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Journal of GLBT Family Studies
ISSN: 1550-428X (Print) 1550-4298 (Online) Journal homepage: https://www.tandfonline.com/loi/wgfs20
Parental reactions to transgender and gender
diverse children: A literature review
Roberto L. Abreu, Dani E. Rosenkrantz, Jonathan T. Ryser-Oatman, Sharon S.
Rostosky & Ellen D. B. Riggle
To cite this article: Roberto L. Abreu, Dani E. Rosenkrantz, Jonathan T. Ryser-Oatman,
Sharon S. Rostosky & Ellen D. B. Riggle (2019): Parental reactions to transgender
and gender diverse children: A literature review, Journal of GLBT Family Studies, DOI:
10.1080/1550428X.2019.1656132
To link to this article: https://doi.org/10.1080/1550428X.2019.1656132
Published online: 08 Oct 2019.
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Parental reactions to transgender and gender diverse children:
A literature review
Roberto L. Abreu
a
, Dani E. Rosenkrantz
b
, Jonathan T. Ryser-Oatman
c
,
Sharon S. Rostosky
c
, and Ellen D. B. Riggle
d
a
Psychology, Tennessee State University, Nashville, Tennessee;
b
Counseling Center, University of South
Florida, Tampa, Florida;
c
Educational, School and Counseling Psychology, University of Kentucky, Lexington,
Kentucky;
d
Political Science, Gender and Womens Studies, University of Kentucky, Lexington, Kentucky
ABSTRACT
Transgender and gender diverse (TGD) individuals face stigmatization from
family members and peers, placing this group at high risk of adverse out-
comes including suicidality, substance abuse, and compromised mental
health. This article uses a literature review approach to explore the com-
mon experiences of parents of TGD individuals as they navigate their rela-
tionship with their TGD children. Across 32 identified studies, the
experiences of parental reactions include: (a) initial experiences (including
noticing gender atypical behavior, diverse emotional reactions, cognitive
dissonance and behavioral avoidance, and lack of knowledge); (b) trans-
formation processes (including seeking informative resources and develop-
ing cognitive flexibility, seeking support and making TGD connections,
facing barriers and isolation, developing awareness of discrimination and
building empathy, and acknowledging the toll on mental health); (c) posi-
tive outcomes (including relational benefits, affirmation of values and activ-
ism, and new personal narratives); and (d) influences on the process
(including time, gender, and attribution of the cause of TGD identity).
Recommendations for health service providers include acknowledging
diverse emotional reactions and cognitive dissonance, cultivating hope,
honoring systemic barriers, and helping parents of TGD individuals create
new positive narratives.
KEYWORDS
Parental figures; parental
reactions; TGD children;
literature review
Transgender and gender diverse (TGD) individuals, defined here as individuals whose gender iden-
tities and expressions do not align with the sex they were assigned at birth (Kuvalanka, Allen,
Munroe, Goldberg, & Weiner, 2018), face stigmatization from family members and peers, in social
spaces and institutions (such as schools), and in the cultural and political environment. For
example, TGD youth often face bias from family members and school peers (Haas, Rodgers, &
Herman, 2014; Kosciw, Greytak, Zongrone, Clark, & Truong, 2018), and are at high risk of adverse
outcomes including suicidality (Connolly, Zervos, Barone, Johnson, & Joseph, 2016;Taliaferro,
McMorris, & Eisenberg, 2018), substance abuse (Eisenberg et al., 2017), and psychosocial distress
(Becerra-Culqui et al., 2018). These negative outcomes may be exacerbated by events in the cultural
and political context, such as restrictions preventing TGD individuals from accessing appropriate
facilities in public spaces based on their gender (Bosman & Rich, 2015).
Research exploring transgender identity awareness and disclosure suggests that children
become aware of their gender identity in early childhood and often disclose to parents before
CONTACT Roberto L. Abreu rabreu@tnstate.edu Psychology, Tennessee State University, 3500 John A. Merritt
Boulevard, Nashville, TN 37209.
ß2019 Taylor & Francis Group, LLC
JOURNAL OF GLBT FAMILY STUDIES
https://doi.org/10.1080/1550428X.2019.1656132
adulthood (Grossman & D’Augelli, 2007; Grossman, D’Augelli, Howell, & Hubbard, 2005).
Parents may buffer against the risks and stresses of stigmatization by providing support to their
TGD children. Exploring the experiences of parents of TGD individuals may lead to insights that
can inform psychoeducational and therapeutic interventions to help parents through their own
developmental growth process so that they, in turn, can support the development and well-being
of their TGD children.
Parental acceptance serves as a protective factor and is correlated with increased well-being for
TGD individuals (e.g., Bregman, Malik, Page, Makynen, & Lindahl, 2013). For example, in a sam-
ple of 73 transgender-identified children ages 3–12, children of parents who supported their social
transition (e.g., children changing their names, hairstyle, and clothing) did not show significant
differences in depression scores compared to their cisgender counterparts (Olson, Durwood,
DeMeules, & McLaughlin, 2016). In another study of 84 TGD youth, participants who identified
their parents as supportive of their gender identity and expression in childhood reported higher
life satisfaction, higher self-esteem, fewer depressive symptoms, and less suicidal ideation com-
pared to participants with nonsupportive parents (de Vries, Steensma, Cohen-Kettenis,
VanderLaan, & Zucker, 2016). These outcomes are consistent with literature on the influence of
parental acceptance of LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning)
children (e.g., Ryan, Huebner, Diaz, & Sanchez, 2009; Ryan, Russell, Huebner, Diaz, & Sanchez,
2010); however, many studies of LGBTQ youth include few TGD participants.
Although parental acceptance is an important support for the well-being of TGD individuals,
research suggests that a significant number of parents of TGD individuals are not supportive (at
least initially) and fail to intervene or show support when their child is discriminated against
and/or bullied (Day, Perez-Brumer, & Russell, 2018; Kosciw et al., 2018). For example, in a quali-
tative study of 110 transgender adults (Riley, Sitharthan, Clemson, & Diamond, 2013), partici-
pants perceived that during childhood, their parents struggled to transcend cultural heritage,
familial influences, and religion to accept their transgender identity.
Previous studies exploring the process of acceptance have predominantly focused on the
experiences of parents of LGB individuals. Chrisler’s(2017) review of the literature presented a
theoretical framework conceptualizing the experiences of parents of LGB children upon finding
out about their children’s nonheterosexual identity. Chrisler suggested that factors such as context
(e.g., individual characteristics, interactions with other people), the child’s behaviors and interests,
parent’s suspicion of the child’s LGB identity, confirmation of the child’s LGB identity, parental
response (i.e., positive, negative, neutral, or a combination thereof), and coping behaviors
influenced how parents made meaning of having a sexual minority child.
In a stigmatizing climate (see Flores, 2015; Jones, Brewer, Young, Lambe, & Hoffman, 2018),
the experiences of parents of TGD individuals may differ substantively from the experiences of
parents of LGB children. The purpose of this article is twofold: (a) to systematically explore the
literature on parents of TGD individuals, and (b) to identify patterns in the literature about the
experiences of parents of TGD individuals, which may differ from parents of LGB children (based
on past literature reviews, e.g., Chrisler, 2017).
Method
Literature search process
To begin the search process, we operationalized parent’s experiences of having a TGD child. We
identified studies for the review through: (a) computer-based database searches, (b) reference list
searches (ancestral approach), and (c) additional resources identified by the authorship team
from other sources (e.g., email notifications of relevant studies). In the computer-based search,
we conducted a database search of Academic Search Premier, PsycInfo, Sociological Collection,
2 R. L. ABREU ET AL.
and Psychology and Behavioral Sciences Collection. Variations of the term parental reactions (i.e.,
parents, mother, father, caregiver parental acceptance, parental rejection, parent experiences, par-
ent perspectives, parent attitudes, parent expectations, parent response, parent-child relationship)
were used in combination with keywords related to TGD identities (i.e., transgender, trans, gen-
der diverse, transgender child, transgender children, gender variant, gender variant child, gender
variant children, gender nonconforming child, gender nonconforming children, gender expres-
sion). In addition to database searches, an ancestral approach (White, 2009) examined reference
lists of included studies to identify additional relevant studies.
The search was not delimited to a specific country, setting, or time range (publications within
certain years) to locate all studies that captured the experience of parental figures of TGD indi-
viduals prior to creating inclusion and exclusion criteria. The search was updated through June,
2019. This initial process identified a pool of 349 studies.
Coding process
Inclusion criteria included studies that (a) were empirically based, (b) reported original research
findings, (c) recruited samples of parental figures of TGD individuals (rather than parents of
LGB individuals), and (d) explored experiences related to parenting a TGD individual. The first
two authors reviewed all abstracts to determine which citations met the inclusion criteria.
