out as non-binary and is insisting they want to be more masculine via non-reversible, medical interventions. This child never expressed gender confusion as a child or younger teen, however, they have had severe anxiety, depression, sensory issues, been bullied, had disordered eating and been in therapy from a very young age. They are also super smart, talented, and sensitive. Currently, they are seeing a DBT therapist and are on medication, but we parents are not seeing huge improvements in their mental health and are very concerned about their desire to alter their body so drastically and permanently. The current therapist doesn't have a lot of knowledge of gender issues and DBT doesn't really address the trauma from bullying. I want my child to be happy and love themself and if I truly believed medical interventions would do it, I think I would be supportive. I really don't think my feelings are coming from transphobia but from a deep sense that these interventions won't solve the problem and then my child may feel even worse. There is a lot of pressure to be accepting and that anything else is transphobia. Does anyone have advice for me? Has anyone been through this with their teen? Anyone been through this themself?  Is there a super-skilled therapist out there who could work with my complex child without buying into the narrative? Someone who could help them love themself and truly thrive? Thank you for your advice. 

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RE: Advice re non-binary teen ()

If you are a Kaiser member, Oakland and SF have multi specialty transitions departments. They have therapists. Your teen may need some therapy and to try hormone blockers if they have not completed puberty. That will give them time to delve into these issues before moving forward irreversibly. 

Gender Spectrum is also a good online resource. It's complicated. Your teen needs to know they are loved and accepted even if they grow in unanticipated directions.  " I think I would be supportive." doesn't cut it. Others are bullying, you need to be a safe haven. Hugs. 

RE: Advice re non-binary teen ()

Hi, 

I highly suggest a therapist with knowledge in the subject, but can’t recommend one. HOWEVER, I also recommend your child be evaluated for OCD. My child had similar issues and it turned out that this was a sort of compulsion. They felt something bad might happen to them if they expressed themselves as their birth gender so was doing various things not to. Also DBT alone would not help with OCD, so a correct diagnosis is really important. 

RE: Advice re non-binary teen ()

First of all, I can tell you are a loving involved parent trying to do your best, so hang in there. I'm sorry that I don't have a referral but I do agree that a good therapist who specializes in trans youth will be your best option, and I hope you will find one very soon. You don't mention your child's age - 13 looks very different from 17 in many ways. My dear friend went through a slightly similar experience, but her son (born a girl) identified as a boy since he could talk. As he transitioned in high school and went through treatments she supported some hormone therapy, which was reversible, but stopped short of surgery until their child was a legal adult. If it were me, I would definitely go the talk therapy route with a specialist before pursuing any medical interventions - could you come to some sort of agreement with your teen that following that route, if at the end (set amount of time) they still feel that makes sense for them that you will, in conjunction with them and their pediatrician/doctor, discuss what can be done? Whatever happens I wish you the very best!

RE: Advice re non-binary teen ()

My AFAB child also told us they identify as non-binary and prefer a different name and the pronouns "they/them" last year when they were 15. It was also somewhat of a surprise to us, and I will admit it took us too long to start using their preferred pronouns consistently. So first of all I commend you for doing that. Our child had never been bullied or had disordered eating, but they have suffered from depression and anxiety and were unable to attend school through much of middle school. We also didn't see huge improvements in their anxiety and depression with medication and regular talk therapy. In their case, they developed very large breasts after puberty and we were already looking into breast reduction even before they came out as non-binary. It turned out that regular breast reduction could only get them down to a "C" cup, which still felt too big to them. We ended up deciding on "top" surgery which they went through last December, at age 16. I am very confident that was the right decision for them. In fact almost the first thing they said when they came out of the anesthesia was "I'm so happy!" They haven't expressed any interest in any other procedures or interventions like hormones. We have Kaiser and had some sessions at the Gender clinic in Oakland. Overall we've found Kaiser to be very good on this (although their mental health care in general is not great.) I think it's important for you to be able to separate your child's gender identity from their mental health issues. The bullying, anxiety etc. did not *cause* their non-binary gender identity, and their gender identity will not be affected by antidepressants. Similarly, any surgeries or other interventions will not solve "the problem" of their depression and anxiety. It will only address the problem of their body dysphoria, which may be contributing to their depression but is not the only factor. Now, 3 months after their surgery, our child is still 100% happy with the surgery. However they still struggle with depression and anxiety to some extent (although they are happier and less anxious now overall.) We found the doctors at Kaiser to be very aware of the mental health issues involved in these decisions, and I imagine the doctors who perform this surgery outside of Kaiser are too. They don't just do irreversible procedures on teens without a fair amount of discussion and counseling. I know this is difficult for you, but your child really needs you to accept them as they are. They are telling you that they are not female or male. If you love them, you have to believe them. Sending love, peace, and understanding to your family. 

RE: Advice re non-binary teen ()

I would try the hormone blockers at this point but wouldn't support surgery yet. I think that it's better to wait to be fully grown and a bit more mature before doing anything irreversible. The only exception would be if they have already grown large breasts, that can be fairly devastating to a nonbinary teen. I would consider a reduction if they have that issue.

