Sexual Orientation, Gender Identity and Chronic Pain

June 13th, 2022

Samantha Levy, PhD
July 28, 2022 / 5 mins read

We often discuss that there are comorbid emotional issues that kids who develop chronic pain tend to have, such as perfectionism, anxiety, OCD, depression, ADD, autism, or learning differences.

One other struggle that tends to come up is around sexual orientation and/or gender identity. I do not have research on the prevalence of youth with pain disorders being nonbinary, gay, or trans. These are issues that are tough for any young person to grapple with as they begin to form their identities overall, and specifically with regard to gender and sexuality. Whenever a child or teen is struggling with an issue, it can become somaticized and lead to chronic pain.

Accepting Your Child’s Sexual Orientation/Gender Identity

I have had many clients over the years who were on a journey to figure this issue out. It’s often difficult for them to determine, and it takes time to sort it out.

While the kids I have worked with typically also have other issues they struggle with besides figuring out gender identity and sexual orientation, this issue often is in the forefront of their anxiety because they worry about their parents’ or religious community’s perception of them.

I have found that many of the parents of those clients have a tough time accepting their child’s sexual orientation if they are not straight, and their gender identity if they are not cisgender. My clients often tell me that their parents seem accepting when it comes to other people not being straight or cisgender, but less so with them (a “not in my house” mentality).

This lack of acceptance can take the form of not believing their child (e.g., “This is just a phase”), denial of the child’s self-perception (e.g., “You can’t feel like a boy -- you always loved girly clothes and toys when you were little”), or rejection for cultural or religious reasons (e.g., “It is not a thing to be gay in our community”).

The parents that I have worked with have not rejected their children outright or thrown them out of the house for being gay, nonbinary, or trans. The lack of acceptance has been more subtle. Luckily, most of the parents whose children I have worked with have eventually become more educated about their child’s identity and have slowly come to accept it. But that slowness in accepting their child’s new identity can feel demoralizing for the child.

The process of self-discovery for the kids is difficult enough without feeling that their parents are going to be disappointed in them or not accept them. When the kids feel these pressures and fears from their parents, they keep their feelings inside. As we have learned already, keeping feelings inside can lead to chronic pain.

Being Open With Your Child

Many kids say that their parents just assume that they are straight and cisgender, and therefore it becomes even more awkward to tell their parents otherwise.

I suggest that as your child becomes a preteen -- or any time after that, if they are already older -- you openly ask your child where he/she/they are on the scale that flows from very male identifying to very female identifying. Many people fall somewhere on the line between the two.

Also, do not assume that your child is straight. Again, this is just from my clinical experience and not based on research, but often my clients tell their parents that they are asexual before they feel ready to say that they are bisexual, gay, or pansexual. The more open you are with your child and the less judgmental you seem when you ask the questions, the more likely it is that your child will be honest with you.

I promise that your child will feel very relieved to be able to be truthful and to feel accepted by you. When kids feel unconditionally loved by their parents and feel that they can be their authentic selves around them, the relationship is so much stronger, and they feel so much less anxious overall.

This acceptance goes beyond being “OK” with your child being gay. A client of mine who identifies as lesbian and queer says that although her mom says it’s “fine” that she is gay, she doesn’t “embrace it.” For example, when her mom assumed she was straight, she would point out boys and ask if her daughter thought they are cute. But her mom doesn’t engage with her in that way about other girls.

Trying Out New Names and Pronouns

Sometimes parents do not believe their child’s gender identity because it changes over time. Some kids try out different names and pronouns. These changes are part of the process of figuring out their identity. People who do not feel completely masculine or completely feminine often choose to use the pronouns they/them to indicate that they are nonbinary.

It is important to meet your child where they are in their process. Whatever name or pronoun your child is requesting at any given time, using that name or pronoun shows your acceptance of your child. If it changes, roll with it. Your child may have to see what feels right.

Tori’s Story

Tori was a 12-year-old with chronic stomach aches and headaches. She was very smart, sensitive, and anxious. She also struggled with OCD. We were addressing the anxiety and OCD, but I was trying to figure out why she often would engage in self-harm.

One day, she came to our session with a dramatic haircut. She went from hair below her shoulders to a pixie cut. It suddenly dawned on me to ask about her gender identity. I did not want to ask her directly, as I was not sure how open she would be. I just asked how it felt to have short hair and then asked if she felt more herself with short hair.

She then opened up about how she wanted to feel more like a boy. Once we began to discuss this, she admitted that she was attracted to girls. She had not told anyone about her gender identity or her sexual orientation.

While she became more and more confident that she was a lesbian, she was not sure about her gender identity. She played around with pronouns and names. We spoke to her parents, who were accepting of her sexual orientation.

However, her mother was very upset about Tori feeling gender fluid, as she enjoyed having a daughter to do “girl things with.” Her mom became even more upset when Tori wanted to change her name, which her mom said was passed down in the family. Her mom’s anger about this really affected Tori, and she felt very conflicted.