Exclusion criteria included articles that (a) were not peer-reviewed published studies (disserta-
tions, theses, book chapters), (b) were non-empirical case examples, and (c) combined samples of
parents of sexual minority and TGD individuals. As a result of the inclusion and exclusion crite-
ria, 32 studies were identified for possible inclusion in the review. The full text of each article
was futher reviewed by the third author to confirm appropriateness for inclusion; articles were
discussed by the group until consensus was reached on final inclusion. After the final list of 32
articles was created, the first two authors independently reviewed each article and met to compare
observed patterns until a consensus was reached and all articles had been summarized.
Results
Across 32 identified studies, we found that the experiences of parental reactions are characterized
by (a) initial experiences (including noticing gender atypical behavior; diverse emotional reactions;
cognitive dissonance and behavioral avoidance; and lack of knowledge), (b) transformation proc-
esses (including seeking informative resources and developing cognitive flexibility; seeking support
and making TGD connections; facing barriers and isolation; developing awareness of discrimin-
ation and building empathy; and acknowledging the toll on mental health); (c) positive outcomes
(including relational benefits, affirmation of values and activism, and new personal narratives);
and (d) influences on the process (including time, gender, and attribution of the cause of TGD
identity). See Table 1 for article summaries.
Initial experiences
Twenty-four articles described parents’experiences when they initially became aware of their
child’s TGD identity. Across studies, the initial reactions included (a) noticing gender atypical
behavior, (b) diverse emotional reactions, (c) cognitive dissonance and behavioral avoidance, and
(d) perceiving a lack of knowledge.
JOURNAL OF GLBT FAMILY STUDIES 3
Table 1. Summary of TGD Focused Parental Acceptance Literature.
Authors (Date) Title Sample Methods Main Findings
Alegr
ıa(2018) Supporting families of
transgender children/
youth: Parents speak
on their experiences,
identity, and views
12 parents of
transgender children.
Five parents had
female trans
daughters, and seven
had male trans sons.
Qualitative;
semistructured
interviews
1) Parents were overly concerned with the well-being of their child.
2) Participants respected and supported their children’s decisions to disclose to others at
their own pace to promote independence and autonomy.
3) Parents relied heavily on support networks for education.
4) Parents described trying to take time away from child-related concerns. Themes related
to participants’identity and views.
5) Parents with strong religious beliefs described that sometimes their religious beliefs
clashed with caring for their child.
6) Some parents said that their children were happier and better adjusted after
transitioning, but that it took time to adjust to their child’s identity.
7) Parents felt guilty for not recognizing dysphoria earlier and had doubts about their child’s
transition. Parents did eventually became advocates.
8) Parents expressed concerns over their children’s futures, including physical harm and
microaggressions.
Barron and Capous-
Desyllas (2017)
Transgressing the
Gendered Norms in
Childhood:
Understanding
Transgender Children
and Their Families.
N¼8; four mother and
four fathers; three
participants were
White, two Japanese,
one Hispanic, one
Ecuadorian, one
not provided.
Qualitative;
case study
1) Parents reported struggling with gender fluidity because they were socialized into a
gender binary. Initially, parents, overall, lacked awareness of their child’s TGNC identity.
2) Several parents allowed children to transition in steps. Parents reported a grieving
process during this stage.
3) Some parents reported difficulty and feeling nervous about setting up social activities
(e.g., playdates) if they hadn’t revealed their child’s identity to other parents.
4) Some parents experienced stress over their children being teased and misgendered at
school.
5) In some families, fathers did not want the transition to occur and delayed it.
Birnkrant and
Przeworski
(2017)
Communication,
advocacy, and
acceptance among
support-seeking
parents of
transgender youth.
N¼56 parents (52
cisgender women,
three cisgender men,
one gender diverse
individual); mostly
heterosexual (82%);
mostly White (93%).
Mixed method;
quantitative
measures of
parent/child
demographics;
open-
ended
questions
1) 50% of parents said their children disclosed directly; 20% of parents reported that they
found out about their children’s gender identity indirectly (i.e., someone else told them
or they found out inadvertently); and 30% of parents did not specify how they found
out.
2) Most parents had discussions about gender face-to-face with their children.
3) Most parents reported total acceptance at the time of their children’s disclosure.
4) About half of the parents disclosed their children’s gender identity to their children’s
school; others reported that they had disclosed to some people, but not all.
5) Most parents discussed their children’s gender identity with all extended family members;
a few only discussed with some family members or not at all.
6) Some parents reported being strong advocates for their children with other family
members; others indicated some advocacy for their children.
7) Level of parental advocacy for their children with school was associated with the school’s
current and initial levels of support for the children.
8) Parents of children who were assigned male at birth reported higher levels of parental
acceptance, compared to parents of children assigned female.
(continued)
4 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
Bull and D’Arrigo-
Patrick (2018)
Parent experiences of a
child’s social
transition: Moving
beyond the
loss narrative
N¼8; all were White;
five non-heterosexual.
Qualitative 1) Parents reported reflection about their own ideas about gender.
2) Participants reported gaining newfound strength and skills as a result of accepting their
children.
3) Parents described initial feelings of grief over their children’s transition.
4) Some parents described feeling hypervigilant in public settings with their children, similar
to constantly being questioned by others.
5) Parents described needing to create a safe environment at home for their children.
6) Parents also described seeking information from people and online to help their
children’s transition.
Chen, Hidalgo, and
Garafalo (2017)
Parental perceptions of
emotional and
behavioral difficulties
among prepubertal
gender-
nonconforming
children.
N¼40; 25 mothers and
15 fathers; mostly
White (80%).
Qualitative;
focus groups.
1) Parents reported that their children would act oppositionally by taking advantage of
parent guilt to get something. These behaviors often occurred in response to parents
limiting gender expression activities.
2) Parents observed anger outbursts when they did not allow their children to engage in
behaviors congruent with their gender.
3) All parents reported their children had worries and fears related to gender diversity,
including nonacceptance, fear of victimization, anticipating failure at romantic
relationships, not being authentically their affirmed gender, and medical procedures.
Coolhart, Ritenour,
and
Grodzinski (2018)
Experiences
of ambiguous loss
for parents
of transgender male
youth:
A phenomenological
exploration
N¼6; parents of
transgender male
youth; two identified
as male, four as
female; ages ranged
from 49 to 55 years
old; all participants
were White.
Qualitative,
semistructured
interviews
1) Parents experienced grief and loss as part of the process of acceptance. Parents mourned
the loss of envisioned future for their child (having children or weddings). Some parents
saw that their children’s transitioning was similar to them dying.
2) All parents utilized coping mechanisms. Some parents felt that their transgender children
allowed them to challenge their gender-binary lens.
3) Parents also reported that focusing on their children’s well-being helped buffer their
feelings of loss.
Di Ceglie and
Th€
ummel (2006)
An experience of group
work with parents of
children and
adolescents with
gender
identity disorder
N¼10 (two
heterosexual couples
five mothers, and one
aunt) of transgender
children attending a
support group for
parents of
transgender children.
Qualitative;
Case study
1) Parents described feeling isolated from others after learning about their children’s gender
identity.
2) Parents reported access to little information about caring for this population.
3) Parents described a range of reactions to children coming out, including feeling a
“traumatic shock”(p. 391).
4) Parents described anger at other relatives and professionals who advised against letting
their children express themselves.
5) Parents expressed fear for their children’s safety.
6) Parents expressed difficulty accepting their children’s identity and wanting to challenge
their children’s identity.
7) Parents described ranging from wanting to be positive and supportive to feeling upset
about their children’s transition.
8) Caregivers expressed concern over their children’s safety in the future, especially from
societal stigma.
(continued)
JOURNAL OF GLBT FAMILY STUDIES 5
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
Field and
Mattson (2016)
Parenting transgender
children in PFLAG
N¼14; three parents
were fathers; average
age was 60.
Qualitative;
semistructured
interviews.
1) Parents shared that it was difficult to accept their children and to help them physically
transition. This led to parents seeking out information.
2) Parents expressed frustration at how little information they had access to about their
children’s gender identity, and how little information is available to the public via the
media. Parents attributed the lack of information to their initial reactions of shock and
grief.
3) Parents’reported wishing they knew their children’s actual genders sooner because it
would have changed expectations and reactions to their children.
4) Parents reported difficulties adjusting to their children’s physical appearances (e.g.,
choosing to dress and act in public spaces).
5) Parents experienced grief and mourned the future hopes they had for their children.
6) Some parents felt gay, bisexual, and lesbian children were seen more favorably and had
more resources available to them compared to their transgender children.
Gray, Sweeney,
Randazzo, and
Levitt (2015)
“Am I doing the right
thing?”: Pathways to
parenting a gender
variant child
N¼11; average age was
45, range was 37–48;
73% mothers; 100%
heterosexual,
cisgender, White;
household incomes
over $65,000. All
parents had at least a
college education;
children’s birth sex
was 55% male and
45% female;
children’s gender
identity was 27%
male, 46% male
gender variant, 18%
female gender
variant, 9%
transitioning
to female.
