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Recognising the needs of gender-variant children and their parents

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The Needs of Gender-Variant Children and Their

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Elizabeth Anne Riley , Gomathi Sitharthan , Lindy Clemson & Milton Diamond
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DOI: 10.1080/15532739.2011.622121

The Needs of Gender-Variant Children and Their Parents

According to Health Professionals
Elizabeth Anne Riley
Gomathi Sitharthan
Lindy Clemson
Milton Diamond
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011

ABSTRACT. Children with gender variance and their parents struggle with negativity on a daily basis
due to ignorance regarding their issues and needs. This study explored professionals’ views of these
issues and needs via a qualitative Internet survey. Responses were examined using content and thematic
analysis. The dominant identified needs for gender-variant children according to the professionals were
to feel accepted, acknowledged and respected. Parents’ needs included emotional support and guidance,
information, and access to competent, caring professionals. Implications of the study’s findings were
the need for professional training, funding for education and research, and efforts to reduce the social
stigma associated with gender variance.

KEYWORDS. Gender variance, transgender, children, parents, gender identity

Professional intervention and support for ied or documented. A number of publications

gender-variant children potentially covers a
range of services from information and support
for the child and the family to specialist referrals
where indicated. The professional provides a
place of stability within often chaotic and dif-
ficult circumstances for transgender individuals,
children, and their families (Lev, 2004). These
professionals are therefore exposed to the issues,
concerns, and needs of gender-variant individ-
uals and their families providing a valuable
window into the needs of gender-variant children
and their parents.
Until recently, the needs of gender-variant
children and their parents have not been stud-
(Brill & Pepper, 2008; Hill & Menvielle, 2009;
Lev, 2004) and organizations have provided
crucial resources and support for gender-variant
children and their parents. The impact of
discrimination, marginalization, and abuse on
gender-variant individuals is well known (Grant
et al., 2010; Nuttbrock et al., 2010; Whittle,
Turner, & Al-Alami, 2007; Wyss, 2004) and
begs intervention to prevent these outcomes
for gender-variant children. One study (Riley,
Clemson, Sitharthan, & Diamond, 2011) has
explored the needs of gender-variant children
and their parents via surveys of parents of
gender-variant children. The authors found that

Elizabeth Anne Riley, Gomathi Sitharthan, and Lindy Clemson are affiliated with the Faculty of Health
Sciences at the University of Sydney in Lidcombe, New South Wales, Australia. Milton Diamond is affiliated
with the Pacific Center for Sex and Society at the University of Hawai’i at Mānoa in Honolulu, Hawai’i.
Address correspondence to Elizabeth Anne Riley, Faculty of Health Sciences, University of Sydney,
Cumberland Campus, Room T419, P.O. Box 170, Lidcombe, NSW 1825, Australia. E-mail: eril6366@uni.
sydney.edu.au
54
 Riley et al.
the dominant children’s needs were to discuss
their feelings, to be accepted, and to be allowed
to express their gender, while the parent’s needs
were to gain knowledge and find guidance and
professional support.
The focus of this report is on the views of
professionals (in clinical and other practice)
of the needs of gender-variant children and
their parents, drawing on years of experience
of those who have direct contact with trans-
gender persons. This is based on the principle
that beneficial information can be gained from
surveying those with a stake in understanding the
needs of their clientele (Charmaz, 2006). This
study aims to provide valuable knowledge and
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011
information to inform guidelines for the support
of gender-variant children and their parents.
The term gender variance is used here to
refer to gendered behavior that does not conform
to prevailing gendered expectations and norms.
Transgender is used here as an umbrella term
to include the widest range of people with
gender-variant behavior (Lev, 2004).
METHOD
Instrument
The Internet was used as a tool to recruit
and survey professionals who work with the
transgender community. No specification was
made regarding the type of work or that the
work be focused on children or families. The
researchers determined that the needs of gender-
variant children and their parents could be
gleaned potentially from any focused work with
transgender people and, therefore, chose not
to limit the input to a specific type or group
of professionals. The only requirement was
that they serve the transgender community. An
international audience was sought to provide
a broad range of views and to provide a
sufficient number of participants. Purposeful
sampling (Charmaz, 2006; Patton, 2002) and
snowballing secured participants via advertising
in newspapers, magazines, radio programs, and
websites and via the listserv and conference pro-
ceedings of the World Professional Association
for Transgender Health. The study was approved
55
by the University of Sydney Human Research
Ethics Committee.
Procedure
Six closed-ended questions were designed to
gather demographic information. Eleven open-
ended questions were developed to provide
the space for rich responses through which
professionals could express their experience,
knowledge, reflections, and ideas (Huberman &
Miles, 2002; Patton, 2002). The survey allowed
participants to skip questions they did not wish
to answer to ensure that all responses would
be voluntary. The questions initially focused
on the professionals’ understandings of parents’
experiences and included questions such as,
What do you understand to be the issues that
parents with gender-variant children face? What
do you believe creates these issues for the parents
[of gender-variant children]? and What do you
believe parents [of gender-variant children] want
and need? The questions then attended to the
children and contained the questions, What do
you understand to be the issues that gender-
variant children face? What do you believe
creates the issues for gender-variant children?
and What do you believe that gender-variant
children want and need? The final series of ques-
tions targeted any concerns that professionals
may have about their work with gender-variant
children or their parents.
Participants
The participants were 29 professionals who
identified as working with the transgender
community. They included clinical practitioners
(n = 22; 76%), directors/coordinators of trans-
supportive organizations or programs (n = 3;
10%), educators/trainers (n = 2; 7%), one
lawyer (3%), and one researcher (3%). Their
demographics, training, and years’ experience
in working with the transgender community are
presented in Table 1.
Data Analysis
The responses were examined using content
analysis to identify common elements and pat-
terns (Charmaz, 2006). Keywords were high-
 56 INTERNATIONAL JOURNAL OF TRANSGENDERISM

