ABSTRACT

Objective

To analyze the social network of mothers, fathers or guardians of transgender children or adolescents.

Methods

This was a qualitative study, based on the theoretical framework of social network, with a focus on the primary network. The study was conducted in Brazil through online interviews between August and October 2021. A total of 30 mothers, two fathers and one grandmother of transgender children or adolescents participated in the study. The thematic content analysis was performed using IraMuTeQ software.

Results

The theme “The family as the center of the network and the challenges in achieving transgender autonomy” emerged from the analyses. The family was identified as the first network, bearing the greatest responsibility. Weak and conflicted ties with relatives, friends, classmates and neighbors, highlighting the role of men.

Conclusion

The networks showed limitations in providing support and the need for strengthening. The analysis is an important tool for improving care, structuring policies and developing transgender-specific care pathways.

Palabras clave
Red Social; Personas Transgénero; Identidad de Género; Niño; Adolescente

Study contributions

Main results

The support networks of these families, especially the immediate family, play a significant role, but also show vulnerabilities, such as conflicting bonds and a lack of adequate support from other community members.

Implications for services

A more structured and specific approach to supporting families of transgender children and adolescents is essential. Health services should enhance family support, provide tailored assistance, and train healthcare professionals to effectively care for this population.

Perspectives

Future research should investigate interventions that minimize conflicts and strengthen bonds, in addition to evaluating the impact of trans-specific policies on the autonomy and well-being of transgender children and adolescents, thereby guiding the development of more inclusive public policies.

Palabras clave
Red Social; Personas Transgénero; Identidad de Género; Niño; Adolescente

RESUMEN

Objetivo

Analizar la red social de madres, padres o responsables de niños y adolescentes transgénero.

Métodos

Se trata de un estudio cualitativo, basado en el marco de referencia de la red social, con enfoque en la red primaria. El estudio se llevó a cabo en Brasil a través de entrevistas en línea entre agosto y octubre de 2021. Participaron 30 madres, dos padres y una abuela de niños, o adolescentes transgénero. Se realizó un análisis de contenido temático con la ayuda del software IRaMuTeQ.

Resultados

El tema “La familia como centro de la red y los desafíos para alcanzar la autonomía trans” surgió a partir de los análisis. La familia se configuró como la primera red, con una mayor responsabilidad. Se revelaron vínculos frágiles y conflictivos con familiares, amigos, colegas y vecinos, destacando la figura del hombre.

Conclusión

Las redes presentaron limitaciones en el apoyo y la necesidad de fortalecimiento, siendo el análisis una herramienta importante para la asistencia, la estructuración de políticas y la implementación de una línea de atención específica para personas trans.

Palabras clave
Red Social; Personas Transgénero; Identidad de Género; Niño; Adolescente

INTRODUCTION

The challenges faced by guardians of transgender children or adolescents, or trans, initially involved the process of recognizing transgenderness. This lack of knowledge can lead to experiences of denial and transphobia, enhanced by feelings of doubt, helplessness in the face of challenges, fear, sadness and guilt.¹1 Jesus JG. Orientações sobre identidade de gênero: conceitos e termos - guia técnico sobre pessoas transexuais, travestis e demais transgêneros, para formadores de opinião. 2nd ed. Brasília: Escritório de Direitos Autorais da Fundação Biblioteca Nacional – EDA/FBN; 2012.

2 Wahlig JL. Losing the child they thought they had: therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child. J GLBT Fam Stud. 2015; 11(4): 305-326. doi: 10.1080/1550428X.2014.945676
https://doi.org/10.1080/1550428X.2014.94... -³3 Alegría CA. Supporting families of transgender children/youth: parents speak on their experiences, identity, and views. Int J Transgend. 2018; 19(2): 132-143. doi: 10.1080/15532739.2018.1450798
https://doi.org/10.1080/15532739.2018.14... These feelings can also be associated with the experience of “ambiguous loss”, which is understood as the psychological and identity loss of a person who is still physically present.⁴4 Boss P. The context and process of theory development: the story of ambiguous loss. J Fam Theory Rev. 2016; 8(3):269-286. doi: 10.1111/jftr.12152
https://doi.org/10.1111/jftr.12152...

