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Darlene Tando has been working with gender expansive and trans youth and adults since 2006. In this episode of the GenderGP podcast, she talks to Dr Helen and Marianne about the trauma she witnesses in the patients she works with, why the distress model is problematic and some of the advice she gives to parents on how best to support their trans child.

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Links
Darlene Tando – http://www.darlenetando.com
Gender Odyssey – http://www.genderodyssey.org
The Conscious Parent’s Guide to Gender Identity By Darlene Tando – https://www.amazon.com/Conscious-Parents-Guide-Gender-Identity/dp/1440596301/
GenderGP FB live stream event – https://gendergp.com/liveonlineevent/
Trans Youth Care – https://www.transyouthcare.com

Darlene Tando - GenderGP Podcast

Darlene Tando – Therapist Specialising in Transgender Youth

 

The GenderGP Podcast

Darlene Tando, therapist specializing in the care of trans youth – The GenderGP Podcast S3 E4

Hello, this is Dr. Helen Webberley. Welcome to our Gender GP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.

Dr Helen Webberley: Hi, everybody. I am really delighted today. Back in January this year, Marianne and I and Abby went over to Los Angeles, and we went to the trans youth care symposium, and we met with Johanna Olson-Kennedy and Aydin Olson-Kennedy and Darlene Tando. We had the most amazing weekend, which was so inspiring, talking about the best way to help transgender youth. So, I am really excited to welcome Darlene with us today. She’s a therapist that specializes in helping transgender youth. And she has a load of experience. As I say, she was totally inspiring to me. So welcome, Darlene. It’s so nice to have you. I just wondered if you wanted to introduce yourself, and just tell us a little bit about you and what you do and how you got into this work.

Darlene Tando: I am a licensed therapist, and I have been working with gender-expansive and transgender youth and adults since 2006. I started working with this population when I got my first client here in private practice who identified as transgender and needed help and support with transitioning. So, my education in that was kind of a whirlwind. I started attending conferences and reading books and educating myself so that my client wouldn’t have to educate me himself. And I had always worked with children, so after working with transgender adults for a few years, my two specialties came together, and I started working with transgender youth. I started to do that a lot now because there aren’t a lot of providers who deal with transgender youth. There are more providers who work with transgender adolescents and adults. So, I see youth and adults, but the emphasis lately has been on youth.

Dr Helen Webberley: And when you say youth, what kind of age group would you say that was?

Darlene Tando: Well, I see kids as young as 3 years old. I would say the cohort of 3 to 12 is a little bit more underserved as far as therapists who feel equipped to work not only with that population because there is special training that goes into working with young children, and to work with the gender piece.

Dr Helen Webberley: I’m interested that you said that you went through a whirlwind of education and you had to educate yourself because certainly that’s been my experience. Until this crosses your door, you don’t imagine that there is such a need or such a population out there that needs support. How does somebody who’s never come across this before, who’s faced with someone they want to help, how do you educate yourself in this field?

Darlene Tando: I think nowadays it is so different. At least in the US. There is so much information now. Thirteen years ago, when I did it, there was not a lot of online information or groups who could educate about this. I went to the conferences that they had—Gender Odyssey was my first conference. And so, reading books and doing that sort of thing was how I approached that. But I didn’t know any other therapist doing the work. When I found someone in San Diego, I said, “Let’s have coffee and talk because I don’t know anyone else doing that work.” And the need was so high. People were travelling to see me from far away because they couldn’t find anyone in their area to serve them. Now that is not the case. We have lots of therapists in San Diego. We’re doing gender identity work. But at the time, there really wasn’t a lot of information. So now I would suggest to someone who wanted to start doing it just to attend conferences and read books written by transgender people, and really listen to trans voices and be set to learn, because that’s really the only way especially as a cisgender provider that I could educate myself.

Dr Helen Webberley: yes, absolutely. Marianne is with me today—Marianne Oakes, who is our head of therapy at GenderGP. We had to travel to you guys in the USA to get our education as well. Marianne, I don’t know about you, but I found that weekend inspiring. I mean, I am a doctor, and I found it inspiring. I’ll let you say how inspiring you found it. I know parents themselves would find it absolutely inspiring as well. It’s not necessarily a conference for professionals alone/ it’s a conference for anybody who wanted to learn how to support children better.

Marianne Oakes: The best way I could describe the experience was that I felt for the first time that I walked into a room where I felt comfortable and able to talk about this. Because in the UK, I’m not sure there are many places where you can just be comfortable.

Dr Helen Webberley: And starting from a position where we all just believe that trans people exist, and we all just believe that trans adults were once trans children and that trans children exist, and it wasn’t about any of that debate. It was about how do we help those children best? And Darlene, it was brilliant, I have to say. Totally brilliant. I’m interested again about what you said that your interest in education was about taking into account things that were written by trans people. Again, I’ve never known this to be so important in medicine or in learning, that you actually need to listen to the people who experience it. You know, listen to parents of trans children. Listen to trans children themselves. Don’t put our cisgender hat on and say pass that one by me again or convince me with that. I’m interested in that.

Darlene Tando: I think there is such a long history of cisgender providers stepping in and saying that they know best. That’s such a dangerous position for providers to take and it places the pathology and the gatekeeping model in place. I don’t believe in either one of those things. I really believe that all people know their own gender; cisgender people know their own gender, trans people know their own gender. There is nothing pathologizing about someone having an authentic gender other than the gender they were assigned at birth. And so, to have this model of someone telling someone else what’s best for them is extremely problematic and so I think we are seeing more and more transgender providers. Which I think is so important. And centring trans voices when it comes to policies so that it’s not kind of someone else overseeing so that they don’t know as truly as transgender individuals themselves.

Dr Helen Webberley: You mentioned the ages 3 to 12. I know you said they were underserved at the moment. Now, people obviously—I’ve heard it, and you’ve heard it—going to say, “How can somebody at the age of three know anything about their gender?” I wondered if you wanted to answer that question, you must have been asked this before lots of times.

