Transgender children: what they experience and how to help

Imagine being five years old and knowing something about yourself with absolute certainty — something so fundamental that no one needs to teach it to you. You know your favorite color, you know which food you like, you know whether you prefer running or drawing. And you know who you are. Now imagine that every person around you — your parents, your teachers, your classmates, the entire world — tells you that you are wrong. That what you feel inside is not real. That you must be someone else.

This is the experience of many transgender children. It is not an abstract idea, not a political theory, not a talk show debate. It is the daily life of children who are trying to tell the adults something that adults often do not want to hear.

This article is written for those who want to understand. For parents who wonder what their child is feeling. For teachers who notice something and do not know how to react. For anyone who believes that a child’s well-being should come before everything else.

When gender identity develops

Gender identity — the inner sense of being male, female, or something beyond those categories — is not something learned in school or absorbed from television. It is a fundamental component of psychological development that emerges very early.

Development between ages 3 and 5

Research on child development shows that most children have a stable sense of their own gender around ages 3 to 5. By age three, children are able to identify themselves as male or female. Between ages 3 and 5, what psychologists call “gender stability” consolidates: the awareness that one’s gender is a permanent feature of one’s identity.

This applies to all children — cisgender and transgender. The TransYouth Project study, conducted by Professor Kristina Olson at Princeton University, examined transgender children of preschool age who had undergone a social transition [3]. The results, published in Child Development Perspectives in 2018, showed that these children expressed gender preferences and behaviors indistinguishable from those of cisgender peers of the same gender [3]. They were not playing a role. They were not imitating anyone. They were expressing an authentic and consistent sense of self, with the same naturalness as any other child who knows who they are.

What trans children experience

For a transgender child, the world is a place that does not match what they feel inside. Adults assign them a name, clothing, a role — and none of it aligns with what the child knows about themselves. This disconnect produces what clinicians call “gender dysphoria”: a deep, sometimes devastating distress linked to the gap between perceived identity and how the world treats them.

The ways children express this distress vary enormously:

• Direct statements. “I am a girl” from a child assigned male at birth, or vice versa. Not as a game, but with seriousness and insistence.
• Rejection of clothing and appearance. Crying, meltdowns, active resistance when dressed or groomed according to the assigned gender.
• Discomfort with their body. Some trans children express distress about their physical characteristics as early as preschool age, with discomfort that tends to intensify as puberty approaches.
• Social withdrawal. Children who stop playing with peers, who become quiet, who isolate themselves — because they do not have the words to explain what they feel, or because they have learned that their words are not listened to.
• Indirect signs. Persistent sadness, irritability, sleep disturbances, anxiety. Children do not always know how to connect these symptoms to gender dysphoria: they feel that something is wrong, but they cannot name it.

It is important to understand that these are not signs of caprice or confusion. They are the signals of a child trying to communicate something fundamental about their identity.

Gender nonconformity and transgender identity: are they the same thing?

No. And this distinction is crucial.

Gender nonconformity is a behavior: a boy who plays with dolls, a girl who prefers “boy” toys, a child who loves colors or activities traditionally associated with the other gender. Gender nonconformity is very common, perfectly healthy, and does not necessarily indicate a transgender identity.

Transgender identity is something different: it is not about what a child does, but who a child is. A transgender child is not playing at being another gender — they are affirming their gender identity. The study by Steensma and colleagues, published in 2013 in the Journal of the American Academy of Child and Adolescent Psychiatry, identified a key indicator: when children were asked “Are you a boy or a girl?”, those who answered with the gender opposite to the one assigned at birth had a significantly higher probability of maintaining that identity over time [6]. Children who simply wished to be the other gender, without identifying as such, showed different patterns [6].

The practical difference is between “I wish I were a girl” and “I am a girl.” Between a wish and an identity statement. Experienced professionals know how to recognize this difference, and that is why clinical support is important: not to label children, but to listen to them with the right tools.

What the research says: supported trans children are doing well

The most important finding a parent should know is this: transgender children who receive family support are doing well. Not “tolerably.” Not “despite everything.” They are doing well — just like their peers.

Olson’s TransYouth Project

The most influential study on this topic is by Professor Kristina Olson and her research team. Published in Pediatrics in 2016, it examined 73 transgender children between ages 3 and 12 who had undergone a social transition — that is, they were living in the gender with which they identified, with their families’ support [1].

The results were clear: these children had depression levels within the normal range and anxiety levels only minimally elevated compared to the national average [1]. They did not differ significantly from control groups composed of cisgender peers and siblings.

This finding needs context. Previous studies of children with gender dysphoria who did not receive support reported very high rates of depression, anxiety, and psychological distress. The difference was not in the children: it was in the environment.

Durwood’s study

A subsequent study by Durwood, McLaughlin, and Olson, published in 2017 in the Journal of the American Academy of Child and Adolescent Psychiatry, extended these findings to children and adolescents between ages 6 and 14 [2]. In this larger sample as well (116 transgender children, 122 cisgender controls, 72 siblings), transgender youth showed depression and self-esteem levels indistinguishable from those of their peers [2]. Anxiety was only marginally higher.

