The Inconvenient Truth About Parental Rejection and Trans Youth Mental Health

A recent letter from “Concerned Mom in Kentucky” (Letter, 2024) to the American Academy of Pediatrics (AAP) regarding her transgender child has highlighted the urgent need for a more informed, evidence-based understanding of gender identity and the challenges faced by transgender youth and their families. The letter, which was originally shared on the website pittparents.com, a platform known for its critical stance on gender-affirming care and its promotion of controversial theories like "rapid onset gender dysphoria," reflects many of the misconceptions, biases, and fears that continue to shape societal attitudes towards transgender individuals and the care they need to thrive.

It is important to note that the perspectives expressed in the mother's letter are not uncommon among members of online communities like pittparents.com, where parents often seek out information and support that aligns with their pre-existing beliefs and anxieties about their transgender children. These echo chambers can be powerful reinforcers of misinformation and bias, as members share anecdotes, articles, and studies that confirm their views while dismissing or ignoring evidence that contradicts them.

As such, it is crucial to approach the mother's letter with a critical eye and to examine the ways in which her involvement with pittparents.com may be influencing her understanding of her child's needs and experiences. While her story is undoubtedly painful and complex, it is essential to separate the facts from the fears and to prioritize the well-being of her child above all else.

The Myth of "Sudden Onset" Gender Dysphoria:

One of the most pervasive and harmful myths about transgender youth is the idea that their gender identity is a sudden, unexpected occurrence that can be attributed to mental health issues, social media influence, or peer pressure. This notion of "rapid onset gender dysphoria" (ROGD) has been widely popularized by anti-transgender activists and media figures, but it has no basis in scientific evidence.

In reality, research has consistently shown that gender identity is a deep-seated, innate aspect of a person's sense of self, not a choice or a trend. While the process of coming to understand and express one's gender identity can be influenced by a range of social, cultural, and psychological factors, there is no evidence to suggest that these factors cause or create a transgender identity.

The concept of ROGD is based on the flawed assumption that a child's gender identity can be determined solely by their external presentation or behavior, and that any deviation from traditional gender norms must be a sign of confusion or disorder. This view ignores the reality that many transgender individuals experience significant distress and discomfort with their assigned gender long before they are able to articulate or express their identity to others.

The Importance of Affirmative Care:

Another key misconception reflected in the mother's letter is the idea that affirming a child's gender identity is a form of "going along with" a delusion or a dangerous trend. This view is not only unsupported by evidence but also actively harmful to the mental health and well-being of transgender youth.

Numerous studies have shown that transgender youth who are supported and affirmed in their identities have significantly better mental health outcomes and lower rates of suicidality than those who are rejected or invalidated. Conversely, research has consistently found that family rejection and lack of access to affirming care are major risk factors for depression, anxiety, self-harm, and suicide among transgender individuals.

The mother's description of her child's worsening mental health and self-harming behaviors following the appointment with the nurse practitioner is a heartbreaking example of the harm that can be caused by parental rejection and invalidation. The mother writes, "Things got much worse for my daughter and our family after that appointment. I was constantly in fear of my daughter killing herself; subsequently, there were a few emergency room visits and an attempted suicidal overdose."

While the mother fails to attributes this deterioration to any one thing or her child’s gender identity, it is crucial to consider the impact of the mother's own negative reaction and refusal to support her child's identity. Research has consistently shown that parental rejection and lack of affirmation are major risk factors for suicidality and self-harm among transgender youth (Travers et al., 2012; Grossman & D'Augelli, 2007).

In contrast, the moments of affirmation and support that the child did receive, such as the school using their chosen name and pronouns and the nurse practitioner validating their gender identity, likely provided a crucial lifeline and sense of hope for the child. The fact that these moments of affirmation were met with such strong resistance and disapproval from the mother may have compounded the child's distress and sense of isolation.

Affirming a child's gender identity is not about "encouraging" or "promoting" a particular identity, but about creating a safe, supportive environment where the child can explore and express their authentic sense of self without fear of judgment or rejection. This includes using the child's chosen name and pronouns, supporting their gender expression, and providing access to appropriate medical care and mental health support.

It is important to recognize that gender-affirming care is not a one-size-fits-all approach, but rather a personalized process that takes into account the unique needs and experiences of each individual child and family. For some youth, this may involve social transition and/or medical interventions such as puberty blockers or hormone therapy, while for others, it may focus primarily on mental health support and family education.

The decision to pursue any particular course of treatment should be made in close consultation with qualified, experienced healthcare providers who specialize in working with transgender youth and their families. These decisions should be guided by the best available scientific evidence, the clinical judgment of the provider, and the self-determined needs and goals of the child and family.

The Intersection of Gender Identity and Mental Health:

A central theme in the mother's letter is the complex intersection of her child's gender identity and mental health challenges, including anxiety, depression, ADHD, self-harm, and trauma. While these co-occurring issues undoubtedly complicate the child's journey and require comprehensive, individualized care, they do not negate or invalidate the child's transgender identity.

Research has consistently shown that transgender individuals are at significantly higher risk for mental health challenges than the general population, largely as a result of the stigma, discrimination, and lack of support they face in society. For many transgender youth, the distress and discomfort associated with gender dysphoria can exacerbate or contribute to other mental health issues, creating a complex web of interrelated challenges.

