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Ella is a 16-year-old Korean American who identifies as non-binary. Non-binary is one
term people use to describe genders that do not fall into the poles of male or
female. Accordingly, Ella uses the pronouns they, their, and them. Ella lives with their
parents, who emigrated from South Korea before Ella was born, and two brothers. Both
English and Korean are spoken at home. Ella self-referred to me (the school social
worker) after encouragement from friends, who noticed a depressed and anxious mood.
In our first meeting, Ella was somewhat reluctant to talk. I noticed that Ella was often
squirming and appeared pained. I asked if something was wrong, and they reported that
they really needed to use the restroom but that the school did not have gender-neutral
facilities. Ella was not comfortable using either the girl’s or the boy’s bathroom and
reported that they “do not drink anything all day” and “hold it in” to avoid the bathroom
until arriving at home. I consulted with a school nurse to consider solutions that would
allow Ella to feel comfortable while also avoiding a physical health issue due to
At our second meeting, Ella was less agitated and was able to discuss the presenting
problem. Ella reported that their legal sex is female but that they identify as non-binary
and are also questioning their sexual orientation. Ella reported feeling this for several
years, but it has only recently become a conflict as Ella matures and their appearance
changes. Ella has come out to their friends but not to family or teachers. Since turning
16, Ella has felt immense pressure from their parents about potential interest in boys at
school. Ella wears their hair in a short crop cut, binds their breasts, and wears polo
shirts and jeans or khaki pants with sneakers most days.
Concerned with the way Ella dresses, their parents have asked if Ella likes boys.
Ella reassures their parents that they like boys but also like to dress their own way.
Ella’s mother comments that if Ella continues to dress that way, they will never be able
to find a boyfriend. Ella does not want to disappoint their parents; however, for the past
year, as their breasts have grown, Ella has had strong thoughts and feelings towards
getting gender affirmation surgery to reshape their chest. Ella wants to share their
identity as non-binary with their parents—along with the fact that they are questioning
their sexuality—but is afraid. Ella reported researching gender affirmation surgery and
what it entails but fears that their parents will disown them if they ask for the surgery.
Additionally, because of this conflict—and the anxiety surrounding it—Ella’s grades
have been slipping from the normal As and Bs. Ella’s parents prioritize education and
see it as a source of pride. In fact, Ella’s older brother will be attending an Ivy League
college next fall, and Ella’s parents want Ella to go somewhere similar. The pressure to
perform well academically is contributing to the already existing anxiety about whether
to disclose their gender identity.
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Ella’s friends have noticed marked changes in their personality because of the pressure
and expectations from home. Ella appears to be more depressed and has made
comments about not wanting to live anymore if they cannot be who they really are. Ella
reiterated that they feel strongly about who they are but are afraid to share this with their
parents. Ella fears disappointing them and their idea of their “girl” and can even picture
a scenario in which they get kicked out of the house.
Ella and I made a plan for further meetings. They participated in theater and music
groups at school, found a gender-neutral bathroom that could be used in the health
center, and seemed to be demonstrating less anxiety as we continued to meet. I
recommended that Ella go to a teen support group at the LGBTQ Center in town, to
hear from what peers in their situation have experienced and how they have worked
through it. Ultimately, Ella felt they had the resources and support to disclose their
gender identity to their parents and brothers.
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