Gender variance or gender nonconformity in children is characterized by behavior or expression where the genital anatomy (sex) of the child does not predict their behavior or gender expression (e.g., a girl who refuses to wear dresses or a boy who prefers to play with dolls). Unfortunately, the emotional bias and assumptions made by society at large about gendered behavior have allowed gender-variant children to be marginalized, blamed, and attacked for their personality characteristics (Grant et al., 2010; Lev, 2004). Furthermore, a standard of conformity to gender stereotypes is imposed on children but is not required of adults (Hill, Rozanski, Carfagnini, & Willoughby, 2007). Also, it has been shown that school results of children with gender variance suffer and that transgender youth are subject to significant levels of violence (Grant et al.; McGuire, Anderson, Toomey, & Russell, 2010; Toomey, Ryan, Diaz, Card, & Russell, 2010). Added to this is the reality that gender-variant children are often misdiagnosed with a mental health issue or otherwise pathologized (Lev). Consequently, parents with gender-variant children are faced with an array of challenges and complex decision making as they contend with their children’s needs and others disapproval of their child’s behavior.

Studies on gender-variant children have largely been centered on etiology, symptomatology, and diagnosis of gender identity disorder in Children (American Psychiatric Association [APA], 1994). Gender identity disorder is diagnosed in people with “a strong and persistent cross-gender identification” (APA, p. 537). The causation of gender-variant behavior has dominated the landscape dictating treatment over agency (Ellis & Eriksen, 2002) even though it appears that only a fraction of the children with gender variance develop into adults with gender identity disorder (Wallien & Cohen-Kettenis, 2008).

Though transpositive approaches to working with gender-variant children and their families have been strongly advocated during the last decade (Brill & Pepper, 2008; Cohen-Kettenis & Pfafflin, 2003; Hill, Menvielle, Sica, & Johnson, 2010; Lev, 2004), there is still controversy among clinicians regarding the most suitable approach for working with gender-variant children (Cohen-Kettenis, Delemarre-van de Waal, & Gooren, 2008; Hill et al., 2007; Langer & Martin, 2004; Zucker, 2006). Also, the issues faced by prepubertal gender-variant children are different to those faced by adolescents (de Vries, Cohen-Kettenis, & Delemarre-van de Waal, 2007; Olsen, Forbes, & Belzer, 2011), who are much more likely to persist into adulthood (Wallien & Cohen-Kettenis, 2008). Treatment approaches for adolescents with gender dysphoria remain controversial and raise significant ethical concerns. Consequently, many professionals have not yet reached a consensus (Baltieri, Cortez, & Guerra de Andrade, 2009). Given the paucity of research guiding the clinical support of gender-variant children and the fact that it is currently unclear which children will “persist” and which will “desist” (Wallien & Cohen-Kettenis, 2008, p. 1413) it is timely to move toward research in support of the needs of gender-variant children (irrespective of the psychosexual outcome).

To capture the elements necessary to determine the needs of gender-variant children and their parents, we require a better understanding of the struggles and processes that gender-variant children and their parents encounter. Some studies have initiated this process of understanding parents’ experiences. The first compilation of parenting experiences of gender-variant children was authored by Mary Boenke (2003) as a selection of parents’ narratives describing their experiences over time with their child. Wren (2002) interviewed 11 families and analyzed the associations between coping mechanisms of parents with transgendered adolescents and the meaning the parents held of their child’s gender identity. More recently, Hill and Menvielle (2009) documented the issues faced by parents of gender-variant children, while conveying the parents’ coping skills, and Hegedus (2009) reported on the influences of parents’ acceptance of their transsexual adult children. This data gathering is the first step in understanding parents’ and families’ experiences with a view to refining the support necessary for gender-variant children and their families.

A number of authors discuss the issues parents and families with children displaying gender variance face (Brill & Pepper, 2008; Ellis & Eriksen, 2002; Lev, 2004; Vanderburgh, 2009; Wren, 2002), though with the exception of Brill and Pepper, the issues are related to adults or youth. Although many of these individuals were aware of their gender-variant situation from a very young age, parental knowledge and support were not sought until either adolescence or adulthood. Hegedus (2009), in a study using interviews of 11 parents of fully transitioned female-to-male adults, reported parents’ experiences of coming to terms with the issues involved in the acceptance of their child’s transition. While identifying the influences that helped the parents to accept their child’s gender and transition, Hegedus consequently reported on the parents’ progression of mourning, adjustment, and acceptance. Ellis and Eriksen’s model of six stages represents a process within the family as they manage their responses, feelings, and need for support to ultimately accept and incorporate the transgender person’s transition. Lev proposed a “family emergence” with developmental stages for families that provided information and outlined likely issues from “discovery and disclosure” through “turmoil” and “negotiation” to “finding balance” (p. 281).

