Is This Child Gay, Transgendered, or Both?
by Nancy Sharp, Co-chair PFLAG Transgender Special Outreach Network

What is the relationship between sexual orientation and gender identity? How does one determine if a child or teen is gay or transgendered? Do parents of gays need to understand transgender issues?

As an example, suppose that a 15 year old teenager attends a PFLAG support group meeting. The teenager is dressed in male attire, has adopted the mannerisms of a male, and uses a name which is androgynous and is different from the "female" name given at birth. The teen identifies as being lesbian. Afterwards, many at the support group say they were surprised that the teen was a lesbian because they thought she was a boy.

Is this teen lesbian or transgendered? Is there a way for us to determine this?

As another example, imagine that an 18 year old teenager attends a support group for gay and lesbian teens and reveals that he feels like a woman and wants to live as a woman and begin hormone therapy. The teenager "came out" to his parents as being gay when he was 12 and began getting harrassed from peers at school for being gay. From the time the child is 12 until he is 18 he thinks he is gay and identifies as being gay. No one in the support group indicates that they are concerned that the child may be transgendered and may benefit from receiving information about transsexualism.

Could we have known earlier that this child would be transgendered rather than gay?

While attending support group meetings for gays and lesbians and their parents, I frequently hear parents say that they identified traits in their children when the child was young. One parent says that the young boy wanted to play with the girls, one parents says that she had thought that maybe she needed to bring the child to the doctors for a sex change, another says that he detected homosexual tendencies in his son because he did not engage in aggressive behaviors during sporting events. These comments imply that at some level parents recognize that there is some connection between gender non-conformity and eventual sexual orientation. Not once have I heard a parent say that they "knew" their child was gay because he or she was attracted to the same sex.

When one takes these examples and relates them to documented cases in the clinical literature regarding Gender Identity Disorder (GID) in children, one recognizes that these teens would probably qualify for a diagnosis of GID. As an examples, I cite the case of Toni, a 6 year old girl with an I.Q. of 123, who was referred because of increasing parental concern over her gender identity development. At the time of assessment, Toni had an "ambiguous" physical appearance, with hair and clothing styles that would make it difficult for a stranger to tell her sex. Toni was interested in team sports , but she would play these only with boys and with boys equipment. At times she displayed exaggerated masculine movements and would lower her voice. She was adamantly opposed to wearing stereotypically feminine clothes and dressed almost exclusively in pants. Her only concession was wearing a dress to church. At school she began to call herself a boy and to spell her name as "Tony," which greatly alarmed her teacher.( Zucker in Clinical Management of Gender Identity Disorders, 1985 )

Kevin aged 10 years and 7 months was referred to a gender identity clinic. Kevin stated that he preferred to play with girls and with toys usually given to female children, such as dolls. When Kevin was asked if he preferred to be a boy or a girl he vascillated, feeling it might be fun to be a girl but concluded that he would rather be a boy. Kevin also stated that in school other children called him names such as "sissy" and "fag" and that he was afraid to respond for fear of getting physicaly hurt. During his interview, Kevin's voice inflection and mannerisms were judged to be an exaggeration of feminine sex-typebehaviors. ( Hay in Journal of Consulting and Clinical Psychology, 1981)

According to the diagnostic criteria for Gender Identity Disorder, these teens could be diagnosed with GID. What happens to these children as they mature? Studies by Richard Green indicate that 70 to 80 % of feminine boys were either bisexual or homosexual at the time of follow-up in adolescence or young adulthood. Transsexualism occurred at a lower rate than would be anticipated.

It is helpful to recognize that a signifant number of gender non-conforming children and teens mature to become gay or lesbian while a few become transsexual. Many of these children meet the diagnostic criteria for gender identity disorder and many are being provided therapy in an attempt to prevent their "pre-homosexual" or "pre-transsexual" condition. This therapy is provided despite the fact that no formal empirical studies indicate that therapeutic intervention alters the developmental pathway toward either transsexualism or homosexuality! There is no concrete evidence that the therapy is effective. There are a few claims that the therapy was successful, but there are also claims by teens who received the treatment that provide evidence that therapy was psychologically harmful and abusive.

Many psychologists do not agree that corrective therapy is beneficial and prefer to provide support to the child and family. It is important to recognize that the future of many gay, lesbian, bisexual and transgendered teens is affected by attempts by adults to disregard that it is often difficult to determine whether or not a teen is gay, lesbian, bisexual or transgendered. Typically, transsexuals report long-term confusion about their gender, sexual orientation , or both. Many gays and lesbians have similar confusions. The discovery process for these teens is very similar. After all they are trying to answer the same questions. (http://www.critpath.org/pflag-talk/gid2.htm)