Gender Development in Childhood

There are many theories about gender identity development, and increasingly, about trans identities. Existing theories attempt to explain gender from various perspectives. There is no single, accepted theory, but much can be learned from the work that exists.

Gender in our world

Before we talk about how gender identity develops, it is important to talk about where it is developing. Trans identities and expressions have been celebrated by cultures around the world for centuries. However, in recent times within Western cultures, gender identities that differ from sex assigned at birth have been seen as problems to be fixed. People have been subjected to treatments intended to change their gender identity, much like treatments to change sexual orientation. These reparative, conversion, or re-orientation therapies are not effective and have caused people a lot of pain. These practices are considered both harmful and unethical1.

Today, ideas about gender are shifting quickly. Trans identities are now seen as a natural part of human diversity. More gender possibilities are opening up as we honour gender identities outside the binary of men and women. Trans identities are being celebrated and affirmed, by trans communities, families, friends, and health care providers. Policies and laws are changing to make our schools and communities safer and to protect the rights of trans people. Instead of focusing on changing healthy trans individuals so that they fit into strict gender norms, society is changing to make room for diverse gender identities and expressions. The path to gender inclusive societies is not always smooth, but progress in Western society is being made faster than ever before. It is important to understand that today’s children and youth are growing up in a new gender world.

Theories of gender development

Traditional theories of child and youth gender development focus on cognitive and social aspects of development. Cognitive theory focuses on how children mentally make sense of gender as they progress through different stages of development. Social theories centre around how people learn about gender through observation, modeling, and social interactions that reward or discourage certain gendered behaviours. Some scientists are also studying in utero hormones and the brains of trans individuals to search for a biological explanation of trans gender development. Trans Bodies, Trans Selves2 has a chapter on gender development that talks more about these theories. While we have no definitive answers about why some people are trans and others are cisgender, scholars are now applying what the theories we have about gender development to the experiences of gender creative children and trans youth.

The authors of The Transgender Child: A Handbook for Families and Professionals3 present stages of gender identity development which draw on traditional theory. They also talk about how development may play out for children and youth who are trans. In their stages, by age 3, children are often clear about what their gender is. They may even be able to express that their gender and sex are different. As children approach school age, they may become increasingly consistent and persistent about their gender identities. School age children may experience distress as they understand themselves to be different from others, and become aware of impending pubertal changes. It is also common for youth to realize they are trans after they have gone through puberty, which can lead to a lot of distress.

True Gender Self

People writing today about trans gender development often take an integrated approach, looking at biology, psychology, socialization, and culture together. Diane Ehrensaft is a developmental psychologist who specializes in working with gender creative children and trans youth. She discusses the roles of nature, nurture, and culture in gender development, and focuses on the potential for many different healthy gender outcomes. We summarize some of her ideas here. For more detailed information, please see The Gender Creative Child4.

According to Dr. Ehrensaft, true gender self includes a child’s gender identity and expression. Nature – chromosomes, hormones, genitalia, brain and mind – plays a big role in the true gender self. Given space to be themselves, children naturally express their gender, whether it conforms to the norms of our society or not.

However, our society strongly promotes the idea that there are only boys and girls, and that gender and sex should be the same. If children feel pressure from the outside world and from families to conform to gender norms, a false gender self can develop. In this case, a child adapts to the expectations of their environment, perhaps by changing their outward expressions of gender. For some children, the pressure to conform to gender expectations, at the expense of their true gender self, causes high levels of distress. Resilient children may present their false gender self to the world, while finding creative ways to hold on to their true gender self in private. Later on, given the language, space, and support they need, these children may be able to express their true gender selves.

Young children

People often ask whether or not young children can know their gender. The combination of developmental theory, new research, and the collective wisdom of experienced clinicians, parents and children themselves, make a convincing case that young children can know their gender. Developmental theory supports the idea that children as young as 2 or 3 know what their gender is. It stands to reason that this would be true for trans kids as well as cisgender kids. However, sometimes we don’t listen to what children are telling us about their gender. Or, they try to hide their true gender self because they have received messages that being gender-nonconforming or trans is not okay.

