Supporting their trans and gender-diverse child’s mental health and wellbeing

Being trans or gender diverse is not a mental health condition. However, young trans and gender diverse people often experience additional pressures related to their gender identity and how they are received by their family and their peers when they come out and socially transition, which can affect their mental health.
Trans and gender diverse young people are more likely to experience depression and anxiety than young people who identify with the gender they were assigned at birth. They are also more likely to self-harm. There are also strong links between these higher incidences of mental health problems and experiences of prejudice and discrimination that trans and gender diverse people face.* Importantly, young trans and gender diverse people who are well supported by their family and get psychological support cope better (Gender Identity Development Services, 2020).
The parents and carers we spoke to have a range of experiences related to their children’s mental health. Some parents emphasised that their children have been doing fine, like Georgina who said: ‘I think there’s an awful lot of children who suffer hugely, again going on what the support sites say. But… our son for the most part is a very happy-go-lucky kid.’ Others spoke about their children suffering from anxiety or depression. A few also spoke about their children self-harming or attempting suicide.
In this section, you can read what the parents and carers we spoke to said about:
  • The importance of support and affirmation for a child’s mental wellbeing;
  • Puberty as a time of additional pressure;
  • The positive impact of social transition on a young person’s mental health;
  • Impact of long waiting lists on mental health; and
  • Getting help.

The importance of support and affirmation for a child’s mental wellbeing

In the context of interpersonal relations, gender affirmation refers to the process where a person’s gender identity and expression are supported and recognised as valid. Gender affirmation is key to trans and gender diverse people’s wellbeing.
In our interviews, parents and carers spoke about how a young person’s wellbeing depends on many, often-connected, factors, and affirming support from the family and school, and access to healthcare play a key role. Ross spoke about how his child’s mental health ‘declined quite badly’ affected by a lack of support from their mother and school, resulting in low self-esteem and low confidence. Lesley felt that not being ‘supported and validated’ had been a factor in her son overdosing and self-harming.

Ross talked about how his child’s relationship with their mother and being bullied at school impacted his child’s mental health.

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I don’t live with my child’s mother. We split up when my child was six months old, but have been a very hands on parent. Weve had a 50/50 split from the word go. Child spent time with both of us on a three, four day split. So hed spend three days with me and three days with mum and then four days with me, four days with mum, cause I didnt wanna end up being a weekend dad and just picking him up at the weekend. I was involved in school, in nursery, the same as mum. We literally had 50/50 over 14 days wed get seven days each. And it kind of changed the weekend thing. So, it could be Thursday, Friday, Saturday that Id have the child and then the child would be Sunday, Monday, Tuesday with mum, so it kept everything, Christmases, everything were always jumbled up. So wed literally have a 50/50 share. Mum was always absolutely anti transition from the word go, will not use, even to this day, well not use correct pronouns. Wont even accept the Deed Poll changed name. So, there’s always been a bit of a clash where I just accepted the transition completely and utterly and was 100% supportive where mum, still to this day, still doesnt accept the transition even though were quite a long way through the journey now. But still wont accept it. There’s always been a lot of friction between my child and my child’s mother, where me and my child have always got on brilliantly. And Ive got a very, very good, strong open relationship and talk about everything where with mum it’s very polar. It’s completely different. The transition began when they were at secondary school. There was a lot of bullying from other students at school. A lot of isolation and that ended up with a suicide attempt and at that point, social services became involved and I was then granted 100% custody, cause it was deemed they were unsafe with mother, because mother was actually causing a lot of the arguments or not helping and not supporting. So they were deemed that they should be with me full time, which they did for about a year. Then the transition moved on a lot. At that point, both of us were attending CAMHS with our child, but separately. So we didnt go to the meetings as a family unit, because we werent a family unit we were two individual parents with a child in common. So we did both attend CAMHS at various times and we were eventually referred on to the [GIDS], where initially I wasnt allowed to go and only mum went. And mum being absolutely anti transition made every or all the very early [Gender Identity Development Service] appointments about her. So it wasnt directed at our child and our child got no benefit from it at all. There was just lots of arguments between mum and the specialist and therapists at the [Gender Identity Development Service], which didnt work very well for our child. Our child didnt feel was getting attention or moving forward or anything. Then after the suicide attempt, I started going solely to the [Gender Identity Development Service] and we progressed quite, quite well. We Deed Polled. At that point, theyd just left school, secondary school passed with some GCSEs. Not quite the grades that were expected. But a lot of that was sadly down to the school who didnt deal with the bullying issues, put my child in the isolation block. So my child didnt attend lessons, they just went to school and done their own thing in the library, which meant they got, they passed GCSEs which I’m really proud of, but didnt get the grades that the school were expecting. And it also put them off education. So although theyd been offered a college place, they decided they didnt wanna go to college, cause theyd lost faith in the education system, had just assumed they would get bullied. Although I assured them college is very different to school and certainly being trans, youd probably be really popular at college, because it’s cool and kind of fashionable and youll probably be fine, and it’s a totally different experience. But theyd been put off completely. So ended up leaving school with some GCSEs and just getting employed, which they have always been employed, well not always been employed, but theyve had periods of employment, periods of unemployment. A lot of that was down to mental health, because their mental health declined quite badly. They had low self-esteem and low confidence. And found friction at work. If there was any sign of bullying they would fold their cards and leave their job rather than deal with the bullying, because theyd been bullied at school they decided they wouldn’t get bullied any more, but left the job rather than going to an employer and dealing with it and getting it sorted out would just jack in the job and leave, which was okay and as I say was supportive of the whole thing and because of the trying to build their self-confidence and self-esteem, it’s kind of youve have actually got mental health issues that need focusing on and you need help with and you will be okay. You will get through it with help and with time.

