THE WALLACE GENETIC FOUNDATION, THE COLCOM FOUNDATION, AND THE CHARLES A. FRUEAUFF FOUNDATION.

>> IT USED TO BE PARENTS WOULD BRING THEIR KIDS INTO MY OFFICE AND THE PARENT WOULD TYPICALLY SAY TO ME, YOU BETTER FIX MY KID, MY LITTLE BOY TOLD ME HE'S A GIRL.

NOW PARENTS ARE SAYING I'M SO CONFUSED, I NEED INFORMATION ON HOW TO BEST SUPPORT MY CHILD.

>> Bonnie: HELLO, I'M BONNIE ERBE.

WELCOME TO "TO THE CONTRARY."

THIS WEEK WE'RE HERE WITH DR. MICHELLE ANGELLO, A THERAPIST WHO SPECIALIZES IN WORKING WITH GENDER VARIANT AND TRANSGENDER YOUTH.

SHE HAS CO-WRITTEN A NEW GUIDE FOR PARENTS CALLED 'RAISING THE TRANSGENDER CHILD'.

WELCOME.

HOW ARE YOU?

>> Dr. Michele Angello: THANK YOU.

I'M DOING GREAT.

THANK YOU FOR HAVING ME.

>> Bonnie: HAPPY TO HAVE YOU.

AND I WANT TO FIND OUT, FIRST OF ALL, WHY DID YOU WRITE THIS BOOK?

>> Dr. Michele Angello: WELL, I WROTE A BOOK A COUPLE OF YEARS PRIOR TO 'RAISING THE TRANSGENDER CHILD' AND HAD TO SELF-PUBLISH, BECAUSE A LOT OF THE PUBLISHERS SAID THAT THERE WASN'T A DEMOGRAPHIC, THERE WASN'T A MARKET FOR IT.

AND A COUPLE OF YEARS AFTER THAT, I WAS APPROACHED BY ALL OF THOSE SAME PUBLISHERS SAYING, 'PLEASE, PLEASE, COULD YOU GET US A GUIDE?

WE WANT RESOURCES, WE WANT INFORMATION.'

AND SO I THINK WITH THE MAINSTREAM MEDIA ATTENTION THAT CAME FROM THE FIRST BOOK, AS WELL AS OTHER ATTENTION THAT WAS OUT THERE, IT WAS JUST A NECESSITY FOR IT.

>> Bonnie: OH, INTERESTING.

SO HOW IS, IS THIS THE BOOK SELLING REALLY WELL?

>> Dr. Michele Angello: IT IS.

IT IS SELLING REALLY WELL, ACTUALLY, YES.

I'M VERY PROUD THAT WE HAVE ABOUT A 50 PAGE RESOURCE GUIDE AT THE END OF IT, EVERYTHING FROM WHERE TO FIND AFFIRMING CHURCHES, OR HOW TO FIND THERAPISTS OR COLLEGES THAT ARE GOING TO BE HELPFUL FOR YOUR CHILD.

>> Bonnie: INTERESTING.

THANK YOU FOR TELLING US THAT.

SO WHAT KIND OF RECEPTION HAVE YOU GOTTEN ASIDE FROM THE FACT THAT OBVIOUSLY, IT'S SELLING REALLY WELL, BUT YOU'RE, YOU KNOW, HAVE, I DON'T KNOW, HOW ACTIVE YOU ARE IN SOCIAL MEDIA, HAS IT ALL BEEN POSITIVE?

WHAT IS GOING ON?

>> Dr. Michele Angello: IT'S BEEN, FOR THE MOST PART, VERY POSITIVE.

WE DID A NATIONAL BOOK TOUR AFTER THE BOOK CAME OUT.

IT WAS RIGHT AFTER THE LAST ELECTION.

SO UNFORTUNATELY, THERE WAS A LITTLE BIT OF, THERE WERE MORE THINGS HAPPENING IN THE WORLD THAN JUST OUR BOOK.

BUT WE DID DO A TOUR AROUND THE COUNTRY.

AND IT WAS INCREDIBLY WELL RECEIVED.

AND WE'RE CONSTANTLY GETTING COMMENTS AND CALLS FROM PARENTS AND CAREGIVERS JUST THANKING US FOR RECOGNIZING THAT THEY'RE NOT THE ONLY FAMILY OUT THERE.

>> Bonnie: RIGHT.

SO TELL ME.

I'M A MOTHER OF A YOUNG SON.

AND HE COMES TO ME AND SAYS, 'I'M REALLY A GIRL, MOMMY,' AND THE CHILD IS FIVE YEARS OLD.

WHAT ARE YOU SUPPOSED TO SAY TO THAT?

>> Dr. Michele Angello: WELL, IT'S UNCHARTED TERRITORY.

OBVIOUSLY, FOR MOST PARENTS, WE DON'T ANTICIPATE THAT BEING A COMMENT OR A CONVERSATION WE HAVE WITH OUR CHILDREN.

BUT IF WE'RE LOOKING FOR -- IN HINDSIGHT, WHAT MIGHT I'VE BEEN ABLE TO SAY TO HAVE THE BEST RESPONSE?

SOMETHING LIKE, I'M SO PROUD OF YOU?