Gender identity can change existing family bonds. Recognition by guardians requires closer connections to the lived experiences of their peers. It is essential to exchange knowledge and experiences with other guardians, to have support of family and friends, to access knowledge produced by research as well as policies that ensure the rights and inclusion of their children.⁵5 Rilei EA, Sitharthan G, Clemson L, Diamond M. Recognising the needs of gender-variant children and their parents. Sex Educ. 2013; 13(6):645-659. doi: 10.1080/14681811.2013.796287
https://doi.org/10.1080/14681811.2013.79...

Social networks are formed by the interweaving of interpersonal bonds, where synergistic interactions take place. Primary social networks involve interpersonal relationships consisting of family, kinship, friendship, neighborhood and work ties, which provide support or containment. Secondary networks, on the other hand, can be informal or formal and include third-sector or non-profit institutions and market-based entities.⁶6 Sanicola L. As Dinâmicas de Rede e o trabalho social. 2nd ed. São Paulo: Veras; 2015.

This study focuses on the primary social network, due to the complexity and depth of existing ties and relationships. Families of transgender people often face rejection, disapproval and social isolation, along with psychological and physical burdens, in addition to a lack of informational support regarding social and health rights, health care and advocacy.⁷7 Abreu PD, Andrade RLP, Maza ILS, Faria MGBF, Nogueira JÁ, Monroe AA. Dynamics of primary social networks to support mothers, fathers, or guardians of transgender children and adolescents: a systematic review. Int J Environ Res Public Health. 2022; 19(13):7941. doi: 10.3390/ijerph19137941
https://doi.org/10.3390/ijerph19137941...

This study aimed to analyze the primary social network of mothers, fathers or guardians of transgender children or adolescents, motivated by the following guiding questions: What are the characteristics of the structure of the primary social network of mothers, fathers or guardians of transgender children and adolescents? What are its functions and dynamics?

METHODS

This was a qualitative, descriptive and exploratory study based on the analysis of social network dynamics.⁶6 Sanicola L. As Dinâmicas de Rede e o trabalho social. 2nd ed. São Paulo: Veras; 2015. This report follows the guidelines of the consolidated criteria for reporting qualitative research.⁸8 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Heal Care. 2007; 19(6): 349-357. doi: 10.1093/intqhc/mzm042
https://doi.org/10.1093/intqhc/mzm042...

This study was conducted at a national level and supported by the National LGBT Alliance, the non -governmental organization (NGO) Mothers for Diversity and the National Association of Transvestites and Transsexuals (Associação Nacional de Travestis e Transexuais – ANTRA); the Transgender Care and Support Space at the Hospital das Clínicas /Pernambuco state; and the Comprehensive Care Center for Black and LGBT Population/Jaboatão dos Guararapes/Pernambuco state, and T Outpatient Clinic for Transgender People in Porto Alegre, Rio Grande do Sul, state. These services have interdisciplinary teams working in management, healthcare and social movement actions. These teams provide health education, conduct research, produce materials and offer support to transgender people and their families.

Mothers, fathers or guardians of transgender children and adolescents living in the states of Ceará, Pernambuco, São Paulo, Espírito Santo, Minas Gerais, Paraná, Rio de Janeiro, Rio Grande do Sul, and the Federal District took part in this study.

People up to 9 years of age were considered children. Those between 10 and 19 years of age were considered adolescents.⁹9 Brasil. Ministério da Saúde. Secretaria de Atenção em Saúde. Departamento de Ações Programáticas Estratégicas. Diretrizes nacionais para a atenção integral à saúde de adolescentes e jovens na promoção, proteção e recuperação da saúde. Brasília: Ministério da Saúde; 2010.

Data collection took place between August and October 2021. Participants were selected using the snowball sampling technique, aimed at reaching a hard-to-access population due to the significant social stigma and cultural, social and historical barriers that disregard the existence of transgender people and outline transphobia. ¹⁰10 Sampieri RH, Collado CF, Lucio MPB. Amostragem na pesquisa qualitativa. In: Sampieri RH, Collado CF, Lucio MPB. Metodologia de Pesquisa. 5th ed. Porto Alegre: Penso; 2013. p. 401-412.,¹¹11 Biernacki P, Waldorf D. Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res. 1981; 10(2): 141-63. doi: 101177/004912418101000205
https://doi.org/101177/00491241810100020...

