If there's one thing a mother never dreams her daughter will say, it's "Mommy, I want to be a boy."
When Julia O'Dwyer heard these words, she couldn't dismiss them as a tomboy phase because her 12-year-old daughter had rejected girls' clothing and toys for years, she says. So instead, the Vancouver mother of three consoled her eldest child and waited for what came next.
Months later, her daughter came home from school and announced she was transgender.
Ms. O'Dwyer says she had a brief moment of "Gee, why me?" but her first instinct was to contact local health professionals.
After months of psychological assessment, followed by hormone treatments, her daughter became known as a boy named Cormac. Last week, at age 15, he had surgery for breast removal.
Her son has been much happier since he "came out" at school, Ms. O'Dwyer says, and friends and family have been supportive. "Having a child who's different has actually been an enriching experience for me."
Few parents are as open-minded, however. For many, it takes years of family therapy and support from other parents before they can accept a change in a child's gender, according to mental health professionals.
"What you're really losing is your dream of what your child was going to be," says Melady Preece, a Vancouver psychologist who works with transgender youth and their families.
More and more parents of school-aged children are facing these challenges as transgender youth "come out" at earlier ages in greater numbers, emboldened by access to information on gender-identity issues via the Internet, experts say.
Since 2004, Toronto's Centre for Addiction and Mental Health has reported a sharp increase in the number of adolescents referred to its gender-identity clinic.
And youth workers in Toronto and Vancouver say their caseloads of teens with gender-identity issues have grown significantly in the past few years.
In response, resources for families of transgender youth are multiplying as well.
This week marks the third annual Gender Spectrum Family Conference in Seattle (September 4 to 6).
It's the only event in North America of its kind, featuring a roster of therapists, psychologists and pediatricians, many of them from Vancouver, including Dr. Preece. Organizers say enrolment for the workshops – which include topics such as sibling relationships and medical issues for transgender youth – has doubled since last year.
As well, support groups such as TransParent Canada have grown online, along with downloadable publications such as Families in TRANSition, a 2008 Canadian resource guide.
"There's so much more available now," says Joan
Wiley, who founded TransParent in 2004. When her son came out as transgender less than 10 years ago, she says, resources for parents were woefully inadequate. "I had Jerry Springer. How good is that?"
Parenting transgender youth is still new territory, however. According to Dr. Preece, many parents have difficulty distinguishing between gender identity and sexual orientation, which are unrelated.
They struggle over whether to give their consent for medical treatments – and if so, at what stage in the child's development. And they fear their child will be bullied at school, jumped in an alley or denied a job.
Some parents disown their child, Dr. Preece says. She has seen marriages break down when parents disagree about treatment options, and relatives withdraw from parents who help a child make the transition to the new gender.
"The very worst problem is when parents feel that somehow this brings shame on the family," she says.
In other cases, parents try so hard to support their transgender child that they bury their own feelings. Anne Hines, a Toronto author, says she couldn't talk about her own experiences for several years after her 17-year-old son came out as a young woman named Jade.
"I needed to be there for her with her issues," she recalls.
As her child prepared for gender-reassignment surgery last fall, however, her emotions came to the surface. "I absolutely had to mourn the loss of a son," says Ms. Hines, who describes the event in her forthcoming book,
Parting Gifts: Notes on Loss, Love and Life .
Now, however, she celebrates her daughter, who is happier and more confident since the surgery, Ms. Hines says. "It created in her a core of peace."
When a transgender child comes out, generally the whole family comes out, Ms. Wiley says.
She and her husband spread the word to friends and family in a Christmas newsletter, "knowing that this would be a newsletter that would not soon be forgotten" Although some people distanced themselves, she says, the couple discovered they had chosen their friends "very well."
Long after the big announcement, however, the transition period may continue. Parents often remove old family photos from view because they bring up painful memories. Some even hire a photographer to doctor old portraits of the transgender child.
Pronouns can be a minefield, Ms. Wiley says, and it can take time before it feels natural to refer to a child by the other gender.
"For me, one of the biggest joys has been the day I realized that I said 'my son' without having to think about it and without mentally adding the word 'trans' in front."
Some adjustments aren't easy at first, she says, but many families learn to see their child – and their broader social network – in a new light.
"If your core value is that you love and support your child," she adds, "then you will be okay."
Preparing to change
The most controversial issue facing parents is whether to approve medical treatments for a change of gender. The effects of many hormone treatments and surgery are irreversible, and not all prepubescent children with gender concerns will continue to seek sex reassignment after puberty.
But studies have shown that the majority of people who undergo sex reassignment surgery have no regrets, are happier and have improved mental health after surgery, especially those who transition earlier in life.
A doctor may prescribe hormones that delay puberty; this buys time for parents and children to consider future options. Doctors generally will not prescribe hormones for a gender change or recommend surgery until after a transgender adolescent has lived as the opposite gender for an extended period and had psychological assessments for up to two years.
Adriana BartonSources: Guidelines for Transgender Care (2006), Gender Spectrum Education and Training, Families in TRANSition (2008)
Although social acceptance for transgender people is growing, parents continue to abandon youth with gender-identity issues when their children need them most, advocates say.
49 per cent of transgender people attempt suicide.
Transgender youth account for 18 per cent of homeless people in cities such as Chicago, but researchers estimate fewer than 1 in 1,000 people is transgender.
1 in 12 transgender people in America is murdered.
Transgender youth whose parents pressure them to conform to their anatomical gender report higher levels of depression, illegal drug use, suicide attempts and unsafe sex than peers who receive little or no pressure from parents.
Less than 1 to 1.5 per cent of individuals experience persistent regret after sex-reassignment surgery.
Sources: Guidelines for Transgender Care (2006), Gender Spectrum Education and Training, Families in TRANSition (2008)