Perspective Chapter: Transitioning to Transgender – How Can We Help?

Abstract

Change is not easy in a professional environment and it is even more challenging in our personal lives. In this chapter, I explore how we can all become champions of the transgender population. My interest in the transgender population started 3 years ago when my child came out as transgender. My daughter is now a son and I have become an ally of the LGBTQ+ community. I have learned to embrace the journey and am continuously learning how I can support and elevate the transgender community in myriad ways. I share the experiences that have shaped my life recently with the hope it might help others, particularly parents of transgender children, understand one simple idea: “you are not alone”.

1. Introduction

“You deserve the best, the very best, because you are one of the few people in this lousy world who are honest to themselves, and that is the only thing that really counts.”

—Frida Kahlo

You are not alone. That phrase resonates with me as the parent of a transgender son. We live in a new era that welcomes changes in gender, identity, and sexual orientation. Unlike past generations who chastised and criminalized those who were different, we now have an established vernacular that continues to evolve toward inclusivity and equality. Among this community is the transgender population comprised of trans men who were assigned as females at birth and trans women who were assigned as men at birth. The transgender population deserves to not only be understood but embraced for their important contributions and authenticity. They deserve our attention and the empathy and sympathy of the personal and professional communities in which they work [1]. They deserve to be their authentic selves without fear of microaggressions and discrimination.

2. Discussion

In this chapter, I explore the following key points to help put these concepts into perspective; (1) How can everyone champion the transgender population and understand their unique population? (2) How should the transgender be cared for, communicated with, and psychologically related to as is done so naturally for cisgender men and women? (3) What society’s obligation in this context and what resources exist? The author also discusses her personal experiences relative to her transgender son and their journey together with the hopes it will guide those on a similar path now or in the future.

My impressions and personal interest in the transgender population began 3 years ago when my child expressed that his contrary to his biological gender, he believed his true gender was male. To illuminate my journey, I offer readers a view into the experiences that have shaped my life in the years since I became mother to a transgender son with the hopes that it might help others understand one simple idea: you are not alone.

There are myriad resources for parents of transgender children and while every transgender person may be on their own path to discovery and personal enlightenment, we cannot discount the ripple effect of the parents, families, friends, and by extension all those with whom a transgender person interacts.

There is a strong connection between the psychological, emotional, and physical feelings of dysphoria and confusion, especially when trans men and women begin their transition. There is beauty in a name especially when chosen as the first step of a brand-new journey in discovering oneself. Imagine the satisfaction that must come with re-branding oneself in a movement toward transitioning to a new gender. What’s in a name? Simply put: everything. Hearing your chosen name used for the very first time by those around you is one of the first steps toward social acceptance and self-awareness. My son chose to use his initials (A. J.) as an interim name while he selected Drew as his formal new name. Retraining myself after 13 years to call my child by these new names wasn’t easy but it was critically important, so he understood immediately that I was by his side, his lifelong champion, and that my love was unconditional. Surprisingly, it was my younger son who was faster at adapting and remember to use the new name, an unexpected resilience that helped our family in so many ways.

Another valuable lesson learned was the huge impact of using preferred pronouns to help the transgender immediately begin to feel more like themselves and more accepted by their family, friends, and community. I’ve known many parents of trans men and women who’ve expressed their own discomfort and inability to bring themselves to make this change or to call their child by their new name. I cannot judge them any more than I’d want them to judge me. However, it quickly became apparent to me that in my situation, the significance of names and pronouns and the power they held for my child could not be overstated. In this sense, I realized I had to quickly adopt both as the first steps in his transition.

Consider how long some transgender people wait to share their true feelings and how by accommodating this request you can illustrate your support for them. I have known transgender men and women who were married for decades and then finally shared their true gender with their spouse. Some were accepted and are living harmoniously and for others it destroyed their relationship. Many trans men use the pronouns he/him and many trans women use the pronouns she/her. Some who identify as nonbinary may prefer they/their pronouns. Using the appropriate and preferred pronouns shows respect and care for those with whom you interact and is one important way to champion the transgender community [2]. Making gender assumptions based on appearance could send a harmful message or be interpreted as offensive. Leadership by example, set by someone who uses pronouns, may be the paradigm to make your coworkers feel more connected, inspired, or empowered to bring their “true self” to work every day and contribute in a more passionate and meaningful way. Leaders and peers should all be encouraged to express their authenticity freely and without fear of judgement. It may be a very small gesture for the cisgender but can have a life-changing effect for the transgender. Using the incorrect pronouns, whether intentionally or not, is known as “misgendering.” This show of disrespect can trigger dysphoria and embarrassment for some individuals because it forces them to have painful conversations and reveal identity information about themselves they may not be comfortable sharing publicly. The sharing of preferred pronouns in business, among both cisgender and the transgender community, has become more popular. But are all the ramifications positive? I include my personal pronouns in the signature of every email I send plus a descriptive informational link as: Pronouns: She/Her/Hers Why pronouns? As the mother of a transgender, I feel ownership about the need to help educate others about the importance of pronouns, which I hope will lead to broader understanding, acceptance, and usage. International Pronouns Day began in 2019 on the third Wednesday in October as an effort to create a more inclusive environment for everyone to “make respecting, sharing, and educating about personal pronouns commonplace” [3]. I appreciated this quote from the International Pronouns Day website:

“Trans and nonbinary people often have to share their pronouns to be identified correctly. As a cisgender person, sharing pronouns costs nothing and naturalizes this process.”

A more generalized set of personal pronouns that evolved from the transgender community and are becoming more widely adopted as gender-neutral are: xe/xir/xem/xeir and ze/zir/zirs [4]. Using the correct pronouns may be particularly challenging in a work environment but as the movement toward better diversity and inclusivity continues to evolve, the conversation has become more important than ever. A McKinsey and Company survey shows that 39% of potential job candidates turned down an offer because they perceived the organization to lack inclusivity in their workplace and 84% of respondents experienced microaggressions in the workplace, everyday slights or biases against them, such as negative remarks about their identity or how they dress, being asked to speak for or represent “people like them” or to correct assumptions of colleagues about their personal lives. Thirty-nine percent of LGBTQ+ respondents were uncomfortable sharing their LGBTQ+ identity with colleagues, or “coming out” to them and 37% responded the interactions were slightly or very uncomfortable [5]. My main motivation is to empower my child and contribute to a world where his path is easier if even in some small way, so he and others are spared unnecessary bias and judgement.

In addition to selecting a new name and surrounding oneself with those willing to help them transition by using their pronouns, for the female to male (FTM) transgender population there is another crucial stage of the transition process: chest binding [6]. Binding affords them another tool in the FTM armamentarium: to look and feel more cisgender. I have witnessed firsthand how binding can help alleviate dysphoria and enable an FTM to present as a cisgender male whose identity pairs more naturally with how they feel authentically. Wearing a compression binder helps flatten the breast and can avoid the embarrassment of looking like a woman or being judged by peers. It is important for parents to monitor their children’s use of binders because wearing sizes that are too small in an effort to “look more flat” can make it difficult to breathe, especially when playing sports, in gym class, or on hot and humid days. It’s also important to know that trans men do not have to bind for the rest of their lives. Once a decision is made to begin a testosterone regimen, eventually the breast will become smaller and menses will stop, both of which are huge developmental and emotional improvements during a transition. Using kinetic tape is another binding method with which I am less familiar, but it could also be effective if care it taken to avoid sensitive skin irritation. According to WebMD finding the right size binder is crucial because failure to do so can cause overheating and rib bruising or even fracture and it’s especially challenging for anyone with asthma, scoliosis, Lupus, or Fibromyalgia [5]. It is also important to monitor those who bind because sleeping with a binder on is not recommended. Like everything, the body needs time to rest and recuperate and more than 8 h of binding can cause longer-term health issues.

Once a transgender person has conquered the beginning stages of their transition and are supported by their family, friends, and co-workers with the use of their new name, preferred pronouns, and they have begun dressing and feeling more like their authentic identity, it may be time to consider puberty blockers or hormone therapy. Puberty blockers will help reduce the growth of breast tissue and block menses and are an accepted and universal first step in the transition process. They are, however, very costly, and sometimes unaffordable. The use of puberty blockers is understood to be reversible—meaning if there was a desire to return to one’s biological gender, there would be no adverse long-term effects. The use of hormone therapy offers no guarantee about reversibility, and in fact it is generally understood that using them is not reversible and may contribute to long-term effects such as an increase/reduction in hair growth, changes to the voice, and more masculinized or feminized body features that result from hormone therapy. The process involves an initial consultation with a pediatrician and referral to an endocrinologist (typically one who specializes in transgender patients). It is also important to seek out a therapist, psychiatrist, or psychologist with transgender experience who can help guide those transitioning during or throughout the process to ensure their mental and emotional wellbeing.

The World Professional Association for Transgender Health (WPATH) and the Endocrine Society created guidelines for doctors to help care for the transgender community and to ensure all decisions are as evidence-based as possible and appropriate for the age and stage of the transition. According to Unger, hormone therapy for trans men is based on treatment of hypogonadal natal men whereas estrogen therapy for trans women is based on the treatment of postmenopausal women. The hormones are most typically administered intramuscularly on a regular basis by needle injection [7]. A study by Korpaisarn et al. applied the 2017 Endocrine Society Clinical Practice Guideline for the Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons and found that within the first 6 months of testosterone treatment, the study participants developed skin oiliness, acne, cessation of menses, increased facial hair, deepening of the voice. After 6 months, they observed an increased muscle mass, body hair [8]. According to Cirrincione and Huang there are 25 million transgender people 15 years or older yet clinical pharmacology for transgender medicine has fallen behind [9]. Grant et al. found that 70% of transgender adults reported taking hormone therapy [10].

