A study conducted by researchers at Stanford Medicine has shed further light on what support structures transgender children most prefer as they explore their gender identity.

Entitled, “Perceptions of Support Among Transgender and Gender-Expansive Adolescents and Their Parents,” the study appears in the March 2021 edition of the Journal of Adolescent Health.

“What we wanted to find out was what would the parents who are being supportive further along kind of have advice for those who are at the beginning,” says Dr. Tandy Aye, a pediatric endocrinologist at Lucile Packard Children’s Hospital Stanford, senior author of the study and mother of two.

“Some parents have just found out from their kids that they’re thinking about their gender identity, whereas other children have been thinking about it for quite some time,” says Dr. Aye, describing the range of participants in the study, during an interview with Lianne Castelino of WhereParentsTalk.com. “They’ve been talking about it with their parents, and now they’re ready to do something in terms of perhaps medical intervention, or want to learn more about it.”

Dr. Aye is also the founder and Medical Director of the Pediatric and Adolescent Gender Clinic at Stanford Medicine, which opened its doors in 2017. The clinic is a ‘one-stop shop’ of specialized medical and social services across a variety of disciplines, that transgender children and their families may require. It includes psychiatric, gynecological, urological, fertility and legal services, in addition to medical expertise in endocrinology or hormone-related conditions.

Transgender is a term used to describe individuals who identify or express their gender differently from the gender they were assigned at birth.

As part of the Stanford Medicine study, researchers spoke to a total of 59 transgender youth as well as parents.

“I think what really surprised us was when we asked, what’s the most supportive thing a parent can do for the teen who’s going through this experience,” continues Dr. Aye. “The result was that the teens just wanted to be respected with their name and pronoun use, as well, as you know, for the parents just to be there to show them love, you know, physical expressions of love, hugs, kisses, and being there to listen,” she says.

 

Having a better understanding of the preferred support trans children want to receive from their parents could help minimize or prevent some of the myriad mental, emotional and physical health challenges these youth may face on their gender exploration journey. These include isolation, loneliness, thoughts of self-harm and eating disorders, among others.

“The other part that we also found was that even as parents are being supportive, deep down, they are also having to adapt,” says Dr. Aye.  “I think that also puts, as a parent, into perspective that you can be definitely supportive and also have your own time and process to also learn and catch up to what your child is saying to you.”

Watch the full video interview with Dr. Tandy Aye:


Click for video transcription

Hello and welcome to Where Parents Talk TV. My name is Lianne Castelino.
Our guest today is a mom of two and a pediatric endocrinologist at Stanford Children’s Health Pediatric and Adolescent Gender Clinic. Dr. Tandy Aye is also an Associate Professor of Pediatrics at Stanford Medicine, and the senior author of a study that appears in the March 2021 edition of the Journal of Adolescent Health.

Dr. Aye joins us from Palo Alto, California. Thanks so much for being here today.

Thanks for having me today.

I wanted to start with just a bit of background because as I read about this study, it really delved into the parental support that transgender teens are ideally looking for from their parents. So let me ask you what the impetus for this study was?

Well, we have a lot of families that come to our clinic, and I realized that they’re in different stages of that journey. Some parents have just found out from their parents, from their kids, rather, that they’re thinking about their gender identity, whereas other children have been thinking about it for quite some time. And they’ve been talking about it with their parents, and now they’re ready to do something in terms of perhaps medical intervention, or want to learn more about it. And we also saw that families had different relationships about this. So what we wanted to find out was what would the parents who are being supportive further along kind of have advice for those who are at the beginning? And then also offer that from the adolescence point of view? Did they agree to see are the parents just, you know, far along as they were?

It’s such a huge topic up for everybody involved. And as somebody who’s been on the forefront of it as the founder of the gender clinic, at Stanford that’s been there since 2017. Can you tell us what surprised you most about the study’s findings?

