Supporting Your Intersex Child Through Puberty

Many intersex⁠ (intersex: Having reproductive and/or sexual anatomy that doesn’t seem to, or isn’t understood to, fit typical definitions of female or male, and/or chromosomal combinations other than XX or XY.) variations impact puberty⁠ (puberty: The process of physical and sexual changes from childhood to adulthood, initiated by hormone signals from the brain to the gonads. ) — in fact, quite a few intersex variations can go completely undetected until that period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.) of development. Some children or teenagers will find themselves undergoing what feels like the “wrong” puberty, some might naturally develop both traits traditionally considered “male” and those traditionally considered “female,” and some might not start puberty at all.

These scenarios are rarely acknowledged in parenting guides, so it’s perfectly understandable to feel at a loss if your child is undergoing an intersex puberty.

How can I emotionally support my intersex child through puberty?

Being intersex often comes with social stigma (like being gender nonconforming⁠ (gender nonconforming: People who do not adhere to or who protest cultural rules or norms about dress, behaviors or activities for people based on their sex.) , or having a body that looks or functions differently from norms for any reason can). Confusing as the situation may be for you as a parent or guardian, it’s likely even more confusing for your child. It’s important to just care for your child, and to let them know that you are by their side through the whole process, however it may go. Here are a few things to bear in mind:

• Do your best not to make it about you. While you might feel mixed emotions witnessing your child undergo a puberty you did not plan for, they are the one primarily affected. Your comfort should not be prioritized over theirs.
• Listen to your child. Do not try to tell them how they should feel about their body. Let them have their own feelings, and use their own words for their experience, even if they are different from how you feel or what you believe they should be feeling or expressing.
• Be sensitive when discussing how puberty would more typically go. Bringing up “typical experiences” that may or will never apply to your child might make them feel alienated from others (for example, talking about periods as “a sign of adulthood” to a teenager who is or may be unable to have them).

Additionally, it might be a good idea to seek out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) therapy for your child or teen if they’re having a hard time. Being intersex can feel isolating even with supportive friends and family. There is no shame in seeking out professional help for your child’s mental health, just like there isn’t for any other aspect of their health.

Should I be worried about my child’s health?

While some intersex variations have no health impact whatsoever, others can come alongside health issues or disabilities. For example, gynecomastia, the unexpected growth of breast⁠ (breast: Glandular tissue, fat, connective tissue and skin on the chest.) tissue, can be a symptom of a testosterone⁠ (testosterone: A steroid hormone produced in the testes and in the ovaries. Is responsible for sperm production, and influences sexual desire, arousal and bone health. Is also blamed for for a lot of things it isn’t actually responsible for.) deficiency, which can cause chronic fatigue and osteoporosis. It’s in your child’s best interest to consult a qualified medical professional to ensure that their unusual puberty is not a symptom of something more severe, and if it is, to ensure that your child can benefit from appropriate treatments for their health and well-being.

Here are some pointers to ensure these appointments go as smoothly as possible:

• Prior to visiting a clinic or a doctor, ask if they are familiar with the term “intersex,” and if yes, if they have any experience with intersex patients. Healthcare providers who are only familiar with the term “DSD” (Disorder of Sex Development) might not be fully up-to-date on intersex activism, and therefore might not be able to provide intersex-affirming care.
• If your child requests to speak privately to a doctor, grant their request. As with any other teenager undergoing puberty, there might be things they don’t want their guardian to know about or don’t feel comfortable talking about with you in the room. Try not to take it personally.
• Some of the exams your child might go through can be fairly invasive (like genital exams). Inform your child that they can always ask to have a trusted adult or chaperone in the room with them during an exam.
• Explain to your child that while some of the exams they will go through are medically necessary and your child will have to go through them, they can always ask the healthcare providers to slow down or explain what will happen in a developmentally-appropriate way. If your child knows what will happen to them and why, they will feel more at ease with these exams.
• Value your child’s input when possible. If there are options when it comes to exams or procedures, let them express their opinion on the matter, even if it is over something small. Exercising even a small choice can feel empowering to a child. (This situation can apply to any medical decision made with children too. Preparing for this conversation is sure to help you even if you turn out to not need it specifically for their intersex care.)
• Stand up for your child. Some healthcare providers may act overly curious to the point of dehumanization towards your child or their body. Don’t let them do that. Similarly, if your child expresses discomfort during an appointment or a medical exam, you should uplift their voice.

Should I reach out to my child’s school?

It might be helpful to inform the school staff of the situation if your child needs accommodations, or even just to prompt teachers to be more mindful of their language, particularly any teaching science, health, or sex⁠ (sex: Different things people choose to do to actively express or enact sexuality and sexual feelings; often this involves genitals, but not always. ) education classes. If your child is alright with it (remember, they’re the one the school staff will have the biggest impact on) you may contact the staff and educate them on intersex inclusivity. If you are unsure what to say, intersex organizations often have pamphlets and brochures available for this very purpose (here is interACT’s, for instanceexternal link, opens in a new tab).

The doctors told me to keep my child’s intersex diagnosis a secret. Should I comply?

