Parenting Trans and Non-binary Children: Exploring Practices of Love, Support, and Everyday Advocacy 3031098633, 9783031098635

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Parenting Trans and Non-binary Children Exploring Practices of Love, Support, and Everyday Advocacy Magdalena Mikulak

Parenting Trans and Non-binary Children “Mikulak’s precision and clarity unpicks the social landscape, throwing a vital and sympathetic spotlight onto the families of trans youth. Challenging hand-wringing moral panics and sociologically contextualising systemic disadvantages, this book adds a much-needed account of navigating life in support, recognition, and inclusion of trans and gender diverse children and young people.” —Ben Vincent, Research Coordinator, Trans Learning Partnership, UK “Patient, precise, and powerfully written, this book offers an urgent and necessary insight into the parenting of trans children. Mikulak expertly marshals evidence from groundbreaking research to show how parents can and do support their children amidst growing social and political challenges. This will be vital reading not just for researchers and professionals who work with young trans people and their families, but also for parents seeking a caring yet critical perspective.” —Ruth Pearce, Lecturer in Community Development, School of Education, University of Glasgow, Scotland and Senior Fellow, Center for Applied Transgender Studies, USA “A vital book about supporting a tiny group of loving parents whose needs are at risk of being ignored in the eye of a contemporary moral panic. The first hand evidence of what these ordinary families have to navigate will shock you. Whether you’re a clinician, teacher, close friend or relative of such a parent you need to read this.” —Christine Burns MBE, Author and Retired Activist, UK

Magdalena Mikulak

Parenting Trans and Non-binary Children Exploring Practices of Love, Support, and Everyday Advocacy

Magdalena Mikulak Department of Social Care and Social Work Manchester Metropolitan University Manchester, UK

ISBN 978-3-031-09863-5    ISBN 978-3-031-09864-2 (eBook) https://doi.org/10.1007/978-3-031-09864-2 © The Editor(s) (if applicable) and The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover credit: © aram_shutterstock.com This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

For my parents

Acknowledgements

Every bit of writing that we produce as academics is always necessarily a compromise and this book is no different. It is a compromise between the sense of political urgency and the limited time, resources, and, at times, support I had to complete it. It is a compromise between trying to write something helpful and informative for both academic and non-academic audiences whilst handling existing bodies of literature and knowledges with respect and care. Whilst I acknowledge these pressures, I want to assure my readers that any flaws and omissions in negotiating them are my own responsibility. Similarly, although this book is based on my work on a larger research project, the arguments and political commitments presented in it are my own and do not reflect the views or commitments of the wider research team—albeit it is my hope that they might align with some of these meaningfully. This book also does not necessarily reflect the views of the funders. I want to nevertheless thank the wider research team on the Identifying the health and care needs of young trans and gender diverse people project and the funders behind it. It is through that project, the many wonderful people involved in its advisory group, and the challenges and tribulations of my 20 months on that project that propelled me to work on this book. I am especially grateful to the trans members of the wider research team and advisory group for their generosity, tenacity, and work, which has been a continuous source of inspiration to me. I am thankful to have had the opportunity of writing this book also in a practical sense, as a relatively early career scholar, with a research career that mirrors and refracts the conditions of precarity in present-day vii

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academia. I want to thank Palgrave Macmillan and the two editors with whom I worked: Nina Guttapalle—who first approached me about the possibility of writing this book—and Linda Braus—who seamlessly and graciously took over from Nina. Their tactful reminders and checking in with me kept me on track. Whilst I wrote this book almost entirely in my spare time, working full time on another research project, I am grateful for the possibility to continue to work with the interview dataset beyond my initial contract with the University of Oxford; a possibility that was enabled by the honorary research fellowship that I received for one year since leaving Oxford in May 2021. I want to thank Prof Sara Ryan for her unceasing support and encouragement throughout my time at the University of Oxford and beyond it. I am deeply grateful to Dr Łukasz Szulc for the many walks/talks/coffees we had that allowed me to ‘air’—literally and figuratively—and refine some of the central ideas presented in this book. I want to also thank the three reviewers who generously commented on the initial proposal for this book and, in effect, made the book better by asking helpful questions and highlighting my dead angles. Further, I want to thank Dr Dylan O’Driscoll for his support and for being the most patient proofreader, and for over a decade of attending to my non-native English tendency to put ‘the’ in places where it does not belong and omit it from places where it is needed. I want to thank the Department of Gender Studies at the London School of Economics and Political Science (LSE) where during my PhD I learnt and grew more than I thought was possible not just as an academic but as a person. Finally, I want to thank all the trans, gender-diverse and gender rebelling people who I have been fortunate to call my friends throughout the years. In many ways, this book is for you.

Contents

1 Introduction:  Parenting Trans and Gender-­Diverse Children—Background and the Current (Hysterical) Historical Moment  1 Part I Gender Challenge(d)  37 2 Leaving  the Comforts of Cis-certitude: Parents Making Sense of their Child’s Gender 39 3 Advocating  for Trans or Gender-Diverse Children: Establishing Foundations, Finding Information and Support, and Negotiating Pressures 61 Part II Challenging the Way the World Is Set  79 4 You  Should Be So Lucky Not to Be Treated Poorly: Experiences of Healthcare of Parents and Carers of Trans and Gender-Diverse Children  81 5 More  than Bullying, Less than Support: Parental Advocacy and Re(inventing) the Wheel of Inclusion of Trans and Gender-­Diverse Young People in School107 ix

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6 Negotiating  Relationships/Managing Harm: Advocating for Trans and Gender-Diverse Children in Families and Communities127 7 Conclusion: The Function of Love Is to Affirm145 Appendix 1: Topic Guide for Parents’ and Carers’ Interviews157 Index161

CHAPTER 1

Introduction: Parenting Trans and Gender-­Diverse Children—Background and the Current (Hysterical) Historical Moment

In February 2019, I joined a team of researchers at the University of Oxford to work for 20 months on a project that set out to understand how health and social care services can better address the needs of young trans and gender-diverse people and their families. This book is a result of my work on and engagement with this project, which also resulted in the production of a HealthTalk module about the experiences of parents and carers of young trans and gender-diverse people (HealthTalk, 2022a). Whilst working on this research, I was astonished how little attention has been paid to families of trans and gender-diverse children and young people in the United Kingdom. Considering the disproportionate public opinion focus on trans adults and children, the moral panic around gender-­ affirming healthcare for under 16s, and the multitude of voices involved, there was almost no academic work that centres the narratives and experiences of the families whose children are the very focus of these debates. This scarcity combined with the cacophony of uninformed and deeply transphobic voices in the public debate on trans children were the driving force behind the writing of this book. This book is a product of an academic research project as much as it is a result of a political sense of urgency, and my hope is that it will contribute in however small way to the wider trans liberation project. Thus, I want to make my own position in

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2_1

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the field of debates and knowledge production, in which this book is trying to intervene, explicit from the start: I write this book as a cisgender woman, a feminist, a trans ally, and a supporter of trans rights. At the very heart of my commitment to writing this book is the sense of urgency as I witness the injustices that trans and gender-diverse people of all ages face in the United Kingdom today. While informed by the overall project, which also involved interviews with health professionals (Mikulak, 2021; Mikulak et al., 2021) and young trans and gender-diverse people (HealthTalk, 2022b), this book is based specifically on interviews conducted with parents and carers of trans and gender-diverse children and young people in the United Kingdom. It presents an account of the love, support, and everyday practices of advocacy involved in parenting trans and gender-diverse children and young people in a social world that at best ignores and at worst denies their existence. Centring stories of parents who affirm their young person’s gender and support their transition, this book aims to offer a trans-positive account of family life and to demonstrate how an affirming approach to trans and gender-diverse children is a ‘justice-based parenting practice’ (Pyne, 2016). Further, it shows how parental stories of affirmation and support are also stories of enrichment, of personal and interpersonal growth, expanded horizons, and greater sensitivity towards, and acceptance of, difference. This book examines how parents and carers understand their children and their own role as advocates and allies. It examines the barriers and challenges families encounter within the different spheres of their lives and how advocating for a trans child can be a lonely and labour-intensive undertaking. It also demonstrates how the ease with which parents come to inhabit the role of advocates, and how they understand this role, varies. However, what is invariable is their love for their children. It is this love, or rather knowing that it is there, that gives me confidence that in holding their parental practices up for scrutiny, my analysis and at times critique will be read as it is intended: to support parents and carers in affirming their trans and gender-diverse children and to challenge transphobic and trans-negative practices, views, and institutions. Relatedly, this book is also about struggles and hurdles that families face, many of which result directly from the failure of the healthcare and education systems to meet their obligations towards young trans and gender-­diverse people and their families. I am writing this book in a context where the dire state of the specialist services and waiting times of

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more than three years at the Gender Identity Development Services (GIDS), and the patchy support from schools and GPs, leave families unsupported and struggling to build their own support in what can be an often-hostile environment. Inevitably, it is against the backdrop of these systemic failings that the individual stories of love, support, and everyday practices of advocacy are told and lived. Equally important, the stories that form the basis of this book are still unfolding, unfinished, and evolving. They are therefore best read as representative of issues and notions as opposed to representing individuals. As a first book on parents of trans and gender-diverse children in the United Kingdom, this book aims to make a unique contribution to understanding the challenges and support needs of this group. The challenges and support needs that, as this book demonstrates, remain ignored and/ or unmet, despite, or perhaps also because, of the media noise and moral panic around trans children. Centring affirmative and supportive accounts, my hope is that this book will help parents and carers of young trans and gender-diverse people out there to better support their young persons and to become better advocates for them. To this end, this book also discusses examples of non-affirming parenting practices and how parents’ lack of knowledge, or knowledge grounded in misinformation, harms young trans and gender-diverse people and negatively affects the support they receive. Importantly, the challenges and discrimination that young trans and gender-diverse people face are only beginning to be analysed in the United Kingdom and there is an urgent need to centre the voices of the young people themselves. This book does not aim to take away from that need, rather it points to the necessity of also engaging with parents and carers’ understandings and experiences of supporting trans and gender-diverse young people. Given the crucial role that parental and family support play for the wellbeing of young trans and gender-diverse people, and how damaging the lack of such support can be, the arguments presented in this book aim to examine, unpack, and, whenever possible, celebrate the processes and practices that make it possible. Theoretically, this book explores how cisnormativity—the assumption that a person’s gender matches the gender they were assumed to be at birth—permeates family and social lives. It examines how parents negotiate and challenge cisnormativity to make the familial, educational, and healthcare settings liveable for their trans or gender-diverse children. By examining the educational and emotional labour that parents perform as

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they advocate for their children across these different settings, this book also aims to highlight the value of parental expertise and labour, as well as its limits, as they come up against the systemic failures that continue to make that labour necessary.

Book Structure The succeeding chapters of this book are divided into two parts and followed by a concluding chapter (Chap. 7). Part I Gender Challenge(d) draws on original research findings about how parents of trans and gender-­ diverse young people make sense of their children’s gender and how they take on the role of advocates for their children (Chap. 2). It explores how parents become experts in supporting their children and what it means to advocate for a trans child in multiple areas of life simultaneously, with little or no support (Chap. 3). Part II: Challenging the Way the World is Set up focuses on three distinct areas in which parents advocate for their trans and gender-diverse children: healthcare (Chap. 4), education (Chap. 5), and social and family life (Chap. 6). Family and community, education, and healthcare are also key spaces for production of gender and gender norms. In each of these areas, parents face a range of challenges that reflect gender-­normative and cisgenderist—so privileging cisgender experiences and delegitimising trans people’s knowledges of their own genders and bodies—assumptions. In this part of the book, I argue that taking on the challenges of making the social, educational, and healthcare spaces liveable for their children, as part of their labour of love and support, parents reshape and at times reinvent these spaces through sustained efforts, creativity, and tenacity. Finally, Chap. 7, Conclusion, offers a summary of the key findings of the research and relates them back to the academic discussions on trans children, parenting trans children, and parents as advocates. It argues that the disproportionate burden placed on parents of trans and gender-diverse children reflect systemic shortcomings which in turn reflect the cisgenderist nature of the social world they and their children occupy. These additional burdens also mirror power relations and structures that disadvantage trans and gender-diverse children, dismiss their claims to self-knowledge, and thus deny their right to self-determination. This book is also a reminder that (a) the advocacy labour of parents of trans and gender-diverse children is not a given, and this book keeps returning to the question of what this means for those trans and gender-­ diverse children who cannot rely on it and (b) individual advocacy can

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only ever achieve so much in the face of structural inequalities, institutional inertia, and uneven distribution of resources. The next part of this chapter sketches out the complex background to my intervention, bringing together relevant strands of scholarship on trans issues and histories, as well as discussing some key moments and developments, beginning with where we find ourselves in the 2020s.

The (Hysterical) Historical Moment Over the last couple of decades social awareness of, and public interest in, trans and gender-diverse adults and children has reached unprecedented levels in many places around the world, including in the United Kingdom. The 2010s were marked by unprecedented improvements in the situation of trans people in the so-called ‘West’ (Burns, 2018; Stryker, 2017), with increased visibility and growing social awareness, even if these very gains have been far from evenly distributed amongst trans and gender diverse people reflecting inequalities along race, class, and disability lines, amongst others (Kattari et al., 2020; Raha, 2017). What followed this uneven yet undeniable progress was a wave of resistance to such reconfiguring of the social world in which more space was being carved out and claimed by trans and gender-diverse people and their allies. In the revised edition of Transgender History, Susan Stryker (2017, p. 226) notes that ‘It would be remarkable if the historic changes in how society understands and accepts trans and gender-nonconforming people failed to produce a backlash among people hostile to those changes’. This book is written in the context of such backlash against trans rights in the United Kingdom and elsewhere. We are living in a historical moment when trans people and trans children are both ‘hyper-visible and hyper-vulnerable’, to borrow Ruth Pearce and colleagues’ phrase (2019b, p. 2). This vulnerability is reflected not only in the statistics and reports from the United Kingdom but also elsewhere (ILGA Europe, 2021a). Human Rights Campaign called 2021 a record year for anti-transgender legislation in the United States (Ronan, 2021). It is plausible that 2022 will break that record. In the United Kingdom, in the last year for which statistics are available (2019–2020), there has been a 16% increase in anti-trans rhetoric and anti-trans hate crimes (Home Office, 2020). Freddy McConnell, a trans man who lost a legal battle to be recorded as ‘father’ or ‘parent’ on his child’s birth certificate, called the ongoing offensive against trans rights in the United Kingdom ‘death by a thousand cuts’; the aim, he writes, is to ‘target laws

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and policies that accidentally or potentially protect trans people, no matter how seemingly inconsequential’ (McConnell, 2021). The legal challenges mounted against the GIDS are an important part of this landscape and so is the resistance that followed moves to roll back rights and provision. The focus of the research project from which this book originates was on experiences of healthcare, and it is not a coincidence that it is in healthcare that some of the most significant developments that threaten trans rights in the United Kingdom have been happening. Healthcare is a site historically fraught with inequalities for trans and gender-diverse people (Pearce, 2018; Vincent, 2018). It is also a site where increased demand for gender-affirming care created a crisis that brought the existing, inefficient, and inadequate system almost to a standstill. In the United Kingdom, gender identity healthcare is free and provided within the National Health Service (NHS) for both children and adults. Children and young people under 18 are looked after by the GIDS, established in 1989. GIDS is based at the Tavistock and Portman NHS Foundation Trust and commissioned by NHS England. The service has clinics in London, Leeds, Bristol, and Birmingham. To be seen by the specialist team at the GIDS, a young person needs to be referred by their GP, a local Child and Adolescent Mental Health Service (CAMHS), school, or a charity. In recent years, trans and gender-diverse children have been increasingly presenting at the GIDS.  The GIDS’ statistics (GIDS, 2019) show an increase from 139 referrals to the service in 2010/2011 to 2590 in 2018/2019. The GIDS waiting times have increased exponentially. In December 2020, the waiting time for the Service was upwards of three years. In January 2021, there were over 4600 young people on the waiting list for the first appointment (Care Quality Comission, 2021, p.  3). Little has been done to address this crisis. In addition, the recent inspection of the GIDS by the Care Quality Commission (CQC) highlighted further serious issues with the GIDS (Care Quality Commission, 2021). The commission’s inspection rated the service ‘Inadequate’, the lowest rating a service can achieve, pointing out the many failings of leadership, lack of structure and clarity in the assessment processes and treatment paths, alongside the overly long waiting times. I return to these issues in Chap. 4, as many of the stories that became the building blocks of this book have been shaped by, and reflect, these inadequacies. The results of the CQC inspection were published less than two months after the High Court ruling in the high-profile Bell v Tavistock case. The

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ruling stated: ‘It is highly unlikely that a child aged 13 or under would be competent to give consent to the administration of puberty blockers. It is doubtful that a child aged 14 or 15 could understand and weigh the long-­ term risks and consequences of the administration of puberty blockers’. It further reads: ‘Given the long-term consequences of the clinical interventions at issue in this case, and given that the treatment is as yet innovative and experimental, we recognise that clinicians may well regard these as cases where the authorisation of the court should be sought prior to commencing the clinical treatment’. Following the ruling, GIDS confirmed that all new referrals to the endocrinology clinic for puberty blockers have been paused, causing a wave of outrage and anguish amongst trans rights and parents advocates. Another block was added to the already dysfunctional healthcare ‘pathway’. The ruling also magnified a sense of being under an ongoing offensive and yet another assault on the rights of trans rights in the United Kingdom (Pearce et al., 2020). The overwhelming sentiment was that the judiciary was swayed by regressive, transphobic voices and that it lacked understanding of trans health. The charity Mermaids, that works to support young trans people and their families, issued a statement in which it called the decision ‘deeply misguided’ and said that the ‘judgment from the High Court risks untold, irreparable damage to young trans people in England and Wales. It heralds nothing less than a new era of discrimination, treating trans youth differently from all other young people and barring them from accessing life-saving care’ (Mermaids UK, 2020). In March 2021, another case of AB v Tavistock and Portman NHS Foundation Trust reversed some of the damage done by the Bell case, when the High Court ruled that if a child cannot consent to taking puberty blockers their parent can consent in their stead (Good Law Project, 2021). Whilst a welcome development, the decision highlighted issues faced by trans children without parental support who would remain disadvantaged. Further to that, Court of Appeal ruling from September 2021 overturned this decision allowing referrals to restart for all eligible young people.1 The above attempts at limiting young people’s access to gender-­ affirming healthcare are symptomatic of the current mobilisation against trans rights that target the already limited self-determination in the field of healthcare, and they remind us that progress, however problematic a 1  It is important to note that all the interviews on which this book is based took place before these rulings, although for many of the people involved, these legal developments would be consequential, as the following chapters will demonstrate.

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notion, is not linear, but rather that rights once granted can be rolled back, or taken away altogether. Had it not been overturned the Bell v Tavistock case might have had far-reaching and damaging consequences not just for young trans and gender-diverse people and their families but for young people at large. The ruling also delayed or derailed access to treatment for those already in the system, amplifying the feeling of anguish and uncertainty that accompany families’ dealings with the healthcare system (see Chap. 4). Further, ruling that a 15-year-old might not be able to understand the consequences of their healthcare decisions and should thus be ‘protected’ from themselves in the name of preventing imagined future ‘regret’ opens a Pandora’s Box of issues around understanding who makes decisions about young people’s health and lives. The questions that flow from these considerations are central to this book and its aims of foregrounding affirming and supportive parenting practices of trans and gender-­diverse young people as practices that further social justice and take children’s and young people’s self-knowledge and claims to gendered self seriously. The historical/hysterical moment in which we find ourselves now is unique in terms of both the risks and possibilities it carries for trans liberation. It is also an outcome of complex, often competing, developments that came before it. As an inroad into this complexity, in the next section, I offer a historical background to transgender issues, trans histories, and meanings of trans.

Trans Meanings and Histories Trans histories and the meanings of ‘trans’ are complex, varied, and time and space-contingent. It is not my intention to map these histories and meanings exhaustively here as this task has been approached with much more expertise, experience, and knowledge than I could ever hope to have on the topic (see for example Burns, 2018; Meyerowitz, 2002; Stryker, 2017). I therefore focus on some tropes that matter specifically for the purpose of this book, whilst signalling the main issues and developments that others have written about as critical. The histories of trans and gender-diverse people are entangled with histories of gay, lesbian, and intersex (LGBI) people (Gill-Peterson, 2018; Manion, 2020; Meyerowitz, 2002). Importantly, just like lesbian, gay, bisexual, and intersex histories, trans histories are defined by much more than the psycho-medical complex and its efforts to manage and

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pathologise lives of people whose gender and/or sexuality do not easily map onto the heteronormative and cisnormative matrix. However, just like LGBI histories, histories of gender-diverse and trans people have nevertheless been shaped in negotiation with and often in resistance to professional discourses and practices of medicalisation. This has been particularly true in the context of the so-called ‘modern Western world’, where conventional medicine and science have shaped people’s understandings of what is ‘normal’, desirable, and, at times, liveable. In the words of Susan Stryker: Medical practitioners and institutions have the social power to determine what is considered sick or healthy, normal or pathological, sane or insane, to transform potentially neutral forms of human difference into unjust and oppressive social hierarchies. This particular operation of medicine’s social power has been especially important in transgender history. (Stryker, 2017, pp. 51–52)

‘Western’ psycho-medical professionals have long occupied themselves with identifying, naming, and categorising gender diversity. This in turn has resulted in over a century of cisnormative and heterosexist pathologisation. As Pearce (2018) observes, over the last century, ‘in seeking to categorise gender-variant conditions, sexologists succeeded in framing deviation from (binary) gender norms as pathological—that is, a disease, illness or medical condition—even when the deviating individuals in question do not seek a medical intervention of any kind’ (Pearce, 2018, p. 26). Medicalisation of gender diversity went hand in hand with conventional medicine’s rise to prominence in the nineteenth and twentieth centuries. The increased attention to transgender issues in the ‘burgeoning medical literature’ in the late nineteenth century signalled that transgender people and lives were increasingly ‘becoming to be seen as a medical problem’ (Stryker, 2017, p. 53). Richard von Kraft-Ebbing’s influential Psychopatia Sexualis published in 1886 discussed—and classified as deviant—a range of gender-diverse and non-heteronormative experiences introducing terms such as ‘androgyny’, ‘gyandry’, or ‘defimation’ (Pearce, 2018, p.  21). From the second half of nineteenth century, terms such as ‘invert’ also began to circulate conflating gender-diverse experiences with other forms of sexual and gender difference (Stryker, 2017). It was, however, Magnus Hirschfeld’s work in the first decades of the twentieth century that set foundations for modern-day understandings of gender diversity;

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considered a crucial figure in the history of gender and sexuality, Hirschfeld was also an early advocate for trans people (Stryker, 2017, pp.  54–56). Hirschfeld’s pioneering work distinguished between what we today refer to as sexuality and gender expression, as well as highlighting complexities of sexuality and gender; his 1910 book The Transvestites was the first book written on the treatment of transgender people (Pearce, 2018; Stryker, 2017). Beginning in 1930s, ‘inverts’ became subjects of interventions by endocrinologists who used ‘the emerging science of hormones to administer hormone therapy’ to them (Pearce, 2018, p. 23). However, as Pearce observes, endocrinology’s failure to ‘cure’ inversion eventually led to a shift from 1950s onwards towards psychological and psychiatric treatments, including aversion therapies and psychoanalysis (Pearce, 2018, p. 22). It is around the same time, in 1946, that Michael Dillon, a trans man himself, wrote Self: A Study in Ethics and Endocrinology, which argued that trans people should be helped through hormonal and surgical interventions as opposed to being cured (Vincent, 2018, p.  49). Harry Benjamin’s highly influential work in the 1950s–1970s lent further legitimacy to gender-affirming medical interventions (ibid.). Benjamin acknowledged the complexity and differences between ‘transvestitism’ and ‘transsexualism’ and the benefits of physical transition for ‘transsexualists’ (Pearce, 2018, p. 25). He also emphasized the role of psychiatrists in assessing patients’ suitability for gender-affirming medical interventions, which, according to Pearce (2018, p. 26), provided the groundwork for a mode of treatment that is still in place today. In the United Kingdom, under the current treatment protocols, this model remains operational for both adults and children. The increased medicalisation of gender diversity eventually made its way into medical diagnostic manuals with ‘transsexualism’ included in the International Statistical Classification of Diseases and Related Health Problems (ICD) in 1975 and in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 (Vincent, 2018, p. 51). Arguably, the later editions of both manuals have moved away from pathologising gender diversity per se and focused instead on distress or discomfort that a person can experience in relation to their body, making this discomfort the grounds for medical intervention (Vincent, 2018, p.  53). The DSM-5, published in 2013, substituted ‘Gender Identity Disorder’ with ‘Gender Dysphoria’ that nevertheless remained in the chapter dedicated to mental disorders. The emphasis is on ‘distress that may accompany the

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incongruence between felt or expressed gender and the gender assigned’ as reflected in the diagnostic criteria: ‘a marked incongruence between the felt gender and the primary and/or secondary sexual characteristics (or in young adolescents, the anticipation of secondary sexual characteristics)’ (American Psychiatric Association, 2013). In the latest iteration of ICD, ICD-11, ‘Transsexualism’ is replaced with ‘Gender Incongruence’ which is no longer part of the chapter on mental disorders but is instead included in a new chapter entitled ‘Conditions relating to sexual health’ (Rodríguez et al., 2018). Medicalisation and the resultant pathologisation of non-normative gender expression and identification had gone hand in hand with states’ attempts to control and/or punish trans and gender-diverse people by limiting their civil and reproductive rights, or, more recently, making access to healthcare dependent on strictly binary gender performance and presentation. For example, until the Gender Recognition Act (GRA) was passed in the United Kingdom in 2004, all European countries required infertility as a condition for legal recognition (Dunne, 2017). Many still do today, including Finland, Hungary and, my own country of origin, Poland (ILGA Europe, 2020). I return to the United Kingdom and the GRA later in this chapter. Moreover, whilst most existing literature focuses on how these historical processes affected adult trans and gender-diverse people, the medicalised histories of trans children have been unfolding alongside, even if they have at times been forgotten or partially erased (Gill-Peterson, 2018). Jules Gill-Peterson’s book (2018) reconstructs clinical histories and examines the processes of medicalization of trans children that took place across much of the twentieth century. According to Gill-Peterson, the particular medical matrix—in which we still live today—for thinking about and managing trans children, was inaugurated in 1980 with the publication of the Diagnostic and Statistical Manual with an entry on ‘Gender Identity Disorder of Childhood’ (Gill-Peterson, 2018, p. 11). Still, it is not until the last decade that trans children became a focus of increased scrutiny of doctors’, psychiatrists’, parents’, politicians’, and public opinion’s interest leading to their increased ‘administrative and institutional categorization’ (Meadow, 2019, p. 3). This is key, as it is in the context of, and in resistance to, such institutional and administrative categorisation that the lives of families, on whose accounts this book is built, unfold.

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More than Diagnosis As significant as medical professionals, and the discourses they generate, are to our current day understanding of trans lives and possibilities, it is equally important to stress that these very lives and possibilities have historically existed and continue to exist in their own right outside of the psycho-medical discourse. Moreover, whilst an important tool for the control and management of trans lives by ‘experts’, the psycho-medical sciences have proven notoriously inept at reflecting the diversity and complexity of gender difference. In the introduction to The Emergence of Trans, Ruth Pearce and colleagues aptly point out the unreliability and limitations of such efforts when they write that: None of the resulting sexological and psychiatric models for gender difference have truly passed the test of time, for the languages of androgyny, gynandry, defemination, uranismus, inversion, transvestism, transsexualism, gender identity disorder, gender dysphoria and gender incongruence… all fail to capture the complications, the fuzzy boundaries and open borders of gendered experience and socio-political affiliation. (Pearce et al., 2019b, p. 1)

Outside of the psycho-medical complex, in the realm of the socio-­ political the meaning of trans remains ‘chronically resistant to definition’ (Plemons, 2019, p. 34). Trans encompasses a diverse range of experiences, embodiments, ways of being in, and acting upon the world. It can be understood as an umbrella term that brings together a range of identities and experiences and the broad scope of its possibilities often directly contrasts with the rigid forms of labelling that happens when trans people, young and old, are assessed for ‘gender dysphoria’ at the gender clinic (Pearce, 2018, p. 6). The emergence of trans identities and discourses is also closely linked to ‘evolution of trans social networks, social movements and citizenship struggles’ (Pearce et  al., 2019a, p.  64). Gender-diverse lives and possibilities have always been and will always be infinitely more than any diagnosis constructed to contain and control them.

The Legal Context in the United Kingdom It was not until the 2000s that trans rights began to be codified in the UK law. Most notably, in 2002, the UK Government lost a case in a landmark ruling of the European Court of Human Rights (ECHR) in Goodwin v

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United Kingdom. The ECHR found the UK government to be in breach of Articles 8 and 12 of the European Convention for denying certain rights, in particular to private life and the right to marry, to people who have undergone gender-affirming surgeries (Sandland, 2003). This ruling led to the introduction of the Gender Recognition Act (GRA) in 2004, a crucial piece of trans rights regulation. Under the GRA, the government granted trans people full legal gender recognition allowing them to obtain new birth certificates. This is done through applying for a Gender Recognition Certificate (GRC). In 2010, the United Kingdom also passed the Equality Act, which included ‘gender reassignment’ as one of the protected characteristics and effectively made discrimination based on trans status illegal. Trans people do not have to have a GRC to be protected under the Equality Act. There have since been efforts to update the existing legislation, and whilst an important step forward, the GRA remains problematic. Based on the GRA, a person can apply for a GRC, if they are over 18, identify as male or female, and submit evidence that states that they intend to live in their ‘acquired’ gender for the rest of their life. There is also a requirement that the person must have lived in their ‘acquired’ gender for over two years and have been diagnosed with gender dysphoria. The GRA process is long and difficult and trans people are expected to ‘prove’ their gender. There are also fees involved in the process. GRA relies on binary understanding of gender and there is a resultant lack of recognition of non-­ binary people, as well as lack of recognition of people under the age of 18. Trans and non-binary people who do not experience gender dysphoria remain unrecognized under the GRA. The requirement for diagnosis continues to carry the historical weight of pathologisation and denies trans and gender binary people’s self-knowledge. Unfortunately, recent attempts to reform the GRA have failed. Following the GRA consultation in 2018 and the 2020 GRA inquiry, any meaningful reform of the GRA was effectively dropped by the Conservative government, despite the overwhelming proportion of the input received pushing for progressive change (ILGA Europe, 2021a). It is important to note that this happened in the context of growing anti-trans mobilisation driven by small but vocal lobby groups, which have successfully delayed reforms to the GRA and influenced public debates on puberty blockers for adolescents and legal recognition for minors (McLean, 2021). What the above outlined legal context means is that in the United Kingdom no legal gender recognition procedures exist for under 18s. For

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comparison, these are present in several other European countries including (at the time of writing) Germany, Spain, Portugal, Greece, Norway, Belgium, Switzerland, Austria, Estonia, Italy, Malta, Luxemburg, Montenegro, and Croatia (ILGA Europe, 2021b). In addition, in Spain, Norway, Estonia, Germany, Switzerland, Austria, Luxemburg, and Malta, legislation in place for legal gender recognition does not include explicit minimum or maximum age restrictions, effectively enabling people of any age to use the same process (ILGA Europe, 2021b). However, this is not the case in the United Kingdom, where, additionally, continuous pathologisation of gender diversity (manifested in requirement for diagnosis to access trans-specific healthcare), lack of self-determination, and non-­ binary recognition give the United Kingdom the lowest score in ILGA’s Legal gender recognition & bodily integrity category in Western Europe (ILGA Europe, 2021b).

Trans Child There is a striking lack of scholarship on trans and gender-diverse children and childhoods not only in the UK context but in general. This is telling, for as Gill-Peterson argues, if the emergence of trans is steeped in complex negotiations across times and places, the emergence of a trans child has additionally been defined by historical erasures and omissions (Gill-­ Peterson, 2018). In the light of this absence, work done in the United States and elsewhere comes to stand in as imperfect substitutes to explore some of the broader issues around trans and gender-diverse infanthood and youth. To begin to think about the meanings and histories of trans child and trans childhoods, what needs to be stressed is that the way we have come to understand childhood in the Euro-American context is historically and geographically specific (Gill-Peterson et  al., 2016; Rosen & Faircloth, 2020). Our understandings of childhood is also deeply raced and classed in ways that can deny the very innocence that is otherwise so central to our collective (mis)understandings of childhood and by extension the protections, paternalism, and care that childhood offers to some children (Breslow, 2019; Gill-Peterson, 2018). To think about trans childhood is thus to think alongside these histories and processes and how they result in a set of associations (with innocence and vulnerability) and assumptions (about capacity, autonomy, and agency) that we so readily make when thinking about (some) children and childhoods in the twenty-first

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century. Accordingly, how we understand childhood matters—and has consequences for what protections and rights are extended to children—as well as reflecting particular historical and socio-economic realities: By taking children in the Progressive Era off the streets, out of factories, and placing them into mass schooling or institutions for juvenile delinquency, childhood was constituted as an ostensibly empty innocence based in deferral and delay: of work, of sex, and of civil rights… This childhood for the twentieth century was deeply, doggedly gendered, with the meanings of innocence for boys and girls shoring up the boundaries of domesticity and the desired, but difficult to induce, heterosexuality that was supposed to be childhood’s end. (Gill-Peterson et al., 2016, p. 496; emphasis mine)

It is under these specific conditions and circumstances that ‘the presumption of children as, de facto, vulnerable and at risk’ became ‘one of the most distinctive social constructions of childhood (and parenthood) today’ (Rosen & Faircloth, 2020, p. 11). To think about childhood is to also consider how it is not just ‘deeply’ and ‘doggedly’ but also cisnormatively gendered and how the very existence of trans and gender-diverse children throws into relief ‘the social process of gendering to which all children are subject’ (Meadow, 2019, p. 6). Childhoods are gendered and children are subject to gender policing and enforcement (Robnett et al., 2018). Gender socialisation and gender policing takes place in the family where parents form gendered expectations as soon as their child is ‘identified’ as a boy or a girl (Blakemore & Hill, 2008; McHale et  al., 2003; Mesman & Groeneveld, 2018; Stockard, 2006) as well as in education (see for example Chapman, 2016; Molla, 2016; Stromquist, 2007). Children also actively participate in socially constructing meanings about gender and sexuality (Blaise, 2005) even if their knowledge is rarely recognized and/or valued (Blaise, 2010). This unwillingness/inability to recognise children’s contributions to how gender and sexuality are understood has far-reaching consequences for all young people, but it matters even more for trans and gender-diverse children. Because trans and gender-diverse children actively disrupt gendered norms and cisnormative gender trajectories, their position is particularly precarious and subject to intensified regulation. Thus, even more so than in the case of a cisgender child, to think about a trans child is to think about ‘a politically disenfranchised person subject to a regime of racially and gender normative governance by medicine and other institutions,

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including the family’ (Gill-Peterson, 2018, p. 10). This book maps out the scope of this disenfranchisement in contemporary Britain. Furthermore, all children are subject to developmentalist assumptions—with developmentalism describing normative assumptions about children’s ‘typical’ development, where adults are believed to be best placed to identify and intervene when ‘something is perceived as “wrong” with a child’s development’ (Riggs, 2019, p. 46). However, in addition to developmentalism, trans and gender-diverse children are also subjected to cisgenderism that when paired with developmentalism is frequently used to deny the legitimacy of their gender self-knowledge (Riggs, 2019); and by extension, as I will argue in the following chapters, access to gender-­ affirming interventions or accommodations.