Darlene Tando: I think that the understanding of development and of psychology is that people can understand their gender as early as 3 to 5. I would say earlier than that, kids can start leaning their gender. And they can do that before they’re very verbal. But really, 3 to 5 is when cognition takes place where kids can really say who they are. It can be very stable at that point. Now, what I always say is that gender itself is not very confusing. But if you were being told that you are a gender that you are not, that is confusing. And so, not that transgender people are confused about their gender, I think some kids can feel very confused that their parents are supposed to teach them all the rules of life are getting something wrong, and it’s in the child’s position to then correct the parent or teach the parent. And that\s a really unique situation for a child. Depending on temperament, it’s going to show itself inconsistently. Some children are very insistent and will push back again and again until the parents listen. A child might be corrected once and shut it down for years to come. It really depends on the environment and the temperament of the kid.

Dr Helen Webberley: And what effect do you think that has, shutting it down for years?

Darlene Tando: You know, I talk to a lot of adults who transition or become consciously realizing of being transgender later in life, and they can recall certain conversations with their parents from a very young age, where they said something about their authentic gender and their parents corrected them, and they tucked that away in their minds and carried on. I think that it creates some kind of ongoing trauma. You know, Aydin Olson-Kennedy and I talk a lot about distress, and about how kids who are living in this state of not living authentically about their gender. It’s like this ongoing traumatic stress of being misgendered and categorized wrong. And kids and adults don’t enjoy being categorized wrong in any way. So, it can kind of be this sense of assault. You may not have the words to explain how distressing that is.

Dr Helen Webberley: Marianne, you and I have often talked about people who have had to shut their true feelings away for whatever reason. Have you got any thoughts on the damage that might do?

Marianne Oakes: I think Darlene used the right word there—this ongoing trauma. I don’t think we can overstate that trauma is quite a powerful word, but the reality is it’s so easy to traumatize a young child. We’re talking about 3-year-olds. And the parents’ influence is powerful. I just wondered, Darlene, if that is a crucial part of your training. If you work with trauma.

Darlene Tando: Absolutely. I always say that a big part of my job is sitting in the room with parents who are in pain. Sometimes, I am helping the person move through that pain and access some medical interventions that may help reduce that pain or understanding from the family, then we reduce that pain. And sometimes nothing is happening to reduce that pain yet, so I am as the therapist sitting with them in the room, I see that, and I see that imprint of trauma that the ongoing pain and distress can really just affect someone’s formative years. They’re trying to assert themselves in the world, they’re trying to form their identity. And yet, they’re contending with something so profound—being misunderstood about one of their core characteristics. It’s really difficult for them to experience that while trying to enjoy a childhood or enjoy a teenagehood.

Dr Helen Webberley: It’s an amazingly powerful word that we’re using there, isn’t it? Trauma. I mean, the trauma department in a hospital is, in my view, where you are rushed in after major trauma, which is road traffic accidents and things like that. It’s an amazingly powerful word. But having worked in the field for the past few years, it’s kind of become so normal that we see this distress that we are talking about. And now we’re kind of talking about trauma in young children. It’s not okay, but it does happen in this group of the population. And it’s quite harrowing, isn’t it?

Darlene Tando: Yes. And I think sometimes the problem is that the trauma is so internal. Some kids don’t show it the same way as others when acting out or crying or something that—Aydin talks a lot about internalizing versus externalizing trauma. Some of this is so internalized that it doesn’t get the same responses as, “What if someone were physically injured?” Or if someone else could understand the traumatic events and kind of put themselves in the same position and say that was extremely traumatising. People have a hard time doing that with gender and what it might feel like to be recognised as in an authentic gender.

Dr Helen Webberley: Yes, absolutely. I wanted to talk about social transition if I may. Recently, in the UK, we’ve had some kind of opinion or guidance from the NHS, that provide the mainstay of treatment for transgender youth in the UK, and they are kind of suggesting that we ought to be careful about allowing children to socially transition. They’re thinking that perhaps there may be a lot of children who would change their mind about their gender, and if they are socially transitions, perhaps it would be harder for them to reverse to their birth gender. Or that it might be in some way encouraging them to act out a gender role that didn’t actually fit them. I think it’s left mums quite confused. Because certainly, Marianne and I are of the opinion that if a child wants to experiment in some way with clothing or pronouns or hair or toys, then that freedom should be allowed. But yes, we’ve got other professionals who are saying, look, be very careful. And I just wondered about what your take on that was.

Darlene Tando: You know, your concerns are common. And I hear that a lot. It makes common sense to be concerned about that, and yet those who are not doing the work, it’s harder for them to use common sense unless they were doing the work. What I see is that I don’t really necessary—I wouldn’t word it as experimenting with pronouns, although it sometimes can be. The pronouns are used to have a child feel categorized appropriately. We talked about children are trying to make sense of the world all the time. We see this emphasis on gender a lot in the younger range. They are very focused, so are their teachers. Society categorizes them as boys and girls. Everything kind of—they try to make sense of the world that way. If they are being categorized wrong, it can create this internal of external distress that needs to be addressed by having the appropriate pronouns used. The gender expression, of course, is a little bit different. First, children should be allowed to express themselves as they see comfortable, playing with what they like, dressing with what they like. So if a child is allowed to express themselves as they want and there is no gender policing as it were as far as gender expression, and the child is still saying, but you’ve got me wrong, you’re either categorizing me wrong or you’re having me line up in the wrong line, that sort of thing. That is when social transition is indicated. It’s not necessarily that it’s allowed or encouraged. I don’t know a lot of parents who are ready to have their child socially transition for no reason. This is really something that comes as a response to hearing someone’s authentic gender identity. And I always say that any type of transition that parents “allow” is a passionate intervention. If a child needs something, parents are there to deliver what is the best intervention. And so, if a child is asserting themselves as something else, then a social transition may be indicated, and it becomes much more of a natural process than I think some people from the “outside” may understand. Because it’s not the parents, who are socially transitioning. The kids, the minute they express something outside of the gender box from which they were assigned, it really is ongoing and understanding of the child. And the social transition can help ease that tremendously. We see the impact when that happens. Sometimes people see a child from having extreme anxiety or mood disruptions to a child who seems to be quite happy and quite confident. And that’s no mistake. I always say the proof is in the pudding.