I think what really surprised us was when we asked, you know, what’s the most supportive thing a parent can do for the teen who’s going through this experience. The result was that the teens just wanted to be respected with their name and pronoun use, as well, as you know, for the parents just to be there to show them love, you know, physical expressions of love, hugs, kisses, and being there to listen. Because oftentimes, I have parents who come, and they want to help or want to get information. But I think parents are thinking much further down the road, and thinking things like medical interventions, and you know, what will happen next? And what if, and what if, and if you’re just in the moment with the team, what they just want is that love and parental support. So I thought that was wonderful, because it’s something that is free. It’s something all parents know how to do. And, you know, to show that from a science standpoint to really was a remarkable result that we were able to find.

What were the top three findings of the study?

I would say the first one was that when parents are being supportive, the adolescents also agreed that their parents for being supportive, which was a great relationship to show that, and that the adolescents really acknowledged that. In addition, in fact, the teens thought that the parents were even more supportive than the parents rated themselves to be, which is a thing sometimes from a parent’s point of view, you know, parents think, Oh, am I doing enough, and the teens really appreciated and could really see that. And then, of course, the other part that we also found was that even as parents are in being supportive, deep down, that they are also having to adapt. And I think that also puts as a parent into perspective that you can be definitely supportive and also have your own time and process to also learn and catch up to what your child is saying to you.

So, as somebody who has been in this in this area, and again, sees this on a data daily basis, what are some of the common areas where parents struggle when they’re dealing with a child that is, you know, a transgender teen or gender identity development question is surrounding that child.

I think often the parents just don’t have the information. And they’re just surprised sometimes. And they want to be able to help but not sure where to go and get the information. There’s a lot of things on the internet and in the media they might have heard of and not knowing what are the best resources and who can help guide them. That’s, I think, where a lot of parents are and I know parents want to be supportive. Also, as an adult, they start with the worrying that can start, you know, leading them down a rabbit hole sometimes with the what if, what if, what if what ifs. And they want to be able to immediately get, you know, whether it’s mental health support or medical support to be able to help their child. And I think in the study, what was really nice was that, yes, all of those things are very important. But where the team wants to be, you know, met with first is let’s talk about this together and give that opportunity for the parent and the team to be able to discuss this as they’re exploring.

How would you describe talking about it, you know, that can mean different things for different people? Are there any tips that you can share in terms of some of the key takeaways, maybe from this study about how that message gets conveyed?

How they have that discussion, parent and child, but we didn’t ask for specific questions in the study. But I think in our experience, you know, open ended questions are the best, you know, just saying, Tell me a little bit more about your gender exploration? What does it mean for you? What are the things that you’re thinking about? How can I learn more about what your identity is teach me. And I think those are just great conversation starters. And it also shows, you know, from parents that have both we interviewed, it is the process for the parents the learning process. And it’s important not only for the parents to recognize it, but I always say for my teens, too, because the teens might have thought about this for a long period of time. But for the parents, they’re just starting to think about it. So you have to give your parents time to think about it, and to be able to help you.

On that note, what did the study find in terms of key takeaways for transgender teens or achieving teens in this category?

I think the fact that parents are willing to be supportive in being able to listen and provide and I think understanding that parents do want to get the right resources for their teens, it may just take some time, and that the parents do all, you know, are loving and wanting to be there. And that the process in which they’re going through all parents are going to have a little bit of difficulty, and it’s not just going to be a matter of Yes. Okay, what do you want next? You know, they need to be given that time to process as well.

Let me ask you, what would you suggest is a logical starting place for a parent who has just been told by their child, that they’re on a gender exploration journey?

I think really asking, you know, the child, if the child mentioned that to them, or sometimes we’ve been learning, it’s by email or something is to say, yes, you know, I heard you and I want to spend that time and take a moment to talk about it. Sometimes it’s a surprise, it’s during a busy day, and apparently not have that time and say, I absolutely hear and I want to learn about what you have to say. So could we set up this time to talk? Tell me what you’re thinking? How long have you been thinking? What is it that you would need from me, I think those are great starting points, and letting the team kind of lead in just having that opportunity to express and then to for the parent, you know, to also be there to say, okay, you know, I hear you and it’s just communication skills, I hear you I’m learning the process, I may make mistakes, and you’ll just have to be patient as I learn.