Claiming the Gendered Self Trans childhoods are valid in their own right but they are also important to the larger project of trans recognition. The pervasiveness of cisnormativity means that a cisgender person’s gender identity is taken as ‘natural’ and goes unquestioned, while such seamless acceptance is rarely extended to trans and gender-diverse people. Gender attribution plays a fundamental role in accomplishing cultural and social intelligibility and trans and gender-diverse people frequently face unfair additional burdens to make their gender intelligible to others (Breslow, 2016; Garrison, 2018; Namaste, 2000). At the same time because ‘childhood … is understood to so easily take on the roles of foretelling and naturalizing for gender’ (Breslow, 2016, p. 220) specific childhood narratives become an important tool in constructing and legitimating claims to ‘coherent gendered selfhood’ for adults (Breslow, 2016, p. 222). Deploying narratives ‘of gendered discovery in childhood’, chiefly ones that ‘fit with binary notions of boyhood and girlhood’ can be ‘one of the strategies by which [adult] trans people’s claims to their rightful inhabitation of their gender is made’ (Breslow, 2016, p. 218). Breslow (2016, pp. 220–222) examines how these narratives can vary from asserting that trans identity was ‘the very first speech act the child made’, through claim that ‘the trans person’s gender identity emerged prior to any awareness of sexuality or sexual difference’, or claiming the opposite, that the child’s ‘precocious awareness of sexual difference and genital anatomy’ was what justified their claims to trans identity. What all of these narratives have in common is their power to naturalise trans

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identity, which in turn positions childhood as a ‘particularly effective technique through which the normative disbelief of trans identity can be interrupted’ (Breslow, 2016, p.  221). This is important not only for our understanding of how stories of the gendered self are told and retold but also what claims for support they legitimate for children and young people. I return to this point in Chap. 2, where I examine how parents of trans and gender-diverse young people make sense of their children’s gender and how they actively co-produce their child’s story of the gendered self.

Parenting Trans and Gender-Diverse Children Because of their disenfranchised position in the world, all children rely on adults for support, access to resources, and, for most of their childhood, healthcare. They also depend on adults for representation and advocacy, in particular, when the socio-legal framework in place offers them little or no protection. The guiding principle of this book positions parents’ and carers’ affirming approaches to trans and gender-diverse children as a ‘justice-­ based parenting practice’ (Pyne, 2016). Support and acceptance of parents and carers is fundamental for the wellbeing and mental health of young trans and gender-diverse people in all contexts (Puckett et  al., 2019; Simons et al., 2013; Wilson & Cariola, 2020). Accordingly, lack of family support is linked to adverse life outcomes and poorer mental health in young trans and gender-diverse people (Puckett et al., 2019; Westwater et al., 2019). Lack of parental support also multiplies barriers for trans and gender-diverse children and young people. Research conducted in Canada shows that the lack of parental support negatively affects access to healthcare, as health providers might impose requirements for parental support/ involvement on young trans and gender-diverse people who seek gender-­ affirming interventions (Clark et  al., 2020). At the time of writing no academic literature exists on this issue in the United Kingdom, but the above-mentioned AB vs Tavistock case is likely to lead to additional challenges for trans and gender-diverse children and young people whose parents do not affirm them. Whilst parental support and acceptance are sadly not a given (Pullen Sansfaçon et al., 2018), previous research has demonstrated that interventions focused on assisting parents in their acceptance process has a positive impact on their child’s mental health (Bauer et al., 2015; Durwood et al., 2017). It is my hope that this book can contribute to these efforts.

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Furthermore, parenting a trans or non-binary child might place additional demands on parents. These demands do not stem from a child being trans or non-binary per se, but from prevalence of cisgenderism and transphobia; conditions that mean that supporting a trans or non-binary child can carry additional emotional and social costs, a point that I demonstrate throughout this book. Whilst trans and gender-diverse children and young people have varied support needs, that might also change over time, many might require support in some or all of the following areas: changing their name, social transition, accessing healthcare (getting referred to the GIDS, going to the GIDS appointment, accessing puberty blockers, etc.) and mental health services, support with additional services (such as for fertility preservation) and advocacy to schools, and other institutions, including the family and community. Because we live in a social world rife with transphobia and ignorance around trans lives and possibilities, parenting trans or gender-diverse children exposes parents and carers to anti-trans prejudice. Parents’ and carers’ decisions to support their child’s gender and/or transition may be questioned or ridiculed by others (Barron & Capous-Desyllas, 2017, p. 408). If parents or carers affirm their child and become their advocate, it might expose them to attitudes and debates—ranging from all shades of ignorance to outright transphobia—that might question their support for their child and/or position them and their choices as causes of direct ‘harm’. Parents of trans and gender-diverse children can also experience secondary stigmatisation which may in turn lead to negative feelings of isolation, anxiety, sadness, and shame (Menvielle & Tuerk, 2002). It is in this context that peer support is particularly significant and existing studies show the importance of in-person and online support groups for parents and carers of trans and gender-diverse children (Hillier & Torg, 2019; Menvielle & Tuerk, 2002; Pullen Sansfaçon et al., 2020). I return to the role of support groups and the ways in which parents carve out support for themselves and their young person in Chap. 3. Furthermore, because parents exist in the same social world that often denies children’s self-knowledge, they might worry whether their child can ‘truly know’ their gender and may seek a diagnosis ‘as means of reassurance’ (Riggs, 2019, p. 21). Parents and carers might also worry about how their child’s gender expression and identity will be received by others and worry that their child might be bullied, or subjected to discrimination (Pullen Sansfaçon et al., 2015). Parents and carers might also worry about

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their child’s future (Riggs, 2019). These concerns are echoed in the narratives of parents and carers interviewed for this book. In addition, parenting a trans or gender non-binary child requires parents and carers to think—sometimes for the first time in their lives—about what gender is and what it does in the world. Having a child of a particular gender can also be an important aspect of a parent’s identity, ‘the rationality of which gets disrupted when their child transitions’ (Field & Mattson, 2016, p.  421). Physical changes that trans or gender-diverse children might undergo as part of their social and/or medical transition can be experienced as upsetting for parents (Field & Mattson, 2016, pp. 417–418), even though, and more importantly, gender-affirming medical interventions are life enhancing for those who desire them (Murad et al., 2010; Pearce, 2018; Vincent, 2018). Finally, some parents may experience a sense of ‘loss’ and feel ‘bereaved’ about their child’s transition, a factor identified as one of the most important challenges in the parental acceptance process (Pullen Sansfaçon et al., 2020, pp.  1222–1223). ‘Grief talk’, to borrow Broad’s term, is not uncommon amongst parents of LGBT people (Broad, 2011, p. 404), and narratives of loss can be found in the literature on parenting of trans children in particular (Field & Mattson, 2016; Norwood, 2013; Wahlig, 2015). However, their normalisation is highly problematic and needs to be read in relation to its heteronormative, trans-negative, and gender-­ normative charge. A helpful reframing of ‘loss’ as ‘loss of certitude’ is offered by Riggs and Bartholomaeus (2018), who highlight how experiences of loss result from the broader cisgenderist context in which parents and their trans and gender-­diverse children exist: Parents of transgender children who experience any form of loss do so because they fall from a place of certitude within an assumed gender norm … this loss of certitude does not attribute the cause of this loss to transgender children but, rather, to cisgenderism. Framed in this way, the loss that some parents of transgender children narrate may more accurately be seen as the loss of the invisible privileges that accord with having a child who is cisgender, and that reflect the ways in which cisgenderism works in many facets of society. (Riggs & Bartholomaeus, 2018; emphasis added)

This is an important point also in the context of work that stresses that increased societal acceptance of gender diversity ‘may leave parents more

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isolated, not less, to the degree they are unable to seek support for their own identity shifts and articulate their feelings’ (Field & Mattson, 2016, p.  426). Field and Mattson (2016) argue that one of the differences between experiences of parents of trans people and parents of LGB people is that the former can be open about discussing ‘their tears and upset over learning that their child is transgender’ (Field & Mattson, 2016, p. 426). In what feels like a warped set of priorities, the logical extension of that argument would be that we should preserve transphobia so that parents can ‘grieve’ more comfortably. The harm to which such musings can lead is obvious and we need to be particularly critical of such moves to innocence that mobilise the language of care for parents’ wellbeing whilst effectively problematising the very existence of trans and gender-­ diverse people. I return to these points in Chap. 2, when I revisit narratives of loss but also discuss how parents and carers actively challenge such narratives and come to understand their child’s gender as well as, at times, their own role in upholding cisnormative gender regimes.

Parents as Advocates Parental advocacy is not an exclusive domain of parents of trans and gender-­diverse children. Parents often take the role of advocates for their children, helping them navigate the social world. Certainly, in the face of systemic shortcomings, lack of resources and support, and/or societal prejudice, parents of some children are forced to do more of that labour than others. To think about advocacy work of parents and carers of trans and gender-diverse children alongside parental advocacy on other issues highlights the social justice element of this labour further. There is a long history of parents advocating for their children, in particular in the area of disabilities and autism (Ryan, 2017; Silverman, 2017; Walmsley et al., 2017). Being trans is not a disability, or a mental health issue, yet, there is an important similarity between parental advocacy in the field of disabilities and advocating for a trans and gender-diverse child, which comes down to the sheer volume of interactions with professionals (healthcare, educational, etc.). It is due to these many interactions—and frequently also their difficulty—with professionals, that for parents of children with disabilities, ‘the advocacy role develops to a level of frequency and complexity, which other parents do not usually face’ (Ryan & Runswick-Cole, 2009, p. 43). The same can be argued about parents of

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trans and gender-diverse children, as this book demonstrates. As much as is the case for care labour, in general, there is a gendered dimension to parental advocacy for children with disabilities (Runswick-Cole & Ryan, 2019), which is also reflected in advocacy work of parents of trans and gender-diverse children; it is still more likely than not that in heterosexual couples it is the mother who takes on the burden of advocacy; for example, a special recruitment drive was issued to involve more fathers in the research project on which this book is based. Parental advocacy can be seen as an extension of the intricate destigmatizing identity work that parents of LGBT children perform to reclaim their identities, and that of their children in the face of societal prejudice (Fields, 2001). The work done by, and in, support groups for parents of LGBT people interweaves with advocacy work against prejudice and discrimination faced by LGBT people (Broad, 2011), where advocacy comes to be viewed as an integral part of being an accepting and loving parent. However, the tendency to compound LGB with T can at times obscure how experiences of parents of trans and gender diverse children may differ from that of parents of gay, lesbian, or bisexual children when it comes to advocacy work in heavily gendered social spaces or in accessing gender-­ affirming healthcare interventions. In the context of the United Kingdom, the most prominent example of organized parental advocacy work is the charity Mermaids, an organization supporting trans, non-binary and gender-diverse children and their families. In the About section of Mermaids website, we can read that Mermaids has been supporting transgender, nonbinary and gender-diverse children, young people, and their families since 1995. Back at the start, we were a small group of concerned parents sitting around the kitchen table, coming together to share experiences, find answers and look for ways to keep our children safe and happy … Whatever the outcome, Mermaids is committed to helping families navigate the challenges they may face. (Mermaids UK, 2021)

As I discuss in Chap. 3, Mermaids is a crucial point of reference and a source of information and ongoing support for affirming parents. Finally, not unlike parental advocacy in other areas (Carey et al., 2019; McGuire, 2016), advocacy work by parents of trans and gender-diverse children is not without its dead angles, and it can produce tensions and contradictions. As Meadow observes, the work of family advocacy

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organizations in the United States and the parent movement there, is ‘fundamentally a movement by cisgender people for transgender people’ (Meadow, 2019, p. 21), and it is only by attending to that characteristic that we can also think about the specific investments and contradictions that parental advocacy and activism might embody. Parents of trans and gender-diverse children may for example be heavily invested in their child’s ability to pass and/or to ‘assimilate’ into the binary gender categories (Meadow, 2019, p. 119). As I explore, for some parents negotiating the tricky terrain of personal anxieties and societal prejudice can results in a set of attachments to their child’s ability to blend in and live a ‘normal’ life. This is of course problematic, as it positions lives of trans people who cannot, or do not want to, blend in as somewhat less ‘normal’ or desirable. Nevertheless, because of the prevailing discrimination against trans and gender-diverse people, parents and carers of young trans and gender-­ diverse people face additional challenges when supporting their child in most areas of life. Parents and carers advocate for their children across a range of settings, including in healthcare, within the family and community, in education, and online (in particular on social media) (Birnkrant & Przeworski, 2017; Carlile, 2020; Tyler et al., 2020). As advocates for their children, parents and carers encounter challenges within many and at times all of these settings, as I discuss in Chaps. 4, 5, and 6. However, and importantly, for many trans adults, care, aid, support, and practices of advocacy are distributed along different lines than the biological or legal ties associated with traditional nuclear families. The role of extended family, foster families, and chosen family have been key in supporting and sustaining trans lives, also in a context of rejection and/or lack of affirmation from the bio-legal family (Jackson Levin et al., 2020). Nonetheless, it is also important to acknowledge that access to such support networks can at times be limited for trans and gender-diverse children and young people due to their relationship of dependency to adults. It is in this context that parents and carers’ advocacy becomes especially important and the lack thereof particularly harmful.

Healthcare Accessing health services—both general and specialist—has been identified as an area of struggle for parents of trans and gender-diverse children (Pullen Sansfaçon et al., 2015). The budding research in the area shows that trans and gender-diverse young people in the United Kingdom

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struggle to access gender-affirming care (Carlile et al., 2021). Further, and reflecting the legal landscape sketched above, the conceptual shift away from pathologising understanding of gender diversity is yet to take place in trans healthcare for both adults and children in the United Kingdom (Horton, 2021; Pearce, 2018). As Horton puts it: In… the UK, children’s gender services have not undergone substantial restructuring or reconfiguration since they were originally established to examine and treat ‘Gender Identity Disorder’. Services remain housed within mental health trusts, and continue to be run by psychoanalytical psychologists, with an ongoing domination of a psychoanalytical approach to working with parents of trans children. (Horton, 2021, p. 2)

Relatedly, Horton’s work on the experiences of parents of the of pre-­ pubertal trans children within UK Gender Services found that parents experienced the GIDS assessment as ‘(1) Judgmental, pathologising and outdated; (2) Intrusive and Irrelevant (3) Insensitive and Inappropriate’ (Horton, 2021, p. 5). Whilst critical research on trans healthcare for children and young people is in its infancy, a large body of research now evidences the many barriers, discrimination, and stigma that trans adults experience in healthcare settings which negatively affects their access to and their engagement with healthcare on all levels, and the existing evidence base for this is unquestionable (Johnson et al., 2020; Kattari et al., 2020; Mikulak, 2021; Pearce, 2018; Poteat et al., 2013; Roller et al., 2015; Vermeir et al., 2018). Given the power imbalance and the gate keeping of services that still characterizes trans healthcare in the United Kingdom, healthcare is an area where adult trans people are faced with disproportionate burdens and exclusions (Davy, 2010; Pearce, 2018; Vincent, 2018). Gate keeping of access to gender-affirming care also takes place outside of specialist gender identity services multiplying obstacles for trans and gender-diverse people (The Women and Equalities Committee, 2016; Whitehead et  al., 2012). For example, the UK Women and Equalities Committee reported that: ‘Trans people encounter significant problems in using general NHS services, due to the attitude of some clinicians and other staff who lack knowledge and understanding—and in some cases are prejudiced’ (2016, p.  3). These findings are echoed time and again in literature that links barriers that trans people face in accessing and utilizing healthcare services to transphobia as well as health professionals’ lack of knowledge regarding trans health

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and identities (Benson, 2013; Davy, 2010; Ellis et al., 2015; McNeil et al., 2012). Consequently, trans and gender-diverse people often avoid seeking healthcare because of their previous negative experiences with health professionals (Lindroth et al., 2017). Poteat et al. (2013, p. 26) note that in the context of healthcare, trans people anticipated that health professionals ‘would not only be unprepared to meet their medical needs, but may also be unprepared for their very existence’. This unpreparedness, I argue, is amplified in health professionals’ encounters with trans and gender-­ diverse children and their parents, a point on which I expand in Chap. 4. Because parents and carers find healthcare professionals to lack knowledge about trans people and gender-affirming care—and thus often find them unprepared to meet the needs of their young person—they also take on the role of educators in healthcare settings. In that sense, they carry the educational burden that is often placed on adult trans people when they access healthcare (Bauer et al., 2009; Benson, 2013; Mikulak, 2021) on behalf of their young person. Simultaneously, within healthcare, the limited research on the UK context shows that healthcare services could benefit from engaging more meaningfully with the insider knowledge and extensive research conducted by parents (Carlile, 2020). This suggests a paradox that I return to in the following chapters: whilst health (and other) professionals often rely on parents for information, they are also likely to disregard parents’ expertise.

School As I discuss in Chap. 5, schools are important spaces of parental advocacy for parents of trans and gender-diverse children. Because schools are spaces that are often intensely gendered and premised upon binary and cisgenderist readings of gender, ‘gender norms, conscribed under heteropatriarchy have established violent and unstable social and educational climates for trans* and gender creative youth’ (Miller, 2016, p. 26). Schools are also often ill prepared to support trans and gender-diverse children and lack inclusive policies and practices (Bradlow et al., 2017; Horton, 2020; Jones et al., 2016; Pullen Sansfaçon et al., 2015; Riggs & Bartholomaeus, 2018). Research from around the world clearly shows that schools are far from safe, neither are they welcoming to trans and gender-diverse pupils, who continue to experience high levels of bullying, harassment, and other forms of violence (Horton, 2020; Jones et al., 2016; UNESCO, 2016). In the United Kingdom, recent work by Horton (2020) shows that

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affirmative language and trans visibility and representation are becoming more common in schools’ policies and guidance documents. However, Horton (2020) also identifies a need for both more comprehensive understandings of safety that addresses cisnormativity and its burdens on the young person as well as pressures and disincentives to trans-inclusive practice (including teachers’ attitudes and support available to them) (Horton, 2020, p. 13). In effect: Trans pupils shoulder a triple burden of persistent often unintentional delegitimisation; having to, often single-handedly, educate about gender diversity and cisnormativity; and having to self-advocate for their right to a trans-inclusive school … This burden is even harder to bear for the many trans pupils facing additional stresses, including those who have unsupportive or abusive families, those facing harassment and hate inside and outside of school, and those with wider intersecting axes of marginalisation including disabled trans children, neurodiverse trans children and trans children of colour. (Horton, 2020, p. 13)

In addition, for supportive parents and carers, the lack of gender-­ inclusive school policies places additional burden on parents and carers who effectively need to ‘educate their child’s educators in order to ensure their child’s inclusion’ (Riggs & Bartholomaeus, 2018, p. 71). However, and importantly, schools can also be allies to trans and gender-diverse children and their families (Meyer & Leonardi, 2018; Sinclair-Palm & Gilbert, 2018). They have an especially important role to play in the lives of trans and gender-diverse children who are not accepted by their families (Horton, 2020). They can also offer support to parents and carers, which can be particularly helpful in the face of co-parenting challenges, when a parent or carer might disagree with their partner or ex-partner on how best to support their child. I return to these issues in Chaps. 5 and 6. Before I move on with this analytical work and in the last section of this introductory chapter, I want to briefly discuss the methodology behind the research on which this book is based.

Methods This book is based on qualitative semi-structured in-depth interviews that I conducted as part of a larger research project on trans health, ‘Identifying the health and care needs of young trans and gender diverse people’,

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located at the Nuffield Department of Primary Care Health Sciences, University of Oxford and led by Dr. Melissa Stepney. The study was funded by the National Institute for Health Research (NIHR) HS&DR programme (project reference 17/51/07). The study’s aim was to understand how health and social care services can better address the needs of young trans and gender-diverse people and their families. Overall, the project comprised over 90 in-depth interviews with young people, adults, parents and carers, and health professionals. My role was to interview parents and carers of young trans and gender-diverse people as well as— alongside Dr. Sam Martin—to interview health professionals (n20) (Mikulak et al., 2021). Whilst not included in this book directly, the interviews with health professionals informed this book by adding an additional dimension to the understanding of the dire state of trans healthcare in the United Kingdom and the power imbalance at its heart (Mikulak, 2021). Dr. Martin was also responsible for conducting interviews with young trans and gender-diverse people and trans and gender-diverse adults. Alongside academic outputs, the project outputs included two sections of the website www.healthtalk.org—one on trans and gender diverse young people’s experiences, and the other on parents’ and carers’ experiences (HealthTalk, 2022a, 2022b).

Recruitment, Participants, and the Interviews Parents and carers were selected purposively to cover different age groups of young people and a wide range of experiences. Participants were recruited through a variety of channels including personal and professional networks of the wider research team, online (via social media and via posting on a charity website) through the Advisory Panel for the wider research project, local and national support groups for parents of LGBTQ people, and snowballing. In total, I interviewed 22 parents and carers of young trans and gender-­ diverse people in 20 interviews (two interviews were conducted with couples). Two participants withdrew from the study. One participant requested a case-by-case approval for any extended quotations (beyond two sentences) used in academic publications, or any instances where multiple quotes would be attributed to one participant. Only one quote from them, a total of two sentences, has been included in this book. Thus, this book is based on the data collected in the 18 interviews, with 20 participants. In that number, five men and 15 women were interviewed. All were

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cisgender. 17 participants were biological parents of a young trans or non-­ binary person, one participant was a stepparent, one was an adoptive parent and one was a foster carer. The interviewees were parents and carers of young trans and gender-diverse people aged from 9 to 25 years old. The age breakdown for the young people (YP) whose parents and carers I interviewed and whose interview data forms the basis of this book was as follows: • 9–10 years old—2 YP • 11–13 years old—4 YP • 14–16 years old—6 YP • 17–19 years old—4 YP • 20–25 years old—3 YP From the 19 YP whose parents and carers were interviewed, 10 were trans feminine, eight were trans masculine, and one identified as non-binary. The interviews were conducted face-to-face in people’s homes (11), or other locations deemed suitable and convenient by the participants and myself (five), over the phone (one), and via Skype (one), at a time that suited the participants. The topic guide for the interviews (see Appendix 1) was developed with assistance from the wider research team and covered a range of issues focusing on, but not limited to, healthcare. The aim was to holistically map out and explore experiences of parents and carers and how these are shaped by (a) structural conditions (such as for example the existing healthcare pathway for young trans and gender diverse people) and (b) parents and carers agency, and creativity, in supporting their young person and themselves through times of uncertainty and in the face of many additional demands and challenges resulting from these structural conditions. Prior to the interview, all participants were given the Participant Information Sheet with information about the project; informed consent was sought from all participants before the interview. The interviews were conducted between June 2019 and January 2020. Interviews lasted between 45 and 140 minutes and were digital audio and/or video recorded for transcription and analysis. Participants were given choice about how they would like their interview to be recorded (video or audio) and about how their interviews were to be used on the website (as video clips, audio clips, or written extracts only). Audio recordings of the interviews were transcribed verbatim by a professional transcriber. Transcripts were then

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checked by me and validated by the participants, allowing for corrections and/or clarifications, as well as edits. Final transcripts were then analysed thematically with the help of analysis software (NVivo 12). The thematic analysis informed production of the HealthTalk module (HealthTalk, 2022a). This was followed by a more conceptual analysis and a more critically discursive exploration (Bacchi, 2005)—focusing on key areas of advocacy (healthcare, education, family/community) and corresponding barriers/ challenges, as well the power relations at play in these spaces—which became the basis for this book. Funding and Ethics Notes This book summarises independent research funded by the National Institute for Health Research (NIHR) under its Health Services and Delivery Research Programme (Grant Reference Number 17/51/07). The views expressed are those of the author, and not necessarily those of the NHS, the NIHR or the Department of Health. The qualitative methods have been approved by NRES Committee South Central—Berkshire (REC reference number 12/SC/0495).

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works. Journal of LGBT Youth, 1–22. https://doi.org/10.1080/1936165 3.2020.1714527 UNESCO. (2016). Out in the open: Education sector responses to violence based on sexual orientation and gender identity/expression. Retrieved from Paris, France. Vermeir, E., Jackson, L.  A., & Marshall, E.  G. (2018). Barriers to primary and emergency healthcare for trans adults. Culture, Health & Sexuality, 20(2), 232–246. https://doi.org/10.1080/13691058.2017.1338757 Vincent, B. (2018). Transgender health: A practitioner’s guide to binary and non-­ binary trans patient care. Jessica Kingsley Publishers. Wahlig, J. L. (2015). Losing the child they thought they had: Therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child. Journal of GLBT Family Studies, 11(4), 305–326. https://doi.org/10.108 0/1550428X.2014.945676 Walmsley, J., Tilley, L., Dumbleton, S., & Bardsley, J. (2017). The changing face of parent advocacy: A long view. Disability & Society, 32(9), 1366–1386. https://doi.org/10.1080/09687599.2017.1322496 Westwater, J. J., Riley, E. A., & Peterson, G. M. (2019). What about the family in youth gender diversity? A literature review. International Journal of Transgender Health, 20(4), 351–370. https://doi.org/10.1080/15532739.2019.1652130 Whitehead, J.  C., Thomas, J., Forkner, B., & LaMonica, D. (2012). Reluctant gatekeepers: ‘Trans-positive’ practitioners and the social construction of sex and gender. Journal of Gender Studies, 21(4), 387–400. https://doi.org/1 0.1080/09589236.2012.681181 Wilson, C., & Cariola, L. A. (2020). LGBTQI+ youth and mental health: A systematic review of qualitative research. Adolescent Research Review, 5(2), 187–211. https://doi.org/10.1007/s40894-­019-­00118-­w

PART I

Gender Challenge(d)

This part of the book holds together and analyses stories of sense making, responses to coming out, and educating oneself that parents and carers shared with me in their interviews. It has two aims. First, it sets the scene for Part II, where concrete examples of advocacy are discussed across a range of important contexts in young people’s and families’ lives. Second, it analyses the practices of parental support and advocacy as complex negotiations that challenge, push, and expand parents’ and carers’ understandings of their children, themselves, and the social world. While this part of the book often moves into theoretical discussions of meanings and implications of parenting trans and gender-diverse children, it is based on, and indebted to, stories of real people. Theorising about— sometimes with, and on occasions in opposition to—people’s stories and interpretations of their experiences is a task that I tried to approach with utmost care. In the case of this book, this task is largely aided by the fact that I see most parents and carers whom I interviewed as committed to supporting and affirming their children and dedicated to making the world better and safer for trans and gender-diverse children and adults. I therefore trust that my sometimes-critical reading of their narratives will be received as contributing to that greater task. Importantly, the emotional and intellectual labour that goes into figuring out how best to support a trans or non-binary young person as a parent or carer needs to be both acknowledged and examined, but we also need to examine the conditions and conditioning that make it necessary.

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The ongoing nature of that labour also means that what is used here as data is necessarily a time and space-bound snapshot of people’s lives and minds as they shared these with me on the days of their interviews and in the conversations that followed. Yet, we know that people’s understandings of issues, of others, and of themselves can and do change. With that in mind, I once again recommend reading the remaining chapters of this book as being about issues and not about individuals, whose voices I draw upon to highlight and discuss these issues.

CHAPTER 2

Leaving the Comforts of Cis-certitude: Parents Making Sense of their Child’s Gender

Cisnormativity—the assumption that people (and by extension children) are cisgender as the ‘norm’ and the related privileging of cisgender experiences—continues to dominate the social world and its understandings and organisation. The experience of parenting or fostering a trans or a non-­ binary child pushes against these understandings and often results in the reorganisation of ideas and relationships. It requires that parents and carers think, sometimes for the first time, about the importance of gender and the taken-for-granted prevalence of cisnormativity that obscures and at times also denies the very existence of trans children (Gill-Peterson, 2018). In this chapter, I examine how, in order to make sense of their child’s gender, parents are often pushed to challenge their understanding of what gender is to an individual and what it does in the social world. This process often starts with the young person ‘coming out’. I explore how parents’ responses to their child coming out are negotiated through a set of assumptions about gender, children in general, and their own role as parents and carers. I also examine the labour of co-production of the gendered self, in which parents engage as they facilitate and co-manage their child’s coming out to others and help to connect (and narrate) the dots of their child’s gendered stories across times and places. In this chapter, I also revisit and challenge the narrative of loss, as the default response to learning that one’s child is trans. I present a number of alternatives, which in turn reflect parents’ creative understandings and revaluations of gender and the weight given to it. As I show in this © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2_2

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chapter, these understandings matter not only because they throw into relief the organising function that gender plays in the lives of families and young people but also because they influence the support that is offered to the young person. Finally, in this chapter, I also highlight one aspect of parenting trans and gender-diverse children that has not been given much attention this far. Namely, how parents of trans and gender-diverse children learn and grow in the process of supporting their young person. The stories of support are therefore also stories of enrichment, of personal and interpersonal growth, expanded horizons, and greater sensitivity towards, and acceptance of, difference.

The Coming Out Or the Many Ways of Leaving the Comforts of Cis-certitude So she was just turned 18 when she came out. She came out to me actually by text. So … she’d been out for a night out, messaged me to say, would I open the gate for her and I said, ‘I will do but I’ll be in bed when you get home’. And she said, ‘No, please wait up, I need to talk’. So I knew whatever it was that had been going on for all this time that I was gonna find out what it was. And to be fair, I thought she was gonna tell me that she was gay … and then just shortly after getting that message … I got a very long text. And it was one that she’d apparently written probably about two years before, had sat on a phone for all that time and she’d never dared press the send button. So she pressed the send button and read it and I, I was very shocked, to be fair, because I didn’t really understand what trans was about. But I messaged her back and I just said, drive carefully, cause it was late and it was winter and it was quite, quite icy. And I said, I’ll have the kettle on when you get home. (Sue)

For trans or gender-diverse people, ‘coming out’ usually describes the act of disclosing a person’s trans status or gender identity to another person.1 Coming out is motivated by the need to communicate a self that is authentic (Brumbaugh-Johnson & Hull, 2019), but it is also negotiated against constraints of social, political, and economic contexts (Levitt & Ippolito, 2014). There is no one way of coming out. There is also no obligation to do so. Still, for children and young people coming out to 1  Some studies also identify a distinction between coming out, as a pre-transition declaration and post-transition disclosure of transgender history (Zimman, 2009).

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their parents or carers is often important and necessary to access support and resources needed for being able to live in the gender they are and away from the expectations and presentation of their gender assigned at birth. As discussed in Chap. 1, the response with which the young person is met, and the subsequent support or lack thereof, are profoundly important for their mental health and wellbeing. For this book, I spoke to parents and carers who shared a diverse range of coming-out stories by their children. Part of this diversity can be explained by the different ages of the young people whose parents and carers I interviewed; coming out to parents as a young adult, who lives away from home, is likely to be very different to having conversations about gender as a young child. While some parents I interviewed described their teenage child coming out to them in a text message they might have waited to send for years—like in the moving example in the opening quote from Sue—for parents of younger children, the process often included conversations about things such as names, appearance, and the body (see also Rickett et al., 2021). In this sense, parents and carers of younger trans and gender-diverse children might also be more closely involved in helping the young person make sense of their experiences, as well as working to make sense of it for themselves. For example, Claire shared: I found some pictures of naked males on [my child’s] device. And she started getting very upset and I said, ‘You don’t need to be upset. I’m sure you weren’t looking for this. What were you looking for?’ And she explained she was looking for boys’ bodies and girls’ bodies, because she felt that there was something wrong with her body. And that opened the discussion then about what is it that you’re not feeling right about? And it just all flooded out. And she said, ‘Please don’t make me live like this mum. I can’t live like it anymore. I’ve tried really hard to change my inside to match my outside. But I can’t do it. Please don’t make me do it’. I said, ‘Fine. We will change your outside to match your inside. That is no problem’. (Claire)

Regardless of their age, young people’s stories of coming out can be messy and fragmented and they often echo society’s—and by extent parents and carers’—inability to see gender as something that can be questioned; they can also reflect the failure to hear these stories, and to take them seriously, when they are told by children and young people. [I]t wasn’t a specific time when they came out. They just started having issues, I guess really the, the turning point really was the bullying at school,

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which was because of the isolation at school … And certainly the coming out thing wasn’t a big announcement, ‘I’m coming out’, it was a gradual thing which kind of started really with the CAMHS [Child and Adolescent Mental Health Service] appointments… CAMHS couldn’t put a finger on it, initially. We, certainly the first interview I went to, the therapist there one week said, my child was PTSD [post-traumatic stress disorder]. The next time we went they were bipolar. The next time they went they were autistic. They were … pigeonholed, but they couldn’t find the right hole. And it wasn’t until my child was saying about gender issues that gender even came up. That was probably the first time I ever was aware of anything gender related at all. They brought it up at a CAMHS appointment. And eventually, CAMHS referred us onto the Tavistock. And at that point, it was like the flood gates opened. Suddenly, my child knew where they were and could relate to the therapists and suddenly said, ‘Finally, somebody’s taken me seriously. Somebody seems to understand’… And everything then started to fall into place. (Keith)

The inability to take children’s gendered claims and self-identification stories seriously can mean that parents can ignore important signals from their young person, which in turn can lead to delay in affirming their child and retrospective feelings of guilt for not being able to respond affirmingly sooner: R: He wanted us to call him a boy’s name and he asked if we could get it to be changed at the register at school and things like that. Now, that bit was new for us, because he had mentioned a few things before, it’s always been the same name. But it, it kind of got forgotten about in, in a kid way. You know, we didn’t think much of it. We thought he was mucking around and playing… the fact that he was wanted it outside of the home was the, the new thing. So I consider that to be his coming out day. Because that was when he, wanted to present to the world as somebody was who he was. And something that I noticed straight away about that was when I very much felt like I’d put my little girl to bed and I came downstairs and I said, I feel like I’ve just put her to bed and he’s gonna wake up in the morning. And it was really strange, really really really strange feeling … But yeah, he, he responded to that name straight away whenever we said it. Whereas his old name it used to take us quite a while to get his attention [laughs]. We realise it was, it was never his name was it, you know? So that was kind of like a bit of a heartbreaking realisation. I: Why was it heartbreaking for you?

