When I woke up from top surgery, I began to sob as soon as I looked down at my chest. Even though I was covered in thick bandaging, my chest was now flatter than it had been in a long time. As I cried, my chest tight on the inside, too, the nurses scrambled to reassure me that everything was okay. They thought I was crying because they’d lost my earring.
“I’m crying because I’m so happy,” I told them through my tears. They laughed in relief.
Though my family had been relatively supportive of my identity, they’d struggled with the concept of medical transition. Everyone was nervous about surgery. In addition to both parents’ uncertainty about going against what the therapists had suggested for me, my mom didn’t understand why I wanted to cut off a part of my body that was completely, theoretically “healthy.” But I knew top surgery was right for me. Despite the medical guidelines at the time that instructed beginning with hormone therapy, I was certain I first wanted top surgery.
When my dad watched me break down in the recovery room, he relaxed. He saw me joyful for the first time in years. Since then, he’s told me that was a pivotal moment for him. He was able to see my peace and joy — to realize that trusting me in my decisions about my own body had been the right call.
“That joy was enough for me,” he told me. “It was so clear this was right for you.”
He was able to see my peace and joy — to realize that trusting me in my decisions about my own body had been the right call.
To this day, my mom laments her ignorance surrounding trans experiences and trans healthcare. She has told me numerous times, sometimes in tears, that she wishes desperately that she could have provided me with those resources so I could have transitioned earlier. And that I could have been spared the pain that resulted from not living my gender from an early age.
While I do not blame my parents for what they didn’t know or understand, I am well aware that education about being trans is lacking. Most people have no clue what they are talking about when we discuss trans issues, especially concerning care for trans children.
In February 2022, Texas governor Greg Abbott (he/him) declared that providing gender-affirming healthcare to a trans child would be deemed child abuse, and that Texas Child Protective Services would investigate families of trans children, effective immediately. That week, some families were broken apart, with trans children separated from parents and removed from their homes. In March of 2023, a Florida Republican followed suit, introducing a bill that would allow the courts to remove children from homes where a parent or sibling is undergoing any medical care related to gender affirmation, as well as trans children from supportive parents. Such legislation is bolstered through claiming that providing kids with gender-affirming healthcare hurts or damages the child.
In the age of disinformation, right-wing politicians no longer refer to science. Instead, they rely on transphobia, lies and fearmongering.
In reality, the exact opposite is true: denying care is abuse; denying care contributes to a number of negative mental health outcomes for children, including self-harm, depression and suicide. This is backed up by peer-reviewed research, as well as by leading medical authorities.
Unfortunately, Governor Abbott, like Florida’s governor Ron DeSantis (he/him) and many others, irresponsibly ignores experts. Despite the fact that every major medical, psychological, and psychiatric association agrees gender-affirming healthcare is necessary, appropriate, and can be lifesaving, these state officials have arrogantly decided they know better. Abbott and DeSantis are far from unique. In the age of disinformation, right-wing politicians no longer refer to science. Instead, they rely on transphobia, lies and fearmongering.
So, let’s talk about the science.
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Can kids really know that they’re transgender so young?
Throughout my career, I have had numerous parents of transgender kids approach me with a confusing combination of respect and inability to extend the same respect to their own children. I frequently receive the following question from adults:
“Well, I understand you know who you are, Schuyler. You seem very articulate and mature, but you transitioned after you were a kid. At eighteen, right? What about the kids who are deciding this so young? Their brains haven’t even developed yet! Aren’t they too young to make this decision?”
Kids are absolutely capable of knowing their gender identity.
Usually the asker is a nervous parent who desperately wants the best for their child and is terrified that affirming the child’s transness will cause the child harm in the future. I have a great deal of empathy for this panic; I know that my mom struggled with this even though I was technically no longer a child when I came out.
Kids are absolutely capable of knowing their gender identity; this is supported by a few key facts:
First, according to major medical associations like the Mayo Clinic, gender identity forms as early as three to five years old. Gender identity is usually established long before sexual orientation, but because many people confuse these, they assume that gender cannot be known prior to adulthood. This is false. As soon as a child is able to verbalize their identity, they are capable of knowing it.
