The meaning of trans* in a family context

Abstract

Though research into gender transition has grown in the social sciences and policy has turned its attention to the rights of trans* people, the social and family environment in which gender transition takes place is often overlooked. Based on qualitative data from two projects in Belgium and Spain addressing the experiences of parents and children undertaking a gender transition, this article explores the experiences of these families. First, we look into the reflective processes that take place within these families. Second, we look into the experience of stigmatisation and the relationship between trans* families and health professionals. These findings have implications for trans* families as well as for policy makers and trans* health professionals.

Keywords

families health care stigma transgender transition

Introduction

Research on the trans* population is often limited to their medical care and mental well-being (Bockting and Coleman, 2007). The family environment in which a gender transition takes place has historically been overlooked (Hines, 2006). Nevertheless, understanding this family context is valuable for numerous reasons, as a gender transition can have a profound impact on the lives of family members. Also, family support has proven to be an important factor for one’s well-being, both in general health and in trans* care contexts. Further, the trans* population can be vulnerable, as they are confronted with stigmatisation and transphobia and a supportive family environment is not always available. It is this relevant, but often neglected family context that is addressed in this article by discussing three issues trans* families may face in contemporary Western European societies: firstly, the meaning of being a trans* family; secondly, experiences of stigmatisation; and thirdly, experiences with health professionals. We consider two types of trans* families: families with children and youth who reveal their need to transition, and families with adults who initiate a gender transition. This article is based on the findings of two research projects: the first explored the experiences of children of trans* parents and their families in Flanders, the northern region of Belgium, in 2015. The second project considered the experiences of families with a trans* child in Spain, and their interactions with health professionals between 2010 and 2016.

As it gains visibility, the trans* population has become the subject of increased research activity and everyday conversation (Turner et al., 2009). Trans* people may be viewed as a gender minority who have to deal with a heteronormative society in which people are assumed to be either a heterosexual cisgender man or a heterosexual cisgender woman. Those who do not fit are subject to stigmatisation (Herek, 2007). Coming out as trans* can impact the family and create challenges to heteronormative expectations (Bertone and Pallotta-Chiarolli, 2014). These issues are apparent in the findings of both of the projects discussed in this article. Before discussing the findings of the research projects, we draw on findings of existing research on trans* families. We then elaborate on the methodology used in the two projects.

Making sense of being trans* in a family context

Social research on families has historically focused on heterosexual, married couples with children and family transitions such as remarriage and divorce (McCarthy, 2012). However, owing to demographic and cultural changes, including the increase in lone parenthood, blended and stepfamilies, and the legal recognition of same-gender relationships, the traditional nuclear heterosexual family in Western societies has lost its position as the dominant family form, resulting in new research interests regarding diverse family forms (Ginther and Pollak, 2004). Studies of same-gender families have flourished (Epstein, 2009; Goldberg, 2010; Weeks et al., 2001) and have been in large part dominated by the question of whether or not children growing up in same-gender families do as well as in heterosexual families. Most literature concluded that children with same-gender parents develop psychologically, intellectually, behaviourally and emotionally in a similar manner to children of heterosexual parents (Crowl et al., 2008; Patterson, 2006). Further, sociological work on trans* practices of intimacy has considered gender transition within family settings (Hines, 2006; Sanger, 2010). Subsequent research questions focus on the specific relational processes and meaning-making within the increasing diversity in family forms. In other words, how do they ‘do family’ (Gabb, 2013; Hudak and Giammattei, 2014; Vanfraussen et al., 2003)? In line with this emerging research tradition, the article contributes to studies of families that differ from the heterosexual norm with more flexible and egalitarian gender roles, and flexible understandings of gender and sexuality.

In line with these evolving family studies, the monolithic traditional definition of family is not used in this article. We use an inclusive interpretation of the concept ‘family’ (Allen and Jaramillo-Sierra, 2015). We refer to the relational language of family of McCarthy (2012). She states that family is more than the sum of people living in the same household. Often family members share a sense of identity and belonging. This togetherness can provide care and support, and is held together by ideals and emotions. However, varying understandings of relationality, personhood and the self can be present. Consequently, different family structures are possible, with both legal and fictive kin ties (e.g., birth, marriage, adoption, chosen relationships), and both same-gender and opposite-gender couples. In this article, we acknowledge this relational aspect of people’s lives, and the importance of the interaction and experiences with significant others in exploring gender transitions within family life.

