If you have a transgender teen, they may desire to shape their physical body to reflect their inner gender more closely. It’s important to remember that not all FTM transgenders desire to look “exactly like a man”, or vice versa. There are different hormonal and surgical options for people who want to alter their physical appearance in terms of gender, some of which are available to minors and some of which are not. If your teen is interested in exploring them, it’s vital that you find an experienced provider who works with transgender youth. While any provider should be open and accepting of transgender patients, not all providers are experienced with their specific medical and psychological needs.

Of course, there are ways to change appearance without medical intervention. Your teen may choose to dress or take on the mannerisms of the opposite gender (in fact, this is recommended and usually required before any medical interventions are put into place.)  They may change their appearance; for example, an FTM teen may choose to use breast binding to make his chest appear flat, while an MTF teen may choose to wear a padded or stuffed bra. However, for many transgender teens non-medical measures are not sufficient to make them feel comfortable in their body.

The first step in physical change- and the only physical step that is available to teens under 18- is taking cross-gender hormones. For teens, this allows them to sexually develop in a way that is different from the sex they were born with. For a biological male, it means developing as a female, and vice versa.

Taking hormones, especially as a minor, is not as easy as walking into a doctor’s office and asking for a prescription.  Any reputable medical provider who prescribes cross-gender hormones will require an in-depth psychological evaluation. This should be performed by a psychologist or psychiatrist who is skilled in evaluating youth suffering from gender identity issues. You can ask your primary care provider or another health care worker for a suggestion, or do an internet search; the Gay & Lesbian Medical Association has a provider locator where you can search by location and the type of care needed. Make sure the evaluation takes at least 6 hours (this can be divided up into a few appointments) and that they follow the WPATH guidelines.

It can be hard for a teen to hear they need a mental health evaluation. If they know what they want, and they understand how they feel, why do they need to see someone who treats mental illness? However, a psychological evaluation is key to this process, because once someone starts on hormones their bodies will change in ways that may be irreversible. The purpose isn’t to talk them out of what they want, or to try to “fix” them, but to make sure they are mentally and emotionally ready for a transition.

Not everyone can take cross-gender hormones. People who have medical problems with their liver, heart, blood, and other organs may not be considered appropriate candidates for safety reasons. They may need to wait, or this may be something that will be true their whole lives (or at least, barring a medical breakthrough.) It can be absolutely devastating for a teen to find out that, because of a medical problem, they cannot take hormones to make their external appearance match their inner identity. If this happens to your teen, make sure they get involved in counseling as soon as possible.

The next post will talk more about specific hormone therapist that teens might take to start transitioning genders.