Diversity of gender creative children

Each child is unique. Their gender is also unique. It involves two important parts: identity and expression. The distinction between these is important for understanding what children are telling us about their gender. While every child is different, some commonalities can be found. In The Gender Creative Child4, Dr. Ehrensaft discusses three different ways that children express their gender identity and expression.

First, some children clearly have a gender identity that is not the same as the sex assigned to them at birth. They are persistent, consistent, and insistent about the gender they know themselves to be. These children may be frustrated with their bodies or think that God made a mistake by giving them the body they have. Nature plays a very strong role in driving both identity and expressions. These children are likely to have a consistent trans identity over time.

Second, there are children who explore gender expression in ways that go against social norms. However, they still identify with their sex assigned at birth. These children are telling us that gender roles and norms don’t fit for them, and they need to express themselves differently. Nature, nurture, and culture are all at work here. Later on they may identify as gay or queer, and their gender expressions may or may not continue to be gender non-conforming.

The third group of children are creative in their identities and expressions of gender. This group can be considered non-binary. They have an identity that doesn’t fit with boy or girl. They may or may not be unhappy with some aspects of their bodies. Their expressions of gender are often a creative mix, and they may continue with this creativity throughout their lives.

All of these gender selves are healthy. None need to be fixed or changed. Gender health comes from being able to freely identify and express the authentic gender self. Paying attention to what children tell us about their identity and through their expressions can help us to learn how to best support them.

Gender Affirmation Model

Gender-affirming care is a term that you may hear in reference to trans health care. Simply put, this is health care that is provided in ways that support the authentic gender self.

Gender affirming care is important for promoting gender health in our children and youth. There is more and more evidence that failing to support gender creative children and trans youth can have serious health consequences. Trying to change a child’s behaviour or not allowing them to express their gender freely may lead to shame and depression in the short and long term5. Trans youth who feel well supported by their parents report better health outcomes than peers without parent support6. New research also shows that children who have support to transition socially before puberty are doing very well7.

Researchers and clinicians working with gender creative children and trans youth and their families have developed principles for a Gender Affirmative Model of Care3. These are also discussed in The Gender Creative Child4.

This is a summary of the principles of the Gender Affirmative Model4,8:

  1. Gender variations are not disorders
  2. Gender variations are healthy expressions
  3. Gender presentations are diverse and varied across cultures
  4. Gender involves an interweaving of nature, nurture and culture
  5. A person’s gender may be binary, non-binary, fluid, or multiple
  6. Distress connected to gender most often stems from negative reactions from the outside world

These principles can help guide parenting as well as health care. Understanding that gender is complex and diversity is natural is important in learning how to support a gender creative child or trans youth.

What’s next?

Parenting is our next topic. We highlight approaches to parenting that create space for gender exploration and promote healthy gender development. You will also find links to a number of helpful parenting guides.


These resources include several books and articles that were mentioned in this section. You may wish to explore these further if you are interested in learning more about theories of gender development and how parents and professionals can use this knowledge in supporting children and youth.


3 Brill, S. A., & Pepper, R. (2008). The Transgender Child: A Handbook for Families and Professionals. San Francisco, CA: Cleis Press.
4 Ehrensaft, D. (2016). The Gender Creative Child: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes. New York, NY: The Experiment.
Ehrensaft, D., & Menvielle, E. (2011). Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children (3rd Revised ed. edition). New York: The Experiment.
2 Erickson-Schroth, L. (Ed.). (2014). Trans Bodies, Trans Selves: A Resource for the Transgender Community. New York, NY: Oxford University Press.


1 Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., … Zucker, K. (2012, August 1). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. World Professional Association for Transgender Health. Retrieved from
How to know if your child is transgender, from an expert – Vox


8 Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., … Olson, J. (2013). The Gender Affirmative Model: What We Know and What We Aim to Learn. Human Development, 56(5), 285–290.
7 Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, peds.2015–3223.
6 Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012). Impacts of strong parental support for trans youth: A report for the Children’s Aid Society of Toronto and Delisle Youth Services. Retrieved from
5 Wallace, R., & Russell, H. (2013). Attachment and Shame in Gender-Nonconforming Children and Their Families: Toward a Theoretical Framework for Evaluating Clinical Interventions. International Journal of Transgenderism, 14(3), 113–126.