Although witnessing the transition of someone you love can be an emotional and lonely experience, there is a consensus in the literature of the importance of family support for the well-being of trans* individuals, as well as on the quality of family life in general (Joslin-Roher and Wheeler, 2009). However, heteronormative family environments are not always well-equipped to cope with the challenges that accompany a gender transition (White and Ettner, 2007), and may need specific professional support, which is often missing (Malpas, 2011; Veldorale-Griffin, 2014). Gender transition challenges societal expectations, sometimes defying the accepted gender role of a child or parent: for example, when a woman becomes a father (Hines, 2006) or a daughter becomes a son (Platero, 2014).

The existing research does not provide evidence for the assumptions that the children of trans* parents develop atypical gender behaviour, gender identity or sexual orientation, nor that they experience mental health problems (Green, 1978). However, children may encounter difficulties related to family conflict, peer relations and stigmatisation (Church et al., 2014; Haines et al., 2014). Coming out as a trans* partner can lead to the end of the relationship, because partners might question their own sexual and gender identity through the gender transition (Israel, 2005).

Coming out as a trans* child may challenge parents’ expectations and their bond with the child. Children are regarded as always in the ‘process of becoming’, unfinished entities that undergo continuous development and only become fully gendered as adults (Castañeda, 2014: 59–61). This representation creates challenges for trans* youth due to the lack of confidence in children’s knowledge about themselves and their gender expression. Parents may be blamed for their parenting style, which can lead them to be seen as absent fathers or overbearing mothers (Platero, 2014). The literature suggests that raising a trans* child may be stressful and is accompanied by feelings of guilt or responsibility, and a lack of resources for parents (Kuvalanka et al., 2014; Malpas, 2011; Riley et al., 2011), challenging parents’ abilities to establish a close relationship and offer support (Brill and Pepper, 2008; Pepper, 2012; Green and Friedman, 2013).

Whether it is a parent, partner or child who is trans*, research on trans* families underlines the relational aspects of a transition. Qualitative aspects such as the quality of parenting, relationships and interactions, and the psychosocial well-being of parents, are of more importance than the family structure in determining the well-being of trans* families (Veldorale-Griffin, 2014).

In sum, we ask what a gender transition means for the family context. Further, we ask how social policy may affect these families, especially regarding their social position and the possible stigmatisation they experience, and second, the professional support they encounter.

Stigmatisation of trans* families

Despite growing visibility, trans* people continue to be victims of stigmatisation (Haines et al., 2014), which may be institutionalised. For example, trans* parents are often discriminated against in formal custody battles (Grant et al., 2011; Pyne et al., 2015), implying that trans* parents would compromise their children’s well-being (Short et al., 2007). Furthermore, some children might not allow their trans* parent to be seen with them in public, or to have any contact with their friends (Church et al., 2014), reporting fear of bullying as a common stress factor (Veldorale-Griffin, 2014; White and Ettner, 2004).

Out of fear of being judged as a bad parent, parents of trans* youth may struggle with adapting their child to social gender norms and with accepting atypical gender expressions (Malpas, 2011). Hence, parents of trans* youth may feel guilty, which is often affirmed by social judgements of their decisions to allow their children to explore their gender in non-traditional ways (Johnson and Benson, 2014; Kuvalanka et al., 2014; Platero, 2014; Riley et al., 2011).

Both Belgium and Spain show similarities regarding the matters of trans* protective rights. In both countries the regional level has been relevant in introducing transprotective policy. In Belgium, the federal level is responsible for the legislative framework regarding gender recognition. The regional government of Flanders has developed additional extensive policies in order to enhance the well-being, care and equal rights of trans* individuals. Similarly in Spain, a growing number of regions are developing nowadays both trans* specific and LGBT antidiscrimination policies, filling the gap that exists at the central state level. In addition, when looking at the ‘Trans Rights Europe Map and Index 2017’ of Transgender Europe we see that both countries have developed protective trans* legislation at about the same speed (http://tgeu.org/trans-rights-map-2017/).