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R: Because I felt guilty that I hadn’t listened to him properly before, because he’d been telling us for years really, but in in a way that only a little kid can. And we don’t give enough credit to little kids for knowing their own minds. (Nathalie; emphasis added) While Nathalie blames herself for not listening ‘properly’ when her son was making claims to his gender, it is necessary to see how her response is mediated through the social context that until recently almost entirely ignored, and at times erased, trans children from the public imagination. Cisnorms and expectations permeate our social worlds in ubiquitous ways and it’s their taken for granted-ness that frequently obscures their operations, as captured in Eve’s statement below: I know trans or non-binary or gender fluid or you know, queer people, I have a lot of people, a lot of friends who are gay. But gender and sexuality has never been anything that’s been questioned in this house. We’re very accepting obviously being a fostering family. We have lots [of different issues] come up that we have to get our heads around [laughs]. (Eve; emphasis added)

It is because of this unquestioned/unquestionable status of gender that to parents a child coming out as trans can—but does not have to, as I discuss below—feel like a shock or profound surprise. A quote from Tom captures that shock and feelings of surprise he felt when his daughter came out as trans: Yeah. I had to process this, this, this information [3 sec pause] I felt, I felt completely, completely unable to really grasp what was going on at the time, at the time, yeah. So I, yeah, I didn’t freak [out. I remained] quite calm. But I was a bit, yeah, I think I was quite, you know, taken aback, really. Yeah, I didn’t, I didn’t sleep much that night. Yeah, that sort of thing, yeah … Initially, when, when, when your child first tells you that they think they’re in the wrong gender, living in the wrong gender. [tch] [3 sec pause] It’s something that you don’t ever think is going to happen. So it’s a, it comes as a bit of a shock, bit of a surprise. And then you have to deal with everything that comes thereafter. You have to see your child change the way they live. Dress differently, hair, make-up, clothes and it, it just takes a bit of getting used to, really, as a parent. (Tom; emphasis added)

The phrasing ‘something that you don’t ever think is going to happen’ is quite telling here; it signals a sense of being both unprepared and

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unaware. Other parents used phrases such as ‘out of the blue’ or ‘bolt from the blue’ when talking about learning that their child was trans. Never having considered it a possibility means that the young person’s coming out evokes feelings of shock. Rooted in the assumption that the gender of their child aligns with the one stated on their birth certificate, finding out that it does not can throw parents off, forcing them out of the comforts of cis-certitude (Riggs & Bartholomaeus, 2018) and into the ‘unknown’ and where they need to both adjust how they understand their child but also ‘to deal with everything that comes thereafter’. Feelings of shock and surprise are not the only way parents and carers can feel upon learning that their young person is trans or non-binary. They are nevertheless important because they demonstrate how the invisibility of trans children and lack of awareness around gender diversity permeate our lives and understandings of how children experience their gender. To move away, or to be pulled away in shock from that taken-for-granted comfort of cisnormative trajectory of gender expectations and destinies (real and imagined) makes a difference. In the stories shared with me for this book, there appears to be a qualitative difference in how parents and carers who had considered the possibility of their child being trans felt at the time when their child came out to them; the experience was much less acute and less unsettling. Kim spoke about how she anticipated her son’s coming out as trans: R: I just felt actually it’s been here years … So there was a real sense of like relief, but at the same time, ‘oh, oh, shit life’s gonna get really difficult now’. But that’s what I remember. I: Why did you anticipate difficulties? R: [huh] Because I, you see the representations on, in the media. You hear about trans adults who were rejected as, as kids, as teens. And you just read their, their experiences and you think … This isn’t gonna be easy. (Kim) In Kim’s account, it is not the coming out that is the news, rather, it is the realisation that things are going to get more complicated for her son and her family, given the hostile environment in which many trans people live their lives. The coming out itself, however, brought a sense of relief. While a sense of relief was echoed in several stories from parents and carers, it could come from both anticipating the coming out and the knowledge that their child trusted them enough to open up and come out to them. For example, Beth shared:

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I: At the time when your daughter came out to you … can you remember how you felt? R: I [sighs] [3 sec pause] I was just relieved that she felt she could trust me. I was concerned, because I couldn’t really know where we would go and what, what kind of journey we would have. But it was good to know that what their concern was that at last we could address it rather than it always being an elephant in the room and I didn’t even know there was an elephant there. (Beth) What the above examples also signal is that stories of parents and carers’ reactions to their young person coming out matter. They influence the immediate response with which the young person is met when they do come out. This point is perhaps best illustrated by Harriet’s account and her description of how her and her husband were not only expecting their son to come out as trans but also tried to actively, but respectfully, encourage him to do so: before he told us, he hadn’t worn girl’s clothes for a good couple of years. But as he was starting to develop, which he did quite young, unfortunately. He was just more uncomfortable. So, we got into, you know, how he could kind of hide some of that as well. So, I think just the way he presented was really yeah it was really clear that it was gonna come. My husband and I remember probably about a year before he told us. I remember we were out for lunch and we were saying, you know, we just knew, at that point that it was coming. We just didn’t know when it was coming. I guess when we were closer to that being, you know, thinking that was gonna happen and we were kind of trying to encourage him to know that it would be okay to tell us. But, at the same time not trying to push him to tell us. (Harriet; emphasis added)

In this context the coming out is not only anticipated but also a welcome disclosure, which in turn makes it less of a disruptive and unsettling event. Relatedly, knowing how important it is for the young person coming out to be met with a supportive and positive reaction makes a difference for how parents and carers can prepare for and process the situation. Kim shared: the most important thing for trans kids is to be supported and affirmed. So we already knew that cause we, there was always a point where, for a while, his early childhood his primary school years that, at any point, I was, I was anticipating him coming back and saying, ‘I don’t wanna be known as his

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birth name anymore. I wanna become this’. I was always anticipating it. It just never, never materialised until he, he hit puberty. (Kim; emphasis added)

Consequently, being aware of the possibility that their child might be trans gave parents a head start: ‘I’ve seen documentaries about trans children … like Louis Theroux and things like that. And I, I was aware … I’ve said to colleagues in the past that I thought [my child] might be trans, but I’d cross that bridge when it came to it’ (Tara). Considering the possibility also gave parents and carers time to prepare and find information and sources of support that would often prove vital in their role as advocates for their young person. Harriet shared that she looked for supportive resources long before her son came out to her: I would just look online. But it would usually be at work just so that there was nothing that he could see or you know, looking at something and he comes in the room or whatever. And so I would, I would look for things about [tch] being gay and also about being trans. So, things like, Mermaids, I’d looked at things like Stonewall, Young Stonewall, not sure that’s what it’s actually called, but that section. And just trying to find information for parents just so that more so I knew what was coming, I suppose and what was out there. (Harriet)

Importantly, my aim is not to invalidate the feelings of parents who do feel surprised and/or shocked upon learning that their child is trans, rather, I want to highlight how such feelings of surprise are linked to the invisibility of trans children and childhoods, whereby the thought that their child is trans might never occur to a parent or carer. It is in moments like these that our collective and individual cisnormative attachments are not only made explicit but also magnified. I return to this point later in this chapter when I examine the narrative of ‘loss’ that sometimes accompanies parents’ stories. How parents respond to a young person’s coming out and how they go about making sense of this information reflects their own understandings of the social world and gender. Trans negative and transphobic readings that position trans lives and futures as less desirable—without investigating how the society’s ongoing discrimination against trans and gender-­ diverse people make their lives more precarious and burdened with inequality—are likely to produce unsupportive and unhelpful responses. Nowhere is it more visible than in the coming-out story shared by the only openly non-affirming parent I interviewed:

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She [sic.] came to us and said, ‘Look, I’d, I’d like to pick a boy’s name and be a boy’. [clears throat] My wife and I were sceptical at first, because we appreciated at 12, 13 it’s a difficult time. I was appreciating she was having a hard time. We were giving all the support we can, but you’ve also got an underlying autism going on there … not diagnosed at that point. So, she tells us this and trying to piece together the bits of the journey. I know there was a GP visit … I flagged up the autism issue within the GP visit …‘cos I’d done a little bit of reading when this first came to the fore that the link between gender dysphoria in autism was very pronounced and well documented. So the only thing I thought, hang on, let’s just understand what’s going on. Let’s get the big picture. (Stephen)

In a different part of his interview Stephen shared: ‘What ‘trans’ implies you then [go] from one place to another. It’s a journey, you never arrive at the destination … the outcomes aren’t good. You’ll end up a life of mental and physical scarring and unhappiness’. His response to his teenage child wanting to be called by a boy’s name is therefore grounded in a very particular and pathologising reading of gender diversity and trans lives; he understands his child’s gender discontent as a symptom of something else, in his case that something else was his child’s autism and the social exclusion they were experiencing at school. This is deeply pathologising and also at odds with the current knowledge that dismisses the causal link between autism and gender diversity (Turban & van Schalkwyk, 2018).

Co-producing the Story of the Gendered Self Parents and carers who affirm their young person become co-producers of their child’s story of the gendered self. They fill in the gaps in their young person’s memories and act as repositories of gendered stories of their child’s early childhood years, as they help to re-construct and weave together a history of their child’s gender discontent and its interpersonal manifestations through the years. One parent said about their child that they have had ‘trouble with their gender identity’ since they were four years old. They said: ‘They’ve kind of said, on and off that they don’t identify with the gender that they were assigned at birth … They’ve said this to me. They’ve said this to their dad and they’ve said this to teachers at school, across the years, right going back to when they were four’. Whether the young person themselves would remember all these occasions ‘across the years’ is perhaps unlikely; in that sense, their parent’s

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memories of these moments of gender disidentification make it possible to capture them and use them as building blocks of the story of the gendered self. Parental stories also add weight to gender claims. Stories of early childhood gender non-conformity or dissidence have a particular role to play in further legitimating the claims to the gendered self. Claire shared about her son: ‘he knows that he’s transgender and he’s always known all his life. He just hasn’t been able to put a label on it or express it to people, you know, as a five or six or seven-year-old’. The having always known and being able to narrate this knowledge as a coherent trajectory leaves no room for doubt and thus for questioning, to which trans people are so frequently and unjustly subjected: He never seemed to be quite as relaxed in his own skin as my other children had been. As he, as soon as he was able to identify the difference between a dress and a pair of trousers, he made it very plain, he wasn’t going to be wearing dresses or skirts. He was very much leant towards male gender associated games, sports, activities. His friends were boys. He behaved effectively as I would have expected a son to behave—in relation to sort of traditional norms and expectations—than a daughter … I remember a conversation that I had with him when he was only about five and … we were walking out of school with my daughter who is two years older than him. He was still living as a female at that time. And he said, ‘Mum, I’ve decided, I’m not going to marry a boy or a man. I’m going to marry a lady or a girl’. And my older daughter said, ‘Well, you’ll just have to be gay then’. And he said, ‘Well that’s fine. I will just be gay then’. And we then entered into a discussion about, ‘You really don’t need to decide that now. You just be what you, who you are and you love who you love and as long as they love you back and everything and you happy. That’s fine. It doesn’t matter if it’s a boy or a girl or man or a lady’. We got back in the car and I didn’t really think anything of it. (Claire)

The early preferences for clothes, company and activities, formulations of romantic plans, the discomfort in the gender assigned at birth that Claire talks about are all building blocks in her son’s story of the gendered self that contribute to its stability and logicality. Such logicality also lends strength to their own position as affirming parents: Yeah, so one of my children, first of all said to me, I think the first memory I have is, ‘Dad I’m not gay, but I’m a transvestite’. And they were very young. And my first response was, how do they know the word, ‘transvestite’? And I think it was from something they’d seen on television and they

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were born male, but quite clearly wanted to wear girl’s clothes at a very young age and a very vivid imagination and would draw and design dresses and were very creative, and would create designs for other worlds and princesses and strong female characters, and then want to play those characters and want to play strong, female characters from history in an imagination type game. And although was into other things which people might associate as more male like Star Wars and other things like that and some sports. Really looked happiest when she was dressed as a girl and really sort of came alive and was much more expressive dancing. (Robert)

These stories of gendered identification and awareness add layers of collective agreement and awareness that tell and retell the young person’s childhood story in a particular way. Importantly, not all parents and carers stressed the early childhood gender discontent or preferences, and not having these certainly does not make a person ‘less’ trans. It is nevertheless important to think how parents and carers’ stories of their child’s gender development and expression from an early age can provide a sense of continuity and coherence to their child’s story of the gendered self, a resource particularly crucial when negotiating access to gender-affirming health care, as I will discuss in Chap. 4. This also points to the question of how children and young people with non-affirming parents might be deprived of this important resource and the support which is contingent upon it. Parents and carers co-produce their children’s stories of the gendered self in another way too. They help their young person to negotiate their social transition and coming out in different spaces and times, and to different people, including to the other parent and, when relevant, to their siblings. In doing so, they actively co-manage these important moments of disclosure, again contributing to how the story of the gendered self unfolds and expands to include new social contexts and relationships. Anne captures these moments of co-production well when she talks about her son’s social transition and the liminal moments that characterised this process: So actually, you know, when we went, it was, the, the strange thing was is that he came out, my son came out to me in the summer, but that was to me and then there was obviously there was a process of coming out to, you know, within ­various different contexts so whether it’s like the rest of the family and at school. So as it was, I actually, we made the decision that he would come out in school at the end of the first term. So this was, the December. And it was just a really bizarre time, because he was, you know, the number of months where it was he had come out to me and then it was kind of like, we need to talk to your dad about it. And then it was also letting the wider family, you

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know, friends know, you know, and also his brother. And then it was the kind of coming out at school, which again, the school was like really really supportive about it and they were, I couldn’t fault them. They’ve been really great. But it was just this weird limbo that he was sort of almost like known as one thing in one space and, and another in another space. (Anne; emphasis added)

In the quote above, Anne mentions her son’s dad and how her and her son planned his coming out to his dad. In the interviews with parents and carers, this was not an unusual trope, where one parent facilitates the coming out to the other parent, or even does the ‘telling’ themselves on behalf of, and as agreed with, the young person. This could be the case for parents who still lived together as well as for those who have split up, as in the case of Nathalie and her ex-partner. The doctor [GP] suggested that it would be an idea for, for my ex to know before the referral went [to GIDS], because he thought it would cause problems, otherwise. And my son, hadn’t at that point told him, but he, he was due to go for a weekend and so I said to him, why don’t you write a letter. Bear in mind we’d had many meltdowns about this, cause I was very aware that when he picked him up from school he was gonna get called the new name by the teachers and the kids. And his dad was gonna hit the roof, basically. Understandably. So I suggested that he write a letter, get him to read it and it was on his, when he came was it before he went yeah, it was before he went. So we got the letter to him and he read it and I got that he received it like ten o’clock at night. So he rang me and gave me an earful and I got the brunt of it. But my theory was that he’d have got it out of his system and started to think about it and research a little bit by the time my son went for his weekend with him. (Nathalie)

Nathalie’s suggestion for her son to write a letter to his father was aimed at managing any negative emotional fallout, and the father’s choice to phone Nathalie first seemed to have mitigated some of the risks involved in the process. Such co-management of coming out is important: these situations reflect not only the family dynamics but can also highlight parents’ own insecurities around the process that get folded into the coming-­ out stories of their child. This is illustrated by Sue’s account: we talked about how to tell her dad, because to be fair, I’ve been married to him, I’ve been with him for such a long time. But I couldn’t actually— because this had come as such a shock—I couldn’t actually genuinely tell

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how he was gonna take it. So … when she finally agreed that I could tell him, so she told me I think on the Friday night and agreed that on the Sunday morning I could tell him … I told him in pretty much the same way as she told me. I showed him the text. And he read it and he said, ‘Oh well that’s a relief. I thought you were gonna tell me she’d got arrested’. Obviously not using female pronouns though, at the time. Yeah and that’s, that’s how we kind of got underway. (Sue)

Sue did not know how her partner would react, and whilst it is unclear how much of that uncertainty influenced the decision that she should be the one to tell him, her partner response was unexpectedly, for Sue, positive. At the same time, parents’ anxieties around their partner’s or ex-­ partner’s reaction can be reactive and unnecessarily delay their child’s coming out. The same can be true for managing the young person’s social transition. I: So in that sense, the whole [social] transition thing happened quite quickly, the whole process. Did you feel that? R: I think it could have gone quicker. It could have gone quicker. And that was me being more insistent on him just slowing down and taking a breath and making sure of certain things before he did it. I know, in my heart of hearts he is who he is and he’s always gonna be who he is, you know. Even though we have conversations, the door is always open. He’s never going to go back. He was never happy. (Eve; emphasis added) Thus, parents and carers can act as facilitators of coming out(s) and social transition, but they can also act as a delaying force, which is there to police through double checking and ‘making sure’ that the young person knows what they know and wants what they want. In most extreme examples, and as illustrated by the example of Stephen in the previous section, they can also straight out refuse to accept their child’s self-declaration and approach their child’s coming out as an issue to be addressed and solved. Such moves undermine the autonomy of the young person and cause harm. Regardless of their views, parents and carers are important co-producers of their young person’s stories of the gendered self, taking an active stance against the young person’s self-identification is likely to have serious consequences for not only the wellbeing of that young person but also for access to gender-affirming healthcare and support.

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As much as all parents participate in the co-production of the stories of their child’s gendered self, affirming parents’ interventions and actions carry a positive value that can act as a resource for the young person. This does not mean that they are never simultaneously marked by the paternalistic approach to children in general; the insistence on delaying and slowing things down reflect our societal inability to trust children’s gendered stories and take them seriously. Yet, affirming parents and carers eventually resolve their doubts in a way that asserts the young person’s right to self-­ knowledge. As I will discuss in the following chapters, in taking the roles of advocates for their young person, they also actively resist the doubting and questioning of that self-knowledge when it is done by others.

Making Sense of ‘Loss’ I suppose it happened because it happened sort of gradually over a few years, I got used to that in a sense. The feeling of loss happens when I look at old photographs of when she was young. I just think, oh my God, what happened, you know? So it’s that feeling of … loss, yes is that there was this gorgeous daughter, you could say. And … now I have a wonderful son. I mean, he’s fantastic. I mean, I love him. But it’s like, there was that person there and now I have this one instead, it’s kind, you know, you know it’s the same of course. But, but it’s different … it’s yeah, it’s difficult to explain that. I, I think, yes, there is a sense of bereavement there over a period of time. But it, it’s when it’s, it’s when you look back at old photos. (Don; emphasis added)

For Don, looking at old pictures of his child brings about a sense of ‘bereavement’ for the person his child was before his transition. There is a contradiction at work in the statement that things are both ‘the same’ but also ‘different’, however, the emphasis is on something, or more precisely, someone no longer being there. This ‘absence’ is what generates feelings of loss. Claire shared: I found it as a mother, I found it, I could cry about it now thinking how tough it was. I felt like I lost my daughter … I couldn’t engage in a grieving process, which is what I think I should have done to manage the process for me in a healthy way. Because I was trying to support everybody else and it was a very busy time. Not only was I trying to support my son in his transition, I was also trying to make sure the other children felt supported … Also, trying to get in place everything that he needed at school. Also, trying to manage the issues that it was creating within my household. And in all of

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that, my little girl had gone and it got lost. But, on the positive side, I had this amazing new son. He, he changed overnight, wasn’t just his physical presentation. His personality changed; it was remarkable. And so I had a new child that I had to get to know, which was really exciting, but, at the same time, it was kind of, in my mind it was tied in with the loss of my daughter. So I probably couldn’t enjoy it as much as I would have wanted to. So I felt that that was probably the most difficult time for me. (Claire; emphasis added)

What is striking in these accounts is how they focus on transition as fundamentally changing the person who transitions; for these parents that is the change is felt as radical and hugely consequential for how they experience their child and their own relationship to them. Conversely, one of the defining features of stories of parents whose experiences challenge the narrative of loss was their emphasis on continuity, as opposed to rupture. Stories of continuity are more likely to insist on the young person being the same, regardless of how they experience, express, and live their gender, as illustrated by Keith’s account, who struggled to understand how other parents could feel bereaved when their child transitioned: It was, it was a bit of an eye opener, because meeting other parents there [in a Mermaids support group] that were having grievance counselling, cause they’d lost a child. I just couldn’t get my head round at all! It’s the worry you have and your child’s still sitting on the sofa next to you. It’s in essence it’s still the same child, a change in gender but you are their parent and you haven’t lost a child. Personally, I couldn’t get my head round it. I couldn’t understand why it was such a big thing … you haven’t lost your child at all. Your child is still there. In essence, it’s still exactly the same child. (Keith; emphasis added)

Keith and other parents who challenge the narrative of loss are likely to think of gender as just one of many attributes that make a person and one that is not central to how they view or relate to their child. Parents, who stressed that their child was the same person, played down the importance of gender by, for example, stressing that the only change for them was the level of happiness (related to coming out and/or social and medical transition) that they could see in their young person. He [Harriet’s son] hasn’t changed, his name has changed. I mean, for us, it wasn’t a big shock … he is the same person and he’s happier now. And that most parents if you ask them what they want for their kids, they want their

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kids to be happy … he’s the same person … [M]y dad had died earlier in the year and I think I was already struggling with grief anyway. I just thought it would be another loss and more grief. But actually because he’s exactly the same person it didn’t, it didn’t impact us that way, in the end […] other parents have said to me, ‘I can’t imagine what it would be like. I can’t imagine how upset I would feel if my daughter wasn’t my daughter anymore’. And I think people, I think people, yeah, put a lot on daughter or son, rather than child. Whereas, my son is pretty much exactly the same as he was other than he’s a bit happier, because everyone loves him and rather than having to pretend to be somebody else. But I think other people they imagine for themselves what it’s gonna be like and they think it’s gonna be awful. It’s not, not necessarily. (Harriet)

To say that a person is happier than they used to be is radically different to say that they are now somebody else who is also happier than the person who was there ‘before’. Because the narrative of loss is a common trope in the stories of parents of trans children, some people I spoke to actively anticipated to feel a sense of loss and—as the quote from Harriet illustrates—at times others expected them to feel it too. However, people’s understandings are dynamic and often change with time. In relation to feelings of loss, this means that parents who experience a sense of loss might be able to move past it, resolving the contradiction between rupture and sameness, in favour of continuity. This is illustrated beautifully by Sophie’s reflection on feelings of loss being replaced by a deepening of her knowledge of her daughter: I did [feel bereaved] … it was really bad and really stupid as well, because you know, some people really are bereaved. Lots of, lots of parents have lost a child. We are really lucky, our child didn’t go anywhere. Yeah, yeah, I did. I did. I, like I say, you shouldn’t beat yourself up about it. I think a lot of people go through that. But then, first of all you realise that you, you haven’t lost your child, it’s just … you know more about them than you did before. You know them better than you did before. And [3 sec pause] yeah, they are not a different person. (Sophie, emphasis in original)

Furthermore, paying attention to parents’ stories of their child’s transition can reveal that in some instances loss that they might experience is not related to feelings of losing their child, but rather can be felt as loss of time in which their child might not have been able to live and express their gender in ways that were authentic to them.

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I love her. Nothing would change that. I did go online and read things about people saying, ‘oh, feels as if I’m bereaved and I’d lost’ I did go online and read things about people saying, ‘oh, feels as if I’m bereaved and I’d lost my child’. And I thought that’s, that’s really silly. But it wasn’t until about a year later that all of a sudden I realised that when I couldn’t have the pictures up of my child when she was little. And because it distresses her that she wouldn’t let me have photographs of her now that I realised that I’d never really known my child. That I’d missed out on a big bit of her life and that she’d missed out on a big bit of her life. And then it really struck home that, you know, somebody’s been living in this tortured state and I haven’t been able to do anything about it. (Beth)

Here what has been ‘lost’ is not a person but time; time when Beth’s daughter could have been happier, and time when Beth missed out on knowing her child. At times, the loss can also be felt in relation to an imagined gendered future that gets reconfigured when a young person transitions. This was expressed beautifully by Robert: So that was my fear losing my son who I was so close to and I guess I was imagining a future without my son rather than imagining a future with my child or my family. That was the anxiety, this sort of imagined future without my son. But the reality was that I had my child throughout that time and still do. So, it was just an imagined loss rather than a real one. (Robert)

As discussed in Chap. 1, the highly problematic narrative of loss continues to surface in the experiences of parents and carers of young trans and gender-diverse people (Wahlig, 2015). Yet, the accounts of parents and carers I spoke to demonstrate that it is far from the default emotional response that parents have to their child’s transition. It is therefore important to stress the diversity of parental experiences. I argue that rather than taking the narrative of loss at a face value, it could be more helpful to rethink it as a form of ontological crisis related to the weight given to gender as a defining aspect of personhood, and one upon which parent-­ child relationships are built. As I have tried to show, stories of loss are stories of rupture, reflecting greater weight and importance given to gender as an aspect of personhood and one through which parent-child relationship is organised. When juxtaposed with narratives that challenge and reject ‘loss’ as inherent in the experience of parenting a trans child, we see that other readings of gender that refuse its centrality and focus on continuity of both the personhood and relationships are possible.

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Finally, how parents think and talk about their child’s coming out and transition is important as it can challenge not only the narrative of loss but also other cisnormative and harmful understandings of trans childhoods that position these as difficult by default. This is captured by Harriet’s account, in which she resists the framing of her boss’ reading of her parenting experience: And people say, my boss said to me yesterday he said, ‘Oh, you’ve done brilliantly’. Cause he knew I was thinking of going to this parents’ [support] group. ‘You’ve done so fantastically’. I said, ‘No, I, I haven’t, not really. I’ve just been a mum’ and I do get uncomfortable with that when people go ‘Oh, I can’t imagine and that’s such a big deal’. Whereas day to day, it’s not. It’s just, just the same. Just the same as it was. (Harriet)

Because cisnormative attachments permeate and regulate social readings of parenting practices and experiences, parenting a trans child is positioned as both extraordinary and trying. Harriet’s rejection of this extraordinary and almost heroic reading of her experiences offered by her boss is therefore fundamental to understanding how parents of trans and gender-diverse children challenge the negative emotional readings of what it means to have a trans child. The opposite of the narrative of loss is here not an account of celebration of one’s child being trans, but rather a refusal to make the fact that they are trans into something spectacular and challenging in and of itself. In supporting her son, Harriet is ‘just a mum’.

Growth and Expanded Horizons As I have argued in the previous section, making sense of their child’s transition and gender, means that parents leave, or are forced out of, the comforts of cis-certitude. I have shown that this departure does not have to feel like a loss, and even when it does, what parents feel they lost varies. I want to end this chapter considering how parenting trans and gender-­ diverse children and young people can also be a source of enrichment and personal growth for parents and carers; how to leave the comforts of cis-­ certitude is also to expand one’s horizons to encompass gender diversity and at times also gender freedom. This can manifest as questioning long-­ held assumptions about trans people, or becoming more aware of the diversity of trans experiences, as demonstrated by the quotes from Vivian and Beth:

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I thought, you see, I thought, I don’t know any transgender people. But that is ridiculous. I probably do know some transgender people, I just don’t know they’re transgender. And I think that’s how I feel now. And, and I sort of think, that’s fine, actually, because if they don’t want me to know what business is it of mine. It’s nobody’s business … You just take it from them as they are. (Vivian)

R: I’d known quite a few people [tch] on the gay scene. So I’d met a few people who were trans and but not, I didn’t know any in any great depth. [sighs] I knew it wasn’t sort of straightforward and simple. I knew that there was a lot of anxiety and a lot of prejudice. But I know that, I also wasn’t aware of the extent of the diversity of people who were trans. I don’t think I’ll ever quite get to grips with the 56 or whatever definitions around [laughs] of trans. It’s just people as far as I’m concerned. But I suppose I did have quite a black and white views that if you’re trans you would follow the pathway of changing completely and complete physical surgery So, yeah, I’d probably had a more black and white view. I: And this has now changed? R: Yeah. I’m more aware that, just as there is with everyone, there’s different grades of people seeing themselves as where they want to end up and their change over time. And it’s not just the intellectual idea, but also the appreciation of that. We’ll just have to wait and see where we end up. (Beth) Beth’s account also signals how her understanding of gender changed to encompass an appreciation of that diversity and an acknowledgement that her daughter’s transition does not have to look or happen in any particular way. This open-endedness allows space for freedom and exploration in ways that do not exist in the trans-normative model of transitioning. This matters because parents and carers’ understanding of what it means to be trans is likely to influence how they go about supporting their young person. Support and acceptance are not synonymous. Almost all of the parents and carers with whom I spoke saw themselves as supportive, with only one parent taking an openly non-affirming approach to their child’s gender. However, how these parents went about supporting their children and how they understood what good support meant differed. Perhaps the most self-reflexive account of making sense of one’s child’s gender and how that influenced the support extended to the young person came from Sophie and I believe that Sophie’s account is worth quoting at length:

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I think the journey for me was kind of three really different stages. And … if you’d asked me at any of those stages if I was being supportive and if I was supportive of trans young people, I would have said, yes. But kind of looking back … at where I was in other stages, I can see that wasn’t necessarily the case. So, the first stage … when we learned that our daughter was trans we were very very worried because her, her mental health was really poor so she was having a lot of suicidal thoughts and she was really depressed. And so we were really really scared about that. And at that point, I was absolutely, one of my fears was that she wasn’t really trans, that it was some sort of psychological thing that she was, it, it was a delusion … at that point, I had a really kind of medicalised view of it, so I was desperate to get to the the, the GIDS and get what at that time I would have called the diagnosis, because I was really really worried that she thought she was trans, but she wasn’t, if that makes sense. And then later on, when we got a bit further through, I was really, I, I believed that she was trans and there was sort of two things going on at once, so I was getting more informed and I was fighting a lot of battles for her and I was kind of making, I was doing everything I could to make sure that everything would be okay, so I was going into school and changing her name and having a fight with the bank and you know, all that kind of stuff. But then sort of alongside of that, I was really really sad about it. I felt really, you know, I, I, I kept it secret from her at the time, but I was, I was really really, I cried a lot and I, I was really terrified about what would happen to her in the future, you know, and I, I, I believed she was trans and I wished she wasn’t. And not because I felt that it was a bad thing to be but because I thought it was, it was gonna be really difficult and her life was gonna be really difficult and I was really fearful about what would happen to her. And then sort of around that time, yeah, and, and I kind of, I kind of sort of believed that, you know, because she had gender dysphoria and she had a medical diagnosis, I was kind of well that proves that she is transgender. That was kinda where I was at that time. And I was also very concerned about things like oh, you know, she’s, she’s never gonna pass as a girl and that’s gonna be really difficult and that would be awful and you know, she’s gonna have a really sad, you know, so it was that kind of thing. But also around that time, I started to suspect that what was happening at the Gender Identity Service wasn’t right and it wasn’t helping her… I was kind of reading around a lot and and you know, finding out stuff. And then the point where I am now is that in all that kind of binary thinking about, you know, are you trans or are you not trans or do you pass or do you not pass. You know, all that kind of stuff’s really, it’s really fallen away. And I, I just, I just think now that being trans isn’t, it’s not a good thing or a bad thing, it’s just a thing. I think it’s just a normal, completely normal variation in what human of how human beings can be. And so I just [sighs] she is

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really happy now. None of it seems like a big deal any more. It’s not really a topic that we, not really a topic that we think about … It’s just, it’s just a thing, she’s just who she is. (Sophie)

What is so interesting about Sophie’s account is the development of her understanding of what being trans is and what it means for her daughter. The trajectory of that development moves from disbelief and the need for diagnosis, through acceptance premised on medical diagnosis and attachment to the binary model of gender, with extra weight given to the ability to ‘pass’, and finally to acceptance that makes no demands of diagnostic, or other kinds. Notably, during each of these ‘stages’, as Sophie calls them, she felt she was being ‘supportive’. This is key to understanding parents whose way of supporting their young person can be based in their own prejudiced views and/or ignorance. Finally, in Sophie’s story as a parent making sense of her daughter’s gender, the hegemony of gender binary is challenged and, eventually, dismissed. What follows is a sense of freedom, freedom from the pressures to be or do gender in a certain way, and a freedom from diagnostic and other labels. It is a hugely astute and evocative account of how parents’ efforts to support their young person happen in a social context, where trans lives continue to be medicalised and pathologised. To accept and support a young trans or non-binary person is to face and challenge gendered assumptions and expectations, it is also to reshape one’s understanding of gender and gender diversity; it can also mean challenging the narrative of loss or accounts that position parenting trans children as exceptionally difficult in and of itself. In negotiating these pressures, parenting trans and gender-diverse children becomes a practice of social justice that contributes to readings of trans lives away from pathologising and cisnormative logic. In the next chapter, I explore how this practice links closely to parents and carers’ ability to find information—and avoid misinformation—and support for their young person and for themselves.

References Brumbaugh-Johnson, S. M., & Hull, K. E. (2019). Coming out as transgender: Navigating the social implications of a transgender identity. Journal of Homosexuality, 66(8), 1148–1177. https://doi.org/10.1080/0091836 9.2018.1493253 Gill-Peterson, J. (2018). Histories of the transgender child. University of Minnesota Press.

