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How school systems, educators and parents can support transgender children

TONYA MOSLEY, HOST:

This is FRESH AIR. I'm Tonya Mosley. About a decade ago, transgender educator Aidan Key started to get what felt like an influx of inquiries from parents and educators desperate for help. On the surface, it felt like a new phenomenon, with more children than ever before identifying as transgender. But as Aidan Key writes in a new book, transgender people have always existed. Part of what we're witnessing, he believes, is a new ability for children to put language to their identities.

Key's book "Trans Children In Today's Schools" asks us to move beyond the polarizing debates over bathroom stalls and locker rooms by offering us a guide to support trans children and deepen our own understanding of what it means to be transgender. Aidan Key is an educator who has developed gender-inclusive policies for school districts throughout the country. He himself transitioned from female to male in 1999. He is the founder of the organization Gender Diversity, which offers support to educators in schools and the nonprofit transfamilies.org, which is a national organization that offers support for transgender children and their families. His latest book is "Trans Children In Today's Schools."

Aidan Key, welcome back to FRESH AIR.

AIDAN KEY: Thank you. It's fantastic to be here.

MOSLEY: You know, Aidan, I'm sure you've had many opportunities to write a book about transgender identity, both in the context of your own personal experience and your work. Why was it important for your first book to be about children?

KEY: Excellent question. There's a lot of - not as much as there could be or should be, but there's a lot of information, there's a lot of books and resources addressing the lives of adult transgender and nonbinary people, but resources addressing the lives of children, especially young children, all the way through their teens - very sparse. The journey that I've been on - I discovered that my experience as a trans person is mildly helpful in terms of understanding theirs, the journeys of children and of families, but only mildly.

MOSLEY: Why is that?

KEY: Well, partly because they're children. They're young. Many of the questions that come up from parents that I've encountered, educators, whomever, is, they're so young - how can they know this about themselves? They're too young to be making these kinds of big decisions. They could be going through a phase. What if they change their mind?

All of those things are excellent questions. And I've heard them asked, and then I've heard a lot of people not actually know how to address them, so they become more statements rather than questions. Aren't they too young to know? Maybe they will change their mind. This could be a phase, and therefore, let's not move. Let's not take action. Let's wait and see, wait and see.

I've watched children as young as 7, 8 years old fall into despair because a parent might say, well, when you're 18, if you still feel this way. For a child that age, that's their lifetime and then some.

MOSLEY: Well, I want to get into what you learned that has helped you write this book. But first, I want to talk a little bit about what we're seeing regarding young children who can articulate that they are trans. I first interviewed you in 2013, and that was during the height of the debates about the bathrooms that transgender children should be allowed to use in schools. And I remember some of the big questions at the time were, what is going on? Why are we seeing so many trans kids? And you were saying, yes, we are seeing more trans kids, but that doesn't necessarily mean there are more trans kids in the world. Can you explain your theory on what's happening?

KEY: I believe that today, children and their families are having more information at their fingertips. They are seeing the lives of other trans people. They're seeing the experiences of other trans children and their families. And that makes a world of difference. The professionals out there, the medical and mental health professionals, are also not in the same place of a complete lack of information. They are stepping in to offer support to these children. And I think that's a real crucial difference.

And let me say, I've had the opportunity to engage with thousands of families over the years through our work at transfamilies.org, which is an organization that I founded that offers support to these families and their children. And it is absolutely what we do day in and day out is help address these questions. What is going on?

And to touch on that, I can just share with you that the medical and mental health communities are discovering a lot more. What we did in the past was, say, a child with a gender difference - that's probably a phase. It's concerning. At some point it moves beyond what they consider a phase and then maybe persists over time. And what those professions felt was that we could step in and work to mold that child's gender identity to match their anatomical sex, that somehow with differing parenting choices and reinforcement that we could get that into a groove.

And what we have found is that we haven't done that. What we've done is really just teach them how to hide, teach them to suppress who they are.

MOSLEY: Before we get into your book, I want to first ask you about some of the actions that we're seeing taking place right now in the news, like the Don't Say Gay law in Florida, which essentially bars public school teachers from talking about sexual orientation and gender to students. How have measures like this impacted your work?