TABLE 1. Demographic and professional practice data of participants (N = 29)

All participants n (%)

Country
Australia 6 (21)
Canada 2 (7)
United Kingdom 4 (14)
United States 12 (41)
South Africa 2 (7)
Finland 1 (4)
Brazil 1 (3)
Norway 1 (3)
29 (100)

Qualifications (highest)
PhD 10 (34)
Masters 7 (24)
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Graduate Diploma 1 (3)

Bachelor 7 (24)
Certificate 1 (3)
No formal qualification 3 (10)
29 (100)∗

Clinical practitioners
Counselor/Therapist 5 (17)
Social Worker 5 (17)
Psychologist 6 (21)
General Practitioner 3 (10)
Endocrinologist 2 (7)
Gynecologist 1 (3)
22 (76)

Other professionals
Solicitor 1 (3)
Researcher 1 (3)
Educator/Trainer 2 (7)
Director/Coordinator of organization 3 (10)
7 (24)

Total professionals 29 (100)

Years working with transgender community

1–5 9 (31)
6–10 5 (17)
11–20 9 (31)
> 20 6 (21)
29 (100)

Did you receive specialized transgender training?

Yes 9 (31)
No 20 (69)
29 (100)
∗
Percentages do not add to 100 due to rounding error.
 Riley et al.
lighted and categorized by needs, separately
for gender-variant children and their parents.
The identified needs were coded and placed
into themes separately for children and parents.
RESULTS
Issues That Gender-Variant Children Face
Professionals reported the following issues
for gender-variant children in response to the
questions, What do you understand to be the
issues that gender-variant children face? and
What do you believe creates the issues for
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gender-variant children? The identified issues
are grouped into categories: (a) on recognition
of difference (b) due to others’ reactions, (c) due
to the lack of support, and (d) concerns about the
future.
On Recognition of Difference
• confusion and distress by the incongruence
between the child’s gender identity and
their body,
• confusion that people do not see them as
they see themselves,
• fear that no one will believe them, and
• not knowing how to understand their situ-
ation or what to do
Due to Others’ Reactions
• child feeling rejected and becoming silent
for fear of disappointing his or her parents;
• isolation and not having friends;
• prejudice and stigmatization; and
• bullying, threats, and physical assault that
may create a fear of going to school
Due to Lack of Support
• family and interpersonal conflict created
by parents’ disapproval and lack of under-
standing;
• lack of recognition, acknowledgment, sup-
port, or access to services;
• feeling cheated and misunderstood as their
reality is denied;
• feeling bad, wrong, guilty, anxious, and
ashamed, potentially leading to self-blame,
57
a lack of self-acceptance, depression, the
need for secrecy, self-hate, and suicidal
ideation; and
• how to deal with demands and pressure for
conformity including the lack of gender-
neutral school uniforms
Concerns About the Future
• fear of adolescence or unwanted puberty
The Needs of Gender-Variant Children
Twenty-nine professionals identified a total of
94 needs of gender-variant children. These needs
were grouped in the following nine themes: (a)
to be accepted and supported; (b) to be heard,
respected, and loved; (c) to have professional
support; (d) to be allowed to express their
gender; (e) to feel safe and protected; (f) to
be treated and live normally; (g) to have peer
contact; (h) to have school support; and (i)
to have access to puberty-delaying hormones.
The themes are ranked below in order of the
frequency of the number of needs mentioned for
each theme.
To Be Accepted and Supported (n = 18)
Acceptance and support were the most fre-
quently cited needs for gender-variant children.
Acceptance needs were described as the need
for “acceptance as themselves,” “social accep-
tance,” “acceptance by families and friends,”
“tolerance,” and, for gender-variant children,
the need “to be left alone” and to have “a
community who will let them be themselves.”
The need for support was mentioned generally
and specifically as the need to “be supported to
make their own choice in their own time” and
“be supported by family, friends and school to
live life as they see fit.”
To Be Heard, Respected, and Loved (n = 16)
The need for children to be respected and
loved included the need for “affirmation,” “to
be heard and recognized,” “to be respected in
their rights and decisions,” to be “heard and
believed according to their inner voice regarding
gender identity,” and “to be valued, heard, and
 58 INTERNATIONAL JOURNAL OF TRANSGENDERISM
helped to live comfortably in the world.” One
professional wrote that gender-variant children
need to receive “love, support and acceptance
regardless of the final outcome of their issues”
and others that “they need to be loved as they
are,” “knowing their parents will love them no
matter who they become.” Time to explore was
also mentioned; some professionals noted that
gender-variant children need “[p]arents . . . who