Brill and Pepper (2008) provide the first detailed guideline of transpositive support in aid of children with gender variance and their families. This publication reflects the changing climate where children are speaking out about their feelings and parents are willing to respond to their child’s gender variance in a positive manner.

Research on gender-variant children and their parents is usually conducted by clinics assessing their patient and client base (Ellis & Eriksen, 2002). The current investigation allowed parents of gender-variant children to identify themselves as participants. It explored the “needs” of gender-variant children (up to age 12 years) and their parents by drawing on parents’ experiences and views of their needs and the needs of their gender-variant child. We included the entries of children with the “age of identification of gender variance” younger than 12 years, as this is the commonly accepted prepubertal age group (Di Ceglie, Freedman, McPherson, & Richardson, 2002), and children older than this are seen as adolescents and are categorized with adults by the APA (1994). There is also current debate on whether adolescents’ needs are distinct from adults and therefore require specialized support and treatment (Haraldsen, Ehrbar, Gorton, & Menvielle, 2010; Olsen et al., 2011).

A “need” for the purpose of this study is defined as “a condition necessary for promotion of the well-being of the individual concerned.” To separate “wants” from “needs,” the “promotion of well-being” was further clarified to be “providing significant advantage to the child’s mood, behavior, and emotional health.” An unmet “need” would thereby create a notable disturbance in the child.

This research is the first to explore parents’ experiences to identify needs in support of approaches that will address the issues that are pertinent to both parents and their gender-variant children.



An Internet survey was designed to capture, identify, and explore the experiences and resulting needs of parents who are raising or who have raised a gender-variant child and the needs of the children themselves. Purposeful sampling (Charmaz, 2006; Patton, 2002), with the criterion of participants identifying as parents of gender-variant children via a snowball technique, ensured the desired target group to gain information-rich data. Additionally, open-ended questions were used to elicit comprehensive responses and allow participants to frame and articulate their experiences, behaviors, feelings, knowledge, and opinions (Huberman & Miles, 2002; Patton). Using the Internet medium provided an efficient collection of valuable contextual data and captured an international audience. This was particularly relevant as it was expected that access to a sufficient number of locally available parents would be difficult and give less capacity to fully explore the nature of the phenomenon. The anonymity of the Internet was also seen as an advantage in the hope that participants would be forthcoming with information given the sensitive nature of the topic (Daley, McDermott, Brown, & Kittleson, 2003; Lyons, Cude, Lawrence, & Gutter, 2005). The study was approved by the University of Sydney Human Research Ethics Committee. The advertising for the study headlined, “Are you a parent of a gender-nonconforming child?” and targeted various publications (e.g., Sydney’s Child, Polare), newspaper articles (Sydney Star Observer, Sydney Morning Herald), Web sites, radio programs, and an international Listserv and conference proceedings of the World Professional Association for Transgender Health.

The Survey

The survey comprised both closed and open-ended questions to obtain demographic data and canvass the experiences, challenges, understandings, and reactions of parents raising gender-variant children. The open-ended questions were designed via ongoing collaboration and feedback with three professionals in the field of transgender health. The team also considered the impact of the length of the survey on response rates to reduce the number of less comprehensive responses and unanswered questions (Galesic & Bosnjak, 2009). The multiple questions regarding identification of the child’s gender variance and people’s responses were intended to maximize memory recall (Yarrow, Campbell, & Burton, 1970). For example, the first three open-ended questions were, “What was it that you first noticed about your child that gave you the idea that your child was different?”; “What were the circumstances that led up to this realization?”; and “What effect did this have on the child?” The survey was designed to allow participants to choose only questions they wished to answer to avoid forced answers or created responses.

The inquiry progressively explored: (a) the event or experience through which parents became aware that their child was different (b) the parents and families response(s), (c) the impact the event or experience had or was having on the child, (d) challenges or difficulties the parents have faced or expect to face in the future while raising a gender-variant child and what would help them meet these challenges, (e) any difficulties their child experiences or has experienced, (f) the wants and needs of their child during this time, (g) any current concerns that parents might have, (h) the outcomes parents want for their child and how this might be achieved, (i) what the parents have learned in the process, and (j) any further comments they would like to add.