Dr Helen Webberley: Is that something that you’ve seen, Marianne, in your work?

Marianne Oakes: Without question, yes. Just when you were talking there, Darlene, we’ve got a friend whose child has socially transitioned, and she’s shown us the photograph of them before they transitioned to now. And basically, they used to be hiding at the back of the photograph is it was a group photo. The head was down and not looking at the camera. Now, they’re at the front and centre. I know it’s just a trivial thing, but it just seems so obvious when you look at the photographs it seems so obvious.

Darlene Tando: Yes, it is so profound to want to be seen.

Marianne Oakes: I think the other thing I was thinking of when you were speaking is the parent’s role in all of this. I think it gets misrepresented as do I want to allow my child to dress and present and behave in this way? When really, that is not the role. I think the role of the parent is saying is my child safe, is my child learning the right values in life, is my child well educated. I think parents don’t really have control over this. And to potentially cause damage by resisting, I don’t know if you’d agree with that or not.

Darlene Tando: Absolutely. I think kids come to us as they are. We may have a certain set of expectations about who this child is, but really we don’t know until they tell us. Sometimes parents really have to shift those expectations from who they thought their child was, and it can be a profound emotional experience, and so for a parent to affirm their child and support social transition, there is typically very much in need when that happens. It’s really not with the parent to say who the child is or what gender they are, or to “allow” them to do certain things. It’s more like the parent is observing and figuring out who the kid is, and then responding appropriately.

Dr Helen Webberley: So, for the mums listening, you may have a younger child who is saying I am not a boy, I am a girl, and please do not call me he, call me she. And mums are obviously scared about the future of that at school and with grandparents. What kind of advice would you give that parent?

Darlene Tando: You know, I think it’s difficult because I know that the environment there is different. Here in the US, there are more supports for parents who do listen to their kids, and still, parents will grapple with feeling that they are going to be accused of encouraging their children or accused of maybe having some ulterior motive. That they wanted a boy or they wanted a girl, that sort of thing. I think until someone is in the room with the parent’s pain, or in the same position, they can’t truly understand what an active love it is to listen to their child, particularly in a place where the people may not be as supportive. It’s an epic feat to be able to do that. And so a lot of times, parents are put into this position of advocates and to say, “I know you may not understand this, but I know my kid, and I know what is best, and I know my child has been telling me this. I refuse to no longer listen to my kid.” It’s very difficult, because a lot of extended family members or society at large may have a lot of criticisms for that. So I think that parents get into a little bit of a defensive state sometimes, and they feel very alone. But the best advice I can give is that when someone gives criticism to a parent affirming their child, it can pull that person towards them and say, “I know a lot of people feel like you. A lot of people are like that at the beginning, and I was until I educated myself and I really am listening to my kid, and I truly believe this is the best course of action.”

Marianne Oakes: The other thing I hear from parents a lot is regarding the: “I’m just so concerned about how hard life is going to be being trans. And I almost want to stop them not because I don’t believe them, but I am just so concerned about how it is going to be for them in the future.”

Darlene Tando: I think that parents sometimes operate from the context of they may not somehow have a trans kid, and if they could make their transgender kid cisgender, that child may have an easier life. So like I was saying before, kids come to us as they are. They are either cisgender or transgender somewhere on the spectrum. And I think that worrying about every possible scenario that may come from that in the future is not good for the parent or the child. And so, sort of reminding someone to stay in the present and realise, okay, my child is transgender, and I don’t know what exactly that will mean for them in the future, but I am here along the way to equip them and to support them and build that ego strength. So that whatever they do come across, they will be as strong as possible.

Dr Helen Webberley: Another issue that we have is that the trans adults of today are looking at the opportunities the trans youth of today in terms of medical intervention, i.e. stopping puberty and stopping the development of those secondary sex characteristics that might identify them as trans for the rest of their lives. And the adults are seeing those opportunities and so many are saying if only I had had that opportunity. And so we are seeing trans youth who do have the opportunity to have puberty blockers, to put puberty on hold and to stop that development. And then what’s happening is that those children are not so distressed. As they enter puberty or go through puberty, some of that distress that they would have had if they were developing body changes has gone. And then when they are trying to access healthcare, if they are not distressed, then barriers are being put up because they are happy, because they don’t need any therapy, and their body is not bothering them because they’re on puberty blockers. They’re not distressed in any way. And that is being used as a barrier against giving children and adolescents further therapy in terms of more therapy or gender-affirming hormone therapy. Some parents are saying, “My child has got to get distressed before they are allowed to have any further intervention.” And I just wondered if that is anything that you see in the States.

Darlene Tando: Yes, I think that’s been the model for a long time, as the distress model. So, until someone is in a lot of pain, we will not give them any type of intervention. That has really set up a lot of people to have more pain than they need to have, and it really puts that pathology lens on being transgender. Because I think that does not necessarily have to come hand in hand, that someone is having such a difficult time because someone has to intervene. If someone is born a gender other than their assigned gender, sometimes that is just the way that it is. And it is not something that the child or the adult has to get into a severe amount of pain to make someone understand. I think that if a child or an adolescent or an adult is telling us who they are, we can believe them. Because gender is something that people can understand. If we respond quickly and appropriately, then it saves a lot of distress. I really think that even here in the US, we are still operating from the distress model. And I have parents who grapple with social transition if their child is not in enough distress, who do intervene with allowing social transition or medical before their child is in a lot of distress. They feel like they don’t have a lot of evidence to show people to explain, “See, this is why I did that.” and so I think moving away from tat distress model is critical, especially if someone who has socially transitioned early needs hormone blockers and hormones. It really is a natural course of action for transgender youth who have been living in their authentic gender and who have been doing good. It’s a very natural course of action to have a medical intervention where they get their authentic hormone. So they do not have to wait until there is distress. Like you said, some of the distress can be bypassed by blocking puberty—not all of it. So I think that is the crucial part; moving away from that distress model.