AND I FIND IT TO BE SO BRAVE THAT YOU CAME TO THIS CONCLUSION SO EARLY IN YOUR LIFE AND HOW CAN I BEST SUPPORT YOU?

MOST PARENTS WISH THEY HAD TO DO OVER WHEN THEY FIRST HEARD THAT FROM THEIR CHILD, BECAUSE OF COURSE, AGAIN, WE DON'T ANTICIPATE THAT BEING A CONVERSATION.

BUT IF THE CHILD CAN JUST FEEL UNCONDITIONALLY LOVED BY THEIR PARENTS, FROM THE BEGINNING, IT'S AN OPPORTUNITY FOR THEM TO EXPLORE.

SOME CHILDREN WILL COME OUT AND IT'S DEFINITIVELY THEIR IDENTITY, AND IT STAYS STATIC FOR THE REST OF THEIR LIVES AND OTHER CHILDREN REALLY JUST NEED THE OPPORTUNITY TO EXPLORE.

>> Bonnie: SO WHAT IS THE BIGGEST MISCONCEPTION THAT YOU THINK PARENTS IN THAT SITUATION WOULD FACE?

>> Dr. Michele Angello: WELL, A LOT OF PARENTS AND SOCIETY AT LARGE FEEL AS THOUGH CHILDREN DON'T KNOW THEMSELVES WELL ENOUGH AT THAT AGE, WHEN IN FACT, DEVELOPMENTALLY FROM A PSYCHOLOGICAL PERSPECTIVE, KIDS CAN BE CERTAIN OF THEIR IDENTITY AS YOUNG AS FOUR YEARS OLD.

AND SO SIMPLY BECAUSE SOMEONE SAYS, 'MOMMY, I'M NOT A BOY, I'M A GIRL,' DOESN'T MEAN THAT'S NOT TRUE, OR DOESN'T MEAN THEY'RE CONFUSED.

IT MAY MEAN THEY NEED TIME TO EXPLORE, BUT IT ALSO MAY MEAN, THEY'RE ABSOLUTELY CERTAIN.

I OFTEN WILL SAY TO PEOPLE WHO ARE PARENTS, WHEN DID YOU KNOW THAT YOU WEREN'T TRANS?

THEY WILL SAY, WELL, I'VE ALWAYS KNOWN.

I SAID EXACTLY AND THAT'S PROBABLY HOW YOUR KIDS FEELING RIGHT NOW.

>> Bonnie: INTERESTING.

SO YOU DON'T, IS THERE NOT -- THERE'S NO AGE GUIDELINES, IN YOUR BOOK.

IN OTHER WORDS, SAY WHAT YOU SAID TO TELL THEM AT FOUR OR FIVE OR SIX, BUT WAIT UNTIL THEY'RE 8 OR 10 TO DO HORMONE... >> Dr. Michele Angello: OH, WE DON'T NEED TO, WE'RE NOT EVEN TALKING ABOUT MEDICAL TRANSITION AT THIS POINT.

THIS IS SIMPLY SUPPORTING THE CHILD AND PERHAPS A SOCIAL, WE CALL IT A SOCIAL TRANSITION.

SO IF A CHILD IS CERTAIN, AND WHAT I MEAN BY CERTAIN IS IF THE CHILD COMES OUT AND SAYS, 'MOMMY, I'M REALLY A GIRL AND I NEED TO DO SOMETHING ABOUT THIS,' AND THEN THE CHILD PROBABLY WILL GO TO THERAPY, THE FAMILY WILL LIKELY GO TO THERAPY.

TYPICALLY, IN MY EXPERIENCE, PARENTS NEED THERAPY, AT LEAST AS MUCH AS THE CHILD IS GOING TO NEED THERAPY JUST TO UNDERSTAND HOW TO BE OPTIMALLY SUPPORTIVE.

AND SO WE'LL TALK ABOUT THAT AFTER SIX MONTHS OR A YEAR, AND IT REMAINS CONSISTENT, THEN WE MIGHT HAVE A CONVERSATION ABOUT STRICTLY A SOCIAL TRANSITION.

SO MOM, YOU MIGHT WANT TO CONSIDER USING FEMALE PRONOUNS FOR YOUR CHILD, OR TALKING A LITTLE BIT ABOUT A DIFFERENT NAME FOR YOUR CHILD, OR PERHAPS HAVING SOME CLOTHING THAT YOU BOUGHT IN THE GIRLS DEPARTMENT, RATHER THAN THE BOYS DEPARTMENT IN THE CLOSET.

AND SO ALL OF THESE THINGS CAN BE REVERSED TOMORROW, IF THE CHILD CHANGES THEIR MIND.

>> Bonnie: BUT CAN YOU REALLY REVERSE IT TOMORROW?

NOW, WHEN YOU SAY A PRONOUN CHANGE, IF YOU GO PUBLIC WITH THAT, IS IT ALL THAT EASY TO CHANGE IT BACK, IF INDEED THE CHILD DOES CHANGE HIS MIND?

