When your child is trans

If you are here, your son or daughter has probably told you something you did not expect. Perhaps they used the word “transgender,” perhaps they expressed a discomfort you cannot decipher, perhaps they asked to be called by a different name. Whatever you are feeling right now — confusion, fear, grief, even anger — it is a human reaction. You are not bad parents. But what you do from here matters more than you can imagine, and science demonstrates this with very clear data.

This article is written for you. Not to convince you of anything, but to give you the information you need to make informed decisions. Because when it comes to a child’s well-being, opinions are not enough: data are needed.

Your reaction is the most important factor

Not school, not friends, not social media. Scientific research has demonstrated that the way the family reacts is the single most determining factor for the mental health of a transgender young person [1][2]. This is not an opinion: it is the result of over fifteen years of studies.

The Family Acceptance Project

The most influential research program on this topic is the Family Acceptance Project, conducted by Dr. Caitlin Ryan at San Francisco State University. The results, published starting in 2009, redefined the way the scientific community understands the role of families [2].

LGBT youth who reported high levels of family rejection during adolescence, compared to peers with accepting families, were [2]:

• 8.4 times more at risk of suicide attempt
• 5.9 times more at risk of severe depression
• 3.4 times more at risk of illegal substance use

Conversely, young people with accepting families showed significantly higher levels of self-esteem, social support, and general health, with marked protection against depression and suicidal ideation [1].

Subsequent confirmations

These results are not isolated. The Trevor Project’s 2022 national survey, conducted on nearly 34,000 LGBTQ youth in the United States, confirmed the same pattern: young people living in an accepting family context reported significantly lower rates of suicide attempts compared to those without family support [10]. A cohort study published in JAMA Network Open in 2022 (Tordoff et al.) followed transgender youth between 13 and 20 years old, finding that access to gender-affirming care was associated with a 60% reduction in moderate or severe depression and a 73% reduction in suicidal ideation [9].

What this means for you, concretely

These numbers are not meant to frighten you or make you feel guilty. Many parents go through a period of shock and confusion: that is normal, that is human. The point is different: the direction you move in after that initial moment has measurable consequences. It is not about being perfect from day one. It is about not closing the door.

The most important sentence you can say to your child today is this: “I don’t understand everything, but I love you and I want to understand.”

First of all: listen

Many parents’ first impulse is to try to fix, to explain, to find a cause. But the most useful thing you can do right away is not to talk: it is to listen.

Your child has probably revealed something they have been thinking about for a long time. For many transgender young people, the period between inner awareness and the moment they speak to their family lasts months, sometimes years. What for you is a sudden moment, for your child is the culmination of a long and often solitary journey.

Listening means:

• Let them talk without interrupting. This is not the moment to set conditions or express doubts. Those will come later, when you have had time to get informed.
• Ask genuine questions. “How do you feel?”, “How long have you been thinking about this?”, “How can I help you?” are questions that open, not close.
• Do not minimize. Phrases like “it’s just a phase,” “you’re doing it for attention,” or “you’re too young to know” communicate rejection, even when the intention is protective. The Family Acceptance Project identifies minimization among the family behaviors most harmful to young people’s mental health [2].
• Do not pretend nothing happened. Silence is also a response, and silence says: “I don’t want to know about it.” A young person who perceives family indifference is a lonelier young person.

“But aren’t they too young to know?”

This is the question almost every parent asks. The answer from science is nuanced but clear.

Gender identity forms early

Research on gender identity development shows that most children have a stable perception of their gender by around ages 3-5. A 2017 study published in Child Development (Fast and Olson) examined transgender children at preschool age who had undergone social transition: these children showed gender preferences and behaviors indistinguishable from those of cisgender peers of the same gender. They were not “imitating” anyone: they were expressing a coherent and deep sense of self.