Marianne Oakes: Sometimes, I would sit with a child in front of me who is every inch who they say they are. And I start saying to them, so tell me about your gender. And I think, never would you sit a cis girl or a cis boy down and ask them to explain your gender to me. A four-year-old girl that I see as a girl, who behaves and does everything like a girl, and I am saying explain your gender. And I think to myself that I could not do that. So the conversations I try to have with them is just to make it a bit fun, empathise a little bit with the situation.

Dr Helen Webberley: I talked to a doctor recently who didn’t have any experience with transgender youth, and the mum had gone to see him, and she said that she wanted to bring her child to come to see him. And that he was transgender, so that means he was born a girl, and he identifies as a boy. And she wanted him to go and see him and to talk about puberty blockers because that will stop him going through puberty. And so, the doctor was like, well, I think I have heard of this. I think I’ve seen it, but you’re going to have to bring that kid in so that I can take a look. I can’t promise anything here. So I was talking to the doctor, and the doctor said that the mum had brought the boy in and he said he was just a boy. He said, “I didn’t know what to do. It was more of a boy than my own lad at home.” He said that he didn’t know what assessments to do and he didn’t know what to say. He was just faced with this lad in front of him, and I thought that’s it. We are taught massive amounts of assessments, you know, and going through hoops and prodding and poking and rattling in cages to make sure and find out anything from the mother’s history or the father’s history trying to see if there is something we can find that gives us the cue that gives us what is this—or, is this what we’ve just got. A lad in front of us? I thought it was a lovely naïve introduction to trans youth, really.

Darlene Tando: If you look at it through that lens, and of course that child had hit the age of puberty, then testosterone makes a lot of sense.

Dr Helen Webberley: He’d be a long way off from getting testosterone in the UK, unfortunately. But actually, he came over to see Johanna recently, so he’s one of the lucky ones. You were going to say something, Marianne.

Marianne Oakes: I was going to ask you, Darlene, that you say thirteen years you’ve been working in this area. And I just wondered how much has changed for you since you started till how it is now. Because I’ve noticed, in the UK in the last five years, it is so different than it was five years ago. And I was just wondering how it is in America.

Darlene Tando: It is so different. There was not a lot of mainstream media coverage. There was not a lot of people who were out and open about being trans. And so I remember when –I think it was a few years after I had started doing this work—I marched in the Pride parade with the transgender contingents, and I think there was about eleven of us. I was so blown away by that and this LGBT parade with all these contingents who were really represented LGB. And there were eleven of us marching for the T. now, fast forward thirteen years, and there is contingent after contingent transgender groups, transgender elders, and families with transgender kids—just so many contingents representing the T. that is quite a profound shift in the community and focus and I think that there are a lot more providers doing this work. There is a lot more information out there. I think there is certainly a lot more information out there for youth to find on their own and I think that some people think that that is creating a little bit of contagion or creating some of this. And I think, it’s not creating anything that wasn’t already there. It’s that now people are finding the language to describe their own personal experiences. They are finding communities online that can represent their community and their experience. And it has allowed for people to be who they are much more openly, at least here in the US. I do realise that I am a little bit of a bubble in California, so I will say that.

Dr Helen Webberley: Just to move sideways slightly, I’ve got a few more questions that mums would love me to ask you. There is an obvious one. So, what if we affirm a child’s gender, and call him by the pronouns they prefer to be called with, changed their name, and allowed them to wear their preferred clothing. What if they change their mind in the future? What damage will we have done?

Darlene Tando: You know, it’s really interesting, the term “change their mind”. We don’t know that that is even accurate. I call that cisgender projection because a lot of cisgender people can’t really envision living their life as a different gender, so I think when they try, I think they say, well, I have changed my mind. It’s a little bit of a projection to understand what someone might feel like if they were aligned with their authentic gender. It’s typically not a change of one’s mind scenario, although I would say that that happens in rare cases. Typically, if there is any changing, it is more of an evolution of the understanding of one’s gender. And change over time. As we evolve as human beings, as we grow, as we understand nuances of gender a little bit more than we could when we were younger, we may decide to express ourselves differently, or we may understand ourselves differently over time. I think it is okay for a child to be listened to and to be affirmed as they are and to have that path changed a little bit down the line. I think that is what creates that ego strength that I talked about that is so important for navigating life. If we were seeing a lot of people doing this just for fun, we might have a little bit of caution. But that is not what is happening. We see someone who is presenting as their own authentic gender, and it’s a huge relief and a tremendous intervention. I think that if a child or an adolescent or an adult needs to do a course correction –I’ve heard the term course correction—down the line, that’s really important, and I think it should be embraced much as you would embrace the asserted gender the first time.

Marianne Oakes: I try to visualize this, that it’s always a movement forward. If a child doesn’t change its mind or people don’t change their mind, we just keep moving forward to a different place. We can change the road or the direction we are on, but it isn’t moving backwards, which changing your mind suggests.

Darlene Tando: Yes.

Dr Helen Webberley: Yes, I like that. That’s a lovely way of thinking about it, isn’t it? And actually, if you look at the beautiful diversity of children, adolescents, young adults, and old adults, look at all the different expressions that they will use in terms of confidence and clothing and style and expression of themselves. Another question I wanted to ask you was about the insistence and persistence. So you know –Marianne knows I hate this word—when clinicians are having to diagnose somebody as being transgender, we are told to look for those very insistent feelings of gender identity. Strong, and I am transgender, and this isn’t right for me. And also, persistent, which means it has been going on since the dawn of time. But as we know, not everybody presents in that way. I’ve been asked to put that to you. If that kid hasn’t been saying that strongly for so many years, can we believe them?