Data Analysis

A content analysis of responses (Charmaz, 2006; Grbich, 2009; Spradley, 1980) using a qualitative data analysis (QDA) tool called Weft QDA (Fenton, 2006), along with an ongoing reflective-interpretive process (Moustakas, 1994; van Manen, 1997), was used to establish the major themes. For example, the needs were coded to identify the major “need” themes. To establish the needs of the children and their parents, themes were accessed via the questions, “What do you think your child wanted or needed?” and “What would help or would have helped you deal with these aspects (regarding difficulties)?” These themes were then clarified with responses to the other open-ended questions to ensure all the “needs” relevant to the child’s identification and the handling of the consequential situations were covered. The themes were checked and rechecked by the team to confirm the categories, subdivisions, and the criteria for these subdivisions (Huberman & Miles, 2002). Themes were analyzed within questions and across each parent’s responses to retain the individual emphases to maintain integrity and intended meaning.



Participant details and demographic information are presented in Table 1. The details supplied by parents regarding their gender-variant children are displayed in Table 2.

Table 1 – Parent demographics

All participants
n (%)
27 (87)
3 (10)
1 (3)
31 (100)
Age range of the Parents/Guardians  
  26-45 years
21 (68)
  46-65 years
9 (29)
  66+ years
1 (3)
31 (100)
Marital Status  
  Unmarried or not in a relationship
6 (19)
24 (77)
  De facto
1 (3)
31 (100)*
  High School
8 (26)
  Certificate or Diploma
4 (13)
10 (32)
  Post Graduate Qualification
9 (29)
31 (100)
  Professionals (Lawyers, physicians, teachers etc.)
11 (35)
  Non-professionals (Sales, paralegal, real estate etc.)
13 (42)
  Domestic duties
3 (10)
  Self-employed (non-professional)
1 (3)
1 (3)
1 (3)
1 (3)
31 (100)*
19 (61)
3 (10)
  United Kingdom
3 (10)
  United States of America
6 (19)
31 (100)

*Numbers do not add up to 100 due to rounding errors.

Table 2 - Child demographics

All participants
Birth Year (Age range of child when survey was completed)  
  2003-2008 (0-6)
5 (16)
  1997-2002 (7-12)
16 (52)
  1991-1996 (13-18)
5 (16)
  1983-1990 (19-25)
4 (13)
  <1983 (>25)
1 (3)
31 (100)
Age of identification of gender variance  
18 (58)
7 (26)
6 (16)
31 (100)
Natal Sex  
18 (58)
13 (42)
31 (100)
Gender Identity  
    Born Female  
    Male Gender
13 (42)
    Born Male  
    Female gender
16 (52)
2 (6)

1 ‘Other’ category was given as a third option to allow for gender identifications that do not fit the binary categories of male or female.

Needs Identified

The following six themes were identified where needs of the parents emerged in each category and are summarized in Table 3. The themes are: (a) identification of their child’s gender variance, (b) parent’s and family’s response/reaction, (c) seeking emotional support, (d) dealing with negative responses from others and concerns about safety, (e) seeking medical support, and (f) seeking political, government, and legislative support. In addition, happiness, success, fulfillment, peace, security, and supportive personal relationships were mentioned in various ways by parents as a “right” of their child. One parent named these “rights” as “what all parents want for their children.”

Parents also mentioned “needs” individual to their circumstances such as religious support, marriage counseling, financial support, and “separating my child’s needs from my own.” A couple of parents stated that their children needed to know there were more options than “male” or “female” and described their children as having more than one gender.

Table 3 - Identified Needs of the Parents and Their Children

Themes Parent needs Children’s needs
Parents identification of gender variance in their child

To have access to:

  • Specific information about gender variance in children
  • Books on and about gender variance
  • Guidelines & information for parents
  • Up-to-date research published in the general media
  • Information on how to choose a gender-variant-friendly school
  • Factual media coverage (not sensationalized)
  • To have permission to discuss feelings/talk about their gender issues
  • To be given age-appropriate information
  • To receive acknowledgement & validation that being gender-variant is okay
  • For their parents to listen
  • To not be blamed for being gender-variant
  • To be loved unconditionally
  • To be respected
  • To have their well-being made a priority
Parent responding to the child displaying gender variance

To have access to:

  • Information for family members
  • Stories of other families with gender-variant children
  • Strategies for parenting
  • Information to support them in setting limits and boundaries on their child’s behavior
  • To have acceptance from family
  • To make choices in friends/clothes/personal expression
  • To not have to conform to societal gender expectations
  • To be referred to in their preferred gender
Emotional support required
  • To have access to available and knowledgeable counselors to support themselves, their child & family
  • To have access to support groups/contact with other parents, face-to-face or online
  • To be able to meet/know transgender people
  • To have access to a support group, either face-to-face or online, for gender-variant children
  • To have gender-variant friends
  • To have strategies for making friends
  • To not be fearful & anxious
  • To have access to supportive counseling when required
  • To be supported at school
The parent dealing with negative responses or concerns about safety
  • To have access to strategies for dealing with bullying, particularly at school
  • To have access to strategies for responding to peoples comments/negative reactions
  • To be able to tolerate uncertainty/ambiguity
  • To have safety & protection from harassment, abuse & violence
  • To not be discriminated against or marginalized
  • To not be punished for their gender variance
  • To have strategies for dealing with bullying
  • To have adults advocate on their behalf where necessary
Parents wanting medical assistance
  • To have access to informed, aware and trained medical personnel
  • To have access to puberty-suspension blockers where indicated
  • To have ‘special needs’ and disability support clinics with awareness of gender-variant children
  • To have access to medical information and support when feeling anxious about their bodies and the impending pubertal changes
Parents wanting political, government and/or legislative support
  • To have guidelines/policies for gender-variant children in schools
  • To be supported by community education
  • To have financial government aid for specialist appointments, blockers and surgeries
  • To have politicians/leaders with awareness of the issues parents of children with gender variance face
  • To have access to political support/lobbying for parents of  gender-variant children
  • To be treated equally/have the same opportunities as other children
  • To have the potential for a fulfilled and successful life

The Themes

The themes that emerged of the parents’ experiences are described in concert with parents’ explanations of needs and/or concerns regarding each category.

Identification of the child’s gender variance

There were two ways in which parents were able to identify their child’s gender variance. They were either informed by their child directly, with some children insisting they were of the other gender or sex—for example, “As soon as he could speak, [he] insisted he was a boy,” or “Everyday he asks me to take him to the doctor so he can cut his willy off, so he can be a girl.” Another mother wrote of her child’s distress:

[There are] constant tears at night time and begging her angels to turn her into a girl. We knew it was serious when she told us at 6 years of age that she wanted to die so she could come back and be a girl as she was supposed to be.

Evident in these statements reported by the parents are the children having a definite awareness that something was “wrong” with their anatomy and demanding that the parent address their plight.

Observations made by parents or relatives indicated clear preferences in clothes, presentation of gender expression, toys, and activities. For example:

At 3 years of age, she refused to wear anything girly and had an interest in male superheroes. She also would only take on a male role whether it be the dad, uncle, etc., in pretend play. She is now 5 and wears only boy’s clothes, including jocks, has short hair, wants to be called [male name], and believes she has an invisible penis.

This parent’s description was typical of most parents (66%) who described their children as assertive and unwavering in their determination to be seen as their preferred gender.

Reaction of parents and family to child’s behavior or demands

When asked what their response was to their child’s gender variance, the reactions varied between those parents who were initially unable to accept their child’s behavior to those parents who were fully supportive from the first indication. Some parents expressed feeling “horrified” or “confused” and held themselves responsible as they struggled to cope with their confusion and the sadness of their children. Others focused on searching for explanations. One mother described how after being initially afraid for their son, they went through self-blame and “looking for causes,” did some research, and eventually concluded that “this was something nobody controls.” She further added that “we needed to learn to manage our anxiety, learn to live with uncertainty and ambiguity as his or her identity emerged over time” and that the family in the meantime needed to keep him safe while “keeping any stigma externalized.”

While many parents conveyed their approach to managing their child by placing boundaries on when and where they could express themselves as their preferred gender, others expressed confusion and great concern about how to know what to do. Some hoped it would “be a stage” or a “phase” and wanted to do the best for their child but were unable to find support or resources. Another mother described the moment of alarm when they realized the depth of their child’s feelings. She reported her child saying, “I go to school disguised as a boy,” and “Mummy, it’s so hard trying to be a boy.” She describes how her daughter (born male) became depressed, showed frequent sadness and anger, and no longer wanted to attend school. This mother then wrote: “We told her we would find help. That we heard what she was saying and we would look after her.”

