Transgender children who are allowed to present their gender identity and change their names have good mental health outcomes, according to a study released on Friday and hailed as “crucially important”.
The study, published in the March issue of the journal Pediatrics, shows the positive impact family support can have on the lives of transgender children, a group long hidden from public view.
Researchers found normal levels of depression and only slightly elevated anxiety levels in transgender children who were supported by their families.
Such support included the use of pronouns that matched the child’s gender identity, calling them by the name of their choosing and, often, and allowing them to change their hairstyle and clothing to reflect their identity. Such children are also known as “socially transitioned” children.
In a commentary published with the study in Pediatrics, Dr Ilana Sherer, assistant medical director at the University of San Francisco’s Child and Adolescent Gender Center Clinic, said the findings were “crucially important”.
Sherer said the study was useful for responding to questions surrounding the impact of social transition, and whether and when children are old enough to know that they identify with a gender different from the one they were born with.
Sherer said: “Olson and colleagues give supporters of social transition evidence that shows what we have suspected all along: that socially transitioned children are doing fine, or at least as well as their age-matched peers and siblings.”
Sarah Painer, a social worker at the Transgender Health Clinic at Cincinnati Children’s Hospital, said: “I think the study is really reflective of what we see in practice.”
Transgender adults experience rates of anxiety, depression and suicide that are dramatically higher than those among non-transgender adults. This is most likely tied to years of discrimination, internal conflict and rejection from social environments, the authors of the study said.
Children in the study had slightly higher anxiety rates than the norm, though these levels were still considered developmentally normal.
The study’s authors said this may have been because children experience victimization from peers, are worried about puberty, may be hiding their identities outside their homes and are aware that their bodies are different from the bodies of children of the gender with which they identify.
“I think more research like this will hopefully help the world see that this can be a good thing – to let our kids be who they are,” said Painer.
Researchers assessed the mental health of 73 socially transitioned transgender children aged three to 12, using National Institute of Health questionnaires answered by their parents. These results were compared to those from two groups of non-transgender children: 73 of the same gender identity from the same community and 49 siblings of children in the transgender group.
It is too soon to know the long-term implications of the study for the mental health of transgender children, the authors said, as instances of depression rise dramatically during adolescence, when normal stresses are exacerbated for transgender teens.
Kristina Olson, a University of Washington assistant professor of psychology and the study’s lead author, said the authors hope to answer questions over later mental health “soon”, as their study is part of a larger longitudinal study on the transgender population.
“In general, early mental health challenges are linked to later ones, but in all people there are some mental health challenges that emerge after puberty – in fact most do,” Olson said in an email.
“Therefore, only by following these children will we be able to say for sure whether children who socially transition in the prepubescent period have better, worse or the same mental health compared to other children during those crucial teen years.”
Susan Maasch, director of the Trans Youth Equality Foundation (TYEF), said she was not surprised by the study results.
“All of that stuff is obvious to us from observation and always has been,” she said.
TYEF is a national organization offering support specifically for transgender youth. It worked with 1,200 transgender children in 2015, and 850 the year before.
Maasch said that in the past five years or less there has been a significant change in resources available for transgender children, and how they are treated by their family and peers. While oppression is still a major problem in the transgender community, she said the situation for transgender youth has improved since 2007, when she founded TYEF.
“In those days we definitely had kids that were more in a dark place, there was less help for them,” Maasch said. “If you’re a willing parent and you have some amount of resources, you can certainly find a children’s hospital near you that will have a gender clinic for transitioning children.”
The issue of resources remains a significant problem for low-income families. Only 15 of the children in the new study were from families that had an annual income below $75,000; 44 lived in households with an annual income of more than $125,000.
The study acknowledges its limits. For instance, the forms were completed by parents, who may have been inclined to show the best portrait of their child’s mental health.
There was also little diversity in the sample group. More than 70% of the transgender children in the study were white; 51 of the 73 were born male.
Study authors said their early findings showed a need for more research and to collect data on transgender children who were not supported socially.
A dearth of reputable research on transgender children, they said, has left clinicians with little scientific evidence with which to make recommendations on how to provide care.