Tandy Aye, MD, of the Stanford Children’s Health Pediatric and Adolescent Gender Clinic, talks about ways that families can be more supportive of their transgender child.
Interview conducted by Ivanhoe Broadcast News in December 2021.
Have you found that both teens and parents are often not sure how to communicate or move forward together when they’re on this transition journey?
DR AYE: Overall, teens and parents have a hard time talking to one another, especially at this age. And when it comes to this sensitive information, when teens are trying to reveal to the parents about their gender identity, I think they get nervous. They’re not sure how the parents are going to receive the information. And then the parents, themselves, are also nervous because they’re not prepared. The parents are going on with their daily lives and then they get this information. Sometimes, they’re just taken aback, and sometimes, parents are not surprised because they had been expecting that there was something going on. And, once in a while, parents feel relieved that something the teen has been shouldering has now been brought out into the open, and they feel like that cloud’s been lifted and they can have open conversations.
Tell me about this study. Why did you decide to conduct it?
DR AYE: So, we started noticing in the clinic that all sorts of parents come in with their child to the visits. Some parents are very supportive, and even accepting, while other parents have just gotten the information and they don’t know where to go. Some parents are not ready to support but are willing to learn to hopefully be able to support. So, the questions we had were, “what makes it unique about parents that are ready to be supportive and accepting? Are there characteristics that we can try to find? For those parents who aren’t supportive, are there tricks or traits that we can teach for the parents who are already supportive to help these other parents get to a path of support?” So, that was really the idea that arose and why we decided to do this study.
How did this study work and what were the parameters?
DR AYE: In this study, we recruited parent and youth pairs. We had the parents interviewed and asked them “what were pivotal moments, or moments that they remembered, about their child disclosing their gender identity or when they decided to disclose their gender? What things did they do to help that line of support, particularly before coming to our clinic?” Then, we took the same set of parents with their children and asked the children about each of those pivotal moments. In a separate interview, we asked them, “what were your feelings, at the time, when your parents stated each of these pivotal moments?” So, for instance, when a parent says, “when I first learned that you were thinking about your gender and that you might be transgender, I felt like I was supporting you by doing whatever.” And then, we asked the child, “what was your perception of that? Did you feel that same kind of support?” And we decided to take all of that information and try to find a correlation between the two. We asked each parent to score based on how they felt, if they were extremely supportive all the way to accepting. We did the same thing with the adolescents and tried to correlate the two values.
What were some of the findings?
DR AYE: I think the first finding that we were pleasantly surprised by was that when a parent learns about their child being gender diverse or transgender, they immediately ask themselves, “what do I need to do?”. They worry about the medical treatment and surgery and what might be coming down the road. They want to intervene and get a child into a gender clinic, like ours, and start to get help and mental health support. Whereas, for an adolescent, when you asked them about the most important thing that they expected when they revealed to their parents about their gender identity, the first thing they really wanted was to be acknowledged about their gender identity. They wanted their parents to respect their gender identity and use the name and pronouns that they wanted to be used. So, for the patients, the most important thing that we found was they just wanted to be respected for their name and pronouns. They felt like that was the first step that they wanted the parents to take in hearing them. What’s also interesting that we found is about what the parents do. The parents really felt like getting either mental help support or medical support, but for the teens, they wanted to just to have someone to hear them out and to be there and offer a hug. They just wanted the support of knowing that they could come home and talk about this in a safe environment.
Were there any other findings?
DR AYE: The other thing we found was that when the teens were asked about how their parents were – if they were supportive or accepting at each of these pivotal moments — they always rated their parents much higher than the parents that just thought they were being more supportive. Looking at the results, it seems like the teens always gave a more positive view of the parents, which is always nice because I think sometimes, parents might be harder on themselves. But the parents may think, “am I doing enough?”. But the teens really notice the love that they were seeing. Having said that, even when the parents were finding that they were supporting and accepting, a lot of them did say they have had a little bit of a struggle adjusting to the information.
What advice would you offer families who were on this road?
DR AYE: I think, oftentimes, the child, or the teen, may reveal the information about their gender identity very quickly just to test it out and see what the parents may be like. It’s important to acknowledge it. You may not have time to discuss it right then and there, but just say, “yes, I heard you,” or “I want to set a time to talk about this because I want to hear what you have to say.” From there, to show the support, you can ask them, “what can I do to help you feel supportive? Are there any names or pronouns that you’ve been thinking of? Are you feeling safe? Can we start having discussions about this?” Also, admitting to yourself that you may not know the information, but you’re willing to learn this together is important. I think those are some of the most basic things that parents can do and say to be supportive of you. Let the child, or teen, know that you might argue, but at the end of the day, you love them are there for them. Those are the main characteristics that the teens want to see, as well.
Do you think that there could be a division between the parent and teen if those tactics aren’t used?
