Living in Pain and Stigma: A Look at Lived Experiences of Mothers with Transsexual Adult Children

Article information

J Korean Acad Psychiatr Ment Health Nurs. 2023;32(1):1-13
Publication date (electronic) : 2023 March 31
doi :
1Associate Professor, Department of Psychology and Education, Faculty of Humanities, Khatam University, Tehran, Iran
2MSc. in Family Counseling, Department of Psychology and Education, Faculty of Humanities, Khatam University, Tehran, Iran
Corresponding author: Khodabakhshi-Koolaee, Anahita Department of Psychology and Education, Faculty of Humanities, Khatam University, No.30, Hakim Azam St., North Shiraz St., Mollasadra Ave., Tehran, 1969774518, Iran. Tel: +98-2189174119, Fax: +98-2189174500, E-mail:
Received 2022 September 26; Revised 2022 November 30; Accepted 2022 December 5.



A mother whose child wants to undergo gender transitioning may have different and even challenging experiences. These challenges are much more intense in the Middle East and Muslim countries than west countries, which are very conservative towards changes. This study aimed to explore lived experiences of mothers with transsexual adult children.


This qualitative study was conducted using a descriptive phenomenological approach. Data were collected through semi-structured interviews with 17 mothers with transsexual adult children in 2021 from cities of Iran. Collected data were analyzed using Colaizzi's seven-step method.


Data analysis revealed that lived experiences of mothers could be divided into five main themes: “mother’s negative and painful feelings”, “mother’s concerns about the future of the child”, and “Frustration in the face of negative and malicious reactions from family and intimate people”, “social stigma”, and “lack of professional and government support”.


Findings of this study suggest that unawareness and inadequate information about transsexualism and gender change could cause fear, shame, and confusion in mothers with transsexual adult children. Non-governmental organizations and support associations in countries that are religiously conservative can serve as centers for informing the public and increasing their awareness.


Fear and discrimination against homosexuality and transsexual people are still unknown and scary in some countries after more than four decades of progressive changes in psychiatric science and civil rights across countries [1]. In these countries, discrimination toward Lesbian, Gay, Bisexual, Transgender, Queer, & Intersex Life (LGBTQs) and their families still exists. Transgenderism, trans, and transsexual mean a desire to live and be accepted as a member of the opposite sex, which is usually accompanied by a feeling of discomfort about one’s anatomical sex and a desire for sex reassignment surgery and hormonal treatment [2]. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-Fifth Edition) [3], the diagnostic name of “gender identity disorder” has been replaced with “gender dysphoria” [3]. A person learns from childhood to think, feel, and behave according to the sex he/she was created. This natural process may take a different path when the person considers himself/herself a member of the opposite sex, thinks that there is a mistake in his/her birth gender, and tries to correct this mistake by changing his/her gender [4]. People who are called “transsexual” have a strong desire to be similar to people of the opposite sex and like to be accepted by the public as the same gender they consider themselves to belong to [5]. According to the World Health Organization (WHO), people with gender identity change and other gender minorities are estimated to make up about 0.3~0.5% (25 million people) of the world’s population. Gender dysphoria has been found in 4% of men and 1.5% of women. About 3% for boys and less than 1% of girls have a desire to be a member of the opposite sex [2]. The exact prevalence of gender identity disorder remains unclear. It seems to be more common in men than in women (1 in 30,000 men vs. 1 in 100,000 women) [6].

Given that people normally perceive members of the community belong to only two gender groups, it is not surprising that some parents reject their children as soon as they find out about their gender choice due to shame and embarrassment. Conservatives and religious societies have negative reactions to sexual variations. In these societies, transsexual persons and LGBTQI are considered to be pathological and need to be medically treated [1]. Parents’ first reactions to their child’s transsexualism are associated with concerns. They try to get information about this issue [7]. Mothers are always exposed to secondary stigma related to their children due to having transsexual children [8]. Parents with transsexual children often experience psychological reactions and feelings of shame, blame, and self-stigma [9].

Some parents seek treatment and counseling to solve their children’s problems, to try to make them conform to society’s standards, and keep the family system stable at their will [10]. In countries with a Muslim majority and conservative groups, male gender is valued more than the female. A child showing masculine behaviors is encouraged. However, if a male child shows feminine behavior, he will be rejected by the people around him. For this reason, these people might be rejected by the family and other people or harassed. In a society like Iran where there is no desire to recognize the wishes and needs of transsexual people, a negative public view can lead to rejection and harassment [4,11]. According the Islamic Penal Code of the Islamic Republic of Iran Article 237, homosexual acts of a male person in cases other than livat (sexual intercourse male to male) and tafkhiz (defined as various forms of homosexual sexual activity either between men or women) such as kissing or touching as a result of lust shall be punishable by thirty-one to seventy-four lashes of ta’zir punishment of the sixth grade [12]. Some of these people are not satisfied with the sex reassignment surgery. To avoid committing a crime that can lead to jail sentence, they have to submit to sex reassignment surgery. This practice affects all family members, especially the mother [10].

