Insight: Inside Out - Raising a Transgender Child. What would you do if your child constantly told you they'd been born in the wrong body? Insight's reporter Teresa Cowie talks to parents about the constant judgement they face, the worries and the practicalities around bringing up a transgender child
From the moment Kate* fell pregnant she was imagining what kind of person her baby would be when they grew up. When it came time for her scan at 20 weeks she was told she was having a boy and began dreaming of the man he would become.
But from the age of two her child, now her trans daughter, was already rejecting stereotypical boys' clothes and toys and was showing extreme distress and anger at any expectations they would be a rough-and-tumble boy.
Kate's daughter socially transitioned from male to female at age eight. Photo: RNZ/Teresa Cowie
Emmie, who is now nine, transitioned a year ago after years of persistently and consistently asking to be seen as a girl.
"It was until she was actually eight that she specifically said, 'I'm a girl on the inside, please stop calling me a boy.' That was a little bit of a shock, in the back of our minds we thought we might be raising a gay child, but obviously sexuality doesn't come into it at that age."
Figures on exactly how many transgender children there are in this country are scant, but the best estimates can be gleaned from Auckland University research from 2012 as part of the health and wellbeing Youth 2000 Survey.
In the survey, 8500 high school students from 91 schools were asked whether they were "a girl who feels like she should have been a boy, or a boy who feels like he should have been a girl".
About four in every 100 students either said they were transgender (1.2 percent) or were not sure of their gender (2.5 percent).
About half of the transgender students had thought they might be trans before they had turned 12, but only a third had told someone close to them how they were feeling.
For children who have not reached puberty, there are no medical interventions and what's known as "socially transitioning" is considered the first step towards living as their preferred gender.
It might mean wearing different clothes, changing their name or changing their pronoun to him/her/they to match their preferred identity.
Choices around medical interventions that could permanently change the body, such as sex hormone therapies, or in some cases surgery, are left to the teenage and adult years.
Auckland 11-year-old Ben socially transitioned when he was six years old. Photo: RNZ/Teresa Cowie
West Auckland boy Ben, 11, is a female-to-male trans boy who socially transitioned when he was six years old.
When I visited his home in Glen Eden, he was enjoying a hot afternoon shooting hoops in his driveway and kicking around a ball on the lawn. But unlike many of his friends at intermediate, he has a lot of decisions to make about the medical side of transitioning to male.
With puberty just around the corner, Ben has recently made the decision to start taking puberty-blocking hormones.
Accompanied by his mother Rebecca, every three months Ben takes the bus to a clinic where he gets an injection that stops him developing the physical characteristics associated with adult women.
Ben in his back yard: "I've already made my decision ... I'm going to stay who I am." Photo: RNZ/Teresa Cowie
"If I want to be myself [a male] there's nothing else I could choose to do. I've already made my decision, no matter what, I'm going to stay who I am."
He would be very upset if he had to allow his body to develop otherwise, he said.
"I wouldn't feel like myself, it would make me feel sad, because of how far I've come."
The idea behind puberty blockers is for a trans child who is already living as their preferred gender to buy time before they can make a more informed choice about whether to take sex hormones to shape their future.
Puberty blockers are reversible, although there is limited research into the long-term effects they can have on development.
Sex hormones are more permanent. They can be taken from about age 16 to change the body and give it physical characteristics such as breasts, broad shoulders, or a feminine or masculine pattern of hair, fat and muscle distribution.
They can also make a person infertile while they are taking them, which is a difficult decision for young teenagers to grapple with.
According to a report from the Ministry of Health (PDF, 2.6MB), about 75 percent of trans children do not go on to identify as trans adults, for various reasons, but many of them retain some sexual preference or gender issues.
The report said those who displayed more extreme distress about their gender seemed to be most likely to persist and identify as a trans person in adult life.
For the parents guiding their young transgender children through decisions around bullying and mental health issues, and future choices about hormone therapies, a huge strain can be placed on their child, themselves and the rest of the family.
Three years ago, Auckland mother and social worker Amanda Aarons set up Holding Our Own, a group for parents with LGBTQI children, after her own son came out as gay.
Holding Our Own founder Amanda Aarons: "Society looks at them and says, 'What are you doing to pressure this child into that?'... I don't think there's a parent in the world who would put upon their children such a difficult life." Photo: RNZ/Teresa Cowie
Her idea was to help other parents deal with the emotional shock and practicalities of parenting a child in a world that at the moment often struggled to accept them.
Many of the parents she dealt with felt grief, guilt and enormous anxiety about what lay ahead for their child as a trans adult, she said.
"I've kind of found that it's about who will love my child, who will love my child in this way, how will my child be in the world, because our fear of what it means to be so different is a very scary concept [for parents]."
Feeling judged
Ms Aarons said many parents felt they were looked upon with suspicion, for supposedly having pressured their child into being trans.
She said, because of this, some of those who took part in her group decided they would make their child put off their feelings until they were old enough to leave home.
"Society looks at them and says, 'What are you doing to pressure this child into that?'... I don't think there's a parent in the world who would put upon their children such a difficult life."
Kate spends a lot of time online researching how best to help her daughter. Photo: RNZ/Teresa Cowie
In Wellington, Kate, the mother of nine-year-old trans girl Emmie admits she was so nervous about being judged she shook every time there was a play-date with a new friend and she had to tell the other parent about her daughter.
"Do you really think that I woke up one morning and thought, 'You know what would make my life so much easier, today I'm going to make my little boy into a girl?' Despite seeming 100 percent on board we went through months of really questioning ourselves as parents, and grieving for that little boy we'd lost."
A 2015 study, Mental Health of Transgender Children Who Are Supported in Their Identities, in Pediatrics, the American Academy of Pediatrics' journal, found socially transitioning before a child hit puberty to be fairly safe.
Despite that, New Zealand data on bullying, suicide and self-harm among trans young people shows a hard road might lie ahead for those who struggle to find acceptance.
In the Auckland University 2012 Youth 2000 survey, trans respondents were found to have much poorer mental health than other young people.
About 40 percent of transgender students had significant depressive symptoms, and nearly 50 percent had self-harmed in the past 12 months.
A fifth of the trans students surveyed had tried to kill themselves in the past year.
Fighting on
Rebecca said she was aware of the judgment she faced from some people but, five years on from her child's transition, she was less worried about what other parents thought.
"I have felt judged, but I haven't let it bother me. As long as I know I'm doing right by my kids, then I'm happy with the decisions I make."
She said, given the grim statistics and the obstacles experienced by so many trans people, she was more concerned about fighting on for what would keep her son healthy and happy.
*Some names in this story have been changed to protect individuals' privacy.