For many people, the world at large, this is still a very new area and evolving rapidly. Are there any other general tips and strategies that you can offer parents in particular, who are on this journey with their children? understanding all of the different complexities of things that can happen from you know, mental health onwards for both parties?

Yeah, absolutely. I think there are having more and more what we call organized gender clinics that are good resources. There’s a lot of parental groups that are resources out there too, such as gender spectrum and websites that have information where parents can go and meet perhaps other parents who’ve been on this journey, or who are on this journey. And looking for resources. I think, for parents to understand that they’re not alone. There are other parent mentors that can help and it’s going to be a process. And it is going to be one where everyone’s going to be learning a lot and to understand people are there to meet them to help provide these resources as A child is on this journey.

In terms of the study, what do you hope that it yields? What do you hope that it leads to?

I think this is only a start. I know, you know, we were limited by the population in our local area. And now we’re looking at another demographic area of the United States to see what are the similarities among parents who are supportive and how the teens are viewing it as well. And I think what we’re hoping is that if it really, you know, we, other studies have also shown if it’s really a matter of the first thing of being respective of the name and pronoun for parents to understand that that’s what the first step is, and it seems like something that is the safe, which parents also want to be sure of, it’s reversible. It’s a simple step. And for parents to kind of feel like they can take a deep breath, and say, Okay, I can go through with this, and learn as I go and not have to worry about all the other things that they’re thinking of, you know, down the road, just take it one step at a time.

Can you tell us a little bit more about the gender clinic that you run, and you’re the medical director of in terms of the services offered, and sort of what are you most proud of?

I think what we’re really proud of is that it’s really a multidisciplinary clinic. So for our teams to come, not only are you going to see a kid’s hormone doctor like myself, but you’re going to be able to have resources, such as a gender, child psychologist, that’s part of our team. We also have a social worker, that’s part of our team. And then from primary care services, we have adolescent medicine, we also have services as needed for adolescent gynecological or urological needs. And as different kids and young adults are on different parts of their journey, we also have additional surgical services. So it’s really a whole team of services so that for anyone from a young kid who’s just exploring to someone who is a young adult, that they can just have one place to be able to come and feel comfortable in getting the services they need for gender care.

We’ve talked a lot about the study, and what it has shown in terms of how parents can better support their transgender team. I’m wondering if you could share some tips and strategies for parents of children on this gender exploration journey?

It is being able to speak and express themselves to be patient, to understand that adults take time to think about things. It’s not it as simple as watching a you know, tick tock video, and then you’re going to get to go to the next one and get a result or something. So it’s going to be a lot of being able to express and talk about it. And things like you wouldn’t understand. You have to be the person as, as the teen or the child to advocate so that the adult can understand because they really do want to hear you out. So be patient and be willing to express what you’re feeling.

Is there anything else that you’d like to add about the study or where you hope to go next with your work, whether it’s in research or elsewhere?

Yes, I think you know, having a positive light on what the actual families are going through. I think as that spreads, it’ll become a lot easier also for other families to go down this process, because a lot of times, there’s just a fear of what the repercussions might be as they’re exploring. And as more and more families learn, actually, this is not all negative. And there’s a lot of positivity that comes out of it in the parent relationships and what can get there at the end of the goal, that I think it’ll become a lot easier not only for the teens to be able to say something about it, but also for the parents to learn about it as well.

Dr. Tandy, pediatric endocrinologist, thank you so much for your time today.

Thank you for having me.

Related links:

Journal of Adolescent Health: Perceptions of Support Among Transgender and Gender-Expansive Adolescents and Their Parents

Dr. Tandy Aye, Pediatric Endocrinologist, Stanford Children’s Health

Pediatric and Adolescent Gender Clinic, Stanford Children’s Health

On Life, Loss, Legacy and Transgender Parenting: A Dad’s Journey

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