are willing to understand them and give them
time to work out their identity” and want “to be
listened to, not told they will grow out of it (even
though some do).”
To Have Professional Support (n = 16)
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011
Specific suggestions were made regarding the
role of medical and mental health practitioners.
In particular, recommendations were made for
professionals who are “understanding, knowl-
edgeable, and educated on gender issues in
childhood” and who have access to “an early
recognition system” so that help can be provided
as soon as possible. It was also suggested
that children need “friendly,” “sensitive and
proactive support from all professionals they
deal with.” Additionally, professionals stated
that children need “to be able to access the
medical resources necessary to grow up mentally
and physically healthy” and that “children need
to be offered the experience of being heard
and recognized in a positive atmosphere” with
support towards “resolution.”
To Be Allowed to Express Their Gender
(n = 10)
The need for gender-variant children to be
themselves was described in a number of ways.
Professionals wrote how children need to have
the “acceptance, love and freedom to explore
who they feel they may have been without
judgement or imposition of restrictions and
expectations that negatively impact who they
are,” that they need to be allowed “to be
themselves and dress and act any way they wish
with no pressure or negative commentary,” and
have “places where they can express themselves
and their gender with no judgement.” Another
wrote, “I think they want to be allowed to wear
and do what they want, without all the constant
negotiations.”
To Feel Safe and Protected (n = 8)
Professionals wrote how children need pro-
tection from “violence and discrimination . . .
[and] bullying” and explained that they also need
the skills to deal with negativity as well as be
protected from it by having access to brochures
and/or booklets to help “coping with bullying
and harassment.”
Respondents also wrote that children need to
be “helped to live comfortably in the world,” that
they had the right to “safe schools and homes,”
and that “more community and school education
[is needed] to sensitize the public and make
things safer for Trans-inclusive families,” as well
as “penalties for adults and children who commit
hate crimes and/or gender-based bullying.”
To Live a Normal Life (n = 6)
There were a number of statements made
about how gender-variant children need “all the
same things gender-typical children need and
take for granted,” including “the basic things that
all children require: support, acknowledgement,
protection and understanding.” Professionals
also wrote that gender-variant children need “to
be able to live normal lives in their affirmed
gender” and need “to be able to make friends,
have crushes, engage socially, without being
seen as being different than other kids” while
“knowing they can live successful lives” with
“equal rights.” One professional explained in
detail that
[gender-variant children are] no different
to any other children . . . it is just that chil-
dren not born with GID [Gender identity
disorder] receive this more easily because
they are not challenging the rigid roles we
somewhere along the line established in
our society, about how males and females
should behave and act to fit into society.
To Have Peer Contact (n = 5)
Professionals expressed “contact with similar
persons” and “knowing other kids” through
 Riley et al.
“peer groups” as a need for gender-variant
children. One professional also wrote that “a
mentor who is older and can help” would also
be useful.
To Have School Support (n = 5)
Educated teachers and staff covering gender
variance and diversity, with policies on bullying
were identified as interventions needed for
gender-variant children. In particular, profes-
sionals wrote of the need for “zero tolerance
of ridicule,” for “teachers who are willing to
understand,” and for “safe schools.”
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To Have Access to Puberty-Delaying Hor-
mones (n = 5)
The need for hormone blockers was stated
by some professionals. Particularly for children
who need them “to grow up mentally and
physically healthy and avoid years of surgeries,
voice training etc. that could have been prevented
if unwanted puberties were stopped/prevented.”
One professional wrote that “hatred for the body
and changes that puberty brings” is an issue
that children face if puberty-delaying hormones
are not available for them. Another professional
outlined in detail the physical discrepancies that
children needing complete affirmation face if not
provided with puberty-delaying hormones:
They will have to combat unwanted facial
hair, Adam’s apple, heavy build, large
hands and feet, excess height etc. for those
who are MtF, And for those who are FtM,
breasts, menstruation, lack of facial hair,