Initial contact was made with professionals or representatives from organizations that supported the study; they made recommendations and shared the interview scheduling forms with potential respondents. Individuals identified comprised the zero wave and, given the difficulty in accessing this target population, referred other participants to comprise the subsequent waves. There were four participants withdrew after three contact attempts.

The characterization tool and interview guide were validated by experts, researchers, and professionals with experience with transgender people and their families. A pre-test was also conducted, via self-completion, with eight people. Two of these participants had their pre-tests included after agreeing to participate in the video interview via Google Meet, and recorded by the researchers.

Participants received the informed consent form and the characterization form via WhatsApp, which they completed on the previously agreed day and time. After signing the consent form, interviews were conducted via Google Meet by trained researchers. The interviews lasted approximately one hour.

Social network exploration involved the construction of maps for didactic visualization of the network components and established ties, called Rousseau’s map.⁶6 Sanicola L. As Dinâmicas de Rede e o trabalho social. 2nd ed. São Paulo: Veras; 2015.

We decided to build the map after the interviews, based on participants’ verbalized responses, who provided the necessary information . The participants received a summary of the responses and the map of their social network including descriptions and legends, in order to validate the information collected.

Individual interviews were conducted. Audio and/or video were recorded and the interviews were fully transcribed, and pseudonyms (flower species) were used to protect the participants identities. The empirical material was organized according into three dimensions: structure, function and dynamics, with an emphasis on the most prominent network components.

The construction of the social network structure of the study participants based on network components, ties and indicators was carried out in five steps: (i) synthesis of information; ( ii ) construction of Rosseau’s maps; (iii) validation by participants; (iv) identification of indicators; and (v) construction of a consolidated map.

The Rosseau’s map was designed to enable the visualization of the social network structures, through the analysis of the function and dynamics of primary and secondary networks, considering ties and bonds established.

The analysis of function and dynamics required a complementary in-depth analysis of the text corpus using the maps and statements, which were subjected to thematic content analysis. A floating reading of the corpus was then performed, which was organized according to the responses of all participants.¹²12 Bardin L. Análise de Conteúdo. 4th ed. Lisboa: Edições 70; 2013.

13 Mendes RM, Miskulin RGS. A análise de conteúdo como uma metodologia. Cad Pesqui. 2017; 47(165): 1044-66. doi: 10.1590/198053143988
https://doi.org/10.1590/198053143988... -¹⁴14 Camargo BV, Justo AM. IRAMUTEQ: um software gratuito para análise de dados textuais. Temas Psicol. 2013; 21(2): 513-8. doi: 10.9788/TP2013.2-16
https://doi.org/10.9788/TP2013.2-16...

The corpus was analyzed using the Interface de R pour les Analyses Multidimensionelles de Textes et de Questionnaires (IRaMuTeQ) software version 0.7, which provided hierarchical descending classification, displayed in a dendrogram.¹⁴14 Camargo BV, Justo AM. IRAMUTEQ: um software gratuito para análise de dados textuais. Temas Psicol. 2013; 21(2): 513-8. doi: 10.9788/TP2013.2-16
https://doi.org/10.9788/TP2013.2-16... Lexical analysis was also performed to complement the content analysis.¹⁵15 Sampaio RC, Lycarião D. Análise de conteúdo categorial: manual de aplicação. Brasília: Enap; 2021. The classes obtained from the analyses were interpreted to define the thematic axes. The thematic axes were condensed into thematic categories and the inductive analysis was performed, following the social network dynamics method.⁶6 Sanicola L. As Dinâmicas de Rede e o trabalho social. 2nd ed. São Paulo: Veras; 2015.

The project was submitted to and approved by the Research Ethics Committee of the Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Opinion No. 4,567,837, on March 2, 2021, 30405720.4.0000.5393.

RESULTS

Thirty mothers, two fathers and one grandmother of trans children and adolescents, with an average age of 46 years, took part in the study. Thirteen had a postgraduate degree; eleven had completed higher education; six had incomplete higher education; two had completed high school; and one had incomplete technical education.