Supported children are doing well

The most important study on this topic is by Olson, Durwood, and McLaughlin, published in Pediatrics in 2016 [3]. The researchers examined 73 transgender children between 3 and 12 years old who had undergone social transition with family support. The results: these children had depression levels within the norm (an average score of 50.1, practically identical to the national average of 50) and only minimally elevated anxiety levels (54.2 versus an average of 50) [3]. Previous studies on children with gender dysphoria who did not receive support reported much higher rates of psychological suffering.

Persistence is high

A piece of data many parents fear: “what if they change their mind?” The longitudinal study by Olson and colleagues, published in Pediatrics in 2022, followed 317 transgender children for five years after social transition [4]. The results: 94% continued to identify with the affirmed gender, 3.5% identified as nonbinary, and only 2.5% had returned to identifying with the gender assigned at birth [4]. Persistence is the rule, not the exception — especially when the identity is expressed consistently and sustainedly over time.

What this does not mean

This does not mean that every child who plays with toys associated with the other gender or who challenges gender norms is transgender. Gender exploration is normal and healthy. But when a child persistently, insistently, and consistently expresses a gender identity different from the one assigned at birth, the scientifically supported response is listening and support, not repression [7].

What NOT to do: conversion therapies

Some parents, driven by fear, seek professionals who promise to “correct” their child’s gender identity. These practices, known as conversion or reparative therapies, have been condemned by every major medical and psychological organization in the world — from the American Medical Association to the American Psychological Association, from the World Health Organization to the Endocrine Society.

The reason is simple: they do not work, and they cause serious harm.

The data on harm

A study published in JAMA Psychiatry in 2020 (Turban et al.) analyzed data from over 27,000 transgender adults [8]. Those who had experienced gender identity conversion attempts during their lifetime were 2.27 times more likely to have attempted suicide. For those exposed before age 10, the risk of suicide attempt rose to 4.15 times compared to those who had not undergone these practices [8]. There was no difference between therapies conducted by secular professionals and those conducted by religious figures: the harm came from the practice itself.

A 2022 study published in JAMA Pediatrics estimated that the long-term consequences of conversion therapies — depression, anxiety, substance abuse, suicidality — cost an average of $83,366 per person in health terms [14].

Why they are harmful

Conversion therapies communicate a message to the young person: there is something wrong with you that needs to be fixed. This message does not “fix” gender identity — which, as neuroscience demonstrates, has biological bases and is not modifiable from outside. What it does is destroy trust in the parent, generate shame, and internalize rejection. It is the opposite mechanism of what protects: family acceptance.

Finding a professional: how and where

Seeking professional help does not mean seeking someone to “cure” your child. It means finding an expert who can support both the young person and you in understanding and accompanying the journey.

What to look for

A good professional in this area:

• Has specific experience with gender identity, not just LGBT issues in general. Gender identity and sexual orientation are different dimensions.
• Has no agenda. They do not want to convince your child they are trans or convince them they are not. Their role is to explore, not decide.
• Works with the whole family. The best pathways include support for parents, not just the young person. You deserve to be accompanied as much as your child.
• Follows international guidelines (WPATH Standards of Care version 8 [6], Endocrine Society guidelines [11], American Academy of Pediatrics policy statement [7]).

Where to find one

• ONIG (National Observatory on Gender Identity) — Coordinates professionals and specialized Italian centers, including a Minors Commission active since 2012. ONIG centers follow WPATH standards. Website: onig.it
• Infotrans.it — The first European institutional portal dedicated to transgender people, developed by the Italian National Institute of Health in collaboration with UNAR [13]. It contains a map of services on the territory. Website: infotrans.it
• Your family doctor can serve as a first point of access for orientation, although not all general practitioners have specific training on these topics.

School: what to do and what not to

School is one of the first concerns for parents. How to handle the situation? Who needs to know? How to protect your child?

The decision belongs to the family and the young person

There is no obligation to communicate a student’s gender identity to the school. The decision belongs to the family and the young person, and should be made together, respecting both parties’ timing.