>> Dr. Michele Angello: SO HOW I WOULD TYPICALLY SUPPORT THAT WITH PARENTS IS TO SAY, YOU'RE GOING TO APPROACH THIS WITH FRIENDS AND FAMILY MEMBERS IN A WAY THAT'S VERY CELEBRATORY.

WE'RE VERY PROUD OF OUR CHILD FOR WANTING TO EXPLORE THIS, TO EMBARK ON THIS JOURNEY.

AND WE'LL SEE WHERE IT GOES.

BUT WHAT WE WANT YOU, EXTERNAL FOLKS IN OUR LIVES, TO KNOW IS WE LOVE AND SUPPORT OUR CHILD, NO MATTER WHAT THE OUTCOME.

IN THAT CASE, PEOPLE TYPICALLY WILL AT THE VERY LEAST, NOT SAY SOMETHING MEAN OR INAPPROPRIATE.

AND SO THEY'LL STEP BACK, ALLOW THE CHILD TO EXPLORE AND AS LONG AS THE CHILD KNOWS THAT THEY HAVE THE ABILITY TO EXPLORE, THEY'LL COME TO THEIR OWN CONCLUSION.

AND SO THE ANSWER IS YES, THEY CAN, THEN TOMORROW, AND FRANKLY, THEY RARELY DO TOMORROW.

IT'S A GRADUAL PROCESS, JUST LIKE THE COMING OUT AS A GRADUAL PROCESS.

THEY MIGHT SAY, YOU KNOW, I'M NOT REALLY CERTAIN IF I WANT TO PROCEED AS A GIRL, OR I'M BEING BULLIED.

AND I DON'T FEEL THAT COMFORTABLE WITH THIS.

SO I THINK I'LL GO BACK TO BEING A BOY UNTIL I'M MORE CONFIDENT.

>> Bonnie: AND WHAT PERCENTAGE OF THE TIME DO CHILDREN STICK WITH A PRONOUNCEMENT THEY MAY MAKE AS YOUNG AS FOUR OR FIVE?

>> Dr. Michele Angello: LARGE MAJORITY OF THE TIME.

AND SO THE FEAR-MONGERING OUT THERE IS, OH, MY GOODNESS, MY CHILD IS GOING TO SAY I'M A BOY, OR I'M A GIRL, AND THEN THEY CHANGE THEIR MIND AND SOMETHING HAS HAPPENED, WE'VE DONE SOMETHING IRREVERSIBLE.

THE REALITY IS, NOBODY'S GOING TO WAKE UP ONE DAY, CHANGE THEIR GENDER, CHANGE THEIR PRONOUNS, HAVE THEIR PARENTS CHANGE THEIR NAME, AND THEN THE NEXT DAY, WAKE UP AND SAY, OOPS, I MADE A MISTAKE.

THIS IS A PROCESS.

AND SO WHEN A CHILD UNDERGOES THE PROCESS, AND HOPEFULLY WE'LL HAVE SOME THERAPEUTIC SUPPORT AS WELL, THEN WE'LL DO OUR DUE DILIGENCE AND MAKE CERTAIN THAT THIS IS THE PATH FOR THEM.

>> Bonnie: YOU KNOW ALL ABOUT THIS, BUT LET ME EXPLAIN A BIT FOR OUR AUDIENCE INTO -- MANY CHILDREN ARE BORN SOMETHING LIKE 10,000 A YEAR INTERSEX?

>> Dr. Michele Angello: YES.

>> Bonnie: CORRECT.

AND THE MEDICAL PROFESSION HAS, IN THE PAST, ANYWAY, DEEMED -- TURN MOST OF THESE CHILDREN WITH TWO SETS OF GENITALIA OR ONE AND A HALF OR SOME, SOMEWHERE IN THE SPECTRUM BETWEEN MALE AND FEMALE, MOST OF THEM INTO GIRLS.

>> Dr. Michele Angello: CORRECT.

>> Bonnie: DO YOU SEE THAT, IS THAT WHAT MANY OF THESE CHILDREN ARE?

OR IS THAT A TINY PERCENTAGE?

OR IS IT HAVING NO IMPACT AT ALL?

>> Dr. Michele Angello: IT'S A VERY SMALL PERCENTAGE, THEY'RE ACTUALLY DIFFERENT PATHS, BUT OFTENTIMES PARALLEL PATHS.

SO THE OLD SCIENCE, AT THE TIME IT WAS CONSIDERED SCIENCE, USED TO BE BLANK SLATE, AS LONG AS WE ARE NURTURING A CHILD IN A CERTAIN WAY, THEN IT'S GOING TO BE FINE IF WE TELL THE CHILD THEY'RE A FEMALE, EVEN IF THEY WERE BORN WITH WHATEVER VARIATION OF CHROMOSOMES.

>> Bonnie: WHY DID THEY ASSUME THAT?

>> Dr. Michele Angello: IT'S A GREAT QUESTION.

BUT YOU KNOW, THE SCIENCE IN THE '60S WAS SUCH THAT THEY THOUGHT IF WE, IF WE PUSH IT HARD ENOUGH, AND WE CONVINCED THEM, AND PARENTS DON'T DARE TELL YOUR CHILD THAT THIS IS HOW THEY WERE BORN, THEN SOMEHOW IT'LL BE FINE, WHICH WE OBVIOUSLY KNOW AND THEY PROBABLY ON SOME LEVEL, OBVIOUSLY KNEW THEN, THAT IT'S JUST NOT PRACTICAL OR POSSIBLE.