In total, 33 individual maps, comprised of primary networks, were developed and analyzed (Figure 1).

The text corpus was divided into 1,681 text segments, comprising 4,553 words that occurred 58,416 times. The descending hierarchical classification retained 86.5% of the total text segments, aggregated into five classes (Figure 2). These classes were grouped into two thematic categories following thematic analysis: “Family as the center of the network and the challenges to achieving transgender autonomy” (Classes 5, 4 and 1) and “Strengths and weaknesses of secondary networks for comprehensive health care” (Classes 2 and 3).

It could be seen that the guardian-child/adolescent transgender social configuration forms the first network of responsibility and affection for the transgender person. This network is not composed by choice but serves a function of dependency for care and protection. The bonds established in this binomial showed shared strengths and weaknesses in the challenges related to the recognition of gender identity, with the nuclear family being the center of the social network, which will be presented below.

It was found that normality relationships between some members of the primary network were evident among those who reacted naturally in the family contexts in which transgenderism had been disclosed.

The statements also reveal that being a transgender person became a reference for other relatives in similar situation to disclose their own gender identity and/or sexual orientation, becoming a source of pride (Box 1).

It is worth highlighting the testimony of a father who changed his work routine to provide care for his transgender son. The father actively participated in peer groups, contributed to research, collected literature on the subject and took part in scientific events and policy-making meetings, aimed to acquire information and contribute to support strategies, as well as understand his role, receive support and support his son (Box 1).

Strong bonds were identified primarily in the mother figure’s role in supporting the child, which facilitated connections with other transgender people and strengthened friendship bonds that had initially been interrupted.

Strong bonds were also identified in relationships between a few close friends and family members of transgender children – who responded naturally to the recognition of their descendant’s gender identity.

The social networks were small – comprising up to nine members - with few members of the network interacting with each other to provide support.⁶6 Sanicola L. As Dinâmicas de Rede e o trabalho social. 2nd ed. São Paulo: Veras; 2015. Despite being limited, the support proved relevant, even enabling other family members to reveal their own LGBT+ identity. (Box 1).

Fragile bonds​ were described in relationships with family, friends, relatives and colleagues as potential bonds to be interrupted. Distancing, neglect and emotional restraint were more frequently observed, particularly in the figure of the cisgender man (Box 1).

It could be seen that conflictual ties were motivated by situations of transphobia, rather than recognition of gender identity. These also converged towards severed, broken and discontinuous ties. The normalization of recognizing transgender identity was more evident among transgender and cis children in the school and neighborhood context. Children appeared more cohesive, as they did not question transgenderism as adults did. However, other parents expressed transphobic behaviors regarding the trans friends of their cisgender children, with an impact on education and the tendency towards transphobia (Box 1).

The recognition of gender identity was a critical point in alliances and transgressions within the dynamics of primary social networks, being decisive in the construction or breakdown of support and advocacy behaviors. The “social transition” of the transgender child or adolescent culminates in the “family transition” within a mutual context of resistance and struggle.

DISCUSSION

The analysis of the social network of guardians of transgender children and adolescents adds a complex layer to discussions about policies and care, with a strong presence of the role of parents or guardians in the latter. Legal guarantees, such as the right to a social name and anti-discrimination laws, have enabled progress. Similarly, the expansion of health services, psychological support for transgender people and their families, and the strengthening of social networks at various levels have been fundamental in promoting adequate inclusion and support.¹⁶16 Abreu PD, Palha PF, Andrade RLP, Almeida SA, Nogueira JA, Monroe AA. Integral health care for transgender adolescents: subsidies for nursing practice. Rev Latinoam Enferm. 2022; 30(spe): e3810. doi: 10.1590/1518-8345.6276.3810

Guardians of transgender children and adolescents represent the center of the social network in providing affection and care, ties that are crucial for building other relationships within the social network. The nuclear family is often exposed to hostility and harassment from relatives¹⁷17 Riley EA, Sitharthan G, Clemson L, Diamond M. Recognising the needs of gender-variant children and their parents. Sex Educ. 2013; 13(6): 644-59. doi: 10.1080/14681811.2013.796287
https://doi.org/10.1080/14681811.2013.79... ,¹⁸18 Rabain NS. Why multi-family groups for transgender adolescents and their parents? Front Sociol. 2020; 5: 628047. doi: 10.3389/fsoc.2020.628047
https://doi.org/10.3389/fsoc.2020.628047... and neighbors.¹⁸18 Rabain NS. Why multi-family groups for transgender adolescents and their parents? Front Sociol. 2020; 5: 628047. doi: 10.3389/fsoc.2020.628047
https://doi.org/10.3389/fsoc.2020.628047...