One parent expressed a fear about harming their child: “[Aiming to cope with] his distress and wishes … [we were] trying to do the right thing for him while being unsure what the right thing was,” and “If I try to steer him away from it [gender variance], will it damage him because he feels that I don’t approve of him???” One father felt that his son wanted to function in “both” genders and explained that his son struggles to “operate in a boy’s world” and was “too self-conscious to operate in a girl’s world.” He later added that his son ought to have been guided to dress neutrally, and it may have been better if his son had been supported to express his needs in “community-accepting ways” through “dance, music, drama, art, [or] fashion.”

Seeking emotional support

The need for emotional support was mentioned by parents in the form of professional counseling (for themselves, their families, and their gender-variant child), support groups, and meeting other transgender individuals. The responses highlight the isolation that parents felt as they sought answers for the ongoing presenting complexities. For some parents, wanting others’ input was their greatest need. For example,

What would be extremely helpful is understanding how other parents handled the situation through the different stages of school life: what they did, what worked, what didn’t, how schools handled the situation. Therefore, a support forum would be great—in person and online.

For others, puberty was highlighted as a time they needed specific support for their child:

We have been searching for gender-variant counseling/gender clinic for over a year and have been unsuccessful … He is entering puberty and I’m informed this is a very difficult time for these children so we really need a support base for him. If he could just meet other children who feel like him, he would at least feel that he fits in a small way.

Some parents noted the support they receive from online forums and through support groups or counseling, with a few stating they had started their own networks.

Dealing with negativity and safety concerns

When asked about their difficulties, parents expressed many concerns generally associated with other people’s reactions and as feeling accused or being “told” what to do. Most parents conveyed a sense of exclusion, with some writing in detail about how they had lost friends, of tension in their marriage and with in-laws, or of how their family is harassed, ostracized, and/or treated with hostility. A few parents described how they had been reported to authorities by another parent who assumed that the child’s gender-variant behavior meant the child was being abused at home. Many felt a sense of sadness that others were unable to appreciate their situation. For example:

A lot of these people believe we are making him gender-variant or worsening the situation by buying him girl’s stuff. Therefore, [they say] it’s our fault, that we are irresponsible parents. They don’t understand these kids don’t choose to be different, they just are.

Some parents expressed frustration in having to explain or justify their child’s behavior and in handling people’s comments:

I just hate the fact other mums at day care and Kinda are noticing that he loves dressing like a girl, loves pink, and they ask me questions. They refer to him as ‘the pink boy.’ One lady the other day said that it’s quite alright for people to have alternative lifestyles, etc., and that she was fine with it. I don’t think other people should be telling me my child will be fine when he grows up.

Some parents expressed their emotional pain, “heartache,” and anger about being a parent to a child who does not fit into the mainstream culture and felt helpless to change it. One parent wrote, “The reality of how the world views my child and how she’s being treated by society breaks my heart,” while another expressed her anger about having to fight for the right to access the medication necessary to prevent the onset of male puberty. She wrote:

[We were] told we had to wait until she had completed puberty, by which time she had assured me she would have killed herself. This has placed a massive financial burden on our family to pay for treatment that should have been available by choice.

Some parents described the treatment of their children by peers, with teasing, bullying, and marginalization resulting in the child being ashamed of their variance. The responses of the children ranged from feelings of sadness and not wanting to attend school, to feelings of depression and/or suicide. One mother wrote about her son: “He was happy about it until about age 7 when people started to think his behavior was no longer amusing and needed to be dealt with. Then he told me he wanted to kill himself.”

Another mother in response to the same question also wrote movingly about her child’s response:

Depression, incredible sadness, and disinterest in Christmas and birthdays, as her wishes were never coming true. Bed wetting [and] general withdrawal from anyone who did not recognize her affirmed female gender … [and later about herself] … I indulged her female self when others were not around as I couldn’t bear her sadness.

Concerns about safety were threaded throughout the responses, particularly in relation to school, with fears and anxiety “that the tougher-type boys will find out and tease him.” These concerns emphasized parents’ inability to ensure the protection of their children.

Parents also related the pressure they constantly felt to defend their child. This consisted of the need to explain their child’s behavior to schools and unaware medical professionals. One parent wrote:

Society and friends mainly have pushed us and made us feel that life for him will be hell, and if he chooses to have further treatment, it could make us lose some friends and family members, as they don’t agree with the decisions we have made.