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Some parents and carers we spoke to felt that their own affirming approach – supporting their child’s gender identity and supporting their child’s social transition – have been key to their child’s mental wellbeing. Leigh said about her foster son: ‘If I hadn’t of supported my child to transition socially and in school, to be where he is now, he, I’m not saying he would have taken his own life, cause he wouldn’t… But he wouldn’t be the person, he wouldn’t be doing well in school. He wouldn’t have friends. He wouldn’t have interests. He wouldn’t come out of his room if he was made to live as his birth gender.’
One parent learnt from the experiences of others the importance for parents to affirm a trans or gender diverse child’s gender identity and how ‘rejecting the child’ can lead to mental distress for both parents and the young person.

Mel felt being trans is ‘a huge amount for someone to take on at such a young age’ and talked about helping her step daughter deal with anxiety.

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I mean it’s a huge amount for someone to take on at such a young age. I mean, it just, when people used to say things to me, Well, it’s just a phase. How could you, how could you let them do this, that and the other wha, wha, wha. I said, Do you think any child would choose to go through this? Do you genuinely. We’ve all been through it. Do you think that you would choose. We all, at that age just kind of wanna fit in and be accepted and belong. You don’t, you would never choose to do something just so difficult, so life changing, to everything and everyone. But I think, yeah, just managing that anxiety was tough for her and for us to continue to be supported. And I feel that we all, as much as we could just held, held her and held her sister and just held the space as best as we could and give her, because sometimes she would be prone to outbreaks where she would just sort of scream. She would scream or she’d roar or she would burst into tears and, which was understandable, and be moody. She was just carrying like all this stuff [softly]. And I heard her not knowing how to express it, you know, at that time. But, on the whole, we didn’t, there was no sort of self-harming. No depression as such. No panic attacks. Nothing else. No other sort of major symptoms that I keep hearing time and time and time again. And no other like mental health diagnosis that says she’s not being diagnosed with autism of any kind or any sort of personality disorders of any kind.

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While Interview 1’s daughter is confident and happy, she has seen elsewhere how lack of affirmation from the family negatively impacts a young person’s mental health.