Trans* care in Belgium and Spain

A third issue we address in the current article is how the trans* families are affected by professional care. Despite the shift in the most recent version of the SOC7 (Standards of Care) of the World Professional Association for Transgender Health towards a more holistic approach and a wider trans* spectrum (Coleman et al., 2012), trans* health professionals’ narrow focus on psychopathology and medicalisation still exists (Benson, 2013). Also, the lack of availability of competent health care professionals can be problematic (Bockting et al., 2013; Mayer et al., 2008; see also Davy et al. in this issue). In both Belgium and Spain, additional medical pathways and legal requirements for trans* care are demanded.

In Belgium, professional trans* care takes place within the frame of the current SOC7. At the time of interviewing, only those who met the legal statutory criteria described in the law of 10 May 2007 on transsexualism (Belgian Government, 2007) could register for a change of sex designation (Motmans, 2010). It is partly because of these legal requirements that many trans* people in Flanders eventually seek professional support. However, the Belgian government recently approved legislation that removes the legal requirement of a medical gender change. The law would take effect from 2018. In Spain, Law 3/2007 permits the change of name and sex in all documents. Applicants are required to be Spanish adults, have a gender dysphoria diagnosis and have ‘no additional disorders’, and have had two years of ‘medical treatment’ (usually hormone treatment). Transgender people of advanced age or poor health are exempt from that last requirement. For those under 18, gender reassignment is only granted under court ruling, based on individual circumstances; most Gender Identity Units are reluctant to treat youths and hormone blockers are only accessible in some regions.

Methodology

This research is based on life stories of both adults and children (Belgium: 28 respondents; Spain: 30 respondents). Both research projects used a methodological framework rooted in grounded theory and related symbolic interactionism. We adopted an open interview method, in which meaning emerges through social interaction (Jeon, 2004). Thus, the children’s and parents’ descriptions of their experiences, concentrating on the processes of making meaning of their gender expressions and transition, are the focus of the research. In both projects, specific ethical considerations were taken into account with special attention to researching children. All the children were considered knowledgeable experts about their own lives (Clark and Moss, 2001; Mayall, 2000) and reliable informants (Einarsdóttir, 2007). The researchers developed an interview protocol including an informed consent form for both children and parents. In the Belgian project, this was approved by the Ethical Committee of the University of Antwerp, whereas in the Spanish project the ethical care was negotiated with Spanish organisations for families with trans* children.

Data collection and analysis

In the Belgian project, an open call for participation was distributed among various LGBT, youth and family, and civil society organisations, clinical practitioners in transgender health care, and through social media. Before the interview, each of the participants received a written explanation of the purpose of the research and an information form was signed. The participants were given the opportunity to read the transcript of their own interview and make adjustments if required. The interviews lasted between 40 and 95 minutes. The in-depth interviews were supported by a topic list including several subthemes. In line with the grounded theory approach the topic list was used as a support for the interviewer, not as a fixed structure of the interview process itself (Charmaz, 2006). All interviews were recorded and transcribed, and all transcripts were coded using the software program Nvivo. As the interviews touched upon a wide range of topics and experiences, they were first open coded using a bottom-up approach in which codes were formed through a reading and analysis process (Starks and Trinidad, 2007). These codes provided the information needed for the analysis of the participants’ discourse.

In the Spanish project, interviews with children younger than eight years old adopted the form of playing as an ongoing conversation (Gollop, 2000). Children were engaged in activities such as playing with toys, paper and crayons, going to the park or looking at drawings they had created (Brooker, 2001; Parkinson, 2001). Children were asked to talk about themselves, their family and friends at school, their favourite toys and their future goals. These interviews were recorded, transcribed, and analysed using codes of themes, which identified relevant events, explanations and participants’ attributions. The interviews took place at their residence and surroundings. Five interviews took place around non-governmental organisation (NGO) events. The goal was to perform an analysis of the discourses, taking into account the ongoing process that families with trans* children were experiencing in Spain, since they were becoming a new social movement that is very active in the political scenario. In the interviews, children and parents described their experiences, relationships with siblings and family members; and the role played by schools, professionals, LGBT public services and NGOs, concentrating on the processes of making meaning of their gender expressions and transition.