There is a historic culture of secrecy among medical circles regarding intersex patients. The (bad) idea is that if a patient knows they are intersex, it might cause them distress and confuse them regarding their gender⁠ (gender: Characteristics that are seen or presented as distinguishing between male and female in a society. Gender may or may not include assigned or chosen: social roles, feelings, behaviors and/or presentation or appearance.) and/or sexuality, so it’s better to hide their condition away from them forever.

This is extremely harmful. Aside from the blatant queerphobia or transphobia⁠ (transphobia: Prejudice against transgender individuals. Transphobia may also include prejudice against any kind of gender nonconformity or gender nonconforming people.) of that attitude, everyone needs to know how their body works. If any complications rise in the future, knowledge of their body and of the treatment they’ve received will be necessary to receive proper care. Additionally, it would be extremely damaging to your child and your relationship⁠ (relationship: An ongoing interaction or association with another person, place or thing.) with them to hide information from them about their own body. It should be obvious, but it is worth stating since often it clearly isn’t obvious to a lot of people: bodily autonomy⁠ (autonomy: The state or condition of being independent and/or having the right to independence.) is a human right.

If you are given any medical diagnosis for your child, it is deeply important to share it with them in a developmentally appropriate way. It is perfectly fine to share that information in chunks over time if you judge it best. The important part is to keep your child in the loop when it comes to their own health. Any medical professional who advises otherwise has shown that they are not an appropriate provider for an intersex patient. We advise you either ask for a referral to another one, or find someone else yourself.

The doctors I consulted advised my child go through a specific treatment and/or procedure. Should we go through with it?

Alright, that’s where things often get tricky.

Some intersex conditions do require medical interventions so that the person with them can remain healthy. However, all too frequently, doctors focus on getting rid of visible intersex traits without any regard for whether these are health-threatening or not, nor any regard for how the person with them feels about them. For instance, a doctor might put someone on feminizing hormones⁠ (hormones: Chemicals – via our endocrine system – that send messages across our bodies and brains. They both naturally exist and can also be made in a lab.) to get rid of their facial hair without checking their hormone levels first, meaning they might miss that said facial hair is caused by PCOSexternal link, opens in a new tab (which can lead to infertility, diabetes, heart disease, or endometrial cancer) rather than any hormone deficiency.

While some intersex conditions can be dangerous, intersex traits are rarely the problem. Growing unexpected breasts is not a health concern. Unexpected body hair is not a health concern. A bigger clitoris⁠ (clitoris: A sexual organ both external and internal on the vulva and inside the pelvis of those often assigned female at birth that is similar to the penis, but serves no other known purpose besides providing sexual pleasure.) than average not a health concern. Focusing on getting rid of intersex traits without investigating what caused them to appear in the first place is actively dangerous, as it means underlying health issues might go ignored.

As a parent, it’s important for you to do what you can to advocate for your child or teen in medical settings. Make sure you understand why doctors are suggesting this or that treatment. What specifically are they trying to fix? Is it to resolve a health concern? Is it for aesthetic purposes? If they give a diagnosis to your child, do your own research on it. Is it a disabling condition, something that needs some kind of management, or a harmless one that just needs to be accepted and left alone? Have other intersex people spoken about it? You may want to consult multiple medical professionals to gather opinions.

As with any medical decision, it’s a good idea to fully understand any procedure or treatment. Ask about risks and benefits: What are the medical implications if your child does go through with it? What if they don’t go through it? Can it wait? Are there alternatives? Some medical procedures recommended for intersex people can actually worsen a person’s health; for instance, Annet Negesaexternal link, opens in a new tab and Caster Semenyaexternal link, opens in a new tab are two athletes who have spoken up on how treatment to lower their testosterone levels made them sick.

Once you are suitably informed, you can explain to your child what treatment has been suggested, what are its intended effects, and what might be the side effects.

If that treatment is a medical emergency, then being transparent with your child in a developmentally-appropriate way will lessen the stress of receiving a procedure. Knowing what will happen to them and why will help your child feel less afraid about their treatment.

If that treatment is not a medical emergency, then it should be your child’s choice whether they want to go through any treatment or not. They might want to postpone receiving a procedure, or refuse to get it at all. You will have to respect that. Intersex variations rarely, if ever, require immediate action. Do not let doctors pressure you and your child into making uninformed irreversible decisions.

Intersex bodies are deeply stigmatized as broken and needing to be “fixed”.

This can obviously be distressing to anyone intersex, and can make figuring out how to center care for one’s own well-being and wellness much harder than it should be. If you need extra help with any of this, you can seek out intersex organizations in your country: these often have resources for parents of intersex children, from information brochures to support groups, like at Interactionexternal link, opens in a new tab in Australia, OIIexternal link, opens in a new tab in Europe, and InterACTexternal link, opens in a new tab in the United States, for instance.

Supporting a child undergoing an intersex puberty may sound difficult. But really, providing emotional support to a child going through deep and confusing personal changes, which may or may not include various health issues or concerns…that’s not too different from supporting any other child during their puberty, is it? I believe that you can figure it out and do this well for your child and yourself.