Darlene Tando: Yes, I think that there are various ages at which this can come into conscious awareness. And what a lot of times we notice is that once someone has this awakening or it comes into their conscious awareness, it really is—they feel like they want intervention immediately. I think that that is a part of the difficulty with having this one trans trajectory that we say kids know this from a young age and then we can believe them because they have been asserting it for so long. And without that, we don’t have enough evidence to allow them to be who they are. I think that base on the evidence is problematic. As I said, some kids can mention it then they get shut down, so they tuck it away for a long time. Other kids, depending on their temperament, some kids don’t insist on anything. I liken it to eating vegetables. Some kids will kind of just eat them because they were told to, and some kids will say absolutely not, I am not doing that. So it really depends on how someone comes to us. If a parent is waiting for a child to be insistent, a lot of times that could be in line with distress; once they are in distress, will they become insistent enough? And that is kind of basing it on the distress model, which I think is damaging to kids. And so we’re certainly not talking about a child saying this one day and the next day they’re being socially transitioned. It doesn’t work like that. It doesn’t work like that for parents. Parents need their brains to adjust to this as well. And that’s sometimes where the persistence comes in. Because parents aren’t, you know, keen to socially transition their kid immediately. That’s typically not what we see happening. And so a lot of times kids will let a parent know who they are over the course of time. And then the parents can listen to that. And so I think that if we’re waiting for a certain number of years, that’s problematic for waiting for a certain intensity level. That’s problematic. It’s more just hearing what the child’s saying and in what context, and letting us know that they’re being categorized wrong that is most important. And that does not have to accompany a lot of distress or insistence. The insistence stories are the ones that are, you know, out there the most. And we read about them, and we see the insistence of the kid. If a parent has a kid who’s not quite that insistent, they start feeling like maybe they need to wait for that, or that their kid is maybe not in need for social transition as much because they haven’t been as insistent. I just don’t believe that’s true.

Marianne Oakes: I think my issue with all of that is that it feels like we’re trying to make people fit a model of transness. This that, you know, insistent about, well, you know, gender expression is as broad as any form of expression. I don’t think the trouble is we get into a situation where we’ve got trans people of all ages to try to dance to somebody else’s tune and fit their ideal of what it is. And I think that’s why I have with the persistent and insistent some—it just doesn’t feel like a legitimate way of monitoring somebody’s gender identity. Although it won’t make sense.

Darlene Tando: Yes.

Dr Helen Webberley: Yes, absolutely. I mean, certainly when I was writing letters to GPs explaining about the children that I was seeing, it was such a relief when I could say, you know, this child has identified quite openly as this gender since a very young age, and that has not wavered. And that was just for me just now. Thank goodness for that. It means my job in persuading that GDP or that doctor is going to be much easier. The other ones, this is a story that started around about puberty, it before that mom wasn’t made aware of any gender differences. And, you know, I say, oh, goodness, you know, I still believe this child completely. But how I’ve now got a harder job to persuade those other people involved in the care of that child.

Darlene Tando: Yes. I think that you get most difficult when, you know, people can’t give the evidence, right? Or their decision. It certainly makes it more difficult for the parents to adjust to when they didn’t have these seeds that were planted. And certainly sometimes puberty can bring on that awakening, and it becomes consciously aware for the individual. And it’s just as legitimate and valid as anyone’s gender from understanding it from any young age.

Dr Helen Webberley: One of the issues that I think perhaps can affect transgender youth is obviously being teased by their peers. And as parents, none of us wants our children to be the ones that are bullied or teased or stand out in any kind of way that might be perceived as negative or traumatic for that child. And Darlene, I remember you talking to us about parents who would perhaps say, look, let’s try this out at home, but let’s not tell anybody outside of the home in case you get teased. And it was so powerful for me. I just wondered whether you just wanted to yours. Your thoughts on that with our listeners today.

Darlene Tando: Sure. I think it goes back to the parenting role. You know, we are in the position as parents to guide and teach and protect. And a lot of our parenting sometimes comes out as a warning. You know, if you choose this behaviour, then this could be the outcome. And that’s a parenting basic. And what ends up happening is we start treating gender expression or gender identity as a behaviour, which is actually not. It’s a reflection of someone’s authenticity. And so when we’re asking someone to modify their gender expression or their assertion of their gender identity, we’re actually asking them to modify who they are. Not a way that they are behaving. So certainly, someone can change behaviour such as wearing a dress or cutting hair short. That could be seen as a behaviour, but that behaviour is really reflecting someone’s authenticity. So if we say do not do those things because you may be teased, the child interprets it as do not be myself because that is bad and I could be teased for it. And so, it is a tricky, tricky thing for parents. I think a lot of times they feel like they’re sending their child to the wolves by not warning them. But what happens by warning or protecting them by only allowing certain things in settings—the message keeps being sent like you are not OK the way you are. And so I’m going to shield you from other people, from seeing who you really are, and that can have a profound impact on someone’s ego strength and confidence, and knowing that that how they are is OK. And it’s difficult. Parents will say, well, then what can I do to help my kid? You know, and I think it’s the best thing you can do is let them know that any way they are is OK. And to help them process if they do get feedback that is less than positive. You know, and to help equip them with knowing how to handle that, but not necessarily warning them of every potential negative outcome, because that could send them out into the world very wary, very anxious.

Marianne Oakes: I think that’s kind of when we talk about bullying. I think if you kind of set your child up to be nervous within a social setting, whatever they’re going to get, they’re going to draw attention to themselves that the more empowered the child feels, probably the less likelihood bullying is going to occur. I’m fairly sure some people might take issue with what. But that’s kind of been my experience. I’m going to go back to those who say, you know, I’ve been learning more recently about micro-aggressions. Parents, you know, they are microaggressive just by the warnings that they are giving out. You know, that this isn’t really. I don’t really feel that this is OK. And that impacts the child as well and reinforces the potential trauma.