DR AYE: Yeah, absolutely. I think when the parents say things like, “this may be a trend,” or “you’re just imagining this,” it really makes the teen shut down because it took a lot of courage. There was a lot of processing before the child, or the teen, had brought it out to be able to talk with the parents. By dismissing it the first time, it makes it difficult for the person to want to come back and talk to the parents, again. We encourage making that statement of “I heard you.”
How long was the study?
DR AYE: The duration varied from person to person. We invited the parents for interviews, and some were available within the week. And then, whenever we could reach the adolescent to talk to us might have taken a little bit of time. But most people we reached within about a week or so. There was a duration for some people. This is a recall. So, that is a limitation in which the parents recall what they remembered and then a recall of what the adolescent remembered that happened. For some people, that might have been a couple months ago, and for others, it might have been a couple weeks or even longer.
We hear a lot about how the depression and suicide rates are rising among transgender youth. Do you think that the lack of support from their network, family, or contributes to that?
DR AYE: Yes, definitely. Multiple studies have shown that if the youth have parental support and a network of friends, they do much better those who are isolated. The studies found that parents who are supportive compared to their peers have less anxiety, depression, or suicidal thoughts or attempts.
Can you tell me a little bit about Rose and her mother and how important they were, and their input to the study?
DR AYE: I remember meeting Rose and her mom very early in Rose’s journey. I think the parents just came to the clinic after Rose had revealed to them. They just weren’t sure what it meant to have their daughter be gender expansive and later revealed being transgender. But they wanted to get information. I think what really helped in their relationship was getting the right information and resources. We encouraged the parents to say, “I hear you” and “let’s talk about it because we love you and we want to hear everything we can about it to be able to support you.” Both parents have been very supportive of Rose. It hasn’t always been a straight journey. Sometimes, there are bumps in the journey. But they always get back together to enjoy the journey together.
So, they’re trying to do the right thing?
DR AYE: Yes. They’re always trying to do the right thing. Putting Rose in the center of the family decisions was the right thing.
Do you think this study helped bring the teens and parents together?
DR AYE: I think for those who participated, it definitely brought them together. Now, the interviews were done separately so that there could be honest answers to both. But I think just by participating, it also brought them together because they would talk about what they said in the study recalling these pivotal moments. I think for the families who participated, it was very reassuring and fulfilling for them as well.
What would you recommend for a transgender person who doesn’t have that kind of network?
DR AYE: I think a young person who doesn’t have parents should find another adult to advocate, to listen, and to be there to talk through what the young person is feeling. That is really important. Sometimes, that person might be another grown-up that is in the family, perhaps, an aunt or an uncle or grandparents. Teachers and counselors at schools are also other advocates. And then, for some of our youth, their social worker may be an advocate for them.
Tell me a little bit about your clinic celebrating five years.
DR AYE: So, we’re very excited because our clinic just celebrated its five-year anniversary! From the initial inception of the clinic, it’s really been a multidisciplinary clinic. What I mean by that is when you’re coming to the visit, we have all the different subspecialty available at the same time. So really, there’s a home for the youth and the parents. What studies have seen is that it takes a lot for someone to pick up the phone and make an appointment to come to a gender clinic. On top of that, if you had to do this so many times for different subspecialties, to pick up the phone every time is very hard for them to do. So, by having one phone number with one base, it’s been comforting and easier for our parents and youth to navigate. So, we’re very excited, and we’re looking forward to our next five years.
So, the transgender clinic covers different needs, like mental, emotional, and physical, right?
DR AYE: Yeah. So, we cover the mental health that’s directly related just to gender. But some of our patients need more ongoing mental health support, for things like anxiety or ADHD, so, we mentor and work with their community mental health providers so that, using the gender lens, we can provide those services in the mentorship. But if they needed an adolescent gynecologist or primary care with adolescent medicine, we would be able to offer them all through our clinic.
So, is the clinic like a “one-stop-shop”?
DR AYE: Yeah. So, our clinic is multidisciplinary. All the services and subspecialists that a youth might need are provided under one roof, in one location, with one phone number. So, it’s easy to navigate and we would be able to provide all those services.
What are the next steps for the study?
DR AYE: The next steps for the study are to repeat it in a different population and another state. We just want to be able to compare the results of the parents and their experiences to those in the Bay Area. We’re looking forward to analyzing those results soon.
Are there very many transgender clinics in the country?
DR AYE: There are increasing numbers of transgender clinics for adolescents and youth all over the United States. I’m not sure how many are as multidisciplinary with providing all the services like we have been. But a lot of academic pediatric children’s hospitals are providing these services. And the need has been continuing to grow. Over the past five years, the children and youth are still identifying and coming out and I think it’ll only continue to increase.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Elizabeth Valente-Pigato
(650)-269-5401
EValente@StanfordChildrens.org
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