Many parents expressed multiple concerns that demonstrated the intensity and relentlessness of the issues they deal with day to day and their concerns about preparing for the future. This was encapsulated by one parent expressing multiple difficulties:

We worry about … people being uncomfortable around us, so choosing to no longer spend time with us, family included, people thinking it is OK to say cruel things to us and our children. I also find it hard to always know how to support my child. This is not a world I fully understand myself; I don’t always say the right thing. As parents, we also worry about the expense of making this all happen; we want our child to be happy, but this will require thousands of dollars. There are also lots of legal costs (name and document changes, etc.).

Some parents did feel supported by their community, though not without difficulty. One parent explained how “very hard” they worked for school acceptance to support their child and in particular to use the female toilets. Other parents felt that the support they received was motivated by people thinking “it was a phase” or because the child was young. These parents were also concerned about how their child would be treated when they became older.

Seeking medical support

In the search for support, some parents lamented a need for “more awareness in the medical profession,” including “better-informed medical professionals” and “better-trained medical staff.” A number of parents conveyed frustration about the scarcity of available medical support and the “difficulty accessing information and medical help.” One parent expressed their thwarted attempts to get local medical support:

I think it is criminal that within the [country], gender-variant youngsters who fit the Dutch criteria are told that they cannot have medication to halt an unwanted puberty. If treatment is sought outside of the one and only [clinic], then patients are effectively cut off from this support. Few families can afford to seek treatment outside of the [country]; therefore, many have to watch their children endure the agonizing and horrific changes that an unwanted puberty brings, often with lifelong and irreversible consequences.

Four parents had children with special needs and felt that their child’s gender variance added significantly to the challenges either they were already facing or that their children were dealing with at school. In particular, the parents highlighted the need for “services [that] really understand the issue from [the child’s] perspective” and for “society to accept difference even within disability groups.”

Political, government, and legislative support

Parents expressed the unrelenting day-today issues as they realized that their child is not only socially marginalized but also that their existence and rights are dismissed in school policies, government legislation, and health resources. One parent noted, “We need to have the proper wordings in our human rights code to protect people with gender identity [issues],” while another stated, “We need proper government-resourced clinics for our kids. It would give validity to the issues, concerns, and situations our kids and we as parents find ourselves in.”

Another parent felt that they had an uphill battle in getting “the support we need from our school district … If we don’t get that support, we may have to move, and that would be a huge disruption to our child’s sense of belonging and protection to then find himself in an unsupportive district.” Other parents mentioned the need to educate government leaders about the issues that transgender people face, the need for government financial support, and the need for “better laws to protect GLBT (gay, lesbian, bisexual, and transgender) people.” One parent in particular summed up what they had learned as a parent of a gender-variant child:

The only way we can achieve many things is to be open and advocate for our children, take part in anything we can to make people, government, and the population more aware about transgender people and the issues that they face.

Three parents felt that their preferred outcome was for their child to be happy with the body they was born with, but all three mentioned that they would support their child irrespective of the outcome.

Parents expressed a wide range of benefits from their experience in raising a gender-variant child. This most often related to being humbled by their child’s courage, being aware of the need to be nonjudgmental and open minded, and being challenged in their preconceived assumptions regarding gender.


This investigation examined parents’ responses to open-ended questions to explore and establish what kind of support and other “needs” parents and their children with gender variance have. The focus of this article was on gender-variant children (up to age 12 years) regarding the issues facing the children and their parents particularly during and after the parents’ awareness of their child’s gender variance. These experiences were examined to identify the needs of the children and their parents.

As might be expected, no parents reported that their gender-variant children identified as the gender assigned to them at birth, including two who were identified as “other” as opposed to male or female. Though some parents did explain that their child’s gender identity had changed at times, it can only be speculated that a variety of factors may contribute to these changes in identity, especially given the negative input, pressures to conform, and lack of support that most children experience.

This study identified parents’ and their gender-variant children’s needs highlighted by six major themes: (a) identification of the gender variance, (b) parents’ responses and reactions, (c) seeking emotional support, (d) dealing with negative responses from others and concerns about safety, (e) seeking medical support, and (f) political, government, and legislative support. Ellis and Eriksen (2002) designated a six-stage model occurring within the family system, similar to Lev’s (2004) Family Emergence stages. Both models recognize a “shock” of discovery followed by distressing and painful feelings. This research shows that parents gradually came to terms with having a gender-variant child as their awareness of their child’s circumstances and needs grew. Their “shock” was expressed more as confusion and sadness that developed into managing the day-to-day hurdles and advocacy. Brill and Pepper’s (2008) description of this process is “from crisis to empowerment” (p. 39), and rather than a recognition of different stages that parents encounter is guidance in handling the various issues that might arise for families.