high voice, hips, etc.
This professional further added that, if treatment
is not made available,
children often have difficulty remaining
in school. That stress can cause problems
such as self-harm, bulimia, anorexia, some-
times depression, sometimes worse. They
[the children] might get into trouble with
the police or the family as they can get very
angry and frustrated.
59
In addition to these nine themes, five needs
were described that included the following:
the need for children to have “gender neutral
spaces,” appropriate housing, information, and
resources to reduce confusion and aid in their
understanding of gender variance, particularly
through “more access to books and videos which
would inform them about all aspects of their
gender identities.” One professional cautioned
that giving the children too much power may
present other problems, in particular, cases in
which the child uses his or her leverage of gender
rights or being special as a way of negotiating
out of other tasks.
Issues That Parents of Gender-Variant
Children Face
Professionals identified the following issues
for parents with transgender children. These
issues for parents cover their initial recognition
of their child’s gender variance and their lack of
knowledge and available resources, the lack of
support and educated professionals, their current
concerns regarding their child’s health and safety
and their own adjustment. These issues are listed
below:
• initial disbelief, confusion, shame, and
embarrassment;
• lack of understanding;
• being unsure what to do, in particular
whether to support their child’s gender
variance;
• not knowing where to access reliable
resources and support;
• lack of acceptance by families, friend, and
communities;
• uninformed medical practitioners and ther-
apists;
• fear of making the wrong decision for their
child;
• social stigma, prejudice, and pressure for
their child to conform;
• schools that do not support their child;
• concern for their child’s emotional, mental,
and physical health and safety; and
• the need to adjust their expectations for
their child’s future.
 60 INTERNATIONAL JOURNAL OF TRANSGENDERISM
Needs of the Parents of Gender-Variant
Children
Professionals identified 98 needs for parents
of gender-variant children. A significant pro-
portion of these needs arose within themes of
support, namely, emotional support—support
from peers, school, society, local community,
and friends and family. Other needs identified
by professionals were the need for education and
information; a diagnosis and treatment pathway;
competent, caring professionals; and research.
The themes are ranked below in order of the
frequency (n) of the number of needs mentioned
for each theme.
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011
Emotional Support (n = 20)
Competent counseling/therapy was seen as
a foundational need for parents where listen-
ing, reassurance, understanding, and guidance
for both parents and child was recommended.
Respondents felt that parents need to “know
it is not their fault,” to know that it is “ok
to support their child,” and to know that there
are other parents dealing with similar issues
and that parents should be given the time to
adjust and reorient their ideas about their child’s
future. Professionals also explained that parents
need help with decision making and proactive
support with “someone to affirm with them
their child’s identity” within an “empathetic
. . . non-evaluative environment in which the
couple can discuss their own views, opinions
and feelings about how to approach raising
a gender variant child.” Finally, professionals
reported that parents need “guidance as to what
will psychologically and physically help their
children to be happy and self-assured.”
Education and Correct Information (n = 12)
Parents’ uncertainty about the facts of their
child’s situation was seen as a major inhibitor
to their confidence in being able to support
the child. One professional wrote that “social
norms relating to gender and the assumption that
anatomy always matches presumed gender iden-
tity teaches parents to be upset by non-gender-
conforming children.” This lack of correct infor-
mation was also seen to sustain “parents own fear
of what their child’s condition could mean they
have done or are doing.” Another professional
suggested that “if the medical system made a
statement and took a position about the validity
of this condition . . . others may follow . . . [as]
people have been taught to believe what doctors
say.”
Support from Society, Local Community,
Friends, and Family (n = 11)
The need for support and understanding from
society, neighbors, churches, and other parents
as well as friends and family was noted as
necessary for parents to be able to support their
children publically. They cited that parents need
“less social pressure to conform to rigid gender
roles” with “suspension of judgement from those
