June is Pride Month: a time to raise awareness of the issues facing the LGBTQ+ community and to encourage inclusiveness. It’s also a time for parents and others to educate themselves about the differences between a person’s biological sex, gender and sexuality, and how understanding these differences can help them support and affirm sexual and gender minority youth (SGMY). As June comes to a close, it is important to remember that education on LGBTQ+ health is an ongoing process that can last all year long.

Differentiating between sex, gender identity, gender expression, and sexual orientation


At birth, babies are assigned a sex, traditionally either “male” or “female,” based on their external organs. As a profession and a society, we’ve come to understand that a person’s “sex” doesn’t always align with the gender with which that person will eventually most identify.

Gender identity

Gender identity refers to a person’s internal sense of oneself, which can differ from a person’s assigned sex at birth. Usually by the age of 4 and 5 years old, most children are able to tell you their gender identity. A child’s gender identity may also change as they progress through normal adolescent development, with influence and enlightenment from their social, cultural and ethnic influences and through their own self-reflection.

In terms of children affirming their gender identity, we typically look for three things: they are insistent, persistent and consistent. This can be applied to any child along the gender diverse spectrum. Being aware of this, supporting your children where they are and allowing them to change as they grow into themselves is key.

Gender expression

It is important to understand that a child’s gender identity does not dictate how they express their identity to the outside world. Gender expression refers to how one expresses themself to the outside world. Gender can be expressed in many different ways – from the types of clothing we wear, the hairstyles we adopt, to the different behaviors and mannerisms we express. These expressions exist along a spectrum and are influenced by society, culture and historical timeframe.

Sexual orientation

By the time your child becomes a teen or begins puberty, they may start to have an interest or attraction towards someone else – which can be physical, emotional or romantic. A person’s sexual orientation cannot and should not be assumed based on their gender. It is a normal part of development for teens and adolescents to explore these attractions and interests. Youth may have fantasies or explore possibilities of being with a person of the same sex. This doesn’t necessarily mean that they identify as gay or lesbian. When your child comes to you, you can show your support by listening to your child in a non-judgmental manner and avoiding placing expectations on how they should act and behave.

The importance of support

Adolescence can already be a stressful and confusing time, so it is important that children and adolescents feel loved and accepted for who they are and who they will become. Studies have shown that parental rejection is directly linked to negative health outcomes for sexual and gender minority youth – such as increased rates of depression, substance abuse and engaging in high-risk sexual behaviors. It is also important to consider mental health in these situations. As parents, you should watch for signs of depression, bullying and anxiety which can be caused by suppressed feelings in fear of stigmatization or judgment. When parents approach youth in a nonjudgmental manner and are open to hearing their perspectives, they set the stage early for open dialogue about topics of this nature.

There is no one specific way to support your child, you should nurture them in their development as you would any other child. At the end of the day, with the love and care from a parent, these youth can live just as happy and fulfilling lives as their peers.

Ways parents can support their child or teen

  • Accept your child or teen for who they are and do not feel obligated to change them.
  • Educate yourself.
  • Talk to your child about how they feel.
  • Read books showing men and women in non-stereotypical and diverse gender roles. Look for books about different gender identities.
  • Talk to their teachers about how they can support your child.
  • Watch for signs of depression or bullying and seek advice from your pediatrician.
  • Encourage your child to form strong friendships.

Resources for parents and their children or adolescents


Joseph Waters Joseph H. Waters, MD, is an adolescent specialist at Children's National Hospital.

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