Of course, this does not mean that every kid realizes that they are transgender as a toddler. Social and parental pressures as well as societal stereotypes of gender, which are often rigidly enforced at school and at home (and everywhere else), can cause many transgender individuals to remain presenting as the gender they were assigned at birth for many years — some unaware of the reasons behind any disconnect, some unaware of their transness altogether.
Let’s not ignore that if a child who is not transgender never wavers in their identity in their childhood, no one claims that they are too young to know they are not transgender. No one is telling little cisgender boys or cisgender girls that they are too young to know they are boys and girls, respectively. Cisgender children are trusted to know their gender from birth. Transgender children deserve the same self-actualization, autonomy and dignity.
As soon as a child is able to verbalize their identity, they are capable of knowing it.
Second, gender identity is not a decision. Trans children do not decide they are transgender, they decide to tell you. And what immense courage that often requires, especially in a world rife with violent transphobia and strict gender stereotypes and expectations. I spent nearly five years harboring and hiding my sexuality, and even longer holding my gender identity. Many kids will have spent months or years crying in bed and laboring over how to share themselves with us.
Third, when people refer to children’s “brains not being fully developed,” they are referring to the prefrontal cortex, or PFC. This is largely regarded as the control center of the brain — it is the most recently evolved part of the brain and controls executive function. The claim that the PFC is not fully developed in kids is accurate: executive functioning does not mature until early adulthood. Executive function is often referred to as cognitive or self-control and includes the following three skills: cognitive flexibility, working memory and inhibitory control.
Everyone inhibits (or hides, avoids, doesn’t show) pieces of themselves for various reasons when they interact with others.
Let’s focus on inhibitory control for a moment. Inhibition includes the ability to hone attention and focus, ignore distractions, and inhibit or regulate base emotions and impulses. While inhibition is often very useful and allows us to adhere to social rules and therefore function appropriately in society, it also allows us to inhibit ourselves — our very identities.
If you’re an adult, you’ve likely experienced this. Everyone inhibits (or hides, avoids, doesn’t show) pieces of themselves for various reasons when they interact with others, especially in social settings.
But as stated by the question-asker, kids do not have mature inhibitory control — they do not have the mature neurological pathways in the PFC yet to enact it. As a result, kids have a unique ability to express themselves exactly as they are, because that is all they have. They have not grown up to learn who they are supposed to be, so they are just who they are.
Mature executive function (from a fully developed PFC) can actually reduce the ability for a person to be able to openly speak their mind and express their authenticity because mature executive function allows for a heightened ability to inhibit oneself—and potentially could allow a trans person to inhibit their expression of self due to fear or some other hesitation. An underdeveloped PFC might actually allow kids to declare their identities with clarity better than an adult.
Lastly, the question posed inserts a comparison between me and other trans people that is often elitist, ageist and sometimes even racist. Confused? Read on.
“You’re so articulate” and “You seem so mature” are handed to me as compliments but are followed with “and my child is not.” The parent or adult then will often explain why they doubt the validity of a young child’s transness or ability to know oneself. This is dangerous reasoning because it declares: “Since my child does not appear as articulate or mature as you are, I do not believe they deserve the same rights or trust that you do.”
This sounds harsh. Because it is. This is what a child will internalize when they share themselves and are met with doubt and rejection. Many parents believe that it is their responsibility to lead the child to somewhere positive, but I firmly believe it is the opposite. The parent must allow the child to lead, and the parent’s duty is to hold the child’s hand, to be back up, to provide support, especially in matters of identity and self-determination.
Invalidating a child’s understanding of themselves not only indicates to the child that they cannot trust you with declarations of self, but they will also learn to doubt themselves. This disruption of learning to trust oneself can become deeply rooted, disturbing the child’s very sense of self. Numerous studies have shown that invalidating childhood environments are hotbeds for the production of serious mental illness such as depression, eating disorders and even personality disorders like borderline personality disorder and dissociative identity disorder.
The answer for our question-asker is: Children are capable of knowing their gender identity as toddlers and are neurologically better equipped to declare their gender identity at a young age due to immature inhibitory brain structures. Children, regardless of their ability to articulate perfectly their identities, should be respected and affirmed for who they are.
about gender and health