KEY: In some respects, my work continues to be the same, continues to be consistent in that the families that I encounter or the educators that I'm in front of - they're asking the same questions. There's - the inquiry is still there because those kids are in their schools. Those kids are in their communities. They're families that they know, they work with, they live next door to. And so in some respects, things are consistently coming.

What's different is that the volume is ramping up, and the distress is ramping up. The distress in these families, the distress of these children is difficult to quantify, but it's very harmful. Families, if they are able to, are packing up and moving out of the states that they have lived in and worked in for their entire - the entire lives of their children. So it's pretty significant.

And I have to say, I don't quite understand what - that if we don't say gay, it doesn't disappear. But I think there's a strong effort to say, we're seeing something different. We're uncomfortable. We're terrified. We don't know what it is. Let's put it back in the bag. Let's see if we can make it invisible again.

Well, that's not the way life works. That's not the way humanity works. And that's not the way our minds and our experiences work. That's - you know, that's common for anyone whose life and experience and/or identity has not been visible. When you see yourself reflected, it changes everything.

MOSLEY: Why do you think segments of the political right seem to be focused - so focused - on transgender people right now?

KEY: I'm not entirely sure. I do believe that there is a strong effort, a well-funded, politically driven effort, to message fear on this topic. So that's driving things - at least from my perspective, that's driving things pretty significantly. And I say that because it's not that liberal-leaning, Democratic families are the ones saying, oh, yeah, I'm supporting my child's gender wherever they want to take it and Republican families are not. Oh, no. It is consistent. It transcends political leanings. And these families have these children, and they all collectively are apprehensive. They're scared. They're thinking about the well-being of their child, what kind of life their child might have. And again, resources can be very difficult to find, especially in certain environments, certain communities. The support - we're shifting from a place of changing the child to one of supporting the child. And we're busy trying to disseminate a memo that says, this is a reasonable thing to do to optimize the experience, the resiliency and the core sense of self of these children.

MOSLEY: What you're saying is that while we're seeing this political action from the right, the ability to understand and support is not a partisan issue. You see in your work that both sides of the political spectrum struggle with their understanding of trans children and how to support them.

KEY: Yes, they do struggle. And the questions are always the same, but they might be worded a tad differently. And I have to say that when I've been able to step into politically conservative environments, one of the things that I really love is people put things on the table pretty directly, and that means we can get to the conversations sooner. I'm not convincing them to do something otherwise. Their own children are doing so, the students in their schools. They know these kids. They know these families. And that's what's driving them. What they need is a bit of conversation about what gender differences are, what to do about it and then how to field the intense, conflicting feelings and impressions that adults have.

MOSLEY: OK. Let's take a quick break. If you're just joining us, I'm talking with Aidan Key, author of the new book "Trans Children In Today's Schools." The book is a roadmap for educators, parents and people with children in their lives to help them understand and support transgender children. Key is an educator who has helped create gender-inclusive policies for school districts throughout the country. We'll be right back after a break. This is FRESH AIR.

(SOUNDBITE OF JAKE SHIMABUKURO'S "143 (KELLY'S SONG)")

MOSLEY: This is FRESH AIR. and today I'm talking with Aidan Key, the founder of the organization Gender Diversity, which offers support to educators in schools, and the nonprofit transfamilies.org, a family support system for transgender and nonbinary children. He is a contributing author to the anthology "Trans Bodies, Trans Selves." His latest book is called "Trans Children In Today's Schools."

There is this conflation of sexual orientation, gender identity and gender expression. And in the book, you break this down, and you say this distinction is probably one of the single most significant barriers in providing support for transgender children. Can you break down the differences of each of these and why this matters when we think about transgender children?