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Levitt, H. M., & Ippolito, M. R. (2014). Being transgender: The experience of transgender identity development. Journal of Homosexuality, 61(12), 1727–1758. https://doi.org/10.1080/00918369.2014.951262 Rickett, B., Johnson, K., Ingle, H., & Reynolds, M. (2021). Support for parents/ carers of primary school aged gender diverse children in England, UK: A mixed-method analysis of experiences with health services. Health Sociology Review, 30(1), 9–24. https://doi.org/10.1080/14461242.2020.1857656 Riggs, D. W., & Bartholomaeus, C. (2018). Cisgenderism and certitude: Parents of transgender children negotiating educational contexts. TSQ: Transgender Studies Quarterly, 5(1), 67–82. https://doi.org/10.1215/23289252-­4291529 Turban, J.  L., & van Schalkwyk, G.  I. (2018). ‘Gender Dysphoria’ and autism spectrum disorder: Is the link real? Journal of the American Academy of Child and Adolescent Psychiatry, 57(1), 8–9.e2. https://doi.org/10.1016/j. jaac.2017.08.017 Wahlig, J. L. (2015). Losing the child they thought they had: Therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child. Journal of GLBT Family Studies, 11(4), 305–326. https://doi.org/10.108 0/1550428X.2014.945676 Zimman, L. (2009). ‘The other kind of coming out’: Transgender people and the coming out narrative genre. Gender and Language, 3(1), 53–80. https://doi. org/10.1558/genl.v3i1.53

CHAPTER 3

Advocating for Trans or Gender-Diverse Children: Establishing Foundations, Finding Information and Support, and Negotiating Pressures

A key feature of the lives of parents and carers of trans and gender-diverse children who affirm their child’s gender and support their transition is the labour of love that is required of them to support their child in a context where ignorance about and prejudice against trans people and children is commonplace (Mikulak, 2021; Mitchell et al., 2014; Pearce et al., 2020). It is in this context—and not because parenting trans or gender-diverse children is difficult per se—that additional burdens are placed on parents and carers to help their young person navigate educational and health systems, as well as the social relationships that might come under strain when a young person comes out as trans and/or socially transitions. Part 2 of this book deals with these three specific areas in more detail. However, to be able to successfully advocate for their child in all these contexts, parents need to build and maintain knowledge and a support base, from which they can draw and to which they can turn whenever they or their young person experiences exclusion or is denied care and/or support by educational and health services; when faced with uncooperative and unsupportive schools, health professionals, and/or family members, parents and carers need to know better and know more. Consequently, the quest for knowledge and support of parents and carers of trans and gender-­ diverse children are foundational building blocks of their parental advocacy work. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2_3

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In this chapter, I discuss how parents and carers go about the task of building their knowledge and support base. I examine where they look for and how they filter information, and where they turn to when they need support for their young person and for themselves. I highlight how such work is ongoing, necessary, intensive, and time-consuming—it requires a lot of effort and dedication. Whilst these practices are part of the labour of love that parents perform because they are parents (or carers), the extra emotional, intellectual, and practical labour that comes with affirmingly parenting a trans or a non-binary child, in the face of societal prejudice and systemic discrimination, make them social justice practices that push against the exclusion and disenfranchisement of trans and gender diverse children and adults. Whilst I highlight the important role that support organisations such as Mermaids play, in this chapter, I also point to the limits of individual efforts in the face of systemic shortcomings and injustices. I discuss how the latter becomes evident in the discrediting of parental expertise, the need to constantly negotiate visibility and safety, and the toll that negative media attention takes on the mental health and wellbeing of both parents and carers and the young trans and gender-diverse people in their care.

Getting Informed There’s a lot of hours sitting awake worrying about your child. So there’s plenty of time for research. And you are kind of hungry for it to try and help your child. (Keith)

Parents and carers of trans and gender-diverse children and young people often find themselves in ‘a knowledge vacuum’, related to long waiting times, where they experience lack of expert guidance (Rickett et al., 2021, p. 17). I return to and unpack that insight below. However, what is important to signal from the start is that because of the vacuum, getting informed is key to becoming successful in advocating for their young person. Moreover, as parents look for information, they must not only overcome their own and others’ cis-ignorance (Mikulak, 2021) and misconceptions about trans people and children, they must actively filter through information about what being trans means, what support is out there, and how to go about accessing it. Looking for information online is one of the first things many parents and carers do when their young person comes out to them (and at times before that, as discussed in Chap. 2):

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[I]mmediately after they [her child] told me … I just remember hitting Google and just googling the hell out of everything and trying to find out as much as possible to inform myself to put my mind at rest. And yeah, to be able to support them in the best way that I could. (Anne)

At the same time, searching for information on the internet can yield mixed quality results that require parents to be both critical and at times also vigilant in relation to how they and their young person go about finding information, with the risk of misinformation and transphobic content disguised as ‘help’ posing a real threat: There does tend to be a bit more information available now on the internet, but it’s kind of watered down a little bit. It seemed, but, but compared to any other ‘condition’ for want of a better word that would be treated by the NHS there still is very little information, very little objective information available. And again, it’s, if you were to, I worry sometimes about my son trying to access information, that’s why we say, if you wanna know anything you come to us and we will help you find it. We’ll help you find what you need, because if one just googles, you know, ‘transgender help’ it can throw up all sorts of really unpleasant things. You know, there is lots of hate on the internet. There’s lots of really negative messages. (Claire)

Therefore, and as demonstrated by the quotes from Keith, Anne, and Claire, for many parents and carers, getting informed is explicitly linked to their ability to support their young person. This also means that looking for information is not a one-off event, but rather an iterative process where parents do their own—often extensive—research, frequently accessing a multitude of sources and formats, comparing and contrasting information they come across (see also Carlile, 2020). When asked about how that experience of ‘hitting Google’ to look for information was for her, Anne explained: I mean it wasn’t just a one-off thing. I did it, you know, it was, it was over sort of weeks, you know, days, weeks, months and continuing going back to it. Just sort of thinking back it was the thing I ended up doing quite a lot of actually was looking at examples of other people who were transitioned, so obviously trans men, cause that was … to kind of really understand from their own experience and their own voices. And to put my mind at rest as well that actually you being trans it wasn’t this kind of this life of you know, misery or bullying or whatever. It was really, it was really really reassuring to

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me as a parent to be able to see those positive stories. But also, you know, real, realistic you know, and talking about things that I wasn’t even kind of aware of. (Anne)

What is interesting and important in Anne’s account above is how she found the first-hand accounts of trans people informative and reassuring, as a counterbalance to negative representations (real or imagined) of trans lives. This is important as first-hand and trans-produced knowledge is generally absent from official sources, such as the NHS, where experts determine what information should be imparted and promoted to the public. For some parents and carers, looking for information can be an upsetting experience, at least initially. Particularly, if they lack awareness of the discrimination and barriers that trans people face: R: Obviously, I went to lots of website and trawled through some websites. I: How was that experience? R: Poor, really. Because you just read loads of things. I mean, I think I’ve sat down and read lots of things. And then I got very very upset…. I: So what was upsetting about finding the information online? R: Oh, there was just lots of things. How long people would wait or how, I mean there is lots of stuff out there about how people trans people are discriminated against. How, you know, violence against them. There’s lots of that stuff out there. It does make you depressed. You do think to yourself, you know, this is not a life I envisaged for my child. And how tough is this going to be? So, I think that’s looking online can make you do that. (Vivian) Finding out that your child might face discrimination and be met with violence can generate a sense of helplessness and fear about the future. However, that fear is also reflective of the privilege that comes with not having to have known about the realities and precarity of trans lives. Not unlike the parental responses to their young person coming out, Vivian’s experience of ‘discovering’ that trans people face stigma and unjust treatment in the society reflect the discomfort and distress that result from the stripping away of privileges of cis-certitude; this is especially palpable in the phrase ‘this is not a life I envisaged for my child’. Nevertheless, finding reliable, up-to-date, and accessible information can be difficult for some, creating a barrier for parents and carers who do

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not have the time to look for it extensively and/or are less able to access and/or understand it. This is particularly true in relation to healthcare, where available information is either very generic or highly specialist: Oh it’s been, it’s been a lot of work. It was really difficult. It was really difficult to find everything that we needed. Yeah, I mean we’ve, we’ve been able to, we’ve been able to to find and read all kinds of of useful information, but I mean a lot of it things like, you know, I mentioned about the [GIDS] protocol for prescribing hormones and blockers and that kind of thing. I mean it, that was a case of, I had to read the whole document. It wasn’t, you know, there was nothing digested to help parents or anything like that. You know what I mean? So it was, I mean, things are available online, but it was quite a lot of work. So for me it was, it was, fine. I, I’m able to read and understand things like that. But that wouldn’t be the case for everybody, you know. It would be a lot of, be a lot of effort. It was quite difficult. I didn’t, I didn’t feel like there was a place where I could go and everything that I needed was on there. You know, like … the [GIDS]’s page or something … I had to find it [information] for myself. That was quite difficult, really [laughs]. (Sophie)

Another issue related to finding reliable information is that the official GIDS information is often not seen as helpful because the service itself is perceived as overly cautious and non-affirming, which in turn adds to a sense of urgency around getting informed via other sources. This brings us back to the idea of the existing ‘knowledge vacuum’ (Rickett et  al., 2021)—or lack of expert guidance that parents experience—as tricky. In a context where the expert guidance can be directly at odds with affirming approaches to gender diversity, and/or not aligned with what parents and carers and the young people themselves might want in terms of gender-­ affirming interventions, that knowledge vacuum might allow some parents to become better equipped with tools and information that allows them to better advocate for their young person and become less reliant on expert guidance that they mistrust. What this means is that given the service’s reputation and the extensive waiting times at the GIDS (issues I revisit in Chap. 4), by the time parents and carers accompany their young person to meet the specialist team at the service, many are often very well informed about the service, different models of care, and issues with the GIDS, as identified through recent audits (Care Quality Comission, 2021). This also means that engaging with the service requires parents and carers to negotiate an often difficult set of emotions and concerns:

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I:

Where do you get information about gender identity and being trans and the care that’s there? R: Where do I get it? Well, I get it from the World Professional Association for Transgender Health. Because of my professional role, I’ve been able to become a member myself. I get, I get first hand access to all of that. There are a lot of academics who are trans or trans friendly on Twitter. They often will link into their, give access to their work and because of [my role] … I can get past the pay wall and not have to pay for the, to access to the journal articles and stuff like that. Plus, there’s loads of really good books out there by people who are trans or—I, I read quite a lot of, I speak to parents, other parents who’ve experienced a variety of different services as well. And I, I link into Mermaids and their residentials and their forums. I try to get it as from as broad a view as possible … I’m trying to keep an open mind with, with certain services and so on because I don’t wanna sway my son in his experience, cause obviously we have to go to one of the tertiary services once a month, at the moment. I’m trying very hard not to be too negative in front of him about those, that service. (Kim; emphasis added) Frequently, parents and carers’ search for information encompasses a multitude of resources and sources and what is significant about the process of finding, filtering, and, as I discuss below, also sharing of information with others, is that many become experts. At the same time, parents and carers’ knowledge and expertise are often undervalued and at times entirely unrecognised in their interactions with the GIDS and healthcare in general: I also think it’s very important that GIDS practitioners actually think about what it means that families have been living with this for two years before they get seen. I’ve read quite a lot of [names of two GIDS clinicians]’s work and they’re so dismissive of parents’ expertise. They talk repeatedly about, oh well, parents read things online and they think they know this and they think they know that. Well, yeah, I did read things online, they were peer reviewed journal articles, where do they get their information from? Do you know what I mean? Just cause I found it online it doesn’t mean it’s stupid. And, and I think they don’t, they don’t take into account the fact that by the time they encounter a family with a trans child, that family probably knows more about it than they do. You know, after two years you certainly would be up to speed. (Sophie)

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Sophie’s account points to how parents and carers like herself1 are in a position where they can actively engage with the views of experts and critique their work. Yet, the service itself is not open to that kind of engagement and critique, a point I revisit in Chap. 4. What is key here is that in educating themselves parents and carers challenge the authority and the monopoly that GIDS professionals have in the field of trans children’s health in the United Kingdom. It is in that sense that their information-­ seeking practices become an important element of social justice work. How the experts respond to this work is another issue, and the following chapters of this book are full of examples of situations where parents are considerably better informed than healthcare and/or education ‘experts’, yet they are repeatedly faced with dismissal of their knowledge. This is well captured by a quote from Kim, who shared her experience she had when her son was in the care of the child and adolescent mental health service (CAMHS), who unilaterally decided to stop his hormone treatment, for which the family was paying privately. When faced with opposition from Kim and her son, the service tried to ‘educate’ her: They [CAMHS professionals] kept on handing me articles written by Kenneth Zucker and stuff like that … not realising that actually Ken Zucker is his, his reputation within the trans community is, not that good [Laughs]. And also, I think that they didn’t realise that I had access to lots of different [3 sec pause] articles that are behind a paywall that I read all the time, because that’s what I do. So I was far more informed than them and they were trying to basically teach me to suck eggs and wouldn’t hear and anyway. (Kim; emphasis added)

The paradox at work here is that parents are forced to know better/ more to be able to make demands against a system that is often bent on denying their young person gender-affirming treatment, or accommodations that would facilitate and ease their social transition. What that means for parents and carers is that being educated and at times extremely well prepared to challenge and educate others is key in ensuring that the rights of the young person are upheld. Such situations and experiences resemble the extent to which educational burdening is an issue that many trans and gender-diverse people face in healthcare and other settings (Bauer et al., 2009; Benson, 2013; Mikulak, 2021). As I argue in the following 1

 There is an additional class/educational dimension here that is relevant too.

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chapters, parents and carers who advocate for young trans and gender-­ diverse people take on that educational burden as they help their child navigate the social world. The extent to which parents and carers go to educate themselves—and often others around them—is as impressive as it is necessary, even if the ability to find and understand information remains contingent on parents and carers’ individual resources and commitment. At the same time, the limited literature available on experiences of parents and carers of trans and gender-diverse children highlights that they often feel isolated and embattled, as well as struggling to access support (Carlile, 2020; Rickett et al., 2021). In the words of Rickett et al. (2021, p. 20) parents and carers experience ‘chronic … uncertainty, anxiety and distress’ as they navigate the long waits and healthcare settings where they are met with uninformed and at times deliberately unhelpful health professionals. It is in this context that peer support becomes crucial, and the next section of this chapter focuses on the role of peer support as exemplified by the charity Mermaids.

Mermaids: Information and Support, Information as Support The entire support that we’ve got has come through Mermaids (Sue) The best information I had come from Mermaids. They had a, when I first contacted them, they had a package, a sort of ready-made package of information that they sent to me. The reason why it was so helpful is because the remit was wide. It was easy to find its way around. So, it was sort of in organised in sections. It was available to me quickly, literally, I had it within a couple of hours. And it was helpful in that it signposted me to legislative provision to, you know, policy to, it was, it was, it was really, it was really helpful. And it gave me a really good head start in loads of different areas. And I could then take what I needed from that and develop my learning and read around whichever given subject matter was relevant to us at that time. (Claire) The absolute best thing was that the, the Facebook group where you can talk to other parents, online and that, that was an absolute, that was a massive sense of support for us. That was an absolute godsend. It was really really helpful. (Sophie)

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Related to the mixed quality of available information and the sometimes problematic expert guidance, being able to not only share one’s experiences but also seek advice from peers is fundamental to parents’ and carers’ wellbeing (Menvielle & Tuerk, 2002; Pullen Sansfaçon et  al., 2020); in particular, in the face of isolation that they often experience (Rickett et al., 2021, pp. 18–19). In the United Kingdom, Mermaids is the best-known organisation for affirming parents and carers of trans and gender-diverse children. Most parents and carers I spoke with for this book had interacted with Mermaids at some point, and the reasons they reached out to this organisation were usually a mixture of the need to get informed and the need for emotional support and understanding. Importantly, Mermaids is often positioned as an unparalleled source of information: I think … [that] something like Mermaids absolutely gets it right, because there’s, there’s this online forum so if you have a question you can just put it up there and then it’s like a conversation and lots of people will come on and talk to you about it. And the fact that you can, you can go on the web chat or you can go on the helpline. And I think for young people and for families I think that’s absolutely, you know, I think that’s absolutely brilliant. And I think that’s a fantastic approach. Whereas it’s more a case of you talking to someone. You know, whether it’s you’re talking online or talking on a, on a phone or whatever. You know, so that you can just speak to somebody, I think that’s really really helpful for people. (Sophie)

Parents and carers who accessed information and support via Mermaids were likely to recommend it to others, stressing the value of being able to connect to families in a similar situation to their own: R: It, it’s not a whole lot [of support] out there. Not that I found and I have searched fairly [thoroughly]. I: What advice would you give to parents or carers of young trans and gender diverse people? R: I would tell them to contact Mermaids. I would tell them to talk to other parents and talk to other trans and gender diverse young people. I would tell them to seek help if they need it. I would tell them that it’s gonna be okay. And tell them it’s gonna be fine. I would tell them not to worry … I mean, yeah, if it was actual advice that I would, I would and do just tell them to get in touch with Mermaids,

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because I think that support from other families is absolutely invaluable. (Kim; emphasis added) In the accounts of parents and carers of young trans and gender-diverse children, looking for information is closely linked to and overlaps with the search for support for themselves. Because accessing information is so central to parents and carers’ ability to advocate for and support their young person—again, in the face of undereducated and at times hostile healthcare, education, and social environments—as well as providing reassurance and contributing to their wellbeing, and I would argue that information is support: I:

So what kind of support was there for you, as a parent? You mentioned that Mermaids have been useful. What else was there for you? R: Nothing [laughs]. Absolutely nothing. I guess probably because again individually had I needed counselling, I’d probably could have asked for counselling at the [GIDS]. They did offer counselling. And I was well, I don’t really need it. I’m totally happy with my child transitioning and some information would be good. And they couldn’t really offer any real information, but I’d already found Mermaids by then and all the information I needed was on the forums. I would ask and within ten minutes, three or four people would reply … So, I gained a lot of information from them. (Keith) I found Mermaids that was helpful for me in regards to the information being passed. And, you know, being able to understand what was possible, what was not possible. Especially in regards with being in the UK because the UK have quite strict guidelines and protocols. Whereas the, a lot of the information I was reading was maybe American on the internet. So, we kind of have to pull yourself back in from reading that stuff. But yeah, no, Mermaids was a big help. And that’s it really. There’s no other support out there. There’s, there’s literally nothing. (Eve)

The way parents and carers engage with Mermaids is not one-sided. For many, there is an element of reciprocity: contributing to Mermaids online discussion forums—where many parents and carers post questions and answer others’ queries—attending residential weekends or group meetings run by the charity are all activities that allow parents and carers to share and access information/support. This in turn enables building a

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network that sustains parents’ advocacy work in an environment with limited sources of both support and reliable information. I came across Mermaids and I emailed them straight away … So we got a call very quickly actually within a day I think I got a call from one of the support workers at Mermaids. And I joined their parents’ forum immediately. And then after six weeks I, I was allowed to progress onto a social media forum for supporting parents. And they had meet ups once every month. So I went, [my daughter] and I went to the first meet up she found it a bit awkward actually, because there was a lot of younger, younger kids. And actually she’s really quite well adjusted. But I find it quite helpful to be able to talk to other, other parents and share experience. And sometimes, actually, our experience, on the whole, apart from the difficulty with the GPs and everything has been very positive because we chose to embrace the change. It’s been less traumatic, I guess, you know, we deal with issues and what have you as they arise. And it’s quite nice to be able to share positive stories with other families who are maybe struggling who can then kind of see that there is some light at the end and that things can be alright. (Sue)

For some, this engagement with Mermaids moved them into an area of activism or extended their advocacy work to involve other young people. Eve was one of the parents and carers I spoke to who was involved in the work Mermaids does—‘I’ve in a role within Mermaids, I do work with the trans youth’ (Eve). Others offered help and advice informally to friends of their children: I’ve just helped a friend of, of my child’s who is 18 and is, has just come out to her parents and she was talking to [my daughter] about the difficulties she’s having … I’ve talked her through what we’ve done. (Sue)

It is through activities and communities of sharing of knowledge and support such as Mermaids and the collective knowledge base that they establish and maintain that parenting a trans of gender-diverse child becomes a social justice practice that transcends the level of the individual family. These communities are also crucial insomuch that they enable a level of generational learning, as the learning shared is not lost—when an individual child grows up and their parents or carers no longer have the need to engage with the charity—but can be passed on to others. Knowledge and experiences are exchanged, shared, and passed on to help others, and by extension, to improve the situation of trans and gender-­ diverse children in general.

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Visibility, Safety, and The Emotional Toll of Transphobic Public Debate I don’t wanna force anyone to be, to stand up and have to do that ‘I’m trans’ thing. But sometimes you need some people who are prepared to be a bit more visible and just stand up and say, yeah, look at us. (Vivian)

Another aspect of parental advocacy work that is central to experiences of parents and carers of trans and gender-diverse children and young people is how they negotiate their own visibility as parents of trans or gender-­ diverse child. In the interviews, parents often spoke about the need for positive role models and visibility of trans lives and possibilities in the public domain. However, in their own lives, they often felt unable and/or unwilling to be open about their young person’s transgender history and their own experiences of parenting a trans or non-binary child. Two sets of concern contribute to this reluctance. First, advocating for their children, parents and carers are constantly negotiating visibility in the context of heightened and often toxic public discourse around trans issues in the United Kingdom today (Pearce et al., 2020). The overall view of the public debate in the United Kingdom that affirming parents and carers had was that it is rife with transphobia and dominated by a regressive, conservative minority that fuels moral panic around trans children and trans rights and that the media are complicit in this process: There’s so much scare mongering … going on around trans healthcare at the moment, particularly for young people. (Kim) I think there is a lot to be said for the, the way the media handle a lot of things. And, 98% of the time it’s all fear based. Anything that comes out in the media, you know, a lot of the time, against the trans community and it’s all about fear. It’s all about sort of dividing and, and causing people to be fearful of something that they don’t understand. (Lucy)

Many found the negative media attention upsetting and draining for them and their young person: When there’s any negativity in the media, he [my son] feels like he has to roll himself back up into a ball a little bit. He feels he has to come back into the house to protect himself. So he doesn’t go out as much when there’s been bad publicity … I haven’t seen … the media attacking like they do with

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trans kids and gender diverse kids. And the charities that are supporting them …. Why are they allowed to attack trans youth and be their first bullies, publicly day in day out. Why are they allowed to do it…? The media are putting it out every single day for millions to read and see … it needs regulating, seriously regulating, because, like I say, my lad when there’s been a negative story in the news or on the, on the TV he’s worried for the next week that someone’s going to do something to him. (Eve)

R: Public debate. I mean, some of it’s, you know, some it’s really, some of it’s perfectly positive and I get that. But certainly in the UK it’s really very negative at the moment and really worrying. I: Does it affect you personally? R: Yeah. Yeah, it does. It, it, it, it makes me feel sad and it makes me feel worried about the future and it makes me feel angry, some of the things. And eventually it all starts to wear you down and you kind of, you start to try and—I try to step back from it sometimes, but other times, you know, you know I’m writing letters to people and, you know, write letters to the papers and stuff, because it yeah, a lot of it’s just really unfair and wrong. (Sophie) Second, being open about their child’s gender history, parents inadvertently out their young person, which might have all sorts of consequences for their family and their young person, one of them being the taking away the possibility of non-disclosure. This is important as trans people of all ages do not owe anyone disclosure and the decision to disclose their transgender history should be theirs and theirs only. These two concerns are closely related, as parents and carers I spoke to have a heightened awareness of the risks that come with visibility and a sense of responsibility towards protecting their young person’s privacy as well as their autonomy. The fear that their child might face discrimination was also an important factor in how parents negotiated visibility: I don’t want to put myself out there and I don’t wanna put my child out there, in the public domain because I wanna give them the right, in the future, to go through life without having everybody know that they are trans … There is no obligation [to disclose]. I wanna, you know, [just like with being] gay or with a disability or any kind of health, you know, social issue that could mean that they are, you know, picked upon or singled out and marginalised in the future. But at the same time, the influencers and

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decision makers need to be able to hear their voices and really understand the nuances and the differences between them. (Anne)

For parents of younger children, there was the additional factor of their young person not being fully aware of the extent of trans negativity—from which they work hard to protect them—and the related risks of being open about their gender history. This is illustrated by Tara’s account, who spoke about these tensions and her wish for her trans daughter to be both comfortable and proud being out: I want sort of more visibility for children with protecting them at the same time. That’s the dilemma that I’ve got a bit, because she just wants to be a, a she just wants to live her life normally and get on with it. But at the same time, the more visibility of trans children would help more children come out and just be themselves. So it’s that balance. But in the current climate, you worry a bit about your child being out, out and proud about being trans. So there’s that dilemma there sort of half wanting to protect them and keep them closeted away and half wanting to improve things for all trans children and be visible and proud about who they are. We have gone to like Pride and I’ve run a Mermaid’s stall and things. But then there’s that little side of me that thinks really I should be putting her like putting her out there so people know she’s trans. There’s like a bit of a dilemma going on. I don’t do it, I don’t force her into it, but she’s probably not as aware of, of the media and things and sort of the transphobia that exists out there … I’ve just got this other side that worries a little bit about her being visible as a trans child … But I think for her, if she could, if she could, if she’s comfortable and she’s proud of who she is and she doesn’t feel that she’s got to hide it, in the long run and if she meets lots of other trans children and they can share experiences, and she can grow up in that knowing that she’s got other trans teenagers, there’s things in the community that she knows, hopefully that’ll just instill confidence. I just want to get the balance right, really. (Tara)

The perceived risks extended to participation in the interviews that form the basis of this book—which many people saw as an extension of their parental advocacy and trans allyship roles. However, here too, parents and carers had concerns about privacy: You out yourself or you out them [your child] by trying to find it [information] and sometimes for whatever reason people aren’t ready to be outed … it’s hard because like, like this and if it was just about me, I wouldn’t have any qualms about being video interviewed. But I know that by being video

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interviewed that there is a consequence of me outing my son and I’m not prepared to do that. So, you, you walk this line. (Kim)

Walking this line meant that parents carefully managed their social media presence and engagement too, which in addition was identified as a site of abuse for affirming parents where much of the toxic public debate was taking place: There’s … some parents on Twitter who remain anonymous, because of the [3 sec pause] of the nasty, nasty stuff that they would get back if they weren’t, weren’t anonymous. Although I’m on Twitter, I’m, I’m not out there as a trans parent, parent of a trans child. I’m out there as somebody who is a trans ally, but not, look at me, I have a trans son. It’s that, it’s a real delicate balance. (Kim)

Concluding Remarks This chapter has focused on parents and carers’ individual efforts and actions and how they are constrained, but also made necessary, by the context in which families of trans and gender-diverse children find themselves. The purpose of this chapter is therefore twofold. First, it set the scene for the chapters that follow, which focus on how parents and carers help their young person navigate through the existing healthcare pathway and its many hurdles, face new trials brought about by, for example, their child’s impending puberty and the long waiting times, or assist their children in negotiating school life and other social contexts. Second, this chapter has positioned the information and support-seeking activities of parents and carers as central to their role as advocates and as social justice work. This work takes place, and is carefully negotiated, against the backdrop of often toxic public debate, ignorance, and moral panic around the existence and rights of trans and gender-diverse children. Relatedly, many parents and carers with whom I spoke were acutely aware of the importance and necessity of this work: If your life is a bit uncomfortable for a few years and you have to go places you don’t want to go and you’re to have conversations you don’t want to have, so what? Your kid’s alive. Your kid’s happy. They’re doing well in school. They’ve got a future. They’ve got hopes and dreams and aspirations. They’re not trapped in a room with the blanket over their heads, scared of going out and being themselves. (Eve)

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At the same time, many also acknowledge the weight of this labour: And the parents, you know, we’re battling. We’re, we’re basically at the forefront of this trying to advocate for our children in, you know, whether it’s med—in a medical profession whether it’s in education. Whether it’s in policy. Whether, you know, in all areas of life, when they’re still young and they haven’t got those skills yet to advocate for themselves. We, we’re being their advocates while, at the same time, having to go through this journey ourselves and the emotional, you know, rollercoaster of being a parent of a, of a trans child. And it’s really hard. You have to be really resilient kind of person to be able to do that. (Anne)

This is key as it signals the dire conditions that continue to make this work needed as well as pointing to the even more dire situation of young people whose parents or carers are not willing or not able to do that work on their behalf. Further, advocating for, supporting, and affirming a young person’s gender are practices of social justice, or justice-based parenting practices (Pyne, 2016). This is particularly visible in the challenging of medical authority and of ‘experts’ that knowledge-seeking and horizontal information-­exchanging practices of parents and carers enable, and to which I return throughout this book. If we agree that an affirming approach to trans and gender-diverse children is a practice of social justice, we also need to see and name non-affirming responses as grounded in, and perpetuating, social injustice that erase young people’s self-knowledge and deny them support; the extent to which the existing healthcare pathways are complicit in this will be the focus of the next chapter. This is particularly pressing in the context of the threat of limiting of autonomy that the (eventually overturned in September 2021) ruling of Bell v Tavistock and the moral panic surrounding it highlighted. Young people whose parents do not affirm their gender and do not support their transition are not only at a huge disadvantage but they are also exposed to harm. This chapter has also demonstrated how organisations such as Mermaids are crucial in supporting parents and carers and by extension sustaining the advocacy work of parents and carers of young trans and gender-diverse children also through facilitating sharing of information and support and building a knowledge base across time. The immense educational work that is done via Mermaids remains the main source of information and support for parents and carers, equipping them to become better advocates for their young person. Yet, parents and carers are rarely signposted

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to Mermaids by ‘experts’, which further limits the support available to families. Finally, the accounts of parents and carers who affirm and support their trans or non-binary child are both testaments of individual strength and resilience and necessary responses to systemic failures. It is only in identifying and addressing these failures that we can begin to undo the erasure and counter the exclusion of trans and gender-diverse young people. As we do this, we need to keep asking what happens when families and other important institutions such as healthcare and education are not willing or able to address, reduce, and prevent the harm in which such failures result?

References Bauer, G. R., Hammond, R., Travers, R., Kaay, M., Hohenadel, K. M., & Boyce, M. (2009). “I don’t think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. Journal of the Association of Nurses in AIDS Care, 20(5), 348–361. https://doi.org/10.1016/j.jana.2009.07.004 Benson, K. E. (2013). Seeking support: Transgender Client experiences with mental health services. Journal of Feminist Family Therapy, 25(1), 17–40. https:// doi.org/10.1080/08952833.2013.755081 Care Quality Comission. (2021). Tavistock and Portman NHS foundation trust gender identity services inspection report. https://api.cqc.org.uk/public/v1/ reports/7ecf93b7-­2b14-­45ea-­a317-­53b6f4804c24?20210120085141 Carlile, A. (2020). The experiences of transgender and non-binary children and young people and their parents in healthcare settings in England, UK: Interviews with members of a family support group. International Journal of Transgender Health, 21(1), 16–32. https://doi.org/10.1080/1553273 9.2019.1693472 Menvielle, E.  J., & Tuerk, C. (2002). A support group for parents of gender-­ nonconforming boys. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 1010–1013. https://doi.org/10.1097/00004583-­ 200208000-­00021 Mikulak, M. (2021). For whom is ignorance bliss? ignorance, its functions and transformative potential in trans health. Journal of Gender Studies, 1–11. https://doi.org/10.1080/09589236.2021.1880884 Mitchell, M., Gray, M., & Beninger, K. (2014). Tackling homophobic, biphobic and transphobic bullying among school-age children and young people: findings from a mixed methods study of teachers, other providers and pupils. London. https:// assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/367473/NatCen_Social_Research_-­_HBT_bullying_-­_ analytical_report.pdf

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Pearce, R., Erikainen, S., & Vincent, B. (2020). TERF wars: An introduction. The Sociological Review, 68(4), 677–698. https://doi.org/10.1177/ 0038026120934713 Pullen Sansfaçon, A., Kirichenko, V., Holmes, C., Feder, S., Lawson, M.  L., Ghosh, S., Ducharme, J., Newhook, J.  T., & Suerich-Gulick, F. (2020). Parents’ journeys to acceptance and support of gender-diverse and trans children and youth. Journal of Family Issues, 41(8), 1214–1236. https://doi. org/10.1177/0192513x19888779 Pyne, J. (2016). “Parenting Is Not a Job … It’s a Relationship”: Recognition and relational knowledge among parents of gender non-conforming children. Journal of Progressive Human Services, 27(1), 21–48. https://doi.org/10.108 0/10428232.2016.1108139 Rickett, B., Johnson, K., Ingle, H., & Reynolds, M. (2021). Support for parents/ carers of primary school aged gender diverse children in England, UK: a mixed-­ method analysis of experiences with health services. Health Sociology Review, 30(1), 9–24. https://doi.org/10.1080/14461242.2020.1857656

PART II

Challenging the Way the World Is Set

This part of the book focuses on three distinct, but also interconnected, areas in which parents advocate for their trans and gender-diverse children: healthcare (Chap. 4), education (Chap. 5), and social and family life (Chap. 6). Family and community, education, and healthcare are all arenas where young trans and gender-diverse people continue to face prejudice and discrimination; they are also key spaces for the production of gender and gendered expectations that trans and gender-diverse children unsettle. In each of these areas, as they go about supporting their young person, parents face a range of challenges that reflect gender-normative and cisgenderist assumptions. In this part of the book, I argue that by taking on the challenges of making the social, educational, and healthcare spaces liveable for their children, as part of their labour of love and support, parents reshape and at times reinvent these spaces through sustained efforts, creativity, and tenacity. Because of how precarious these sites are, parents also do a lot of damage control, managing difficult interactions with relatives, doctors, and schools for their young person. The energy that goes into such management and the costs (emotional, social, and material) that come with this labour reflect the continuous and multifaceted harm that happens to trans and gender-diverse children. Nowhere is it more visible than in the framing of positive and non-discriminatory interactions and outcomes as ‘lucky’, as irregularities in an otherwise hostile world where understanding and informed GPs, inclusive schools, and families where everyone is accepting and affirming are few and far between.

CHAPTER 4

You Should Be So Lucky Not to Be Treated Poorly: Experiences of Healthcare of Parents and Carers of Trans and Gender-Diverse Children

As I discuss in Chap. 1, within the current set up, parents’ and carers’ support is fundamental in healthcare. One way to gauge the importance of something is to look at the consequences of its absence. Not having parental support means young people might struggle to get referred to the specialist service, and if they manage to get past that hurdle, they are unlikely to be offered gender-affirming interventions. Ruth Pearce writes in her book, Understanding Trans Health: A handful of young adult participants in this project had recently accessed child and adolescent services; they described a struggle to persuade cautious practitioners that they qualified for hormones or blockers, particularly if their parents did not support them. (Pearce, 2018, p. 68; ephasis added)

However, even with full parental support, healthcare is a site where young trans and gender-diverse people face multiple barriers. This chapter focuses on healthcare as a site where parents’ and carers’ advocacy efforts are both especially intense and continuously necessary, as well as a site where lack of such support is particularly damaging. The necessity and urgency of parental advocacy work in this area is caused by a range of interrelated conditions: healthcare and gender-affirming interventions for young trans and gender-diverse people are currently at the centre of a © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2_4

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moral panic; the ‘pathway’ through which these can be accessed is difficult, lengthy, and characterised by cisnormative gatekeeping that undermines autonomy of the young people and rejects their claims to self-knowledge; levels of ignorance and prejudice against trans people and children remain high across the healthcare workforce including in the specialist gender identity service (Mikulak, 2021; Mikulak et al., 2021). In this chapter, I discuss these conditions and how they are reflected in the accounts of affirming parents and carers and how they are refracted in the account of the non-affirming parent with whom I spoke. This chapter critically follows the narratives of parents and carers as they negotiate the existing healthcare ‘pathway’, with their young person, from referral to being on the waiting list, and, at times, seeking private care, and ‘being seen’ by the GIDS. What becomes clear in the process is that what is spoken about as a ‘pathway’ is far from linear, or straightforward. Like with ‘luck’ signalled above, it is therefore also worth thinking about the work that term ‘pathway’ does and what it obscures. As I demonstrate in this chapter, what is called a pathway is in practice a range of often unclear and complicated processes that take years, these years can be filled not only with anguish but also anger at the inadequacy and failures of the system to meet the needs of the young people and their families.