around [them]” and, moreover, “societal support
and understanding and people to advocate for
them in society.” This need for support was
stressed by one professional, as “[parents] need
so much support if they’re going to follow [the]
child’s lead instead of pressing them to hide.”
General Support (n = 11)
This category includes the number of re-
spondents who suggested support but gave no
indication of the type of support they were
referring to.
Competent, Knowledgeable Professionals
(n = 10)
Educated, caring professionals and competent
medical care for the child was stated as a need
for parents. They wrote specifically that parents
need to see professionals who have “respect for
their response and the time needed to adjust [to
their child’s gender]” and who “would do their
best to get things right [for the child].” They
also wrote that parents need professionals “who
are welcoming and caring and understand [what
parents are going through]” and, in particular,
who are willing “to alleviate the child’s pain and
distress at the effects of puberty.”
 Riley et al.
Diagnosis, Treatment, and Beneficial Out- elementary school where children can cross-
comes for Their Children (n = 10) dress and play with gender roles without censure
The need for correct diagnosis and certainty
about the recommended treatment pathways and
outcomes was, according to professionals, an
important concern. They felt that parents need
“a clear diagnostic process” and “clear direc-
tions, and routes that will make their children’s
(and their) journeys easier, not harder.” Pro-
fessionals further explained that parents “need
best practice medical guidelines for navigating
puberty/adolescent years,” to be able “to know
their child will be ok” and to “trust [that] a good
life [would be available] for their child.”
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011
Peer Support (n = 9)
Support and understanding from other parents
and families with gender-variant children was
stated as a need that would enable parents “to
meet other families like theirs.” One professional
also wrote that this would help parents know that
they are not alone and provide “assistance with
parenting issues.” This communication with
other parents was also seen as an important form
of emotional and social support, particularly
in spending time with other parents “who are
struggling or who have struggled with these
issues.”
Support, Understanding, and Acceptance
from Schools (n = 6)
Professionals had some clear ideas about what
parents want and need from schools. They wrote
about “schools that [need to] allow their children
to be who they are with no bullying” and the need
to “improve conversations at the elementary
school level between kids and teachers about
diversity issues,” as well as the need to educate
parents “in school systems . . . about sensitivity
to kids who are gender variant or who may
be developing GLB [gay, lesbian, or bisexual]
identities” and for “more community and school
education to sensitize the public and make things
safer for trans-inclusive families.” Furthermore,
they suggested “cross communication [between]
families, medical services and schools” and that
“they [parents] need a culture in which adults
are much more tolerant of gender variance in
61
or punishment.” Additionally, they proposed
that parents need “school counsellors . . . [able]
to help kids [who are] struggling with gender
variance” and “education in elementary schools
about sexuality and gender roles, gender identity
and helping children develop knowledge about
their own bodies.”
Research (n = 5)
Evidence-based practice was noted by some
professionals as a need for parents to have
confidence in recommended treatment proto-
cols. In particular, they stated that parents need
“evidence for some origin of the condition,”
“more research showing the outcomes of earlier
transitions,” and “verification that their child’s
condition is real,” as well as a “guarantee of
some right direction” for their children.
In addition to these themes, professionals
mentioned other needs of parents, namely, the
need for their child to be happy, the need of sup-
port for the family, and the need of legal support.
DISCUSSION
This study aimed to identify the needs of
gender-variant children and their parents from
the experience and perspectives of professionals
who work with individuals and families seeking
support for transgender issues. We have pre-
sented both what the professionals see as the
issues facing these children and their parents as
well as what the professionals deem to be their
needs.
The issues that gender-variant children face
highlight consistent deficits and negativity in the
children’s lives and focus our attention to the
extraordinary burden placed on gender-variant
children in their formative years. A report by
Grant et al. (2010) describes in detail the extraor-
dinary levels of harassment, physical assault,
and sexual violence experienced by transgender