The mother bears the most blame and humiliation due to her child’s gender dysphoria [11]. Transsexual people need family support and integration into the society. Family rejection and neglect of transsexual people may lead to drug use and suicide [13-14] and unprotected sexual relations [15]. Moreover, family support can lead to more resilience in these people and decrease distress levels [16]. Fear and stigma toward LGBTQ people are widely rooted in religious, political, and cultural values and beliefs of society members [17-18].

Studies conducted in Iran have shown that mothers are always blamed and humiliated for their children’s psychological and educational problems [19]. Motherhood is very difficult in a world that demands “normalcy”. At times, psychological distress and dysphoria can get out of family control and disrupt homeostasis [20]. However, depending on the type of problem, blames and insults directed at mothers are different. A mother living with a child who has changed gender for some reason has to care for the child. She also faces many adversities and problems caused by negative public views and criticisms of her parenting style. Mothers who have transexuals adult children might hide themselves because of the negative view of the conservative and strict Iranian society. They mostly do not talk about their psycho-social problems. Their problems need to be recognized in order to help them and their parent-child relationship. Thus, this study aimed to explore psychosocial experiences of mothers with transsexual adult children.


1. Study Design

This qualitative study was conducted using a descriptive phenomenological approach to explore experiences of people involved with a given problem and give meaning to concepts and phenomena that could be understood by them.

2. Participants

Participants were selected through a purposive snowball sampling. First, the researcher asked one of the activists working with transsexual people to introduce a person who was well-informed about the subject in question and was interested in participating in this study. Participants were selected from mothers whose children underwent a sex reassignment surgery (SRS). The sampling procedure continued until data were saturated. Based on the mentioned technique, the selection of people continued until the interview with new people did not provide the researcher with more recent information. Accordingly, data were saturated after interviewing 17 mothers with transsexual adult children. No new information and theme were discovered upon additional interviews. To control the researcher’s bias in her personal views and inference in detecting data saturation, sampling was continued until data were saturated. Collected data were reviewed by three professors of psychology, psychiatry, and nursing. Data collection continued until the adequacy of data was confirmed by the three professors.

3. Data Collection (Interview)

Data were collected through semi-structured interviews with participants. Additional questions were asked for further clarification. At the end of each interview, the respondent was asked to add any further comments if she wished. Examples of interview questions are as follows:

• How do you feel about your child changing his/her gender?

• What is your main concern for your child?

• How do you react when your child talks to you about his/her problems?

Interviews were conducted face-to-face at the Counseling Center of XXXX University from April 2021 to July 2021. Participants were 17 mothers with transsexual adult children. The minimum interview time was 40 minutes and the maximum interview time was 87 minutes, totaling 884 minutes. First, participants’ demographic data such as age, education, employment status, mother’s marital status, number of children, city of residence, type of child’s sex reassignment surgery (female to male or from male to female), and the type of interview were recorded. Participants then responded to main interview questions. At the end of each interview, the content of the interview was transcribed for subsequent coding and analysis.

4. Data Analysis

Collected data were analyzed using Colaizzi’s seven-step method [21]. In the first step, at the end of each interview after taking field notes, the researcher listened to participants’ recorded statements several times and transcribed their statements word by word on paper. In the second step, significant statements related to the phenomenon in question were identified and underlined. In the third step, themes related to each statement that reflected participants’ ideas and experiences were extracted and classified. Extracted themes were then compared with corresponding statements to ensure their relevance. In the fourth step, the researcher carefully reviewed themes and classified them into related categories based on their similarities. Related categories were merged into thematic clusters. In the fifth step, emerged thematic clusters were merged into more general categories. In the sixth step, a thorough description of the phenomenon in question was provided. Finally, in the final step, findings were reviewed and confirmed by asking participants to express their opinions about findings of this study.

5. Rigor

The rigor of this study was checked through credibility and trustworthiness and via long engagement with the research setting, triangulating findings with previous studies in the literature on gender identity disorder, experiences of mothers with transsexual children, participants’ statements, engaging participants and returning to them frequently in interpreting the data and reviewing findings, and describing research procedures clearly to help readers understand the findings. Findings were also reviewed by three professors in psychology, nursing, and psychiatry (peer checking) from data collection to analysis data.

6. Ethical Consideration

To comply with ethical principles for voluntary participation and withdrawal, conducting interviews, and recording participants’ voices, informed consent was obtained from each participant. Participants were also reassured of the confidentiality of their names, phone numbers, and addresses. This study was confirmed by the Research Council of Khatam University.


