Gender-Affirming Care: The Impact of Parental Rejection on Transgender Youth When Support Falls Short

This highly publicized rift has brought renewed attention to the already contentious issue of gender-affirming care and support for transgender youth. There are several common misconceptions about transgender identity and gender-affirming care. According to Han Wetmore, LISW, a LifeStance therapist practicing in Ohio who specializes in LGBTQ+ and gender-affirming care, “The most frequent one I come across is the insistence that ‘the science’ does not support affirmation of self-identified gender. In fact, most studies on gender dysphoria support affirmation of identity as the best intervention for improving mental health outcomes.” Wetmore emphasizes the importance of validating clients’ lived experiences of their gender identity and helping them explore ways to feel more comfortable in their own bodies.

In fact, most studies on gender dysphoria support affirmation of identity as the best intervention for improving mental health outcomes.

Han Wetmore, LISW

Another prevalent myth is that gender-affirming medical care involves a comprehensive array of interventions such as hormone replacement, top/bottom surgeries, and hair transplants. Wetmore clarifies, “For many transgender or gender nonconforming individuals, gender-affirming care can include all, some, or none of these interventions. It’s entirely up to the individual what interventions will help them feel more affirmed.”

Elon Musk’s public statements about gender-affirming care have sparked widespread debate on social media and in the media globally. Parents of transgender youth often struggle to accept their child’s gender identity and choices. Wetmore reassures parents that their reactions—whether it is fear, anxiety, confusion, doubt, or guilt—are valid and normal.

Therapists providing gender-affirming care often adopt a grief-oriented approach, acknowledging that parents are, in essence, grieving the loss of the person they believed their child to be. Furthermore, Wetmore advises parents to avoid projecting their grief onto their child during the transition process. Instead, Wetmore advises allowing children to initiate conversations about identity, practicing mindfulness during these discussions, taking breaks as needed, and spending quality family time together.

A frequently asked question by parents and caregivers is whether gender confusion can be a phase. They may want to believe a child can “grow out of it” and want to use that belief as a reason to delay gender-affirming care.

Gender dysphoria is a medically recognized health condition, listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), characterized by a profound and enduring discomfort with one’s assigned gender at birth. Treatment typically requires ongoing support and intervention to improve mental health and quality of life for those affected.

Wetmore advises parents, “Many things that children experience are phases, including the exploration of alternative identities. Your children will remember as adults when you were supportive and when you demonstrably were not. It isn’t whether it’s a phase that matters, it’s how you as the parent respond to them.”

According to Wetmore, “Gender dysphoria isn’t a ‘phase’ that comes and goes at will. It usually stays with a person throughout their life, though it can ebb and flow in degree and severity. People may also wish to live as members of their gender identity.”

Creating a space where everyone feels heard and validated is key to resolving conflicts within families.

Nicholette Leanza, LPCC-S

Nicholette Leanza, LPCC-S, a therapist practicing in the state of Ohio, recommends that caregivers and parents research more around the topic of gender dysphoria to better support their transgender or non-binary children. “Creating a space where everyone feels heard and validated is key to resolving conflicts within families. Caregivers should respect their child’s preferred name and pronouns to maintain positive communication and trust,” she says. Leanza emphasizes the importance of respecting a child’s preferred name and pronouns to maintain positive communication and trust.

While Musk’s and his daughter’s public exchange has fueled controversy, several celebrities have embraced their children’s gender identity choices. Basketball legend Dwyane Wade has been a vocal supporter of his daughter Zaya, who came out as transgender publicly in 2020. British actress Naomi Watts proudly supported her 15-year-old transgender daughter Kai Schreiber at the Dior pre-fall fashion show in Brooklyn, New York, in April 2024. Jamie Lee Curtis and Charlize Theron are also outspoken supporters of their transgender daughters, Ruby Guest and Jackson, respectively.

A 2023 report found that LGBTQ+ people are much less likely to be happy in adulthood when they were not supported at home and school during their youth. Han Wetmore says that “lack of support in youth can result in transgender adults feeling isolated from their families and mistrustful of their parents, often leading them to reduce or cut contact with immediate family entirely.”

Family Science research conducted by NCFR in 2021 has revealed the critical benefits of familial and community support for transgender children and adolescents. Among other things, the research concluded that overall family acceptance is associated with improved well-being among transgender youth, while specific support for gender identity significantly reduces depressive symptoms and suicidal ideation. This underscores the importance of affirming environments for the mental health and stability of transgender individuals.

According to Wetmore, transgender adults who lacked support as children often struggle with building secure, healthy attachments and have difficulty with self-esteem and self-confidence. “Poor self-esteem is linked with the development of mental health issues such as generalized anxiety and major depression; beyond that, my transgender clients who experienced severe alienation, invalidation, or abuse from their families sometimes develop chronic, complex post-traumatic stress disorder, an illness that takes a lot of work and many years of practice to manage,” shares Wetmore.

The public fallout between Elon Musk and his daughter Vivian Jenna Wilson is undeniably tragic, underscoring the profound impact of parental rejection. In spite of this, this high-profile rift has brought crucial attention to the importance of family support for transgender youth. It serves as a powerful reminder for caregivers to reconsider the potential consequences of withholding support. It also emphasizes the vital role of affirming family relationships in fostering the well-being and mental health of transgender individuals.

…my transgender clients who experienced severe alienation, invalidation, or abuse from their families sometimes develop chronic, complex post-traumatic stress disorder, an illness that takes a lot of work and many years of practice to manage.

Han Wetmore, LISW

This dialogue highlights the urgent need for compassion, understanding, and acceptance within families to ensure that all children, regardless of their gender identity, thrive in a supportive and loving environment.

If you or someone you know would like to address mental health issues related to LGBTQ+ concerns, find a LifeStance therapist near you today to book an appointment.