Written by three therapists with extensive experience in counselling individuals and families wrestling with gender identity concerns, When Kids Say They’re Trans is, in many ways, the book thousands of Christian parents have been waiting for. Comprised of fifteen chapters, six appendices, a glossary, resource pages, references, and an index, it covers almost everything that “thoughtful parents” could hope for and, remarkably, does so in just over 300 pages. The irony is that this is not a Christian book, nor are any of its authors Christians. Nevertheless, until there is a Christian alternative that is as clear, informed, and insightful as this one, it is the book not only to read but also to recommend—especially to parents who have been caught off-guard by their child’s sudden declaration of a trans identity.

Let me begin with a brief word about the book’s three highly accomplished authors. Sasha Ayad is a US-based counselor who works with adolescents struggling with gender identity issues. She also runs a coaching group to help parents respond wisely to their child’s identity exploration. Lisa Marchiano, also based in the US, is a psychotherapist and Jungian analyst. She, too, consults with parents of both trans-identifying teens and detransitioners. Stella O’Malley is an Irish psychotherapist and author who had her own experience of gender-related distress as a child. Her work focuses on teenagers, parenting, and family dynamics. In addition to facilitating a coaching site which offers practical help to parents navigating their child’s gender confusion, she is the cohost (with Sasha) of the Gender: A Wider Lens podcast and the executive director of Genspect, an international organization that advocates for a non-medicalized approach to gender dysphoria.

From the book’s preface on, it is clear the authors have major misgivings about medical transition for anyone of any age. This is largely due to the damage that cross-sex hormones and “transgender surgeries” inflict upon the body. As they state, “we see medical transition as a life strategy that comes with certain costs” (p. 2). Indeed, it does, and the authors devote a whole chapter to detailing these costs (pp. 85–107). However, their particular concern is for children and adolescents and, in terms of the book’s primary audience, for those parents who have come to the conclusion that “social and/or medical transition is not the best option for their child.” They are aware, of course, that some parents will (or have) come to a different conclusion. If so, they politely suggest that “this book won’t be likely to help you much,” particularly as the evidence it presents will “steer you away from transitioning your child” (p. xi).

In fact, the authors are unequivocal in their rejection of the basic premise of the (so called) affirmation model of care, which is that “some kids are ‘truly trans’” (p. 16). To the contrary, they write,

we don’t believe there is such a thing as a “trans child”. There is no evidence that children can be born in the wrong body, or that some children are born with an innate gender which is misaligned with their sex. We do know there are some children who suffer from gender dysphoria, and we recognise that medical interventions are offered in the belief that these will alleviate their distress. Nevertheless, it is not possible to change sex. (p. xiv)

This conviction has practical implications, not only therapeutically (as we will see below) but also linguistically. As they explain: “Because we do not believe there is a separate category of people who are innately transgender, we use sex-based pronouns. We refer to children’s sex and not their gender identity, and we do not use terms such as ‘trans boy’, preferring the accurate term ‘trans-identified female’” (p. xiv).

Consistent with this understanding, the authors have little time for gender identity theory, which they define as “the belief that some people have an unknowable, unfalsifiable, inner essence that makes them ‘trans’ and which may require the person to transition before they can be happy” (p. 2). Nor do they find any scientific evidence to support claims that “there is a biological reason for gender-related distress”—e.g., “a female foetus being exposed to too much testosterone” (p. 238). This does not rule out the possibility that certain somatic conditions (e.g., polycystic ovary syndrome or rare disorders of sex development) “may play a role in some young people developing gender dysphoria” (p. 11). But the primary contributors would seem to lie in the social and psychological realms. (To this end, “Appendix 2: Social and Cultural Movements That Can Shape Gender-Related Distress” and “Appendix 6: Common Coexisting Conditions” are valuable additions to the book.)

Accordingly, the authors hold to (what they call) “a developmental model of understanding gender dysphoria.” Behind this is a view of gender as “the social norms associated with being male or female,” norms that “often rely upon regressive stereotyping” but can also be helpful “to categorise group behaviour” (p. 238). While relatively unproblematic for most people, these norms can be confusing for some, especially teenagers who have been “swayed by a combination of queer theory and gender identity theory.” Nevertheless, taking “a holistic view of the individual,” the developmental model is curious about any and all influencing factors that may contribute to a person’s gender-related distress. Therapeutically speaking, then, a developmental approach to gender dysphoria “typically involves learning about how the imposition of gender roles might affect an individual, while building self-awareness, self-acceptance and, perhaps, tolerance of distress” (p. 239).

