Imagine worrying that your loved one’s physical appearance will make other people confused, uncomfortable, embarrassed, and very likely to stare – sometimes discreetly, more often blatantly.
Or stressing about which toilet facility they should use and when, because you fear they will be harassed for not feeling comfortable in a bathroom that doesn’t match their self-identified gender.
For parents of transgender (trans) children, who are trying to deal with the staggering complexities of their loved one’s gender identity and expression, support is vital.
Thankfully, there are remarkable people who can help, like Waterford woman and trans activist Vanessa Lacey, who stresses that “gender is a core sense of identity”.
Vanessa (56) works for Transgender Equality Network Ireland (TENI), a national organisation, with headquarters in Dublin, that advocates for the trans community’s rights in Ireland.
“Families know that their loved one is suffering, but they’re also confused about what the process of gender-transition entails, particularly for younger people considering that adolescence is often a time of identity exploration,” says Vanessa, who is Health and Education Manager at TENI.
To help tackle head-on the conundrums that families of trans people often face, and with TENI’s support, Vanessa started TransParenCI: “It’s spelled a little different but it stands for Trans Parents Connect Ireland,” she explains.
“It involves monthly group sessions – in Dublin, Cork, Waterford and Kerry – to help families to connect and form a better understanding and acceptance of whatever trans situation is at hand, which in turn, benefits their trans loved one.
“We currently have over 400 families that we support. Some only need information whereas others may have more complex needs.”
Increased awareness, as well as access to information and support means people today are ‘coming out’ at a younger age, than they had in the past.
While most trans people experience gender conflict from childhood, some go through years of pain and social stigma before transitioning – ‘coming out’ as trans is a personal experience, unique to every individual.
“Some parents may have no inclination that their child is trans, especially if they ‘come out’ in later life,” says Vanessa, referring to the difficulties that some families face, including her own.
Vanessa knows first-hand what it’s like to suppress her gender identity for a long time.
Like most trans people of her generation, she spent most of her life being misunderstood and hiding her true inner gender.
Vanessa, who transitioned in 2007, says that her family struggled and that, at the time, she was at a loss to support them.
“There were absolutely no supports to help my family understand what my situation was all about. There was nobody to talk to that had any insight or understanding of what being trans meant,” she says.
“Mainly, the attitudes and portrayals of trans people that existed at that time were sensationalistic and negative.”
Dr Lisa Brinkmann, a Cork-based Clinical Psychologist who specialises in gender issues, says that when someone ‘comes out’ as trans, it can be difficult for their family and friends to accept.
“Family members often experience the transition of a loved one through feelings of grief or loss, especially when the trans person’s role was uniquely defined by gender, such as being a husband or wife,” she explains.
“The trans person often experiences uncertainty about whether their family and friends will continue to love and support them if they pursue transition.”
Since her transition, Vanessa has been blazing a trail that’s improving the situation and public understanding of trans people in Ireland. She has continued her education too, with a PhD in psychology.
“Over the last decade there has been an exponential rise in people seeking gender identity related supports and services in Ireland,” she says.
“Healthcare professionals can experience confusion when addressing the needs of both adults and young people in terms of understanding their needs and making referrals to specific services.”
Because of this, ground-level community engagement is always important for Vanessa.
As part of her work with TENI, she also designs and delivers trans-awareness training, in partnership with HSE and other national and international experts in the area, and has been part of a team that developed a high-level three-day training package called Gender Identity Skills Training (GIST) for healthcare professionals throughout Ireland.
At the sharpest end of Vanessa’s focus, though, is supporting those families trying to make tough and complex decisions that may not be clear-cut.
“Not every trans young person needs to medically transition, but those that do are required to seek a diagnosis of gender dysphoria,” she explains.
Gender dysphoria is a prolonged feeling of distress due to a strong desire to be a different gender. This mismatch can significantly impact on day-to-day life.
“For many adolescents, it may well be the case that having feelings and thoughts that seemingly signal a gender conflict is often short-lived, a normal part of atypical development,” says Vanessa.
“However, some who are experiencing significant distress because their body is developing in a way that is incongruent with their gender identity, usually end up having to see a psychiatrist.”
Assistant Medical Director and Consultant Psychiatrist, Dr Aileen Murtagh, who specialises in child and adolescent mental health at St Patrick’s Hospital in Dublin, says “it’s important to create a space where it’s safe to think about choices”.
“Even before disclosing symptoms of gender dysphoria, some more vulnerable young people can experience mental health difficulties like depression or social isolation that can lead to suicidal thoughts,” says Dr Murtagh.
Supportive therapy helps young patients, and their families too, find solutions and coping strategies that reduce anxiety and build self-esteem.
“The entire family needs to be educated about trans issues, whether it’s just coping with a loved one’s gender change, or accessing social and emotional supports for themselves,” Dr Murtagh adds.
While HSE guidelines recommend that prepubescent trans youths should not undergo medical interventions, allowing them to ‘socially’ transition, which can include changing their name and style of clothing to match their self-identified gender, can greatly benefit their wellbeing.
Medical treatments for adolescent trans people can include temporarily suppressing puberty through the use of prescribed medication.
This fully reversible hormone therapy temporarily suppresses the production of testosterone in boys and oestrogen in girls.
“The young trans person goes through a comprehensive assessment period before puberty blockers are considered,” says Dr Murtagh, stressing that “discussions with families are crucial”.
Gender Identity Development Service UK (GIDS) looks after the administration of puberty-blocking hormone interventions at a clinic in Crumlin Children’s Hospital, Dublin, as Ireland is still in the process of developing a similar service.
The specialist endocrinology service is funded by the HSE under the EU Treatment Abroad Scheme. According to Freedom of Information (FOI) data, less than 20 Irish children are currently attending the clinic.
Opinions around medically transitioning adolescents are often contentious. Some believe that it’s safer to wait and see than to put young people on a path that could prove difficult to reverse.
Like Harry Potter author JK Rowling, who recently made her opinions known online when she made reference to what she describes as the “huge explosion” of young women transitioning, which she believes may soon be followed by “increasing numbers” of detransitioners.
Using her popular blog, she brands the rising number of young trans people ‘coming out’ as a “contagion” spread by social media, and wonders whether she might have tried to transition too, if she’d been born 30 years later.
While there is little information available on trans people detransitioning – that’s when someone reverts back to their birth-assigned gender – the facts that do exist seem to indicate that it is an infrequent occurrence.
In a 2015 survey of 28,000 trans individuals, undertaken by the US-based Transgender Equality Centre, 8 per cent of respondents detransitioned, and 62 per cent did so temporarily, while only 0.4 per cent said that transitioning wasn’t right for them.
Those working closely with trans people, like TENI’s Health and Education Manager, Vanessa Lacey, caution against the sensationalist reporting of the increases in transitioning young people as a “huge explosion” and also debunk the idea that a social media-fuelled “contagion” is at its root.
“The medical route is embarked on only after a long period of self-discovery and self-reflection as well as stringent international protocols that require six specialist assessments are carried out before young people begin hormone treatments,” says Vanessa.
Making sure that young trans people have safe and supportive structures that allow them to participate in all aspects of life without experiencing exclusion or distress, is Vanessa’s life’s mission.
“What most trans people are looking for is acceptance and support,” she says.
“This can start anytime, at home over the kitchen table with a cuppa and a chat.
“Many families do develop an understanding of their loved one’s gender identity and help them to live happy and meaningful lives post-transition.”