As shown in Table 1, participants’ age ranged from 36 to 62 years. Seven participants had a high school diploma. Four had a bachelor’s degree. Six were illiterate. Results concerning participants’ employment status indicated that 11 persons were housewives and 6 persons were employed. Regarding the number of children of each participant, the highest number was 5 and the lowest number was 1. Ten persons lived in Tehran and 7 lived in other cities. Three mothers had children with male to female (MtF) gender identity and 14 mothers had children with female to male (FtM) gender identity. Four mothers attended face-to-face interviews and 13 mothers who lived in other cities or could not attend face-to-face interviews were interviewed by phone. Themes, main categories, and subcategories extracted from the data on psychological challenges of mothers with transsexual children are detailed in Table 2.

Demographic Data of Participants

Main Themes and Sub-themes Extracted in the Study

Theme 1. Mother’s Negative and Painful Feelings

1) Denial and non-acceptance of the reality:

When mothers found out that they had a transsexual child, it was difficult for them to accept the fact at first and they denied it:

When I found out about it, I couldn’t accept it until three years later. I never let her cut her hair. Finally, when she was in the seventh grade, she cried so much that I let her do it. I did it with swearing and cursing. I was angry and fed up with her boyish behaviors. At that time, I did not know about her problem. That night I annoyed Bahar (FtM) because I didn’t want to accept it. I thought that girls who wore boys’ clothes and did their hair like boys would stop doing it after a while. (Participant #1)

2) Feeling of sadness:

Most mothers stated that they felt sad because of having such a transsexual child:

To be honest, I’m not satisfied with her boyish behavior and style from the bottom of my heart. I’m not happy at all because it is very difficult for me to see my daughter change her sexuality. I wish he was still a girl. He wasted his life. He cannot marry. Nobody will marry him. It’s all in vain. I’m always crying. I feel very sad. He did not see his better days when he was a girl nor now when he is a boy. (Participant #8)

3) Feeling of shame and keeping the issue secret:

Mothers with transsexual children stated that as soon as they found out about the issue, they felt very ashamed and embarrassed about having such a child:

Because his father was a teacher, he was ashamed in front of his colleague. This issue was very difficult. Many of my husband’s relatives and my close family members still don’t know about it because we don’t hang out with them. They still call him by his girlish name. For example, when my husband talks to them on the phone, they ask about our daughter, and none of my husband’s colleagues know that his daughter has changed sex. I emigrated from Kermanshah to Karaj and started working as a tailor and none of my clients knew that my daughter became a boy. I’m ashamed to reveal it. It’s a fact. You’d be crazy to try to prove it. Once Muhammad (FtM), his father, and I were in a supermarket. My husband’s colleague was there by accident. My husband said to his colleague, who was Muhammad. He said it was my wife’s nephew. We couldn’t tell him the truth. (Participant #14)

4) Feelings of depression and despair:

When the mother could not accept the fact that she had a transsexual child, she began to deny and retreat to solitude. As a result, she would suffer from depression and psychological distress:

I am still depressed and confused, I am still sad. If God gives me another 20 years of life, which He will not, I am so angry with this child that I cannot describe it. As long as I live, I am really sad and depressed about this issue. I can never get over this issue and get along with it. When I first found out about it, I was shocked and got anxious, and I went to a psychiatrist. He said that I had panicked. I couldn’t sleep at all. I used to jump up from sleep with anxiety and a lot of sweat, and my heart was beating fast. At first, I thought I had a heart problem. I was sweating so much that my clothes were soaked and my mouth tasted bad. My vision was reduced. It was as if I could hear all the parts of my body, whereas I used to be a very relaxed person. (Participant #4)

5) Bargaining with God:

All mothers stated that they started bargaining with their God when they found out their child was trans:

When I got pregnant, I just said, ‘Oh God, I know that you have bestowed your mercy to us, but if you give me a daughter, I won’t ask you for anything else for the rest of my life’. My husband said that it doesn’t matter if the child is a girl or a boy. It should be healthy. Now, I always say that I wish I wouldn’t have asked this from God. All I say is, God, you answered my prayer, but how! At what cost! With crying and humiliation! With displacement and being away from my relatives!. (Participant #11)

6) Feeling guilty:

Another feeling that most mothers struggled with was the feeling of guilt and blamed themselves for having such a child:

I have to blame myself. I was strictly focusing on my studies and I left alone this child. I was not taking care of or controlling her at all. When I was pregnant, I kept saying I wanted a son. I thought how I was unlucky that God gave me a girl, but I didn’t appreciate it, so I lost her in this way. (Participant #16; having an FtM child)

7) Decline of emotional relationship between the mother and child:

Mothers who had transsexual children complained about the unemotional relationship between themselves and their child because there was a deep emotional connection between them and the child with their original sexuality rather than a child whom they didn’t know at all:

When she was a girl, I loved her more than now. Now I’m far away from him. He says he wants to leave us and start an independent life. Well, this is very hard for me to accept. I see Mohammad maybe for 2 hours, from 8 am to 5 pm. He goes to Tehran from 5 pm until 1 am (he lives in one of the cities near Tehran). So what does this mean? What kind of life is this? I wish he was still a girl; she was at least with me. You can keep a girl with you, but you can’t keep a boy at home. They are kind of abnormal! They are unbridled and run away. It doesn’t matter to him at all whether he sees me or not. It’s very difficult to have a daughter for 17~18 years and then she suddenly becomes a boy and runs away from home. (Participant #14)

Theme 2. Mother’s Concerns about the Child’s Future Life

1) Possibility of the child’s deception:

Most transsexual children have to pay a lot of money to be accepted as members of new communities according to their gender. They are more likely to be deceived:

My daughter, Bahar (FtM) is very frank and naive, but she was not like this before. She is kind of an odd person since she had sex reassignment surgery. It’s like she has to pay her friends to be with them. She gives all her money to her friends and does not keep any money for herself. She is so naive that she believes whatever her friends tell her. (Participant #1)

2) The child’s vulnerability:

Naturally, a girl who changes gender to a boy wants to communicate with other boys after surgery. Their mothers are very worried about their children’s lives:

The Iranian community is not ready to accept transsexual people. Before having surgery, Ali asked me to change our place of living because boys had found out that she had been a girl and bothered him. They used to come and tell him sarcastically: “You are a girl, you are not a boy” and they hurt him with their questions. They even beat my child once. Well, it’s true that now he has had surgery and become a boy, but he used to be a girl. He does not have the strength expected of a boy with all the drugs he’s taking, so I’m afraid he hangs out with boys. He smokes and tends to bully other boys. I’m afraid that he might be stabbed. (Participant #10)

3) Gender identity interference after sex reassignment surgery:

Mothers with MtF children stated that they were very upset about the interference with their children’s gender identity and even scared at times:

She has no shame or modesty in dressing. I have seen her change clothes in front of others many times. I always tell her that she should be modest as a girl (male to female), but she doesn’t pay attention at all. She wears a lot of make-up. She does a lot of risky behavior as if she was not a girl. She is always fighting with boys. Suddenly, her voice becomes hoarse and treats boys in a bullying manner. (Participant #11)

4) Negative effects of hormone therapy:

Taking hormonal medicine even for one time or for several periods has side effects, what about people who have to take hormonal drugs suitable for their gender for the rest of their lives:

I’m only concerned with the hormonal drug he has to take every month because I know it will kill people. If he doesn’t take it, he will naturally get cancer and osteoporosis. If it does, indeed, he may not have cancer, but he will get osteoporosis and also steatosis (fatty liver). I heard that hormonal drugs reduce a person’s life (crying). Someone who lives with hormonal drugs has a different philosophy from me and you who live comfortably without taking any medication. I’m just sad about the fact that he has to be take hormones for the rest of his life. (Participant #7)

5) Increased suicidal ideation after surgery:

Sometimes children regretted their gender change for some reason, which made mothers afraid:

I’m afraid that he regrets his sex reassignment surgery and may suffer from mental problems and kill himself. I know someone who has undergone a sex reassignment surgery and developed mental problems. He was isolated. They said that he regretted his sex reassignment surgery and killed himself. (Participant #3)

6) Threatening the family to commit suicide:

One might have heard the news that a young man committed suicide because of his family’s opposition to his gender change. Thus, mothers stated that the reason for agreeing with their child’s sex change surgery was fear of their child’s suicide:

I had to agree with him because I went to a psychiatrist in Rasht. He said that if you disagree with such people, they will either leave their parents forever or kill themselves. Well, I only have one child in this world. I had a 17-year-old boy who died and I’m still grieving for him. I don’t have a husband with whom I can have children anymore (they had divorced), so I had to agree with him lest he may commit suicide. (Participant #5)

7) Worries about consequences of surgery:

All mothers were afraid that their children might have to undergo several long and painful surgeries:

Her father and I, who were not familiar with this trans issue, went to a psychiatrist and watched some videos and interviews. We then just realized what a painful surgery was awaiting her. I was very worried about her surgical operations. She had to do several operations; one more difficult than the other. Of course, her doctor said that it would be much better if she did surgeries abroad, but the cost was too high. We had to do them here in Iran, but she went through a lot of pain. I also suffered a lot for her surgical operations. (Participant #6)

8) Uncertain career future:

All parents are always worried about their children’s future careers. Families with transsexual children are more worried about their child’s jobs in the future. In the end, they perceive a vague and dark future for their children. They have no hope for their future:

You don’t know how much I’m worried about his future. I have so many worries that sometimes I wonder what he wants to do! I’m more worried about his social character. I’m afraid he’ll be unemployed and disappointed. You know that there’s a lot of unemployment. Before doing the surgery, she was a girl, she worked well and found good girly jobs. But now he has changed all his identity and academic documents and he has to work as a man. So w,hat if she can’t handle men’s jobs?! He does not have physical strength required for a man. What if he cannot find a job and manage his life? He’s getting older. It’s true that he’s a man, but he doesn’t have the strong character of a man. (Participant #13)