People read the guidance on the NHS website, which is very dismissive of the fact that a child can be trans. And they just will continue rejecting their child and that’s painful to the parents, because the parents see how much harm it’s causing. But they don’t feel confident to accept their child until a medical professional has told them that’s okay to do. And with a two year wait and the medical professionals – they vary at GIDS – but some of them never say affirm your child at any point. Some of them will say it at some point, but theyll like assess for like a year before theyll say okay, it’s okay to do that. And, and I know a lot of parents who keep going back and back and theyre kind of waiting for the professional to say, okay now’s the time. And a lot of the professionals they don’t see that as their job to ever say now’s the time. And so, there’s a decision vacuum where some parents don’t feel like they should be the ones to say, okay, now is the time and theyre waiting for a professional to say now’s the time, but the professional, some of them never want to make that call. And the period at which the child is still being rejected and I, and I know too many families who have kept their child in the rejected state and the parents, you know, they, they talk on these forums and stuff. They feel, they feel torn about it. And it takes a crisis before the parents say, okay, this is not working. And sometimes that crisis is, you know, self-harm and you know, something quite serious. And it’s the child’s mental health going from very distressed to, you know, not wanting to be here anymore and we hear that a lot. And it’s sad that it takes a child to really nosedive really badly before people – because people are so scared of the option of accepting their child as trans that it takes that kind of crisis and we know lots of families who the response after affirmation and acceptance can be a happier kid. But the kids whove really crashed in mental wellbeing before theyve got that affirmation, you know, they still have those issues. Like it’s not like the next day they’re suddenly like without those mental health issues. Theyve still got those mental health issues. Whereas the kids whove from my, from lots and lots of anecdotes the kids who have been accepted by their parents a bit earlier seem to be getting on a lot happier. So like my daughter’s a good example. She’s just really happy. She’s confident. She’s not got any problems at all at the moment. I think the only problem she’s got are like just to do with cisnormativity at school and stuff. So like the school are a little bit hesitant about educating about trans stuff. She’s a bit frustrated about that. But other than that, she’s she’s really happy.

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Puberty as a time of additional pressure

Puberty can be a challenging time for trans and gender diverse young people. Bodily changes due to puberty can be sudden and distressing, and sometimes lead to body dysphoria. Parents and carers spoke about distress caused by changes in a child’s voice, facial hair, and other physical developments. For example, Ali’s daughter had panic attacks and ‘became very introverted over that period of time [when puberty started] and extremely anxious.’

Having a female sounding voice has caused anxiety for Ross’s child, who won’t talk to people on the phone.

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Nearly all of them are suffering depression and suffering anxiety certainly for mine, still telephone conversations, they cant do telephone, because theyve got a female voice. They sound like a female when they talk on the telephone. So then the person on the other end of the telephone will miss-gender them, because they sound female. I know that is gonna change with the testosterone. It will have an effect and their voice will hopefully get much deeper and then theyll start using the telephone. But that’s an issue at the moment is, they refuse to do anything on the telephone. Theyll send emails, they will send text. But they wont talk on telephone, because their voice sounds female.

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For parents of pre-pubertal children, like Oonagh, there was the concern that puberty might bring a deterioration in their child’s mental health, as they anticipated some difficulties in how their child would feel about the changes happening to their body.

Oonagh worried that her daughter could be ‘susceptible to a deterioration in mental health’ when puberty started.

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At the moment she’s, at the moment she’s okay. But I do feel like she could be susceptible to a deterioration in mental health, because she’s quite, she’s quite sensitive. I don’t know what will happen if and when puberty starts happening. I know that she is, as she’s getting older, because she’s just becoming more aware of everything. And I think the more aware she is of her peers and how theyre developing. She’s always felt a little bit different anyway. She’s always felt like she didnt fit in with the boys and she didnt fit in with the girls. And now that she’s a trans girl, she doesnt, I think that she has got a fear that she’s not quite like all the other girls and that she wants to fit in with them. And she just wants to be normal and just do all the things that all her peers are doing. And I can see as well that she’s noticing that other girls are developing in a different way, because they get, theyre shooting up. Theyre getting, developing breasts and all those things that go along [with] it. I think she’s just, things becoming a little bit more acute for her and she’s not distressed as yet, but I think there’s a potential there. So I am just keeping an eye on her really and making sure that she’s okay and if anything happens where I think her mental health is deteriorating then I would be quick to try and sort it out in whatever way I could. So I don’t know what that would be if we hadnt reached the point where we were in GIDS then maybe I would go to CAMHS, maybe. You know, there’s always these options available. So, I, I’m just waiting to see what will happen and just keeping an eye on, on how she is. Just answering all her questions and making sure she knows that were there to support her.

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You can read more about puberty related pressures here.