In the old days people had to be on hormones for a couple of years before getting surgery and I think it's a good idea. After that everyone knows if it's a phase or not. In my opinion, there's a lot of pressure on butch women and feminine men to transition that wasn't there when I was growing up and it's harder to tell who's truly trans and in need of life-saving surgery versus a typical teen/young adult questioning everything.

I think that you are awesome and doing the right thing. Support them by using the desired name and pronouns and getting the hormones but impose a delay of a few years on surgical intervention (other than breast reductionif needed). Hopefully you can find them a great primary care doctor who understands these issues and will help your family through the process. Maybe someone on here has a good referral.

RE: Advice re non-binary teen ()

OP here. Thanks, to clarify. my kid is an older teen, past puberty. Also, the bullying was not related to gender issues but to their weight and happened many years ago and possibly created trauma around their body shape and size. I agree about love, acceptance, and validation and am working on it. 

RE: Advice re non-binary teen ()

My family has been through this with my nephew. Your concerns are understandable and I think being supportive while keeping the door open for your child to change their mind is a good approach. You may get called transphobic, but you know your child best. Good luck. 

RE: Advice re non-binary teen ()

My transgender child sees Jay Williams at:
https://spectrumpractice.com/
He has been an incredible therapist that has helped my child through really difficult times. My 15 year old also anxiety, depression, sensory issues, been bullied, & had disordered eating/ARVID.
To gain deeper understanding of all the terms and identity labels prior to conducting the activity, read Sam’s “Breaking through the Binary: Gender Explained Using Continuums” article (szp.guide/bttb) or book A Guide to Gender (szp.guide/g2g).
Check out this great website:
https://thesafezoneproject.com/activities/genderbread-person/
https://thesafezoneproject.com/resources/
Read books:
Beyond the Gender Binary (Pocket Change Collective)
by Alok Vaid-Menon, Ashley Lukashevsky (Illustrations)
https://www.goodreads.com/book/show/48190203-beyond-the-gender-binary

My Gender Workbook: How to Become a Real Man, a Real Woman, the Real You, Or Something Else Entirely
https://books.google.com/books/about/My_Gender_Workbook.html?id=NjH32xMT...

Feel free to ask me questions

RE: Advice re non-binary teen ()

Hello my assigned female at birth child also expressed the same things.  It started around age 15 at first as non-binary and then as trans male.  Also, he had bullying at school and a molestation at age 10, a trauma that I don't feel was properly addressed at the time. Up until age 15 he had long, long hair and dressed and acted like a girl never expressing that he didn't feel comfortable with his gender or that he didn't want to be a girl.

At 16, he wanted to take testosterone and also talked of having top surgery.   Many of his online friends were non-binary.  We let him start the testosterone.  He took it for about a year and then decided on his own to stop.  He still has facial and body hair from that.  We were torn about the top surgery since we didn't feel that at 16 he had the maturity to make that decision and although we didn't want to make him sad, we kept putting it off.  When we finally began talking with a Dr. and setting up appointments, it turned out that my insurance company wouldn't cover it until the age of 18. (BUT the doctor WOULD have)

Thank God because his 18th birthday came and went (he's 19 now) with no mention of it and he told us he changed his mind and doesn't want to ever do that.  

At one point last summer he expressed wanting to be referred to as 'she' again but that didn't last long.  He seems to want to be feminine a lot of the time but at the same time wants to be referred to as 'he'.  This is with no pressure from me at all.  He wears dresses sometimes, and makeup, earrings and nail polish daily. 

For me as a mother, i see a confusion of self,  anxiety with the world and an underlying mental illness (diagnosed with dissociative disorder) caused by childhood trauma.  

I would urge you to be supportive of your child and allow them to express their identity but without taking any non-reversible steps.  It was so easy to get the testosterone at 16 that it's frightening.  My son was born and raised outside the U.S. where it would not have been possible at all.  We didn't move back here till a few years ago, so I was not used to what to expect.

I would also urge you to keep trying therapists, psychologist and psychiatrists until you find the right one.  I can recommend Zara Drapkin but she doesn't take insurance.  It has only been in the last 5 months that I've finally decided to pay out of pocket and it is expensive but I think worth it.

First and foremost, you know and love your child better than any therapist or doctor.  Be very assured of that.  Find someone you can explain your questions and apprehensions to.

Another place that was very very good is Alta Bates (on Dwight) that has an outpatient program (but is hard to get in) and also might not be meeting because of the coronavirus.

I'm sorry for you and your child because I know it's very difficult for both of you.  Try to take things one by one and get through little milestones. 

I hope they get better soon.

Take care

RE: Advice re non-binary teen ()

This is a challenging issue.  On one hand, we want to honor our children and their ability to define themselves and know their needs.  On the other, they are young, with still developing brains, who may not be able to fully and accurately identify issues, and act on impulse more than careful consideration.  Add mental health challenges to the mix, and it is hard to know what to do, and in what order.  

The Atlantic magazine had a very thoughtful piece about this issue.  https://www.theatlantic.com/magazine/archive/2018/07/when-a-child-says-shes-trans/561749/

UCSF Benioff Chlidren's Hospital has a Child and Adolescent Gender Center.  https://www.ucsfbenioffchildrens.org/clinics/child_and_adolescent_gender_center/

Good luck.