The alias identity

Many schools and all major Italian universities have introduced the so-called “alias identity” or “alias career”: a confidentiality agreement that allows the student to use their chosen name in internal registers, communications, and institutional emails, before the official legal name change. It is not a perfect solution, but it is a concrete tool of protection.

How to talk to the school

If you decide to inform the school, some practical suggestions:

• Request a confidential meeting with the school principal and class coordinator.
• Bring information. Not all teachers are familiar with the topic. A brief and clear document can make a difference.
• Agree together on the use of the preferred name, pronouns, and the management of spaces (bathrooms, changing rooms).
• Establish a contact person — someone in the school your child can turn to in case of difficulty.
• Prepare for bullying. Not because it is inevitable, but because prevention is more effective than reaction. Data from GLSEN show that the presence of inclusive school policies and trained staff significantly reduces harassment incidents.

Protect without isolating

An understandable temptation is to keep everything secret to protect your child. But research shows that isolation is among the most documented risk factors for the mental health of transgender youth [1][2]. Protection is not silence: it is creating a network of informed and safe people around the young person.

Medical aspects: do not panic

One of the main sources of anxiety for parents concerns medical interventions. Misinformation on this topic is aggressive and widespread. Here is what international guidelines actually recommend — WPATH Standards of Care version 8 (2022) [6], Endocrine Society guidelines (2017) [11], American Academy of Pediatrics policy statement (2018) [7].

Before puberty: no medical intervention

For pre-pubertal children, no pharmacological intervention is planned [6][7][11]. No medications, no hormones, no surgery. The approach is exclusively psychosocial: listening, psychological support, and, if the family and child wish, social transition — meaning the use of the preferred name and pronouns, clothing choices, and self-presentation. Social transition is completely reversible at any time.

Puberty blockers: what they really are

When pubertal development begins, the guidelines provide for the possibility of using GnRH agonists to temporarily suspend puberty [11]. These medications have been used for over 40 years in pediatric endocrinology to treat precocious puberty in cisgender children. They are not experimental.

The prospective study by de Vries and colleagues, published in 2011 in The Journal of Sexual Medicine, followed 70 adolescents during puberty blocker treatment: behavioral and emotional problems decreased and overall functioning improved significantly [12]. A subsequent study by the same group (de Vries et al., 2014, Pediatrics) confirmed the improvement in long-term psychological functioning [5].

A crucial point: blockers are reversible. When treatment is discontinued, puberty resumes its course. The purpose is not to “change” anything: it is to give the young person time to mature, to be followed by a multidisciplinary team, and to make any future decisions with greater awareness.

Hormones: not before adolescence

Hormone therapy (testosterone or estrogen) is considered only after a thorough evaluation by a team that includes endocrinologists, psychologists, and psychiatrists [11]. The Endocrine Society guidelines indicate that most adolescents have the capacity to give informed consent around age 16 [11]. This treatment has partially irreversible effects and is introduced gradually.

Surgery: not on minors

Gender-affirming surgical interventions are not performed on minors according to the main international guidelines [6][11]. The claim that “they operate on children” has no basis in clinical practice or existing protocols.

The pathway is gradual

Every step — from social transition to blockers, from hormones to surgery — represents a separate stage, evaluated individually with the family and the young person [6]. No one pushes anyone toward any treatment. The goal is to find the right pathway for that specific person, with all the caution and time needed.

What you feel matters: support for parents

No parent receives this news without feeling something strong. Many describe a sense of grief — not for the child, but for the image of the child they had built in their mind. Others feel fear for the future, concern about discrimination, confusion about their own identity as parents.

These feelings are legitimate. The difference is what you do with them.

Find your own space

Your child needs your support, but they are not your therapist. The emotions you feel need to be processed elsewhere: with a professional, with other parents who have lived the same experience, with a trusted friend. This is not selfishness: it is the necessary condition for being able to be present for your child.