>> Bonnie: WELL, OF COURSE, THERE WAS MUCH MORE SHAME AROUND IT.

>> Dr. Michele Angello: EXACTLY.

>> Bonnie: AND THEN THERE IS NOW... >> Dr. Michele Angello: NOW THE MOST RECENT PEDIATRIC PENDULUM GUIDELINES DO STATE THAT IS NOT BEST PRACTICE TO JUST ASSUME THAT A CHILD WHO WAS BORN INTERSEX SHOULD BE REARED AS FEMALE.

>> Bonnie: SO WHAT ARE THE GUIDELINES?

>> Dr. Michele Angello: THE GUIDELINES ARE TO, THIS IS A REALLY DIFFICULT PLACE TO PUT PARENTS AND FAMILIES BUT IS JUST ALLOW YOUR CHILD TO -- YOU GENDER YOUR CHILD HOWEVER YOU DEEM MOST APPROPRIATE TO GENDER YOUR CHILD FOR THE FIRST FEW YEARS OF THEIR LIFE, AND THEN THEY'LL TELL YOU HOW THEY MOST IDENTIFY.

>> Bonnie: AND WHAT DO YOU THINK ABOUT THAT?

>> Dr. Michele Angello: I THINK IT'S GREAT BECAUSE SURGICAL INTERVENTION AS AN INFANT, IT'S VERY DIFFICULT TO REVERSE IT.

SO IF A CHILD AT FIVE, AND WE'VE HEARD THE HORROR STORIES OF PEOPLE COMMITTING SUICIDE, BECAUSE THEY WEREN'T GIVEN THE FACTS OF THEIR BIRTH.

AND SO IF A CHILD CAN BE REARED IN A WAY THAT IS GOING TO BE MOST SUITABLE, LET'S SAY FOR THE FAMILY, AND THEN THAT CHILD BEGINS TO SAY, YOU KNOW, THIS ACTUALLY IS NOT HOW I FEEL, THEN THEY CAN CONTINUE FOR THE REST OF THEIR LIVES AS THEIR MORE APPROPRIATE AND ALIGNED GENDER.

>> Bonnie: I'M JUST CURIOUS, ARE THERE ANY PARENTS WHO SAY, I CAN'T DEAL WITH THIS, AND I'M NOT THE RIGHT PERSON TO RAISE THIS CHILD?

>> Dr. Michele Angello: ABSOLUTELY.

THE PARADIGM HAS SHIFTED DRASTICALLY.

I'VE BEEN DOING THIS WORK FOR 22 YEARS.

IT USED TO BE ALMOST WITHOUT A DOUBT PARENTS WOULD BRING THEIR KIDS INTO MY OFFICE, AND THE PARENTS AND THE CHILDREN WOULD BE KICKING AND SCREAMING COMING DOWN THE HALL.

AND THE PARENT WOULD TYPICALLY BE SAYING TO ME, YOU BETTER FIX MY KID, MY LITTLE BOY TOLD ME HE'S A GIRL.

AND OBVIOUSLY, THERE'S NO WAY I'M GOING TO FIX THE CHILD IN THE WAY THAT THE PARENT WANTED THE CHILD TO BE FIXED.

BUT NOW, ON I'D SAY OVER THE LAST FIVE TO 10 YEARS, PARENTS ARE COMING IN SAYING, I'M SO CONFUSED, I REALLY NEED INFORMATION ON HOW TO BEST SUPPORT MY CHILD, MY LITTLE BOY SAID, HE'S A GIRL.

I DON'T KNOW, I DON'T EVEN KNOW WHAT THIS WORD TRANSGENDER MEANS.

CAN YOU HELPED ME?

>> Bonnie: AND HOW MUCH HOW MANY OF THEM TODAY VERSUS 30 YEARS AGO, COME TO A POINT WHERE THEY'RE FINE WITH IT, VERSUS PARENTS WHO STILL, I MEAN, THEY'RE, THEY'RE STILL LARGE POCKETS OF PEOPLE IN THIS COUNTRY, WHO I IMAGINE SINCE, FOR EXAMPLE, CHRISTIAN EVANGELICALS ARE NOT ACCEPTING AT ALL OF LGBTQ, THAT WE ARE A PARENT IN THAT SITUATION MIGHT NOT BE ACCEPTING AT ALL OF THIS CHILD.

>> Dr. Michele Angello: WELL, THE UNFORTUNATE THING IS THAT THOSE PARENTS ARE OPERATING STRICTLY FROM A FEAR BASE.

IT MIGHT BE, THEY MIGHT BE USING AN EXCUSE OF MORALITY OR RELIGION.

REALLY, WHEN YOU GET DOWN TO IT, MOST OF THE TIME, THOSE PARENTS ARE TERRIFIED FOR THE CHILD.

THEY DON'T WANT THEIR CHILD TO BE HARASSED, THEY DON'T WANT THEIR CHILD TO GO TO HELL, THEY DON'T WANT THEIR CHILD TO BE KILLED OR BEATEN UP, THEY WANT THEIR CHILD TO BE ABLE TO FIND SOMEONE WHO LOVES THEM.