KEY: We often think of gender as being clearly defined by one's anatomical sex. What chromosomes do you have? What set of genitalia do you have? And then we put a period, end of story. We exclude a lot of people by doing that because we're not recognizing the diversity in our human bodies with respect to chromosomes. There are many chromosomal designations. Some people have XX and XY chromosomes in their body, both. There are internal and external genitalia differences. We go there because that's what we've learned along the way. But we don't make gender determinations based on looking at chromosomes, looking at genitalia. We do that based on gender expression. And that's where we, as adults, we need to remind ourselves that that's how we do it. How does somebody look? How do they present themselves? What clothes are they wearing? How long is their hair? That's the way children make gender determinations also.

Gender identity is a person's internal sense of their gender, which has scientific validation. We're in the midst of learning and discovering that there are areas in the brain that correlate with gender that might be different than what we expect based on their anatomical sex. Gender identity, the way kids relate to that, it's - they say, you know, while you may see me as a girl, in my heart and my mind, I'm a boy. Very clear, very simple and straightforward. The outside presentation versus who they actually are on the inside. That is one of the most crucial pieces to find our way through these conversations with children in a way that we can have age-appropriate discussions with them. We, as adults, we like to bring sexuality into the mix, and that's where we get into some significant trouble. We also - not just sexuality, but some type of fringe sexuality.

Oftentimes, people don't really understand transgender people, decide it is some form of sexual orientation and since they can't even wrap their minds around what that might be, their imagination runs wild. And that imagination is what brings the fear and the anger and the resistance to having conversations with children about who they are, the types - the toys they play with, the activities that they engage in, whether they wear their hair short or long, any number of things that we've all talked about when we were children.

MOSLEY: You were actually able to see this in real time early on as you came into your understanding of this. You visited a school in Oakland back in 2007. You were there to help teachers build a support system for a student who had identified as trans. And something remarkable happened when you spoke with the kids. Can you tell that story?

KEY: Well, we went through this school classroom by classroom. I didn't know - I - the child who was transgender was not identified to me. So we chatted about who we are on the inside versus what people see on the outside, and not just with respect to gender but just about anything. And one of the things that - when we brought in the conversation about gender, that sometimes a person might feel themselves to be a different gender than what people see on the outside, there were children - maybe one or two in a classroom, maybe not in the next classroom, but the classroom after that, another one - who said, yeah, that's me. That's me. That's who I am. And the first time it happened, I thought, oh, well, boom, there we are. There's the trans kid. Except the wide-eyed look on the teacher's face afterwards was saying, that's not the kid.

Now, I think that kids can really love and celebrate this idea of gender expansiveness, that you might be a different gender on the inside than what people see on the outside or that you might be a bit of both genders or maybe neither gender. That expansiveness is not difficult for them to do. And is that - does that mean that they are a transgender child? Not necessarily. Again, children, when they consider gender, it's in the category of gender expression. So a kid might say, I'm a boy on the inside because I like playing baseball and I like playing soccer, and I want to have a short haircut like my dad's. We don't know whether that child is expressing a gender the way they want to express their gender or whether it's a gender identity distinction. And the thing that I understand and know and that these families discover and learn is that you don't need to know to be supportive of their exploration.

MOSLEY: I'm just thinking, when a school community calls you, they're typically asking for assistance in how to support a transgender student or more and how to talk with other kids about them and how to integrate their experiences into the school community. But how do you handle when parents of that community are against this kind of education?

KEY: Well, that's the real heavy lift. Conversations with kids - very straightforward. I've watched joy in the faces of teachers and principals and counselors, etc., who witness how the children actually engage in discussions about gender. And as one teacher said, well, this is all fine and good, and I feel pretty good about having conversations with my students, my third graders, but I have to send them home. If I could keep them 24/7, no problem. How do I send them home? That's where we have to step in and address all of these layers, all of these complexities that adults bring into the room and essentially say, I appreciate your concerns. I'm glad you're raising them. We're going to have a discussion. We're going to move through these things together.

Because that is the crucial difference. Does somebody have an opportunity to learn, or are they having their questions and concerns existing in a vacuum, a sort of an echo chamber, where anybody around them is just feeding back the same concerns with no ability to step in and say, oh, well, actually, I thought that the conversations might include A, B, C, D, all the way through Z, but the reality is it's just conversations about how we express our gender, and it's just conversations about who we are. So, yeah, figuring out how to address these concerns with adults means that we have to talk about bathrooms. We have to talk about locker rooms. We have to address their concerns about genitalia, the concerns that are present about safety and sexuality and sexual assault. They all show up. It doesn't matter that it's a transgender second grader.

