At the age of 13, our younger twin wrote us a letter expressing their convictions about being transgender. This twin struggled to express themself verbally, but always had a knack for writing. So a letter was their chosen method of communicating the big news.

At that time, I was still very certain of my conservative faith and view of the world, and I believed that a faithful reading of the Bible and commitment to things of faith would solve any problem that presented itself. I just needed to be strong and faithful, and persuade others to do the same.

Were I to do that time of life over again, I think and hope I would do it much differently. A retrospective look provides some clues of things not to do:

• Don’t speak your opinion so readily. Rather, ask questions, ask questions, ask questions.
• Don’t attempt to handle all the moments at once. Only deal with the one in which you currently find yourself. Don’t play out all the possible scenarios.
• Don’t belittle the opinions and feelings of a child, even in your own mind. Don’t assume they have no idea what they’re talking about.
• Don’t think that your way of viewing the world, life, faith….is the only valid one.
• Don’t assume you know the results of learning before you do the learning.
• Don’t allow your emotions to control you, but also don’t invalidate any of your emotions because they all provide perspective and are valuable and real.
• Don’t keep everything to yourself because you’re afraid of how people will respond.

Little did I know that we’d have a second chance at handling the situation when it occurred again with our older twin this past November. It was similar in that they communicated with us through writing. It was different in that we were now dealing with an adult. I use the term loosely because turning 18 and going off to college does not make one an adult, but there has to be a demarcation where childhood ends and adulthood begins, so 18 is it for our culture and time.

Though even now I don’t have a clear idea of what to do in this situation, one thing I’m doing differently is researching as thoroughly as I can. It’s helpful to know how the psychological community approaches gender dysphoria when trying to wade through the experience.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by healthcare professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. It is currently in its fifth edition and is a product of the American Psychiatric Association.

Current recommended practice is for a multi-disciplinary team to diagnose gender dysphoria on the basis of the DSM-V criteria. They assess the individual’s gender identity, gender dysphoria, history and development of gender dysphoria, the impact of stigma on mental health, and the availability of support. Gender dysphoria is broken down into separate categories for children, adolescents, and adults. The only method for collecting assessment data is through personal interview and observation with the individual and their family members or people close to them.

Gender dysphoria in DSM-V replaces gender identity disorder which was listed in DSM-IV. The change was made because GID focuses on identity as the disorder where GD focuses on the distress caused by the disconnect. Transgender is not a diagnosis or official medical term. It came into usage between 1980 and 1994 and has a variety of definitions with varying degrees of specificity, so it is not helpful as a precise title but rather as a broad category.

Once a diagnosis is reached, there is assessment for any co-occurring disorders, followed by a determination of treatment plans. For young children, it is left to the family to determine the course of action. Recommended interventions vary from parents giving children ample possibilities to explore gender feelings and behavior in a safe environment, to allowing a child to fully socially transition at an early age. For adolescents, hormone blockers are a recommended course of treatment along with social transition. Hormone blockers postpone puberty and the changes associated with it, so that biological secondary sex characteristics are prevented from developing.

For adults, what is designated triadic therapy includes:

• RLE (Real Life Experience) – Fully Reversible – Social Transition
• Hormone Therapy – Partially Reversible – Medical Transition
• Gender Confirmation Surgery – Irreversible – Surgical Transition

Though psychological support is highly recommended for any part of the transition process, it is not required. It is not even required for the prescription of hormones or seeking surgical intervention.

Through Christian psychologist and author, Mark Yarhouse, our younger twin received a thorough evaluation and gender dysphoria diagnosis as a high school junior. We followed up with family counseling through a Christian provider. After nine months, we determined it was not productive for any of us, so we discontinued.

This fall as college freshmen, both twins started on testosterone. Neither are required to receive counseling as a part of their process, nor was it required to have an official diagnosis. All that was expected was that they receive a brief explanation, and then sign that they understood the potential benefits and risks involved.

Our older twin did not receive a gender dysphoria diagnosis until after starting testosterone. Following their coming out and diagnosis, we have not pursued family counseling, though they have a personal counselor they visit almost weekly.

I am in a very different place today than five years ago. My list of things not to do is still pretty apropos, but it’s often easier to actually do something than prevent yourself from doing the wrong thing. So here is my personal to do list as it appears on the bulletin board of my office at work:

• Be humble.
• Ask questions.
• Wait.
• Be myself – my best creative self.
• Agree more.
• Say yes more.

These apply to all of my life, but particularly as a parent, and more specifically a trans parent.