Medical Transition Affects the Family

Dr. Stephen Levine, Sarah Stockton, Evelyn Ball and Nancy McDermott in discussion at Genspect’s 2026 Detrans Awareness Day conference

When a young person identifies as trans, the entire family is affected. Parents are thrown into crisis. Should they affirm the child? Should they simply be understanding and supportive? Should they negotiate? Should they adopt a pseudo-therapeutic role? Or should they put their foot down and just say no?

A social transition is, quite literally, always a social process. Transition alters the emotional landscape of everyone—spouses, the children of trans-identified parents, often silently suffering siblings (as Sarah Stockton points out in this panel discussion), and above all parents. Never before has the assertion of an alleged individual human right (in this case, to determine one’s own ‘gender’) caused such distress, forcing family members to deny their shared past or question their beliefs about the fundamental nature of their lived experience — and indeed, of reality itself.

The prospect of a minor’s medical transition confronts parents with the heartrending realisation that their child will engage in socially legitimised self-harm and face a lifetime of medical treatment. Transition, social and medical, is a family affair, says Stephen Levine in this panel discussion. It has enormous significance and the potential for immense suffering for everyone in the family. At the same time, mothers and fathers, says Levine, have a responsibility to help everyone in the family, including themselves, to respond to the meaning of what may be a pubertal response (a trans identity) to puberty itself.

A parent’s job is to have a long-term perspective, even when that involves making decisions that a child doesn’t like. This applies to many aspects of life, not just gender. And it is why parents are acknowledged to play a vital role in child safeguarding. But, as the 2025 U.S. DHHS report explicitly recognises, in the “desire to ensure their children’s health and well-being, parents of transgender-identified children and adolescents often struggle with how best to support them”. How easy is it to provide support when parents live in an affirming sociocultural landscape? And what impact do contemporary parenting patterns and family culture have on struggling parents? These are the questions that the panellists in this video from Genspect’s Detrans Awareness Day conference address.

The Unmooring of the Family

The family unit has undergone radical changes in recent decades. It is in this context that trans identification can be seen as an extreme manifestation of a much wider malaise. Since the 1960s and 1970s, there has been a breakdown in consensus about the meaning and purpose of family and marriage, and about child-rearing practices. This has made it increasingly difficult for parents to feel confident about how to respond to the challenges of raising their children in today’s world. There is widespread agreement that we are currently facing various mental health crises, but, as Nancy McDermott says in this video, this is itself part of a broader cascading phenomenon that has been unfolding since the 1970s.

The crisis relates to how children learn about themselves and their place in the world. The family has always been at the forefront of socializing kids. But in the massive social upheavals of the 1970s, the “bourgeois family—a child-centred, yet adult-led, institution that balanced individualism with social integration—began to crumble.” Divorce rates skyrocketed, with half of marriages from the 1970s ending in splits. As family stability declined, the focus shifted from raising children as a collective family effort to “managing the parent-child relationship as the primary vehicle for child-rearing.”

The traditional family, says McDermott, while not perfect, was built around the idea that children needed a stable environment in which to internalize social norms, develop a sense of purpose, and balance individuality with community. The liberalisation of family life coincided with a greater emphasis on children’s desires, feelings and rights, as part of a shift from an authoritarian to a permissive ethos. This shift bypassed the middle ground of authoritative child-rearing, which combines warmth with boundaries and demands.

Parent-child relationships became increasingly individualised, intense and anxiety-fuelled projects. Buffeted by expert ‘how-to’ advice, parents’ confidence was systematically undermined as they worried about making mistakes or exposing their children to the potential trauma of experiencing life’s inevitable disappointments and frustrations. Do you need a PhD in child psychology or a stack of parenting manuals to raise your children? Nancy McDermott is sure you do not.

The Erosion of Boundaries

Evelyn Ball argues that, alongside the desire to overprotect and the anxiety of getting things right, came a compelling attentiveness to children’s needs and feelings: a child-led (rather than child-centered) celebration of overwhelming and boundary-eroding choices and options. This is exacerbated by the alluring options offered by electronic devices. These devices are preventing young people from gaining the grounding in sensory experiences that helps them to develop a sense of self and successfully navigate adolescence. It is painfully tragic that children so often now go from sitting in a car, to sitting in classrooms, to sitting on their beds with their smartphones.

The emphasis placed on individual autonomy and choice, as well as parents projecting their hopes and anxieties onto their children, reinforces the breakdown of the distinction between adults and children. We neglect the distinction at our peril. “These are children”, says Dr. Stephen Levine. Why do we assume that only 13-year-olds know exactly what they need to be happy for the rest of their lives? Teenagers are teenagers”: they’re passionate and certain of themselves; they’re building their personalities; they’re constantly changing; and they can be both charming and exasperating. According to Levine, the eight-year period of adolescence is vital in the process of growing up. ‘We don’t want them to shut themselves off from developmental processes,’ he says.

The boundaries between adult and child must be reestablished. As Sarah Stockton says in this panel discussion, this means that parents need to assume responsibility for raising their children again. It is not their role to act as therapists or friends to their children, but to provide the love, stability and grounding that allows their offspring to come through the growing pains of adolescence, until they are ready to venture out on their own. It’s a truism to say that having children is not always easy. And particularly not today when parents sometimes need to say ‘no’. Stephen Levine sums up the dual role of caregivers, who must both set boundaries and equip children to find their own way as they grow into adults:

“One of my favourite phrases as a therapist is, ‘I think you’re steering the ship of your life right into the rocks. My job is to get you into a deep current. Go wherever you want, but make sure it’s a deep current’.”

Parents need to trust their instincts. But they will sometimes need support when making difficult decisions. They ought to find that help in the people around them: from extended families, friends and neighbours. But all these connections have been undermined by the onslaught of a culture of spurious expertise and therapeutic professionalism.

The role of therapy is raised by a member of the audience at the end of this panel discussion: Why is so much therapy now so bad? Stephen Levine points out how the now discredited World Professional Association for Transgender Health (WPATH) has miseducated generations of mental health and physical health physicians. The chain of trust has been broken and “it breaks our heart today”. Pure affirmation is not kindness. Parents know this. Which is why the authority of parents must be restored.

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