AND WITH ALL OF THESE ADDITIONAL BARRIERS PUT IN FRONT OF THE CHILD, IT MAKES IT DIFFICULT.

AND SO IF IT LET'S ASSUME MOST PARENTS ARE LOVING PARENTS, IF A LOVING PARENTS CAN COME IN AND JUST HEAR THE FACTS, AND CAN ASSESS THAT THEIR CHILD IS ACTUALLY HAPPIER, AND HAS THE POTENTIAL TO BE HEALTHIER, IF THEY MOVE FORWARD WITH GENDER EXPLANATION, THAN MOST OF THE TIME WE CAN GET THEM ON BOARD.

>> Bonnie: WHAT ARE THE RISKS FOR, YOU MENTIONED THIS EARLIER, BUT FOR TRANSGENDER CHILDREN AS FAR AS BULLYING, DEPRESSION, SUICIDE, ALL THOSE AWFUL PSYCHOLOGICAL CONSEQUENCES?

>> Dr. Michele Angello: YEAH, THE RISKS ARE EXPONENTIALLY HIGHER.

THE SUICIDE ATTEMPT RATE FOR TRANS YOUTH IN THE LAST STUDY WAS SOMEWHERE IN THE NEIGHBORHOOD OF 41% IN COMPARISON TO 1.6% FOR NON-TRANS OR CIS-GENDER, CHILDREN.

SO THAT'S JUST A HORRIFIC STATISTIC.

AND MOST OF THE TIME, IT'S NOT BECAUSE THERE'S SOME INTERNAL SENSE OF, OR INHERENT SENSE OF UNBROKEN, IT'S MORE, AGAIN, THE BULLYING AND THE HARASSMENT AND THE I CAN'T USE A BATHROOM IN ORDER TO SIMPLY RELIEVE MYSELF, AND SO I HAVE CHRONIC UTIS, JUST THOSE KINDS OF THINGS, OR MY FAMILY DOESN'T ACCEPT ME OR MY RELIGIOUS INSTITUTION DOESN'T ACCEPT ME.

IF GOD DOESN'T EVEN ACCEPT ME, WHAT'S THE POINT?

>> Bonnie: WHY IS IT THAT IF A CHURCH REJECTS A TRANSGENDER CHILD OR A FAMILY, OR WHAT HAVE YOU, THAT THEY WANT TO TRY TO FIND A CHURCH THAT WON'T TURN THEM AWAY AS IT AS OPPOSED TO TURNING AWAY FROM THE RELIGION, WHICH, AT LEAST THE MAJORITY OF THE ADHERENCE, AGREE WITH THE DOGMA THAT SAYS YOU ARE A SINNER?

>> Dr. Michele Angello: TRUE, BUT IF THERE'S THAT LONG STANDING, TYPICALLY GENERATIONAL IMPACT AND ATTACHMENT TO THE PARTICULAR LET'S SAY, DOGMA, RELIGION, SPIRITUALITY, THEN PEOPLE WILL DO A FRANTIC SEARCH TO FIND ANOTHER HOME BASE.

AND SOMETIMES IT'S IMPOSSIBLE TO FIND.

OTHER TIMES THEY HAVE TO CHANGE WHAT RELIGION THEY'RE GOING TO, WHERE THEY'RE GOING TO GO TO WORSHIP.

BUT IF THAT HAS BEEN SUCH AN IMPERATIVE, SUCH A SIGNIFICANT PART OF SOMEBODY'S COMFORT, AND WHAT THEY FEEL IS JUST AN INTERNAL SENSE OF WHO THEY ARE, THEN THEY'RE GOING TO SCRAMBLE TO FIND ANOTHER HOME.

>> Bonnie: AND SO YOU'RE SAYING 40% OF TRANS GENDER, CHILDREN SUFFER DEPRESSION, ANXIETY, BULLYING, ETC?

DO WE HAVE A GOOD NUMBER YET, ON WHAT PERCENTAGE OF CHILDREN ARE TRANSGENDER?

>> Dr. Michele Angello: WE REALLY DON'T HAVE BECAUSE THE STATISTICS ARE SKEWED, THE NUMBERS REALLY ARE COMING FROM SURGICAL OUTCOMES.

AND OBVIOUSLY, CHILDREN ARE NOT HAVING SURGERY.

AND SO THE NUMBERS HAVE INCREASED, I CAN SAY, CERTAINLY, ANECDOTALLY, FROM MY PRACTICE, THE NUMBERS HAVE INCREASED.

BUT WE'RE STILL LOOKING AT HOW MANY PEOPLE ARE HAVING SURGERY EVERY YEAR, HOW MANY PEOPLE ARE ENGAGING IN HORMONAL INTERVENTION EVERY YEARND SO WE DON'T REALLY HAVE A GOOD SENSE OF HOW MANY CHILDREN ARE ACTUALLY COMING OUT.

>> Bonnie: IS THERE ANY WAY TO FIND THAT?

CAN ORGANIZATIONS, LGBTQ RIGHTS ORGANIZATIONS, OR DO POLLS?

