Puberty is scary for most kids. Bodies change, hair shows up in places, and new smells arrive. We are held hostage by our biology, and some kids will experience concerning body image issues.
Not all kids who express frustration with their changing bodies are transgender, but for transgender or gender-nonconforming kids, puberty can be and usually is terrifying. It doesn’t matter if a child is out or not; the fear of their body changing to something that does not express their true sense of self increases their risk of depression, self-harm, and hopelessness. If your child has expressed excessive worry and panic over puberty and tries to hide their body or themselves from others, it’s important to be sensitive to the dysphoria your child may be experiencing.
It’s also important to be ready to have a conversation about gender identity and the options your child can take to feel comfortable in their own skin.
Gender dysphoria is a psychological conflict between a person’s true gender identity and one they were assigned at birth. It is an internal battle of knowing how we see ourselves versus what others see or how we want to be seen. This is common in transgender individuals and can become worse when puberty starts.
For a transgender girl like my daughter who was assigned male at birth, a deep voice and facial hair are the last things she wants. There are many ways to be a girl, but most transgender females desire the physical appearance and shape of a stereotypical female-bodied person. The same is true for transgender males. Breasts and menstruation are horrifying for many transmasculine folks. It can also lead to being outed as transgender and can lead to being bullied and assaulted.
Getting my period was not something I looked forward to when I was a tween. I learned about the menstruation cycle in school and had witnessed classmates go to the nurse’s office because they stained their pants. I remember the dread of not knowing when my period would arrive for the first time, and when it did I wasn’t appropriately taught when it would return each month. Everything about menstruation was an unpleasant surprise, and getting my period did not feel like a welcome rite of passage; it felt wrong.
My rounding hips and growing breasts were just as mortifying. I knew before I went through puberty that I was gay. I also knew I felt most comfortable presenting in a masculine way. I was assigned female at birth and over the course of many coming outs during my lifetime, I know I am nonbinary. My gender identity is both male and female, and I use they/them pronouns.
Much of my dysphoria is based around my body and people’s perception of my gender. Because my biological sex is female, I developed secondary female sex characteristics (boobs, hips, menstruation) when my body went through puberty. Those sex characteristics took my body from the androgynous state I long for now to the one that makes people assume I am female.
Before I had gender-affirming top surgery to remove my breasts, I experienced crippling anxiety and depression, especially right before and during my period. I had hated my breasts even as a kid, but I didn’t know I was transgender — even if I did, I wouldn’t have been given the support I needed. However, many kids today openly and confidently question their gender or know their gender is not what was assigned to them at birth.
A lot of dysphorias can be eliminated or improved if a transgender tween’s puberty can be blocked before those secondary sex characteristics develop. Depending on what stage of puberty a child is in, hormone blockers that stop or pause puberty may be an option.
At the beginning signs of a child’s start of puberty, an affirming team of doctors, therapists, and adult caregivers can help relieve the stress of their body changing into a gender presentation that does not match their identity. This is a safe and reversible solution to allow the child and care team to figure out the next steps. It buys time for a child to live as their true identity as they age and then decide if starting cross-sex hormone therapy is right for them.
The most important thing a parent can do is listen to their child and be sensitive to the overwhelming discomfort a child can feel when their body seems to be betraying them. Puberty isn’t a picnic for anyone, but for a transgender child, it can be a nightmare. The goal should be to take care of a child’s mental and physical health without stigma and expectations of society’s gender constructs.