9) Inability to marry and have children:

After having a job, getting married and having children are issues concerned by parents, especially for mothers of transsexual children:

Although he has changed into a man, he is not a real man. He can neither get married nor have children. If he married someone like himself (a transsexual person), they couldn’t have children. They don’t have the reproductive organs to have children. I’m afraid that he will end up becoming a homosexual. We had a neighbor named Davoud, who underwent sex reassignment surgery and became Narges. She got married, but they separated because the doctor told them that she has neither a uterus nor ovaries. She cannot be a mother. I don’t want this to happen to my child. A girl will marry this GENTLEMAN [mockingly] with many dreams and hopes. Well, love and affection are very important in a marital life, but when this girl realizes that her husband is not able to have any sexual relation with her, she will leave him after a year or two. (Participant #2)

Theme 3. Frustration in the Face of Negative and Malicious Reactions from Family and Intimate People

1) Jealousy of siblings:

Several mothers stated that siblings of transsexual children were jealous of them because they paid more attention to their transsexual children than their other children:

My eldest son was 38 years old when Ali (FtM) underwent sex reassignment surgery. Of course, he is married and has two children, but one of them was the only son of the family for 38 years. I don’t know if it was out of pride or jealousy. He was against Ali’s gender change (FtM). Even after the operation, he did not like to call him by his boyish name. I once heard my eldest son saying no matter what you do, it’s not worth it, he can’t be a real man like me. It’s of no use. (Participant #13)

2) Rejection from family members:

Family members cannot get along with a transsexual child in the family at the beginning and sometimes for years:

My son and I went to another city for our child’s sex reassignment surgery. After the surgery, his father came to the airport to welcome us. You should have seen my husband’s face at the moment he saw Arash (FtM) who was wearing a man’s shirt and pants. You can’t believe how scared he looked. I thought he was going to have a stroke. When we came home, my eldest son saw Arash in a man’s outfit for the first time. He didn’t speak to him or greet him for a month. After a month, when Arash had to go somewhere, my eldest son (Mohammad) had to take him to a different place. At that time, Arash was still suffering a lot of pain from his scars. Mohammad told Arash to go four alleys away and wait for him. He was ashamed if friends and neighbors see both of them together. He’s still very sad about what Arash did and still unhappy with it. (Participant #14)

3) Rejection from relatives and friends:

In addition to family members, relatives might also reject transsexual people and limit their relationships with them. Besides, parents, especially mothers of transsexual people, have always been misjudged by those around them:

My sisters and their husbands and my sisters-in-law cursed and said bad things to us. They used to say: “You did a damn thing by letting him wear boys’ clothes”. They used to say that we were intentionally making our child miserable. They talk a lot behind my back. Nobody liked me. I became a by-word. They say that I’m a reckless and unworthy person and I did something bad that God gave me such a child. They didn’t talk with us for a long time. An important issue is that families should support their transsexual children. I mean if we do not support our child, he would be severely criticized and mistreated by his aunts, uncles, and cousins. (Participant #4)

4) Rejection and blame from relatives / neighbors / colleagues:

Mothers in this study complained a lot about being insulted and harassed by neighbors, relatives, and acquaintances:

Once I went to a birthday party of my sister-in-law’s daughter before Shahryar (FtM) underwent sex reassignment surgery. I could hear them talking about my son: “Wow, why is this child like this?! What is this now?! It was a girl when she was a child! So now is she a boy?! What a chuffing hell?!” ... One of the relatives had shaken hands with Shahryar and kissed him. He didn’t know that she was a girl and dressed like a boy. Later we heard that he had disclosed it to everybody. Well, you don’t think that we are bothered or depressed by these short-sighted people. I told my sister-in-law that Shahryar was very annoyed and did not want to come to the party. I had brought him by force. You cannot guess what she said! She said: “Well, why did you bring him? You shouldn’t bring him”. I said I don’t like my child to be backward and isolated. Neighbors kept making fun of Shahryar and did not allow their kids to be with him. My husband’s colleagues told him why he let him show up in this style freely without any restraint. They advised him not to do it. Otherwise, people may think that he is shameless. (Participant #7)

5) Siblings’ fear of genetic and gender-related problems caused by transsexualism and failure to have children:

Siblings in families with transsexual children may refuse to marry or have children to prevent it from occurring in their children:

My eldest son has been married for 8 years and both he and his wife don’t want have a child because they are afraid that their child will be trans. His wife is getting older. I ask them how long he wants to do so and he says he would adopt a child from the orphanage. I say not all children are transsexual. Out of 100 children, only one will be like this. He says mockingly that they are so lucky that one will be his child. (Participant #15)