An additional difficulty identified for parents is that gender variance is often assumed to be about sex or sexuality. Finding language that supports dialogue regarding the sharing of self-awareness of gender variance has been an ongoing issue for gender-variant people (Ellis & Eriksen, 2002; J. Green, 2004; Israel & Tarver, 1997; Mallon, 1999a). Publications that comprise children’s voices and requests incorporating various gender identities will perhaps enable the development of a more inclusive language and attitude in support of gender-variant children.

The literature reveals select similar “needs” to the ones found in this study. For example, Hegedus (2009), in a retrospective exploration of the acceptance parents had of their transitioned adult female-to-male children, found parents needed information and peer support to set limits on their children’s gender-variance expression and to tolerate uncertainty and ambiguity. Hegedus also identified similar needs for unconditional love and to be listened to and referred to in their preferred gender of their adult cohort. Hill and Menvielle’s (2009) study focused on the experiences of parents with gender-variant children and teens and captured some elements found in this study—in particular, the parents’ struggles leading to unconditional acceptance and the fears for their child’s safety and future as well as the parents’ reflections on what they had learned from the experience. In “Practice with Transgendered Children,” under “Implications for Practice,” Mallon (1999b) identified some general needs for families including the necessity for information, the need to access informed professionals, and the need to get help with stigmatization and support with advocacy. Mallon (1999b) also found that children need to express their felt gender, need to be listened to, and need their parents’ unconditional love.

The need to “grieve” (Hegedus, 2009; Menvielle & Tuerk, 2002; Wren, 2002) was not directly stated by any parent as a “need,” though a small number of parents (3) did describe initial feelings of sadness, confusion, frustration, and fear. This is similar to Hill and Menvielle’s (2009) experience where they report that although the literature cites a necessary process of bereavement, only 3 out of 41 parents mentioned the feelings of loss and sadness in facing up to the reality that their child was gender-variant. The previously assumed “need” to grieve (Ellis & Eriksen, 2002; Hegedus; Lev, 2004; Menvielle & Tuerk) appears to be related to an older child or adult children “coming out” to parents after many years of living in their designated gender, or perhaps becomes apparent only after parents become aware that their child’s gender variance is persistent and the need for medical intervention emerges.

Examination of parents’ concern about stigmatization appeared to increase particularly regarding bullying as their children moved through school. This is confirmed by Menvielle and Tuerk (2002), who canvass that stigmatization increases in intensity at elementary school age, reaches the maximum in middle school, and potentially continues in high school. These fears are also verified by Wyss (2004), who describes the impact of violence on gender-variant youth in schools.

Though studies of children attending clinics for gender nonconformity often discuss at length parents’ fears and concerns about their children being transsexual as adults (Cohen-Kettenis et al., 2006; Vanderburgh, 2009; Wallien & Cohen-Kettenis, 2008; Zucker, 2005), none of the parents in this study focused on transsexual outcomes as their main concern. In contrast, parent’s main concerns were very much the particular issues they were facing at the time.

The parents’ input shows a strong bias toward mothers’ participation (87%) compared with 10% of fathers. (There was also one guardian). It is notable that the “Parent-Report Gender Identity Questionnaire for Children: A Cross-National, Cross-Clinic Comparative Analysis” study (Cohen-Kettenis et al., 2006) was analyzed with results showing maternal ratings but no paternal ratings. Also, the article “A Support Group for Parents of Gender-Nonconforming Boys” states that “mothers were the primary participants” (Menvielle & Tuerk, 2002, p. 1011), and Hegedus’s (2009) study of parents’ acceptance was also biased heavily toward mothers’ input in the ratio of 11 to 1. Indeed Wren (2002) reports that communication requiring sensitivity and awareness with the transgendered child appeared to be “the job of the mothers” (p. 383).

An area of current concern for some parents in the care of their child was the availability of hormone blockers for children approaching puberty. A number of parents identified the need to access puberty blockers for their child, while others expressed apprehension for the future as they anticipated the possible necessity of blockers for their children (see Cohen-Kettenis et al. [2008], de Vries et al. [2007], and Wallien & Cohen-Kettenis [2008] for the latest research in this area). Even in countries with gender clinics, parents struggled to gain medical support for their children approaching puberty.