The positive impact of social transition on a young person’s mental health

Many people we spoke to talked about how socially transitioning positively affected their child’s mental health. Lisa observed about her son: ‘We had a planned transition over a half term period, where she had her hair cut and immediately I could just see the difference in, she just seemed relaxed as ‘he.’ He …was happier, he was more confident… the impact on my son was remarkably positive. Just looking at himself in the mirror you could see it was almost like awash with relief.’
Ali talked about how her daughter’s mental health has improved after socially transitioning and how she has since ‘met people online and she’s visited them, and she’s got so much more confidence.’ She observed that ‘it took… a long time for her to get the confidence up to come out socially and she’s has (now) completely [come out].’

Ali’s daughter no longer self-harms and there has been a huge improvement in her mental health since her social transition.

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How has her mental health been since she started on that journey?

It’s much better. It’s gradually improved and I havent had any self-harm. I know, she hasnt been self-harming for [sighs] it’s probably a good year. And even then, it’s, (it had) slowed down, considerably. She was having terrible panic attacks and but she got herself back on course when she went to sixth form college. And her academic side really picked up. And she really seemed to be starting to pull herself together. And she got the confidence to come out completely, socially. And she’s so much more positive about herself. She’s still, you know, the dysphoria is still there. She still gets angry. And she’s a typical teenager, she’s really grumpy [laughs]. But, yeah, she’s becoming more, she’s, there’s fewer panic attacks. She’s less anxious about things. She’s prepared to go out and meet people. She’s prepared to go out as herself. And, I mean, she flew off to [name of country] to see one of her friends and they were going out together as themselves. She’s just blossomed, absolutely. I could still throttle her sometimes, but it’s like a normal, you know, teenager. And it’s so much better. I’m not worrying that the police are gonna come to my door and say that she’s gone, anymore. So it’s much better.

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Being able to fit in better with his peers was something that Leigh talked about as a positive outcome of her foster son’s social transition. She said that, ‘before his transition, he was the kid in the playground, sat reading a book with no friends. Because he didn’t fit with the girls and he didn’t fit with the boys. They didn’t understand him, because he didn’t understand himself. Once he transitioned, it wasn’t a magic moment, it did take a few weeks. But he managed to create a really nice big social group of boyfriends. Joined in the boy’s things, joined the boy’s clubs and he basically it’s like he blossomed over the first few months.’

Impact of the long waiting list on mental health

The long waiting times to access specialist Gender Identity Services for both children and young adults can affect the young person’s mental health particularly where there is existing body dysphoria, rapid changes due to puberty, or mental health issues. Ross said that his child’s ‘mental health was in such decline that I couldn’t, I couldn’t envisage them being around that long [on the waiting list]. I think they would have probably had a successful suicide attempt, because they were really in decline and depressed, and isolated, and I don’t think they’d have made the two year waiting list.’ Ross decided to explore private healthcare options for his child. Other parents, like Lesley, whose son’s mental health was deteriorating, the long wait meant they felt they also had no choice but to pay for private healthcare.

Lesley talked about the long waiting list and seeking private healthcare for her son, because of his deterioration in mental health.

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The challenges have been the extraordinary long waiting lists to be seen by the Gender Identity Services for kids. We waited twenty months from the first referral through to our first appointment with them, the NHS service. That it was always approached from a cisnormative perspective. So it was never, it was always being seen, being trans was always seen as it was others. So it was an assumption that maybe it was a phase and he’d grow out of it. There was a perspective that the norm is to be cis. And so from the, because he’s been involved in CAMHS for a long time. So the perspective from the CAMHS team was, this was almost like a mental health, part of a mental health difficulty. And we didnt really approach the GP about it until it was around trying to manage his periods and the GP was amazing. And we talked about it and she immediately put him on the pill, which made things a bit worse for a while. But she was trying.

When you say that your son was with CAMHS. So the referral have come from CAMHS?

The referral to GIDS is by CAMHS, yeah.

How did that come about, that referral?

Well partly it was because that he, there was a lot of increase in dysphoria and he had, he’d made several attempts to take his life. There was lots of things like self-harm and overdose type stuff going on. And part of it, I felt, was around him being trans and it not being supported and validated in that way.