OR IS THERE ANY WAY TO FIND THAT INFORMATION OUT PRIOR TO CHANGING MEDICATION OR SURGERY?

>> Dr. Michele Angello: WELL, THERE ARE A COUPLE OF STUDIES, NATIONAL STUDIES AS WELL AS STUDIES AT A COUPLE OF THE LARGER CHILDREN'S HOSPITALS RIGHT NOW WHERE THEY'RE TRYING TO ASSESS FOR THIS, BUT AGAIN, THE NUMBERS ARE GOING TO BE SKEWED BECAUSE THE CHILDREN COMING INTO THOSE HOSPITALS, A, TYPICALLY HAVE SUPPORTIVE PARENTS, AND ARE GOING TO BE KIDS WHO HAVE PROBABLY PRETTY DEFINITIVELY ALREADY IDENTIFIED AS TRENDS ARE OUT AND NOT EVERY KID EITHER HAS A SUPPORTIVE ENOUGH ENVIRONMENT OR HAS A SENSE OF THEMSELVES YET, IN ORDER TO COME OUT OF THE YOUNG AGE.

>> Bonnie: WE'RE TALKING ABOUT CHILDREN AFFECTED BY TRANSGENDER CHILDREN IN OUR SOCIETY AFFECTED BY DEPRESSION, ANXIETY, BULLYING, ETC.

ARE THERE ANY SOCIETIES WHERE THAT DOESN'T HAPPEN TO THEM?

>> Dr. Michele Angello: WELL, THERE ARE POCKETS IN VARIOUS SOCIETIES, INCLUDING OUR OWN, INCLUDING WESTERN CULTURE.

IT'S GETTING BETTER FOR SURE.

THE PROBLEM IS, AS SOON AS SOMEONE AND THIS COULD BE A CHILD OR AN ADULT, IS BRAVE ENOUGH, COURAGEOUS ENOUGH TO COME OUT A LOT OF TIMES, FOLKS WHO HAVE A DIFFERENT OR OPPOSITE DICHOTOMOUS BELIEF SYSTEM FEEL EMBOLDENED TO THEN JUST KIND OF RAMP UP THE HATE AGAINST THAT GROUP OF PEOPLE.

AND SO YES, THERE ARE MORE, THERE ARE SO MANY TV SHOWS.

NETFLIX HAS A VARIETY OF DIFFERENT SHOWS ON.

SOME OF THE SHOWS FOR THAT HAVE FEATURE CHILDREN.

'I A.M. JAZZ' HAS BEEN RUNNING FOR A NUMBER OF YEARS NOW.

AND IS VERY WELL RECEIVED IN JUST MAINSTREAM MEDIA.

SO THERE ARE SHOWS LIKE THAT, AND THERE ARE OPPORTUNITIES LIKE THAT, BUT WE'RE STILL GETTING A LOT OF THE BACKLASH, UNFORTUNATELY.

>> Bonnie: AND YOU SAID, YOU SAID SOMETHING ABOUT THE A -- YOU KNOW, CHILDREN AS YOUNG AS X WOULD NOT HAVE HAD SURGERY.

AT WHAT AGE, YOU KNOW, AND ASSUMING EVERYTHING YOU'VE TALKED ABOUT ALREADY THAT THE CHILD HAS COME OUT THAT THE PARENTS ARE, ARE SUPPORTIVE THAT, AT WHAT AGE IS SURGERY APPROPRIATE?

OR BEFORE WHAT AGE IS SURGERY NOT APPROPRIATE?

>> Dr. Michele Angello: SO THERE ARE A COUPLE OF WAYS TO VIEW THAT.

ONE IS IF WE'RE LOOKING AT THE WORLD PROFESSIONAL ASSOCIATION FOR TRANSGENDER HEALTH, WHICH PUTS OUT THE STANDARDS OF CARE FOR BEST PRACTICES, THEY'RE STICKING WITH TYPICALLY THE AGE OF CONSENT IN MOST COUNTRIES, MOST STATES ACTUALLY AND COUNTRIES.

A LOT OF PEOPLE ARE SAYING THAT'S -- WE'RE MISSING THE BOAT, BECAUSE SOMEBODY THESE KIDS, AGAIN, NOTING THE INCREASED RATE IN SUICIDE ATTEMPTS, OR SUICIDAL IDEATION, SOMETIMES IT'S, IT'S DANGEROUS FOR A CHILD TO GO TO SCHOOL, AND FOR THEIR PEERS TO WONDER, YOU KNOW, IS THIS PERSON MALE OR FEMALE?

HOW DOES THIS PERSON FIT?

IS THIS PERSON A NON BINARY IDENTIFIED INDIVIDUAL WHO WAS JUST SORT OF A LITTLE BIT OF A COMBINATION OF MASCULINE AND FEMININE?

AND SO THERE ARE SURGEONS IN THIS COUNTRY WHO WILL PERFORM SURGERY YOUNGER THAN 18.

SURGERY ISN'T SURGERY IS CERTAINLY NOT THE PANACEA.

