But sadly, a growing understanding still does not always equal acceptance. For LGBTQ adolescents, lack of acceptance is not merely a social issue but a health risk. High school students who identify as lesbian, gay, or bisexual are at increased risk for bullying and violence, they are almost 2½ times more likely to be absent from school, and homelessness and alcohol use are more prevalent. This is not due to the LGBTQ identity itself, but rather due to social stigma, an unaffirming culture, and lack of acceptance that LGBTQ people face. They are almost five times as likely to attempt suicide compared to their heterosexual peers. And it doesn’t end with high school: 48% of all transgender adults report that they have considered suicide in the past 12 months, compared to 4% of the overall US population.
If you’re a parent, the statistics can be pretty scary and feel like they’re out of your control to change or influence. But parents really do have an opportunity and a responsibility to increase positive health outcomes for their children. Loving and accepting your children, creating an open and accepting environment regardless of how your children identify, is healthcare. So how do we do that? What do we need to do? There are some simple steps parents can take.
#1: Use accepting language and respect the identity of all who are LGBTQ
Many children do not “come out” and declare a different gender than the sex they were born as. Many children do not express a different sexual preference until much later in life, and sometimes not at all. But they still may identify in a certain way from a fairly young age and can be highly attuned to the attitudes of those around them. Declarative, black-and-white statements like "Marriage is between a man and a woman" and "Pink is for girls, blue is for boys" are very narrow and don’t allow for other options. Further, using the example of a public figure like Caitlyn Jenner, if a parents says, "Oh, he'll always be Bruce to me..." it’s mislabeling and misgendering someone, but more, it is not respecting who that person is.
When you don’t exhibit accepting, affirming beliefs about others, children may conclude that your love and care for them is in jeopardy if they are LGBTQ. This can build anxiety and stress and decrease positive health outcomes, creating such thoughts as, "My parents would only love me if I'm straight and cisgendered [meaning that they are the sex that they were assigned at birth]. My parents would love me less if I came out to them."
If children are unsure of your acceptance of LGBTQ people, they may not feel like they're able to bring a friend who is LGBTQ around family. Not only can this create a sense of isolation and increase depression and anxiety, but children might keep interpersonal relationships a secret. It's important for children's health for parents to know who their children are hanging out with and what's going on. If your children don't feel like they can talk to you about their interpersonal relationships, including with people who are LGBTQ, then you're not going to know as much about their friends and the situations they're in. As certain relationships, regardless of gender and sexuality, can be unhealthy, it's important as parents to create an open and accepting environment to help children foster healthy self-esteem and interpersonal relationships. If your children do not feel that they can talk to you about all of their interpersonal relationships, they are left to navigate alone without your guidance.
#2: Have open conversations about sexuality and gender
First of all, it’s obviously not necessary to launch into explicit conversations about sexuality with your children at the dinner table. Instead, it can be helpful to express a willingness to talk about sexuality and gender when situations present themselves. For example, if you are in a store and there are Pride month items for sale, you could remark, "Look, it's Pride month. That's for people who are lesbian, gay, bisexual, and transgender." If your child asked, "What does that mean?" you can answer in a matter-of-fact way. Through opportunities like these, your child will come to know that you are open to having these conversations with them and that it is safe to talk with you.
By creating an environment of acceptance and support, children and teenagers who may be in transition are more likely to go through appropriate channels and attain the safest health outcomes. For example, say a child identifies as male but was born a female and wants to transition to affirm his make gender and present as a boy. In isolation, he may do things to transition that could be unsafe like binding his chest with an ACE bandage, which can severely damage tissue, versus using a specific medically-identified binder for the chest with the appropriate medical oversight of his doctor. Another concern is that, with the internet, it's possible for older teenagers to get hormones and gender affirming drugs online, and it's far safer that they go through a doctor who can carefully guide their use and properly support them.
#3: Find opportunities to let your children know that you will love them and support them regardless of their gender identity or sexual identity
It really is that simple. Improving the health of children who are LGBTQ can be as simple as saying to them, "I love you no matter what. No matter who you are. No matter who you love." As discussed previously, conversations like this can happen even if it appears that your children are heterosexual and cisgendered. As parents, we don’t know what is going on internally or how our children are experiencing the world, and unconditional love and support is universally helpful. If and when children and teenagers are willing to come out and have these conversations, you may need to acknowledge to yourself that yes, this is different than what you expected, but different doesn't have to be bad. This is still your child. Instinctually and according to scientific data, the best way to ensure your child's happiness and your continued close relationship is to affirm who they are and walk with them on this journey.
As health professionals, we don’t pretend to think this is easy. However, we do know that parents are capable of doing hard or difficult things, especially when it comes to their children. Our culture – clothes, hair styles, language and pronouns, and our more colloquial expressions – is chock-full of limiting, narrowly-defined assumptions and attitudes on gender and sexual identity. Therefore, acknowledge that it can be difficult to be gender affirming and can be easy to slip and use cultural norms even as you try to be mindful and respectful. " I will do my best, and work to be better every day, but I am swimming upstream. I might make mistakes because of what I’m used to or how I’ve been conditioned to think about sex and gender, and I'm learning all this stuff. But I love you, and it's totally worth swimming upstream with you."
#4: Seek Resources
If your child is LGBTQ and you are looking for more information, there are several great resources for parents and caregivers, such as the organization Parents, Families, and Friends of Lesbians and Gays (PFLAG) and their curated, suggested reading list. A more recent book specifically focused on the transgender community is Trans Bodies, Trans Selves. And Gender Spectrum has several good articles and resources to support families. There is also the Boston Alliance of Lesbian Gay and Transgender Youth (BAGLY) that has available resources and information as well.
If you’re feeling out of your depth with terms and definitions, it’s okay – here’s a good reference glossary. The American Psychological Association (APA) provides countless educational and support resources on a range of LGBTQ topics, including a good overview and FAQ on sexual orientation. But one of the most important things to do is work with your family’s medical providers, therapists and other health professionals as necessary to help you and your child navigate this journey one step at a time.