In terms of the book’s main aim, which is to offer practical parental guidance, this begins in earnest in chapter 4: “Parenting Alternatives to Affirmation.” Here the authors draw an important distinction between acceptance and affirmation, suggesting that there are ways to “meet your child’s gender-nonconformity with acceptance while affirming the reality of biological sex.” Likewise, with teens particularly in mind, they advise: “Apologise for the times when you lost your temper, and take responsibility for things you regret saying. But don’t lie to them” (p. 62). They even suggest language that a parent might find helpful to use with their child, for example:

I know you really want us to use different pronouns. This is something I’ve reflected on a lot, and it just feels inauthentic for me. We have always been honest with each other, and I can’t refer to you in a way that feels like I’m lying to you or being false. (p. 63)

Equally practical is chapter 7: “Dealing with Therapists, Schools, Universities and Other Professionals.” This chapter is necessitated by the sad fact that, right across the world, numerous institutions and health practitioners, “though tasked with supporting the well-being of youth, have adopted contemporary gender beliefs that only confuse kids and exacerbate their vulnerabilities” (p. 108). Consequently, when seeking psychological help, discernment and patience are required, for it is not always easy to find a therapist “who treats your child as an individual rather than a walking gender identity” or who is “aware of the risk of exacerbating rifts in the parent-child dynamic” (pp. 110–11). After providing equally sagacious advice about how to deal with schools and choosing a university, the chapter ends with a timely word on the need for parents to exercise self-compassion and avoid needless self-blame. The fact is this: “A certain type of naïve, socially awkward, cerebral, gullible child is vulnerable to this issue, and it’s important that parents don’t weaken themselves at this crucial time by trawling over the previous twenty or so years worrying about what they did wrong” (p. 122).

Also of particular practical value is chapter 9: “Managing Conflict with Your Child.” Here the authors’ stress on parental authority is welcome, as is their challenge to an excessively responsive approach to parenting that “gives the child too much power, and risks communicating to kids that they can’t tolerate distress” (pp. 142–43). Along with counsel on how to navigate conflict with prepubertal children, adolescents, and adult children, the chapter concludes with a calm and clarifying section on suicidality. Here the authors expose the harms caused by exaggerated statistics and alarmist rhetoric. The truth is that “suicidality among trans-identifying teens is only slightly higher than rates among youths referred to clinics for other mental health difficulties” (p. 155). While this is still a cause for concern, there is “no robust evidence that transition reduces suicidality in the long term” (p. 156). Mercifully, however, there is a range of other more effective (and less destructive) strategies, which the book goes on to outline, that are known to encourage “stability, capacity and resilience” in a depressed person’s life (p. 157). The take-home for parents is this: “if you have been told by a professional that your child may kill herself if you do not allow her to access transition interventions, you have been misinformed and your parental authority has been stripped from you” (p. 156).

The authors are painfully aware that not all conflicts resolve happily and that in the attempt to manage a child’s declaration of a trans identity many parent-child relationships are damaged. Indeed, where this damage is significant, it is not uncommon for trans-identified young adults to cut off contact with one or both of their parents—at least for a time. Hence the importance of chapter 11: “Alienation and Estrangement.” After defining and distinguishing these terms and an illuminating discussion of the “factors at play in cases of estrangement” (including the reality of “indoctrination” and “online radicalisation” [p. 178]), the authors ask how estrangement might best be addressed. Drawing on the work of estrangement expert Jonathan Coleman, they commend various strategies, including writing an amends letter, and provide a helpful list of dos and don’ts (see p. 186). However, the authors do not want to be overly prescriptive, as the history and dynamics of each parent-child relationship are unique. Consequently, they write, “As with all suggestions in this book, we recommend that you take what you need and leave the rest” (p. 188).

The book’s latter chapters cover the realities of “Desistance” (ch. 12), “Detransition” (ch. 13), and an answer to the question, particularly poignant for some parents, “How to Row Back After Affirmation” (ch. 14). The final chapter, titled “It’s Not Really About Gender” (ch. 15), looks behind the curtain to see what is actually driving the gender crisis—at least for many young people. Here the authors identify “the seductive idea that a single solution will resolve our painful and difficult problems,” the desire to feel like part of a tribe—“especially during adolescence and young adulthood,” and the perennial need for teenagers to differentiate themselves from their parents. The problem, however, is that while the “adoption of a transgender identity, and social and medical transition, offer adolescents a prefabricated, easily accessible and culturally salient way to individuate,” the solution is a “maladaptive” one, “with potentially long-term consequences” (pp. 228–29). Nonetheless, the authors believe there is hope even for those parents whose children have chosen to medicalise their identities, for “living inauthentically is unsustainable for our mental well-being.” Therefore, although there are no guarantees, they are confident that, “at some point, something will shift” (p. 232). In the meantime, parents need to learn to love wisely and to wait patiently. To this end, the chapter concludes on this sobering yet fortifying note:

This is an unfolding medical scandal. You, your child and society are in the middle of a process. Few of us understand what’s going on, and none of us know where this is going. You and your family have been caught up in something larger, an enormous maelstrom from which it is difficult to emerge with your sanity intact. For many parents, this will be the hardest experience you’ve ever faced. This journey may alter the way you understand the world. It may test your strength and courage. Facing this test will require an act of heroism. (p. 233)

Christians, of course, know precisely where to turn for the strength we need to face such a test: “be strong in the Lord and in the strength of his might” (Eph 6:10). Nevertheless, there are many reasons to be grateful for When Kids Say They’re Trans and for the courage and compassion of its authors. The fact that they do not share our faith does not diminish its helpfulness, nor is it a barrier to believers benefitting from the wisdom it contains. In my judgment, it is a timely gift of God’s common grace, and we have every reason to “spoil the Egyptians” in this instance.