MOSLEY: Our guest today is educator and author Aidan Key. He's written a new book called "Trans Children In Today's Schools." The book is a roadmap for educators, parents and people with children in their lives to help them understand and support transgender children in the classroom and beyond. I'm Tonya Mosley, and this is FRESH AIR.

(SOUNDBITE OF CHICK COREA'S "WHERE ARE YOU NOW?: PICTURE ONE")

MOSLEY: This is FRESH AIR. I'm Tonya Mosley. And if you're just joining us, my guest is educator and author Aidan Key. His new book "Trans Children In Today's Schools" gives us a detailed view of the ways to understand and support transgender children. Aidan Key transitioned from female to male in 1999.

Aidan, one interesting proposal in your book is to separate trans people from the umbrella acronym of LGBT, which stands for lesbian, gay and bisexual and transgender. Can you share more on why?

AIDEN KEY: Yeah, I'm not sure I would say I want to separate them. We have an LGBTQ-plus, you know, acronym that describes a community with shared experience. It's fantastic too in that it helps us find each other. It helps us find resources. It helps us build community. The problem or the area that's problematic is that it's grouping together aspects of our identities, including our gender, including our sexuality, including physical differences like intersex differences. LGBTQI - the I stands for intersex.

So if we're pulling all of those together conceptually and describing the individuals with these identities as a group, then we are pulling together the sexuality piece with the gender piece with the body piece. And I'm wanting to tease those apart in our conversations. I'm not advocating to eliminate an acronym that describes a community, but if we frame it conceptually with the four concepts that I've outlined in the book, then we're including everyone.

MOSLEY: Yes. Let's break this down a little bit. This acronym that you talk about - AEIOU - that you're proposing. A for anatomy, E for expression, identity, orientation, and U for universal.

KEY: Correct. Yeah. How convenient that we have a familiar acronym that likely we've all grown up knowing, AEIO and U, to describe the vowels and how lovely for me that they match up.

And I - the U, especially - universal. We all have a body. We all have anatomy. We all have a way of expressing our gender. We all have a gender identity whether we think about it or not. And we all have a sexual orientation, whether that's bisexual, heterosexual or asexual. Some people describe themselves as asexual, meaning, you know, they don't want a sexual relationship with someone else.

So no matter what way you slice it, at least so far - I might knock on wood here - is that the AEIOU acronym and the concepts that it describes can really encompass all of us. And if that is the case, then we're not talking about us versus them. We're not talking about a particular agenda. We're talking about human experience. So that's what I really love about it.

MOSLEY: Right. It's separating the transgender identity from sexuality and including those who are anatomically different, like intersex people, which you mentioned. You give a significant part of your book to the identity of intersex, and you tell the story of a young woman who discovered something about herself after never getting a period. Can you share this story?

KEY: Sure. It's with a good friend and colleague of mine who speaks brilliantly on the topic of intersex differences. And her story was, as a young woman, her peers are beginning their menstruation, and she hasn't yet. And she waits, and she still hasn't. At some point she goes to her mother and says, you know, when am I going to start my period? And her mother said, honey, the women in our family are late bloomers. Don't worry, it's coming. Enjoy your time off.

And so she waited and waited. And she graduates from high school. She gets married. And at age, I think it was 20 or 22, she decided, I need to know what's going on. She went to a doctor. The doctor ran some tests, invites her back and says, sit down. You have what's called, abbreviated, AIS. It stands for androgen insensitivity syndrome. And what that means is that your chromosomes are XY. So the chromosomal designation we collectively believe is only the domain of men - she has XY chromosomes.

He says, I'm really sorry. You can't have children. And it's best just not to speak of this ever again. She goes home. She's very, very devastated. She's sure that her husband will likely want a divorce. Through her tears, she finally tells him what happened. And he says, oh, OK, honey, but what's for dinner?