AGEDO: parents who understand

AGEDO (Association of Parents, Relatives, and Friends of LGBT+ people) is the reference association in Italy for families. Founded in 1992, it has 37 local branches throughout Italy and offers listening groups, peer support, and accompaniment. At AGEDO you will find other parents who have been exactly where you are now — and who can tell you, from direct experience, that the journey is possible. Website: agedonazionale.org

GenderLens: for families of minors

GenderLens is an association born from a collective of Italian parents with transgender children in developmental age. It offers online meetings, private consultations, educational resources, and training for professionals and schools. Their approach is affirmative and centered on the well-being of the minor and the family. Website: genderlens.org

You are not alone

When it seems like no one can understand, remember: thousands of families have gone through this journey. Some initially reacted poorly, said things they later regretted, needed time. What they have in common is that they chose, at some point, to put love for their child ahead of fear. And the data show that this choice has concrete and measurable consequences on their children’s well-being [1][2].

What you can do today: a practical list

The Family Acceptance Project identified specific family behaviors associated with better health outcomes [1][2]. They are not grand gestures. They are everyday practices.

To do

• Use the name and pronouns your child asks for. It is the most basic gesture and one of the most significant. It is not necessary to “understand” in order to respect.
• Tell your child you love them. It sounds obvious, but for a trans young person who has just come out, hearing “I love you no matter what” is a lifeline.
• Get informed. Read, consult scientific sources, speak with professionals. Ignorance is not a fault, but remaining ignorant is a choice.
• Find a professional experienced in gender identity, for your child and for you.
• Do not isolate your child. Allow them to attend safe spaces, peer groups, and associations.
• Defend your child. When they face discrimination at school, in the extended family, or elsewhere, your active presence is a powerful protective factor.

Not to do

• Do not try to “correct” gender identity. Conversion therapies cause documented harm and do not change anyone’s identity [8].
• Do not minimize. “It’s just a phase” communicates rejection, even when the intention is protective [2].
• Do not impose silence. Asking a child to “not tell anyone” means telling them their identity is something to be ashamed of.
• Do not look for blame. Gender identity has biological bases and is not caused by upbringing, social media, or friendships. It is not your fault, and it is no one’s fault.
• Do not make hasty decisions. You do not need to decide everything today. You only need to let your child know you are on their side.

Resources

Institutional services

• Infotrans.it — Portal of the Italian National Institute of Health and UNAR with information on health pathways, rights, and a map of services [13]. Website: infotrans.it
• ONIG (National Observatory on Gender Identity) — Brings together professionals and specialized centers, with a Minors Commission active since 2012. Website: onig.it

Associations for families

• AGEDO — Association of parents, relatives, and friends of LGBT+ people, with 37 branches throughout Italy. Listening groups, peer support, accompaniment. Website: agedonazionale.org
• GenderLens — Parents’ association with specific resources for families of trans minors. Online meetings, consultations, training. Website: genderlens.org

Useful numbers

• Gay Help Line: 800 713 713 — National toll-free number against homophobia and transphobia, active Monday to Saturday (4:00 PM-8:00 PM). Free from landlines and mobile phones.
• Telefono Amico Italia: 02 2327 2327 — Active every day (9:00 AM-midnight), offering listening and support.

The journey is long, but you are not alone

No parent has all the answers on the first day. Science does not ask for perfection: it asks for presence. It asks for the willingness to listen, to get informed, and to question your own assumptions when data point in a different direction than expected.

Your child is not “broken.” They do not need to be “fixed.” They need to know that their family is the safest place in the world — even when the world outside is not. The data show that this safety, this sense of belonging and acceptance, is the difference between a young person who suffers and a young person who thrives [1][2].

The most courageous thing you can do as parents is not to have all the answers. It is to say: “I don’t have them, but I’ll look for them together with you.”