Fortransgender kids, the simple act of finding and using a restroom has been complicated by adult politics, particularly at schools. More than 100 anti-trans bills passed this year in the U.S., with many focused on children and students.
Most recently, Oklahomas governor signed into law a bill that forces all public school students to use the bathroom that matches the sex on a students birth certificate. Sex is a medical determination assigned at birth based on genitalia and chromosomes. Gender is a persons own internal sense of who they are. The law went into effect immediately, forcing children, parents and school administrators to grapple with private body decisions publicly.
Bathroom bans a colloquial term for the rules and laws that restrict which bathrooms transgender kids are allowed to use get a lot of attention. But the reasons why kids should be able to choose where they pee dont often get explored.
Medically, its important for kids of all genders to be able to make their own decisions about bathrooms, says psychologist Diane Ehrensaft, PhD, the mental health director for the Child and Adolescent Gender Center at the University of California at San Francisco. Denying kids access to bathrooms that match their gender identity endangers their health, safetyand well-being, and leads to negative health outcomes, according to the American Medical Association. Bathroom bans also heighten stigma and discrimination.
Urinary tract infections (UTIs) and clinical depression are real possibilities, Ehrensaft explains. Transgender kids are already at high risk for bullying and discrimination, which lead to higher rates of depression and anxiety and more suicide attempts. In a conversation with WebMD, Ehrensaft discusses why it matters where kids pee.
When are kids first exposed to gendered bathrooms?
Whenever families go to restaurants or public spaces with gendered bathrooms. Or in schools, most typically in kindergarten or first grade. Preschools usually dont have gendered bathrooms.
A number of parents I work with are very anxious about how to confront gendered bathrooms with their trans kids. Those are the kids who sometimes get urinary tract infections (UTIs) as early as 6 because they dont go all day.
How do kids develop the idea that going to the bathroom is private?
Parents might say, When the bathroom door is closed, you have to wait until somebody comes out, or When you go to the bathroom, you close the door. Both are messages about privacy. But they take some time to sink in.
Little kids in preschool never close the door, for example. They like to watch each other. Little kids with penises love to pee against walls. They get a lot of pleasure from publicly peeing. Little kids with vaginas may feel jealous that they cant make that trajectory.
Its fascinating for little kids to see what comes out of their body.
I also want to add that some trans kids may seek out privacy really early.
In our culture, if youre a girl with a penis, you learn that people might be surprised, or shocked, or just tell you that you cant be a girl with a penis. To protect yourself, you hide. You dont want anybody to know whats between your legs.
How do parents prepare their trans kids for gendered bathrooms?
Its often a problem-solving approach. We might sit down with the family and say, When you go to your new school, theres going to be a boys bathroom and a girls bathroom. So how should we think about it? And what do we want to do about it?
Thats more effective than saying, You have to use the bathroom that matches your designated sex at birth.
Ill give you an example of a trans boy in third grade. He used the boys bathroom. He had a little bit of anxiety about someone seeing through the cracks in the stall or peeking underneath the door. That never happened. What did happen, though, is he had a really good group of friends who were often in the bathroom at the same time he was. And they said to him, Boy, you sure do poop a lot.
He felt quite fine with them thinking that. But in some ways, it means you have to camouflage.
And then heres the opposite story. This is a trans girl Im working with. She was 5 when this happened. She goes to a very progressive school in San Francisco. Shes a girl, she looks like a girl, but she uses the boys bathroom because she likes to pee standing up and there are no urinals in the girls bathroom. So of course, a little boy walked in and said, What are you doing here? And she said, Well, I have a penis, so I use a urinal, and walked out.
Parents need to talk to the schools, too. A lot of schools say, Well just offer that student the nurses bathroom. Well, you might as well put a target on your back if youre the only kid going to the nurses bathroom. If schools want to do that, well say, Make the nurses bathroom available to anybody who wants to use it. Lots of kids dont feel comfortable in shared spaces and maybe youll get a rush on the private bathroom.
I was an expert witness in a court case with a teenager in Florida. He was a trans boy, and the school insisted that he use a single-stall bathroom. It was way across campus, and the only way to get there and back was to be late for class. This was not a good solution. He won a lawsuit to be able to use the boys bathroom.