And, you know, I wasn't sure that that was a true, accurate story, except when I did meet him, the first thing he says when he comes to the door is, what's for dinner? So she's been married decades since, very happily. But she took that doctor's advice in terms of not talking about it because intersex differences are very stigmatized as well.

MOSLEY: Aidan, you are an identical twin. You grew up in Alaska. What are your first memories of feeling like your physical body did not represent what you felt inside?

KEY: You know, my first recollections are really not until kindergarten or so where the expectations to look, behave, dress in a certain way if you're a girl, and that boys could do it differently - that was when I thought, well, how come I don't get to wear the clothes I want to wear? How come I don't get to engage in the activities that I want to do? When I was 9 years old, one of the times that I had to wear a dress was going to church, and it must have been Easter or Mother's Day, so some particular celebratory event. And my mom insisted. She didn't normally insist.

It was always horrible. It was always distressing. And my mother allowed me to bring a change of clothes in the car. But in the meantime, I still have to move through the church service. And right before the church service starts, I saw a couple, a young couple with a couple of kids running around, and I thought, oh, everyone expects me to grow up, get married and have a family. And OK, I would like to be married. I would like to have a family.

And then my heart just sunk because I realized in that moment that who I was and who I wanted and needed to be was the father and the husband, not the wife and mother. And it was at 9 years old that that light bulb went off. So that realization met with a significant moment of despair.

MOSLEY: Right. Because you did not have the language.

KEY: Because I wasn't - it was impossible.

MOSLEY: Yes.

KEY: Well, it was impossible. Even if - there was no language. There was no pathway. So fast-forward to me as an adult. I see a fella on TV, a transgender man, sitting there with his wife, talking about his child and his career. And what was definitively impossible from 9 years old onward - I had an absolute paradigm shift. Oh, this is possible. There is a path. And then thinking about what to do about it was another story. But one foot in front of the other, and here I am today.

MOSLEY: If you're just joining us, I'm talking with Aidan Key, author of the new book "Trans Children In Today's Schools." The book is a roadmap for educators, parents and people with children in their lives to help them understand and support transgender children. Key is an educator who has helped create gender-inclusive policies for school districts throughout the country. We'll be right back after a break. This is FRESH AIR.

(SOUNDBITE OF CHARLIE HADEN'S "EL CIEGO (THE BLIND)")

MOSLEY: This is FRESH AIR. And today I'm talking with Aidan Key, the founder of the organization Gender Diversity, which offers support to educators in schools, and the nonprofit transfamilies.org, a family support system for transgender and nonbinary children. He is a contributing author to the anthology "Trans Bodies, Trans Selves." His latest book is called "Trans Children In Today's Schools."

I want to get to one of the more contentious subjects around transgender children, and that is the use of puberty suppression and cross hormone therapy. And it's often what comes up for people when they think about the choices that parents of trans children are making on behalf of their children. First, can you describe these two tracks? Let's start with puberty suppression.

KEY: There's medication that can pause puberty at the onset. It stops puberty at the pituitary level. And it's a temporary interim measure. It's one that families sometimes take when they're uncertain about whether their child might indeed have a gender identity difference. It's one that helps them buy time - pausing puberty for six months, for a year, for two years. It can even be up to three years or so of pubertal suppression. It doesn't send anyone down a particular path.

MOSLEY: Right. And then there's hormone therapy. And some feel it's unethical to give a child hormone therapy before 18. First, can you describe what is hormone therapy, and what is your thinking about this?

KEY: Well, hormone therapy is basically an introduction of testosterone or estrogen at age-appropriate developmental stages that facilitate pubertal changes. So any kid is likely - unless they have a medical condition that prevents it, is going to move through pubertal changes with the hormones that their body produces. So again, the puberty suppression is great because it can pause that. But then thinking about introduction of hormones, whether that's testosterone or estrogen, what I - it's a common, common question amongst the families of these kids. How do we know that this is the right thing to do? Well, what I love about the medical profession and their understanding is that we can start gradually. The mantra of the physicians that I know is, we start low, we go slow. So...

MOSLEY: And what ages are we talking about here?