Darlene Tando: Yes.

Marianne Oakes: So in trying to protect your child, you could actually be causing more damage because you’ve not dealt with your own issues. Really?

Darlene Tando: Exactly. Or even sending the message, you know, I’m OK with who you are as long as it doesn’t involve outside society. Or if someone else disagrees with who you are, then I may have a problem with it.

Dr Helen Webberley: It moves me on to the guilt that parents feel. I mean, I’ve spoken to a lot of parents who, you know, in the beginning, they either just didn’t understand it, didn’t want it, just couldn’t face it–well just actually just did not have the knowledge or skills even to start where to start. And you mentioned at the beginning, Darlene about, you know, children who had to educate their parents and parents they have to educate doctors. But that guilt. I’ve seen so much when the parent goes, okay, I can’t cope with this, and I’m just going to have to go with my child on this one. And then they see that absolute beautiful flourishment of the child beginning to relax and be happy and skip. And then they feel so guilty about all that time that they did try to resist it. I think the guilt of parents is big and I think it’s something that we ought to talk about a little bit, really.

Darlene Tando: Yes. I think that just validating how difficult this is. Like I said, parents go into parenthood with these set of expectations. And once they feel they’ve learned the child’s gender, they think that’s it, that’s not going to change. And so to have a child inform them, and actually, I’m not the gender you think I am is a really, really profound experience for parents. And it’s more unusual for a parent to just very fluidly, naturally get on board with that than it is for a parent to resist that idea because they know who their child is. And so to really validate the parents and hold space for that parent to have those emotions and to allow that to be there, hopefully, more separate from the child and get their own support and help is really important. But also to say, you know, as you evolve in this journey as you will, it is good to go back and have those corrective conversations with your child and say, you know, when I said this in the very beginning, I didn’t understand, or I didn’t educate myself yet. And now I understand because I think a lot of times parents go through this and feel like the child is witnessing their evolution and their understanding. But the child may have still tucked away those statements in the very beginning and worry that the parent still feels that way or that other people feel that way. And so to have the parent go back and say, “And now I understand, and I am sorry that I said that,” is a really powerful experience for the child so that they can sort of relax into the support they’re now getting from the parent.

Dr Helen Webberley: Yeah. Marianne, do you see parents, too, who feel that that guilt and distress themselves?

Marianne Oakes: Just as you were talking the Darlene, it was just going through your mind how much focus we’re talking about, the parents here. And actually, you know, if we’re talking about getting help for a transgender child, that you know how crucial it is, it’s the parents that need to get as much help as the child, I think, because the child can grow, they will not need in therapy, you know, without all that stress. Actually, if the parents could accept that, you know, perhaps they need the therapy, or they need to talk to them to be able to help the child better, I think that would be the perfect outcome. I’ve made no secret of it. I’m sure Helen will support me here. You know, I’m always saying I just wish the parents would come to therapy.

Darlene Tando: I think that it’s the parents really who have to do the transitioning. They really have to shift this expectation in their minds. And the child is getting to align themselves with who they authentically are. And that can be at a hugely relieving and exciting experience. And the parents are not sitting there feeling relieved a lot of times. So it’s it is quite a different journey. And I’ve had parents, you know, I had one mom look at me, and I was playing with her young child and, you know, she was happy as a clam. And she looked at me and said, he doesn’t need to be here, does he? She needed to talk to me. She needed to ask questions. She needed to process and maybe grieve a little or process how she was going to inform other people. And it really is quite profound how, once someone is authentically recognized, they really can flourish and can go off and live their life. And if someone else is struggling with that, that is the person who maybe needs the therapy the most.

Dr Helen Webberley: Darlene, I want to pick his brains about something that I’ve struggled with. So we have the lucky youngsters, as I call them, lucky youngsters who have supportive parents and parents who are willing to go with that and understand the journey ahead. Schools that have taken steps to embrace someone, a child who’s transgender, and help them through their schooling, they perhaps had the opportunity to have puberty blockers and maybe even gender-affirming hormones in line with their peers so that nobody knows that this child has a difference. And I’ve seen young youngsters who oh, there’s lots of there’s a big spectrum, but there’s two sides of that spectrum, one where they proudly waving their transgender flag and saying, this is me and embrace me and accept me and others who say, “Mom, don’t you dare let anybody find out, because this if anybody finds out,”—and actually, I have goosebumps here. It was also such an immense secret. That is, how can we keep that secret forever? And I just worry for those youth who want that secret so much.

Darlene Tando: I do a lot of work with my youth on that. And I have to be careful as a cisgender provider because I know that I want to hear from them their transgender experience. And it is going to be different for everyone. And I do think that I need to respect that profound relationship they may have with being transgender and not ascribe one way that I think it needs to be done. But I do notice that those people who can integrate their transgender identity with their sense of self is very important. And that denial of being trans does lead to lower self-esteem and more dysphoria and maybe some more mood disruptions. So children who transition young a lot of times stop thinking about it and they don’t really want to think about it. They don’t really want to talk about it, especially as they approach middle school age, and maybe even those kids who were involved in gender conferences and groups, they stop wanting to do that. They want just to present themselves, as you know, Aydin and Joe, call it just a girl, just a boy. And that’s sort of a denial of their trans experience. And as they get older, and they will need some things that bring being transgender into their conscious awareness, such as hormones, or dating and disclosure and that sort of thing, that would be a little bit more difficult to embrace that part in themselves or have presented to others in a way that’s positive and not shameful. So it’s really—I do a lot of work with my youth on their relationship with being transgender. Is it healthy? Is it open? Is it civil, you know, if not friendly? And I think that’s really important because some of my youth if they are undisclosed, they feel very safe that way. And then over time, they feel less and less safe because they feel like no one truly knows who they are. And peers are such an important part of their development that if they feel like there’s one thing their peers don’t know or they’re close, close friends don’t know, that that can really start to feel a little bit emotionally unsafe. And so a lot of work between private and secret, that this is private. You don’t need to lead with it. You don’t need to define yourself by it. You can get to know someone based on just who you are and all your interests and your values and all that. But if you guard this like a deep, dark secret, you’re walking around with something that you are assuming if someone found out about you, it would be bad. And that’s sort of, it’s almost like a cloud over their head, you know. And so I think if you can consider this private, you know, I get to choose who I tell and who I don’t. And I may choose not to tell anyone right now, but I am peaceful enough with it that I feel like if someone did find out, I would be okay with it and they would probably be okay with it, too. And it really is just sort of this internal process that, you know, working on thoughts and what’s the kind of the record player that’s playing that that can be really important work to do with transgender youth.