Theme 4. Social stigma

1) Public rejection:

Transsexuals and transsexual people are still not accepted or welcome in the Iranian community. Transsexual people are rejected by the public. This causes distress to the children and their mothers:

In fact, these children are living in a community with many misconceptions. I mean, in my opinion, trans children don’t have any problems. It’s people in the community who have problems. These are healthy and smart children. These children can succeed and grow. They have the right to live in their own country like other people and get to the position that they deserve. They will succeed if people allow them instead of putting them through the wringer by our negative views. (Participant #8)

2) Public ridicule:

Transsexual children, both FtM and MtF, have always been exposed to ridicule and harassment by some members of the community:

Before having the sex reassignment surgery, Reza (FtM) wore boy’s clothes. Once we went to the wedding ceremony of one of his friend’s brothers. Only Reza and I were invited. When we wanted to go back, Reza took his dress from me. One of the host women who was watching us said why he should wear a dress. He can go home in boys’ clothes. This is a boy. She said this with a smirk and a ridiculous look. I was very ashamed. I didn’t say anything, but Reza told her if she wanted to say anything she had better tell him instead of upsetting his mom because he doesn’t like anyone upsetting his mom. (Participant #9)

3) Rejection from school officials and parents of other students:

Another problem that most families with trans children are facing is that their children are rejected by school officials and assistants:

When he didn’t go to school and I noticed he was doing everything in a girlish way, I said it’s normal. He is a kid. He doesn’t know how to do things. When he went to school, he didn’t behave like a boy at all. He was very irritable. He couldn’t have a relationship with his male classmates. When his classmates bullied him, he couldn’t defend himself. Either they beat him or made him cry so that they would laugh at him and call him a girl. His elementary school passed with many difficulties. His teachers and principal said that it might be because he was spoiled as the only child of the family. When he went to middle school, school officials asked his father and me to attend the school. They treated us aggressively. They called me and talked to me as if they wanted to report a crime. I said his father and I knew anything. We defended him in such a way that they retreated and allowed him to go to school. But children’s parents did not allow him. Even though he was a gifted student, we enrolled him in two other schools. Mothers of other students were afraid of my child and me as if we were criminals or had a contagious disease and they would also get infected if they approached us because they don’t know anything about trans. (Participant #6)

4) Forced migration to bigger cities or abroad:

Some families with transsexual children decided to send their children to other countries to have a better life, escape from public blame, and facilitate surgery. Some who do not have the financial means decide to leave their town and they run to big cities to be safe from negative public attitudes:

We had to send him to France to have a better life for him and his father and me. My husband said this would be good for us too. We did many investigations and found that she should have sex change surgery in France so that she (MtF) could have a child. My husband always said that he didn’t feel good about him as his father, what about others. So he’d better be away from me. Well, I’m not like him. I’m a mother and it’s very hard for me to stay away from my child [crying]. (Participant #17)

Theme 5. Mothers’ Concerns about Their Children’s Future Life

1) Lack of awareness raising by health experts:

Mothers stated that public awareness should be raised by psychologists and counselors.

Some studies, like this one, need to be conducted to promote public culture so that people don’t look down on transsexual children or make fun of them. If you have the power to raise these issues, you can hold training courses or make TV programs to raise public awareness. (Participant #2)

2) Biased and negative awareness raised by mass media:

Another way to increase awareness and culture, as stated by the mothers, is to increase public awareness about transsexual children through mass media:

Most often, interviews shown in TV programs are very insulting. These people are constantly insulted during interviews. I even watched a program where the person with this problem started crying at the end and his/her character was shattered. The reality is that these issues exist, but it’s better to report facts impartially rather than in a biased way. (Participant #1)

3) Lack of government support for transsexual individuals:

Participants highlighted the need for a governmental institution or organization to support transsexual children:

I feel that transsexual children have no support in society. No one protects them. For example, people with disabilities are supported by the welfare department, but trans people have nowhere to receive support. What is their fault? Who will support them? If I die one day, then my brothers and sisters who have 4 or 5 children and her uncles and aunts cannot take care of him. There should be an organization where transsexual children can work, study, and live. For example, a boarding school or an association can employ them. (Participant #9)


Results of the present study showed that having a transsexual child in the first place was a trauma for family members, especially the mother in Iranian society. The lack of adequate information about these children, the lack of family and government support, and most importantly, social stigma and public attitudes cause negative reactions and feelings of mothers. Thus, mothers of transsexual children experience sadness, discomfort, and psychological problems. Frigerio et al. have examined the experience of Italian parents with a transsexual child and concluded that this issue is something impossible to understand for parents of teenagers [22].

The present study showed that mothers of transsexual children reported that they were sad. This finding was consistent with results reported by Johnson and Benson [10]. In their case study, they showed that a single mother in a rural area of the United States who had a child with FtM gender identity always received ironic messages from those around her for having such a child and that people judged her parenting styles. Thus, she was always sad [10].