Some “needs” not ascertainable within the scope of our study have been proposed by Hegedus (2009). Hegedus identified some specific psychotherapeutic needs via interviews—for example, the need for parents to acknowledge shame and become aware of unhelpful thinking.

Limitations of the Research

The parent participants in this study are a highly self-selected group due to their knowledge about gender variance, access to the Internet, and their willingness to take part in so many open-ended inquiries. It seems likely that parents who are not ready to acknowledge or discuss their child’s gender variance would have some different requirements than those identified in this study. Also, parents who did not participate due to lack of Internet access or simply because they were unaware of the study or unwilling to take part may well have different needs unable to be acknowledged in this study.

This study explored the needs of gendervariant children. It is acknowledged that gender-variant children may either “persist” into adolescents with gender variance or may “desist” and become adolescents without gender variance (Wallien & Cohen-Kettenis, 2008). Given the lack of available research on gendervariant children, we are unable to determine whether these groups of children do in fact have different needs. Until these groups of children can be distinguished with certainty in childhood, there can be no differentiation in their needs.

The countries represented were Australia, the United States, Canada, and the United Kingdom. The data therefore is representative of Anglo-Saxon values and circumstances and does not include a wider diversity of values and opinions.

Although the survey asked about difficulties that gender-variant children experienced not related to their gender variance, interviews were not conducted to determine any familial dynamics (e.g., alcoholism, mental health issues, etc.) or transitions (e.g., death in the family, divorce, etc.) as key indicators in assessing specific needs of the gender-variant child and family. Each child in context is part of a more complex picture where the authors acknowledge that there may be complicating factors; in family dynamics, parenting (Cohen-Kettenis & Pfafflin, 2003) or circumstances such as loss, grief, or trauma (Bleiberg, Jackson, & Ross, 1986; Di Ceglie, 1998; Di Ceglie et al., 2002) will have a direct impact on the “needs” of the children and/or their parents.


This study explored the needs of gendervariant children and their parents from the point of view of parents who self-identified as raising or having raised a gender-variant child. We found that parents of gender-variant children generally felt that there was not enough information or assistance, both emotional and medical, nor guidance in how to raise a happy, healthy transgender child.

These results imply that parents’ needs vary depending on their level of knowledge, the age of their child, and how recently they have become aware of their child’s gender variance. Parents’ initial “needs” related to the need for access to information and professional guidelines. Following this understanding, parents’ needs became associated with professional support, parenting strategies, and peer support. Succeeding this, parents’ needs focused around ongoing advocacy and medical support as their child approached puberty.

Gender-variant children’s needs were also identified as progressive. Their primary need was to talk about their feelings and be accepted, respected, and given information. Following this, they then needed to be supported to express their gender, to meet gender-variant peers, to have strategies for bullying, and to be advocated for, protected, and treated as equals. For gender-variant children approaching puberty, the need for medical information and support became apparent for those children who became concerned about the forthcoming changes in their body.

Parents in this study showed great reflection of their situation, sensitivity to their gender-variant children as a priority, and consideration of the ongoing implications of their decisions. They expressed purposeful and active advocacy in support of their children. This is a far cry from the pathological parents described in the clinical referrals from which many past treatment decisions have been made. What was also clear from these accounts is the enormous impact that raising a gender-variant child has on the parents’ and families’ lives. Parents “live and breathe” their child’s gender variance as a “moving target” in their day-to-day decision making. They were relentlessly faced with harsh judgment of their child and family, through the policing by others of their child’s behavior.

Consequently, parents needed to be “on guard” and ready to defend their child, often within their own families. Having been challenged to the core of their own beliefs and prejudices, tentatively embracing the process of “getting to wisdom” they were shunted into, many parents displayed an ongoing commitment to advocacy for their children.

The results of this study support the development of affirmative approaches in supporting gender-variant children and their parents. This is particularly evidenced by the parents’ own approaches to supporting their children where parents experimented with different ways of responding to various scenarios and realized that acceptance of their child was the only option as they learned that their child’s need for expression was not changed by their attitude or management of the behavior.

Future research surveying other gender-variant populations—for example, gender-variant adolescents, members of the GLBT communities, or professionals who work in the field—would also shed light on the needs of gender-variant children and their parents. Long-term outcome-based trials employing support guidelines based on the “needs” identified in this study and of other authors using life satisfaction and success indicators are needed to validate the effectiveness of transpositive approaches for gender-variant children and their parents.



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