Gender identity and the chemical delay of puberty

[Eunuchist (imported)]

Gender identity and the chemical delay of puberty

A call for more clinics and treatment for children at an early stage in their growth

Stephanie Brill,Herbert Schreier

Sunday, November 18, 2007

After agonizing for most of his 48 years over who he really was, Steven Stanton began the process of becoming a woman two years ago. Six thousand miles away in Germany, a 12-year-old boy named Kim has started hormonal therapy in preparation for surgery to make him a girl. He may be the youngest person to begin this treatment.

Stanton and Kim represent the small proportion of gender-variant individuals who wish to change the body in which they were born to conform to the person they believe themselves to be. In the nomenclature of the American Psychiatric Association, both individuals would be said to be suffering from Gender Identity Disorder.

<< Two Cents: Has your thinking about transgender changed? >>

Though the public is becoming more aware of gender variance in children, there is still a lot of misunderstanding about what exactly it means to be transgender. Most people who ultimately live their lives as the other gender have felt they were given the wrong body since very early childhood. Most parents of children like Kim, plus a growing number of professionals who have experience with these children, recognize two things:

First, the children who see themselves as of the other gender are born with this belief. It is "hard wired," emerging at around 2 to 2 1/2 years of age, just about the time other children begin to recognize themselves as being a boy or a girl. And second, although these children are unhappy about the body they inhabit, they are otherwise normal, often endearing and creative.

However, there is still a common assumption that these children suffer from a disorder and should be treated to alter their internal sense of gender to align with their biological sex.

In response to this damaging reparative approach, clinics in support of cross-gendered children have sprung up. And a growing number of professionals are working to support younger children and their families despite the opprobrium of colleagues and ethical challenges to their stance.

The endocrinologists and surgeons who support beginning the process of gender reassignment sooner often have arrived at their conclusion after seeing adults such as Stanton come to doctors so late to seek bodily change that the process is much more difficult.

Many transgender people reach desperate psychological straits not only because of the reflection they see of themselves in the public at large, but also because of professional indifference or refusal to help them when they are younger. Child psychologists and therapists generally arrive at a more appropriate stance when they see the variety of children and families who come in for advice - and who do not fit the stereotypical perceptions or psychodynamic explanations of family pathology common in the field.

In a peer-run support group for parents of children whom we prefer to call gender-variant, most of the children reflect the bias we see in a child psychiatry clinic - that is, many more boys who want to dress, play like and be with girls. Girls who have gender-variant preferences do not attract much concern or attention, and those whose parents come to the group are the ones who actually insist that they are boys.

Thus we see a wider range of anatomical boys - more who have a female gender expression and a few who have a female gender identity.

The preponderance of anatomical boys in the group is likely because it is much less troublesome to the world at large for a girl to engage in boy behavior. Though most gender-variant children do not end up being transgender, many do go on to prefer same-sex partners, indicating that the gender variance may have been part of their sexual orientation and not necessarily their core gender identity.

Uniform to the parents in our group is the anguish they experience as their kids enter kindergarten and increasingly appear "different" to their peers in a way that invites teasing and worse. Taking a leap of faith, some parents have supported their child's reidentified gender identity, not their biologically given sex. The results are frequently astounding; once anxious and depressed children, some even expressing suicidal thoughts at very tender ages, make dramatic psychological turnarounds for the better.

In the group, two children under 12 have begun therapy that delays the middle and late states of puberty for three to four years. Both have been living as boys for several years.

This treatment is reversible should the child change his/her mind, but it prevents the development of secondary sexual characteristics (such as Adam's apple, deepening voice, breasts) that are more difficult to deal with should the children go on to surgery following the future administration of "opposite sex" hormones.

This may partially account for the positive outcomes reported thus far in young starters compared to those such as Stanton who start as adults. The suppression of puberty is seen as a diagnostic aid that allows therapists and patients to evaluate problems under less time pressure.

At the Amsterdam Gender Clinic in Holland, it has become clear that the earlier the decision is made to start the process, the better off the child. After administering the medications to delay puberty, the doctors - if all goes well - provide opposite sex-hormonal treatment in children at age 16, the age when children are able to give medical consent in Europe. With this process in place, doctors have had not one child regret the change after surgery. While much is known about the effects of delaying puberty on the body, less is known about its effects on the brain, and both continue to be carefully evaluated.