Qualitative;
semistructured
interviews.
1) Parents journey to rescue/accept children:
a. Parents accepted their children when they came to terms that it was not a phase.
b. Parents who perceived their children’s identity as something they could not change
accepted them easier. Parents who thought they could change their children had
taken longer to accept their children.
c. Parents who were able to link happiness to their children’s identity were easier to
accept. Parents who wanted to shelter their children from prejudice had a harder time
accepting.
d. Parents who had more connections to the LGBT community were more accepting.
2) Parenting self-efficacy and worry about the child are impacted by child’s gender variant (GV):
a. Parents had more difficulties navigating their children’s sexual identity if the child had
other concerns (e.g., disability).
b. Parents discouraged their children from expressing their authentic selves for fear that the
children would experience negative consequences.
c. Acceptance led to better parent-child communication.
3) Having a GV child changes relationships in the whole family:
a. Parents disagreement about how to handle their children’s identity caused tension in their
relationship.
b. Parents described a range of reactions from family members, from accepting to complete
rejection.
4) Parents of GV children struggle with how to create a normal childhood for their children in
thefaceofstigma:
a. All parents expressed wanting to protect their children. Some parents changed their
children’s environment.
b. Parents accepted a different future for their children.
c. Parents engaged in advocacy for their children.
(continued)
6 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
5) Social intolerance and child factors can amplify the stressors of raising a GV child:
a. Parents described witnessing their children being stigmatized, from which they experienced
anger and sadness.
b. Parents were concerned about how others perceived their children’s gender identity.
6) Future uncertainty:
a. Parents’concern about their children will develop.
b. Parents fear future medical procedures for their children.
c. Parents hoped that their childen will be able to develop interpersonal relationships and not
further stigma.
Gregor, Hingley-
Jones, and
Davidson (2015)
Understanding the
experience of parents
of pre-pubescent
children with gender
identity issues
N¼8; parents of
children with gender
identity issues that
had been in contact
with the Gender
Identity Development
Service in London,
UK; 63% mothers;
100% of children
diagnosed with
gender dysphoria;
children’s assigned
sex was 40% female,
60% male; children’s
age ranged from 6 to
10 years old.
Qualitative;
semistructured
narrative
interviews.
1) Many parents spoke about the loss of a child. Parents reframed their children’s gender
identity through a lens of positive personal growth.
2) Many parents initially did not connect their children’s unhappiness or acting out with
their gender identities. Parents blamed themselves for their children’s gender-variant
behavior.
3) Parents expressed a great deal of uncertainty regarding a child’s diagnosis and prognosis.
Some parents discussed that their children were born “this way;”others hoped their
children would revert to their sex assigned at birth.
4) Parents expressed willingness to support their children. Parents struggled with managing
support for their children’s gender and concerns about potential pushback from society.
5) Some parents expressed mixed feelings regarding other individuals calling their children
the correct gender.
Hidalgo and
Chen (2019)
Experiences of gender
minority stress in
cisgender parents of
transgender/gender
expansive prepubertal
children: A
qualitative study
40 parents of gender
expansive children.
Mean age was 41
years old, 32 of
whom identified
as White.
Qualitative;
focus groups.
1) Distal stress
a. Parents reported experiencing discrimination from peers and were constantly watched
and talked about by others due to their children’s identity. Parents also realized that
society discriminated against their children.
b. Parents experienced rejection from family members or other parents.
c. Parents reported experiencing verbal harassment from other people.
d. Parents reported that other people misgender their children. Parents anticipated
having nonaffirming interactions with other people in regard to their children’s gender
identities.
2) Proximal stress
a. Parents reported an anticipation of personal negative future experiences as a result of
their children’s gender identity and/or expressions. Parents felt challenged by thinking
about how much they could disclose about their children’s gender identities to others.
b. Parents experienced feelings of loss, guilt, and anger and social isolation.
Hill and
Menvielle (2009)
“You have to give them
a place where they
feel protected and
N¼42 parents who had
contacted a program
for gender variant
Qualitative;
semistructured
interviews.
1) Some parents reported that they did not struggle to accept their children’s gender
identity, nearly half of parents had unconditionally accepted children at the time of
interview.
(continued)
JOURNAL OF GLBT FAMILY STUDIES 7
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
safe and loved”: The
views of parents who
have gender-variant
children and
adolescents
children; mothers
average age ¼43.5,
ranging from 22 to
58 years; fathers
average age ¼46.6,
ranging from 35 to
61; mothers 80%
White, fathers 85%;
100% of the 31
children were gender
variant, with 74%
male and 26% female
sex assigned at birth;
sample primarily from
the Wisconsin or
Washington, DC area.
2) 38% of parents’first reactions after disclosure were to think that it would change with
time or was just a phase. Some of these beliefs were held by friends or professionals.
3) 60% of parents expressed discouraging dressing in a fashion that was contradictory to
their assigned gender. Some parents believed that if the parent of the same gender
spent more time with them that they would display gender expressions consistent with
their assigned gender.
4) Acceptance seems to come when parents stopped thinking that they had to do
something for their children to be ok; some parents expressed a sense of loss of a child.
5) 14% of parents’acceptance facilitated was feelings of empathy, and deeper
understanding about the hardships that their children were experiencing.
6) 21% of parents invested significant amount of time thinking about and finding
information about what their children were experiencing.
7) 60% of parents fear that their children would experience verbal and physical violence as
a result of their gender and gender expression; only a few parents were able to recall
events where their children were exposed to such acts of violence and harassment.
8) 40% of parents expressed concerns about negative circumstances and situations their
children have to face (e.g., being unhappy, suicidality).
9) Upon first learning or having suspicion of their children’s gender identity, 50% of parents
conflated gender and gender expression with sexual identity.
10) 51% of parents expressed concerns about the medical aspects of their children’s trans
identities (e.g., hormones).
Ishii (2018) Rebuilding relationships
in a transgender
family: The stories of
parents of Japanese
transgender children
N¼12; nine mothers,
three fathers; all lived
in Japan; age ranged
from 40s to 60s.
Qualitative;
semistructured
interviews.
1) Participants reported having to learn more about transgender individuals through
reading, going to groups, and talking to others.
2) Parents were able to use information they gained about the transgender community to
make sense of their children’s identity and to display the deep knowledge they had
about this community.
3) Parents reported having to reconcile the new image of their children by realizing they
were the same people.
4) Parents rebuilt the relationship with their children through perspective taking and seeing
transgender issues as a systemic concern.
5) Parents reported children’s being transgender had a positive impact on them.
6) Interviewees reconsidered their own gender and sexual identity, such as seeing their
gender presentation as not static or fixed.
7) Participants actively altered their interaction with peers, family, and religious institutions.
8) Fathers often attended support groups and talked about their children’s identity less
frequently than mothers. Fathers struggled more with acceptance.
Johnson and
Benson (2014)
“It’s always the mother’s
fault”: Secondary
stigma of mothering
a transgender child
N¼1; 40-year-old
White, middle-class
divorced mother.
Qualitative;
case study
1) Mother stated that she initially tried to push her daughter toward masculine activities but
was met with resistance. This led to the discovery that her daughter had a different
gender identity than what was assigned at birth.
2) Mother’s choice to let her daughter live authentically led to allegations of abuse from the
family. This led to a sense of self-blame.
(continued)
8 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
3) Mother encouraged the father to see their daughter, but the father does not often see
her due to discomfort with the transition process.
4) Mother reported that mental health professionals were not helpful or supportive and
having little education about transgender families.
5) Mother reported the Internet was helpful—particularly online support groups for parents.
This also allowed her child to connect to other children for support.
6) After learning about the transgender community, the mother sought to educate
education and health institutions about this group to improve services.
Johnson, Sikorski,
Savage, and
Woitaszewski
(2014)
Parents of youth who
identify as
transgender: An
exploratory study
N¼8; seven mothers
and one
grandmother; all
participant were
White; all from
middle-class
backgrounds
Qualitative;
interviews.
1) All participants reported supporting their transgender children.
2) Mothers were the main advocates for their children and engaged in research about the
transgender community and sought resources. Fathers were noted to be passive or not
supportive initially.
3) Participants noted that religion played either a positive or negative role in the children’s
transition (e.g., Christian preschool not allowing the children to display their genders).
4) Participants described their children’s personalities as helping navigate transitioning.
5) Many of the participants were supportive of their children and used their cognitive
abilities to advocate for their children and find resources to help educate themselves and
their communities.
6) A source of support was supportive physicians, doctors, and psychologists.
7) Some participants had different experiences with schools and school policies. For
example, one school had loose antibullying rules, leading to her child being constantly
bullied, but another school had strict rules.
8) Parents identified bullying as the most pervasive issue for their children. Some mothers
had to change their children’s schools or there were concerns for their children’s safety at
school.
9) Many participants noted physical and psychological issues associated with their children’s
transitions. Parents noted that puberty felt traumatic for them and their children.
