A small study published in the journal Pediatrics has shown that young transgender children allowed to live openly as the gender they identify with fared as well psychologically as other kids.suggests parental support may be the key.
Rates of depression and anxiety were equal in the study, which compared 73 transgender kids aged 3 to 12 with 73 nontransgender youngsters. The trans kids also fared as well on both measures as a group of their nontransgender siblings.
Research in the USA has shown that transgender children whose parents pressure them to conform, when compared with accepting, supportive parents, have a four times higher suicide and drug abuse rate, twice the risk of contracting HIV/AIDS and a five times greater chance of suffering depression.
Rates of anxiety among trans kids were "a smidge higher" than national averages for children of the same age, but otherwise they matched national norms, said lead author Kristina Olson, an associate psychology professor at the University of Washington.
She said it's the largest study to examine the psychological health of transgender youth who have socially transitioned. Parents recruited from support groups, conferences and a special website rated their kids' well-being on a standard mental health scale.
The parents weren't randomly selected and Olson acknowledged that parents of kids who aren't well-adjusted may have opted not to take part.
The study "certainly suggests that family support is linked to better mental health," although that idea wasn't tested directly and Olson said the results don't prove that is the explanation for the children's well-being.
Read: Respecting a transgendered person
Why the study's findings are encouraging
The findings are "truly stunning," given previous studies showing high rates of mental health problems including suicidal behaviour in transgender children, Dr. Ilana Sherer, a Dublin, California, pediatrician, wrote in a Pediatrics editorial.
Most previous research is in children who haven't come out, Olson said.
Study children had not had any sex reassignment treatment, and some parents initially opposed letting their kids come out.
Read: How Bruce Jenner transitioned to a woman
Micah Heumann, an academic adviser at the University of Illinois's Champaign campus, was among study participants.
His 10-year-old child, Daniel, was born a girl and named Naima, but has identified as a boy ever since he knew about gender, Heumann said.
In second grade, the family agreed to let Daniel legally change his name and at the boy's request, his school agreed to go along with the change, even letting Daniel use the boy's bathroom.
"He is very well-adjusted" but still feels stress because he knows not everyone is so accepting, Heumann said.
Daniel "was very anxious before coming out at school," but refused the option of keeping the secret, Heumann recalled.
"He looked at me and said, 'Dad, I can't. It's harder to live a lie and not as I am truly than to deal with this anxiety right now.'"
Heumann said the family reacted to Daniel's choice with mixed feelings, mourning the loss of a daughter but never wavering in love and support for Daniel.
Olson, the study author, said the results don't apply to all transgender kids, especially those whose parents oppose their change in identity.
Opponents of allowing these youngsters to adopt names, hairstyles, clothes and pronouns opposite their birth gender have argued that kids so young "cannot possibly know their gender at such an early age," said Sherer, the editorial writer.
Letting these kids live openly as the gender they identify with "can be an incredibly affirming process," Sherer said, "showing the child that their identity is supported."
Read: At birth, a transgender's hormones are consistent with their assigned gender
Where to get help
There are two public sector transgender clinics in South Africa, one at the Steve Biko Academic Hospital in Pretoria and the other - a more comprehensive service -at Groote Schuur Hospital (GSH) in Cape Town.
Both have links to the main referral NGOs, the Triangle Project and Gender DynamiX. Both NGOs were set up in Cape Town as a response to harmful stereotyping, attitudes and behaviours towards transgender, transsexual and gender-non-conforming people and to advocate for their human rights.
Transgender and intersex South Africans can find help and support from http://www.intersex.org.za, http://triangle.org.za and http://genderdynamix.org.za.
Transgender discrimination is linked to risky health behaviour
Understanding gender identity
How hate crimes burden the health of transgender people in SA
Watch: Frontline documentary: Ariel's Story, "Growing Up Trans". Source: Youtube
How to support someone who is transgender
Stephanie Brill, Director; Gender Spectrum Education and Training, USA, and Caitlin Ryan, PhD, ACSW, specialist in lesbian, gay, bi-sexual and trans-sexual studies, University of San Francisco on ABC TV News 20/20 story on transgender children, broadcast April 2007.