Recognition of gender identity was found to be permeated by denial and doubt. The “social transition” of the transgender person was also permeated by a “family transition” according to the participants in this study, also understood as recognition. For them the term “transition” highlights the stages before and after the recognition and disclosure of gender identity. These stages can be considered critical moments for the consolidation of bonds.

The decision to support their transgender descendants sometimes resulted in the potential loss of friends³3 Alegría CA. Supporting families of transgender children/youth: parents speak on their experiences, identity, and views. Int J Transgend. 2018; 19(2): 132-143. doi: 10.1080/15532739.2018.1450798
https://doi.org/10.1080/15532739.2018.14... ,¹⁹19 Riley EA, Sitharthan G, Clemson L, Diamond M. The needs of gender-variant children and their parents: a parent survey. Int J Sex Health. 2011; 23(3): 181-95. doi: 10.1080/19317611.2011.593932
https://doi.org/10.1080/19317611.2011.59...

20 Testoni I, Pinducciu MA. Grieving those who still live: loss experienced by parents of transgender children. Gend Stud. 2019; 18(1):142-162. doi: 10.2478/genst-2020-0011
https://doi.org/10.2478/genst-2020-0011...

21 Pyne J. “Parenting is not a job… it’s a relationship”: Recognition and relational knowledge among parents of gender nonconforming children. J Progress Hum Serv. 2016; 27(1): 21-48. doi: 10.1080/10428232.2016.1108139
https://doi.org/10.1080/10428232.2016.11...

22 Dangaltcheva A, Booth C, Moretti MM. Transforming connections: A trauma-informed and attachment-based program to promote sensitive parenting of trans and gender non-conforming youth. Front Psychol. 2021. 12: 643823. doi: 10.3389/fpsyg.2021.643823
https://doi.org/10.3389/fpsyg.2021.64382...

23 Sansfaçon AP, Kirichenko V, Holmes C, Feder S, Lawson ML, Ghosh S, et al. Parents’ journeys to acceptance and support of gender-diverse and trans children and youth. J Fam Issues. 2020; 41(8): 1214-36. doi: 10.1177/0192513X19888779
https://doi.org/10.1177/0192513X19888779... -²⁴24 Szilagyi N, Olezeski CL. Challenges in providing care for parents of transgender youth during the coronavirus pandemic. Smith Coll Stud Soc Work. 2021; 91(2): 85-114. doi: 10.1080/00377317.2021.1878083
https://doi.org/10.1080/00377317.2021.18... and recurring challenges in maintaining bonds with friends, family, and neighbors.²⁰20 Testoni I, Pinducciu MA. Grieving those who still live: loss experienced by parents of transgender children. Gend Stud. 2019; 18(1):142-162. doi: 10.2478/genst-2020-0011
https://doi.org/10.2478/genst-2020-0011...

In this study, the limited participation of fathers may indicate lesser involvement of the father figure in the functions of taking responsibility for the care of descendants. Weaknesses in support were more frequent in male relatives, such as fathers, partners and paternal family members.²⁵25 Katz-Wise SL, Galman SC, Friedman LE, Kidd KM. Parent/caregiver narratives of challenges related to raising transgender and/or nonbinary youth. J Fam Issues. 2021;43(12): 3321-45. doi: 10.1177/0192513X211044484
https://doi.org/10.1177/0192513X21104448...