Sample

In Belgium, 13 children (2 sons and 11 daughters) and 15 parents (7 trans* parents and 8 partners) from 9 different family situations were interviewed. Two of the 13 children were stepchildren, all others were birth related to the trans* parent. The youngest child was 9 years old and the oldest was 26 at the time of the interview; all of them were under 18 years old when their parent started transitioning. A gender transition was in this research defined to be a change in social gender role, with or without medical intervention. Hence, the sample consists of children and a broader group of trans* individuals, who ‘came out’ as trans* once they were already engaged in the parental role. Of the 7 trans* parents, 2 were men and 5 were women; their partners comprised 1 man and 7 women. Out of the 9 family situations, 6 parents were living together and 3 couples were separated. Eight family situations could be identified as heterosexual before the transition and as same-gender at the time of the interview, while one couple could be identified as same-gender before the transition and heterosexual at the time of the interview.

In Spain a total of 15 gender-variant children and 15 parents were interviewed between 2010 and 2016. There were 9 mothers and 6 fathers (7 were separated and divorced), between the ages of 35 and 56, including a Roma¹ family, a lesbian family, a Latin American family and a family with a disabled person. Their children, 9 daughters and 6 sons, were between the ages of 5 and 19.

Enacting trans* families

A key issue that emerged was the extent to which a gender transition is an individual or a family process. In some cases, a transition could be seen as an egocentric act and lead to distress among family members. Ann perceived her trans* partner as self-absorbed, especially in the beginning of the transition, but conceded that “it has to come out after all these years”. In another family, however, the partner was the main supporter in the transition process:

I experienced it as a family process. Of course to keep me alive. In moments when I had doubts about continuing the transition process, because I was reluctant towards the surgeries, it was my partner who said: ‘It’s part of who you are’. (Yves, trans* man, parent of two sons, 12 and 9 years old)

Reflective processes within families could be related both to the aftermath of a transition and to parenting roles. All parents pointed out that their children’s transition revealed important insights into their parenting role; as one mother stated: “having a trans* daughter has made me challenge my own gender performance, questioning myself in ways I had never suspected”. A cisgender parent highlighted the necessity of this reflective process in terms of the parental role of her trans* partner:

It’s your duty to reflect on your transition as a parent. Of course you do not have to problematize it […] But you are responsible that your child’s family situation is deviating from the norm. You can see that as a richness, but it still and will always be different. (Margot, partner of a trans* man, mother of two daughters and a son, 16, 14 and 3 years old)

All families in both projects reflected similar processes, acknowledging their need to be critical about their parental role while being aware of the many obstacles each family member was facing. Being trans* in a family context facilitates non-traditional gender roles, which were regarded as something positive by most families. Some children, especially teenagers with a trans* parent, had the need to redefine their relationship to account for its departure from heteronormative expectations. Charlotte, the 19-year-old daughter of a trans* woman, perceived it this way:

there is a fundamental difference between ‘father’ and ‘dad’. ‘Father’ is the sperm; no matter what, you can’t change that. ‘Dad’ is the man at home, and he is not here; that is ‘Pipa’, but she is still my father.

Often children needed to come up with their own explanations and vocabulary to name what they were experiencing, sometimes also creating their own words (Platero, 2014), sometimes ahead of their ages, acquiring specific vocabulary.

For everyone, recognition of the trans* person’s gender identity was crucial: accepting the family member’s gender was seen as the turning point where relationships evolved and families could come up with strategies to face external challenges. These experiences created stronger bonds, helping the families develop resilience while coping with transphobic reactions.

Once we were at a park and she started playing with a little girl, who came to ask me what was her name? I didn’t know what to say… My daughter told her that she could not remember her own name. I replied, she is Leila, and she smiled at me. I hadn’t given her away. (Fernando talking about his 7-year-old trans* daughter)

Some trans* parents found acknowledging their past gendered parental role difficult after transitioning to the opposite gender. Discussions about when children could call them ‘dad’ or ‘mom’ or a new parental nickname illustrate the negotiation of their ‘new’ gender expression. Lauren, the 19-year-old daughter of a trans* woman, insisted on using ‘daddy’: “When we go out that sometimes makes it difficult, thinking, ‘How do I address her?’ At home I just use ‘daddy’. I think that’s also a reason why I never doubted our relationship.” Trans* parents were aware that their relative parental role had to be accepted, especially regarding the identity of the child: “Maybe they don’t see me as a male daddy. I’m still their daddy. I’ll always be their biological father” (Alice, trans* father of two sons, 10 and 8 years old).