10) Some participants noted that their families became closer through the transition process
and more accepting of others who are different from themselves. However, some
participants noted that there was inner family conflict initially related to their children’s
identities.
11) Most parents noted positive changes for their children once they had transitioned. Some
negative consequences included difficulties at school and distress about having to
conceal their gender.
Kane (2006) No way my boys are
going to be like that!’
Parents’responses to
children’s gender
nonconformity
N¼42; parents of
preschool-aged
children; parents’
average age ¼35,
with a range from 23
to 49 years; 57%
mothers. Parents had
22 sons and 20
Qualitative;
semistructured
interviews; brief
questionnaire.
1) Parents were mostly positive toward their daughters expressing gender-nonconforming
interests or activities.
2) For parents of male children, femininity was seen as a negative behavior in sons.
3) Perceived normative masculinity played a large role in parental acceptance of gender
nonconformity in parents of boys.
(continued)
JOURNAL OF GLBT FAMILY STUDIES 9
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
daughters; 83%
White; 71% working
or middle class; 88%
heterosexual;
recruited from the
northern New
England area.
Katz-Wise, Budge,
Fugate
et al. (2017)
Transactional pathways
of transgender
identity development
in transgender and
gender-
nonconforming
(TGNC) youth and
caregiver perspectives
from the Trans Youth
Family Study
N¼16 families with
transgender youth,
including 29
caregivers (17
mothers, 11 fathers,
one grandmother).
Qualitative 1) Participants were several parents noted that children suddenly disclosed their gender identity.
2) Parents’reflections focused on difficulties their children experienced during puberty and how,
prior to that stage, children were comfortable with the gender assigned at birth.
3) Most of the parents stated that they were supportive of their children’s transgender identity.
Other parents were skeptical about their children’s trans identity and questioned if they were
just going through a phase.
4) Parents struggled seeing their child experiences with stigma from people in their lives (e.g.,
friends).
5) Parents described the importance of finding spaces where they could talk to others about
their experiences, such as attending parents support groups.
6) Parents reported that they sought support groups, advocacy organizations, counseling, and
medical advice. Parents also used hormone blockers when they felt it was needed.
Katz-Wise, Budge,
Orovecz
et al. (2017)
Imagining the future:
Perspectives among
youth and caregivers
in the Trans Youth
Family Study.
N¼16 families (29
caregivers); mean age
was 47 years old;
mostly mothers
(62.1%); mostly
White (75.9%).
Qualitative;
semistructured
interviews
1) Participants concerned about how being transgender may affect youth. Parents found
some comfort talking to other transgender adults.
2) Participants mentioned barriers, including institutional discrimination (e.g., at work,
school, medical care). Parents stated that until policies change they will worry for the
well-being of their child.
3) Parents engaged in activism too, which helped their own mental health.
4) Parents reported many fears for their children (e.g., affirmative medical procedures and
their safety, interacting with people).
5) Parents described initially rejecting their children. Parents also felt a sense of loss after
the children’s disclosure.
6) Parents described fear for their children’s future, so they wanted to make the decisions to
protect their children (e.g., making decisions about safe schools).
7) Parents described expectations for their children when they came out, such as wanting
them to be able to successfully transition. Parents also stated hoping their children find
fulfilling, accepting romantic relationships.
8) Parents acknowledged that being transgender will hopefully help their children be more
open-minded and accepting of others in the future.
9) Parents expressed several emotions when thinking of their children undergoing
affirmative surgery (e.g., fear, sadness, nervousness).
Kuvalanka, Weiner,
Munroe,
Goldberg, and
Gardner (2017)
Trans and gender-
nonconforming
children and their
caregivers: Gender
N¼49 (44 mothers,
three fathers, two
grandmothers).
Caregiver’s ages
Mixed methods;
initial
completion of
telephone
1) Participants were supportive of their children’s gender identity and gender expression.
2) Caregivers of transgender and gender nonconforming children scores on a measure of
depression and anxiety were below the clinical cutoff.
3) Caregivers’level of anxiety had significant associations with children’s well-being and
(continued)
10 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
presentations, peer
relations, and well-
being at baseline
ranged from 31 to 67
(M¼42), primarily
White (95.6%)
sample; most had a
bachelor’s degree
(80%); most
identified as
heterosexual (75.5%).
interviews
followed by
questionnaire.
children’s internalizing.
4) As caregivers’scores of anxiety (both in the moment and longer-term) increased,
children’s scores of internalizing increased.
Kuvalanka, Allen,
Munroe,
Goldgerg, and
Weiner (2018)
The experiences of
sexual minority
mothers with
trans children
N¼8; all
nonheterosexual
mothers; all White;
ages 32–55 years
old (M¼43.4).
Qualitative;
semistructured
interviews
1) Most mothers assumed that their children were cisgender, even if they initially allowed
them to engage in gender atypical play and activities. Mothers assumed that this meant
their children would be gay, lesbian, or bisexual.
2) Some mothers tried to steer their kids toward clothes/activities aligned with their
children’s assigned sex.
3) Several parents had to switch children’s schools due to teasing for gender-atypical
behavior.
4) One participant easily accepted her child as trans, but most mothers had mixed reactions,
ranging from grief, panic, guilt, and anxiety.
5) Two parents noted that being part of the LGBT community allowed them to access
information more easily about the trans community.
6) Four participants initially blamed themselves for their children’s identities; others reported
being blamed by other people for their children because the mothers are sexual minority
women.
7) Some participants mentioned grief over the loss of their children’s perceived genders.
Other mothers mentioned fears for their children of being marginalized.
8) Some participants noted that their partners had either negative reactions or took longer
to accept the children, making participant experiences more difficult.
9) Some participants noted that they had fears for their children, given negative experiences
of trans individuals in the LGBT community, which sometimes stigmatized and
marginalized trans individuals.
Kuvalanka, Bellis,
Goldberg, and
McGuire (2019)
An exploratory study of
custody challenges
experienced by
affirming mothers of
transgender and
gender-
nonconforming
children.
N¼10; all mothers of
TGNC children who
were separated from
ex-partners and were
in various stages of
child custody of
transgender child;
ages ranged from 32
to 52 (M¼43.6);
mostly White.
Qualitative;
semistructured
interviews.
1) All participants reported being blamed by ex-partners for child’s transgender identity and
for past mental health concerns of their children.
2) Some mothers reported ex-partners were coercive or manipulative with them and their
children. Ex-partners would tell the participants not to use correct gender pronouns with
their children and were emotionally abusive toward them.
3) Some participants felt the legal system was transphobic and heterosexist. Judges did not
approve of letting their children express their gender identity and encouraged them to
reject their children’s gender identities. Failure to do so resulted in lost custody for some
participants.
4) Some participants stated that custody challenges negatively impacted their children (e.g.,
some children felt responsible for parent’s losing custody).
5) Some participants said that custody battles had negative impacts on them (e.g.,
depression, financial problems).
6) Mothers expressed that court officials need more education and training about
(continued)
JOURNAL OF GLBT FAMILY STUDIES 11
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
transgender issues, so that decisions can be made that will validate and support
children’s gender identity.
Kuvalanka, Weiner,
and
Mahan (2014)
Child, family, and
community
transformations:
Findings from
interviews with
mothers of
transgender girls
N¼5; average age was
43.8, ranging from 34
to 55; 100%
heterosexual and
White; 40%
participants had
graduate degrees,
40% had
undergraduate
degrees, and 20%
completed high
school; average age
of children was 9.4
years, ranging from 8
to 11 years old.
Qualitative; in-
depth
interviews.
1) Child’s transformation: "She was given wings":
a. Mothers prepared their daughters for potential negative reactions from others.
b. Mothers reported positive changes in their daughters after transitioning (e.g., happier;
expressing their gender in public and not only at home; more social and open to
interactions with others, including school).
c. Mothers described that after their daughters’transitioned. they understood that their
daughters were expressing externally who they always were internally.
2) Family transformations:
a. Mothers expressed various degrees of understanding of their daughters’gender identity.
Some mothers described being completely uninformed about transgender identity and
others thought that their child’s gender expression was a sign of nonheterosexual
identity; all mothers expressed a period of adjustment; the idea of loss of a child was
expressed by some mothers.
b. Mothers described moving from not being aware of transgender issues to being experts
and advocates on the subject.
c. Mothers report that it took their husbands longer to accept; extended family members
were hesitant to accept child but eventually accepted; one participant had an experience
of immediate acceptance by an uncle.
Menvielle and
Tuerk (2002)
A support group for
parents of gender-
nonconforming boys
N¼12; families of GNC
boys ages 3–11 years;
primarily mothers (n
not indicated);
participation in
parent support group
ranged from
attending 24 or more
sessions (n¼6), 12 or
more sessions (n¼4),
and fewer than 12
sessions (n¼2).
Qualitative;
Describes a
group process.
1) Coming to terms with their children being different from what they envision, loss of an
idealized heterosexual child.