The message from the research is clear: psychological suffering in trans children is not inevitable. It is not a consequence of being transgender. It is a consequence of not being supported.

The persistence of identity

A common concern among parents is: “What if they change their mind?” The longitudinal study by Olson and colleagues, published in Pediatrics in 2022, provided an answer based on long-term data [4]. The researchers followed 317 transgender children for five years after social transition: 94% continued to identify with the affirmed gender, 3.5% identified as nonbinary, and only 2.5% had returned to identifying with the sex assigned at birth [4].

When a child expresses their gender identity in a persistent, insistent, and consistent manner over time, the likelihood that identity is stable is very high. Persistence is the rule, not the exception.

The clinical debate: “watchful waiting” vs. the affirmative approach

In the field of childhood gender health, there are two main approaches, and it is important for parents to know about them in order to make informed choices.

The watchful waiting approach

The traditional approach, known as “watchful waiting,” involves not actively encouraging the child’s social transition, but observing and waiting for the identity to consolidate over time. This approach is based on older studies suggesting high rates of “desistance” — children who stopped identifying as transgender as they grew up. However, many of these studies have been criticized for methodological problems: in several studies, children who did not show up for follow-up were counted as “desisters,” artificially inflating the percentages. Moreover, many of those children did not meet the diagnostic criteria for gender dysphoria but simply displayed gender-nonconforming behaviors.

The affirmative approach

The affirmative approach, now recommended by the American Academy of Pediatrics, WPATH, and the Endocrine Society, does not mean “deciding for the child” or “pushing them toward transition” [8][9][10]. It means creating an environment in which the child can freely express their identity, be listened to, and receive specialized psychological support.

The AAP’s 2018 policy statement defines the affirmative model as “an integrated approach combining medical, mental health, and social services,” in which professionals “work together to reduce stigma associated with gender variance, promote the child’s self-esteem, facilitate access to care, educate families, and create safer community spaces” [8].

In practice, the affirmative approach for pre-pubertal children involves no medical intervention whatsoever. It involves listening, psychological support, and, if the child desires it, social transition — the use of the preferred name and pronouns, the freedom to dress and present as they wish. All of this is completely reversible at any time.

Puberty blockers: what they are and what they are not

When a transgender child approaches puberty, the development of secondary sex characteristics of the assigned gender can dramatically intensify gender dysphoria. Breast development, voice deepening, facial hair growth — changes that are natural milestones for a cisgender teenager can become, for a trans adolescent, a source of deep and persistent anguish.

How they work

Puberty blockers, technically GnRH agonists, temporarily suspend puberty. They do not eliminate it: they put it on pause. These medications have been used in pediatric endocrinology for over 40 years to treat precocious puberty in cisgender children. They are not experimental.

The Endocrine Society guidelines (2017) and WPATH (SOC-8, 2022) provide that treatment may begin when the young person has reached Tanner stage 2 — that is, the very first signs of pubertal development [10][9].

Safety and efficacy data

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 [14]. A subsequent study by the same group, published in Pediatrics in 2014, confirmed long-term psychological well-being improvement, with no participant reporting regret [5].

The study by Turban and colleagues, published in Pediatrics in 2020, analyzed data from over 20,000 transgender adults, finding that those who had received puberty blockers during adolescence had a 70% lower likelihood of lifetime suicidal ideation compared to those who had wanted but not received them [7].

Reversibility

A fundamental point: puberty blockers are reversible. When treatment is discontinued, puberty resumes its natural course. The purpose of treatment is not to “change” the young person: it is to give them time to mature, to be followed by a multidisciplinary team, and to make any future decisions with greater awareness, without the additional stress of a puberty that does not correspond to their identity.

What blockers are not

They are not hormones. They do not cause a transition. They do not cause sterility. They are not irreversible. The narrative that doctors are “giving hormones to children” does not correspond to clinical reality: blockers temporarily inhibit hormone production; they do not add new ones. Actual hormone therapy (testosterone or estrogen) is considered only at a later stage, after careful multidisciplinary evaluation, and generally not before mid-adolescence [10].

What parents can do: a practical guide

If your child has communicated something about their gender identity — or if you are observing signs that make you reflect — here is what the research suggests.

Listen and affirm

The most important thing you can do is listen. Do not judge, do not seek explanations, do not minimize. Your child is communicating something they have probably been thinking about for a long time, and the way you react has measurable consequences on their mental health [1].

Affirming does not mean “deciding that your child is trans.” It means communicating: “I hear you, I believe you, I love you no matter what.” It means using the name and pronouns your child asks you to use, letting them dress in a way that feels comfortable, not forcing them to hide who they are.

Find an experienced professional

A professional with specific experience in childhood gender identity can help both the child and the family. Their role is not to “confirm” or “deny” the child’s trans identity: it is to explore, accompany, and support. Look for someone who follows the international guidelines (WPATH, Endocrine Society, AAP) and who works with the whole family, not just the child [8][9][10].