For some, scientific knowledge on trans* topics, such as the idea of gender identity disorder, could facilitate acceptance of the gender identity of their loved one. All families reported searching for information on transgenderism on the Internet, highlighting the lack of childhood and parenting resources. Some trans* families were searching for normative knowledge on trans*, such as religion and scientific knowledge. Violeta’s 7-year-old trans* daughter asked herself: “Who’s to blame for what’s happening to me? The doctors? God?”

Some families emphasised the different emotions they went through while facing the shock of having a trans* child: surprise, fear, disappointment or even mourning as they became aware of previous expectations that could no longer be fulfilled. A mother of a 9-year-old trans* boy described it as mourning when she learned her daughter was actually a boy.

Sometimes these emotional processes led to hypothetical musings about what it would have been like if their loved one were not trans*. Some family members could have nostalgic feelings about the past. Nonetheless, having a trans* family member could have noticeable positive effects. Former mental health problems caused by feelings of gender incongruence could pass, and result in a more balanced family life:

My daughter was expelled from three different boarding schools; she was always full of anger. It wasn’t until I accepted him as Samuel that we started to have a better relationship. (Teresa, mother of a 19-year-old trans* son)

Lucas, a 12 year old, wished his trans* parent had decided to come out and transition earlier, expressing that the suffering left its marks on his parent’s well-being. Furthermore, family members experienced the impact of a gender transition on an individual level in their own lives. Eric, partner of a trans* man and father of two sons, expressed the hope that the transition taught his children to be tolerant of anything that deviates from the norm. For some adults, the experience with their trans* children facilitated new engagements as they became leaders of a social movement of families with trans* children. The transition opened their minds to new social realities.

Parenthood could also be a motivator to start the transition, since the involvement in family life raised awareness of one’s gender identity. Two trans* men who had given birth found that parenthood had made them aware of their gender identities; at some point they had both had the feeling that they were not ‘real’ mothers. As described by Lennert, a trans* man and the parent of a 2-year-old son and of two stepdaughters (16 and 14 years old):

The presence of [my son] supported me in taking that step [to start the transition]. Because of him, I was more aware of it. He would come home from kindergarten and say, ‘Daddy’. I would normally be the mother. I was already confused and it made it even more confusing to have that little boy see me as a daddy.

In sum, identifying as trans* may cause several changes in the family relationships, including challenges to heteronormative expectations and family roles. These changes were sometimes deeply emotional, challenging and even problematic, but also positive and empowering. Also, the experiences highlighted above make clear how trans* families deconstruct family processes and kinship formations, and build new ones through social practices, adapted to the trans* identity of loved ones. Individuals are linked to each other biologically, socially, intentionally and/or legally and these different ties and relationships do not always correspond with each other. Hence, there is a gap on the one hand between the daily practices of these families who deviate from the traditional family norm, and on the other hand, the knowledge and information available, the general attitudes towards these families and the accommodating social and legal framework. This inadequate framing of trans* parenting families may affect conflict situations, such as divorce and separations in which authorities are not acknowledging the real identities of trans* individuals and their relationships with their loved ones and family members.

Stigmatisation

Because heteronormative expectations conflict with the idea that a person could be trans* and still have a future in a family, a second common experience in both research projects was stigmatisation. The stigma sometimes manifested as refusal to acknowledge the child’s trans* experience, at times denying these behaviours and waiting for them to pass. One couple wished they could use different words other than transgender for their daughter. Some parents had engaged in some degree of denial until the child’s behaviour made professionals and other family members become aware of their suffering. Some were ‘child-taught parents’ – parents who choose to follow their child’s lead (Hill and Menvielle, 2009); what they learned in the process of finding professional help and contact with other families was crucial to making sense of their experience.