2) Parents may benefit from the process of hearing about the experiences and feelings of
others in similar circumstances.
3) Parents developed ideas about how to handle embarrassing situations in support group.
4) Embarrassment and fear of negative outcomes to the child prevented parents from
talking about their feelings with others.
5) Parents found it helpful to use humor to reduce tension and increase group cohesiveness.
Platero (2014) The influence of
psychiatric and legal
discourses on parents
of gender-
nonconforming
children and trans
youths in Spain
N¼12; parents who
had sought help
supporting GNC
children (in addition
to a sample of
professionals);
average ages ranged
from 35 to 56; 75%
mothers; 100% from
Qualitative;
interviews were
conducted in
different
locations in
Madrid, face to
face, along with
3 telephone
interviews.
1) Received information from the Internet, hospitals, psychologists, and medical materials.
Sought peers and professionals for information.
2) Parents had to educate the professional; providers have inaccurate information.
3) Positive relationship with professional is linked to taking medical viewpoint of GV and
acceptance. Negative relationships are linked to coping strategies such as denial.
4) How parents dealt with professionals medically and socially indicated acceptance.
(continued)
12 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
Spain; children were
ages 4 to 19;
indicated mixed-
socioeconomic status;
one parent identified
as Roma (gypsy)
Analysis was
done using
thematic
analysis.
Pyne (2016) "Parenting is not a job
…it’sa
relationship":
Recognition and
relational knowledge
among parents of
gender non
conforming children
N¼15; parents of GNC
children within 10
families in Canada;
80% mothers; parents
were 53%
heterosexual, 13%
queer, 13% lesbian,
20% bisexual/
pansexual; 67%
White; 87% middle
class; children were
between 5 and 14
years old.
Qualitative;
semistructured
interviews in
participants
homes. Analysis
was conducted
using
grounded
theory.
1) Parents often blamed themselves for their children’s identity.
2) Parents blamed external factors as the source of the problem (e.g., transphobia).
3) Parents found other families who shared similar experiences, joined community
organizations for support, and looked for expert advice.
4) Over time, parents provided autonomy to their children.
5) Parents were open-minded about their children’s own exploration and different
outcomes.
6) Parents knew they were right to affirm to their children’s gender identity.
Rahilly (2015) The gender binary
meets the gender-
variant child: Parents’
negotiations with
childhood
gender variance
N¼8; parent dyads and
eight individual
parents of a
transgender or
gender-variant child;
mostly White; mostly
middle-class, and
well-educated.
Qualitative;
semistructured
interviews
1) Parents attempted to reduce their children’s gender-atypical behaviors. Parent restricted
what they allowed their child to wear in public that was gender atypical (e.g., pink shirts,
were allowed but no dresses).
2) Parents reported using the Internet to learn more about the gender binary with children.
Parents mention learning through conversation with other parents and professionals. This
allowed parents to advocate for their children in school settings.
3) Parents struggled to use gender literacy to navigate situations where their children were
misgendered. Parents struggled in deciding when to intervene and try to correct others
who used gender binary terms.
Rahilly (2018) Re-interpreting gender
and sexuality: Parents
of gender-
nonconforming
children
N¼56 parents; 90%
White; mostly female
and heterosexual.
Qualitative;
semistructured
interviews.
1) Parents initially worried their children were sexual minorities.
2) Parents used the Internet and online resources to learn about gender noncornformity.
Parents sought out research to understand their children.
3) Parents noted that often helping professionals did not know about gender
nonconformity, often attributing behaviors to being a sexual minority.
4) Parents also noted that their children experience depression and anxiety.
5) Parents had to learn the difference between gender nonconformity, transgender identity,
and being LGB.
6) Some parents came accept their children’s identity. Parents became advocates for their
children to ease their transition.
Riggs and
Due (2015)
Support experiences and
attitudes of
N¼61; 90.5% mothers;
100% heterosexual
Mixed method;
quantitative
Quantitative:
1) Parental acceptance increased over time (present M¼3.88, 3 years prior M¼3.11).
(continued)
JOURNAL OF GLBT FAMILY STUDIES 13
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
Australian parents
of gender
variant children
and Australian; 52%
of children born male
and now identify as
female, 47.6% of
children female at
birth and now
identify as male;
average age of
children was 10.33
years (SD ¼4.08);
71.4 % indicated that
their child had
received a formal
diagnosis of gender
identity disorder.
Likert scales
with qualitative
open-
ended
questions.
2) Parental support is higher if the child has been given a formal diagnosis (M¼3.8) over
no formal diagnosis (M¼3.1).
3) 76.2% of participants had accessed health care professional for their child; health care
professionals’attitude toward GV child played a large role in parents’sense of support.
4) Participants indicated that gender is based on biology (M¼5.95) and not upbringing
(M¼1.20).
5) Male’s rate female partners as more supportive (M¼4.00) than female’s rating male
partners support (M¼3.23).
Qualitative:
1) Participants identified most of their children wishing to dress and be their preferred
gender.
2) Male participants were more likely to use children’s gender pronouns congruent with
their assigned sex at birth.
3) Male-identified parents took longer to accept child’s identity.
Riley, Sitharthan,
Clemson, and
Diamond (2011)
The needs of gender-
variant children and
their parents: A
parent survey
N¼31; mostly married;
age 26–45 years old;
all White.
Qualitative;
Internet survey.
1) Parents reported needing more information about gender variance, such as access to
books. Parents also sought guidelines and information for parenting transgender children,
such as research. The parents desired having information on how to choose schools for
their child.
2) Parents’reactions varied from being fully supportive to not accepting after child’s
disclosure, to feeling confused or worried. Some parents blamed themselves or looked for
causes of their children’s gender. Parents also feared hurting their children with their
actions.
3) Parents sought professional counseling, support groups, and meeting other transgender
individuals for support.
4) Some parents reported feeling excluded (e.g., losing friends), feeling tension in their
families, family harassment, and/or hostility. Parents reported feelings of sadness about
having a gender variant child and fearful for their child’s well-being.
5) Parents wished that there were more awareness in the medical profession (e.g., better
trained providers and staff). Parents noted lack of resources.
6) Parents described frustration that their children were dismissed in school policies,
government legislation, and health resources.
Sansfac¸on,
Robichaud, and
Dumais-
Michaud (2015)
The experience of
parents who support
their children’s
gender variance
N¼14; 67% had a
male assigned/
female-identified
child, 33% had
female-assigned/
male-identified
children; children
were between 4 and
Qualitative; open
discussion
through
focus groups.
1) All participants fully accepted children’s GV identity. Parents expressed that accepting
their child came with lack of social support.
2) Parent’s understanding of child’s experiences:
a. Finding a label for their child was an important step to affirm their child’s identity.
d. Parents expressed feelings of stress, anxiety, powerlessness, and loneliness. Parents also
express challenges within family unit, school, and accessing healthcare services. Many
parents became activists and desired to change laws and society.
(continued)
14 R. L. ABREU ET AL.
Table 1. Continued.
Authors (Date) Title Sample Methods Main Findings
13 years old, with
one in their 20s.
Spivey, Huebner,
and
Diamond (2018)
Parent responses to
childhood gender
nonconformity:
Effects of parent and
child characteristics
N¼236 parents; 63.9%
identified as female;
30–39 years old.
Quantitative 1) Male sex of parent and child were associated with greater parent discomfort at gender
nonconforming behaviors.
2) Parents were more uncomfortable with gender nonconformity when their children did
not often engage in atypical behaviors.
3) Parents’efforts to change behavior were associated with the children’s sex (mostly
biological males), children’s gender nonconformity, parents’attitudes toward gender, and
parents’warmth.
Wren (2002)‘I can accept my child is
transsexual but if I
ever see him in a
dress I’ll hit him’:
Dilemmas in
parenting a
transgendered
adolescent
N¼15; parents of
transgender children
ages 14–19; 60%
mothers; 100% White,
cisgender,
heterosexual, and
British; reported a
"range of socio-
economic
background;" 64% of
the families had a
transgender
adolescent that was
biologically female,
36% of the families
had a transgender
adolescent that was
biologically male;
None of the children
had fully transitioned.
Qualitative; semi-
structured
interviews.
1) Communication between parent and adolescent:
a. Parents described being prepared due to atypical gender behaviors children displayed
growing up.
b. Several parents expressed concern over body surgery.
c. Mothers stressed maintaining communication with their child as important to develop
understanding of their children’s identity. Fathers reported an avoidance of difficult
conversations, and leaving conversations about gender to the mothers.
d. Parents described hesitancy seeking social support and sharing with others for fear of
being ridicule.
2) Parental acceptance and nonacceptance:
a. Different levels of acceptance: continuity (gender-atypical behavior displayed in early
childhood), parents’and children’s moral worth (being honest about who they are;
accepting child), unconditional love of children, and biological understanding of their
children’s identity.
b. Parents who showed less positive regard for children assumed that their children were
too young to make decisions for themselves and believed that atypical gender behavior
were a cover for other issues, and saw gender as impossible to change.