Dr Helen Webberley: It’s interesting. It’s going back to what you were saying about, you know, the advice that we give. You know, if you keep this big secret and someone then finds out you that this may happen, and that’s kind of, as a doctor, I kind of want to say that. But of course, they know that you know, they don’t need me to tell them that. So it’s actually just exploring their relationship with the identity and what it means to them. It goes back to exploring it with them, isn’t it? Rather than being that advisor. Of course, I know what would happen if someone found out. Yes, they might get teased.

Darlene Tando: I mean, some of it is just kind of knowing that it doesn’t have to be considered a secret. I think that just hearing it as private just shifts it Psychologically, and so it depends on how strongly one protects that private information that can create more distress, I think. Like I said, it doesn’t mean running out and disclosing either. It’s just that internal shift of their relationship with it.

Dr Helen Webberley: Fertility is another thing I’m asked a lot, and I’m sure you are as well. And again, in the UK, it’s used as one of those reasons why we shouldn’t allow youngsters to go through puberty with their peers, and we should delay it as long as possible so that they can perhaps be a little bit older to understand the effects of the potential loss of fertility. But of course, let you know when we talk to two youngsters, it’s the furthest thing from their mind. And actually what they want to do is be the same as all the kids in the class and go through puberty at the same time. So how do we provide responsible health care advice? Again, advice and support when obviously these children just haven’t got the capacity to think about fertility in the same way that we do?

Darlene Tando: I think, you know, the fertility issue is very interesting because like you said in teenagers are not thinking about that very much. Some are, and some can mourn maybe that they won’t have the cisgender fertility experience, but others are just very focused on the present, and they’re focused on a desperate need to get some relief from their dysphoria, which takes precedence and it takes precedence in their mental health. And I think that sometimes it’s the parents who have to do more shifting about that. And again, it’s that parental expectation. This is what I thought my kid was going to do, you know, and have children and that sort of thing. And so, shifting that for the parents can be more difficult and prolonging someone’s dysphoria to preserve fertility can be life-threatening. It’s certainly more of that trauma of living inauthentically for a longer period of time to do something that a child or the youth can’t really wrap their brain around just yet. And so I think sometimes it’s sort of helping both the youth and the parents realise there may be some things that come from this that aren’t ideal. And that’s true. Johanna Olson-Kennedy says, you know, bad versus bad. That you have the dysphoria like I said, which can be life-threatening. And unfortunately, there can be some negative fertility side effects, too. So it’s not an easy necessarily choice, but it doesn’t really feel like a choice of the to the teen at the time. It’s that they need that relief from the dysphoria so urgently that fertility takes a much lower precedence for them. And I think that there’s an understanding that there’s a lot of different ways to have children and there’s a lot of different ways to be a parent and youth embrace that. And then as they get older, if there is some mourning that needs to be done for maybe not be able to have their biological children, then that is something that they will receive support and process that. And that’s going to be easier for some than others.

Dr Helen Webberley: There are some medical treatments or medical interventions that cause difficulties with fertility or potentially can cause difficulties with fertility. And this is one, and it’s sad, and I wish it didn’t, but unfortunately, it can be that. But I agree with you. It’s wrong that we have to again. It’s that kind of system to advice model, isn’t it? You know, I’m going to advise you not to have any gender affirming until you are older just in case you regret this later and when you’ve got someone in front of you going, please, will you help me, please, please, please, would you help me? Because this is hurting.

Darlene Tando: Exactly. Yes.

Dr Helen Webberley: I hate the fact that there is a higher rate of self-harm and suicide in transgender youth. And as a GP, before I even started working deeply with transgender people, I’ve never seen a child commit suicide. I’ve just never—I’ve never seen anyone take a child, take an overdose. It has just never hit my radar. And some people over here kind of say, you know, that that statistic, that kind of 50 per cent statistic saying up to 50 per cent of people, young people are so distressed that they are taking measures to hurt themselves. And some of those are successful. This is shocking. And people some people are saying here that we’re just making that up. We’re just making that up to kind of fuel and, you know, add fire to it and make it bigger than it is. But it’s true. And we’ve seen it. We see it in the newspapers. Johanna puts that side up every time. And she adds more faces on that slide of people who have lost their lives. It’s awful, and it’s true, and it’s real. And I think, you know, we’ve got to, we’ve got to believe that that that this that gender dysphoria is really, really distressing.

Darlene Tando: Yes. And extremely dangerous. And I think a huge role in suicide prevention is hope. And when there is no hope, and especially for a teenager living in the moment and feeling like tomorrow is so far away, you know, to feel like they have to wait so long for medical intervention to feel any relief from their dysphoria–if they don’t have hope for that, that combined with dysphoria is just so incredibly dangerous.

Dr Helen Webberley: I’ve got another question for you that a mum wanted me to ask you. And it’s this concept that if we give puberty blockers too early, the brain hasn’t been developed and the frontal part of the brain hasn’t been developed. And I’ll be in some way going to do some harm. I just wanted when you get asked that question, how do you approach it?