Referrals and the Wait before the Wait In theory, there is a multitude of avenues through which a young person can get a referral to the GIDS. However, young people cannot currently self-refer.1 The NHS Standard Contract for Gender Identity Development Service for Children and Adolescents states: ‘Referrals can be made by staff in health and social services, schools, colleges of further education and by people in voluntary organisations who may have concerns about a young person’s gender identity development and associated difficulties’ (NHS England, 2019, p.  16). In practice, many health and social care 1  In England, adults can self-refer to the Gender Identity Clinic, however, there is an expectation that a person’s GP is involved:

If you are submitting the referral as a self-referral, please note that you would still require your GPs involvement in providing us with your medical assessment. The GP’s involvement is required throughout the whole treatment so it is advisable that you have a GP who will support you through this pathway. (Gender Identity Clinic, 2021)

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professionals are unaware of the existing processes, which in turn can result in delays and/or actual denial to refer the young person to the specialist service. This is particularly true for general practitioners (GPs) and experiences of getting referred through a GP range from instances of ignorance, to outright discrimination: And the referral that we wanted to GIDS he [the GP] was going to take it to a panel to decide whether that was gonna be the case. So, I pursued it by getting advice from Mermaids and wrote them a letter and asked them to refer us and then, then it happened. So he, he obviously wasn’t aware of what he should do in that situation … He seemed open. He was professional. He didn’t display any prejudice or anything. But he, you could tell that he didn’t really know what the process was or what would happen with a child and how the referral, what would happen with a referral to GIDS. (Tara) We also went to the GP and asked him to make a referral. That was an awful experience. He was quite obviously unsupportive of our difficulties. He told us that he wouldn’t make the referral because the protocol was to refer to CAMHS. [clears throat] And CAMHS would then refer on if they diagnosed a gender identity disorder, which I knew to be incorrect. He wouldn’t, he wouldn’t listen to me. So, I then had to leave the doctor’s surgery. My son said to me, ‘He doesn’t wanna help us, does he mummy?’ And I said, ‘I don’t think he does today. But I’ll make sure he does the next time I see him. Don’t worry about it. I’ve got it’. And but then we had a battle with the GP to get the GP to make the referral. CAMHS refused to accept the referral, because there was no diagnosed mental health condition. (Claire; emphasis in original) the GP was not keen at all to do a referral and it was only because we A) knew that the service existed and B) we printed out the referral form ourselves and we literally kind of sat down with the GP and said, ‘We have a right to this referral, here is the form’. (Rachel)

Getting their young person referred via a GP was the most common route for parents and carers, whom I interviewed, yet as illustrated by experiences of Tara, Claire, and Rachel, this route is far from easy. Whilst some parents and carers reported no issues with getting the referral via their GP practice—‘Our GP has been super helpful … They knew to refer straight to the Tavistock’ (Eve)—people spoke about positive experiences with getting their young person referred and the way they have been

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treated by their GPs in terms of ‘being lucky’, a point I revisit below. This is hugely inadequate on many levels, and in cases of refusal, it leaves parents and carers having to challenge individual health professionals even just to have their child considered to be put on a waiting list for the GIDS. Whilst I have not come across a scenario when the young person was not accepted onto the waiting list, the procedure adds another period of wait and delay; Harriet shared: ‘they checked that we, that’s what we wanted and we [parents] were happy to do that, and we were, they referred us … but they were clear that that didn’t mean we would be accepted onto the waiting list’. In that sense, getting the referral sent in is like stepping into the waiting room of a waiting room. At this first step, young people who lack parental support are already disadvantaged. The NHS states that parental support for referral is ‘encouraged’, as ‘[r]eferring professionals’ are ‘encouraged to discuss the referral with the family/carer and seek their agreement’ (NHS England, 2019), and as already mentioned, the service does not accept self-referrals (GIDS, 2021c). Given the emphasis on parental approval for the referral, it is easy to see how young people can be denied access to the service, should their parents or carers oppose it, and how ‘encouraged’ can instead function as ‘required’: There was a little bit of a stumbling block in that he was, my son was very scared to tell his dad. And his dad was the last person on this little to do list of, of who to tell and things. So, it, the doctor suggested that it would be an idea for, for my ex to know before the referral went, because he thought it would cause problems otherwise. (Nathalie)

The quote above highlights how even being considered for accessing gender-affirming care is not only contingent on a support of a parent, but health professionals might delay sending the referral in if the other parent is not onboard, or simply not aware of it. In Nathalie’s situation, it was her ex-partner, her son’s father, that was a potential ‘stumbling block’ for the referral process. I revisit the difficulties of negotiating such intra-family conflicts in Chap. 6.

Primary Care I have written about ignorance and its functions in trans healthcare elsewhere (Mikulak, 2021), but arguably, when it comes to children and young people, the so-called ‘knowledge gap’ on the part of health

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professionals is even more striking than in case of trans adults, and nowhere is it more visible than in primary care: the GP was very uneducated and basically didn’t, didn’t believe that a child so young could have gender issues that were significant. And so it was quite a dismissive interaction. (Rachel) GPs don’t understand. They have very little understanding of gender dysphoria and trans kids, very little. I don’t think they cover it much in their education, although I think probably they will be in the future. But our GPs didn’t really know much at all about it. They didn’t quite know where to refer. They just, a huge lack of knowledge with our GPs. (Tom) I have a concern about the lack of knowledge GPs have initially I think about transgender children. I think they’ve got experience of adults and they seem to have experience of that. But locally, in [name of the area], I don’t think there’s a lot of knowledge within GP circles. And the GP that we saw, initially, he admitted he hadn’t, hadn’t had any dealings with a child that young. And he needed to take it to a panel to approve funding, which showed that, I didn’t know at the time, but it showed that he wasn’t aware of the process that he needed to go through to support the child. (Tara)

What this means is that families are faced with an array of additional difficulties and discriminatory practices ranging from educational burdening to denial of care. In this dire landscape, positive experiences with GPs that amount to simply not being treated poorly, or as an object of ridicule, are considered ‘lucky’, as opposed to meeting the minimum standard that one should expect from healthcare professionals. Sadly, and as I discuss later in this chapter, something similar is happening in relation to the preposterously long waiting list and the care that young people receive from the GIDS. The perceived ‘luck’ does some heavy lifting in the context of healthcare for young trans and gender-diverse people: I think fundamentally that [3 sec pause] we’ve been really fortunate that our, our GP the whole practice has been exceptionally supportive of us. (Kim; emphasis added) Well, we were really lucky. Before we went, it was lovely actually … I rang the receptionist and you know, cause they triage everything. So, I spoke to the receptionist and, and I explained, and I said, so, you know, I need, we need to make an appointment to see one of the GPs and she said, ‘Oh, which GP

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do you want?’ And so, I said, ‘Oh I don’t know. Who would you recommend?’ And she went, ‘I think you should see Doctor So and So’. And she was absolutely right, because he’s just the loveliest, he’s just the loveliest GP. He’s really, really nice. (Sophie, emphasis added)

It is not possible to know whether Sophie’s experience would have been equally positive should her daughter been allocated a different GP within the same practice, it is however plausible, given that the receptionist chose to recommend a particular individual, as opposed to being able to say that any GP working there would be fine. This shows that even the ‘lucky’ outcomes are at times carefully engineered. How parents and carers take on the extra labour of making sure their young person GP is supportive is demonstrated by Keith’s account: R: Our experience there has been good, on the grounds that our GP was supportive. I, I read through Mermaids that a lot of GPs have no clue. So maybe they could do some education on gender issues. But in our personal case, we’ve had a very very good GP. But again, it’s down to research and before you register with a GP. Check before you sign up. If you’ve got a trans child, ask the questions before you register. And if you find that it’s a transphobe running the surgery, go to a different surgery. You do have free will. You don’t have to go to that one. Okay, it might be half a mile from your house rather than three miles, but it’s your health and your child’s health. So, do a little bit of research first and you can make life easier or hard, it’s up to you. I: What kind of questions would you ask a practice to— R: Immediately mine was black and white: Have you dealt with any trans, you know, patients in the past. What’s your stance on transitioning patients? Have you had any training in trans issues? Are we likely to get a good response?. (Keith) What Keith describes is effectively a process of screening out transphobic GPs. His take on it is that it is a question of ‘having choice’ and ‘free will’, but what it shows is how even the simplest of healthcare-related actions, choosing a GP practice, are complicated and compromised for trans and gender-diverse young people and their families and dictated by prevalence of transphobia and related discrimination. Those who trust the system in place might find themselves less ‘lucky’ and face delays and care that is substandard. Those who mistrust it might nevertheless not be able

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to access alternative GP practices, or know they have a right to do so. They can face situations where their experiences and the healthcare needs of their child are invalidated and/or dismissed: I:

You’ve mentioned that you felt that the GP [has] been quite condescending in the way they received your daughter as a patient. Do you want to tell me something more about that? R: So it’s, it’s … really hard to articulate. But it’s the way they look at us. And the tone of voice that they use, and the look in their eyes and I know, you know, it’s, it might sound daft, but actually to be sitting there under the kind of gaze that almost feels like it’s bordering on ridicule is very very uncomfortable. You know the first … GP, you know, very nice, soft voice and everything, but you could just see in his eyes it was just, it was not something that he was comfortable with, at all. You know, he was keen to make the referral and just kind of get us out of there. And was keen not to to really have, to have any involvement in any kind of bridging care for [name of participant’s child]. And then … he suggested, ‘Well if you know you’ve got a problem with this I suggest you write into the clinical lead’ … I wrote into that clinical lead. And… he questioned why I was even bothering writing to him, because he hadn’t, in this, the letter it said, ‘I haven’t seen your child for half a decade’. It, it was like trying to make it sound better, that he hadn’t seen my child for such a, a, such a long time. But that wasn’t that the practice hadn’t seen her. He personally hadn’t seen her. So yeah, it, it, they almost didn’t take our concerns very seriously at all. You know, had I been writing in about something else, I don’t know having not dealt with a broken arm correctly or what have you. I do feel they would have taken that far more seriously than the fact that I was writing in about transgender care. (Sue; emphasis added) Experiences such as Sue’s are testament to the ongoing failure to provide good quality care to young trans and gender-diverse people at the level of primary care. They also throw into sharp relief the importance of having a supportive parent or carer. In a way the unfair burden of extra labour that many adult trans people perform to access decent healthcare is shouldered by supportive parents and carers of young trans and gender-­ diverse people, who make the phone calls, write the complaint letters, and push for their young person to be treated with dignity. The fact that this

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work remains necessary but is not a given highlights the dire circumstances that young people who do not have such support in their life face: We’ve had to fight so hard to get that [appropriate healthcare] and my daughter has had me in her corner who is willing to pick up this kind of challenge, you know, to challenge the system and and try to make things right, but there are so many people out there, you know, young trans children, teenagers, adults. People who don’t have a support network behind them who just wouldn’t have any idea that they, they could potentially challenge or certainly wouldn’t have the confidence to do it … her healthcare and her mental health and her physical health really mattered. And for me, potentially, felt like it was at risk because our GPs weren’t responding to us in the early days. So, taking on, taking them on to try and get them to give her what I felt was appropriate and correct healthcare, it was a necessity, and you know, I found it very frustrating at points. Just felt like I wasn’t making headway. I did make headway in the end, but it wasn’t easy, and families shouldn’t have to go through that. (Sue)

The Waiting List: Symptom of a Broken System The waiting list, once we did get onto the waiting list and that took three or four months just to get onto the waiting list. By the time we got onto the waiting list, I think that was in excess of a year. (Claire; emphasis added) I don’t think someone should have to wait two years … to even get into the service, you know, to get that first [inhales] initial discussion and appointment. It just seems, especially at this point in their lives, it just feels like you can make such a difference if they were seen sooner … They’ve already gone through, you know, enough waiting … then to be told well, you gotta wait for a year and a half or two years before we can even start moving down that, that, that path, I think is such a shame. And as a parent it’s horrible because there’s nothing you can do. (Harriet; emphasis in original)

From the start of the research project, on which this book is based, and beyond my immediate work on it, I have watched with dismay the seemingly never-ending increase in the waiting times at the GIDS. In the quote above, Harriet makes a point about two years being a long time to wait for the first appointment. It seems beyond absurd that since her son was referred, the waiting times at the GIDS got even longer, and by a large

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margin at that. In December 2021, the GIDS’ website said that: ‘We are currently seeing young people for their first appointment in GIDS who were referred in 2018’ (GIDS, 2021b). This means that a young person who is referred is unlikely to be seen for at least three years since the moment they are accepted onto the waiting list. The waiting time has been increasing for years now and little has been done to address this. This is reflected in narratives of parents and carers I interviewed for this book, who again often spoke of being ‘lucky’, when discussing the waiting time and how their young person was fortunate to avoid the worst, meaning the longest, waits. Here, the idea of being ‘lucky’, in addition to discursively obscuring the failures of the system, when juxtaposed with others’ accounts, also chronicles the deteriorating situation that young trans and gender-diverse people and their families have been facing in the last few years: I mean, we were, we were quite lucky when, when we first learned that she was trans, so I quite quickly went online and found out about the Tavistock and so on. And at that time it was an 18 week waiting list. (Sophie; emphasis added) When he had been under the Tavistock, he was quite lucky in that, at the moment it’s about a two and a half year wait from referral to his first appointment. But … when my child was first transitioning, he made it within the twenty weeks. So he was probably the last cohort of young people to be in the early intervention team quite early. (Eve; emphasis added) We were really lucky actually because the time that it happened was before this sudden kind of influx of young people kind of being referred. So actually, we only had to wait for about five months and so it was with, within the NHS kind of target timeframe. But that was a few years ago now. So obviously it has changed dramatically. (Anne; emphasis added) Anyway, it got sent off and we were put on the waiting list for Tavistock and at the time, probably lucky and we got in just before the big boom. So they quoted as nine months wait I think it was and that was about what we waited if not a little bit less. So, in regards to the wait times, we were incredibly lucky. (Nathalie; emphasis added) We waited twenty months from the first referral through to our first appointment with them, the NHS service. (Kim)

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I: Do you know how long the wait will be? R: Well, I think, on the letter it said sort of 18 months to 2 years. (Harriet) It is perhaps justifiable to think that a nine-month wait makes one ‘lucky’ compared to the person who must wait for two or over three years for their very first appointment at the GIDS. However, neither should be acceptable and allowing the waiting times to spiral out like they have constitutes a serious failure of the NHS in meeting the needs of young trans and gender diverse people. It is also in violation of NHS England’s statuary duty to provide appropriate treatment within 18 weeks, a point on which it is currently being challenged and one that I return to later in this chapter. It is beyond questioning that the long waits are damaging and unacceptable. The sense of helplessness that parents and carers experience in the face of the long wait is often directly related to the urgency with which their young person needs to access the service: it was difficult when we were on the waiting list without support. Just desperately wanting to go through it. And at that point she was going through puberty and that was creating an awful lot of stress. I didn’t know where to go. And nor did she, obviously. (Beth)

It is important to emphasise that this often-excruciating wait happens in the context where getting onto the waiting list is not straightforward, nor always quick, as discussed in the above section on referrals. The broken system that emerges from parents and carers narratives is one where young people wait to be on the waiting list, only to then wait ludicrously long to be seen by the specialist service. Unsurprisingly, for many, this wait means that they miss out on gender affirming interventions they would have had a chance of getting, at least in theory, had they been seen sooner: I know two years when you’re an adult doesn’t seem like that long. But that’s two years out of somebody’s childhood. Two years, they could, you know, at the beginning of that time they, they could have not entered puberty. By the end of that time, you know, they could be having periods. They could have breasts. They could have a full beard. Their [voice] could have a broken, you know, it’s, it’s really urgent that, that, that young people get seen and the, that the level of, it, it’s hard looking back and the level of anguish and distress. Our daughter was really really ill. She was really unhappy. You know, I used to have to sleep on her bedroom floor at night,

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because she was frightened that she would get out and harm herself. And all that time, we were waiting for help and if it’d been two years, I just, you know. And that’s only, that’s only for the beginning of somebody helping you. (Sophie)

In that sense, having a waiting list that is over three years long is nothing short of denial of care to young trans and gender-diverse people. It ignores the pressures young people face and the time-sensitive nature of their situation. To understand how this functions as a mechanism of control that gatekeeps access to gender-affirming interventions, it is worth quoting the only parent who thought the long waiting times were a positive thing, unsurprisingly, it was the one who self-identified as being ‘gender critical’ and did not accept that his child was trans: R: All the services are massively overstretched at the moment … if you are unlucky you get to Tavistock and then they are massively overstretched as well. So, fortunately, there’s a massive waiting list there, so things hopefully, you know, there’s no rush to do anything. I: So, this kind of brings us to the question around waiting lists. What are your views on the waiting lists? R: I’m very pro waiting list … Say between you and I, we are recording this for posterity. I: Okay. R: Oh, I’m very much not alone on that. Amongst the parental group I chat to, everyone goes, ‘thank God for the waiting list’ is a, is a quite a common repeated phrase, because everyone is terrified of the children going to Tavistock. I’m saying, everyone, everyone in our particular group of about 40, 50 parents. (Stephen) Allowing the waiting lists to balloon out seemingly ad infinitum is thus perfectly aligned with views and wishes of groups and individuals who want to deny young trans people any right to gender-affirming care. It is also evident that the failings of the service to reduce the waits have been allowed to continue for too long. However, and finally, there sems to be some pressure being put on the NHS England to address the issue. In October 2020, Good Law Project, a not-for-profit campaign organisation, sent a Letter before action under the pre-action protocol for juridical review to the NHS England in which it stated that NHS England if ‘acting unlawfully by failing to ensure that

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92% of patients referred by their GP for services commissioned by them… have commenced appropriate treatment within 18 weeks’; it further stated that NHS England has acted unlawfully by failing to take any steps to provide alternative provisions (Rook Irvin Sweeney LLP, 2021). The point on alternative provision is an important one, as the Tavistock and Portland Foundation Trust holds a monopoly over gender identity development services and, as I show in the remaining parts of this chapter, it is often uncooperative when it comes to families paying for private care. The Good Law Project’s website informs that the above-mentioned letter was sent ‘to give them [NHS England] an opportunity to make a concrete and meaningful commitment to meet their statutory duty to young people. If they don’t, we will issue legal proceedings’ (Good Law Project, 2020). Last but not least, the 2021 Care Quality Commission’s report about the service specifically stressed the fact that young people are waiting too long for treatment and the need to reduce waiting times at the GIDS (Care Quality Comission, 2021). It remains to be seen what effect these developments will have. For now, and until it is radically reduced, the waiting list remains a symptom of a broken system and a victory for transphobic groups and individuals.

Gender Identity Development Services: ‘I don’t feel that it is “care”’ (Claire) Of the parents and carers to whom I spoke about half had experiences of going to the GIDS with their young person. Their experiences have largely been a mix of disappointment, despair, and frustration, with only a couple that were satisfied with the care their young person received from the service. When it did work, parents and carers spoke about the value of the relationships between the therapists and their young person and continuity of these relationships in particular: I’m aware that not everyone has had as positive experiences we have as a family. The two people that we see regularly have been amazingly supportive and understanding and informative and we feel really grateful that we have had the opportunity to speak to people that were so understanding and empathic to our family in the individuals and as a collective … the two individuals that we speak to have been just really amazing with how supportive and how understanding and how able, our daughter, and we are able to speak to them. They make it quite fun. They make it quite something that our daughter looks forward to. (Robert)

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When he attended the Tavistock he went monthly for assessment with his therapist who has remained his therapist throughout. So he has had that constant and he’s managed to build up a really good relationship with his therapist at the Tavistock. And finally, maybe a year or so ago, started opening up about other stuff. So, in that way, he’s been supported with them. That’s, that’s been quite good … He speaks to his therapist on his own now. The last year he’s gone in by himself. The first couple of years that he went, I went in with him. (Eve)

Unfortunately, for many parents and carers, going to the GIDS was an experience that was far from positive, but instead left them feeling angry and at times confused, questioning as the title of this section suggests whether what the GIDS offers can even be considered ‘care’. Several parents shared their dismay at what they felt was a lack of structure and clarity in how the service works and who was making the decisions about their young person’s care and on what basis. This, in turn, left families in a lurch, without a meaningful way to engage with or challenge the service when they felt their young person was being failed by it: We’ve completed feedback forms at the Tavistock. We haven’t heard anything. I’ve asked for a meeting with their director of service and haven’t heard anything. So, at the moment, we are in a really difficult situation where we want to be engaging with that service. We want to be managed entirely by that service. But we are prevented from doing so for reasons that we are not clear about and on the basis of decisions that we don’t really understand where they’ve come from. So, it becomes very difficult then to challenge anything … it’s reached a point I think with, within our family where we feel a little bit, feel a little bit hopeless, really … It’s just there doesn’t seem to be a process. There doesn’t seem to be a structure that’s, that supports families in our situation. (Claire)

Claire’s account captures the inadequacy of the existing system: in a service that specialises in looking after trans children, there does not seem to be a structure to support a family with a trans child. The lack of structure and transparency in the way the GIDS specialists work with the young people is also directly linked to the stark inconsistency of the care they provide, an inconsistency that is both a known fact and a cause of anxiety for parents and carers: In talking to other people about their experiences as well and from doing kind of, I suppose by doing research it, it seemed as the Tavi has lots of different types of therapists that work under their, that umbrella. So there’s no

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really kind of standardised care. It really is a bit of a Russian Roulette in terms of who you get. And, I mean, I know that there’s some therapists that are working in the Tavi that are actually ideologically opposed to the notion of trans kids getting any level of support … So, I find it really really concerning…. But actually, they are there as therapists meant to be supporting our kids and yet they’re there potentially looking to try and talk them out of it. (Anne; emphasis added)

Such concerns are present for families still on the waiting list. For example, Tara has only had the very initial phone contact with the GIDS. Her child is still relatively young and has been put on the waiting list; she shared: I have read some articles by some of the GIDS clinicians, which pointed towards transphobia, really. I think, yeah, transphobic ideas. I’m not sure that they are best placed sometimes to be an expert in the area … with that particular consultant, something that happens on the Mermaid’s people are discussing different people [who work at the GIDS] and whether they, what their view is of the children. How they’ve been dealt with and this particular consultant, I was pleased, because she has got a good reputation as being supportive and one of the best … So, I feel confident about the possibility that we will have a good experience, whereas I know a lot of other parents have not had as good experience with GIDS. (Tara)

There is something quite shocking in that transphobic therapists are working with young trans and gender-diverse children at a publicly funded service and that this is somehow common knowledge. It appears that just like in primary care, parents feel they need to screen the service. Perhaps unsurprisingly, the view that ‘unsupportive’ or straight-out transphobic therapists can be found working at the GIDS are refracted in the account of the ‘gender critical’ parent, who shared: The health service, you don’t know what you are gonna get. You’re gonna get some—you can get an activist, an affirming activist, they’ll just get one, there’s just one point of view. I wanted someone who’s gonna look at the broader picture with my daughter and understand the underlying issues of not merely affirm and maybe hurry her onto a medicated pathway. I needed her to speak to a proper professional that’s gonna look at the big picture and I was able to find one through a broader network of supportive parents who work on the non-affirmation model. (Stephen)

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There is a lot going on in the above quote that recycles the most common transphobic tropes of looking for causes and not having the young person ‘hurried onto a medical pathway’, ideas that masquerade as concerns and caution but are effectively aimed at dismissing the young person’s claims to self-knowledge and explaining these away as grounded in some ‘underlying issues’. There is, however, no question that the ‘non-­ affirmation model’ Stephen favours cannot be called anything other than transphobic.

The Appointments Whilst in the mind of Stephen going to the GIDS meant his child will be given testosterone as soon as they step into the building, the accounts of parents and carers who have gone through the process suggest this could not be further from the truth. Perhaps the most striking aspect of the experiences that parents and carers shared with me is how pointless, tedious, and repetitive the appointments at the GIDS felt for them and their young person: Sadly, we did go over the same ground a lot … we did keep finding different teams each time. Various people would leave the service. So we’d have another fresh team and we’d cover the same ground. It was almost like they were treading water … So, it did feel like I say a waste of time, but we didn’t really gain anything … May have been just our situation was unfortunate … Certainly Tavi it was all kind of treading water, really. Wait until you’re old enough … over 18 when you’re an adult and you can make decisions. Up until that point all we can do is have our little friendly chats over the table, which doesn’t help. (Keith) It felt like that’s the thing [going to the GIDS appointments] that needs to be done in order for him to get the blockers … as time went on, my son was kind of going, ‘Do we really need to keep going to these appointments. They just feel pointless’. And I was like ‘Yeah, well we kind of, we do’. (Anne) When we finally got there [to GIDS], we had an assessment appointment. We then, we were allocated two therapists. We had meeting after meeting after meeting … I think there has to be a better way of doing it. But at the moment, we are stuck with the provision that there is. So, we had been seen by the Tavistock and Portman with these two therapists for, I think a little

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over a year. All we had to show for that was an interim report, which didn’t draw any conclusions. Didn’t reach a diagnosis…. (Claire)

Another striking feature was how little the young people and their families were told about the aims of these appointments and what to expect from them and when: they made a diagnosis of gender dysphoria and, and so on. And we had several sessions where we were with one practitioner and she was with another practitioner. But as time went on, the sessions just started to distress her more and more … And we started to have concerns as well, because it was really, we couldn’t really understand what they were doing. So the first bit was really clear. Nobody actually told us, but it, it was pretty clear that what was happening was that she, that they were gonna make a diagnosis … But once they had done that and the sessions just kept going and kept going and kept going, we couldn’t understand what they were doing. We thought they were doing therapy, but then they actually said, ‘oh no, this isn’t therapy’, but it wasn’t really an assessment either … we just couldn’t understand and, and, and they just, they didn’t, they wouldn’t, it was as if they were waiting for us to do or say some magic password, but there was no, there was no indication of what that was. (Sophie; emphasis added) I had heard that they, after six appointments they give you like, almost like diagnosis … But they haven’t given us that … I mean, they’ve been seeing them over four years, and he hasn’t wavered once. So maybe that’s their evidence, I don’t know. I just feel like they don’t, they’re not being thorough enough for me to feel confident in what their [clears throat] what their assessments are gonna be. (Nathalie)

Whilst the appointments felt pointless for many, they were also characterised by never-ending probing and questioning that paradoxically seemed to leave little room for doubt or exploration,2 as the context in which it was happening—that of being assessed and/or diagnosed, and/ or approved for puberty blockers, etc.—prevented it by design; expressing doubts could only mean more questioning and probing, and potentially further delays in accessing gender affirming interventions. It is clear that this format puts a lot of pressure on the young person:

2  The very mission of the GIDS is to provide that space for exploration: ‘We help our clients to explore their feelings and choose the path that best suits their ideals’ (GIDS, 2021a).

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with the therapist that she had to, in that small window she had to make, you know, any concerns that she had, she had to bring up there and then. She had to restate and state again how she felt and what she wanted to go and where she wanted to be. And any expression that she had of doubt would then have to be examined again and gone over again and she’d have—it was almost like you go forward two steps and back one and then forward two steps and back one each time with each session. I can understand that with, yeah, psychologists want to make sure that everything was sorted out as far as possible. But it’s very difficult for a young person who sees time slipping away rapidly to come into a session and get through everything and take on board the help that’s given and, and also try and push forward for what they want. (Beth)

Here again, considering something Stephen shared might make the profound harm of such probing and re-probing approach clearer. When asked what he would like to happen when his child eventually gets to the GIDS, Stephen responded: ‘[I’d want] somebody to say, wait and see. What are the underlying issues? … What is the thinking that makes you think there’s a simple solution. Let’s unpick all the other bits first’ (Stephen). It is in the quest for origins and the focus on leaving no proverbial stone unturned, in unpicking the young people’s accounts of themselves repeatedly that the way the GIDS works, and the wishes of a transphobic parent align ever so perfectly. Open and honest exploration seems further thwarted by a disciplining mechanism that some parents and carers described, where their young person, or themselves wanted to explore certain important for them topics, yet they were made to feel like the time is not yet right to have the conversations they wanted to be having: There was really conversations that felt off limits as well. So, because of how we have been talking at home it was like, okay, we really wanna talk about say … cross sex hormones and although he wasn’t at that point where he was gonna be taking them, he really wanted to talk about it… for instance I would really want to talk about things like fertility preservation … But it was kind of like, ‘oh no, no, no, we’ll talk about that when you get to sixteen and we will allow you to do that’. But we needed to be able to do that then, you know, these were the thoughts that we were having … and there was nobody there to guide us or to say, this is what’s out there or these are the options, and it was all kind of like felt like really, we’re trying to put the brakes on … you know, ‘let’s not talk about that … that’s too far ahead’ and

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it just became more, more frustrating really that there was no place to explore that. And it felt, it became evident as well that actually, you know, the therapy, the therapist, you know, that we saw wasn’t really giving my son any tools in which to deal with the issues that he was maybe going through such as kind of, you know, loneliness or how he might be feeling about his body. (Anne)

What this suggests is that it was predominantly the therapists’ agenda that determined the content of the appointments for Anne and her son. The ‘untimeliness’ of their own concerns can in this context function as a disciplining mechanism and one that effectively denies the young person and their family the right to have their questions answered or concerns addressed and the care and support the service is there, at least in theory, to provide. The appointments can also feel like a never-ending test of the young person’s transness that needs to feel just right to the experts in the room, where the same specialists who do the questioning and testing are responsible for allowing gender-affirming interventions or keeping them out of reach. This is integral to the so-called ‘watch and wait’ approach that is central to the way the service operates. However, and as pointed out by Sophie, waiting and watching in the name of caution is not a neutral act, it is a mechanism of gatekeeping and control that causes harm: being cautious … that’s actually sometimes the most risky thing of all. So … they [the GIDS] have a massive reluctance to … provide blockers and to provide hormone treatment. And if you ask them, I think they would say, ‘Well, we, we are steering a middle course. We, we are being really careful. We are being really cautious’. But they don’t see the damage that that’s doing to young people, you know, they might say, ‘Well it’s only a year. It’s only this’, but in the context of your childhood, that’s a huge amount of damage that, that doesn’t need to be done … withholding treatment is not a neutral thing to do. And I think they, I think they feel like it is. I think they’re saying, ‘oh for, you know … first do no harm’. But sometimes if you don’t do anything that’s the harm. (Sophie; emphasis added)

Such gatekeeping has real and serious consequences for young people’s lives: Yeah, but we were under Tavistock and my daughter was very keen to go on puberty blockers and [3 second pause] … Yeah, she was fifteen and when

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she was going and she was really desperate. The anxiety about everything developing and, and her voice hadn’t broken when we went, initially. But obviously it has, it did. [sighs] She was very frustrated, because she wanted that space and time just marched on … I wish it’d move a bit quicker, but you know, you know yeah … my daughter was desperate to go on puberty blockers, which would have given her more of a breathing space to explain how she felt, that she was a bit let down there, because we had to delay so long. And yeah, there’s been a lot of changes (physical) which she’s even more unhappy with. (Beth)

For many parents and carers, challenging the decisions made by the GIDS might feel impossible, as they are acutely aware that the service provided by the Tavistock and Portman NHS foundation trust is currently the only gender identity development service offered by NHS England. Such monopoly is another symptom of a failed system that is in urgent need of reform; Sophie observed: The fact that the Tavistock is monopoly service … that to me is just, you know, how can that be? How can there be one service that you can go to? And then if everything breaks down like it did with us there’s literally nowhere else for you to go. (Sophie)

It is also clear that such monopoly puts families at the mercy of the service, especially those who lack resources and/or capacity to challenge its decisions. To be able to mount such a challenge, parents and carers need knowledge, confidence, and tenacity (and resources), as illustrated by Claire’s account: we’d been in that service for over a year before we actually realised what was happening. We insisted on a referral to endocrinology. The referral was made. Initially it was refused. We pushed the Tavistock to review their protocol for treating and supporting families of children who were taking the blocker that was prescribed outside of the NHS. They did make some changes to the protocol. We still haven’t had answers to the questions that we want like, who is actually making decisions for our son? … The reason that endocrinology refused to accept our referral was because [my son] was already taking the blocker … I then had to point out that actually, as he was entitled to access private medical treatment as well as NHS treatment, at the same time. And that we could not be refused NHS treatment, because we were accessing private treatment … I was making waves about the fact that my son was being treated differently. (Claire; emphasis added)

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Finally, what can also happen is that a young person can age out of the children and adolescent service and are then pushed onto a waiting list for adults, without receiving any actual help from the GIDS, a point I return to in the next section of this chapter. [my child] had moved on from Tavistock … we got the referral from Tavistock to the [GIC] in London, Charing Cross when they were 17½ … Were told that the adult GIDS had a minimum two year waiting list. Couldn’t survive that two years. Their mental health was in such decline that I couldn’t, I couldn’t envisage them being around that long. (Keith)

It is in moments of desperation like these when the waits seem never ending, or when puberty-related changes are imminent or already happening and their young person feels that they are running out for time, that those who can afford it turn to private healthcare.