Some families had outspoken negative reactions. One mother reported receiving little support from school management and having to make difficult decisions, such as moving to the countryside and allowing her teenage son to stop attending school. Many children with a trans* parent reported strangers staring or even shouting when they were accompanied by their parent, as well as being asked insulting questions:

First, he was still living as a man, but, for example, he was wearing a handbag and other female stuff. That was a very weird period, because it was also very difficult for us to go out. When we went out people started talking about it to us or yelled: ‘You dirty gay!’ (Kim, 18-year-old daughter of a trans* woman)

Despite reporting negative experiences from strangers like the one above, most children with a trans* parent expressed that they never experienced bullying or hostile reactions from close acquaintances. Ellen, the 19-year-old daughter of a trans* woman, was surprised by the positive reactions of her friends. She admitted to being more worried about the reactions of others than about the transition of her parent itself.

Several protective factors were identified, such as the social environment of the family. Parents often prepared their children by introducing them to safe environments first, as well as to friends who were trans* allies. Children preferred to manage their ‘outing’ as trans* or children of a trans* parent themselves. Some families preferred an abrupt, low-key disclosure without too much ‘fuss’, while others preferred a conscious step-by-step disclosure:

I know how to tell people. It is like a ‘trust ladder’. First I will tell you, you are the one I love the most, then my brother. Later dad and everyone else… So when I go to school dressed like a girl, everyone will know. (Jesse, 6-year-old trans* girl)

Stigmatisation can also be related to trans* visibility and the possibility of passing. Moreover, trans* teenagers reported being more at risk of bullying compared to younger children. The negative outlook of a trans* future motivated some parents to become activists, while others’ own transphobia prevented them from supporting their children:

My ex-husband had a hard time with his own gay brother, and our child felt this rejection. My daughter was afraid that her father would find out he was a girl; I had to put a stop to her suffering. (Susana, mother of an 8-year-old trans* daughter)

Subjects reported that their own attitudes regarding the transition process had an influence on others’ reactions. If families did not portray their loved one’s gender transition as a problem, others would not perceive it as a problem. Being part of a family can have a culturally normalising influence (Haines et al., 2014) and promote acceptance of others, leading to a milder social environment. Ann, partner of a trans* woman and parent of two children, experienced how the presence of their children could reverse some initially negative feelings toward her trans* partner. It was noteworthy that the family context occasionally acts as a buffer against severe social stigmatisation from the social environment outside the family.

Although gender fluidity increasingly finds its way into the broader mainstream discourse, the above observations show how a gender transition still challenges the essentialist understanding of the gender binary model in mainstream society and how it affects family members. Respondents were often saved from harsh transphobic physical violence; however, all respondents had encountered trans* negative experiences, mostly staring by strangers, inappropriate questions and verbal insults. It was notable that respondents themselves minimised these experiences. These observations make clear that trans* negative behaviours are still normalised. Although both Belgium and Spain have developed a protective legislative framework and antidiscrimination laws toward trans* individuals, the underlying heteronormative assumptions and binary gender roles are challenging trans* families. In a liberal democracy where freedom of expression is highly valued, it is essential that manifest transphobic behaviour is disallowed. We come back to this in our conclusions.

Experiences with health care professionals

A third common experience in both research projects was the criticism directed toward health care professionals. Most trans* parents received care from a multidisciplinary gender team and sought additional support from other mental health professionals. Half of the Belgian families expressed mixed experiences or inadequate assistance from these professionals. These families criticised the narrow focus on medical aspects, as well as the lack of contextual support, long-term follow-up and family therapy, which the professionals did not offer by default: “To look at it in a contextual way, in order to maintain all those relationships and connections between people… I don’t think that happens enough” (Reine, trans* woman, parent of a daughter, 26, and a son, 24). Consequently, these families searched for additional psychological counselling and had difficulty finding a professional trained in trans* families, leading to frustrations and misunderstandings. This was similar in the cases of families with trans* children, who were confronted with reparative therapies. All families with trans* children had negative experiences with mental health professionals, stating that ‘often professionals knew less than themselves about trans* issues’. Having bad experiences conditioned the families’ later contact with health professionals, sometimes leading to painful situations. For example, two couples painfully experienced the common belief among mental health professionals that a relationship cannot survive a gender transition. A trans* woman and parent expressed it this way: “The therapist did not get gender dysphoria at all […] At one moment she was guiding my partner towards a divorce!”