The mother's letter also reveals the ways in which her own fears, misconceptions, and biases about transgender identities may be shaping her perception of her child's mental health challenges. For example, she writes, "Surely, they would do a neuropsych evaluation so that my daughter's real issues (anxiety, depression, ADHD, self-harm, sexual assault, sensory processing disorder, school refusal and internet addiction) could be addressed."

The framing of these issues as the child's "real issues," as opposed to their gender identity, reflects a fundamental misunderstanding of the complex interplay between gender dysphoria and mental health. As noted earlier, research has consistently shown that untreated gender dysphoria and lack of affirmation can exacerbate or contribute to a wide range of mental health challenges (Turban et al., 2020; Durwood et al., 2017).

Moreover, the mother's dismissal of the possibility that her child's gender identity could be a genuine and integral part of their sense of self, rather than a "delusion" or a result of "social contagion," may be preventing her from fully seeing and accepting her child for who they are. This lack of validation and understanding can be deeply harmful to the child's self-esteem, sense of belonging, and overall well-being.

However, it is crucial to recognize that being transgender is not itself a mental illness or disorder. The American Psychiatric Association, the American Psychological Association, and other leading mental health organizations have all affirmed that gender diversity is a normal and natural part of human experience, and that the pathologization of transgender identities is harmful and unethical.

The goal of affirming care for transgender youth with co-occurring mental health issues is not to "fix" or "cure" their gender identity, but to provide them with the support, validation, and resources they need to cope with the unique stressors and challenges they face. This may involve a combination of gender-affirming medical care, mental health therapy, family support, and social transition, depending on the individual needs and goals of the child and family.

The Role of Parents and Families:

Perhaps the most heartbreaking aspect of the mother's letter is the sense of fear, confusion, and rejection that pervades her relationship with her child. While it is understandable that parents may struggle to understand and accept their child's transgender identity, especially in the face of pervasive societal stigma and misinformation, it is crucial that they prioritize their child's well-being and happiness above their own discomfort or preconceptions.

Research has consistently shown that family support and acceptance are among the most important protective factors for transgender youth mental health and well-being. Transgender children who are loved, affirmed, and supported by their families are significantly less likely to experience depression, anxiety, self-harm, and suicidality than those who are rejected or invalidated.

The mother's letter also highlights the urgent need for greater education and support for parents of transgender youth. The fear, confusion, and sense of loss that the mother expresses are common experiences for many parents in her situation, and it is crucial that they have access to accurate, evidence-based information and resources to help them navigate this journey.

However, it is equally important for parents to recognize the potential harm that their own reactions and behaviors can cause, even when motivated by love and concern. The mother's refusal to use her child's chosen name and pronouns, her opposition to gender-affirming medical care, and her overall rejection of her child's identity are all factors that have been associated with increased risk of depression, anxiety, self-harm, and suicidality among transgender youth (Russell et al., 2018; Simons et al., 2013).

As painful as it may be, parents must be willing to examine their own biases, fears, and assumptions about gender and identity, and to prioritize their child's well-being and happiness above their own discomfort or preconceptions. This may require seeking out their own therapy, support groups, or educational resources to help them process their emotions and develop the skills and understanding needed to support their child.

In Closing…

The letter from the concerned mother to the AAP is a powerful reminder of the urgent need for greater education, understanding, and support for transgender youth and their families. While the challenges and complexities of this journey are undeniable, the evidence is clear that affirming, compassionate care is essential for the health and well-being of these vulnerable young people.

As healthcare providers, mental health professionals, educators, and community leaders, we have a responsibility to ensure that transgender youth and their families have access to the resources, support, and care they need to thrive. This includes providing accurate, evidence-based information about gender identity and affirming care, connecting families with peer support and advocacy networks, and working to create more welcoming and inclusive schools, healthcare settings, and social environments for transgender individuals.

To the mother who wrote this letter, and to all parents struggling to understand and support their transgender children: your love and concern for your child are evident, and your fears and worries are valid. However, it is crucial that you recognize the power you have to shape your child's mental health and well-being, for better or for worse.

By rejecting or invalidating your child's identity, refusing to use their chosen name and pronouns, and opposing gender-affirming care, you may be inadvertently contributing to the very distress and mental health challenges you are seeking to alleviate. Your child needs your unconditional love, acceptance, and support now more than ever, and your willingness to listen, learn, and grow alongside them can make all the difference in their ability to thrive.

Ultimately, the most important message we can send to transgender youth and their families is one of love, acceptance, and support. No matter how difficult the journey may be, no matter how much fear, confusion, or resistance they may encounter along the way, they are not alone. There is a growing community of professionals, advocates, and allies who are committed to ensuring that every child has the opportunity to live authentically, to be celebrated for who they are, and to know that they are worthy of love, respect, and happiness.

The road ahead may be long and challenging, but the destination is worth it. Together, we can create a world where every child, regardless of their gender identity or expression, can grow up knowing that they are loved, valued, and celebrated for exactly who they are.

Bibliography

Letter (2024). “Letter to the American Academy of Pediatrics” by Concerned Mom in Kentucky

Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 116-123.

Grossman, A. H., & D'Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37(5), 527-537.

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.

Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012). Impacts of strong parental support for trans youth: A report prepared for Children's Aid Society of Toronto and Delisle Youth Services. TransPULSE.

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2).