KEY: Yeah. It depends because it would depend on the age of disclosure. So if a kid is 15, a kid can start hormones at age 15 in that gradual way. If a child moved through an initial social transition at a younger age and has been living - say, living as a girl since she was 4 years old and now she's 12, 13, 14, her peers are starting their pubertal development. That is a time when a low dosage of estrogen could begin, often in tandem with the puberty suppression medication, because that allows a very measured pathway. So it's, yeah, peer concordance pubertal development.

MOSLEY: It sounds like it's very nuanced and it takes very deliberate understanding of where your child is in their stage of discovery of themselves and their identity.

KEY: Correct. More information is better than less. Stepping in and learning and figuring out where are you getting your information as well as so important. We live in the world of the internet. Everything at our fingertips is not necessarily helpful. So I think looking to the professional entities like the American Medical Association, the American Academy of Pediatrics, the World Health Organization and their recommendations for children is really helpful. And that course of action, that puberty suppression and/or hormones, is part of that recommendation.

MOSLEY: You know, one of the more heartbreaking things I've heard before is from a parent of a trans child - and I know that you hear this often - that every day they live in fear that their child will be violently attacked or killed or marginalized by society in a way that won't allow them to live a full life. How do you help, in particular, families who live in hostile communities, and they can't just up and move to another state or another part of the country?

KEY: Those are hard conversations. And the options that they have available to them are limited and painful. Sometimes I recommend - or I don't recommend, I suggest to a family that they might consider taking their child out of school if they can because of the daily nightmare that they're experiencing and the lack of support that they get from any of the adults in that school community. You know, thinking about safety, sometimes there's some pretty harsh things that occur. And I've known of families who've had to pack their bags and move in the middle of the night because of the death threats that - not the parents receive but targeting their child. So it is pretty frightening. It is hard to understand why that occurs. And, you know, transgender people are not the only ones who are targeted in these really ugly and violent ways. And so what I try to focus on is the importance of what that particular parent or caregiver does because that is also the difference between life and death for their kid.

MOSLEY: What is happening in the home.

KEY: Yes. Caitlin Ryan is the principal researcher of the Family Acceptance Project, and what they have found is that if a child receives support from just one adult - doesn't even have to be a parent, could be a teacher, could be a neighbor, could be an aunt or uncle - one adult, their ability to navigate life, their harsh statistics for risk factors of children who do not get that support, it goes way, way down. And, again, that means that someone said, once upon a time, you're amazing. You're beautiful. Don't go changing.

MOSLEY: The bathroom issue is still such a highly contentious issue. A lot of people have fears around transgender children using bathrooms that match their gender identity. What are the realities that you found around these fears?

KEY: The question about safety in bathrooms is one that is just so prevalent. And if we actually took time to look at the statistics of who is safe and who is not, we are going to find that the risks for the transgender people are significantly higher for violence and sexual assault and even murder. So those statistics about safety - if we care about the safety of people in bathrooms, then we definitely can look at that. The realities of trans students stepping in and using the bathrooms that align with their gender identity, those happen readily and easily, as long as the adults in the environment recognize that that's the way it could and should go, that people use the facility that aligns with their gender identity.

Again, there's a generational difference. For the kids, it's a no-brainer. For adults, we're busy grappling with a lot of complexities. And that is the hope that I have of putting this book out there, that we can start naming some of these complexities and finding our way through it in a really - in a compassionate, respectful and informative way.

MOSLEY: Aidan Key, thank you so much for this conversation.

KEY: Such a wonderful opportunity to have it. Thank you, Tonya.

MOSLEY: Aidan Key is an educator and author of the new book "Trans Children In Today's Schools." Coming up, TV critic David Bianculli looks at the changes at TCM and what they mean for people who love movies. This is FRESH AIR.

(SOUNDBITE OF JIM FARMER'S "STOLEN DOG JAM") Transcript provided by NPR, Copyright NPR.

Tonya Mosley is the LA-based co-host of Here & Now, a midday radio show co-produced by NPR and WBUR. She's also the host of the podcast Truth Be Told.
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