We have to prepare our kids for this because if we dont, we have kids who hold it in all day and dont drink any liquids as their solution. And we know medically thats not safe.
What are the consequences of not being able to use the bathroom?
These are the risks weve talked about: harm to your body in the form of urinary tract infections (UTIs) from holding in your pee all day, harm to your psyche in the form of anxiety, depression, and other mental health effects of rejection rather than acceptance. Every time you cant use that bathroom, youre at risk. Youre putting a child at risk for all of those things.
Having accidents, too. Imagine that on top of everything else youre having an accident and youre not an infant or a toddler. You just cant hold it in anymore.
Also, kids cant concentrate if their bladder is full. I dont know if youve ever had that experience, but when my bladder is really full, Im not going to be able to do a math problem.
What changes around bathrooms and gender when kids start puberty?
What changes most specifically is adults attitudes towards kids once theyre not little kids. Once kids themselves are thinking about sexuality, adults start getting anxious about it.
Middle school, where puberty usually starts, is not a happy time in our culture. People say, Those were the worst years of my life. Thats because everybodys looking to be accepted, and a lot of mean girl stuff happens. So bathrooms can be fraught, and there can be a particular ire from adults if they think that their children are going to see genitalia in the bathroom.
We know from the data that bullying in schools is typically based more on gender presentation, which creates a hostile environment for trans kids.
Lets imagine a trans boy in middle school. He has socially transitioned and looks like any other boy. He stands in front of the two bathrooms. Where should he go? Hopefully hell go into the boys bathroom. If he goes into the girls bathroom, somebody is going to say, What are you doing in here? Youre a boy.
But a lot of kids get stuck right in the middle. They dont see a good option. Physically and psychologically, they have a frozen moment, which becomes, I think Ill just keep it in.
Or they face potential harassment, particularly if they go into the bathroom that matches their gender and other people dont see it that way. Trans kids are much more likely to be harassed than their cisgender peers.
All people want to do when they go to the bathroom is pee and poop. Theyre there for bodily function. And as every human being needs to go, so do trans kids.
You can also go to the bathroom to hide from class. You can go to the bathroom to put your makeup on. You can go to the bathroom to change your clothes because you cant socially transition at home, so you put your outfit in your backpack and go to the bathroom to change at school.
Whats different in the high school context?
Some kids have a stronger sense of self you could say stronger gender resilience in high school.
Other kids dont have that. Maybe they havent been accepted, or theyve been bullied. For those kids, bathrooms can be an awful experience because the bullying gets worse and it gets more physical.
And kids are not exempt from reading the literature about violence against trans people. By high school, they are well aware of that violence and well aware of themselves as potential targets.
I work with many high school students worried about violence or about being outed. They are so anxious. Sometimes this anxiety leads them to avoid the bathroom for the entire school day. Or they skip out of school. They find somewhere else to go.
My parents live in a small town in Texas, and they encounter people who say, What is this thing about bathrooms? I just dont get it. Whats the big deal? Why cant this kid with a vulva just use the girls bathroom?
I ask mothers, Look in the mirror. Who do you see? And how would you feel walking into a mens bathroom? I ask fathers, Suppose you had to use the womens bathroom. What would that be like for you? I try to help a person think about the bathroom they use and how horrifying it would be to go into the other.
Thats a problem for the adults who say, These kids are not really boys. This is just a performance or a disease, so Im not going to in any way validate that by saying they could use the boys bathroom. Its ridiculous, theyre girls. Those are the harder group, and sometimes theyre not mature. And those are the ones who are also usually afraid of harassment. But for a lot of grandparents, aunts, or uncles, its a learning curve.
We talk about a gender spectrum. I think theres an acceptance spectrum.
Editor’s note: This interview has been edited for length and clarity.
- No Place to Go: How Public Toilets Fail Our Private Needs by Lezlie Lowe, Coach House Books, 2018
- Trans Kids and Teens: Pride, Joy, and Families in Transition by Elijah C. Nealy, PhD, W.W. Norton & Company, 2019
- “Youre in the Wrong Bathroom!” And 20 Other Myths and Misconceptions About Transgender and Gender-Nonconforming People by Laura Erickson-Schroth, MD, and Laura A. Jacobs, Beacon Press, 2017