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Maryhope Howland gave birth to a baby she thought was a boy. But at 6 years old, the child asked her questions such as “Mom, am I a boy? How do you know I’m a boy?”

“Once I clued in, I said, ‘The doctors make a best guess based on your body … but only you can know, and we love you no matter what,’” said Howland, now co-lead for the Families United for Trans Rights, an organization of transgender kids and their loved ones.

Her child’s questioning didn’t stop there. It marked the beginning of a yearslong evolution not just for her daughter, who came out as nonbinary at age 8 and transgender at 10. It was also a journey for Howland and her husband as they navigated what it means to be trans, ways of affirming their daughter’s gender identity, their responsibilities as parents, and the grief associated with “letting go of one idea of what our life is going to be,” Howland said.

“One of the hardest things for us to do as parents is pause when that vision gets interrupted and really listen to what our kiddos are saying to us,” said Nova Bright-Williams, a trans woman who is head of internal training at the Trevor Project, a suicide prevention and crisis organization for LGBTQ+ youth.

Listening to a child’s experience can be difficult for many parents, regardless of their political or religious beliefs.

But there’s good reason to try. “Research is constantly showing that LGBTQ young people report lower rates of attempting suicide when they have access to affirming spaces, communities (and) adults,” Bright-Williams said.

CNN spoke with a doctor, gender rights activists and parents of trans children about what to say when a child comes out as transgender, how to address certain challenges and what receiving gender-affirming care is like. Here’s what they want you to know.

The Rev. Rachel Cornwell’s child, Evan, was assigned female at birth and had been showing aversion to the trappings of girlhood. When Cornwell asked Evan at age 4 if he were upset he was born a girl, Evan’s answer shocked her: “Yes, Mommy. I told God when I was a star in the sky that I was a boy, but God made me a girl, and now I just have to live with it.”

“It seemed that my child knew something very deep and true about himself, and that he had an awareness of how his identity was also wrapped up in his relationship with God,” Cornwell, a pastor at Dumbarton United Methodist Church in Washington, DC, and author of “Daring Adventures: Helping Gender-Diverse Kids and Their Families Thrive,” said via email. “We started to go to therapy as a family and just after Evan turned 6, he decided that he wanted to use male pronouns and a new name, at first just at home.”

Cornwell initially felt surprised, and she feared for Evan’s well-being, which is common for many parents, experts said. But these discussions can also create a moment of joyful bonding for families, said Dr. Kade Goepferd, medical director of gender health at pediatric health system Children’s Minnesota.

It’s also common for a child’s revelations about gender identity to provide a sense of clarity and relief for parents who have been witnessing behavioral and mood issues for which they couldn’t pinpoint a cause, Goepferd added.

Other parents have always noticed their child has never quite fit into gendered expectations and feel the conversation is a confirmation. That was the case for Cornwell, whose son had preferred typical boys’ clothes, hairstyles and activities since preschool. He had also started to ask when he would develop breasts and said that whenever he did, he was going to cut them off.

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Some parents want to support their child but worry if their gender identity is the result of a phase, or if they’ll change their mind later. But the consensus of those interviewed is that even if a child changes their mind one day — which is rare — that’s OK. It would be their decision resulting from the exploration of their gender identity, rather than someone trying to control it for them.

“There’s really no harm in ever affirming or loving our kids when they share with us who they are,” Goepferd said. “The harm really can only come if we refuse to listen or acknowledge the truth that they’re sharing with us and how vulnerable they’re being.”

Rejecting them could not only cause hurt and anger but also could ruin chances of a long-term relationship. Therefore, when your child tells you they’re trans, your first response should be to thank them for sharing and learning about their experience, Bright-Williams said. Say you want to get to know more about this part of who they are. Ask how long they’ve known this about themselves, who else they’ve shared their identity with and how you can support them.