The mother figure sometimes needs to recognize the gender identity of the child in advance to strengthen the dialogue with the extended family.²⁶26 Kuvalanka KA, Weiner JL, Mahan D. Child, family and community transformations: findings from interviews with mothers of transgender girls. J GLBT Fam Stud. 2014; 10(4): 354-79. doi: 10.1080/1550428X.2013.834529
https://doi.org/10.1080/1550428X.2013.83... This study and the literature also show that mothers have a greater physical, emotional and organizational burden,²⁷27 Carlile A. The experiences of transgender and non-binary children and young people and their parents int healthcare settings in England, UK: interviews with members of a family support group. Int J Transgend Health. 2019; 21(1): 16-32. doi: 10.1080/15532739.2019.1693472
https://doi.org/10.1080/15532739.2019.16... Given that their position is considered a reference point for decisions that impact relationships. In addition, discouragement and conflicts with other generations, such as grandparents,²¹21 Pyne J. “Parenting is not a job… it’s a relationship”: Recognition and relational knowledge among parents of gender nonconforming children. J Progress Hum Serv. 2016; 27(1): 21-48. doi: 10.1080/10428232.2016.1108139
https://doi.org/10.1080/10428232.2016.11... ,²⁸28 Hill DB, Menvielle E. “You have to give them a place where they feel protected and safe and loved”: the views of parents who have gender-variant children and adolescents. J LGBT Youth. 2009; 6(2-3): 243-71. doi: 10.1080/19361650903013527
https://doi.org/10.1080/1936165090301352... as well as friends or family members, who believed that providing support could contribute to significant harm to the child, were evident.²⁴24 Szilagyi N, Olezeski CL. Challenges in providing care for parents of transgender youth during the coronavirus pandemic. Smith Coll Stud Soc Work. 2021; 91(2): 85-114. doi: 10.1080/00377317.2021.1878083
https://doi.org/10.1080/00377317.2021.18...

In this and other studies, the approach of guardians to transgender people resulted in strengthened bonds of friendship, emotional and informational support. Knowledge building was more expressive through peer-to-peer knowledge exchange and less evident in bonds with healthcare professionals, as they did not know how to address transgender-specific needs.⁷7 Abreu PD, Andrade RLP, Maza ILS, Faria MGBF, Nogueira JÁ, Monroe AA. Dynamics of primary social networks to support mothers, fathers, or guardians of transgender children and adolescents: a systematic review. Int J Environ Res Public Health. 2022; 19(13):7941. doi: 10.3390/ijerph19137941
https://doi.org/10.3390/ijerph19137941...

This study highlights the fragility of bonds between the components of the social network due to the lack of recognition and information about transgender people. In this sense, in the health field, knowledge production for health education can be done through: books and stories about gender identity of transgender children and their families; research; guidelines and strategies for transgender people and their families, and it is essential that they are available not only online, but also in physical spaces with public access.¹⁷17 Riley EA, Sitharthan G, Clemson L, Diamond M. Recognising the needs of gender-variant children and their parents. Sex Educ. 2013; 13(6): 644-59. doi: 10.1080/14681811.2013.796287
https://doi.org/10.1080/14681811.2013.79... Informational support for guardians has been more evident in relationships with gay or transgender friends.²⁹29 Frigerio A, Montali L, Anzani A, Prunas A. “We’ll accept anything, as long as she is okay”: Italian parents’ narratives of their transgender children’s coming-out. J GLBT Fam Stud. 2021;17(5): 432-49. doi: 10.1080/1550428X.2021.1932005
https://doi.org/10.1080/1550428X.2021.19... -³⁰30 Lorusso M, Albanesi C. When the context rows against. Voicing parents of transgender children and teenagers in Italy: a qualitative study. J Community Appl Soc Psychol. 2021; 31(6): 732-48. doi: 10.1002/casp.2518
https://doi.org/10.1002/casp.2518...

The inclusion of participants linked to civil society support networks may have suppressed the experience of those who do not recognize the gender identity of their descendants, and represents an important limitation of this study. The family perspective may have excluded the context of transgender children and adolescents living in shelters and potential participants who are not linked to NGOs.

The primary social network showed ineffective support with limited support and need for strengthening. This analysis is an important tool for structuring policies, care pathways, and educational technologies aimed at comprehensive care within the context of primary healthcare, with an emphasis on the family and its social network. The purpose is to design individualized projects aimed at transgender health from childhood.

The networks presented limited support to guardians of transgender children and adolescents and needed to be strengthened. The analysis of bonds between network components is an essential tool for planning care and health actions, structuring policies, and constructing a trans-specific care pathway.

REFERENCES

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