In honor of LGBTQ+ Pride Month, Seattle Children’s patient Iris shares her story as a self-identified transgender woman and offers advice on how you can support the mental health and well-being of other transgender youth.

In July, Lisa picked up her 17-year-old, who had been identifying as gender non-binary, from summer camp. When her teen got into the car, they had news.

“I want to change my name to Iris and I am going to use feminine pronouns from this point forward.”

Lisa remembers her light-hearted response. “I just said, ‘Okay. But you may have to give me a minute to adjust.’”

For Lisa, this was not a tremendous, earth-shifting announcement. It was just another opportunity to support her daughter’s journey of self-discovery.

Research suggests this kind of support and acceptance has the most positive impact on the mental health of transgender youth, who have a significantly increased risk of depression, anxiety, eating disorders, substance use, suicidal ideation and suicide attempts.

Physical distancing, economic strain and increased anxiety related to the COVID-19 pandemic may be worsening these mental health concerns among LGBTQ+ youth.

“When mental health concerns arise, it often isn’t that there’s anything wrong with these young people, it’s that they are at greater risk of being stigmatized and not supported while questioning their identity,” said Dr. Cesalie Stepney, a clinical psychologist at Seattle Children’s. “Parents who affirm a child’s identity by using the right name and pronoun, or letting their child dress and style their hair the way they want to, can help reduce their child’s mental health risk.”

The first of many challenges

Iris, age 7, in the Neurosurgery Unit at Seattle Children’s.

Iris first came to Seattle Children’s when she was 6 years old. She had a high-grade tumor on her spine and brain, requiring months of treatment, including radiation and chemotherapy that necessitated many long inpatient stays.

“It was devastating,” Lisa remembers. “But Seattle Children’s provided amazing care to help her recover.”

Iris’ tumor responded well to treatment but her body was severely affected. She had to go through intensive outpatient rehabilitation to regain the ability to walk, as well as occupational and speech therapy to help with her hearing loss. She still experiences chronic pain and has cognitive disabilities.

The physical effects have been detrimental to Iris’ mental health. She has been diagnosed with an anxiety disorder and clinical depression.

“There are a lot of things my peers can do that I am physically incapable of,” Iris said. “It’s pretty easy to get down on myself. Sometimes getting out of bed is hard for me and I get really anxious in social situations. I often joke that I am deathly allergic to confrontation.”

For Lisa, Iris’ negative view of herself is heartbreaking.

“Being self-conscious as a teen is fairly normal, but Iris takes it to an extreme. She’s been through a lot and has some significant challenges, but she’s also a really remarkable person in so many ways. I wish she could see that.”

A journey of self-discovery

“My family’s philosophy has always been: Be yourself. If people aren’t okay with that then it is their problem, not yours,” Iris said.

Iris first began exploring the meaning of gender and sexuality in middle school.

“I didn’t feel comfortable in my body,” Iris said. “It didn’t look or feel the way I wanted it to, especially as I began to go through puberty.”

Iris now understands she was experiencing gender dysphoria — which the American Psychiatric Association defines as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”

Iris began to think of gender differently after a middle school camping trip.

“I was getting my nails painted when it occurred to me that it was okay if I wasn’t super masculine,” she says. “I realized I didn’t have to present as male, and that there was a disconnect between how I wanted to be seen and identified and what society was telling me I should be.”

In high school, Iris began identifying as gender non-binary, meaning she did not identify as having only masculine or feminine qualities, but somewhere in the middle of the gender spectrum, and used they/them pronouns.

Now, she identifies as a transgender woman and a lesbian.

“I’ve come to realize you don’t have to know everything about yourself right away,” Iris said. “You don’t have to make a formal decision about who you are right off the bat. You can have time to experiment and find yourself.”

Through it all, Iris has been fortunate to have support at home. Lisa has never pressured Iris to commit to a certain narrative about her identity.

“I struggled to keep my kid alive for years,” Lisa said. “I know suicide rates among teens in general are sky high, even more so among transgender youth. Supporting a kid through exploration of identity and getting to have the surprise of who they are going to become is an absolute gift.”

Iris has also found comradery in the transgender community.

“The community has been a high point of my experience,” Iris said. “Being a transgender individual, there are a lot of other people you can share your experience with who have similar experiences as you. There are a lot of friends I wouldn’t have today if I wasn’t transgender. My life wouldn’t be the same without them.”

Experiencing hate

Still, Iris is not immune to negative attitudes directed at the LGBTQ+ community.

After she shared a coming-out project on a coding website, another user reported Iris, saying “Being gay is inappropriate.” Iris challenged the statement, asking, “How is exposing kids to people who are not necessarily like them harmful?” The user told Iris she was an abomination.

Some members of Iris’ extended family have also rejected her identity and refuse to call her Iris or use she/her pronouns.

“I don’t understand why someone would hate people just because they identify different than their gender assigned at birth or love people of different genders,” Iris said. “It’s like, there are two people and one of them has ice cream and the other one is going to get some ice cream and the first one says I don’t want you to have ice cream.”

However, most of Iris’ family have taken the lead from the attitudes of acceptance modeled by her mother and brother.

Finding compassion at Children’s

Iris says: “People often tell me I will never really be a woman because of my genitalia, but gender isn’t based solely on physical traits.”

Seattle Children’s has always been a safe space for Iris and a tremendous source of support for her family.

“Seattle Children’s intention as an organization has always been to serve patients and families in very affirming ways,” Lisa said.

Seattle Children’s Gender Clinic has helped guide Iris on her gender transition, especially since she started hormone therapy. “I have more feminine characteristics and feel more confident now,” Iris says. “I actually think I look cute.”

Iris found a therapist through the clinic who understands the medical and emotional implications of her gender transition as well as her cancer history.

That’s characteristic of the clinic, Lisa says, dealing with unique individuals and the families they come from.

“They are committed to meeting each kid and family where they are,” Lisa said. “Iris’ therapist understands the indignities she dealt with as a cancer survivor and how gently she needs to work with her. I feel so fortunate that they totally get her. It has been a real gift.”

Resources:

  • Seattle Children’s Gender Clinic: Seattle Children’s Gender Clinic cares for children, adolescents and young adults whose gender identity is different from their sex at birth and/or who do not identify with traditional definitions of male or female.
  • Lambert House: A community center for lesbian, gay, bisexual, transgender, and questioning youth in the greater Seattle area. Online programs and resources are available.
  • Ingersoll Gender Center: An organization that has been building community, connecting folks to resources and advocating for our communities in the Puget Sound region for over four decades. Now offering COVID-19 Response Programs.
  • The Trevor Project: A national 24-hour, toll free confidential suicide hotline for LGBTQ youth. Safe, confidential lifeline for LGBTQ young people.
  • Supporting Mental Wellness and Family Life During COVID-19: Comprehensive website to help support families’ mental wellness and assist in adding structure and learning to their day. More resources are being added as they are developed.