They referred him old that actually they can’t GIDS couldn’t expedite his referral, because everybody was on tthen cause I requested it and then they followed it up, because his mental health was deteriorating. So about six months after the first referral they, they chased it up. They were this long waiting list. And it was roughly about that time that we decided to go for a private assessment and it was because my son had been admitted to CAMHS Inpatient Unit at that particular point. It was our second, if I don’t do something, he’s not gonna survive. He’s not gonna live. He’ll end up taking his own life.

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You can read more about people’s experiences of being on the waiting list to the Gender Identity Development Service.
However, not everyone felt that accessing specialist care would be good for their child. Elijah worried about the long-term mental health of his child and felt the decision to have hormone therapy and surgery too early could lead to a life of ‘physical scarring and unhappiness’. He felt that the long waiting time for Gender Identity Services was good and said: ‘I’m holding out that my daughter will become comfortable in her own skin, which is the most important thing here, to be comfortable in her own body. To be happy as who you are and not pushed into medicate for life. That’s the route I hope she will take.’

Getting help

Parents and carers we spoke to had varied experiences of getting help for their young person. Not everyone felt their young person needed additional support and for example, Jan stressed that her daughter did not have mental health issues. For other parents, there might have been periods when their young person needed help with their mental health and other times when they were doing fine. Andrew emphasised ‘Our daughter has suffered some mental health issues… We dealt with it ourselves, really. We did phone CAMHS and explained to them, but it was a very quick one day blip and she… was fine the next day. So apart from that she hasn’t had any major, major health issues.’
For parents and carers whose children needed more input from mental health professionals, there were options. Whilst some were able to pay for private counselling or therapy for their young person, others were relying on the of the support Child and Adolescent Mental Health Services (CAMHS).
Some parents praised the positive impact that joining local support groups and getting involved with local LGBT charities had on their young person’s wellbeing. Leigh emphasised the positive influence of ‘finding local support groups for kids.’ She said that for her foster son, being able to be surrounded by other trans youth and ‘being able to be himself everywhere’ and be supported and accepted has been more helpful than anything else. Many parents and carers saw joining support groups as something that was helpful for them too.
Getting the right kind of help at the right time was another issue identified in our interviews with parents and carers. One mother, whose son was on hormone blockers, felt that the time when her son was on the medication should have been used to explore his gender identity with the GIDS, but she also felt the service was not doing that. Another parent also felt that the time the young person was on hormone blockers was when the therapist should ‘come in and be talking about all of the things that they need to talk about to really use that space.’ She felt the GIDS therapists weren’t doing that for her child and that ‘it’s just press this pause button [for puberty] and then he’s in limbo.’
Schools can sometimes offer support to the young person and their family. However, the kind of help available might not always be well suited to the needs of the young person. Ali said about her daughter’s school that ‘the school did provide a bit of support, but it was mainly, she was lumped in with a therapy group for very violent pupils, which wasn’t particularly helpful.’ Other parents spoke about making sure the support offered by the school was ample and at times changing schools if did not meet their child’s needs. For example, Lesley stressed that she did plenty of research to make sure her son would be supported in his new school and that the support would be there in practice and not just on paper.

Lesley looked at what support schools offer when choosing a new school for her son. She felt what was advertised was not always there in reality.

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We looked at the pastoral support, in general. The emotional support that they offered to students. But not only what they not only the jargon of, of what is said, but actually speaking to them to see what they did in practice because we had, we’d already moved schools once and the jargon from the second school we went to was all about individualised wellbeing support and stuff like that. And I was sold on it. I thought that, that’s fantastic. But in reality, reality didnt fit. So what they said they’d provided and what they actually provided there was a huge discrepancy. So with this school, I went to great lengths to ensure that actually what they said they provided they actually did provide. That’s the bit that’s made a difference. He’s got a pastoral support, a named pastoral support, that he can link to at any point. He has ways of being able to manage himself and his emotions during the day. And they’ve been great.

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Finally, supporting a trans or gender diverse child can be challenging for parents and carers, who might need support themselves.
Please see our Resources page for links to charities and organisations that offer mental health support to young people and their families.
* LGBT Health and Wellbeing, 2018. LGBTI Populations and Mental Health Inequality.

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