Private Care I don’t know what would have happened if we hadn’t been in that position to be able to do that or I actually do have a fear that he probably wouldn’t be here now if we hadn’t accessed private treatment. (Kim)

The options for ‘going private’ when it comes to gender-affirming healthcare are limited for children and young people, with only one provider, GenderGP, offering treatments such as puberty blockers and hormone therapy for under 16s. However, there has been strong resistance to the model of care that Gender GP offers, with the person behind the service facing disciplinary challenges and accusations of misconduct. The case in the Medical Practitioners Tribunal—The General Medical Council versus Dr Helen Webberley—is ongoing and at the time of writing a decision has not been reached (expected outcome spring 2022). Dr Webberley considers the proceedings against her to be ideologically motivated and insists that she has acted in the interest of her patients (GenderGP, 2021). The proceedings against GenderGP have been closely followed by many parents and carers with whom I spoke. Given the inadequacies and pitfalls of the existing system described above, it is not surprising that those who can afford it look for private healthcare options for their young person, especially if their young person and they feel that time might be running out:

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before we started seeing the therapist at the Tavistock and Portman … we had begun to pay privately for hormone blockers for my son. The reason that we did that was because we felt that he deserved an opportunity to be able to explore his identity free from the pressure of time that pubertal development was bringing…. We did a lot of research. We’re both educated people. We consulted closely with [our son]. We knew what the risks were. And we knew what the benefits were likely to be. And we felt that it was worth trying … my son didn’t have any side-effects from the blockers, none whatsoever. If anything … it gave him peace of mind that he didn’t have to worry that he was going to see even more problems created like breast development, like hip development, like the change in the shape of his hands or his face. He didn’t have to worry about a period starting. He didn’t have to worry about how he was perceived by other people. He could just get on and look the way he wanted to look and be the way he wanted to be and be the person he wanted to be, free of any pressure. I think that’s the best decision that we have made. (Claire)

Experiences with the private provider are important to consider because they contrast strongly with the way GIDS works also in terms of what interventions are available to the young people and when. This creates a two- or even a three- tier system when those whose parents or carers can afford it and are affirming can have their gender claims taken seriously and access gender-affirming interventions without having to wait for years: I thought that the way that they conducted [the assessment] was always, with respect and in a very affirming way, I always felt valued and listened to and not, and not judged … there was separate sessions when my son was asked about, quite a lot of depth about his experience. So we’d had, so we’d filled in a huge questionnaire which took us hours to complete. We’d had several assessment interviews … Including one where the therapist explored with my son about fertility and maybe the options to like store eggs and things like that. And then, we got a blood tests with our GP and then went to see the, the consultants and so he was part of the service, where myself and my son had, it was about an hour again, an hour and a half where ultimately they decided and it was a joint decision between ourselves that we’d go straight onto the hormones at that point and not the blockers because of how far my son was through puberty. He’d almost completed puberty. (Kim)

For some, their experiences with the NHS gender identity services made them wish they opted for private healthcare for their young person instead:

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I was doing this journey again starting with what I know now, we would definitely have sought private healthcare, because the, the time when [name of participant’s daughter] was waiting on blockers and waiting for oestrogen was really harmful for her. She, she missed, you know, it was, it was a really bad time. And all that she needed, all that she needed was to be on the correct treatment, that was all that she needed and as soon as she was on it, she was alright. So, if we’d known then yeah, then we would have gone privately. (Sophie)

Further, parents and carers whose children are on the waiting list were considering private care as a future option as a form of contingency planning against their child receiving poor treatment from the NHS services: if we were at GIDS and they were putting us on hold and I could see that see [my daughter] was suffering and her mental health is deteriorating and they were maybe saying, ‘we got to wait a bit longer. She can’t go on puberty blockers’ or whatever. ‘We need to wait’ and then she was, I could see that she was suffering, I would be really tempted to try and go elsewhere to, to help to get her the help she needed. I’d prefer to stay in the NHS if I could if she was getting the right support and I feel like possibly we are gonna get the right support for her, because we’re in the system soon enough. But … I can see other families in the situations where I definitely would go private, because they’re just not getting the support they need at the time they need it. I know of the GenderGP and all the controversy around that. So, I am aware of all the things that are going on with that. (Tara)

Importantly, the solution, in my view, is not more marketisation and privatisation of healthcare that reinforces inequalities based on socio-­ economic status and other axes of inequality. Rather, what is needed is a public health system that delivers timely and affirming care—eliminating the watch and wait approach, which by definition deepens the crisis of inefficiency and creates insufferable waiting times would be the first step—to trans and gender-diverse people of all ages. The fact that that is currently lacking in the United Kingdom means that ‘going private’ becomes, in some instances, the only viable option. Yet, the nature of that option is exclusive by default, with the attached costs prohibitive for many. In addition, young people can be excluded from being able to access private care on the basis of their legal situation, which was the case for Eve’s foster son:

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With my child being looked after, he hasn’t got the option of going through private care. I know there are, there is a GP out there who … saw younger people and did prescribe hormone blockers and cross sex hormones a bit earlier than the GIDS. But it’s never been an option for my lad. (Eve)

Finally, negotiating private healthcare and the NHS services can prove complicated, and is often down to the individual parents or carers to make any arrangement work and pick up any extra labour that results from the lack of integration between the two systems: it’s just a lot of like sorting out, well when we get a blood test, whose gonna do it? How we gonna get the results? How does that work? How does that, is that authorised? How do I get that back and that is a lot of, you know, difficulty, because there isn’t that integration with, you know, private health and the NHS. And it’s not anybody’s fault, particularly … It’s like oh I’ve to get the blood tests done and they’ve sent it off, but they [the private provider] have to ask particular things to be done and then sometimes it isn’t done [on the NHS], because people go ‘oh, it’s a female. We don’t need to test for testosterone’ even through [the private provider] they’ve gone ‘yeah, testosterone’ … so then it comes back and they haven’t done it and so we need to go and get it done again and then they get the results back and then they won’t give me the results until the doctor, the GP has authorised it and so you have to call them and say, can you authorise getting the results and printing it out. Then I have to go and physically get it and then I have to be the one to send it off to [the private provider], you know, so it’s a really kind of long drawn out process. So, there’s that which is, you know, we’re really having to like build this healthcare system from the bottom up. And as a parent, having to manage that, I’m like the case worker, you know, essentially having to kind or organise all of that. (Anne; emphasis added)

Concluding Remarks Writing about healthcare as a site of parents’ and carers’ advocacy is difficult, insomuch that their work in this area feels truly Sisyphean and their experiences and the experiences of their children are often distressing. Whilst the impact of the lack of parental support in the context of healthcare is particularly far-reaching, the support of parents and carers is often simply not enough in the face of systemic failings and institutional inertia within the existing public health ‘pathway’. Based on the above-discussed status quo, I argue that the inadequacy of the healthcare system in place,

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and its overall model, are a source of injury and distress for young trans and gender-diverse people and their families and should thus be reformed away from the harmful ‘watch and wait’ towards a publicly funded model that takes young people and their self-knowledge seriously. As I have demonstrated in this chapter, the advocacy work of affirming parents and carers that happens in this area is crucial at mitigating some of that harm and distress for the young people, but the extent to which this is successful is once again dependent on parents’ and carers’ individual circumstances and access to resources, including financial ones, that might allow them to pay for private healthcare, for example. Again, a question that we should be asking is what happens to the young people whose parents or carers are less willing, or able to advocate for them and/or pay privately for gender-­ affirming treatments. What this chapter has also highlighted is how the serious failings of the current healthcare system plays into the hands of transphobic groups and individuals in ways that make them part and parcel of their agenda. Ignoring this collusion makes one complicit in perpetuating the harms it causes. Whilst it is important that a young person is supported and affirmed by their parents or carers, access to gender-affirming healthcare interventions should not and cannot be made dependent on that support and affirmation. To have such dependency in place violates the right to self-­ determination and deprives young people of agency over their bodies and health and once again gives power to regressive and transphobic narratives and initiatives. Importantly, all the interviews that form the basis of this book took place before the Bell v Tavistock case, which made the situation even more dire, further limiting and delaying access to gender-affirming interventions for young people. To recap, in December 2020, a High Court ruling prevented young people under 16 from getting puberty blockers; the ruling was partially overturned in March 2021, allowing access to puberty blockers, if parental consent was present. Court of Appeal ruling from September 2021 overturned this decision allowing referrals to restart for all eligible young people. However, FOI requests made by the press revealed that since the initial ruling in December 2020, no young people in GIDS’ care have started puberty blockers (Andersson, 2021) and instead an assessment panel was being formed, whilst the service was waiting for an independent review before it would make any more referrals. Combined with the over three-year waiting time that is currently in place to even be seen by the GIDS, it is fair to say that gender-affirming

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healthcare for young trans and gender diverse people in the United Kingdom is borderline non-existent on the NHS. As a way of concluding this chapter, I want to return to the idea that there is an existing ‘pathway’ within the NHS for young trans and gender-­ diverse people. Metaphors can be helpful, as words convey shared meanings and elicit emotional responses. Therefore, I argue that instead of thinking about the existing system as a pathway, it is more accurate to imagine a half-finished multi-level crossing that has been part abandoned, is partially fenced off and full of stop signs and blockades. Another way to imagine it is to think of a dangerous, extremely crowded, roundabout with a ridiculous wait and exits leading to nowhere or bringing you back into the queue from a different direction, but one where you can buy yourself access to an actual exit, provided your parents agree. What operates as the Gender Identity Development Services all but takes away the chance from young people, whose families cannot afford to pay for private treatment, to access gender-affirming interventions to which they have a right; it denies care to young people whose parents do not accept that their child is trans; it keeps families and young people in a limbo, with no support and no alternatives. To call the existing arrangement a ‘pathway’ adds insult to injury.

References Andersson, J. (2021). No under-17s referred for hormone treatment in the last nine months after gender clinic approval. https://inews.co.uk/news/health/ transgender-­y oung-­p eople-­n hs-­h ormone-­t reatment-­p uberty-­b lockers-­ transition-­1205675 Care Quality Comission. (2021). Tavistock and Portman NHS foundation trust gender identity services inspection report. https://api.cqc.org.uk/public/v1/ reports/7ecf93b7-­2b14-­45ea-­a317-­53b6f4804c24?20210120085141 Gender Identity Clinic. (2021). Self-referrals. https://gic.nhs.uk/referrals/ self-­referrals/ GenderGP. (2021). MPTS hearing update from Dr Webberley—What now? https://www.gendergp.com/mpts-hearing-update-from-dr-webberleywhat-now/ GIDS. (2021a). About us. https://gids.nhs.uk/about-­us#main-­content GIDS. (2021b). How long is the wait for a first appointment at GIDS? https:// gids.nhs.uk/how-­long-­wait-­first-­appointment-­gids#how-­long-­is-­the-­wait-­for-­ a-first-­appointment GIDS. (2021c). Information for referrers. https://gids.nhs.uk/referrals

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Good Law Project. (2020). The NHS must fulfil its duty to young people. https:// goodlawproject.org/update/nhs-­duty-­to-­young-­people/ Mikulak, M. (2021). For whom is ignorance bliss? ignorance, its functions and transformative potential in trans health. Journal of Gender Studies, 1–11. https://doi.org/10.1080/09589236.2021.1880884 Mikulak, M., Ryan, S., Ma, R., Martin, S., Stewart, J., Davidson, S., & Stepney, M. (2021). Health professionals’ identified barriers to trans health care: a qualitative interview study. British Journal of General Practice, 71(713), e941–e947. https://doi.org/10.3399/bjgp.2021.0179 NHS England. (2019). NHS standard contract for gender identity development service for children and adolescents. https://www.england.nhs.uk/wp-­content/ uploads/2017/04/gender-­development-­service-­children-­adolescents.pdf Pearce, R. (2018). Understanding trans health: Discourse, power and possibility. Policy Press. Rook Irvin Sweeney LLP. (2021, October 20). Letter before action under the pre-­ action protocol for juridical review. https://drive.google.com/file/d/ 1Qb5iUshzWopd3OkjkJvXy1-­OqT2xEVs2/view

CHAPTER 5

More than Bullying, Less than Support: Parental Advocacy and Re(inventing) the Wheel of Inclusion of Trans and Gender-­Diverse Young People in School

I’d heard of other situations where schools hadn’t been accepting. So, it was a relief more than anything, a relief that they were going to be supporting of her. And then it made me confident, and we could instill confidence in each other so the day that we walked, we went to school when she was first dressed [in girl’s uniform]. We both were scared. But we supported each other and that gave me confidence that she could do it and she was confident that I supported her and that I would do my best to make it as easy as possible for her. (Tara) We’ve been really really lucky … it’s been fantastic … her school friends were very supportive. The school were very supportive. Things have been fine at college and … the way that she’s been received by everybody has been really really positive. Everyone’s been really great about it. (Sophie)

The importance of both the school and parents or carers being supportive and affirming cannot be underestimated for the wellbeing of young trans and gender-diverse people. It is also crucial that parents and carers communicate with schools and vice versa. The benefits of school-­home liaison are well documented (Bastiani & Wolfendale, 1996), even if they are yet to be explored from the perspective of families of trans and gender-diverse young people. It is through the combined and sustained support from schools and parents that Tara and Sophie’s daughters can go to school © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2_5

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without the fear of being treated unfairly, singled out and/or bullied, and can just get on with their education like their cisgender peers. Unfortunately, such positive experiences with schools are still not the norm, they are also related, albeit not always in a linear way,1 to families’ socio-economic status, and several parents and carers shared stories of varying degrees of lack of support and/or understanding, with which their young person was met by both school authorities and other pupils. This resonates with existing research in this area, which shows that despite some positive changes, and an increased focus on LGBT inclusion, schools are spaces that continue to be unsafe for trans and gender-diverse young people (Bartholomaeus & Riggs, 2017; Bradlow et al., 2017; Horton, 2020). The Stonewall School Report makes several recommendations for making schools safer for all LGBT youth; these recommendations focus on leadership, inclusivity in policies, curriculum, and practice, as well as on the need for extra support and information for both the young people and staff. A particular recommendation is made in relation to trans pupils, and schools are urged to provide specific support for this group: Explicit references to supporting trans pupils should be included in all relevant policies, which are understood by all members of staff. Staff should work together with each trans young person to ask them what would make them feel comfortable and discuss levels of confidentiality, and ensure they have access to uniforms, activities and facilities they feel most comfortable in. Clear signposting should be given to resources, local support groups and trans organisations. (Bradlow et al., 2017, p. 39)

Interestingly, the Stonewall report does not focus on the role of supportive and affirming parents and carers, instead it urges schools to also ‘provide information and signposting to parents and carers’ (Bradlow et al., 2017, p. 39). In this framing, schools are seen as potential drivers of positive change that are encouraged to ‘talk to parents and carers about their work to combat homophobic, biphobic and transphobic bullying and support LGBT pupils, and answer any questions they might have’ (Bradlow et al., 2017, p. 39). This is key for young people whose parents are unsupportive and/or prejudiced, a point I revisit later in this chapter. At the same time, in this framing, parents appear as another group to be 1  I spoke with parents who were from middle class, whose children faced discrimination in school, as well as with working-class parents and carers who shared more positive experience of trans-inclusive education.

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educated by schools on issues of inclusion and equality, and, undoubtedly, many parents and carers can and will benefit from being educated by their young person’s school, provided the school is indeed equipped and willing to take on this educational task. Yet, and as this chapter stresses, these roles are often reversed and affirming parents and carers are frequently engaged in making school life more inclusive, and at times working with uninformed and inexperienced school leaders. Through their often-relentless advocacy work, they challenge exclusionary and transphobic practices, assumptions, and settings with and on behalf of their young person. This chapter focuses on these experiences and highlights the work parents and carers of trans and gender-diverse children do to make school environments safer and better for their young person. This is not unlike the extensive labour that they perform in relation to healthcare (see Chap. 4). Exploring issues around uniforms, activities, and the physical environment of the educational landscape, this chapter also demonstrates how the intense cisgendering of children that takes place in schools not only presents challenges for inclusion but also how it offers some limited possibility for gender-affirming experiences to young trans people. Here again, I show how supportive parents and carers are key to facilitating negotiations with the school around issues that inevitably arise from the binary, cisnormative ordering of school life and environments. Because, and as discussed in the previous chapters, parents and carers are often equipped with an arsenal of information and knowledge, they also have a fundamental role to play in holding schools accountable for failings to meet their statutory obligations towards trans and gender-diverse pupils. However, and as I discuss in this chapter, parental advocacy can certainly not fix everything, and in certain areas, such as transphobic bullying, it is necessary for schools to do more and do better. At the same time, when discussing the issue of bullying, I emphasise how individual problems are symptomatic of systemic issues that enable and reproduce trans negative attitudes and prejudice towards trans and gender-diverse children and adults. As signalled above, in this chapter I also highlight how schools can and should play an important role and be allies to young trans and gender-diverse people in situations where their parents hold transphobic views and choose not to affirm them. Finally, I critically engage with the idea that inclusion of trans and gender-diverse pupils is something new and argue that the wheel of inclusion should not have to be reinvented with every trans or non-­ binary pupil.

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Girls to the Left Boys to the Right and You Go Change in the Staff Toilet In terms of using toilets and … PE and stuff like that. They [the school] weren’t as forthcoming or as supportive in him using the, the male toilets or do PE with boys and stuff like that. (Kim)

Schools (re)produce, maintain, and police gender binaries through activities, policies, and the resulting physical environment—which in turn reinforces and reproduces the binary gender division—that group young people along the line of cisgenderist and often heterosexist assumptions. The resultant gender segregation can be distressing for trans and gender-­ diverse young people (see also Jones et al., 2016): She was nine. She went to middle school, and they segregated the boys from the girls. So, they made them line up and they separated them for PE. They made them line up differently … and the fall-out from that was catastrophic, actually. (Claire)

When articulated and taken seriously, young trans and gender-diverse people’s claims to their own gendered selves chip away at the foundations of this naturalised and naturalising order pushing against the cisgenderist and binary norms that rule school life and activities. However, being different often comes at a cost, as those who cannot be easily accommodated in the existing regime risk being singled out, or excluded, even if the exclusion is framed as an accommodation: we had to inform the school, because things were getting a little bit tricky with regards to PE and, and changing rooms and sports, ‘cos it’s a typical school where boys play football and rugby and girls played hockey and netball. So, and the school, in fairness got on board with it and were very supportive and just said, whatever our daughter wanted to do then that was absolutely fine by them. They just still wanted her to continue with her schooling and … [but] sport was completely out. She didn’t have to attend any sport. And the toilets, which again, she would have the key to staff toilet. (Tom)

Having a key to a staff toilet is not the same as being allowed to use the toilet one feels most comfortable using, which is what schools should be accommodating (Jones et al., 2016, pp. 167–168). Rather, existing beliefs

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about gender are reflected in the physical environments and reproduced in school’s responses to the trans girl’s presence, which is made exceptional. I return to the issue with exceptions and ‘lack of precedence’ later in this chapter. Nevertheless, what is key here is that the sharp, yet completely arbitrary divide along the gender binary (in sports, activities, and places such as toilets or changing rooms) leaves young trans and non-binary people stranded, caught in unsettling negotiations and deliberations: ‘It was a bit tricky in the beginning because I mean the talk was around toilets. Which toilet does she use?’ (Lucy). Schools can, and at times do, respond affirmingly from the get-go: ‘[My daughter] was always … allowed to use the girl’s toilets from the start’ (Tara). But they also can and have refused to accommodate trans and non-binary young people, leaving them isolated and excluded: Things like toilets, they were never allowed to use the male toilet, because the school had them down as female. So, you’ve got to use the girl’s toilets. Changing for PE there was none of this, which now I think is in place that you can go and use the disabled toilet to change in [which was not there at the time]. (Keith)

Uniforms Perhaps because I grew up and went to school in a country where school uniforms were not a thing—reflecting the break from the socialist past, where uniforms and uniformity were fetishised—I find the insistence on ‘girling’ and ‘boying’ of young people through rules around uniforms gratuitously punitive. However, this gendering happens in the larger context of binary gender policing and cisgendering (Moon, 2019), and as queer studies scholars continuously point out, it is also an important reminder that gender is accomplished (Butler, 1997, 2004), as much as it is felt or experienced: Wearing particular clothes or acting in certain ways in the social world helps to constitute the body as male or female because social experiences, actions and practices become embodied over time … As children and young people develop their gendered world, it will be expected that they present appearances, actions, behaviours and practices that reflect an embodied cis-­ gendered ‘self’. (Moon, 2019, p. 69)

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The cisgenderist and heterosexist regime that makes it impossible for a trans child to use a toilet or changing room they feel comfortable using is thus further impressed onto the young people’s bodies through rules about uniforms and haircuts, visually marking and segregating them. Here another minefield of potentially distressing experiences awaits as young people are made to wear clothes of the gender they were assigned at birth. At the same time, what the gendering of uniforms means is that young people are effectively forced to choose between coming out at school and having to wear clothes and hairstyles that they might find distressing: My daughter wouldn’t let me tell the school what the concern was. But there was a very strict policy at the school … regarding uniform and haircuts. And it’s very difficult to explain to somebody why your child was having a meltdown because they had to have their hair cut. (Beth)

It is because gender is so strictly policed in schools and rules that ensure compliance with the cisgenderist binary are folded into the physical environments and impressed onto pupils’ bodies that schools become sites of intense negotiations for young people who cannot easily be pushed into the existing tracks. For the young person, these negotiations might be central to their social transition, as discussed in Chap. 2; if they are successful in negotiating the minefield of gendered expectations at school—a task often managed and facilitated by affirming parents and carers. The intensely gendered school environments can at times offer a possibility for affirming their gender, again, provided that it can be mapped onto the binary model and thus remains intelligible: [My son] got his hair cut shortish and not, not hugely short, but a short bob. And he was made up that around about the time when the school photographers had come in, they positioned the, the girls and the boys differently. And so they positioned him as a boy when he was five and he was made up. (Kim)

The logic of ‘positioning’ five-year-old children differently for photographs based on their gender highlights how relentless the gendering that takes place in schools every step of the way is, yet that does not take away from the joy Kim’s son experienced in that gender-affirming moment. Similarly, for trans girls and boys, being able to move to wearing a uniform of the gender the young person is becomes a way to assert the gendered self and can, again, be an important milestone of their social transition:

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He asked if he could wear boy’s uniform when he was probably about six. So, I think he only had one school year of wearing summer dresses. Head teacher was very accommodating, and she said ‘he—or she at that time—is here to learn, and that’s fine’. (Claire; emphasis added)

Here again parental support and advocacy come into play, as parents and carers can act as important intermediaries between the young person and school staff, they can help the young person articulate their wishes and facilitate the process of making them known. Thus, affirming parents and carers are key allies in helping the young person make their claim to gendered selfhood outside of the family, as much as within it, as I discuss in Chap. 6. The importance of that claim and its emotional weight for the young person is captured in Tara’s account, which deserves to be quoted at length also because it highlights the anxieties of both the parent and the child as they negotiate the transition to a girl’s uniform: I didn’t want her to be in that position where she was teased and bullied for wearing a girl’s uniform. But eventually, after we bought her a pair of girl’s school shoes and she wore those with her … boy’s uniform … it was like one step at a time for her … I felt like she was trying to move forward and sort of questioning me whether she’d be able to do that and so we, we decided to go and see the head teacher. We made an appointment. Oh no, actually, just before we made the appointment, we went to a parents evening and with her teacher and she was like, ‘tell her, tell her, tell the teacher’ [whispers]. So I said, ‘He—at the time—wants me to tell you that he wants to come in a girl’s uniform’. And the teacher’s response was, without flinching, ‘That’s fine. Don’t worry. There’s no problem with that, you know’. As soon as she said that, the teacher, [my daughter] started crying. It was like a relief … [that] the teacher accepts me and I can move forward with what I want to do next … she wanted me to go see the head teacher and so we made an appointment with the head teacher and again, he was accepting. So, all these, all these accepting steps meant that she felt more confident, every day through this quite short process, really. He said, ‘When do you want to come dressed in the girl’s uniform’. And she said, ‘Tomorrow, tomorrow’. So, we left the head teacher’s office and went round to George at Asda then tried on all the uniform, bought her the uniform. The next day she went in the girl’s uniform and that was at the beginning of it all of her just becoming this confident little girl that she always was, and we didn’t realise. (Tara)

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In this quote, what is both deeply moving and significant is how the anxious build up is resolved in the accepting response from the class and head teachers. This accepting response is crucial for the young girl’s confidence but also for Tara, the relief they both feel demonstrates that such a positive response was not a given for either of them. It also signals the lack of awareness and a sense of exceptionalism that surrounds even the most positive experiences with schools.

Bullying It is without doubt that no young person should be subjected to bullying or violence at school, or anywhere else for that matter, because of their gender yet bullying remains a serious issue for many trans and genderdiverse young people. The prevalence of bullying that trans pupils experience in the United Kingdom is both shocking and indicative of the scale of the problem of schools being unsafe for young trans and gender-­diverse people; the Stonewall School Report states: Trans pupils are at particular risk of bullying: half (51 per cent) are bullied at school for being trans. Trans pupils are also bullied on the basis of their perceived or actual sexual orientation: when taking into account those who experience bullying due to their gender identity and/or sexual orientation, nearly two in three (64 per cent) trans pupils overall are bullied for being LGBT at school. (Bradlow et al., 2017, p. 10)

Sadly, my research with parents and carers of trans and gender-diverse young people echoes these findings. Several parents shared stories of their young person being bullied at school and the toll that took on their young person’s mental health; in some cases, the bullying was so bad that they felt the only solution was for the young person to change schools: He’s had to move school a few times and partly that’s because he was subject to quite a significant amount of … transphobic bullying … which amounted to like several hate incidents from other students and that contributed to the, the deterioration in his mental health … they weren’t responding to the issues of bullying. They … weren’t acknowledging the true impact of the bullying and the extent it was happening. They, they were, not that they tried to dismiss it, but I think they tried to minimise it. (Kim)

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For some young people, previous experience of bullying meant that they chose not to disclose their trans status in the new school to avoid further victimisation: We had a planned transition over a half term period, where she had her hair cut … And he went back into school. All was well for a few months. Then the bullying started … soon, he became a bit of a target and so that got really uncomfortable. We then moved him into a different school, and he’s been in stealth since then. (Claire)

Parents and carers with whom I talked felt particularly despondent about the often-inadequate, insensitive, and ignorant responses from the school: They [the school] … were absolutely diabolical, really. Didn’t, didn’t do any—I went in to see the headmaster over the three-year period I think I went in six or seven times. And all they’ve actually done was put my child in the isolation block, rather than deal with the bullies. There’s five or six people doing the bullying. It’s easier to deal with your one individual than it is deal with the five or six, rather than stop the bullying we’ll extract your child from the situation where they get bullied and put them in the isolation unit, which, my child was isolated already or feeling isolated, feeling different from everybody and then was put in the isolation block, which then actually created more bullying. (Keith) When we did go and tell school, we had to in year eleven, he didn’t, he was on a restricted timetable and he didn’t actually go to school as much. He went every day. So, he was brilliant in that his attendance didn’t suffer. But he was not in any social time at school, so he was completely isolated. So, he went, he missed tutor group at the beginning of the day. At break time, he was given a special place to go to. At lunchtime, he would come home and then he wouldn’t return to lessons after lunch. He, out of his ten subjects, he didn’t go to three of them anymore because he just felt unsafe in those lessons. He felt unsafe in social times at school … he just kind of existed at school as a bit of a ghost, if you like. He wasn’t actually participating in school. (Harriet)

In the above accounts, the schools’ responses to bullying fall short, to say the least. Worse still, they make the young person who is being bullied and ostracised carry the weight of adjustment in ways that exclude them from social life, isolating them further and exacerbating the problem.

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These responses are wrong per se, but they also signal a wider problem, where young trans and gender-diverse people do not get adequate support that responds to their individual circumstances and needs, but are instead treated as somehow problematic, effectively punishing them for being different: she became very introverted over that period of time and extremely anxious, had panic attacks [sighs] and the school did provide a bit of support, but it was mainly, she was lumped in with a therapy group for very violent pupils, which wasn’t particularly helpful. (Beth)

Conversely, supportive and early responses from the school leadership to bullying can make a huge difference to how the young person is received at school, they can support the young person’s social transition and prevent the problem escalating: ‘any little bits of bullying that she had initially, the head teacher just nipped it in the bud straight away and she hasn’t really had a problem at school at all since then’ (Tara). The accounts presented here make it evident that bullying remains a serious problem that affects many trans and gender-diverse young people; it is also key to acknowledge that no amount of parental support is ever going to be enough if the school does too little, does it too late, or does the wrong thing to address the issue. Individual circumstances might mitigate the impact bullying has on the young person and parents can act as whistle blowers in cases where bullying is not being addressed. However, and agreeing with Horton (2020), I want to stress that bullying needs to be seen and treated as a symptom of a larger systemic issue and, therefore, to focus on bullying is not enough in and of itself: Commitment to tackling intentional transphobic bullying is very important, but it is only a first step toward a positive school climate for trans pupils, not an end goal. Underpinning this shift is commitment to understanding the ways in which trans pupils experience and are negatively impacted by systemic cisnormativity, the additional burden this places on trans pupils’ shoulders and the cumulative toll it takes. (Horton, 2020, p. 13)

To tackle transphobic bullying and other issues faced by trans pupils successfully, schools need a ‘strategic, longterm approach’, policies that also focus on prevention; they also need to incorporate teaching about gender diversity throughout the curriculum in age-appropriate ways from

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an early age (Mitchell et al., 2014, p. 6). Lack of such strategic approach and foresight results in young people being let down, repeatedly, and harmed: it got worse when he had his hair cut. He started binding as well, wearing a binder. And so, that was a much obvious sign to everybody that he was different to them. He had told them that he was gay some years earlier. So, I think that whole, you know—I don’t know that they thought he was trans or, or what they thought. But they were vicious. And to be fair to the school because we didn’t know, we didn’t tell them and so the school couldn’t do anything about it. I do sometimes feel let down that nobody noticed at school. That nobody kind of was looking out for him. Especially, as he had had these problems before and the main person that was causing him the problems was the same person from previous years. So, I do sometimes feel quite disappointed that, actually nobody, nobody thought to even ask the question. (Harriet)

Schools cannot expect that young people will always come forward and report bullying, they should also not rely on parents to identify and report transphobic bullying. Harriet has every right to feel disappointed for the way her son’s school failed in their duty of care towards him. Eradicating transphobic bullying and creating an environment that is safe for all pupils is the responsibility of the school, and whilst parental involvement might be key, schools must do better to identify transphobic bullying and be more proactive in preventing young people being targeted in the first place. As I discuss in the next part of this chapter, schools also have a role to play in the lives of students who face rejection and transphobia at home, a role they cannot fulfil if they fail to provide trans and gender-diverse young people with a space where they feel safe to be who they are. Last, but not the least, even though what parents and carers can do about their young person being bullied at school is limited, if things fail to improve, they can help their young person change schools. They can seek out alternatives to toxic educational environments and help their young person choose a school that might offer more support. This can be a labour-intensive process as parents and carers have to invest time and energy into identifying and researching alternatives and ensuring that the support schools claim to offer is in fact there: [when choosing the new school] we looked at the pastoral support, in general. The emotional support that they offered to students. But not only what they [3 sec pause] not only the jargon of, of what is said, but actually speak-

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ing to them to see what … they did in practice because … we’d already moved schools once and the jargon from … the second school we went to was all about individualised wellbeing support and stuff like that. And I was sold on it. I thought that that’s fantastic. But in reality, reality didn’t fit. So, what they said they’d provided and what they actually provided there was a huge discrepancy. So, with this school … I went to great lengths to ensure that actually what they said they provided they actually did provide. That’s the bit that’s made a difference. He’s got a pastoral support, a named pastoral support, that he can link to at any point … And they’ve been great. (Kim)

When Home Is Where the Transphobic Bullying Happens Because not all young trans and gender-diverse people are affirmed and accepted by their families, it is even more important to make schools not only free from transphobic bullying but also into spaces that are gender-­ inclusive and trans positive. For young people whose parents are unsupportive, having the support of their school might be key in allowing them a small degree of freedom and self-determination, even if they are being denied it at home: R: [name of Stephen’s child] was also asked at school if she could have arrangements made for her. We had a meeting with the school, the school were concerned, ‘cos there was a precedent at the school … So, I’m seeing social contagion here … So, some arrangements were made … she’s got a new, she’s got a name as such at, at school now. She goes by a nickname with her friends and teachers … We call her naturally by her proper name at home. And we don’t use any … new pronouns. We’re quite firm on this, because from our point of view, as parents, we need to stay firm a troubled 13-year-old cannot make momentous decisions about … medicalisation and surgery. So, we need to stay firm and compassionate, but firm in this. We don’t want to feed into this. Unfortunately, some elements of the school refer to my daughter as ‘he’ and make a point of doing so … I don’t believe this is the correct approach. I think you need to wait and see. I: So when you say that some of the teachers refer to your daughter as ‘he’ how does your daughter want to be referred to? Is it… because she’d requested to be referred to as a ‘he’? R:  Sort of. She’s picked, some teachers have picked up on it. The school, I’d said to the school, I’d said, ‘Look just leave things as they are for now’. (Stephen; emphasis added)

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In the case of Stephen’s child, the school is a place where their wishes regarding the name and pronouns are respected, despite Stephen’s explicit disapproval. There is a lot going on in the extract above; Stephen seems to believe that accepting his child’s choice of name would inevitably lead to them having gender-affirming surgery, an outcome he considers as a guarantee of ‘life of mental and physical scarring and unhappiness’ (Stephen); further, he believes that his child ‘caught’ transness at school.2 Refusing to address his child by name and pronouns, with which they are comfortable is thus folded into a range of prejudiced and misinformed views. The outright transphobic beliefs held by Stephen were, however, not enough to stop the school from respecting his child’s wishes. This points to the possibility of schools offering a safe space for young people whose parents or carers hold transphobic and harmful views. It is perhaps in these situations that schools can provide the most support—in relative terms—and be a counterweight to the non-affirming home environments, in which some young people live. To be able to be that for the young people, schools need to have clear policies in place and trans-­ positive practices that are ambitious. This means that they should be putting the wellbeing of the young people in their care first, part of this means that they should also be doing more to challenge transphobic views held by parents and carers. Trans-positive language in schools is important and using the correct name and pronouns demonstrates the very basic level of respect (Horton, 2020). Importantly, in situations when misgendering happens in the school, supportive parents can intervene to ensure their young person’s rights are upheld: when I enrolled him, when we went to enroll, we got his name legally changed that morning. We got it witnessed so that he was always on the register as his male name so that there could be no mix up. And so he was, he has still been misgendered by teachers there which he finds very upsetting obviously because his name is, is you know, categorically a boy’s name. There’s no room for, it’s not an ambiguous name. But we have, I, I said to him, we need to sort it out straight away, not just let it drag on. So, I got in touch with the person at school and that was sorted out. And they apologised to him so, you know, that’s good. They’ve dealt with that well. (Harriet; emphasis added) 2  Along this belief, Stephen also held that his child ‘suffers’ from ‘rapid onset of gender dysphoria’, a made-up diagnosis that has been dismissed as transphobic pseudo-science (Ashley, 2020; AusPATH, 2020; WPATH, 2018).

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Here, once again, we need to stop and think about what happens to young people whose parents or carers hold transphobic views and refuse to affirm their child, who might also end up in a school environment that is unsafe and discriminatory, with nobody to challenge it on their behalf? It is only by addressing lack of support within schools and equipping schools to challenge harmful views that parents and pupils might have that we give these young people a chance at a safe and happy school life. Harnessing the positive input of supportive and affirming parents should be part and parcel of this effort, yet and as I examine next, such input is often underutilized and at times squandered.