Participants of this study stated that they had feelings of shame and tried not to reveal that they had transsexual children. Similarly, Russell et al. [23] have reported that parents of children with a transsexual identity often experience negative emotions such as withdrawal and shame. Moreover, Johnson and Benson [10] have shown that mothers of transsexual children try to make their children get accepted by the community and subsequently seek treatment and support for children. These mothers often faced disagreements and lost their ties with family members and friends. These problems were linked to their parenting styles. Thus, they became confused, disappointed, and depressed [10]. In another study, Kuvalanka et al.[19] showed that some mothers were blamed by others for having trans children.

Transsexual people try to engage in social activities after a gender change surgery. They try to prove and confirm themselves in the community. Thus, they may pay a ransom and engage in risky behaviors such as smoking and drug use, fights, and beatings to present themselves as men or women in society [4]. One of the most important concerns of mothers with transsexual children was the fear of suicide of their children. These mothers also experienced public rejection and fear of child suicide. Accordingly, Russell et al. [23] have concluded that if parents do not support children with gender identity inconsistency, children might face negative consequences such as depression and suicidal thoughts. Most of these frustrations stem from public rejection, uncertain job prospects, and inability to marry and have children. In a similar vein, Hill and Menvielle [24] have found that parents express concern about their child’s well-being and safety in the future. The attention of parents, especially the mother, to the transsexual child and the presence of a sibling who had been the only daughter or son in the family for years and now showing up as a sibling of the same sex can cause jealousy and sometimes resentment between the sibling and the trans person. Thus, parents may reject their trans child to save face or keep the matter a secret from relatives and friends. Likewise, other studies [25,26] have found that family acceptance has a positive effect on emotions and behavioral health of transsexual youth, including self-esteem against drug abuse and suicidal thoughts. Jin et al. [26] have also shown that young transsexual women who receive adequate support from their mothers have lower levels of suicidal ideation compared to daughters of mothers who are not supportive.

Results of the present study indicated that families of transsexual children were rejected ad blamed by relatives and neighbors. Johnson and Benson [10] also showed that after the mother persuaded family members to accept her transsexual child, she tried to persuade first-degree relatives who did not accept her transsexual child and started to oppose and blame parents of the trans child and limit or cut off their relationships.

Negative public attitude was one of the themes identified in this study. Participants often complained about public attitudes, their harsh blame and mockery, and harassment of their transsexual child because of their clothing style. Similarly, previous studies have revealed that some people might provide encouragement and support about wearing a disguise, whereas others have hostile behavior along with ridicule and even blame the mother, with maternal blame having a gender bias [19,24]. Interestingly, Gonzalez et al. [27] have shown that with political and social changes in society, views towards (GLBTQIs) individuals and families play a key role in supporting their members.

Rejection of transsexual students by school officials and parents of other students is a social crisis and stigma that stems from an unawareness of transsexualism. Findings of the present study showed that some families decided to migrate to other countries or larger cities in the country to decrease negative public views and blame. Sometimes they forced their children to migrate alone. Kuvalanka et al. reported similar results about the migration of families with transsexual families to other cities [19]. Moreover, after revealing gender identity, families react differently according to their race, ethnicity, and immigration status. Moreover, media play a very important role in shaping public attitudes. Counselors and psychologists can also help transsexual people and their families [27].

However, other studies have reported conflicting results about immigration to other countries. Western culture is very different from Iranian culture in terms of public attitudes toward transsexual people. In western cultures, families try to provide comprehensive support for their children with the help of support groups. Their focus is on their child rather than on public attitudes. However, in Iran, public attitudes and preserving the reputation of families are more important than anything else.

Since gender dysphoria has replaced gender identity disorder in psychiatric textbooks, preventing prejudice among mental health professionals and developing new education curriculum are necessary, especially in Muslim countries. In addition, raising awareness by mental health experts, through the media, or government institutions is of great importance. The existence of clinics to increase awareness among parents and the existence of a positive therapeutic environment and family therapy are very helpful for families of transsexual children [28]. A systematic review by Malpas et al. [29] showed that preventive and family therapy programs are very effective for families with trans children. They have pointed out that in addition to educating families and supporting them, advocacy plays a very important role in the acceptance of families, ultimately increasing public support for them [29]. In conservative societies with a more closed culture such as Muslim and Middle Eastern societies, social networks and non-governmental organizations (NGOs) are very effective in helping mothers and families with transsexual children. Mothers who participated in this study were very upset that they could not hang out with others and that they were socially isolated. In all human societies, accessing education and information about transsexual people can help these people and their families [30]. Thus, holding training programs about transsexualism and cultural values by health care professionals and increasing information and receiving information through the Internet can be very helpful in increasing support for families with transsexual children [10]. In summary, results of this study are helpful for emphasizing the importance of what needs to be improved to support parents with transsexual adult children.

