Watchful waiting is a medical term used to describe the approach taken when a condition is expected to resolve naturally.
While transgender ideation can be seen as a phase – there is no guarantee that the phase will pass in a suitably short time.
Clinicians and parents should, where possible, delay social gender transition (Steensma et al., 2013). This is based on evidence that gender dysphoria (and cross-gender identities) frequently desist in prepubertal children (Drummond et al., 2008; Singh et al., 2021; Zucker, 2018) and that premature social gender transition may foreclose the child’s gender identity development, increasing the likelihood that gender dysphoria will persist (possibly necessitating medical transition in adolescence onward). This approach has been referred to as “watchful waiting” (de Vries & Cohen-Kettenis, 2012).
There are different cohorts of patient wishing to be the opposite sex. Watchful waiting is appropriate for pre-pubescent boys since the vast majority will grow out of it.
For young adolescents (<~15), rapid holistic intervention is necessary. Their cases are time critical.
Holistic means looking at the whole. There are a whole raft of factors that might be contributing to an adolescent having transgender ideation:
- Prior Trauma
- Bullying
- Anxiety
- Depression
- Homosexuality
- Neurodiversity
- Discomfort with puberty
- Autism
- ADHD
- Sexual abuse
- Giftedness
- Non-conformity with sex stereotypes
- Disability
You might know which of these factors are present, or your child might need counselling to establish which are causing damaging feelings. Once surfaced, the young person needs help to learn to cope with or manage the feelings these factors generate.
Supportive Waiting
Once older, or if excessive rumination has rendered the transgender ideation somewhat intransigent, then a less proactive (but still not passive) approach is called for.
Given the need for an active variant of watchful waiting, the term supportive waiting has been coined to describe such an approach.
This approach can be described as “creating the right environment for the penny to drop”.
A young person with transgender ideation has to work out for themselves that they are not in fact transgender and that it was just a social identity – albeit one with drastic consequences if the medical route is pursued.
How each individual reaches their decision to desist of their own volition will vary. The right environment can include substitute activities and the encouraging of healthy friendship groups. Useful reading materials can be made available for (but not forced upon) the affected youth. Ultimately, what works for any family will be different. This is where peer support becomes useful because parents can compare notes.