IT REALLY MOST OF THESE KIDS WILL HAVE GONE THROUGH A SOCIAL TRANSITION, MANY WILL HAVE ENGAGED IN HORMONAL THERAPY, SO THEY'LL BEGIN DEVELOPING SECONDARY SEX CHARACTERISTICS THAT ARE MORE ALIGNED WITH HOW THEY IDENTIFY.

AND THEN FINALLY, SOME CHILDREN WILL WANT SURGERY IN ORDER TO HAVE CONGRUENCE BETWEEN THEIR BODIES AND THEIR BRAINS.

>> Bonnie: AND WHAT IS -- I MEAN, IS COST THE OVERWHELMING DIVIDER THERE, OR IS IT, WHAT IS IT IF IT'S NOT COST?

>> Dr. Michele Angello: COST CERTAINLY IS ONE FACTOR, BECAUSE MANY PLACES FOR MANY INDIVIDUALS, AND AT MANY HOSPITALS, THIS IS CONSIDERED AN ISSUE OF ACCESS AND DISCRETIONARY INCOME.

BUT INSURANCE COMPANIES ARE COMING AROUND AND RECOGNIZING THE MEDICAL NECESSITY OF THIS SURGERY AND SO IT'S NOT ALWAYS A FACTOR.

BUT THE OTHER THING IS, ONCE AGAIN, WE'RE CIRCLING BACK AROUND TO PARENTS SAYING, I HAVE TO MAKE CERTAIN BECAUSE THIS POTENTIALLY IS IRREVERSIBLE FOR MY CHILD.

AND IS THIS SOMETHING THAT MY CHILD REALLY NEEDS IN ORDER TO FEEL OPTIMALLY HEALTHY AND SECURE?

>> Bonnie: AND WHAT DO YOU, HOW DO YOU TELL THEM TO MAKE THAT DECISION?

WHAT DO YOU, HOW DO YOU ADVISE THEM ABOUT MAKING THAT DECISION?

>> Dr. Michele Angello: SO I DON'T TELL THEM HOW TO MAKE IT, OBVIOUSLY, BUT I WILL WORK WITH THEM ON WHAT'S GETTING IN THE WAY OF MAKING THE DECISION OR NOT MAKING THE DECISION BECAUSE NEUTRALITY CERTAINLY IS NOT NEUTRALITY, WE ARE NOT MAKING A DECISION IS NOT NEUTRAL, IN THIS CASE.

AND SO IF A CHILD HAS LIVED FOR A PERIOD OF TIME IN THEIR ASSIGNED GENDER ROLE, AND THEY FEEL MOST COMFORTABLE IN THAT, AND EVERYBODY IS GENERALLY SPEAKING ON BOARD, AND WE'RE NOTICING JUST THE ENVIRONMENT FOR THE CHILD IS HEALTHIER, THE CHILD IS HAPPIER, THEN WE START RECOGNIZING, FIRST OF ALL, THIS PROBABLY IS THE RIGHT PATH FOR THE CHILD.

SECONDLY, YES, SOME FOR SOME, THIS MIGHT BE A THING WHERE THEY WILL SAY I WASN'T QUITE READY FOR THIS IS MAJOR SURGERY.

AND SO I WILL WORK WITH THE CHILD AND THE FAMILY ON.

HERE'S WHAT TO EXPECT FROM A POST OPERATIVE PERSPECTIVE, THIS IS MAJOR SURGERY, REGARDLESS IF IT'S ABOUT YOUR GENDER OR SOMETHING ELSE, YOU HAVE TO BE PREPARED FOR THE RAMIFICATIONS AND THE RECOVERY, AND EVERYTHING ELSE THAT COMES ALONG WITH THAT.

>> Bonnie: AND THE PAIN, HOW PAINFUL IS IT ?

>> Dr. Michele Angello: IT CAN BE PRETTY PAINFUL.

I MEAN, THAT'S ACTUALLY KIDS ARE PRETTY AMAZING.

AND WE'RE MILLIONS AND MOST OF THE TIME AND LIKE KIDS, I MEAN, TYPICALLY LATE TEENS, EARLY ADULT YOUNG ADULTS, BUT THEY'RE USUALLY SO HAPPY WITH THE SURGICAL OUTCOMES, THAT THEY'LL SAY, YEAH, IT WAS PRETTY UNCOMFORTABLE.

AND FORTUNATELY, OUR MEMORIES DON'T ALLOW US TO HOLD ON TO THAT FOR VERY LONG, BECAUSE THEY'RE SO EXCITED WITH JUST BEING ABLE TO BE PURE CONCORDANT THAT THEY FORGET THE PAIN.

>> Bonnie: NOW, LET'S TALK JUST A LITTLE BIT IN THE LITTLE TIME WE HAVE LEFT ABOUT USE OF PRONOUNS, HOW IMPORTANT IS THAT, FOR PARENTS, TO USE, TO REFER TO THEIR CHILDREN AS THEY AND THEM AS OPPOSED TO SHE OR HE?

>> Dr. Michele Angello: WELL, IT'S IMPERATIVE IF THAT'S WHAT YOUR CHILD NEEDS, OR EVEN REQUESTS AT THAT POINT, BECAUSE THERE'S REALLY NO OTHER PARAMETER FOR HOW THE CHILD IS GOING TO FEEL.

