When a baby is born, that mushy little bundle is immediately assigned a gender identity that’s written on their birth certificate—boy or girl. It’s a label that’s instantly determined by their genitalia. But, contrary to popular belief, sex organs are not the same thing as gender.

When a child is old enough to identify his or her gender, it’s a matter of who they feel they are authentically on the inside—and this can differ from the gender they were assigned. Though it is rare, it has increased over the past few decades. “Someone who is transgender has a gender identity that is not congruent or the same as the gender they were assigned at birth, often by the doctor who delivered them,” says Georgia-based gender identity therapist Katie Leikam, LCSW, certified member of the World Professional Association of Transgender Health.

And this can be confusing for parents. Experts agree the most important thing is support, love, and acceptance to help them foster a deep sense of self-worth and self-esteem. Studies show, when transgender children are accepted by their families, they’re more likely to believe they’ll have a good life and be happy, productive adults.

To help you make sense of your child’s behavior—and most of all, help them be who they truly are in the most supportive way possible, here are some of the most common questions surrounding gender identity.

At What Age Is Gender Identity Established?

Children as young as two years old can understand the concept of sex/gender and by the time a child is five or six years old, they may have a more rigid gender identity, Leikam says. According to the Mayo Clinic, most children can categorize their own gender by age 3.

Since gender stereotypes tend to be reinforced, some kids may not present as their true selves until adulthood.

How Can You Tell If Your Child Has Gender Dysphoria?

If your child has gender dysphoria, they might be happy they have realized who they really are, Leikam says, or it could create anxiety, frustration, depression, despair, and potentially suicidal thoughts.

According to the American Psychological Association, in children, a gender dysphoria diagnosis involves at least six of the following and significant distress or impairment in functioning lasting at least six months:

  1. A strong desire to be another gender or an insistence they are the other gender
  2. A strong preference for wearing clothes typical of the opposite gender
  3. A strong preference for cross-gender roles in make-believe play or fantasy play
  4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender
  5. A strong preference for playmates of the other gender
  6. A strong rejection of toys, games, and activities typical of their assigned gender
  7. A strong dislike of their sexual anatomy
  8. A strong desire for the physical sex characteristics that match their experienced gender
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Could Your Child Have Gender Dysphoria?

Take our 2-minute quiz to see if they may benefit from further diagnosis and treatment.

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My Child’s Gender Identity Seems To Be Different From Their Assigned Gender, What Should I Do?

Don’t ignore or trivialize it if your child says they think they are transgender, says Margaret Nichols, Ph.D., president of Nichols Counseling and Psychotherapy in New Jersey and founder/president emeritus of the Institute for Personal Growth. “The best thing for parents to do is let their child come out to them,” Leikam says. “Self-exploration of gender identity is a process, and when a child comes out to a parent, it involves a lot of trust that the parents will be affirming,” she says. If you think your child is transgender, make it clear you’ll love them and provide shelter and kindness no matter what.

Is This Something They May Grow Out Of?

Experts say, it’s common for many kids to exhibit gender nonconforming behaviors before puberty, and they don’t ultimately become transgender. But, by the time a child reaches adolescence, if their gender identity doesn’t match the gender they were assigned at birth, it’s likely they will stick with that gender identity.

Being transgender is not a fleeting thing and dismissing it as a phase can be detrimental when your child needs the most love, support, and validation. “I sometimes ask people I’m training to express how they know they are the gender they are without referencing anatomy, anatomical functions, or gender role preferences,” Nichols says. “Most say it, ‘I don’t know why I am a male/female, I just know it inside’; that’s true of trans/nonbinary people as well.”

My Son is Playing With Dolls: Does That Mean Anything About His Gender Identity?”

“Decisions about gender go so far beyond what a child likes to do,” Leikam says. “Gender norms are just that—normative behavior based on the binary of society. Gender identity decisions shouldn’t be based just on what toys a child chooses.” Knowing your child is transgender is based on “persistent, insistent, and consistent expressions by the child, over some period of time, that they are not the gender they have been assigned,” Nichols says.

What’s The Difference Between Gender And Sexual Orientation?

Gender is how we see ourselves while sexual orientation is who we are physically, emotionally, and romantically attracted to. Confusing the two can be detrimental because it makes assumptions—like a boy who tries on his sister’s dresses is assumed to be gay, and a girl who cuts her hair short and dresses like a boy is assumed to be a lesbian.

It can also confuse the child about who they are—i.e. a transgender or nonbinary child might think they are gay or lesbian before understanding their gender identity.

What Does It Mean To Be Non-Binary?

A nonbinary person is someone who doesn’t identify as strictly male or female and who uses the pronouns “they” and “them.” According to the National Center for Transgender Equality (NCTE), nonbinary individuals are identified as those who don’t neatly fit into the categories of ‘man’ or ‘woman,’ or ‘male’ or ‘female.’ A person who does not conform to the binary expectations of the stereotypical presentation or feelings of male or female.

How to Support Your Child Through This

“Sometimes adolescents will suffer from depression without any obvious cause, and that may be related to a hidden transgender or gay identity,” Dr. Nichols say. “Gender nonconformity may be a cue for gender dysphoria, but often is simply a nontypical gender expression, not a nontypical gender identity.

 If you suspect or know your child is transgender, seek support, care, and education both for your child and for your family. Some resources are Human Rights Campaign (they provide resources for children, families, and pros); Family Acceptance Project; and Gender Spectrum.

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Last Updated: Jul 27, 2020