children in years during primary and high school.
These issues, if unable to be alleviated, are likely
to present ongoing and accumulative difficulties
that then impact their lives as adults (Grant
et al., 2010; Riley et al., 2011).
 62 INTERNATIONAL JOURNAL OF TRANSGENDERISM
The needs of gender-variant children as
specified by professionals (apart from the need
for puberty-delaying hormones) are needs that
correspond to the rights of all children. That
these needs cannot be taken for granted by
gender-variant children speaks volumes in terms
of the lack of equality and level of discrimination
enacted towards them.
The issues that parents face according to
professionals suggest that the lack of knowledge
and awareness about transgender people and
their concerns in the general and professional
community creates a vacuum leaving them with
little resources and support. This adds an extra
burden on parents as they have to deal with
Downloaded by [Elizabeth Anne Riley] at 15:12 16 December 2011
the opinions and attitudes of those around them
in addition to managing their own concerns
and decision making regarding their child. The
needs of parents overwhelmingly feature the
various types of support that would help parents
become informed, be able to cope, and make
the best decisions for their child. Societal and
community support appear to be crucial factors
for parents to comfortably engage with the tasks
required of them to support their child.
This combination of issues and needs of
both the children and the parents provides a
window into the dearth of available resources
and education that could provide much needed
relief for the whole transgender community.
It may appear from the needs for gender-
variant children that puberty-delaying hormones
are a necessity for every child. It should be
stated that gender variance in and of itself is
not a reason for any child to take puberty-
delaying hormones. Evaluations for puberty-
delaying hormones are based on professional
consultation including the assessment of the
child’s level of discomfort (dysphoria) with his
or her body and parental support.
Cultural variations have not been taken into
account due to the small numbers of profession-
als in the countries represented. There simply
were not enough data, partly due to the limited
pool of professionals available, to take culture
into consideration. Riley et al. (2011) indicated
that educated professionals are in short supply
even in countries where there are clinics and
support services.
It is likely that the needs of the children
and their parents’ attitudes and ability to accept
and advocate for them are related. However, the
nature of this relationship cannot be discerned
from our data. Future research is required to
examine this relationship.
CONCLUSION
The aim of this study was to identify
the needs of gender-variant children and the
needs of their parents from the perspective of
professionals who work with the transgender
community. The study found that the issues
gender-variant children and their parents face
provide a stark example of the void within which
parents manage the plethora of circumstances
that arise when rearing a child with gender
variance. This in turn appears to create an
unnecessary burden on the children themselves
who then may often not have much choice but
to retreat into silence, isolation, conformity, and
self-blame.
The needs of gender-variant children identi-
fied from the professionals’ responses revealed
a lack of respect for the rights of children
who experience gender variance. The most
frequently mentioned needs were to be accepted
and supported; to be heard, respected, and loved;
to have professional support and recognition;
to be allowed to express their gender; to feel
safe and protected; to live a normal life; to have
peer contact; to have school support and; to
have access to puberty-delaying hormones. The
needs of the parents focused primarily on areas
of support and professional assistance, namely,
the need for emotional support and guidance;
education and information; support from society,
local community, friends, and family; com-
petent knowledgeable professionals; diagnosis,
treatment, and beneficial outcomes for their
children; peer support; support, understanding,
and acceptance from schools; and research.
Together, these findings call for education
programs to provide knowledge and exposure to
the issues that transgender people face, across
such sectors as medicine, mental health, and
teaching in schools. The targeted education of
 Riley et al.
medical and counseling professionals, the inclu-
sion of printed materials in doctors’ surgeries,
and the distribution of best practice guidelines
and training in schools would signal a major
change across the professional and community
sectors that the needs of transgender children are
being taken seriously.
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