Children of trans* parents were not happy overall about how therapists addressed trans* families. Kim, a daughter of a trans* woman, felt that health professionals do not always acknowledge the feelings that come along with a gender transition: “You can be a transgender specialist, but you cannot understand how it feels when you are not in the situation.” A young participant further highlighted this lack of awareness: “The doctor keeps on asking me if I am ok about my body. If you ask someone enough times, you start thinking you are not” (David, 19-year-old trans* youth).

The gatekeeping role of psychiatrists mentioned in previous literature was an issue for some respondents. Two trans* people thought the gender transition, due to the protocol followed, was too slow. However, several family members felt this built-in delay in the protocol gave them time to find acceptance. Yves, a trans* man and parent of two sons, perceived it this way: “For the children the surgeries happened quite suddenly. But for me it was slow enough”. The Spanish families perceived the gatekeeping role of psychiatrists as more negative and coercive; at first, professionals refused to treat minors and, more recently, started demanding that parents attend therapy in order for their children to be treated.

Not only do psychiatrists want to supervise the identity of our children. They are also trying to declare us incapable, threatening to take away custody and making us pass a psychiatric exam to certify that we are capable parents. (Saida, mother of a 9-year-old trans* daughter)

Some of the families interviewed were members of the Spanish organisations of parents of trans* children, which were taking this critical perspective on health care, education and awareness raising actions. These organisations have become organised in the past 5 years, being invited to the discussions on trans* specific and antidiscriminatory policies for trans* people that have been passed in several regions.

Lastly, families could face practical barriers. Spanish families highlighted regional differences in both access to services for their trans* children and protocols for changing names and receiving hormone blockers. Few families in densely-populated Belgium complained about regional accessibility.

The experiences in both the Belgian and Spanish studies show there is still room for improvement in the field of trans* gender health care and, in particular, the contextual support. First, the rather paternalistic informed consent approach often appears to be still present in trans* health care, both for children as for adults. The result is that trans* health care does not always correspond with the needs of trans* families. Second, awareness regarding the family context is not always present among trans* health professionals. Support for family members is not always available in certain regions, or is not adequate. We would argue for trans* health care that sees the trans* person as a client searching for support, psychosocial or medical, not as a patient in need of treatment and a fixed care protocol.

Conclusion

Our aim in this article was to shed light on the experiences of trans* families, using data from two different research projects to demonstrate the similarities between families with trans* children and those with trans* parents. First, we observed that family is the main social scenario in which individuals construct their identity. A gender transition can be a challenging process for trans* families and can cause a variety of emotions among family members. Individuals develop a reflective process, in order to give meaning to their changing situation. In regard to these findings, we refer back to the relational language of family of McCarthy (2012). Belonging and togetherness are important aspects of someone’s identity. This is no less the case when somebody is trans* and starts to transition. A transition is shaped by its relational context, which is formed through social interaction. Being trans*, to consider and/or start a gender transition affects not only the trans* individual, but the people surrounding the trans* person as well. Family members are not passive bystanders. They influence the transition process themselves.

Further, trans* families deviate from the traditional perception of ‘the family’. Perlesz and colleagues stated that “Viewing ‘family’ through a lens provided by those on the margins and those in the process of experimenting in new ways of ‘doing family’ invites us to locate and critique our own ideas and practices in our work with families” (Perlesz et al., 2006: 196). Current studies may challenge our own discourses around family and we may ask ourselves as academics, professionals and policy makers: to what extent do trans* families in this research challenge our beliefs and norms about family? To what extent are traditional and heteronormative beliefs still dominant in our field? Now that same-gender marriage and adoption are legal and discrimination based on gender identity and gender expression have become illegal in several European countries, the challenges in these countries need to shift to new frontiers as public perceptions around parenthood and family seem to lag behind legal concepts.

A second issue that trans* families face is the reactions in the social environment. Over the past decades, there has been a growing awareness of gender diversity. However, negative reactions have been common. On the one hand, the social position of trans* individuals and others challenging the gender binary can be protected by a strong legal framework, which is present in both Belgium and Spain (Belgian Government, 2014). However, a strong legal framework alone appears not sufficient to protect trans* individuals and their families. Policy interventions that are more proactive seem necessary. Research has shown that diverse social contacts combined with education and knowledge construction lead to more positive attitudes between social groups and reduce intergroup prejudice (Christ et al., 2014; Herek and Capitanio, 1996). Consequently, we argue that greater visibility of gender diversity in media, politics and mainstream popular culture is needed. Further, establishing diverse social environments combined with adequate information in the workplace, classroom, popular media and sports is also essential to enhance and protect the position of both trans* and non-binary people which captures the broad expressions of gender diversity within these groups. Real acceptance of gender diversity can only be achieved when the dual female/male boxes are critically questioned and alternative narratives regarding gender identity are offered.