Jocelyn Rhynard’s son, then 15, told his family he was nonbinary by frosting a cake he’d baked with the phrase “I am NB.” “I was like, ‘That’s awesome. Congratulations,’” she said.

Rhyland’s son later realized he is trans masculine nonbinary and uses he/him pronouns, and he’s OK with Rhyland calling him her son. (Trans masculine nonbinary means someone’s gender identity is nonbinary, yet they present in a typically masculine fashion with their name, style and more.)

If you feel fear, concern, bias or grief, process that away from your child, said experts and parents, who also emphasized the importance of learning about transness by doing your own research. Don’t rely solely on your child to guide you.

Not every transgender person feels the need for any or all forms of changing their gender expression or their body, experts said. When older children come out, they typically already have chosen a new name, pronouns and more.

But if your child isn’t sure what support or changes they need, you can have conversations over time about what stylistic choices, hobbies and toys help them feel most like themselves, Bright-Williams said. Many children aren’t in a rush to make these changes, experts and parents said — some experiment at home for a while before debuting a new style or name at school, for example.

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Once kids reach adolescence, some experience distress over their body nearing or going through pubertal changes — which can be relieved by puberty blockers that temporarily put a pause on these developments.

One thing that helped Howland feel more comfortable with her daughter starting puberty blockers at age 12 was realizing that withholding them would not be a neutral decision, since puberty is permanent — which could have negative consequences for a child who doesn’t identify with that body.

The response from Howland’s family and friends was one of support, she said. But Rhynard, a descendant of “some of the very first Mormons,” didn’t have that experience.

“It has been difficult for our extended family, some more than others,” Rhynard said. “Some of the family members have been accommodating, and they have tried their best to use different pronouns, but they still get it wrong a couple years later.”

Rhynard and her husband have had to have some really difficult conversations in which “we’ve said, ‘Our child comes first, and we would love for you to be a part of our lives, but you can’t call them by their dead name. It is too painful for them,’” she added.

Their parenting philosophy is based on humility, learning and growing, but they realized they can’t make everyone learn and grow with them. While some family relationships have become strained, Rhynard knows her responsibility is to her children.

“If we centered them in the conversation about our child, we would no longer be centering our child, the most vulnerable person in our family and the person that we’re lucky enough to raise,” Rhynard added.

For parents struggling with complicated family relationships, Goepferd recommends finding support from another parent of a transgender child, a trustworthy friend or an understanding church leader. Organizations such as the Human Rights Campaign and PFLAG have resources for how to talk about your child’s identity with loved ones and their school.

“We, as a society, put a lot of pressure on appearance and how other people perceive us,” Bright-Williams said. But parents have the burden of shouldering that pressure so their kids don’t have to.

“Maybe your child is biracial and some people in your family have a problem with that,” she said. “Would you want them to experience that type of bias or hate, or would you protect or shelter them from that? It is up to you to create a safe and affirming space for your child.”

These parents have said their kids are doing well, and that their support has led to strengthened, more trustful relationships with them. Howland, Rhynard and Cornwell all said they have also changed — they’re more accepting, open-minded and confident in protecting their families.

“She’s great,” Howland said of her daughter, but “we keep waiting for the world to rear its ugly head on her. She is aware that trans people are a political lightning rod. Sometimes she says things that break my heart, like ‘There are people who hate me,’ or ‘There are people who wish I didn’t exist.’”

Howland and her husband know they can’t shield their daughter from every news story or potential bully. “Desperately afraid about my child not having federal civil rights protections in this country,” Howland said she even has a spreadsheet of what countries they could move to if they had to one day.

To make her daughter aware and prepared, she has exposed her to the issues in as positive of a context as she can — such as the time she took her to a recent fundraiser for Sarah McBride, a Delaware-based trans woman who is the nation’s first known transgender person to serve as a state senator and who is now running for Congress.

“I say to her that it’s my job to carry that right now, not hers,” Howland said. “And that she’s safe and that we will always do everything we can to protect her.”

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