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trans.formation: The Biological Roots of Being Transgender

When Preston Agee first learned his child was transgender, he walked into his own bedroom, shut the door, and thought, “Oh, my God, not this. Anything else.”

He wasn’t being judgmental about his then 13-year-old’s decision to transition from a boy to a girl. He was scared.

“It’s something that could hurt her, seriously hurt her,” says Agee, aware that transgender people face higher risks of abuse, depression, and suicide.

But sitting side-by-side with his wife, Jet Leblanc, in their single-level brick home in Charlotte, North Carolina, Agee makes it clear he supports his child, now known as Gwendolyn, no matter what.

Rejecting gender-specific clothes

Gwendolyn, now a thoughtful and confident 14-year-old, doesn’t seem upset.

Sitting in her dark green bedroom, incense burning in one corner and her pet snake Samba slithering around a glass terrarium in the other, Gwen says her main concern is that her hard drive crashed, spoiling days of web design she was working on.

​She’s wearing a charcoal T-shirt and tight-fitting black jeans. Her brown hair sweeps across her forehead, partially covering her oversized glasses. She could easily pass for a boy or a girl.

In the year since she told her parents about her gender identity, Gwen hasn’t even bothered taking many steps that would make her appear more like a girl.

“I don’t really feel the need to wear female clothes,” she explains. “I haven’t really been attached to clothing. I just don’t really enjoy wearing skirts or dresses or anything like that.”

Gwen has pretty much always been uncomfortable with rigid gender stereotypes. Even as a 3- or 4-year-old, she would sometimes have intense reactions to clothes that labeled her as a boy.

“This is stupid,” Gwen’s mother recalls her saying on one occasion as they stormed out of a kids clothing store that only had truck-themed boys clothes. “I don’t want clothes like that.”

Gender dysphoria

It wasn’t until 10 years later, right as puberty started to hit and her body began to change, that Gwen realized something more significant was going on.

One of her main fears was that her voice would get deeper and that she’d start growing facial hair. That hasn’t yet happened. But even now, when she looks down at her body, she gets a “kind of painful, nasty feeling.”

That feeling of being uncomfortable with the gender one is assigned at birth is known as gender dysphoria, and it can start showing up in kids as young as 2.

Often times, those feelings are temporary, reflecting only a natural part of growing up. But with others, the feeling never goes away, and scientists are discovering more about why that is.

Until very recently, medical experts treated gender dysphoria as a mental health disorder, the result of social or environmental factors, and tried to “cure” people who experienced it (much like the way they once “treated” homosexuality).


But scientists are discovering evidence that suggests gender identity is hard-wired and cannot be changed.

One of the leading experts to take this view is Dr. Joshua Safer, an endocrinologist and professor at the Boston University School of Medicine.

​“I am very much in the camp believing that there is a biological basis for gender identity,” says Safer, who has treated hundreds of transgender individuals at the Boston Medical Center.

The best evidence that gender identity is built-in, according to Safer, comes from a 2004 study documenting attempts over the last 25 years to treat babies born with male-pattern XY chromosomes, but who had ambiguous genitalia.

Since it is easier to surgically create female genitals, the children were given female body parts shortly after birth. They were also given estrogen at puberty, to ensure breast and other body development, and otherwise raised as “typical” girls.

But when scientists checked in on the kids years later, they found the majority were living as men. The effort to manipulate the babies’ gender had largely failed.

“Basically, we know gender identity is biological because we thought it was malleable, and we found out (we were) wrong,” Safer explains.

Chromosomes, genitalia and gender identity align in most people, but in transgender individuals they don't. Why?

Brain scans may hold one clue. When examined with an MRI or under a microscope, the brains of transgender individuals appear to differ in size, function, and anatomical pathways from brains usually seen in those with their natal sex, says Deanna Adkins, director of the Duke Center for Child and Adolescent Gender Care.

“(The brains) don’t look like the sex these kids were born with, nor do they look exactly like their gender identity, but they’re somewhere in between for most characteristics,” Adkins says. “And some characteristics match their gender identity, which is very interesting.”

But why would transgender brains be different from anyone else’s? There’s lots of theories.

One possible reason is they may have been exposed to different levels of certain hormones when they were developing as a fetus.

“It looks like hormonal exposure during that time frame is really key at forming your gender identity,” Adkins says.

Social factors

There is no scientific consensus on the exact biological roots of gender dysphoria. But what is indisputable, according to medical experts, is that transgender people can experience more or less dysphoria depending on social pressures.

In Gwen’s case, she has a healthy support base – parents who have never questioned her expressed gender. She also has many accepting friends.

Parker Smith is a youth outreach worker at Time Out Youth (TOY), a LGBTQ youth center with a support group that Gwen attends.

“The majority of our youth are trans at this point,” Parker says. “That’s the population that’s most marginalized, the least understood, and the most violently resisted.”

Many of the kids who attend TOY, have families who are not supportive. As a result, the only way they can attend the support group is by sneaking out of the house, telling their parents they are “going to the library” or coming up with other excuses, Parker says.

“It’s really, really sad and it’s really, really common,” says Parker, a transgender person who identifies as non-binary (not male or female) and prefers the pronoun “they.”

Several kids at TOY have committed suicide, Parker says. And sadly, that’s part of a nationwide trend, according to a study published last year in the Journal of Adolescent Health.

Compared to their non-transgender peers, transgender youth are almost three times more likely – 17 percent vs. 6 percent – to have attempted suicide, the study indicates. Transgender kids also have a much greater risk for mental illnesses including depression and anxiety, it said.

Other studies are more encouraging.

Trans kids who are allowed to live openly fare just as well psychologically as their straight peers, one study published earlier this year suggested. Notably, parental support may be a key factor to better mental health, said the lead researcher in the study, published in Pediatrics.

Transgender or gender expansive?

But how can you know if your child is truly transgender or is simply going through a phase in which he or she is being imaginative or playful?

You won’t necessarily know right away, says Kristen Russell, the lead clinical social worker at the Duke Center for Child and Adolescent Gender Care.

“With young children, our policy is very hands-off,” Russell says. “Our suggestion is for parents to allow the child to explore what that is, without necessarily labeling it one way or another.”

Kids who show signs of being “gender expansive” often grow out of such behavior, Russell says. “And then others really persist.”

The key thing to watch for is whether children begin developing distress about their gender identity. “Anxiety, depression, or any kind of change in social functioning – then we start paying attention.”

True transgender

If a child is truly transgender, they won’t be able to let it go. And, Russell adds, any attempt to “cure” those feelings not only won’t work, it will make things worse.

“The psychological and medical communities for a very long time tried that approach, only to find these feelings continued to persist, and these individuals ended up in psychiatric institutions and committing suicide,” Russell says.

While there are more things for scientists to learn about what makes someone transgender, Russell says there is now more than enough evidence to conclude that the old approach was wrong.

“I think finally more information and education about biological determinants and environment helped the psychological community realize 'OK, we can’t really change a person’s mind to match their body, but perhaps we can help their bodies align more with their minds,'” she says.

For Gwen, the transition is ongoing. She and her family are still examining their options, including whether to move forward with hormonal treatment once they get medical approval. For now, they’re moving forward in small steps, together. (This past weekend, Jet and Gwen went bra shopping for the first time).

Jet says it’s crossed her mind that Gwen may want to one day go back to being her son, or that she may even land somewhere in the middle, identifying as neither or both genders. But in her view, the most important thing is that Gwen knows she has the support of her parents. And she insists there’s nothing remarkable about that.

“I’m a mom. That’s what we do,” she says. “I just want my kid to be healthy and happy.”