3) Coping:
a. Accepting parents used adaptive strategies to change expectations of child and to
accommodate new beliefs.
b. Nonaccepting parents aimed at recovering perceived loss of status quo, ignored child
behavior, urged secrecy, became frustrated at professionals, and felt helpless with lack
of control.
JOURNAL OF GLBT FAMILY STUDIES 15
Noticing gender atypical behavior
In six studies (five qualitative and one mixed-method), researchers reported that parents observed
gender atypical behavior or other cues that indicated their children were not behaving in a man-
ner congruent with expectations of gender norms (Hill & Menvielle, 2009; Johnson & Benson,
2014; Kuvalanka et al., 2018; Kuvalanka, Weiner, & Mahan, 2014; Rahilly, 2015; Wren, 2002).
Some parents first considered the possibility of having an LGB child, then learned later about
their children’s gender identity (Kuvalanka et al., 2014). In two studies, researchers found that
some parents tried to discourage their child from engaging in gender diverse behaviors (e.g.,
wearing clothes that did not aligned with the sex they were assigned at birth); others allowed
their child to engage in certain gender-atypical behaviors such as wearing clothing colors gener-
ally associated with a sex they were not assigned at birth or engaging in cross-gender activities
(Kuvalanka et al., 2018; Rahilly, 2015).
Diverse emotional reactions
Sixteen studies (14 qualitative and two-mixed method) found that parents experienced intense
emotional reactions when they first learned about their child’s TGD identity (Barron & Capous-
Desyllas, 2017; Birnkrant & Przeworski, 2017; Bull & D’Arrigo-Patrick, 2018; Coolhart, Ritenour,
& Grodzinski, 2018; Di Ceglie & Th€
ummel, 2006; Field & Mattson, 2016; Hidalgo & Chen, 2019;
Johnson & Benson, 2014; Kane, 2006; Katz-Wise, Budge, Fugate et al., 2017; Katz-Wise, Budge,
Orovecz et al., 2017; Kuvalanka et al., 2014,2018; Menvielle & Tuerk, 2002; Rahilly, 2015; Riley,
Sitharthan, Clemson, & Diamond, 2011). Reactions included parental feelings of grief and loss of
their children’s identity as assigned at birth (i.e., a male/boy or female/girl). Some parents
mourned the loss of the future they envisioned for their children (e.g., such as having children,
getting married); others conceptualized their children’s transitioning as similar to their children
dying. Six studies reported that some parents experienced strong, positive, loving reactions to
their children’s TGD identity (Birnkrant & Przeworski, 2017; Kane, 2006; Katz-Wise, Budge,
Fugate et al., 2017; Kuvalanka et al., 2014,2018; Riley et al., 2011). In addition, parents in some
studies specifically mentioned being shocked when they first learned about their child’s TGD
identity. For example, Di Ceglie and Th€
ummel (2006) reported that some of their participants
described feeling a “traumatic shock”(p. 391) after learning about their child’s TGD identity.
Cognitive dissonance and behavioral avoidance
Twelve studies (10 qualitative, one quantitative, and one mixed-method) described parents’strug-
gle to reconcile previously held beliefs about TGD issues and their children’s TGD identity
(Alegr
ıa, 2018; Barron & Capous-Desyllas, 2017; Chen, Hidalgo, & Garofalo, 2017; Coolhart et al.,
2018; Gray, Sweeney, Randazzo, & Levitt, 2015; Hill & Menvielle, 2009; Johnson, Sikorski, Savage,
& Woitaszewski, 2014; Kuvalanka et al., 2014,2018; Rahilly, 2015; Spivey, Huebner, & Diamond,
2018; Wren, 2002). Three articles described a tension between parents’ideologies and beliefs
about gender and their children’s TGD identity (Gray et al., 2015; Hill & Menvielle, 2009; Spivey
et al., 2018). Eight studies indicated that parents had difficulty reconciling their children’s TGD
identity with previously held prejudices about TGD individuals, gender expression, and gender
binaries overall (Alegr
ıa, 2018; Barron & Capous-Desyllas, 2017; Chen et al., 2017; Gray et al.,
2015; Hill & Menvielle, 2009; Rahilly, 2015; Spivey et al., 2018; Wren, 2002). In three studies, the
authors reported that it was difficult for parents to understand distinctions between gender and
sexual identity and the ways these distinctions impacted their understanding of their TGD child
(Hill & Menvielle, 2009; Kuvalanka et al., 2014; Wren, 2002). Two articles indicated that the
teachings of religious traditions created difficulty for some parents in accepting their children
(Alegr
ıa, 2018; Johnson et al., 2014). Four studies discussed how some parents avoided engaging
in a conversation about what having a TGD identity would mean for their children and/or
16 R. L. ABREU ET AL.
delayed their children’s transition (Barron & Capous-Desyllas, 2017; Chen et al., 2017; Kuvalanka
et al., 2018; Wren, 2002).
Lack of knowledge
Six studies (five qualitative and one mixed-method) reported that early in the process, partici-
pants felt overwhelmed by a lack of knowledge about TGD identity and the TGD community (Di
Ceglie & Th€
ummel, 2006; Field & Mattson, 2016; Gregor, Hingley-Jones, & Davidson, 2015; Hill
& Menvielle, 2009; Kuvalanka et al., 2018; Riley et al., 2011). In these studies, some parents had
little or no information about the TGD community and/or had difficulties finding information
about their children’s TGD identity. Two of the studies described how parents’lack of under-
standing led them to believe their child’s TGD identity was a phase (Gregor et al., 2015; Hill &
Menvielle, 2009). Field and Mattson (2016) noted that some parents perceived the lack of media
information contributed to their initial reactions of shock and grief, increasing their difficulties in
resolving their negative reactions and psychological distress.
Transformation
Findings from 29 studies suggested that parents underwent a transformation process of their own
upon learning they had a TGD child. This process involved developing new parent behaviors and
skills such as (a) seeking informative resources and developing cognitive flexibility, (b) seeking
support and making TGD connections, (c) facing barriers and isolation, (d) developing awareness
of discrimination and building empathy, and (e) acknowledging the toll on their mental health.
Seeking informative resources and developing cognitive flexibility
Ten studies (nine qualitative and one mixed-method) reported that parents actively sought
resources to help them understand their child’s TGD identity and developed cognitive flexibility
by modifying and re-evaluating their beliefs (Bull & D’Arrigo-Patrick, 2018; Gray et al., 2015;
Ishii, 2018; Johnson & Benson, 2014; Kuvalanka et al., 2018; Platero, 2014; Rahilly, 2015,2018;
Riley et al., 2011; Wren, 2002). Although none of the studies measured cognitive flexibility, find-
ings across studies reported characteristics consistent with Martin and Rubin’s(1995) definition
of cognitive flexibility (e.g., being able to consider multiple options, being flexible and adapting to
situations, feeling confident in one’s ability to be flexible). Parents in some studies educated
themselves by accessing media, books, newsletters, the Internet, and other forms of literature
(Bull & D’Arrigo-Patrick, 2018; Ishii, 2018; Johnson & Benson, 2014; Platero, 2014; Rahilly, 2015,
2018; Riley et al., 2011). Other studies reported that accumulated knowledge led parents to
change their own views about their children’s TGD identity, to feel more comfortable with their
children’s identity, and learn about appropriate language for communicating with their children
and others about TGD identity (Bull & D’Arrigo-Patrick, 2018; Ishii, 2018; Gray et al., 2015;
Rahilly, 2015; Wren, 2002).
Seeking support and making TGD connections
Seventeen articles (15 qualitative and two mixed-method) reported that parents sought support
and initiated contact with the TGD community to learn more about their child’s identity
(Alegr
ıa, 2018; Bull & D’Arrigo-Patrick, 2018; Gray et al., 2015; Ishii, 2018; Johnson & Benson,
2014; Johnson et al., 2014; Katz-Wise, Budge, Fugate et al., 2017; Katz-Wise, Budge, Orovecz
et al., 2017; Kuvalanka et al., 2018; Menvielle & Tuerk, 2002; Platero, 2014; Pyne, 2016; Rahilly,
2015,2018; Riggs & Due, 2015; Riley et al., 2011; Wren, 2002). In 11 studies, parents sought sup-
port from the TGD community, parents, friends, and family members of TGD individuals, and
JOURNAL OF GLBT FAMILY STUDIES 17
TGD-related groups and networks (e.g., Alegr
ıa, 2018; Bull & D’Arrigo-Patrick, 2018; Ishii, 2018;
Johnson & Benson, 2014; Katz-Wise, Budge, Fugate et al., 2017; Katz-Wise, Budge, Orovecz et al.,
2017; Menvielle & Tuerk, 2002; Pyne, 2016; Rahilly, 2015; Riley et al., 2011; Wren, 2002). Parents
in nine studies sought out medical and psychological professionals who provided information and
support (Gray et al., 2015; Johnson & Benson, 2014; Johnson et al., 2014; Platero, 2014; Rahilly,
2015,2018; Riggs & Due, 2015; Riley et al., 2011; Wren, 2002).