Darlene Tando: You know, I don’t have a medical background, so I defer it a little to doctors. But I’ll quote Jo again. Jo Olson-Kennedy says that—she says, you know, we don’t wait for cisgender kids for their prefrontal cortex to close before we believe their gender, you know? And so gender can be known and understood far, far before the prefrontal cortex is completely developed. And so to wait for something like that, which I don’t believe happens, you know, more than I do until, what, 20-something? That’s way too long to wait to believe someone about their gender.

Dr Helen Webberley: Yeah, yeah, absolutely. And again, we’ve seen that the damage that we do by waiting by holding off just in case. While these children and youngsters and adolescents in a lot of distress and it causes such a lot of harm. Doesn’t it?

Darlene Tando: It does.

Dr Helen Webberley: Darlene, I’ve read your book. I love your book. I just wanted to know whether you wanted just to tell us, who did you write it for? Who is your audience on it? Just tell us a little bit about it.

Darlene Tando: It really is for those parents we were talking about. I think that some professionals can definitely benefit from reading it who are supporting parents through the journey. But, you know, I think that this is such a profound experience for parents, not only their own emotional attachment to their child’s gender but also responding to outside input about this and responding to criticism about supporting their kid. And so the book is really for helping the parent walk through this and consciously mindful way, being aware of what their own feelings are, being aware of how those are separate from maybe their child’s feelings and needs. And then also how to remain mindful and that and the journey of outside input and also just kind of navigating all these things that go along with having a transgender child.

Dr Helen Webberley: I mean, I think I found it very empowering because, again, it’s not full of advice. This is what you should do when your child does this. It is all about getting people to think, think things through and work things out the best way, you know, in that family environment, which again, you know, as as a doctor, you’re kind of taught to be the adviser. As a parent, you’re the adviser. And this is a journey that doesn’t come from needing advice. It’s a journey that comes from needing support along that journey, whatever path it takes.

Darlene Tando: Right. And mindfully listening to the child think can be hard sometimes.

Dr Helen Webberley: Yeah, absolutely. And I think as well, actually, you know, I mean, a lot of it is about gender identity. But actually, there isn’t one set of rules is, therefore, for children and adolescents who are exploring their gender or telling us that their gender is different from what we think it is. You know, parenting and doctoring and and and therapy with youngsters, it’s not one rule for trans children and one rule for other children. These are these basic premises and concepts are the whole way through parenting or therapy, or medical attention. And that listening that you talk about is so important. I remember when I was training to be a GP back in 1995, it was at that time where all of a sudden doctors were not at the other side of the desk anymore. You sat at right angles to your patient rather than across the desk, and it was missing, you know, don’t preach to a patient, don’t tell the patient what you know. Ask a patient what they feel and what they understand. Listen, because that patient with a headache will be completely different from that patient with a headache. It’s not about that. It’s not about the headache. It’s about the experience of a headache. And it couldn’t be more true with gender. You know, you have to listen. Every single person is different. And not only are they different in themselves, but they are different in their families. And their school and their town and their street and their grandparents. And you couldn’t have a more diverse set.

Darlene Tando: Exactly.

Dr Helen Webberley: Yeah. I’ve kind of led this session with the burning questions that I had that have been given to me to ask you. I wondered whether there’s anything that you think would be valuable to tell people or share things that you come across, commonly.

Darlene Tando: We covered the big ones. You know, the distressing thing is, is the big thing that I really want other people to understand, having a relationship with being trans. I think we covered the main concept.

Dr Helen Webberley: Brilliant. Okay, well, Darlene, as I said to you, you three inspired us three so much when we came over to you, honestly. And also then when we did the Facebook live event, again, you know, the panel there, you know. It was really well received. And I think we’ve just got to talk and talk about gender, haven’t we? We’ve got to normalize gender. And in the same way that, you know, people were scared that if if you allowed homosexual people to come out, then everyone would become a homosexual. It didn’t happen. It wasn’t a problem. And I think, you know, we just got to allow people to start talking about gender and understanding it. And yes, some people find it very scary and confusing, and that’s okay. But along the way, we mustn’t cause harm. And I think, you know, by us talking about this, by people listening and wanting to learn, we can really make a difference so that people when they come become (unclear 1:02:30— guess “Marianne’s generation, then”) that life journey was easier. And that’s what we want. So thank you. Thank you so much for your time. I’m sorry. We’ve run over, and you’ve been brilliant.

Darlene Tando: Tremendous work out there. And you’re up against a lot. So thank you for what you do.

Dr Helen Webberley: I love it. I was looking at my notes earlier from when we were with you in January. And I’ve written that I’ve written down “Give up trans work. Question mark. Question mark.” How could I ever possibly not deal with a trans person again in the whole of my life? Helen, don’t give up. I hadn’t seen my comments, so I just I wouldn’t know what it was that inspired me to write that. But it’s good. It’s true. So thank you, Darlene. And we will put if you don’t mind, I’ll put your website because you’ve got an amazing blog on your website which is so helpful. And again, your book, if anyone wants to read it. I think it’s great for parents, great for grandparents, great for friends, great for therapists, great for doctors. It’s learning from your experience over the last 13 years. And it’s a big learning curve. So thank you for coming on. Really lovely to talk to you. And you have some lucky, lucky children under your care.

Darlene Tando: Thank you. I love what we do.

Dr Helen Webberley: Bye-bye, then.

Darlene Tando: Bye.

Thank you. We hope you enjoyed our program. Do go ahead and subscribe if you haven’t done so already. If you or anyone else is affected by any of the topics discussed on our podcast and would like to contact us, please drop us a line at doctor@gendergp.co.uk. We’re very happy to accept ideas for future episodes and guests, or if there is something specific you would like us to cover. You can also visit our website, www.gendergp.co.uk. You can follow us on social media @gendergp, and you can sign up to our monthly newsletter. Full details can be found in our show notes on the podcast page. Thanks for listening.

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