Yesterday, President Donald Trump reversed the Obama administration's 2016 directive for public schools to allow transgender students to use the bathroom corresponding to their gender identity. The controversial subject has divided many parents and lawmakers. But one group against the latest guidelines is the American Academy of Pediatrics, a professional membership organization of 66,000 pediatricians.
"This is about taking care of our youth," says Lynn Hunt, MD, FAAP, chairperson of the American Academy of Pediatrics Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness.
Transgender children who do not feel comfortable entering a bathroom often refrain from going at all, she explains to Health—which, in addition to being stressful, can increase risk of urinary tract infections. "These are children who are extremely vulnerable, especially in school, which is such a big part of their lives."
Here, five facts about transgender children that you should know, regardless of where you stand on this debate.
It's unclear how many children identify as transgender
According to data from a 2014 government survey, about 1.3 million American adults identify as transgender. But it's unclear how many children identify with a different gender than the one they were assigned at birth. Dr. Hunt explains that because it's up to individual states to determine whether or not to include questions about gender identity in their surveys, there is a lack of data on the topic.
Local surveys from Massachusetts (in 2006) and Wisconsin (in 2015) found that of students polled, a respective 1.6% and 1.5% consider themselves transgender. The New York Times reports that the Centers for Disease Control and Prevention is not planning on adding a question about gender identity to its adolescent health survey until after 2019, meaning it could be years until we have better nationwide data about transgender youths.
The transition process is different for everyone
Transitioning is a very personal process and can take years. "The age that somebody understands themselves is quite variable," says Dr. Hunt. Some children may be able to express that they identify with a different gender than the one they were assigned at birth by age two or three, she says. But for other children, it can take longer, especially if they don't feel empowered to express their feelings.
"Children are smart, and may suppress something they think is divisive," Dr. Hunt says.
They're more likely to experience harassment—and severe long-term consequences
Studies show transgender children are more likely to be anxious and depressed, and whether or not they feel supported in their gender identity may play a role in their well-being. Last year, researchers analyzed data from the Cincinnati Children's Hospital Medical Center and found that 63% of transgender patients ages 12 to 22 had a history of being bullied. And a 2016 study of about 250 lesbian, gay, bisexual, and transgender teens published in the American Journal of Public Health found that LGBT youths who suffered harassment went on to experience lasting mental health damage, including depression and post-traumatic stress disorder.
"We were struck by how severe [harassment] was for some of these kids who were getting highly victimized over their four years of high school," said study author Brian Mustanski in a news release. "If that's your experience for several years of high school, you can imagine how scarring that would be."
They have increased suicide risk
Transgender children and teens are more likely to attempt suicide than their peers, often due to bullying and transphobia in their communities. The same Cincinnati Children's Hospital Medical Center study found that 30% of transgender youths who visited the medical center had a history of at least one suicide attempt, while almost 42% reported a history of self-injury.
Attempted suicide rates were higher—46.5%—among transgender university and college students in a 2016 study of more than 6,000 transgender adults published in The Journal of Homosexuality. And those rates spiked even more for students who were denied use of bathrooms (60.5%) and campus housing (60.6%) that corresponded to their gender identity.
An accepting environment helps
Research tells us that transgender children fare better in communities that support them. "Negative outcomes are not a given," says Dr. Hunt. "Family and school support can make a difference."
In a 2016 study in the journal Pediatrics, transgender children who socially transitioned (meaning they have changed their gender expression, choosing to go by a different name and pronouns and possibly also altering their clothing and hairstyle) and felt supported in their identities had normal levels of depression and only slightly elevated levels of anxiety compared to kids whose gender identity corresponded to their birth sex.
Supportive environments also lower attempted suicide rates. Research on transgender adults from 2015 identified factors that appeared to help protect transgender persons from suicidal thoughts, including social support, self-acceptance, and being able to live according to their gender identity.