Co-producing Positive Change (Over, and Over Again…) school were very supportive, teachers-wise they delivered a programme, which my sister actually has devised for another school … in her role as a member of the teaching staff. And we, and that all seemed to be really successful. We learned, you know, it’s a really steep learning curve, but we managed it well, I think. (Claire)

In her book, Gill-Peterson speaks of the ‘conceit of the newness of trans childhood’ (Gill-Peterson, 2018, p. 195), this is key when thinking about gender-inclusive school policies and how these are often and still absent. Just as trans childhoods are not a ‘new’ phenomenon, inclusion of trans pupils should not be treated like something exceptional or novel (Horton, 2020; Mitchell et al., 2014), which means that with each trans pupil, the wheel of inclusion should not need to be reinvented, placing the burden of education over and over again on parents and carers—when they are up to the task—and the young people themselves. In the third decade of the twenty-first century, a trans or a gender-diverse pupil should not amount to a situation where any school finds itself embarking on a ‘steep learning curve’, yet here it is. Claire’s account above is not an exception in capturing how the school leadership relies on parental involvement to provide the most basic of training around inclusion of trans pupils. Thus, affirming parents and carers actively participate in co-producing trans-inclusive school policies in settings where these are absent: he transitioned at school in primary year five. Primary school was really supportive … They didn’t quite understand how they didn’t have the right to

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tell every single parent in the school that he was trans. They thought, you know, because he wanted to use the boy’s toilets, he wanted to get changed separately from the girls. That they had to inform everybody. So, it was just a case of updating them in regards to the [law] … Once they’ve got the swing of that they changed the policy and they created a whole new trans policy for the whole school. The transition went really smoothly. (Eve)

I: Did the school have any previous experience [supporting a trans child]? R: No, no, but the teacher, as soon as this situation happened, he … obviously researched locally and found other schools locally that had trans kids in their school and he wrote up a policy based on some of the websites that I sent in through my contact with Mermaids. I sent him like a toolkit and things from Brighton and he took that along with the advice from other schools in the area and he wrote the policy, quite quickly, which he gave to me to look at. And then once that was approved, that was in place. (Tara) What is quite striking in these accounts is how the lack of competence and ignorance on the part of school leadership is glanced over by parents and carers if the schools are willing to make changes and allow for accommodations. In Eve and Claire’s accounts, schools are identified as ‘supportive’ even if they clearly lack the very basic policies and knowledge about how to support trans pupils. Tara accredits the teacher with the creation of the policy, to which she clearly contributed, and which she was asked to review. In all these cases, the schools had no existing policies and had to scramble to put these in place. The arrival of a trans child caught them by ‘surprise’, an exceptional event that mobilised exceptional measures. Conversely, this was not the case for all the young people whose parents I interviewed, and Tom and Camilla found the school to be somewhat experienced and largely supportive: she finished school for the summer as [male name] and then went back to school in September as [female name]. So that was, that was really how it happened … And the school had been brilliant … we were a bit [pauses] worried how, how the school would react. [3 sec pause] Do you know what I mean…. we thought maybe they, that they struggle, the school would maybe struggle with, with these issues, ‘cos maybe we thought that we were the only parents on the planet that were going through this. But of course the school told us that there’ve been three or four children before, before ours that, that transitioned in the, in the school. So they were, they were

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quite familiar with it, actually. And then we had a meeting with the ­teachers … And got everything out and sorted and—that was the essence of it. (Tom)3

Nevertheless, the reality is that many schools still claim to lack experience and knowledge in accommodating trans and gender-diverse pupils, and by extension do not have any trans-inclusive policies in place. Such claims to what is effectively wilful ignorance are far from innocent and should be seen as negligence on the part of educational providers, not unlike the claims to ignorance I have written about in relation to trans healthcare (Mikulak, 2021). Just like in healthcare, in education, young trans and gender-diverse people and their families are met with unacceptable levels of ignorance that leave them having to advocate for basic accommodations and inclusion guaranteed by the existing laws. This task can be made even more difficult by institutional inertia, which Claire understands to be both endemic and grounded in fear: I really struggled to get [support] other than school who purported to be helpful, but actually, they were helpful, but they were scared. I think they were very anxious about. And every, in fact, every service pretty much that I’ve engaged with … every organisation that I’ve approached always comes with this note of caution. You know, there is always sort of always sort of looking over their shoulders to make sure that they are not going to be in trouble for one thing or another. And I didn’t really, I didn’t really feel that that was helpful to me. The school were helpful, and they did implement what we wanted. On a couple of occasions, they tried row back from that. I had to be very robust and say, I had to equip myself with legal knowledge, practical knowledge, and encyclopaedia of contacts, articles. (Claire; emphasis added)

Claire’s account is troubling because it shows that supportive parents and carers might need to not only set the foundations of inclusion for their young person but also watch over them and remain vigilant, engaged, and resourceful to be able to respond to any ‘rowing back’. The added burden of monitoring falling squarely onto their shoulders and making any, however modest, victories conditional. In this context, it is the parents who educate the schools and they do it repeatedly. What this points to is an

3  However, this is the same school where their daughter ‘didn’t have to attend any sport. And … she would … have the key to staff toilet’ (Tom) (see earlier in this chapter).

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urgent need for systemic solutions that would take the pressure off individual families, a point also made by Horton: At present, trans-inclusive adaptations [in schools] are too often prompted by a specific pupil, a ‘sacrificial lamb’ who sends a school into ‘panic’, and for whom individualised adaptations are made, adaptations that may not be sustained or transferred to wider classes. The pressure that this individualised approach puts on pioneer children and families is immense and unreasonable. (Horton, 2020, p. 13)

Such sense of panic and the resulting pressure that is placed on the families is present in the accounts of several parents and carers, with whom I spoke, and it is woven throughout this chapter. Considering that this is an additional source of pressure that families experience, in the context of societal prejudice and the almost non-existent access to healthcare, schools must do more, and better, to meet the needs of trans and gender-diverse pupils proactively and systemically. Relatedly, the fear that Claire identifies as a basis of operating for many institutions links back to the issue of toxicity of the public debate surrounding trans kids and its impact on all social contexts, including schools. It also connects to a larger problem of schools existing in a landscape where they are directly exposed to anti-trans lobbying and pressures from conservative groups that campaign against trans inclusion and rights (Bartholomaeus & Riggs, 2017). For supportive parents and carers this is a real worry: There’s a lot of work out there that looks legit … There is a, a group of anti trans adults out there who have created their own toolkits, basically saying, don’t support the child in their preferred gender, keep ‘em as their birth gender, you know, and it looks very professional. And the scary thing is, if schools access this they’ll think it’s the right thing to do. (Eve)

Concluding Remarks In this chapter, I examined the different layers and limits of parental advocacy in schools, as well as making the case for schools to do more, and to do it methodically as opposed to ad hoc, to meet their duty of care towards trans and gender-diverse pupils. I argue that the lack of trans-positive and gender-inclusive policies in schools and the constant reinventing of the wheel of inclusion, paired with the overreliance on individual, parental

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labour are different facets of the same issue of historical erasures and omissions of trans childhoods and youth identified by Gill-Peterson (2018); this is because, as she so eloquently puts it: The twenty-first century figuration of the trans child as futuristic does harm when its novelty erases historical precedents to the demands for recognition, dignity, and a livable life that are being made by and on behalf of transgender children today. (Gill-Peterson, 2018, p. 195)

The apparent sense of exceptionalism with which the schools approached almost every young person whose parents or carers I spoke with points to a systemic inability and unwillingness to accept the simple fact that trans children exist not as an exception and that they are disenfranchised within the current educational systems. Consequently, here again, affirming and supportive parenting practices of trans and gender-diverse young people and the often-intense labour done by parents and carers with schools must be understood as practices that further social justice. Yet, and as I have argued in this chapter, exclusion, transphobia, and the resultant bullying cannot be resolved by individual advocacy alone. When parents and carers engage with schools, what is thrown into sharp relief is the limits of individual and isolated parental efforts to challenge trans-negativity in the school context; even if these efforts are at times able to improve the situation for their individual young person. Relying on parents and carers to address gaps and omissions in school policies is not where the bar should be set for gender-inclusive education. Nowhere is it more visible than in cases where parents are unsupportive of their young person, who then might be allowed a degree of self-determination and freedom in school, even if they are denied it in the family home.

References Ashley, F. (2020). A critical commentary on ‘rapid-onset gender dysphoria’. The Sociological Review, 68(4), 779–799. https://doi.org/10.1177/003802 6120934693 AusPATH. (2020). AusPATH position statement on ‘Rapid-Onset Gender Dysphoria (ROGD)’. https://auspath.org/auspath-­position-­statement-­on-­ rapid-­onset-­gender-­dysphoria-­rogd/ Bartholomaeus, C., & Riggs, D. W. (2017). Whole-of-school approaches to supporting transgender students, staff, and parents. International Journal of Transgenderism, 18(4), 361–366. https://doi.org/10.1080/1553273 9.2017.1355648

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Bastiani, J., & Wolfendale, S. (1996). Home-school work in Britain : Review, reflection and development. David Fulton. Bradlow, J., Bartram, F., Guasp, A., & Jadva, V. (2017). School Report: The experiences of lesbian, gay, bi and trans young people in Britain’s schools in 2017. Retrieved from London: https://www.stonewall.org.uk/system/files/the_ school_report_2017.pdf Butler, J. (1997). The psychic life of power: Theories in subjection. Stanford University Press. Butler, J. (2004). Undoing gender. Routledge. Gill-Peterson, J. (2018). Histories of the transgender child. University of Minnesota Press. Horton, C. (2020). Thriving or surviving? Raising our ambition for trans children in primary and secondary schools. Frontiers in Sociology, 5(67). https://doi. org/10.3389/fsoc.2020.00067 Jones, T., Smith, E., Ward, R., Dixon, J., Hillier, L., & Mitchell, A. (2016). School experiences of transgender and gender diverse students in Australia. Sex Education, 16(2), 156–171. https://doi.org/10.1080/1468181 1.2015.1080678 Mikulak, M. (2021). For whom is ignorance bliss? ignorance, its functions and transformative potential in trans health. Journal of Gender Studies, 1–11. https://doi.org/10.1080/09589236.2021.1880884 Mitchell, M., Gray, M., & Beninger, K. (2014). Tackling homophobic, biphobic and transphobic bullying among school-age children and young people: Findings from a mixed methods study of teachers, other providers and pupils. Retrieved from London: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/367473/NatCen_Social_Research_-­_ HBT_bullying_-­_analytical_report.pdf Moon, I. (2019). ‘Boying’ the boy and ‘girling’ the girl: From affective interpellation to trans-emotionality. Sexualities, 22(1–2), 65–79. https://doi. org/10.1177/1363460717740260 WPATH. (2018). WPATH position on ‘Rapid-Onset Gender Dysphoria (ROGD)’ [Press release]. https://www.wpath.org/media/cms/Documents/Public%20 Policies/2018/9_Sept/WPATH%20Position%20on%20Rapid-­O nset%20 Gender%20Dysphoria_9-­4-­2018.pdf

CHAPTER 6

Negotiating Relationships/Managing Harm: Advocating for Trans and Gender-Diverse Children in Families and Communities

The aim of this book is to demonstrate how advocating for, supporting, and affirming a young person’s gender are practices of social justice, or justice-based parenting practices (Pyne, 2016). As I have argued in the preceding chapters, these practices encompass a range of arenas and institutional contexts; affirming parents and carers take on the role of educators on behalf of and advocates for their young person within healthcare and education. I have also discussed how the lack of parental support disadvantages young trans and gender-diverse people in these settings. However, the work of advocacy does not stop when the young person comes home from school or from a doctor’s appointment; it continues within the family, its social circle, and the wider community. Not unlike schools, or GP practices, the young person can be met with discriminatory attitudes from their family members near or far, as well as from others, including complete strangers, and it is often affirming parents who intervene to challenge these attitudes. The initial reactions to when she is socially transitioned, from friends that I had, most people they either just they, they are quite nice and all my friends have been quite nice and accepting and I just worry about what people are saying behind my back. I think that’s what I worry about most. And the one or two that have said things have said, ‘She’s a bit young, isn’t she? She’s a bit young to know’. So people don’t realise that trans people come from

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somewhere that they were once children and, and that they can know that they are trans. (Tara) My parents they didn’t understand what it [my daughter’s transition] was all about at the beginning but now they, you know, they’re absolutely fine. All my family are absolutely fine with it, which is so lucky, so so good. Only takes one member of the family to not deal with it very well and that that can upset everybody. But we don’t have that. Everybody’s fine with it. Absolutely fine and supportive. (Tom)

The two quotes above are from parents whose circles of friends and wider families were accepting and affirming of their child. They paint a relatively positive picture, even if they also hint at issues that will become more palpable in the accounts of parents and carers who to paraphrase Tom were ‘less lucky’. Here again ‘luck’ does some heavy lifting to obscure trans-negative and transphobic reality that means many young people are rejected by their families and communities. The above quotes also point to some familiar tropes that I have discussed in the previous chapters. The first one captures the anxiety of Tara that people might talk negatively about her daughter behind her back, as well as pointing to the erasure that trans children experience, and the persistent invalidation of their self-­knowledge and, by extension, their claims to gendered self. The ‘too young to know’ argument encapsulates this issue. The quote from Tom hints at the lack of understanding and knowledge about the possibility of a young person being trans, this time on the part of grandparents. The reason I chose these quotes to start this chapter is because they demonstrate that even in positive scenarios, when the family and friends of the family are accepting and affirming, parents and carers (and their young person) still face prejudice and varying degrees of ignorance. Because what is at stake in these situations are the often-important relationships with friends and relatives, it is the kind of ignorance and prejudice to which parents feel compelled to attend. However, this educational labour is also extended to colleagues, acquaintances, and, at times, complete strangers. In this chapter, I examine how parents and carers support and advocate for their young person in the family and within their communities. As I consider the additional labour of love that takes place within the extended family, I highlight the social and emotional costs that affirming parents face. I also explore what happens when parents disagree and discuss the

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damage caused by parental differences over important issues such as access to puberty blockers, or acceptance of young person’s social transition, as well as discussing the work that supportive parents perform to control this damage. In doing so, I also highlight how this affects the right of the young person to timely and adequate healthcare and argue that insistence on consensus within the existing healthcare ‘pathway’ undermines young people’s autonomy and reinforces transphobic attitudes. Finally, I highlight how parents use social media to show their affirmation of their young person and signal their expectations towards their friends and relatives more widely.

‘My Son Won Hands Down Every Time’: Families as Sites of (Struggle for) Acceptance The preceding chapters of this book have emphasised that parental support and acceptance is sadly not a given for young trans and gender-diverse people, even if there is no doubt that it is fundamental to their wellbeing and mental health (see amongst others Pullen Sansfaçon et  al., 2015, 2020; Simons et  al., 2013). The same is true for wider family support, where young trans and gender-diverse people might be met with a range of responses, some of them uninformed, prejudiced, and harmful (Koken et al., 2009). Not unlike parents (see Chap. 2), extended family members can also move from an initial lack of understanding to acceptance of the young person’s transition and gender (Kuvalanka et al., 2014), and affirming parents and carers can play an important role in managing this process for their young person. Relationships with grandparents can be challenging but grandparents can also have a crucial role in affirming their trans and gender-diverse grandchildren, as previous studies show (Kuvalanka et al., 2014; Travers, 2018). My research echoes these findings as parents and carers accounts demonstrate the often-complex negotiations between affirming parents and grandparents, as well as an evolution of these relationships over time. It’s been really difficult because my parents are finding it, finding it exceptionally difficult not to misgender our son. Well, they will always say … ‘You will always be my beautiful granddaughter’. He’s 15. He’s growing a moustache. Yet, you, you still refer to him as your granddaughter. They find that really hard. And my son feels rejected by them … it is a form of rejection.

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But I think that they, they’re trying, and they are getting there slowly, but it’s so frustratingly slow. (Kim)

Importantly, affirming grandparents1 can be a source of support for the parent as well as for the young person, which in the context of limited support (see Chap. 3), is not to be underestimated: I spoke to my mum a lot about this, she was giving me a lot of support anyway and sort of helping bring up the kids and she was really on board with it. And just really supportive. (Anne) My mother, her [my daughter’s] grandmother is quite accepting, she actually lives with us. She’s quite supportive. (Beth)

Further, parents and carers might act as messengers between the young person and their siblings and do the ‘coming out’ on behalf of their child to their siblings: My younger son had no idea … He says now that he can’t believe he had no idea, ‘cos it’s so obvious. But he just had never really considered it [his brother being trans]. You know, he was always absolutely fine with him wearing boy’s clothes and, and looking like a boy and he used to be addressed as ‘he’ when we went out. People, you know, mistook him for a boy then. My younger son was actually absolutely fine with that. But when I told him, that night, because my son didn’t wanna tell anyone [himself]. I had to tell everyone, which was quite hard, actually. But he [my younger son] really cried. He really really cried … and it was just before my son’s birthday … But my son was like, that means I don’t get a sister card. I haven’t got a sister anymore. And … he went out and bought him a brother card and he’s been fine since. (Harriet)

However, and importantly, in the interviews on which this book is based, siblings’ support and affirmation were reported consistently. My daughter’s siblings were very accepting of when she finally told them, that we’d been at the Tavistock for about a year before she actually got the

1  Interestingly, some parents shared that they expected grandparents to be less supportive than they turned out to be, pointing to a certain stereotyping of the older generations: ‘Family members were really supportive … the grannies were particularly supportive, which really really surprised me’ (Claire).

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courage up to say, that was what she was going to London to see them about. But they were very supportive, and they always have been. (Beth)

There was also a view that siblings were quick to adapt to name changes and new pronouns with much greater ease than other family members and at times the parents and carers themselves: But his younger sibling, he’s eleven now, just eleven. Never been an issue to him. When he first transitioned, you know, it took me weeks and weeks to remember to say his new name. I was getting it wrong. I was saying, ‘she’ pronouns still. You know, it took, it took me weeks. The kids were instantly correcting me. As soon as I was wrong, they were correcting me. They never got it wrong. They never said the wrong name. They never said the wrong pronouns from day one. (Eve)

Such supportive and affirming responses are fundamental to the wellbeing of the young person and their affirming parents or carers. Consequently, responses that are based on rejection and prejudice negatively impact the family. Yet, the impact of transphobia and cis-ignorance within the family on supporting parents of young trans or gender-diverse people and on their relationships with their families, including with grandparents, has not been given much attention in the existing literature. This is important as it further highlights the strains caused by trans-negative views and attitudes, under which young trans and gender-diverse people and their families come: I remember the early days … really managing the expectations and the emotions of my husband’s … parents. That was really really tough. That’s the toughest bit actually was that those been that first year and them not wanting to use her chosen name. And, behaviours towards a child that it, it’s kinda heartbreaking … And so, first of all, they were trying to put the blame on the mum: ‘It’s the mum. It’s the mum. It’s the mum! She did this. It’s her fault, [it’s her] mental health, mental health, mental health’ … and it wasn’t any of those things, actually, it really wasn’t … The grandparents wouldn’t … call her by her chosen name. There was lots of confusion between gender and sexuality … quite violent reactions to things in what they say and how they behave. And my husband was like, ‘look, this is happening’, you know, ‘and if you continue to behave and say these things then we just won’t see you’ … now, I feel like [there is] complete acceptance … everyone’s really come on board. (Lucy)

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In situations where grandparents reject their grandchild, it is the parents who often do the work of explaining and managing the process of ‘coming to terms’ through which some grandparents go. In the case of Lucy’s stepdaughter, an ultimatum was made that meant grandparents were forced to change their behaviour towards their trans granddaughter or lose contact with their son and his family. The fact that it took the grandparents a year to come to ‘complete acceptance’ shows how much pressure there is on the young people and their affirming parents. It also shows the importance of parental support who can educate family members and when necessary also choose to limit contact or distance themselves and their child from relatives who reject them (see also Travers, 2018), creating a buffer between their child and transphobic attitudes and views within the family. In addition, affirming parents and carers can instigate and facilitate changes that further affirm their young person. This is illustrated by Lucy’s account of how she and her partner addressed the issue of their daughter’s pictures from before she socially transitioned, which were on display in the house of her grandparents: You know, and things like having photos around the place of when she was a boy. In the grandparents’ house, there were loads. We were, ‘right, it’s time’, last Christmas or the Christmas before like ‘right, we’re going, we’re going to get brand new photos done’ … we’ve got these new photos done and, and they were lovely. And that’s what we gave out for Christmas presents … she didn’t like them [the old photos] … I think she struggled sometimes … seeing them … And I felt like we, we really need to get something else up there as well to show this is the person that she wants to be. This is the person who she is. But yeah, I remember that being tricky. And I think there is still the odd baby photo around. She doesn’t mind the baby photos. It’s just when, you know, she was a bit older. (Lucy)

In the context of navigating the wider family life, parental support and acceptance are key. However, advocating for a trans child within the family also requires constant checking in with the young person to ensure that they are comfortable with what is being shared and discussed. At times, parents can feel caught between their desire to help and their young person’s need for, and right to, privacy: My son is really, not secretive, he’s very private about what’s going on for him. And he doesn’t like me to talk to my extended family about it, but

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actually it’s, to me it’s really important that they know so they can adjust. So sometimes I feel a bit caught in between … the need to talk to them, but respecting his wishes and not to talk to them about it too much. And then he’ll feel betrayed because I have spoken to them about it. But that’s because I want things to be easier for him. And sometimes I don’t think he gets that bit. (Kim)

Whilst Kim’s wish to help and make things easier for her son is understandable, parents and carers need to be aware that it should always be the young person’s decision to come out or share what are often very private aspects of their experiences with the wider family. This is particularly key because young trans and gender-diverse people are being systemically disempowered across multiple arenas. Fundamentally, cisgender parents must be aware and remain attentive to the power imbalance embedded in their relationship to their trans and gender-diverse children, an important point I revisit in the conclusion. Further, within families, as in other contexts, young people who are not affirmed by their parents are left without the vital support that might allow them to negotiate the at-times difficult family relationships. However, things also get complicated and distressing for young people whose parents or parents’ partners are not in agreement about supporting their transition. For couples or ex-couples, this might create a split where the young person is affirmed and accepted by one parent, but rejected by the other parent, or by the affirming parent’s partner: The only person that wasn’t supportive was my husband … this isn’t my son’s father. This is, was my partner at the time. And I made it absolutely clear that there was a zero tolerance policy that my son was to be called by his new name. That male pronouns were to be used and that there was to be no deviation from that. And it caused, it caused dreadful problems in our relationship it, you know, really it was for, for me, if I’m honest I felt like I was having to choose at times between my son and my partner. And of course, there was never any contest. My son won hands down every time. But it was, it was really really unpleasant. (Claire)

I discussed the harm done by lack of parental affirmation and support already but here I want to also stress the additional burden co-parenting with a non-affirming parent places on the supportive parent who might not always be able to intervene on behalf of their child or protect them from harm that they might experience:

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It’s, it’s my ex’s family that have been a bit difficult … they went through a phase of calling him [my son] by his surname instead because they couldn’t make themselves do it [call him by a boy’s name], which I thought was almost worse … when it comes to the rest of the family, I do know he [my ex] didn’t tell them for an awful long time, like months. So they were seeing my son and calling him by the wrong name and stuff and he wasn’t correcting them or anything, which I know my son found really really difficult and it’s damaged their relationship more than anything else, I think … I’m just trying to think how many years it’s been. He’s nearly eleven and so it’s, four years nearly [since he socially transitioned]. And he [his father] still has a problem. He does call him the right name and the right pronouns and things like that. But they, they don’t talk about it. They don’t like to discuss it. And his girlfriend is much much worse. She’s quite transphobic. So it isn’t nice sending them there knowing that’s the atmosphere. They quite often don’t want to go either. (Nathalie)

Last, but not least, because parental support matters beyond the family, Nathalie and her son, and other young trans and gender-diverse people in similar situations face additional difficulties in other arenas, a point to which I turn next.

Consensus and Its Perils As I discuss above, affirming parents and carers mediate interactions between their young person and the rest of the family and community, at least initially, to ensure that they are met with respect and understanding and at times also protected from transphobic prejudice and ignorance. As shown by Nathalie’s account, affirming parents can feel powerless when co-parenting with someone who rejects their child’s gender. Such circumstances spill over into other important areas of the young person’s life, as co-parents can disagree on what is the best course of action to take at school or in healthcare. However, this is particularly relevant within healthcare, as under the current system interventions such as puberty blockers may become out of reach for young people who have one non-­ affirming parent. For example, as one parent shared: ‘In the UK, the approach is, they look for parental consensus [about gender affirming interventions]. And if there’s not parental consensus they don’t move forward with the child even if it’s in the child’s best interest’. This is troubling as it further disempowers young people and denies them autonomy, recentring parental power over their bodies and choices, causing harm (see also Priest, 2019). In effect, it can lead to denial and/or delay of care:

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I don’t live with my child’s mother. We split up when my child was six months old, but [we] have been a very hands on parents … [My child’s] mum was always absolutely anti transition from the word go, will not use, even to this day, will not use correct pronouns. Won’t even accept the Deed Poll changed name. So, there’s always been a bit of a clash where I just accepted the transition completely and utterly and was 100% supportive where mum, still to this day, still doesn’t accept the transition even though we’re quite a long way through the journey now … There’s always been a lot of friction between my child and my child’s mother, where me and my child … got a very very good, strong open relationship and talk about everything … we were eventually referred on to the Tavistock and Portman up in London … mum being absolutely anti transition … Tavistock had previously offered hormone blockers, but that was at the point when mum was going to the meetings and mum fiercely went against blockers. So, then Tavistock never ever mentioned it again until my child was eighteen and pretty much out the other side of puberty. (Keith)

Lack of unified parental support can also affect other aspects of healthcare and/or social transition where consensus is required, or is believed to be required, and it can rightly cause anxiety for affirming parents around future access to gender-affirming interventions: He [my son’s father] was a stumbling block with the doctors, but only a little bit … what happened was, he wanted to go and … have a check over the referral form [for GIDS], basically and make sure that we’d, we’d put in what he thought was right…. I haven’t done his Deed Poll yet. And the reason is partly because my ex-husband is in, let’s put inverted commas, “no rush”, which I think means don’t do it yet or otherwise I’ll be cross … I have asked [GIDS] a specific question about that…. I have said, if he disagrees with the course of action that we decide on or that we decide is best for [my son] would that stop that happening. Would he be able to stop any medication or whatever? And they said, “We would always do what’s best for the child.” And that was their answer. So if they thought that [puberty] blockers was the best thing for [my son] then that’s what they would do. That said, I think they would probably factor in that the relationship with his dad may deteriorate if he was given those and therefore, would that then be in his best interest. How would they weigh it up, I’m not sure. Do you know what I mean? (Nathalie; emphasis added)

In such situations, the affirming parents need to work extra hard, anticipating future challenges and potential obstacles that might arise from

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their co-parent’s lack of acceptance. This adds an additional layer of difficulty for them and their young person, who also suffer the effects of parental rejection.

Social Costs Apart from the huge amount of emotional, educational, and organisational labour that goes into managing relationships with families, schools, and health professionals, there is also the additional cost of social rejection and shunning that many affirming parents face. In the first quote of this chapter, Tara speaks about her worry that people might speak critically behind her back about her daughter and her own support for her daughter’s transition. These fears are not ungrounded as in a society that erases trans children from its collective imagination and denies their self-­ knowledge, supportive parents face harsh and uninformed judgements in the public debate and in their everyday lives: R: I have lost so many friends through supporting my, my foster child. In fact, one of my sisters, I haven’t seen or spoken to her in five years now. So she didn’t want my foster child to be around her children … She’s [exhales] … struggles to be outside of any box so having a trans child in the family was way out of her realm of comfort. And it was a case of, do you know what, you’re an adult and yes I will lose contact but I’m here if you know, if you ever want to build the relationship back up again. And as her kids have got older and, and kind of a couple have left home now I still got contact with those. But the younger children who are at home with her I haven’t seen apart from like a family wedding or at a family funeral in five years. I: You mentioned that you also lost friends. R: Yeah even foster carers who don’t want my foster child near their looked after children, because their looked after children understandably a lot of them are very vulnerable [3 sec pause] … And I think it’s scared a few of the foster carers thinking, if your kid is trans and they have conversations it might be the thing that my child saying it and I have to do. So, yeah, my social circle was massive five years ago. I was never in. I was always out doing things. Now, not so much so. (Eve)

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What Eve describes is a reality where people, including family and friends, have turned away from her because she chose to support her foster son’s transition. This happened in the context where his biological mother ‘wasn’t supportive at all’ (Eve). Added to this mix there is also the ludicrous notion that vulnerable young people looked after by other foster carers might want to copy her son in being trans and should thus be kept away from him. The layers of transphobic prejudice folded into ignorance are clear in such narratives, and so are their harmful, ostracising effects. For affirming parents and carers, there is also a social cost associated with going against ‘expert’—that is, GIDS’—recommendations and rules: After the age of eighteen it’s his decision anyway. So I kind of came to the conclusion that, you know, I needed support what was best for him here and now and so looked at getting testosterone for him. But it was a lot of soul searching, particularly knowing that I was gonna be going against you know, what the NHS was doing. But there was loads of people out there that would criticise me, you know, I’ve been called child abuser and awful things, anyway. And I knew that other people may not make that decision, but just, you know, the personal decision that I made, you know, not just for my child, but with my child, ‘cos my child was, you know, very intelligent and mature at sort of saying, that’s what I wanted to do. (Anne; emphasis added)

What I find particularly powerful in Anne’s account is not just her resolve and courage in seeking out ways to support her son despite the social and emotional cost but also the commitment her account demonstrates to respect her son’s claims to gendered self and the emphasis on making decisions with and not for her son. This is key to thinking through parental power and responsibility but also love and respect that propel affirming parents to choose to believe and support their child in the face of adversity.

Online Presence and Advocacy The online advocacy work of affirming parents deserves much more attention than I can give it here, as it could easily become a basis for a separate book. What I want to highlight though is how affirming parents and carers use the internet to help them manage and inform relationships with wider family and friends. When discussing how her family responded to her son’s social transition, one parent asserted: ‘We constantly, well I

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constantly refer to him on social media’ (Kim; emphasis in original). This can be interpreted as part of a wider campaign of individual visibility meant to send the signal to her social circle that she has a son and that she expects people to accept this and act accordingly. Such pre-emptive strategy was often employed by supportive parents: I hear stories about a lot of people who their family members are, are really kind of resistant and reject and, you know, their child or grandchild or you know, nephew and basically say, you know, ‘I will never call them by those pronouns’ or ‘I’ll never call them by that name and they’ll always be such and such to me’. And they can be really kind of big family rifts. But there has not been a single person in my immediate or extended family who has done that. I mean, I made, on the same day that my son came out at school, I did like a Facebook post to my, you know, close family and friends and my Facebook’s really kind of literally just that. It’s not like a public facing thing. It’s, it’s just for that. And everybody came back with really, you know, supportive comments. And they knew and the thing is see, a really important thing is that, they knew my son beforehand. They’d seen him grow up. They saw what he was, he was like. They knew his personality. So it wasn’t an, an abstract thing for them. (Anne) When we told like our nuclear family everybody in the nuclear family knew … I did a very public post out on social media and basically said, this is what’s happening in our family. Those who can accept and [are] willing to embrace the change along with us, you’re welcome for the ride. Those that aren’t you’re no longer welcome as part of our lives. (Sue)

Social media is thus used to inform and, notably, to set expectations for friends and family, and making such announcements can also be an important way to not only manifest support but also gather support for affirming parents and carers. However, for some parents and carers, social media were also spaces where they engaged with the often-toxic public debate where visibility and safety need to be managed carefully (see Chap. 3). When it came to social media activity that was more public facing, like Twitter, parents and carers deployed different strategies to navigate concerns around safety. Some used Twitter under a pseudonym; other identified as trans allies, but did not disclose that they were parents of trans young people. Nevertheless, those who engaged in online debates and advocacy felt that advocating for the rights of trans and gender-diverse children and young people on social media required being informed and alert; labour that at times felt both draining and unceasing:

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It appears that, that the world is particularly, there’s a transphobic element around at the moment, particularly in the, in social media. And when you’re trans or when you’re a parent of somebody who is trans and you see it more often … and maybe in a way that people who aren’t as involved as me they probably don’t even know … It’s just like it … it’s just like a drip, drip, drip all of the time. And you have to be aware of like the counter arguments. I have to do that as almost like protect me, but also to protect him. I can shield him against some of the really nasty shit that’s about at the moment. (Kim)

Beyond the Family In the final section of this chapter, I want to focus on the work of affirming parents and carers that challenges transphobia and prejudice in the real world in every day, at times random, interactions that nonetheless further demonstrate the social justice aspect of affirming parenting practices. Because trans and gender-diverse people face prejudice in many settings, parents and carers can encounter transphobic views in all spheres of their and their young person’s lives. Consequently, parental advocacy work also extends beyond the home and into the communities. This point is demonstrated particularly well in the accounts shared by Robert, Claire, and Tom below. These accounts capture the everyday advocacy work that takes place in workplaces, cafes, and parks as parents stand up to transphobia in the society and challenge transphobic views and attitudes, once again taking the role of educators and allies in ways that benefit not just their young person but trans and gender-diverse people in general. R: I remember a colleague saying that they didn’t agree with ‘transgender’, and they said it was the parents’ [fault] and that just sounds really old-fashioned to me. I just thought that they sounded quite ignorant. I: Did you challenge them on that? R: I think I basically said what I just said to you. I laughed and said, well, that sounds really old-fashioned, and actually if you know someone then you will see them as them and you will understand them. It’s people’s imagination and not reality which they are scared of, I think. I: How does it make you feel that people have those ideas?

