Transgender youth
Transgender youth are children or adolescents who do not identify with the gender associated with the sex they were assigned at birth. Because transgender youth usually depend on their parents for care, shelter, financial support, and other needs, they face different challenges than transgender adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.
According to the American Academy of Pediatrics, most children have a stable sense of their gender identity by age four, and research substantiates that children who are prepubertal and assert a transgender or gender-diverse identity know their gender as clearly and consistently as their developmentally equivalent peers who identify as cisgender and benefit from the same level of social acceptance. A 2022 review found that most pre-pubertal children who socially transition persist in their identity in 5- to 7-year follow-ups. Gender dysphoria is likely to be permanent if it persists during puberty.
Coming out
Transgender youth may experience family exclusion and discrimination. Some transgender youth choose to remain closeted until they determine it is safe and appropriate to disclose their gender identity to family members and friends. In the LGBTQ community, "coming out" refers to the process of acknowledging and publicly sharing one's sexual identity or gender identity.Family acceptance
Family acceptance, or lack thereof, significantly impacts the lives of transgender youth. Predicting a parent's reaction to their child's gender identity can be difficult, and the coming-out process may be challenging for many transgender youths. In some cases, parents may react negatively, which can include disowning the child or forcing them to leave the home. Research suggests that transgender youth involved in the juvenile justice system are more likely to have experienced family rejection, abuse, and abandonment compared to cisgender youth. Because transgender youth depend on their parents for support and acceptance, family exclusion can contribute to emotional vulnerability for transgender youth, and some may regret coming out as a result.Parents can seek gender-affirmative counselors and doctors and connect their children with LGBTQ support groups. Some parents join organizations such as Mermaids in the United Kingdom and PFLAG in the US to meet other parents and learn how to advocate for their children. Parental reactions to transgender children may change over time, with some parents who initially respond with negativity later offering support.
Support
Research has consistently shown that familial support and acceptance of transgender youth contribute to more positive outcomes in mental, physical, and emotional health.Studies have identified various ways in which parents or guardians can support transgender youth, including providing opportunities for open discussions about gender identity. Transgender youth experience greater emotional stability and success when parents take a supportive approach rather than a controlling or dismissive stance. Addressing challenges during the transition process as they arise, rather than imposing views or dictating the process, has been associated with healthier transitions. Additionally, informing professionals and other key individuals in the child's life helps build a support network for transgender youth.
Access to information is an important factor in aiding and advocating for transgender youth. Information allows parents to connect their children with resources related to gender identity, such as medical care, counseling, educational materials, and local youth groups that provide community support.
Support in schools also plays a significant role in the well-being and mental health of transgender youth. Many schools implement policies to support transgender students, and educators can reference trans-inclusive school guidance documents to inform their approaches. Ongoing research continues to explore best practices for transgender inclusion in educational settings.
Health risks
Family acceptance of transgender youth is associated with higher self-esteem, increased social support, and improved overall health. It also serves as a protective factor against depression, substance abuse, and suicidal ideation and behaviors. Research has indicated that, in carefully selected patients, those who transition at a young age experience few negative effects and maintain a higher level of functioning compared to before transitioning. Additionally, treatment outcomes, such as those from counseling, tend to be more favorable when offered at an earlier age.Family behaviors play a role in either increasing or decreasing the health risks faced by transgender youth. Negative behaviors, including physical or verbal harassment, pressure to conform to gender roles, and exclusion from family events, are linked to higher risks of depression and suicide. Conversely, supportive behaviors, such as acknowledging and discussing the youth's gender identity and working to support their choices despite potential parental discomfort, contribute to increased confidence and help mitigate the health risks associated with rejection.
Medical interventions
s are sometimes prescribed to trans children who have not yet begun puberty to temporarily halt the development of secondary sex characteristics. Puberty blockers give patients more time to solidify their gender identity before starting puberty. While few studies have examined the effects of puberty blockers for transgender and gender non-conforming adolescents, the studies that have been conducted generally indicate that these treatments are reasonably safe and can improve psychological well-being.Short-term side effects of puberty blockers include headaches, fatigue, insomnia, muscle aches, and changes in breast tissue, mood, and weight. The potential risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists may include adverse effects on bone mineralization. Additionally, genital tissue in transgender women may not be optimal for potential vaginoplasty later in life due to underdevelopment of the penis. Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited. In the Netherlands, youth are allowed to begin taking cross-sex hormones at age 16, following their course of puberty blockers.
Some studies support the ability of children to provide informed consent for puberty blockers, arguing that if parents oppose a child's transition, the child may lack access to medically necessary treatment. Comparisons have been drawn to the legal precedent allowing children of Jehovah's Witnesses to receive blood transfusions despite parental objections. Research highlights the psychological benefits of puberty blockers and the potential psychological and physical harm resulting from lack of access. Transgender minors, particularly homeless transgender youth, who do not have standard access to blockers may seek them from unreliable sources, increasing the risk of dangerous side effects. Transgender youth have voiced support for their right to access puberty blockers.
In Bell v Tavistock, the High Court of Justice of England and Wales ruled that it was unlikely that a child under the age of 16 could be Gillick competent to consent to puberty-blocking treatment. This was overturned by the Court of Appeal, which ruled that children under 16 could consent to receiving puberty blockers.
For those who are over 18 and do not require parental consent, there are several medical interventions available. For those wishing to transition from male to female, options consist of facial feminization surgery, vaginoplasty, breast augmentation surgery, and cross-sex hormones. For those wishing to transition from female to male, options consist of penile construction surgery, breast reduction surgery, and cross-sex hormones. Under American Psychiatric Association criteria, in order for any individual to receive these medical treatments, they must have a written diagnosis of gender dysphoria and have undergone up to a year's worth of therapy. Citizens of Malta can change their gender marker through a relatively simple paperwork process. In the United States, changing a gender marker typically requires medical documentation and may require individuals to return to their home state to obtain various legal documents. To update an existing gender marker and name, applications can be submitted for driver's licenses and banking documents.
In February 2024, the American Psychological Association approved a policy statement supporting unobstructed access to health care and evidence-based clinical care for trans, gender-diverse, and nonbinary children, adolescents, and adults. The statement also opposes state bans and policies intended to limit access to such care.
The British Cass Review, which examined gender services for trans youth in the United Kingdom, stated in its systematic review of the literature that "the quality of the studies was not good enough to draw any firm conclusions, so all results should be interpreted with caution". However, other countries, including the United States, France, Canada, Australia, Germany, Switzerlands, Austria, and Japan, have disagreed with this conclusion through statements from relevant medical organizations, systematic reviews of their own, or subsequently released medical guidelines.
In May 2025, a two year systematic review commissioned by the state of Utah as part of a ban on trans youth healthcare concluded that "The consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer". The review's findings were thereafter dismissed by the Utah state legislature, who kept the ban in place.