Facing barriers and isolation
Seventeen studies (15 qualitative and two mixed-method) reported that parents underwent their
own coming-out process and faced multiple barriers, including stigma and rejection from their
social groups, health-care professionals, and educational institutions. Some parents felt isolated
due to disclosure of their children’s TGD identity (Barron & Capous-Desyllas, 2017; Birnkrant &
Przeworski, 2017; Di Ceglie & Th€
ummel, 2006; Field & Mattson, 2016; Gray et al., 2015; Hidalgo
& Chen, 2019; Hill & Menvielle, 2009; Johnson & Benson, 2014; Johnson et al., 2014; Katz-Wise,
Budge, Orovecz et al., 2017; Kuvalanka, Bellis, Goldberg, & McGuire, 2019; Menvielle & Tuerk,
2002; Pyne, 2016; Platero, 2014; Riggs & Due, 2015; Riley et al., 2011; Sansfac¸on, Robichaud, &
Dumais-Michaud, 2015). Nine studies described parent frustrations in finding affirmative health-
care guidance for their children (Gray et al., 2015; Hill & Menvielle, 2009; Johnson & Benson,
2014; Katz-Wise, Budge, Orovecz et al., 2017b; Pyne, 2016; Platero, 2014; Riggs & Due, 2015;
Riley et al., 2011; Sansfac¸on et al., 2015). The parents in these studies explicitly stated that health-
care providers lacked proper training to work with TGD individuals and/or family members of
TGD individuals. In five articles, parents described facing challenges as they navigated school sys-
tems (Birnkrant & Przeworski, 2017; Johnson et al., 2014; Katz-Wise, Budge, Orovecz et al., 2017;
Menvielle & Tuerk, 2002; Riley et al., 2011). These studies described parents’difficulties gaining
support from school personnel to protect their children from bullying and to locate or initiate
inclusive school policies. As a result, some parents moved their children to another school for
fear of their children’s safety. In addition, three articles mentioned parents’feelings of isolation
and loneliness as they learned about their children’s TGD identity (Hidalgo & Chen, 2019;
Platero, 2014; Sansfac¸on et al., 2015).
Developing awareness of discrimination and building empathy
Thirteen studies (12 qualitative and one mixed-method) described parents’growing consciousness
of the discrimination faced by TGD individuals (Alegr
ıa, 2018; Barron & Capous-Desyllas, 2017;
Bull & D’Arrigo-Patrick, 2018; Di Ceglie & Th€
ummel, 2006; Gray et al., 2015; Hidalgo & Chen,
2019; Hill & Menvielle, 2009; Johnson et al., 2014; Kane, 2006; Katz-Wise, Budge, Orovecz et al.,
2017; Kuvalanka et al., 2014,2018; Riley et al., 2011). In nine articles, researchers indicated that
parents gained new perspectives and understanding about the discrimination faced by the TGD
community when they witnessed the stigma their children faced as a result of their identity
(Alegr
ıa, 2018; Barron & Capous-Desyllas, 2017; Bull & D’Arrigo-Patrick, 2018; Di Ceglie &
Th€
ummel, 2006; Gray et al., 2015; Hidalgo & Chen, 2019; Hill & Menvielle, 2009; Kuvalanka
et al., 2018; Riley et al., 2011). The parents in these studies feared for their children’s future and
often shared their concerns that their children would be emotionally and physically harmed by
being misgendered, teased, and bullied. Parents in six studies developed increased empathy
toward their children and other TGD individuals as a result of learning about the hardships and
oppression their children experienced (Gray et al., 2015; Hill & Menvielle, 2009; Johnson et al.,
2014; Kane, 2006; Katz-Wise, Budge, Orovecz et al., 2017; Kuvalanka et al., 2014).
18 R. L. ABREU ET AL.
Acknowledging toll on mental health
Seven studies (six qualitative and one mixed-method) found that parents described mental
health symptoms they experienced as they processed their child’s identity and interacted with
different systems (Barron & Capous-Desyllas, 2017;Bull&D’Arrigo-Patrick, 2018;Hidalgo&
Chen, 2019;Kuvalanka,Weiner,Munroe,Goldberg,&Gardner,2017; Kuvalanka et al., 2019;
Sansfac¸on et al., 2015;Wren,2002). Specifically, some parents in these studies reported feel-
ing anxious, stressed, and depressed (Kuvalanka et al., 2017,2019; Sansfac¸on et al., 2015;
Wren, 2002). Some parents shared feelings of stress and anxiety as the result of navigating
schools, healthcare, and other systems to find support for their child (Barron & Capous-
Desyllas, 2017; Sansfac¸on et al., 2015;Wren,2002). In addition, Bull and D’Arrigo-Patrick
(2018) reported that some parents felt hypervigilant in public places for fear that they would
be questioned by others about their child’sidentity.
Positive outcomes
Sixteen articles described positive outcomes as a result of having a TGD child. These included (a)
relational benefits, (b) affirmation of values and activism, and (c) new personal narratives.
Relational benefits
Seven articles (all qualitative) described the relational benefits parents attributed to having a TGD
child (Alegr
ıa, 2018; Bull & D’Arrigo-Patrick, 2018; Coolhart et al., 2018; Gray et al., 2015; Ishii,
2018; Johnson et al., 2014; Platero, 2014). These studies found that parent–child communication
became more open, previous disruptions in the parent–child relationship were mended, parents
experienced fewer negative feelings about their child’s TGD identity, and they felt closer and
more supportive of their child.
Affirmation of values and activism
Fourteen studies (13 qualitative and one mixed-method) found that parents felt affirmed in
their personal values and became involved in activism as they developed their relationship
with their TGD child (Alegr
ıa, 2018; Birnkrant & Przeworski, 2017;Bull&D’Arrigo-Patrick,
2018; Gray et al., 2015;Ishii,2018; Johnson & Benson, 2014; Johnson et al., 2014; Katz-Wise,
Budge, Orovecz et al., 2017; Kuvalanka et al., 2014;Platero,2014;Pyne,2016;Rahilly,2018;
Sansfac¸on et al., 2015;Wren,2002).Parentsinthreestudiesaffirmedthevalueofuncondi-
tional love for their children (Pyne, 2016; Sansfac¸on et al., 2015;Wren,2002). Connecting
values to action, parents in 11 studies found meaning in being advocates, and challenging and
educating those around them (including school and healthcare professionals) about their
children’s identity and how to best support them (Alegr
ıa, 2018; Birnkrant & Przeworski,
2017;Bull&D’Arrigo-Patrick, 2018; Gray et al., 2015; Ishii, 2018; Johnson & Benson, 2014;
Johnson et al., 2014; Katz-Wise, Budge, Orovecz et al., 2017; Kuvalanka et al., 2014;Platero,
2014;Pyne,2016).
New personal narratives
Three articles (all qualitative studies) described the construction of new personal narratives as
parents navigated their relationship with their TGD child (Alegr
ıa, 2018; Bull & D’Arrigo-Patrick,
2018; Ishii, 2018). In these studies, researchers described parents re-envisioning their children’s
future, realizing that their children were the same people with the same personalities, and chang-
ing their personal stories to include being the parent of a TGD child.
JOURNAL OF GLBT FAMILY STUDIES 19
Influences on the process
Across 20 articles, various factors influenced parents’process of learning they had a TGD child.
These factors included (a) time, (b) gender, and (c) attribution of the cause of TGD identity.
Time
Seven articles (six qualitative and one mixed-method) reported the passage of time as an influen-
tial component in the parent–child relationship (Alegr
ıa, 2018; Bull & D’Arrigo-Patrick, 2018;
Johnson & Benson, 2014; Johnson et al., 2014; Katz-Wise, Budge, Orovecz et al., 2017; Kuvalanka
et al., 2014; Riggs & Due, 2015). The parents in these studies learned to accept their children’s
TGD identity over time and came to view TGD identity as immutable. However, the amount of
time needed for this process varied among parents. Five studies described parents going through
a period of adjustment, grief, shame, and guilt before being able to accept their children’s TGD
identity (Bull & D’Arrigo-Patrick, 2018; Johnson & Benson, 2014; Katz-Wise, Budge, Orovecz
et al., 2017; Kuvalanka et al., 2014; Riggs & Due, 2015). In two articles, parents celebrated their
children as TGD individuals after a brief period of adjustment (Alegr
ıa, 2018; Kuvalanka
et al., 2014).
