Dear Prudence

Help! My 13-Year-Old Can’t Decide if They Want to Start Hormone Replacement Therapy.

Dear Prudence answers more of your questions—only for Slate Plus members.

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Every week, Dear Prudence answers additional questions from readers, just for Slate Plus members.

Q. Helping my trans kid make decisions about HRT: My 13-year-old came out to my husband and me as nonbinary/transmasculine two years ago—they use they/them and he/him pronouns. They have been incredibly open and communicative; we have a terrific and affirming therapist as well as supportive friends and family. My kid knows we’re not invested in any particular “outcome” when it comes to identity or transition and that all we care about is supporting their best life. Next month our kid will turn 14, and will be able to start HRT if they want to. But they can’t decide—they go back-and-forth on the question, they cry at night before bed freaking out about the gravity of the decision, and they worry about whether they’ll miss a window. I don’t know what to do. I just want my kid to feel safe and supported. We’ve listened to a few episodes of your podcast together and appreciated your insight. Do you have any advice for my child as they make a decision, or for me in supporting my kid in turn?

A: While our circumstances are remarkably different in other respects, I can certainly relate to going back-and-forth on the question of starting HRT, of panicking about the possibility of missed opportunities, and of letting “I dare not” wait upon “I dare.” You know, I think, that I can’t promise you one decision or the other will be the right one for your kid—but I do think information gathering can be a really useful, practical response to panic and uncertainty. Encourage your kid to speak to people who started HRT at different ages to get a sense of the depth and breadth of possible experiences. Are there any support groups for trans/nonbinary/questioning youth in your city that your kid could visit? What do you and your kid know about the physical effects of HRT? What potential changes does your kid find the most interesting, appealing, and desirable? What potential changes do they feel uncertain or ambivalent about? What potential changes do they find distressing? Bring these questions up with your family doctor, to your therapist, to any medical professionals working in trans health care willing to take your call, and keep a written record of what you learn. Remind yourselves that there are no stupid or inconsequential questions when it comes to asking about HRT. Encourage your kid to keep written notes on their biggest fears, especially ones that lead them to cry: What are some of the worst-case scenarios currently rattling around in their head, and how can you reality-test them?

It may help, too, to remind your kid that this is not the single moment of decision that will govern the rest of their life. Yes, there may be some changes that HRT can provide most effectively or even exclusively during adolescence, but HRT will still be available at 16 or 18 or 22 or 30 if they decide to give it more time. The most important thing to stress, I think, is that no single option will perfectly eliminate ambiguity, uncertainty, or the possibility of regret. These three things are part of the business of living with a body. That doesn’t mean we can’t make informed decisions, or act in our own best interests, or separate internalized transphobia from meaningful ambivalence, but it might feel a little bit freeing to treat the possibility of regret not as a shocking sign that you’ve definitely made the worst possible decision but as emotional information. It also helps to have a plan in place for acknowledging and incorporating regret into your life. “If you started HRT and experienced [whatever outcome your kid’s most worried about], what would your options be?” That’s a practical question with real, practical answers—anything from “I’d decrease my dose” to “I’d talk to my doctor about [finasteride]” to “I’d go off HRT” to “I’d ask for advice from other people who’ve experienced the same thing.” A useful guiding principle before making any decision might be “Do I have sufficient support in place to do this, and if not, how might I get it?”