Supporting and Educating Children and Families on Gender Identity and Transgender Youth

The National Association of Pediatric Nurse Practitioners (NAPNAP) is committed to advocacy and promotion of optimal health and well-being for all of our nation’s children and youth. As an organization, we have become increasingly concerned about misinformation and lack of accurate facts or understanding being shared in the national discussion regarding recently passed transgender bathroom use legislation in North Carolina. The purpose of this statement is to provide accurate information to educate the public and support transgender youth.

Gender identity describes one’s persistent inner sense of belonging to either the male or female gender category. The term transgender describes people whose gender identity differs from the biological sex to which they were assigned at birth. Gender identity is distinct and separate from sexual orientation. In contrast, sexual orientation refers to the gender to which someone is sexually attracted.  

Many transgender children express feeling like they are a gender different than their biologically assigned sex as early as preschool or early school age, although some may not realize a sense of gender discrepancy until adolescence. Transgender people are not part of a “new” phenomenon. History suggests that transgender people have existed in a wide range of cultures for thousands of years. It is important to understand that children’s internal sense of gender identity is innate and stable. Gender identity is not acquired or subject to change, nor is it caused by environmental, family or societal influence. 

Protecting the health, well-being and civil rights of transgender children and adolescents in public schools and other facilities remains a top concern of NAPNAP’s members. NAPNAP’s “Health Risks and Needs of Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescents Position Statement” clearly states that discriminatory actions can have a profound negative effect on the emotional and physical health of transgender adolescents. This group of children has a strong desire to be treated equally and fit in with their peers and do not want to be singled out and isolated for their differences. Transgender youth are at risk for misunderstanding, victimization and discrimination. Without adequate support, and a positive school climate, transgender youth are at an increased risk for depression, suicidal thoughts and behaviors, and substance abuse. They are also at an increased risk to experience bullying and violence compared to others. 

Controversy related to North Carolina’s recent law restricting transgender individuals only to public facilities based on the “biological sex” as stated on a person’s birth certificate reflects a lack of understanding about transgender youth and the significant challenges they face. It is discriminatory and potentially exposes transgender youths to an increased risk of both emotional and physical harm. The recent guidance jointly issued by the civil rights offices of the U.S. departments of Justice and Education correctly applies Title IX of the Education Amendments of 1972. Title IX prohibits sex discrimination based on a student’s gender status. However, this guidance only applies to K-12 public schools, colleges and universities.

Although the discriminatory legislative proposals are unfortunate, the current controversy presents a unique opportunity to educate all families on gender awareness and expression, emphasizing that these children need to be treated with sensitivity and compassion. It remains imperative that healthcare professionals continue to advocate for equal treatment and acceptance of transgender children, adolescents and young adults.

Healthcare professionals, teachers, administrators, coaches and parents must be supportive of the social and emotional well-being of all children, regardless of their gender expression.