IF THEY'RE NOT GETTING IT FROM THEIR HOME.

OBVIOUSLY, WE HOPE THAT THEY'RE GOING TO BE GETTING IT FROM PEERS, AND MUCH OF THE TIME THEY ARE, BUT AS THE PEOPLE WHO ARE RAISING THEM, AND WHO ARE SUPPOSED TO BE UNCONDITIONALLY LOVING THEM, CAN'T GET ON BOARD WITH SWITCHING UP PRONOUNS.

AND I'M NOT SAYING IT'S A SIMPLE TRANSITION FOR THEM.

BUT IF THEY CAN'T AT LEAST GIVE IT A TRY, AND I'LL SAY TO PARENTS, IF THEY WILL SAY TO ME, I CAN'T DO THIS, I DON'T KNOW HOW TO SHIFT FROM EITHER HE OR SHE OR GO TO THEY -- SAY, LET'S JUST DO IT IN THE OFFICE WILL DO IT AN HOUR A WEEK IN THE OFFICE, WHERE WE WILL REFER TO YOUR CHILD WITH THEIR CHOSEN PRONOUNS.

AND MOST OF THE TIME, THOSE PARENTS WHO ARE WILLING TO ENGAGE IN THAT ACTIVITY, LOOK OVER AND SEE THE CHILD IS BEAMING, AND SO EXCITED, AND SO HAPPY.

AND THEY'LL TYPICALLY WITHOUT EVEN MY SUGGESTION, SAY, HEY, OUT OF THE OFFICE, I TRIED 'THEY' THE OTHER DAY, AND THEY WERE SO EXCITED.

THAT'S FANTASTIC.

AND THAT'S, THAT'S THE GOAL IS TO JUST MAKE CERTAIN THAT THEY'RE GOING TO BE AS HAPPY AND HEALTHY AS POSSIBLE.

>> Bonnie: ANY OTHER TIPS TO PARENTS?

>> Dr. Michele Angello: KNOW THAT YOU ARE DEFINITELY NOT ALONE, THERE ARE A LOT OF OTHER PARENTS OUT THERE, THERE ARE A LOT OF SUPPORT GROUPS THAT THEY HAVE ACCESS TO, WHETHER IT BE IN PERSON OR ONLINE.

AND THAT REALLY JUST LOVING YOUR CHILD AND BEING OPEN TO THE EXPLORATION IS WHAT'S GOING TO KEEP YOUR KID HAPPIEST, YOU'RE NOT GOING TO MAKE A MISTAKE BY LOVING YOUR CHILD.

>> Bonnie: YOU CAN THINK OF NO EXAMPLE WHEN THAT'S EVER BEEN A MISTAKE IN SOME WAY.

>> Dr. Michele Angello: OKAY, WELL, SO I'LL GIVE YOU -- WHAT A LOT OF PEOPLE WILL COME TO ME WITH IS, BUT WHAT IF MY KID CHANGES THEIR MIND?

AND I'LL SAY, YOU KNOW WHAT THE LESSON YOU JUST TAUGHT YOUR CHILD WAS?

YOU LOVE THEM UNCONDITIONALLY, EVEN IF YOU'RE NOT CERTAIN, AND THEY'RE NOT CERTAIN IF THE PATH IS APPROPRIATE FOR THEM.

IT WAS APPROPRIATE IN THAT MOMENT.

AND THEN THEY SHIFTED AND WENT TO ANOTHER PATH, AS BY THE WAY, WE ALL DO AS HUMAN BEINGS IN DIFFERENT ASPECTS OF OUR LIVES.

AND TO KNOW THAT WE CAN COME BACK AND BE LOVED BY THE PEOPLE WHO ARE SUPPOSED TO BE LOVING US, IS A REALLY FANTASTIC LESSON.

>> Bonnie: I'M THINKING, FOR EXAMPLE, A LOT OF COLLEGE STUDENTS CHANGE MAJORS, FOR EXAMPLE, OR GRADUATE FROM COLLEGE GO INTO A FIELD THAT THEY THOUGHT THEY WOULD LOVE AND THEY DON'T.

>> Dr. Michele Angello: HOW MANY OF US HAVE GONE TO THE ALTAR.

TILL DEATH DO US PART.

>> Bonnie: 50 PERCENT DON'T LAST, RIGHT?

SO, GOOD ANALOGY.

THANK YOU VERY MUCH FOR JOINING US.

VERY ENLIGHTENING DISCUSSION.

THANK YOU.

>> Dr. Michele Angello: >> Bonnie: THAT'S IT FOR THIS EDITION OF TO THE CONTRARY, PLEASE FOLLOW ME ON TWITTER AND VISIT OUR WEBSITE PBS.ORG/TOTHECONTRARY, AND WHETHER YOU AGREE OR THINK TO THE CONTRARY.

SEE YOU NEXT WEEK.

S A. FRUEAUFF FOUNDATION.

FOR A TRANSCRIPT OR SEE AN ONLINE EPISODE OF "TO THE CONTRARY," PLEASE VISIT OUR PBS WEBSITE AT PBS.ORG/TOTHECONTRARY.