How to talk to transgender youth, according to experts and their parents

“Your son is transgender? I never would have known. He looks so much like a boy!”

It’s one of the well-meaning comments San Diego mom Kathie Moehlig heard over and over from strangers after her son, Sam, transitioned from female to male when he was a teenager.

“I’m like, of course he looks like a boy, because he is,” Moehlig tells NBC News BETTER.

Transgender youth and their families are often bombarded with unsolicited comments from strangers, family, and friends related to the teen’s gender identity. These comments range from well-meaning advice to intrusive questions and even accusations of child abuse, according to Diane Ehrensaft, the director of mental health at a gender clinic in San Francisco and the author of “The Gender Creative Child.”

“All of a sudden, because you have a child who says ‘I’m transgender,’ now people look at you funny and wonder ‘Why are you letting your child do that?’” Ehrensaft says.

In the United States, 0.7 percent of youth between ages 13 and 17 identify as transgender, according to a recent report from the Williams Institute UCLA School of Law. More and more of America’s youth are identifying outside the male-female binary: 56 percent of Generation Z kids know someone who uses gender-neutral pronouns, one survey found, and New York City joined four states in allowing gender-neutral birth certificates.

For many people, adjusting to a young person who is transitioning or using new pronouns may seem challenging. Experts who work with these individuals and their families say there are a number of do’s and don’t’s to keep in mind when interacting with these youth and their families. The first step, these experts say, is to not question the young person’s identity.

“Some of the recent literature that’s coming out is demonstrating that all the ills that we have known to be associated with transgender youth and adults as in anxiety, depression, self harm, even suicidal thoughts, drug and alcohol addiction in later life, risky sexual behaviors, go way down when there is social support for a person to be a gender that feels authentic to them,” says Ehrensaft.

Here are some of the most common misconceptions about sex, gender, and gender identity, according to experts and parents interviewed for this story.

People often conflate “gender” with “sex,” but they are not the same, according to Ehrensaft.

Whereas “sex” refers to a person’s reproductive system, “gender” refers to one’s personal sense of oneself as a man or woman, she explains.

“Your gender lies not between your legs but between your ears,” Ehrensaft says.

The term “cisgender” refers to anyone who identifies with the gender assigned to them at birth.

“Gender dysphoria” is the distress a person experiences when their gender does not match the sex they were assigned at birth, and is not classified as a mental illness. Nevertheless, Ehrensaft says there is still a perception among some people that it is a disorder.

“There are certain people who think that these are disordered parents with disabled children, and both of them need to be fixed, and that can cause tremendous harm to the parent and child,” she says.

“Transgender” is an umbrella term that refers to anyone who does not identify with the gender they were assigned at birth, according to Melinda Mangin, an associate professor in education at Rutgers University, whose research focuses on trans children in schools.

“Trans” means “across or beyond,” says Mangin.

“So it’s really anyone who cuts across social norms for what it means to be a man or a woman could be considered transgender,” she says.

“Gender identity” is a phrase that refers to one’s personal sense of being a man or a woman.

There are a range of identities that fall outside of “man” and “woman” as well, like “nonbinary.”

Whereas some transgender people may see their gender as binary — meaning they identify as either a man or a woman — those who identify as “nonbinary” may see their gender as more complex, and usually wish to be identified with “they” and “them” pronouns, Mangin explains.

Others may shirk these identities all together, according to Ehrensaft.

“Some kids also will say ‘I’m agender,’ meaning, ‘I don’t have a gender. I think of myself as a human being, I don’t use those categories at all,’” says Ehrensaft.

What are some mistakes to avoid when interacting with trans youth and their families? Here are some of the most common, according to parents and experts.

Being the parent of a transgender teen can be stressful and isolating, according to Moehlig. Before her son transitioned, she says he was self-harming and talking about suicide.

When Moehlig allowed her son to transition socially at the age of 11, many people told her: “11-year-olds can’t know who they are.”

She says many of these comments were from the parents of cisgender kids who “don’t understand the overwhelm of it.”

“Imagine a 10-year-old saying ‘I don’t see myself living to 16,” Moehlig says.

Parents interviewed for this story say the decision to allow their teenager to transition was not made brashly or easily. Nevertheless, some people tended to assume they hadn’t thought it through, or that they were making the decision for their children.

Ehrensaft says it’s common for people to not only criticize the child’s identity but the parent’s choice to support them.

“It’s a double whammy,” she says, “because you’re also criticizing the parents at the same time who have supported their child in being that person.”

Parents are generally open to educating others about their child’s identity, and understand there is a learning curve for most people, according to Mangin. However, people will often ask questions about their child’s private parts, possible medical treatments and surgeries, which objectifies the child, she says.

“Transgender children are not predators, they’re not overtly sexually active, they’re just kids, and if nobody else’s genitals are a topic of conversation, then you probably shouldn’t worry about that one child’s genitals,” Mangin says.