Educate yourself

Read the research, consult reliable sources, talk with other parents who have had the same experience. Ignorance is not a fault — but remaining in ignorance when clear data are available is a choice with consequences.

Build a support network

Trans children who live in supportive environments — not just within the family, but also at school and in the community — show the best mental health outcomes [1][2]. Talk with the school if the child desires it, seek out family groups, and create an environment around your child where they can be themselves without fear.

Take care of yourselves

Parents need support too. Discovering that your child is transgender can evoke intense emotions — confusion, fear, grief, guilt. These emotions are legitimate, but they should be processed with a professional or with other parents, not offloaded onto the child. Your child needs your support, not your internal conflict.

What NOT to do: harmful practices

Conversion therapies

Conversion therapies — any attempt to modify a child’s gender identity through psychological pressure, punishment, coercion, or manipulation — have been condemned by every major medical and psychological organization in the world. The American Psychological Association, in 2021, adopted a resolution explicitly declaring that gender dysphoria is not a mental illness and that attempts to change gender identity are harmful [12].

The harms are documented: depression, anxiety, substance abuse, suicidal ideation, loss of trust in the family. Conversion therapies do not change anyone’s gender identity — because gender identity cannot be changed from the outside. What they do is destroy the relationship between the child and the people who should be protecting them.

Minimization and silence

“It is just a phase,” “you are too young to know,” “do not say these things.” These phrases, even when spoken with protective intent, communicate rejection. They tell the child that their inner experience is not valid, that they must hide who they are, that their parents’ love is conditional. The Family Acceptance Project’s research identifies minimization as one of the family behaviors most associated with negative mental health outcomes.

Isolation

Preventing the child from spending time with peers, from accessing safe spaces, or from expressing themselves freely does not “protect” them: it isolates them. And isolation is one of the most well-documented risk factors for depression and suicidal ideation among transgender youth.

School: a crucial environment

School is where children spend most of their time, and the way the school environment welcomes or rejects a trans child has an enormous impact.

Talking to the school

If the child wishes it and the family agrees, informing the school can make a significant difference. Request a private meeting with the school principal, agree on the use of the preferred name and pronouns, and establish a point of contact the child can turn to. Many Italian schools and most Italian public universities have introduced the “carriera alias” (alias career), which allows students to use their chosen name in internal records. (For international readers: the “carriera alias” is an informal administrative mechanism in Italy, not a national law, that allows transgender students to use their chosen name on internal school documents without changing official legal records.)

Preventing bullying

Trans children are at elevated risk of bullying. The presence of inclusive school policies, trained staff, and a climate of respect significantly reduces incidents of harassment. Do not wait for something to happen: work with the school to create a preventive environment.

Safe spaces

Bathrooms, locker rooms, physical education activities: these are all settings where a trans child may struggle. Simple solutions — such as access to gender-neutral bathrooms or the option to change in a private space — can make the difference between a bearable school day and a day of suffering.

Resources

Institutional services (Italy)

• ONIG (Osservatorio Nazionale sull’Identita di Genere) — Coordinates Italy’s specialized gender identity centers, with a Minors Commission active since 2012. Follows WPATH standards. Website: onig.it
• Infotrans.it — The first European institutional portal dedicated to transgender people, developed by Italy’s Istituto Superiore di Sanita (National Institute of Health) and UNAR (national anti-discrimination office) [13]. Contains information on healthcare pathways, rights, and a map of local services. Website: infotrans.it

Family associations (Italy)

• AGEDO — Association of parents, relatives, and friends of LGBTQ+ people, with chapters throughout Italy. Listening groups, peer support, and guidance. Website: agedonazionale.org
• GenderLens — Association of parents with specific resources for families of gender-diverse minors. Online meetings, consultations, and training for professionals and schools. Website: genderlens.org

Helplines

• Gay Help Line: 800 713 713 — Italy’s national toll-free helpline against homophobia and transphobia, active Monday through Saturday (4:00 PM - 8:00 PM). Free from landlines and mobile phones.
• Telefono Amico Italia: 02 2327 2327 — Active daily (9:00 AM - midnight), offers listening and support.
• Trans Lifeline: 877-565-8860 (U.S.)
• Trevor Project: 1-866-488-7386 (U.S.)

The most important thing

A transgender child is not a problem to be solved. Not a phase to be gotten through. Not a mistake to be corrected. They are a child — with the same dignity, the same needs, and the same right to happiness as any other child.

Scientific research tells us something very simple: when these children are listened to, believed, and supported, they are doing well [1][2]. When they are rejected, ignored, or forced to be someone else, they suffer. This is not an opinion: it is data replicated across more than fifteen years of studies.

As parents, as teachers, as a society, we are not being asked to have all the answers. We are being asked to listen. To put the child’s well-being at the center of every decision. To choose data over prejudice. And to remember that every child deserves to grow up in a world that tells them: “You are fine just as you are.”