Her parents had a hard time understanding why Tori kept changing her name. Tori explained that she had to hear people use the name when referring to her in order to tell if it seemed like a good fit. Some names felt too masculine and some felt too feminine. Eventually, her mom came to understand how Tori’s given name did not feel right to her.

We made a deal with her parents that they had to use the pronoun and name that she wanted, but that she had to give each name a week so that her parents could have time to remember to use the new name consistently. This strategy worked, and eventually Tori came up with a name that stuck.

She felt much better after her parents accepted these changes and believed that they were important to her. Eventually, Tori decided on the pronouns they/them, and chose a gender-neutral name that felt right. Their self-harm decreased, and they felt less guilty about disappointing their parents.

Supporting Your Child

It is natural and normal to feel confused and disappointed if your child feels that their gender does not match what they were assigned at birth and wants to be called a name different from the one you gave them. There is a feeling of loss if you have always had a son and now you have a daughter. It is okay that this will take you time to adjust to.

But your child has to feel unconditionally loved in the process. If you are afraid of what others in your community or extended family will think of your child, this will affect your child’s mental and physical health. It is important to show your child that you will support them no matter what. It is OK to let your child know that sometimes you may slip up and use the wrong pronoun or name, but that you are trying. It is OK to say that even though this is difficult for you, you still love your child.

Remember, this is still your child who you have always loved.


Familiarize yourself with (some of) the terms that your child and people in the LGBTQ+ community are using:

Gender Expression - The external manifestations of gender, expressed through such things as names, pronouns, clothing, haircuts, behavior, voice, body characteristics, and more.

Gender Identity - One’s internal, deeply held sense of gender. Some people identify completely with the gender they were assigned at birth (usually male or female), while others may identify with only a part of that gender, or not at all. Some people identify with another gender entirely. Unlike gender expression, gender identity is not visible to others.

Cisgender or Cis - A person whose gender identity matches the gender they were assigned at birth.

Nonbinary - People who experience their gender identity and/or gender expression as falling outside the binary gender categories of man and woman.

Transgender or Trans - People whose gender identity differs from the sex they were assigned at birth.

Pansexual - Used to describe a person who can form physical, romantic, and/or emotional attractions to any person, regardless of gender identity.

Queer - Used by some people, particularly younger people, whose sexual orientation is not exclusively heterosexual.


The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-Binary Teens by Stephanie Brill & Lisa Kenney

Lost in Transition by Paria Hassouri

The Conscious Parent's Guide to Gender Identity: A Mindful Approach to Embracing Your Child's Authentic Self by Darlene Tando

The Gender Creative Child: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes by Diane Ehrensaft

Raising My Rainbow by Lori Duron



PFLAG is the first and largest organization for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, their parents and families, and allies.

Transforming Family

An LA-based family support group creating a positive environment for children, adolescents and their families to explore issues of gender identity. Groups: Family/Caregiver (18 and older), Adolescent/Young Adult (13-24), Tween (10-13), Sibling Peer (13-24), and Elementary Play Group (5-11)

UCLA EMPWR (“empower") Contact Information: 310-825-7573 |

Program designed to promote well-being and resilience in LGBTQ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning) children, teenagers, and adults. Specialized services to build on personal strengths, foster healthy identity formation, and mitigate the consequences of stressful and/or traumatic experiences. Services Provided: Individual therapy, LGBTQ Teen Resilience Group, family interventions, and medication evaluation & management.


This is a virtual LGBTQ+ teen/parent support group.

TransFamily Alliance

The TransFamily Alliance is a collaboration between parents on their own gender journeys raising trans children and Dr. Shawn V. Giammattei the founder & director of Gender Health Training Institute, a clinical family psychologist, and a gender specialist.

The GLBT National Help Center

The Center offers a 24-hour peer counseling hotline for support, resources, and more for GLBT people of all ages. They can also direct you to more sites and resources.

GLBT Near Me

This is an enormous database of local resources for the LGBT community.

Gender Spectrum

This organization has great resources for transgender and gender questioning youth.


There are many good resources for teens who are questioning their gender identity and sexual orientation.

A good workbook for teens is called The Gender Quest Workbook: A Guide for Teens and Young Adults Exploring Gender Identity by Testa and Coolhart.


There is a lot of great young adult fiction out there about transgender and gender-nonconforming youth. Here are a few books to check out:

I am J by Chris Beam

Parrotfish by Ellen Whittlinger

Luna by Julie Ann Peters

Beautiful Music for Ugly Children by Kirsten Cronn Mills


Beyond Magenta: Transgender Teens Speak Out by Susan Kuklin

Offers stories of transgender and gender nonconforming teens physical and personal journeys.

Hello Cruel World: 101 Alternatives to Suicide for Teens, Freaks, and Other Outlaws by Kate Bornstein

A great read from a longtime transgender activist, writer, performer, and advocate for transgender youth.