Often, when people find out a child is trans, they suddenly feel it’s ok to ask questions about their bodies, Moehlig says.

The mom recalls: “My kid was 12 when our mailman of all people asked me what was in his pants.”

People also frequently asked her son questions related to surgery and medical treatments.

“You wouldn’t ask somebody else what kind of medical treatment they had,” Moehlig says, “but it seems ok for people to ask my trans son that.”

When a child is dysphoric, misgendering them over and over can exacerbate their distress, according to Ehrensaft. Whereas some children might simply be annoyed, others can experience extreme anxiety, Ehrensaft says.

Randi, a mother in New Jersey, says her teenager, who identifies as nonbinary and uses “they/them” pronouns, sometimes experiences panic attacks when people refer to them with gendered pronouns. The mother asked her and her’s child’s names be withheld to protect their privacy.

For instance, if a store employee greets her child with “Hello, miss,” the teen will get upset. After hearing comments like these, she says her child believes people will judge them negatively if they look for clothes in the boy’s section.

“For me, as an adult woman, if somebody called me ‘gentleman,’ if somebody said, ‘Sir, can I help you?’ I would correct them, because I’m confident in the fact that I’m a woman,” the mother says, explaining: “My child doesn’t feel empowered to correct them.”

Some adults may think children experiencing distress over pronouns are overreacting, but Ehrensaft says it’s important to look at it from the child’s point of view: Ask yourself how you would feel if people constantly referred to you as the wrong gender everywhere you went, she says.

“That’s how it feels for a lot of these kids,” she says.

The only way to know for sure if someone is transgender is if they tell you, says Mangin. But if you are unsure how a person identifies, you should ask them what their pronouns are, she says. You might feel uncomfortable doing it, she says, but many people who are trans or gender nonconforming usually see it as a huge sign of respect.

“It sounds really awkward,” she says, “but it’s even more awkward to make a mistake.”

If a teen or someone you know has switched pronouns, you might worry about remembering to get it right, or fear how they will react if you make a mistake. The best thing to do if you are worried is practice, according to Mangin.

“Maybe I’m driving a car and tell a story [to myself] about this person I know practicing the pronouns,” she says. “That way I’m not doing it in a public space or doing it where the stakes might be higher.”

Moehlig says it all comes down to learning to be conscious.

“Our minds like to be filled with all kinds of things,” she says. “We multitask, and breaking that habit when it comes to names and pronouns really does require us to be conscious.”

If you are unsure about someone’s pronouns, she says, you can introduce yourself with your own. This will give the other person space to tell you theirs, she says.

“I say ‘My name is Kathie Moehlig, she/her/hers,’ and move on from there,” she says. “And that opens up a space so that other people then can use their pronouns if they would like to share it.”

Tina Nacrelli, a mother who lives in Jersey City, NJ, is the parent of 12-year-old Esme, who identifies as agender.

Nacrelli says it was difficult for her to get her child’s pronouns right at first.

She says she and Esme created a habit where if she used the wrong pronouns by mistake, Esme would simply reply “ouch.”

“Then I would say ‘oops,’ and then we move on,” she says.

Over time, this helped Nacrelli get used to using the correct pronouns, she says.

“When your attention is drawn to ‘ouch,’ it makes you more cognizant of it, and you’re more likely to get it right the next time,” she says.

If you get someone’s pronouns wrong, the best thing to do is to simply correct yourself and move on. Drawing too much attention to it can embarrass the individual, according to Mangin.

“If you apologize kind of emphatically on and on and on, it suggests that there was something wrong,” she says.

Kids who are trans and gender nonconforming experience high rates of bullying at school. According to the 2015 U.S. Transgender Survey, 77 percent of respondents said they were verbally harassed, physically or sexually assaulted as students. A recent report from the American Academy of Pediatrics found that 14 percent of trans adolescents had attempted suicide.

Mangin says it’s important to help kids understand that not all boys and girls follow strict gender norms. She says this can help reduce bullying these students experience.

“We have very strong gendered social norms about what constitutes feminine behavior and what constitutes masculine behavior,” Mangin says.

She says there are ways parents can help kids understand that gender is not always simple for everyone. “I think trying to question social norms and think about that help children think that through,” she says.

For example, asking children questions like, “If it’s ok for girls to wear pants, is it ok for boys to wear a dress?” can help them question stereotypes and understand there are lots of different ways to be a boy or a girl, she explains.

“I think having those conversations is really important, because it’s not just about supporting transgender children,” Mangin says. “Those social norms are really harmful for all children, because they’re limiting. In worse case scenarios, they’re not only limiting, but they give rise to inequity and violence, so it’s really important that all kids get to have those conversations.”

For more on how to talk to trans people and their families, see this guide from GLAAD.

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