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R: Oh, not surprised … you get some really lovely people who say really sexist or homophobic or racist comments without realising that they are saying something really offensive, and I think, in general, they have just been brought up with a kind of institutionalised or cultural racism, or sexism, or homophobia that they don’t even think they have. And they make comments which come from somewhere else and they’ve just been naïve enough to absorb it and share it. (Robert) In the above quote, Robert’s intervention is quite simple, yet effective. His reading of the situation is also rather generous, almost equating ignorance with innocence underpinned by lack of critical capacities. Whether sexist, racist, and homophobic views can be explained away through naivety is questionable at best, but what Robert rightly points out is how they are institutionalised and normalised, allowing them to continue to circulate unquestioned and unchallenged. The same is true for transphobic and trans-negative attitudes and views. Yet, I would argue, and have argued (Mikulak, 2021), that we must attend to such ignorance and hold it accountable; the ignorance that makes it somehow acceptable for a person to proclaim that they don’t ‘agree with transgender’ is as pernicious as it is sadly common. Such discursive violence that positions trans and gender-­diverse people’s existence as a point of debate, one that can possibly be disagreed with and rejected, is exactly what has been fuelling the vicious public debate in the UK and beyond, causing real harm and suffering to trans and gender-diverse people (Pearce et al., 2020). It is also in this context that challenging transphobia can be risky, in particular when it involves outing the young person or revealing that one is a parent of one. I was with my son, in a café the other day and the table just—it was only very small, like four or five tables—and the table across the way started talking to the owners about that one of them had a transgender nephew who had transitioned. And they kept using the wrong pronouns. And they kept referring to this kid by the wrong gender. And I said to and I said to my son, ‘Do you want me to say anything?’ And he said, ‘Let me just listen’. And then so they started saying, you know, ‘Well, you know, these days you can be whatever you want to be and so on’. And he then said, ‘Yeah, I would like you to say something, mum’. I said, ‘Okay, well how about we offer some support. How about we say, if you feel comfortable with me saying that you are transgender. We can then say: Look if you would like, if your family member would like some support, either the adults or if the child would like to talk to my son, that’s okay because a lot of people don’t really understand that

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being transgender isn’t actually a choice’ and then we’ll give them my phone number’. And he was like, ‘Yeah, that’s brilliant. We’ll do that’. And we did that and the people who were discussing it were really embarrassed. But, you know, you could see that they were sort of checking, like ‘oh, what did we say, what did we say?’ (Claire)

What is quite moving in the above account is the utmost sensitivity with which Claire goes about addressing the situation, making sure her son is comfortable and checking in with him with regards to what he does and does not feel comfortable doing and sharing. The offer of support is a powerful educational act, one that humanises and centres the young person who is being talked about and demonstrates allyship in action. In speaking up, Claire and her son speak up for themselves and for that young person. Taking a stance and actively choosing to challenge and educate others is not an easy or comfortable task, but it is one that affirming parents and carers perform repeatedly alongside and at times on behalf of their children and other trans people; Tom is explicit about both his commitment to this work and the discomfort that might come with it: I feel like I want to educate people, because our daughter is in a very small minority … I walk the dogs most mornings with three or four guys down the park … all from different walks of life. And we walk around the fields nearly every morning and there is a transgender lady that lives down the road … I remember before she transitioned, twenty years ago I, I knew this person. Anyway, she walks her dog down the park, sometimes at the same time as us and, and we can see her from a distance. And these three guys [3 sec pause] would often make little comments about this person, derogatory comments jokes, call it what you want to, really. And I was starting to feel a bit uncomfortable with this, really. I wasn’t quite sure how to, how, how to handle this. Do I keep quiet? Just get on with it. Do I tell them that our youngest is transgender and that I’m telling you … because I don’t want you to say stuff that’s gonna make me angry. So, I came out one day and told them in the morning, I said, ‘Just to let you know guys, ‘cos you talk about it when you see this lady and our youngest is transgender’. And then there was a slightly awkward, awkward pause for twenty seconds, whatever and, and then somebody might say, ‘Oh gosh’. You know. ‘That’s interesting’. And then maybe I just tried to explain it in a nutshell what, what it’s all about maybe in a couple of sentences. But anyway they know that our youngest is transgender. I, I, I felt the need to tell them, because I wasn’t happy with them making jokes about this transgender lady that we occasion-

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ally see down the park … I think they, because they know that we have a transgender child that they probably think about that before they open their mouth and make some derogatory comment. (Tom)

The discomfort that parents like Tom experience in these interactions also links back to the loss of certitude (cis-certitude) that being cisgender and parenting cisgender children entails (Riggs & Bartholomaeus, 2018). Thinking back to a quote from Eve (see Chap. 3), that discomfort is however secondary to the importance of affirming and supporting young trans and gender-diverse people, for as she put it: ‘If your life is a bit uncomfortable for a few years and you have to go places you don’t want to go and you’re to have conversations you don’t want to have, so what? Your kid’s alive … They’ve got a future’ (Eve).

Concluding Remarks In this chapter, I focused on the work parents and carers do to support their trans child within the wider family and beyond, both online and in the community. I have demonstrated that families are sites of uneven affirmation for young trans and gender-diverse people and that it is often the affirming parents and carers who help to manage and navigate family relationships that might become strained or fray due to the prevailing prejudice against trans and gender-diverse people and the continuous erasure of trans children. I also highlighted the social and emotional cost that affirming parents and carers face and how this increases, for both them and their young person, when they find themselves in a situation of co-parenting with a non-affirming partner or ex-partner. I have demonstrated how such parental disagreements might have grave consequences for young people’s access to gender-affirming care and transition. The anxiety that affirming parents express around future challenges around managing a non-­affirming co-parent’s input is not assuaged by the existing ‘pathway’ that favours parental consensus; and—in the views of parents and carers with whom I spoke—might position such consensus as valuable in and of itself, regardless of the young person’s own wishes and best interests. This poses an important question of who benefits from such a consensus-seeking model and what happens to the young person’s agency in the process? Moreover, and thinking beyond the nuclear and wider families, I examined the advocacy work that parents and carers perform as allies to trans children and adults both online and in real life. I have showed that whilst

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this work comes with emotional costs and risks and at times a level of discomfort, it is a central feature of how affirming parents and carers relate to the wider world and that they themselves see it as necessary and key to their role as parents. Last, but not least, I have also shown how affirming parents do best when their advocacy centres their young person’s wishes and happens in conversation with them; this is true for all the settings, including within families. The role of affirming parents and carers is thus also to remain aware of, and attentive to, their own cisgender privilege and their position of relative power as adults.

References Koken, J. A., Bimbi, D. S., & Parsons, J. T. (2009). Experiences of familial acceptance–rejection among transwomen of color. Journal of Family Psychology, 23(6), 853–860. https://doi.org/10.1037/a0017198 Kuvalanka, K. A., Weiner, J. L., & Mahan, D. (2014). Child, family, and community transformations: Findings from interviews with mothers of transgender girls. Journal of GLBT Family Studies, 10(4), 354–379. https://doi.org/1 0.1080/1550428X.2013.834529 Mikulak, M. (2021). For whom is ignorance bliss? ignorance, its functions and transformative potential in trans health. Journal of Gender Studies, 1–11. https://doi.org/10.1080/09589236.2021.1880884 Pearce, R., Erikainen, S., & Vincent, B. (2020). TERF wars: An introduction. The Sociological Review, 68(4), 677–698. https://doi.org/10.1177/ 0038026120934713 Priest, M. (2019). Transgender children and the right to transition: medical ethics when parents mean well but cause harm. The American Journal of Bioethics, 19(2), 45–59. https://doi.org/10.1080/15265161.2018.1557276 Pullen Sansfaçon, A., Kirichenko, V., Holmes, C., Feder, S., Lawson, M.  L., Ghosh, S., Ducharme, J., Newhook, J.  T., & Suerich-Gulick, F. (2020). Parents’ journeys to acceptance and support of gender-diverse and trans children and youth. Journal of Family Issues, 41(8), 1214–1236. https://doi. org/10.1177/0192513x19888779 Pullen Sansfaçon, A., Robichaud, M.-J., & Dumais-Michaud, A.-A. (2015). The experience of parents who support their children’s gender variance. Journal of LGBT Youth, 12(1), 39–63. https://doi.org/10.1080/19361653. 2014.935555 Pyne, J. (2016). “Parenting Is Not a Job … It’s a Relationship”: Recognition and relational knowledge among parents of gender non-conforming children. Journal of Progressive Human Services, 27(1), 21–48. https://doi.org/10.108 0/10428232.2016.1108139

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Riggs, D. W., & Bartholomaeus, C. (2018). Cisgenderism and certitude: Parents of transgender children negotiating educational contexts. TSQ: Transgender Studies Quarterly, 5(1), 67–82. https://doi.org/10.1215/23289252-­4291529 Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019 Travers, A. (2018). The trans generation: How trans kids (and their parents) are creating a gender revolution. University of Regina Press.

CHAPTER 7

Conclusion: The Function of Love Is to Affirm

Love is a combination of care, commitment, knowledge, responsibility, respect and trust. —bell hooks

This book has examined the ways in which parenting practices of advocating for, supporting, and affirming their trans or non-binary child are social justice-based practices. It has demonstrated how everyday parental advocacy practices challenge pathologising cisgenderist and cisnormative logic, as they support and sustain young trans and gender-diverse people in navigating the healthcare, education, and family and community contexts. In affirming, supporting, and advocating for their trans or nonbinary child, parents and carers contribute to not only the wellbeing of their individual young person but also social change at the micro level. Their efforts, however local and individual, challenge erasure of trans children and push against negative understandings of what being trans means, contributing to more positive social readings of trans childhoods, lives, and possibilities. As this book has demonstrated, to do this work together with, or on behalf of, one’s child can be risky, costly, and disruptive, but it is also continuously necessary. Further, support for parents and carers is limited and the work done by charities like Mermaids is essential. Parenting trans or

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non-binary children also means abandoning the comforts of cis-certitude and facing a world that is not set up to accommodate, never mind cherish gender diversity. The preceding chapters of this book capture the labour of love that parents perform in the UK, in the first decades of the twenty-­ first century, and it is important to see these affirming parental practices as situated in this particular moment and place. As this book has demonstrated, and others have argued, it is a context in which (a) trans children are a subject of fierce debate, yet somehow also continue to be invisible (as subjects of inclusive policies and accommodations), (b) trans and gender-­ diverse children and youth are denied their self-knowledge and, by extension, agency and are thus reliant on parental support and are harmed when such support is not available, and (c) trans lives and possibilities are devalued, whilst simultaneously being made hyper visible (Pearce et al., 2019b). I have dealt at length with the first two characteristics of the current historical moment, but the final one also deserves to be examined. It is the devaluing of trans lives that is at the heart of trans-negative attitudes and views but also educational and healthcare policies, and the resulting discriminatory and adverse social realities for trans people of all ages. Crucially, this devaluing of trans lives, the positioning of trans childhoods and adulthoods as less desirable, happens without attending to the conditions that make them less liveable and prevent trans people, young and old, from thriving. Affirming parents and carers exist in a social world that denigrates trans lives and they are not immune to it; one parent shared: When, when she [my daughter] first came out, she was feeling really really really unhappy. And you know … she was depressed. She was self harming. She was having suicidal thoughts. And I sort of tangled those things up in my mind with being trans. But, actually, I can see now that … is not a feature of being trans. Do you know what I mean? It was to do with the situation that she was in. (Sophie)

Reading mental health issues as inherent feature of being trans mirrors diagnostic overshadowing that many trans people face, where all distress is understood to be related to their gender and stem from it (see, e.g., Ellis et  al., 2015). In everyday interactions, it is reproduced in how non-­ affirming parents might understand their child’s possible trans future— ‘the outcomes aren’t good. You’ll end up [with] a life of mental and physical scarring and unhappiness’ (Stephen). It is important to note that non-­ affirming parents formulate such views without trying to understand or attend to possible consequences of their own rejection of their child’s

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gender and thus their own complicity in that very ‘outcome’. Yet, we know that parental support and affirmation are absolutely crucial for the wellbeing of trans and gender-diverse children (Durwood et  al., 2017; Puckett et al., 2019; Simons et al., 2013; Wilson & Cariola, 2020). The epistemic violence (Dotson, 2011; Fricker & Jenkins, 2017) embedded in this process of equating distress with being trans has dominated understandings of trans lives historically (see Chap. 1 for more on this issue). The injustices and disenfranchisement that trans people experience as the result of such epistemic violence are symptomatic of the status quo where trans lives are valued less yet somehow not doing as well as their cis peers is blamed on being trans. This book has also demonstrated that for young people, especially those who cannot count on parental support, the consequences of this status quo can be particularly dire; positioning trans lives as less valuable, coupled with the devaluing of children’s self-knowledge and cisnormative developmentalist assumptions produce a reality when even the best-supported young people face struggles and so do their affirming parents and carers: I feel like we are fighting a battle, everywhere. I don’t want to feel like that. It shouldn’t be a battle … if there was anything else different for him, people would be falling over themselves to help us … I just feel like gender identity, generally, is so misunderstood. (Claire; emphasis in original)

What Claire describes is a double standard that is so prevalent it makes her life as an affirming and supportive parent a battlefield. Claire’s views were echoed in other parents’ and carers’ accounts, which recurrently captured the effects of this double standard on how they and their children have been treated in healthcare, education, and other settings. Sue complained to the GP surgery about the lack of support and substandard care her daughter received there, she felt that the practice: didn’t take our concerns very seriously at all. You know, had I been writing in about something else, I don’t know, having not dealt with a broken arm correctly or what have you, I do feel they would have taken that far more seriously than the fact that I was writing in about transgender care. (Sue)

Affirming parents and carers are thus acutely aware of the differentiated value that our society attaches to the lives of their children, and they continue to challenge and resist it, whilst dealing with its harmful consequences and harnessing and creating the bits of support that are there for them and their young person.

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The added difficulty for children and young people is that the double standard to which all trans and gender-diverse people are subjected can also become a basis for decision making rooted in paternalistic logic of preserving the child’s (imagined and/or desired) cis-future for them, a future that is valued so highly that any current distress becomes a means to an end in ensuring it is not jeopardised. It is in the name of that imagined cis-future that some parents justify their choice not to affirm their young person. The harm embedded in such commitments is captured well by Sophie: It is really difficult to get away from a, a kind of cis normative way of looking at things. Because I think … in their heart of hearts, I think a lot of health professionals, like a lot of people, just think that a cis outcome is better than a trans outcome. I think that’s what they think. And so, you know, hence the [3 sec pause] … they haven’t got the balance right between thinking, ‘oh but, what if, in the future … What if they change their mind? What if, in the future it causes them distress that they decided to transition?’ That they’re giving too much weight to this possible thing that might happen in the future and not enough weight to the distress that a young person is, is feeling now … that sort of balance between well they’re definitely in distress now. And then thinking ‘oh well they might be in in distress in the future’ kind of thing. They need to get the balance between those two things right [5 sec pause] And also just stop being so binary about the whole thing, you know … if somebody transitioned and then, you know, I hate that word where they say, ‘detransitioned’ or ‘desisted’, that’s even worse. You know … if you changed your mind again that doesn’t negate what you did before. It just means you’ve moved forward in your life. (Sophie; emphasis added)

The moral panic surrounding detransitioning—exemplified in the Bell v Tavistock case (see Chap. 1)—is thus not a coincidence, but rather it needs to be understood as a mobilisation in defence of imagined cis-­ futures. It is also yet another tool for disciplining and dismissing young people’s claims to a gendered self that devalues and delegitimises trans lives. As Sophie rightly points out in this framing, detransitioning becomes a zero-sum issue, a negative outcome that needs to be prevented (see also Hildebrand-Chupp, 2020). ‘Protecting’ children from future regret and attaching disproportionate weight and reductive meanings to detransition are therefore part and parcel of a cisgenderist and cisnormative logic. That logic draws sharp boundaries around what is deemed desirable and appropriate also in terms of support in healthcare and education for trans and

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gender-diverse children. It is another reiteration of the logic that fuels conversion ‘therapies’, which focus on preventing trans children from growing up trans; interventions that are harmful and must be banned for all LGBTQ+ children and adults (Ashley, 2020; Mikulak, 2020). Yet, this logic continues to dominate mainstream ‘debates’ about trans children in the UK today. It is folded into the existing systems and upheld institutionally. In healthcare, the devaluing of trans lives is at the core of the GIDS’ ‘watch and wait’ approach, which due to the service’s failures is mainly just ‘wait’ these days (see Chap. 4); it is what lies behind GIDS’ insistence on parental consensus (see Chap. 6) that gives power to trans-­ negative and transphobic views and standpoints over the young person’s self-knowledge and wishes. In education, the reinventing of the wheel of inclusion echoes this differential value that society places on trans people’s lives, it also enables their repeated omission and erasure and burdens individual families (see Chap. 5). The unevenness of inclusion of trans children in education results in a situation where affirming parents are forced to either take on the burden of challenging the lack of trans-inclusive policies in schools or look for alternative schools for their children. Here again, individual resources bear heavily on what options are available to parents and their young person. Furthermore, the fact that some parents feel ‘bereaved’ when their child transitions (see Chap. 2) is another facet of the differentiated value attached to cis and trans lives, as is the uneven landscape of family support that many young people and their affirming parents/carers face (see Chap. 6). Parental advocacy labour happens because of and against this devaluing and the resulting denials of support across multiple arenas and times— with the latter being particularly important in the context of the perpetual deferral and delays within healthcare—and, again, as a challenge to social injustice, as the preceding chapters of this book have demonstrated. Further, ‘luck’ and ‘being lucky’ has featured throughout this book with uncanny persistency. Adequate, affirming, and timely support should not, and cannot, be left down to luck. Yet, despite its questionable explanatory power, the fact that parents and carers discursively rely on ‘luck’ for making sense of their and their child’s positive experience is a constant reminder of the thinly disguised systemic failures and inadequacies. Positive experiences in healthcare, education, or family and community are constructed as lucky because they carry a sense of exceptionalism. If we attend to the heavy lifting that luck performs, we are faced with the simple realisation that at the opposite side of this discursive construct we have

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‘unlucky’ and that ‘unlucky’—meaning treated poorly, dismissed as ‘too young to know’, denied care also by being placed in what feels like an infinitely long queue, exposed to bullying with no support, made to change in the staff toilet, isolated, rejected by family members—might indeed be the standard. In affirming and supporting their trans and gender-­diverse children, parents and carers have the odds stacked against them, the devaluing of trans lives and futures means they are much more likely to experience and witness their child face the effects of the double standards I discuss above.

Love This book is titled Parenting Trans and Non-binary Children—Exploring Practices of Love, Support, and Everyday Advocacy. Whilst the focus on support and advocacy have been explicit throughout the book, this far I have not specified why love matters and what kind of love I mean, beyond referring to the everyday parental advocacy as a labour of love. Love matters because it is an organising principle and motivation of parental advocacy efforts, but it is also a powerful ground for resistance in the face of the devaluing of trans lives and futures. It is their love for their biological, step, adoptive, and foster children that drives parents’ and carers’, often-­ relentless, efforts to make the social world less hostile, prejudiced, and ignorant, and thus more liveable for their young person. The injustice and discrimination that trans people of all ages face are filtered through this love and this love also reaches beyond the individual child: I feel proud of myself, and I feel proud of my [trans] daughter … I feel really proud of her to have the courage to face it [social transition] head on. I feel proud that she’s been able to have the confidence to be honest with me and share that with me and trust me to support her and protect her. The thought of parents rejecting their children because of this is heart-breaking. (Robert)

Does this mean that non-affirming parents do not love their children? No, and to say that they do not would be both dishonest and unfair. But I would nevertheless argue that love is not their main motivation in the same way as it is for affirming parents, at least not love as bell hooks (2003) defines it as combined of ‘care, commitment, knowledge, responsibility, respect and trust’. Non-affirming parents love their children, but they do not trust them, they do not respect their claims to self-knowledge,

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in fact they actively dismiss them, they might also operate and make decisions from a place of misinformation, and knowledge grounded in prejudice and their own and/or wider societal fears. What affirming parents and carers do is the opposite: I think this situation is played out in a way that it is, because the people that we are and because we love her and her sister unconditionally and we just want the best for them. But that doesn’t mean forcing what I think is best on them, you know, on her, if it’s to the detriment to her, if that makes sense. Some people’ll say, ‘You know, taking these hormones blockers, isn’t that to their detriment?’ No, not, not when we’ve had a balanced look at everything. We are, I, I genuinely feel like we are making the right decision. She’s making the right decision. (Lucy)

I want to argue that the function of love is to affirm. Anything less lets young trans and gender-diverse people down and serves purposes and aids aims and agendas other than their wellbeing, perpetuating their disenfranchisement. This is important because if the current landscape of control, gate keeping, denial, dismissal, and deferral, in which trans and gender-­ diverse children and youth continue to exist is to be transformed, we need to stop disbelieving trans and gender-diverse young people; we need to know (and love) better: if it was me, I wouldn’t want people to judge me … I’d like people to be on my side. I think it’s perhaps one of the most important things that you feel people are on your side and are not sort of they are just make an assumption that it’s just a phase they are going through … And I think and I’m going to be absolutely honest now, when she first told us [she wants to transition], I did think to myself, I’m not sure she’ll go through with this. And … I’m her mother and I know much better now. (Vivian)

When asked ‘What do you think is most important to young trans patients when accessing healthcare?’ several parents and carers responded that what matters most is that they are being listened to. Further, parents and carers also sometimes feel guilty for not having listened to their child sooner/better: ‘I felt guilty that I hadn’t listened to him properly before, because he’d been telling us for years really, but in in a way that only a little kid can’ (Nathalie). Jules Gill-Peterson points out that as adults, we have an ethical obligation to ‘stop questioning the being of trans children and affirm instead that there are trans children’, that trans childhoods are both

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happy and desired form of childhood that is not ‘new’, but one that is rich, beautifully historical, and varied (Gill-Peterson, 2018, p. 33). This book foregrounds stories of parents and carers who affirm their children and thus take their claims to gender self-knowledge as valid and important. It demonstrates what listening to trans and gender-diverse children looks like in practice, but it also signals the direction for positive change. In the current embattled moment, we as parents/carers, adults, trans allies, and society need to listen to young people and not just see them as statistics, subjects of media articles, or social media exchanges (see also the discussion on limits of visibility by Faye, 2021). For that to happen, our default position cannot be that of doubt, explaining away, and dismissal. Love is responsibility and respect. Moreover, as much as all parents participate in the co-production of the stories of their child’s gendered self (see Chap. 2), affirming parents’ actions carry a positive value that can act as a resource for the young person. Trans and gender-diverse children are being systemically disempowered across multiple arenas because they are trans or gender-diverse and because they are children. Fundamentally, cisgender parents must be aware and remain attentive to the power imbalance embedded in their relationship to their young person. Love is responsibility. In the uneven relationship of power between trans and gender-diverse children and cis adults, and until a systemic shift that would allow for its more equitable distribution, affirming parents and carers remain their children’s most important allies. Love is commitment. Moreover, elsewhere, I have written about loving ignorance as an epistemic departure point for transforming one’s practice for health professionals working with trans and gender-diverse people, operating from a sense of humility towards difference (Mikulak, 2021). Parents’ and carers’ hunger for information and knowledge is a facet of their loving ignorance, as they equip themselves to help their young person deal with forms of ignorance that are more wilful and pernicious (see Chap. 3). Because being informed is so central to parents’ and carers’ ability to advocate for and support their young person—again, in the face of ignorant and at times hostile healthcare, education, and social environments—as well as providing reassurance and contributing to their wellbeing, I have argued that information is support. Knowledge and care are central facets of love. But knowledge has another important interpersonal dimension that matters in this context, it is the kind of knowledge that allows parents and carers to know their young person. Thinking back to a quote by Beth in

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Chap. 2: ‘I realised that I’d never really known my child. That I’d missed out on a big bit of her life’, to love and affirm a trans child is to know them. It is to allow oneself to be enriched by the experience and grow as a parent and as a person. With parents and carers too, cis-ignorance can take many forms and for example, as I have highlighted, to move away, or to be pulled away in shock from the taken for granted comfort of the cisnormative trajectory of gender expectations and destinies that parents might have for their children makes a difference. This is further manifested in the qualitative difference in how parents and carers who had considered the possibility of their child being trans felt at the time when their child came out to them; the experience was much less acute and less disquieting (see Chap. 2). Moreover, one of the defining features of stories of parents whose experiences actively challenge the narrative of loss, which positions feelings not unlike grief as a default response of parents of trans children, was their emphasis on continuity, as opposed to rupture. Stories of continuity insist on the young person being the same, regardless of how they experience, express, and live their gender, these stories foreground the person and the relationship they have with their parent; their shared love and commitment to each other deepened. However, (individual) love is also not enough in a society that devalues both the young people’s self-knowledge and the often-extensive parental expertise developed to support it. Parents and carers are forced to know better/more to be able to make demands against a system that is often bent on denying their young person gender-affirming treatment, or accommodations that would facilitate and ease their social transition. Affirming parents and carers need to be educated and at times extremely well prepared to challenge and educate others, in particular those in positions of relative power. Yet, they are not always successful in their efforts, which might be futile when negotiating the systemic inertia and obscure processes of the GIDS or when ensuring that their young person is well supported at school. Seeking out alternatives, educational and/or private healthcare demands further resources and labour, which many, of even the most loving affirming, parents simply do not have. In situations when they co-parent with a non-affirming parent their ability to support their young person is further compromised, as Chap. 6 has argued. Further, by challenging the need to have their children diagnosed and ‘managed’ by a team of experts affirming parents of trans and gender-­ diverse children work to unsettle the power imbalance that denies trans

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people of all ages self-knowledge by placing it in the hands of the powerful psycho-medical complex. I have demonstrated how the discounting of parental expertise of affirming parents in the context of healthcare reinforces the gate keeping model that re-centres and reinforces health professionals as experts on trans experience, perpetuating inequality and disempowering trans children and the parents who affirm them. Whilst individual parental efforts might not be enough to redefine how the GIDS operates, they nevertheless bid a similar question to the one asked by Pearce and colleagues about access to gender-affirming healthcare contingent upon a diagnosis: ‘If trans patients challenge the logic of pathologisation, what consequences might there be for a medical system that rewards particular forms of diagnostic expertise?’ (Pearce et  al., 2019a, p.  7). If affirming parents and carers, trans adults and trans allies continue to push against the logic of pathologisation and the constant probing and testing of trans and gender-diverse children by clinicians in their efforts ensure no cis-future goes unrealised, what will become of the GIDS, their outdated model of ‘care’, circular assessments, and self-serving, obscure practices? The recent challenges and scrutiny that the GIDS has been facing offer a glimmer of hope (Care Quality Commission, 2021; Good Law Project, 2020, 2021), even if their outcomes and potential reforms towards a more affirming model are yet to materialise on the horizon. The political context in the UK will continue to influence what becomes possible over the next decade. Finally, and as the preceding chapters of this book demonstrate, love that is caring, respectful, committed, responsible, trusting, and knowledgeable is not a given. Whilst it is important that a young person is supported and affirmed by their parents or carers, gender-inclusive education and access to gender-affirming healthcare interventions should not and cannot be made dependent on that support and affirmation. Indeed, to have such dependency on parental support in place is the most persistent testament to the devaluing of children’s self-knowledge and trans lives and futures. It violates young people’s right to self-determination and deprives them of agency over their bodies and health. Additionally, to make parental support a condition for access to gender-affirming healthcare hands power over to regressive and transphobic narratives and initiatives, fuelling moral panic and making the very existence of trans children a topic of debate, as the recent developments in the UK demonstrate. As a society we need to urgently attend to the gap that is created when parental support is refused and work collectively to respond to it. Harnessing the

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knowledge, experience, and commitment of affirming parents and learning from their advocacy meaningfully adds to this task, but trans and gender-­ diverse young people need allies and advocates beyond their nuclear family. They deserve and urgently need our love.

References Ashley, F. (2020). Homophobia, conversion therapy, and care models for trans youth: defending the gender-affirmative approach. Journal of LGBT youth, 17(4), 361–383. https://doi.org/10.1080/19361653.2019.1665610 Care Quality Commission. (2021). Tavistock and Portman NHS foundation trust gender identity services Inspection report. https://api.cqc.org.uk/public/v1/ reports/7ecf93b7-­2b14-­45ea-­a317-­53b6f4804c24?20210120085141 Dotson, K. (2011). Tracking epistemic violence, tracking practices of silencing. Hypatia, 26(2), 236–257. https://doi.org/10.1111/j.1527-­2001.2011.01177.x Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-­ worth in socially transitioned transgender youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2), 116–123. e112. https:// doi.org/10.1016/j.jaac.2016.10.016 Ellis, S. J., Bailey, L., & McNeil, J. (2015). Trans people’s experiences of mental health and gender identity services: A UK study. Journal of Gay & Lesbian Mental Health, 19(1), 4–20. https://doi.org/10.1080/19359705.2014.960990 Faye, S. (2021). The transgender issue: An argument for justice. Allen Lane. Fricker, M., & Jenkins, K. (2017). Epistemic injustice, ignorance, and trans experiences. In The Routledge companion to feminist philosophy. Routledge. Gill-Peterson, J. (2018). Histories of the transgender child. University of Minnesota Press. Good Law Project. (2020). The NHS must fulfil its duty to young people. https:// goodlawproject.org/update/nhs-­duty-­to-­young-­people/ Good Law Project. (2021). Our parental consent case against the Tavistock has succeeded. https://goodlawproject.org/news/tavistock-­success/ Hildebrand-Chupp, R. (2020). More than ‘canaries in the gender coal mine’: A transfeminist approach to research on detransition. The Sociological Review, 68(4), 800–816. https://doi.org/10.1177/0038026120934694 hooks, b. (2003). Communion: The female search for love. Perennial. Mikulak, M. (2020). Telling a poor man he can become rich: Reparative therapy in contemporary Poland. Sexualities, 23(1–2), 44–63. https://doi.org/ 10.1177/1363460718797543 Mikulak, M. (2021). For whom is ignorance bliss? ignorance, its functions and transformative potential in trans health. Journal of Gender Studies, 1–11. https://doi.org/10.1080/09589236.2021.1880884

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Pearce, R., Moon, I., Gupta, K., & Steinberg, D. L. (2019a). The Emergence of Trans: Cultures, Politics and Everyday Lives. Routledge. Pearce, R., Moon, I., Gupta, K., & Steinberg, D. L. (2019b). Introduction: The many-voiced monster: collective determination and the emergence of trans. In R. Pearce, I. Moon, K. Gupta, & D. L. Steinberg (Eds.), The emergence of trans: Cultures, politics and everyday lives (pp. 1–12). Routledge. Puckett, J. A., Matsuno, E., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019). Mental health and resilience in transgender individuals: What type of support makes a difference? Journal of Family Psychology, 33(8), 954–964. https://doi. org/10.1037/fam0000561 Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019 Wilson, C., & Cariola, L. A. (2020). LGBTQI+ youth and mental health: A systematic review of qualitative research. Adolescent Research Review, 5(2), 187–211. https://doi.org/10.1007/s40894-­019-­00118-­w

Appendix 1: Topic Guide for Parents’ and Carers’ Interviews

Personal Journey 1. As a mom/dad/carer/sibling of a young trans person, what are your experiences? Can you talk me through your journey? 2. When did you realise that your child/sibling might be trans/gender-­ diverse? Can you remember how you felt at the time? 3. What were your ideas about being trans/gender non-conforming before that? And now? 4. What are your main concerns in relation to the care that your child is receiving? 5. How has your child’s social transition been for them/yourself/ your family?

Experiences of Healthcare 6. Can you remember the first time your child’s gender identity was discussed with a health professional? How was that? 7. As a mom/dad/carer/sibling of a trans young person what kind of support was/is there for you within the healthcare system? What kind of support would you find useful? 8. How helpful have you found the health professionals your child has seen in relation to gender identity? How helpful were they for © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 M. Mikulak, Parenting Trans and Non-binary Children, https://doi.org/10.1007/978-3-031-09864-2

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you as a mom/dad/carer/sibling of a trans/gender-diverse young person? 9. What are your views on the support young people receive before entering specialist care? 10. What are your experiences with GPs? 11. What role do the GPs play in providing care to trans and gender-­ diverse youth? 12. What do you think is important for GPs to be aware of when it comes to trans/gender-diverse youth? 13. What are your experiences with CAMHS? 14. What are your experiences with GIDS? 15. What are your views of GIDS? 16. What are your views on the long waiting list? 17. What do you think should/could be done in the meantime? 18. How do you think a trans/gender-diverse young person experiences healthcare? Healthcare professionals? 19. Can you describe a time when your needs or the needs of your child were not met in healthcare settings? 20. Do you have any examples of positive experiences in healthcare? 21. What are your experiences of private healthcare? If none: what do you know about it? 22. What are your experiences of discussing fertility preservation options? If none: have you thought about this aspect?

Discrimination and Barriers to Care 23. Do you think young trans and gender-diverse people face any biases in healthcare? What about their parents? 24. What do you think could be done in healthcare to combat discrimination against trans people? 25. What are the major barriers to providing good care for trans youth? 26. What do you think is most important to young trans patients when accessing healthcare? 27. What is most important to you, as a parent/friend/relative? 28. What do you think about the levels of autonomy that young trans people have in healthcare?

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Information 29. Where do you get information about gender identity and being trans? How about gender-affirming care? 30. How did you first learn about different terms and identities related to gender diversity? 31. What do you think about the information available to you? What is the role of the internet? 32. What do you think about the information available to young people on trans health and gender identity?

Future 3. How can healthcare be improved for trans and gender-diverse youth? 3 34. What resources would you like to see developed in the future? 35. How can access be improved for young trans and gender-diverse people? What about those who come from marginalised backgrounds/experience multiple inequalities based on their race, class, ability, sexuality, and so on? 36. What advice would you give to doctors and nurses working with trans youth? 37. What advice would you give to parents/carers of young trans and gender-diverse people?

Public Debate 38. What are your thoughts on the current heightened interest in trans-issues in the public debate? 39. Is there anything we haven’t talked about you wanted to add?

Index1

A AB v Tavistock, 7 Appointments at the GIDS, 95

Communities, 139 Co-parenting, 133, 134, 142

B Bell v Tavistock, 6 Bullying, 114–118 Burden of education, 120

D Detransition/detransitioned/ detransitioning, 148 Dr. Webberley, Helen, 100 DSM-5, 10

C Cis-certitude, 39–59, 64, 142, 146 Cis-futures, 148, 154 Cisgenderist, 4 Cisnormativity, 3, 39 Coming outs, 40–47, 40n1, 49–51, 53, 56, 130

E Early childhood, 47 Education, 108, 122 Educational, 68 Educational burdening, 67 Everyday advocacy, 139 Extended family, 128, 129, 132, 138

 Note: Page numbers followed by ‘n’ refer to notes.

1

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INDEX

F Family, 128

L Loss, 52–56

G Gendered self, 8, 16–17, 47–52 Gendered selfhood, 16 GenderGP, 100, 102 Gender Identity Development Services (GIDS), 3, 6, 82, 94, 95, 96n2, 97, 99–101, 105 Gender-inclusive education, 124 Gender-inclusive school policies, 120 Gender Recognition Act (GRA), 13 General practitioners (GPs), 83, 85, 86, 92 Getting informed, 62–68 GIDS, see Gender Identity Development Services Goodwin v United Kingdom, 12–13 GPs, see General practitioners Grandparents, 129–132, 130n1

M Medicalisation, 9 Mermaids, 7, 21, 62, 145 Moral panic, 72, 75, 76, 148

H Healthcare, 22–24 HealthTalk, 1 Histories of trans children, 11, 14 I Information, 62–64 J Justice-based parenting practices, 2, 17, 76, 127 Justice-based practices, 145

N Non-affirming, 46 approach, 57 home, 119 parents, 49, 82, 133, 134 partner, 142 O Online advocacy, 137 P Parent, 46 Pathologisation, 9 PE, 110 Peer support, 68 Physical environment, 109 Primary care, 84–88, 94 Private healthcare, 100, 101, 103, 104 Public debate, 72–75 Public discourse, 72 R Referrals, 82–84, 90, 104 Referral to the GIDS, 82 S School, 24–25, 107 Siblings, 130, 131

 INDEX 

Social media, 129, 138, 139 Social transition, 49, 51, 67, 112, 116, 129

U Uniforms, 109, 111–114

T Toilets, 110, 111 Trans child, 14–16 Trans childhoods, 14, 16 Trans histories, 8 Transition/transitioned, 53, 113, 115, 120, 121

V Visibility, 72–75 W Waiting times at the GIDS, 88

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