Some in the transgender community talk about being survivors because they are faced with the challenge of chronic misgendering in addition to things we take for granted such as using public restrooms (or in the case of school-aged children, locker rooms), public showers at the gym, and swimming in pools and at beaches. I have observed this in my own child, a complete reticence to wear a bathing suit because of his dysphoria. But do they identify as being survivors because of their identity change or are they survivors of their past identity (or “dead name” as many call their birth name)? Budge et al. looked at anxiety and depression in the transgender population and found it was higher than in the general population. They found that symptoms of depression were present 51.4% of transgender women and 48.3% for transgender men and symptoms of anxiety were found in 40.4% of transgender women and 47.5% for transgender men [11].

How else can the world at large help offset the psychological turmoil felt by this population? A new study in the Journal of Adolescent Health by Turban et al. [12] looked at the timing of transition, harassment during elementary, middle school, and high school, and mental health outcomes in adults. The study reports on more than 27,000 transgender men and women who transitioned at different times (ages 3–9; ages 10–17; or 18 and older). They found those who transitioned in adulthood (18 or older) experienced higher use of marijuana and lifetime suicide attempts but an equally important factor was having a safe and affirming social environment that avoids harassment between grades K and 12. In an aptly named article by Andrzejewski et al., “Perspectives of Transgender Youth on Parental Support: Qualitative Findings From the Resilience and Transgender Youth Study,” [13] the authors looked at the intervention of parental support on outcomes in this population. While there is a general paucity of information and data to address this data point, they interviewed 33 parents of transgender youth, looking at these forms of support: (1) emotional; (2) instrumental; (3) appraisal; (4) informational. While they found a general support for their child’s transition, it was more limited than expected, indicating parents could benefit from help and information to help gender-affirming behaviors and transitions.

One of the most dynamic and useful resources I have found is this one: https://pflag.org/. Nine days after my son told me he was transgender I was referred to this group, which meets locally throughout the country. It is a diverse group of transgender boys, girls, men, women and their parents. Prior to COVID, we met monthly and the support, guidance, and knowledge I gained has been invaluable throughout my journey with my son. During some of the most challenging times, the group has provided support and perspective and I often left feeling humbled by the experiences of others and grateful to know they understood what my son and I were going through from personal experience.

3. Conclusions

Whether you are considering a transition or are guiding a loved one through the journey, there are a few simple steps you can take to be a champion and to be a survivor and to help someone navigate their own journey. The easiest first step is to begin using pronouns in the workplace in their email signatures, on video conference calls, and referring to colleagues with their preferred pronouns [14, 15]. This helps support the transgender community and allows the freedom of expression among their cisgender peers [14, 15]. I encourage you to learn all that you can to help the transgender population because it will have exponentially positive ripple effects as we all work toward improvements in diversity and inclusion. I never suspected that I would become a tangential part of the LGBTQ+ community, but now that I am, I feel it is a unique honor to participate in any way I can to help educate, guide, and counsel those around me who need support. Issues of diversity, epidemiology, and mental health are interrelated and must be carefully observed in the transgender population, especially by parents and close associates to ensure their mental and physical stability [16, 17, 18, 19, 20]. This population is more prone to mental health issues and suicidal ideation as a result of the social issues and physical dysphoria they face. It is critical that public policy, laws, and social practices be improved to avoid transgender discrimination and marginalization because even plastic surgery procedures such as gender-affirming facial procedures and top surgery are not effective without such reform because mental health issues will persist [21].

Sharing what I’ve learned and helping those who I can has been one of the most rewarding experiences of my life. Where I initially felt I was not capable of managing all the emotions and challenges and questions, I now impart to others that it will be OK, you can survive. It is critical to remember that gender does not define who your child is; they will always be your child. Being their champion and ultimate supporter will help them become the incredible individual they were meant to be. We all go through the experience at a different pace and there is no right or wrong in this regard. The best advice I can offer is to love your child unconditionally so they will love themselves unconditionally. Everything begins with knowing they are supported, loved, and understood so the lessons they’ve learned can be taken forward with positivity and creativity to help them evolve into a strong and confident person who knows their value and is proud of themselves. We parents may not have all the answers and may sometimes feel as if we have nothing but questions, but you’re now raising a survivor and that means you, too, are a survivor. Good luck, and Godspeed my friends!