Thirdly, despite the attention to the familial context in which a gender transition takes place in the most recent SOC (Coleman et al., 2012), trans* care seems still lacking a relational approach. Professionals who have an understanding of both the trans* subject and family relations are not always available. Those who are available have not always knowledge or experience of the family context. A contextual, family approach could be an important amelioration in the existing trans* health care. However, this family-friendly trans* support was not always available for our respondents.

In this article we have moved away from heteronormative and transphobic problematisation of trans* families. We hope this inspires future researchers, policy makers and anyone who works with trans* families to approach them as they would any other family, as well as taking into account their specific needs. Like other family processes, a transition can mean the starting point of individual reflections on identity and lead to both troubled and improved family relations. Second, transphobia is common in contemporary Western societies and embedded in a wider gender binary social system that oppresses those who deviate from this heteronormative norm. To enhance the well-being of trans* people and their families, these persistent values and norms regarding gender should be questioned. Third, this article challenges the prevailing pathologising focus among professionals, policy makers and public opinion on gender transitions in which questions about physical and medical traits are dominant. Often trans* individuals have been considered “impossible subjects” (Spade, 2011: 33), an error that “require[s] surveillance”, or an idea that impacts the intelligibility of their experiences. This dominant pathologising focus is problematic, as the trans* person is seen as a patient and the relational aspects of one’s identity are ignored. This study is limited due to its modest samples; it was not possible to make general comparisons that took into account the possible differences ascribed to the gender, marriage status, household composition, educational level or age of the subjects. Further research has several prospects for exploring new insights into the impact of these intersections and differences.

Footnotes

Acknowledgements

We would like to thank the respondents who participated in both studies for their participation.

Funding

This article was produced with the support of VOSATEC Multiple Voices, Plural Knowledge and Biomedical Technologies (FFI2015-65947-C2-1-P) funded by the Spanish R and D National Programme of MINECO (2016–2018) and the Government of Flanders’ research project ‘Families in Transition’, led by the Policy Research Centre on Equality Policies under the supervision of Dr Dimitri Mortelmans (University of Antwerp), Dr Joz Motmans and Dr Guy T’Sjoen (University Hospital Ghent).

Notes

Author biographies

Myrte Dierckx obtained a Master’s degree in sociology at the University of Antwerp, then worked as a junior researcher on different policy-oriented research projects at the University of Antwerp and Thomas More university college. In 2013–2014 she conducted a national survey on sexist, homophobic and transphobic attitudes among the Belgian population. In 2014 she started working for the Policy Research Centre on Equality Policies supported by the Flemish government. There she did research on trans families and in particular the experiences of children with a trans parent. She is now finishing her PhD on the family context of a gender transition. Most recent publication: Dierckx, M. et al. (2016) ‘Families in transition: A literature review’, International Review of Psychiatry 28(1): 36–43.

R. Lucas Platero has a PhD in sociology and political science. Since 2003 Lucas has been involved in European research projects (MAGEEG, QUING and HERMES) mostly working with policy frames, intersectionality, the entrance of LGBT into the Spanish political agenda and homo/transphobia. Lucas is the co-author of the book Herramientas para combatir el Bullying Homofóbico (Tools to combat homophobic bullying, Talasa, 2007); the editor of Lesbianas, Discursos y Representaciones (Lesbians, discourses and representations, Melusina, 2008) and of Intersecciones: cuerpos y sexualidades en la encrucijada (Intersections: Bodies and sexualities at the crossroads, Bellaterra, 2012). He is also the author of Trans*exualidades. Acompañamiento, factores de salud y recursos educativos (Trans*genderisms. Accompaniment, health factors and educational resources) and ‘Por un chato de vino. Historias de travestismo y masculinidad femenina’ (For a glass of wine. Stories of travestism and female masculinity).

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