Gender
Nine articles (six qualitative, two mixed-method, and one quantitative) explored the impact of the
parent’s and/or the child’sgenderontheparent–child relationship (Barron & Capous-Desyllas,
2017;Birnkrant&Przeworski,2017;Hill&Menvielle,2009; Ishii, 2018; Johnson et al., 2014;
Kuvalanka et al., 2014; Riggs & Due, 2015; Spivey et al., 2018;Wren,2002). In eight studies, moth-
ers were noted to have less difficulty and be more comfortable accepting and advocating for their
gender-diverse children (Barron & Capous-Desyllas, 2017; Hill & Menvielle, 2009; Ishii, 2018;
Johnson et al., 2014;Kuvalankaetal.,2014;Riggs&Due,2015;Spiveyetal.,2018;Wren,2002).
Similarly, Riggs and Due (2015) found that fathers rated their female partners as more supportive
of their child’s gender than mothers rated their male partner’s supportiveness. In two studies,
some parents felt differently toward their child depending on the child’s gender. The study by
Spivey and colleagues (2018) found that parents were more likely to want to change their child’s
gender diverse behaviors if the child was assigned male at birth. In contrast, Birnkrant and
Przeworski (2017) found parents of children who were assigned male at birth reported higher levels
of acceptance compared to children who were assigned female at birth.
Attribution of the cause of TGD identity
Ten articles (seven qualitative, two mixed-method, and one quantitative) found that parents’beliefs
about the causes of gender identity influenced their relationship with their children (Di Ceglie &
Th€
ummel, 2006;Grayetal.,2015;Gregoretal.,2015; Kuvalanka et al., 2018,2019;Rahilly,2018;
Riggs & Due, 2015; Riley et al., 2011; Spivey et al., 2018;Wren,2002). Some parents in six studies
worried that it was their fault their child had a TGD identity and expressed fears that their child’s
TGD identity was caused by a poor parent–child relationship (Gray et al., 2015; Gregor et al., 2015;
Kuvalanka et al., 2018,2019; Riley et al., 2011; Wren, 2002). Parents in two studies cited peer pres-
sure and psychological disorders as possible causes for their child’s TGD identity (Gray et al., 2015;
Wren, 2002). Parents in four studies conceptualized their child’s TGD identity as a phase (Gray
et al., 2015; Gregor et al., 2015;Katz-Wise,Budge,Fugateetal.,2017; Wren, 2002); parents in three
other studies viewed TGD identity as genetic or biological (Gregor et al., 2015; Katz-Wise, Budge,
Fugate et al., 2017;Riggs&Due,2015). Finally, some parents perceived their child’s gender atypical
behaviors to be indicators of nonheterosexual identity, rather than a TGD identity (Kuvalanka
et al., 2014,2018; Rahilly, 2018).
20 R. L. ABREU ET AL.
Discussion
Parents of TGD individuals may have experiences substantively different from parents of LGB
children (which have received greater attention in the literature). The studies in this review sug-
gest that parents of TGD individuals grieve the physical loss of their children’s sex assigned at
birth, worry about medical interventions and the health of their children, and advocate for
improved treatment in medical and school systems. This review highlights the need for continued
research to better understand the experiences of TGD individuals and ways in which their parents
can advocate and support them, specifically in medical and school settings.
The studies reviewed described mental health symptoms (e.g., anxiety, stress, and depression)
that parents experienced as a result of stresses associated with a child’s TGD identity; these expe-
riences were linked to external sources such as socialization about gender norms or discrimin-
atory treatment of TGD individuals (including their children). Although parents of LGB children
may experience similar symptoms, some of the studies reviewed explicitly name different mental
health outcomes for parents of TGD individuals. For example, current political and social dis-
course stigmatizing transgender individuals reflects less accepting public opinion of transgender
people compared to sexual minorities (Jones et al., 2018; Newport, 2016). Parents and family
members of TGD individuals experience this stigmatization by association and through empathy
with their children, which may be associated with increased risk for mental health symptoms as
reported in some studies with parents of TGD individuals. In addition, some of the findings may
reflect parents’greater familiarity with LGB individuals than TGD individuals.
In this review, some experiences of parents of TGD children mirrored those of parents of LGB
individuals. For example, similar to studies with parents of LGB individuals (e.g., Goodrich, 2009;
Goodrich & Gilbride, 2010; Phillips & Ancis, 2008), some parents of TGD individuals experienced
intense emotional reactions upon learning about their children’s identity (e.g., grief, loss, shock).
Also, similar to the experiences of having an LGB child (e.g., Fields, 2001; Horn & Wong, 2017;
Saltzburg, 2004; Wakeley & Tuason, 2011), some parents of TGD individuals struggle with a lack
of information and seek information, community resources, and support to better understand
their children and their children’s needs. The literature on parents of LGB children (e.g.,
Gonzalez, Rostosky, Odom, & Riggle, 2012; Goodrich, 2009; Grafsky, 2014; Gray et al., 2015;
Platero, 2014; Wakeley & Tuason, 2011) and parents of TGD individuals suggests that some
parents experience positive benefits, including an increased emotional connection to their chil-
dren, a sense of purpose, activism, and positive personal stories about being a parent and about
their child.
Limitations and future research directions
There are several limitations in the literature on parents of TGD individuals. There is a discrep-
ancy in the number of studies examining parents of LGB individuals versus parents of TGD indi-
viduals. We located only 32 empirical studies that address the experiences of parents of TGD
individuals. Knowledge about the experiences of parents of TGD individuals needs to be
expanded to reflect the full range of experiences and the full range of identities of TGD individu-
als and their parents.
Most of the empirical research on the experiences of parents of TGD individuals uses qualita-
tive methodologies. Future research is needed to develop appropriate measures of the experiences
of parents of TGD individuals that reflect issues specific to this population. Conceptual models of
parental acceptance can then be hypothesized and tested with larger samples. For example, studies
may test factors associated with parental acceptance and rejection of TGD individuals, and
hypothesize more complex interpersonal and social environmental interactions that facilitate
parents’acceptance of their TGD children. Future research might examine the contribution of
JOURNAL OF GLBT FAMILY STUDIES 21
community support and collective self-esteem to the well-being of parental figures. Also,
future studies might consider how cognitive flexibility and emotional regulation influences the
process of acceptance in parents of TGD children (Rosenkrantz, Rostosky, Toland, & Dueber,
in press).
White participants are over-represented across studies. Inclusion of ethnically and racially
diverse parent samples is needed to reflect the range of experiences and cultural factors influenc-
ing parental reactions and processes (see Abreu, Riggle, & Rostosky, 2019). To address the lack of
diverse samples in this body of literature, future research will ideally include community-based
samples of Parents of Color, including international (non-American) parents. Although there is a
lack of research with racially and ethnically diverse parents of LGBTQ individuals more generally
(Heatherington & Lavner, 2008), recent research suggests that specific cultural values and beliefs
influence how Parents of Color navigate their relationship with their LGBTQ children. For
example, in a study with 30 Latinx parental figures of LGBTQ individuals, the authors found that
Latinx-specific cultural values (e.g., familismo, caballerismo, machismo, marianismo) influenced
these parental figures’process of accepting their children (Abreu et al., 2019). Recruitment of
non-White, non-US-based samples is essential to understanding and fully informing the cultural
context of parents of TGD individuals. Additionally, narratives from fathers or male parental fig-
ures are important to fully understanding the role of gender, gender norms, and parental experi-
ences, especially in diverse cultural contexts.
Intervention research is needed to develop evidence-based practices for helping families with
the process of accepting their TGD children. Although some interventions exist (e.g.,
PFLAG, Family Acceptance Project), systematic and rigorous empirical testing of these interven-
tions with parents of TGD individuals is needed (Huebner, Rullo, Thoma, McGarrity, &
Mackenzie, 2013).
Clinical implications
Our findings provide important information for health service providers who work with TGD
parents and their children. Clinicians can use this body of literature to increase their own under-
standing of parent experiences and to educate and encourage parents who feel isolated and
unsupported. By acknowledging and normalizing negative emotional reactions and cognitive dis-
sonance, cultivating cognitive flexibility and support, mobilizing affirming values and positive
meaning-making, and creating new narratives of strength and hope, health service providers can
support parents on their acceptance journeys. Additionally, recognizing the systemic barriers and
parents’mental health challenges and stresses demonstrates empathy and promotes empowerment
and healing.
Health service providers may use this literature to educate themselves with the goal of being
culturally competent to provide for parents’and TGD individuals needs. Finally, the American
Academy of Pediatrics (Rafferty, 2018) provides an excellent resource inclusive of definitions, epi-
demiology and health disparity information, mental health implications, and gender-affirmative
care with respect to developmental considerations, medical management, clinical settings, and sys-
temic advocacy within families, schools, and medical school education. The American
Psychological Association guidelines (American Psychological Association, 2015) for supporting
TGD individuals, and Hidalgo et al.’s(2013) study based on experiences from a four-site child
gender clinic group may also serve as resources for engaging in affirming therapy practice to sup-
port the wellbeing, healing, and empowerment of TGD individuals and their parents. The well-
being of these parents and their children will benefit from the expansion and growth of this line
of research.
22 R. L. ABREU ET AL.
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