Six-year-old Sophie says she has always known she's a girl. "I used to be Yoshi," she says. "But I didn't like being called Yoshi." And she didn't like being called a boy.
Sophie lives with her family in Bellingham, Wash. Her mother, Jena Lopez, says she started seeing the signs before Sophie turned 2.
"She'd say things like, 'I'm a she, not a he,' " Lopez says. "She would cry if we misgendered her. She'd become angry."
Sophie's parents didn't know what to do. They didn't know if this was just a phase, and they knew the statistics for transgender people are grim. Nearly all the research into transgender mental health shows poorer outcomes. Attempted suicide rates are nine times higher than for people overall, and rates of depression and anxiety are higher, too. But Sophie convinced them. "I proved it," she says.
There's very little data on children who have fully socially transitioned, says Kristina Olson, an associate professor of psychology at the University of Washington. Olson got interested in the subject when a friend's 10-year-old was transitioning from male to female. Olson knew attitudes about transgender people were changing, both in society and in science.
"Forty years ago everyone considered this to be a pathology," Olson says. It was considered a "gender identity disorder" until 2013, when it was changed to "gender dysphoria" in the fifth edition of the DSM, the diagnostic manual for mental health.
Olson says a lot of research still works under this assumption and is based on children in clinical settings where they've often been brought to be treated.
"So I had no idea, based on the literature, what impact my friend's decision would have on her child's life," Olson says.
That's especially important, since what research there is paints such a bleak picture. But it's not clear what's the cause of mental distress for transgender people. It could be due to internal factors, such as gender dysphoria, the tension resulting from having a gender identity that differs from the one assigned at birth. Or it could be due to external factors, such as discrimination and lack of support. As Tara Haelle reported last month in Shots, researchers are just starting to try to figure that out.
So Olson decided to do her own study looking at families who are supporting their child's decision to live as a gender different from their biological sex. The study, published in the March issue of Pediatrics, looked at the mental health of 73 transgender children between ages 3 and 12. What it found was strikingly different from other research.
"They had exactly the national average for depression," says Olson. "They are no more or less depressed. They show a marginal, like, a tiny bit of an increase in anxiety, but nowhere near the rates that previous work has found."
The study can't make a direct connection between the healthier outcomes and parental support, but Olson says it shows that the struggles that have been reported by people who transition aren't inevitable. Olson plans to follow the children to see what happens as they grow older. Adolescence is a time when many mental health problems emerge, and no one knows what will happen with these children over time.
There is a desperate need for research in this field, according to Dr. Aron Janssen, clinical assistant professor, Department of Child and Adolescent Psychiatry at NYU Langone's Child Study Center. "It's incredibly refreshing to have this little bit of good news, because I've seen in my work a lot of these kids with really positive outcomes. And their stories aren't often the stories that are told," Janssen says.
The more common stories are of transgender people who are not supported and face discrimination that can lead to problems at school and at work, as well as poverty and increased risk of substance abuse
The hope is that if Sophie's gender identity is validated early on, she will be less vulnerable to mental health issues. Her mother says that rings true for her family. "She's blossomed," Lopez says.
Sophie says: "I like being a kid." And she likes "that I get to be Sophie."
RENEE MONTAGNE, HOST:
And new research finds young transgender people might have a brighter outlook than once thought. It stands in contrast to older findings that showed high rates of anxiety, depression and even suicide. The difference, explains Gabriel Spitzer of member station KPLU in Seattle, could be a supportive family.
GABRIEL SPITZER, BYLINE: It started when a friend's 10-year-old was transitioning from male to female. That got Kristina Olson reading up on transgender kids. She's an associate professor of psychology at the University of Washington. And she knew attitudes about trans people were changing, both in society and in science.
KRISTINA OLSON: Forty years ago, everyone considered this to be a pathology. And honestly, until 2014, it was considered gender identity disorder.
SPITZER: Olson found a lot of the research still works off that assumption, based on kids in clinical settings, where they've often been brought to be treated or cured.
OLSON: There were no studies to date about kids who had actually fully socially transitioned. So I had no idea, based on the literature, what impact my friend's decision would have on her child's life.
SPITZER: That's especially important since what research there is paints a grim picture of struggles with depression and anxiety. But how much of that is part of being transgender, and how much comes from the way trans people are treated? To find out, Olson had to look to families who have allowed their child to live as a gender different from their biological sex
SPITZER: A child like Sophie, a curly-haired, twinkle-eyed 6-year-old who loves her pet rat, hers chickens and her dog. And if she could have any pet in the whole world...
SOPHIE: I'm stuck between a rat or a dog.
SPITZER: Well, you're lucky because you've got both of those.
SOPHIE: Oh, can I choose two?
SOPHIE: Rat and a dog.
SPITZER: Sophie's family lives in Bellingham, Wash. Her mom, Jena Lopez, says she started seeing the signs before Sophie turned 2.
JENA LOPEZ: She'd say things like, I'm a she, not a he. She would cry if we mis-gendered her. She'd become angry. She would not allow us to call her by her birth name.
SOPHIE: I used to be Yoshi, but I didn't like being called Yoshi. And they used to think I was a boy.
SPITZER: Sophie's parents didn't know what do. They didn't know if this was just a phase, and they did know about the grim statistics. Attempted suicide rates are nine times higher for trans people than for people of all. But Sophie convinced them.
How did you tell them that that wasn't who you are?
SOPHIE: Because I proved it, right?
SPITZER: You proved it?
SPITZER: So what kind of future do kids like Sophie have? That's what Professor Kristina Olson wants to find out in the first large, longitudinal study of supported transgender kids. She published results in the March issue of the journal Pediatrics, comparing 73 trans kids age 3 to 12 to control groups. What she found is strikingly different from that earlier research.
OLSON: They have exactly the national average for depression. So they're no more or less depressed. They show a marginal, like, a tiny bit of an increase in anxiety, but nowhere near the rates that previous work has found.
SPITZER: The study can't make a direct connection between the healthier outcomes and parental support., but Olson says it shows the struggles aren't inevitable.
OLSON: These are certainly the first results to ever show that you could have a large group of gender nonconforming kids who are doing well.
SPITZER: Olson plans to keep recruiting kids and follow them for years. No one really knows how these kids do overtime.
ARON JANSSEN: This is a field in desperate need of research.
SPITZER: Dr. Aron Janssen directs the Gender and Sexuality Service at NYU's Child Study Center. He was not involved with Olson's research.
JANSSEN: I think it's incredibly refreshing to have this little bit of good news because I've seen in my work a lot of these kids with really positive outcomes. And their stories aren't often the stories that are told.
SPITZER: Sophie's mom, Jena Lopez, says that rings true for her family.
LOPEZ: She blossomed much more. She was much more expressive. And she kind of bubbles sometimes. She just sits there, and she's jumping around. And that wasn't really there before.
SPITZER: Lopez says she knows things could change. But for now, she and her daughter are sure that this is the right approach.
SOPHIE: I like being a kid.
LOPEZ: You like being a kid?
LOPEZ: What do you like about being a kid?
SOPHIE: That I get to be Sophie.
SPITZER: You like being you?
SPITZER: For NPR News, I'm Gabriel Spitzer in Seattle. Transcript provided by NPR, Copyright NPR.