One of the limitations of the present study was that participants hardly trusted the interviewer. Many times interview appointments were canceled or interviews were refused. Thus, the data collection process took a long time. Accordingly, future studies need to focus on problems faced by transsexual children and their families and examine children with gender identity change who have not yet undergone surgery and problems faced by their families. Future research should address concerns and experiences of siblings. In addition, fathers were not present in the research. Some of the husbands of these women left the house because of their child’s problem and blamed the mother. Hence, interviewing fathers is very important. Also, it seems necessary to examine the role of organizations supporting trans people in Iranian society.


The present study reveals that mothers of transsexual children are likely to suffer a lot because of their child’s gender change. Mothers are lonely. They face negative and harsh judgments from family and other people. These are often beyond their tolerance. Furthermore, worries about the child’s future and the risk of child suicide are other challenges faced by these mothers. Raising awareness and unbiased treatment of trans people without blaming mothers for an incident (that sometimes nature plays a greater role than nurture and parenting) can play a significant role in reducing these challenges. Findings of the present study can help mental health professionals and officials of the national health system to organize mental health programs such as; family-based interventions and manfulness reeducation stress based on needs and experiences of mothers with transsexual children. One of the main concerns of trans’ siblings is about the role of heredity, which mainly stems from misconceptions.


The authors have no potential conflicts of interest with respect to the research, authorship, and/or publication of this article to disclose.


Conceptualization or/and Methodology: Khodabakhshi-Koolaee A

Data curation or/and Analysis: Khodabakhshi-Koolaee A & Kaviani L

Funding acquisition: No Funding

Investigation: Khodabakhshi-Koolaee A

Project administration or/and Supervision: Khodabakhshi-Koolaee A

Resources or/and Software: Khodabakhshi-Koolaee A & Kaviani L

Validation: Khodabakhshi-Koolaee A & Kaviani L

Visualization: Khodabakhshi-Koolaee A & Kaviani L

Writing: original draft or/and review & editing: Khodabakhshi-Koolaee A


The authors would like to thank the mothers and their adult children.


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Table 1.

Demographic Data of Participants

Code Age Education Occupation Marital status Number of children City of residence Type of surgery
1 47 High school diploma Housewife Married 3 Shahriar FtM
2 51 Illiterate Confectioner Divorced 4 Shiraz FtM
3 36 Bachelor's degree Midwife Married 2 Malayer FtM
4 49 High school diploma Housewife Married 3 Shahr-e-Rey FtM
5 46 Lower education Housewife Divorced 1 Anzali FtM
6 47 Bachelor's degree Housewife Married 1 Tehran MtF
7 37 Bachelor's degree Housewife Divorced 2 Tehran FtM
8 59 Lower education Housewife Married 5 Mashhad FtM
9 40 Lower education Housewife Divorced 3 Pakdasht FtM
10 50 Illiterate Housewife Married 3 Firouzabad FtM
11 42 High school diploma Salesperson Married 3 Gharchak MtF
12 54 High school diploma Housewife Married 3 Sanandaj FtM
13 61 High school diploma Housewife Married 3 Tehran FtM
14 59 High school diploma Tailor Married 2 Karaj FtM
15 60 Illiterate Housewife Married 3 Tehran FtM
16 40 High school diploma Hairdresser Divorced 1 Islamshahr FtM
17 45 Bachelor's degree Employee Married 2 Babol MtF

FtM=female to male; MtF=male to female.

Table 2.

Main Themes and Sub-themes Extracted in the Study

Primary subthemes Main themes
․ Denial and non-acceptance of reality The mother's negative and painful feelings
․ Feeling of sadness
․ Feeling of shame and keeping the issue secret
․ Bargaining with God
․ Feeling guilty
․ The decline of the emotional relationship between the mother and child
․ The possibility of the child deception The mother's concerns about the child's future life
․ Vulnerability of the child
․ Gender identity interference after sex reassignment surgery
․ Negative effects of hormone therapy
․ Increased suicidal ideation after surgery
․ Threatening the family to commit suicide
․ Worries about the consequences of surgery
․ Uncertain career future
․ Inability to marry and have children
․ Jealousy of siblings Frustration in the face of negative and malicious reactions from family and intimate people
․ Rejection from family members
․ Rejection from relatives and friends
․ Rejection and blame from relatives/neighbors/colleagues
․ Siblings' fear of genetic and gender-related problems caused by transsexualism and the failure to have children
․ Public rejection Social stigma
․ Public ridicule
․ Rejection from school officials and parents of other students
․ Forced migration to bigger cities or abroad
․ The failure of health experts to raise public awareness Lack of professional and government support
․ Biased and negative awareness raised by mass media
․ Lack of government support for transsexual individuals