Definitive studies are not yet in that demonstrate that these children's understanding of themselves stems from a particular biological process, but for those of us who have worked with these children and their families for years, it is overwhelmingly apparent that family dynamics cannot explain the dysphoria these children feel at such an early age.

On the contrary, while researchers 50 years ago felt strongly that gender was malleable and could be assigned, current studies find the opposite to be true. When various therapies for gender-variant children aimed at "realigning them according to their biological sex" were studied, there was little to suggest any "success."

One such study was a behavioral approach that in therapy sessions grabbed dolls away from boys and replaced them with tanks and such, telling the children that these were the toys boys played with. New research is showing that family acceptance or rejection of these children has a major impact on their health and mental well-being.

Watching the parents in our group suffer over the treatment their children receive in the earliest grades, and anticipating the truly horrendous scenes that many will face as adolescents, even in the Bay Area, it is no wonder that many of these parents have turned to advocacy and activism for their children.

This includes meetings with grade-school teachers, bringing in experts to the schools, developing reading material for the kids and curricula for schools starting in the very early grades, and presenting programs aimed at the education of pediatricians, many of whom are not well versed in the current research on these issues.

But for the minority of gender-variant children who are truly transgender, the issues for the parents are so much greater. Parents of these children fear that if they force their child to endure puberty in the "wrong" body, they might altogether lose their children. This is not an exaggeration: Current statistics reveal that an astoundingly high percentage of transgender teenagers attempt suicide.

So for these parents, the decision to delay puberty medically for their children becomes a difficult if obvious choice. The treatment appears to be effective and completely reversible. But when and how do you decide to start such a course of treatment?

In the Netherlands, the children must meet certain criteria of wanting to be the opposite sex from an early age. Then they are evaluated by more than one psychiatrist or psychologist experienced with such children. The children must be reasonably free of serious mental illness, which does not include anxiety and/or the dysphoria of living in the wrong body.

Such children are then candidates for delaying advanced puberty - and a two-year trial period in which they must live out life as the opposite sex. The length of the trial period gives them time to reflect on their decision. (Our British colleagues object to the fact that because the trial period delays the development of secondary sexual characteristics, it does not provide a child the opportunity to live in the advanced adolescent body of their biological sex.)

However, when this procedure is followed, the Dutch have not had one case of surgical regret in more than 25 cases published in peer-reviewed journals.

One clinic in Germany will start the hormonal treatment as young as 12. Though treatment at age 16 is now possible at the Dutch clinic and from some American endocrinologists, such an age is still seen by some as too young.

Frustration continues for American parents of transgender children, as it can be difficult to find care providers who are willing to medically delay puberty and then to provide cross-hormones at or before 16 years of age so that children can experience the puberty of their gender identity.

Psychological support and evaluation is usually available only in a few specialized clinics. And it is very difficult to find an insurance company that will cover all of these treatments. In a system that can afford the plethora of expensive surgical procedures for advanced cardiac disease in people of well-advanced age, we surely can afford more clinics to evaluate and treat these children, and not condemn them to psychological morbidity at an early age.

From: http://www.sfgate.com/cgi-bin/article.c ... MT7C9C.DTL

[Danya (imported)]

Thanks for posting this. I can see myself in a lot of it. I don't know if I was ever a true transexual and suspect I was not or that would have become more clear to me over the years. On the other hand, I became extremely competent at hiding whoever I really was. I'm certainly a transgenderist of some type. Some of my earliest memories are of being extremely depressed. Back in those days, 1950's, it wasn't believed that children could be depressed. I sure as hell was because I felt I didn't fit in with any of the the boys. I vivdly remember feeling those feelings that today I would recognize as depression. I had enjoyed many moments playing with paper dolls and having tea parties with a girl down the street and those are wonderful memories. I was probably 4 at the time. It was when my father found out and insisted that I play with boy things and get active in sports (he was only slightly successful at this) that the depression set in, big time. It got much worse as puberty started and I wasn't really sure I'd make it. I did everything I could to hide the effects of puberty, including shaving off my body hair and not wearing clothes that would reveal it when it hadn't been shaved. Yes, I did think at times that I should be a girl but I pushed those thoughts from my head. [In 7th grade my parents couldn't handle the fact that a neighbor girl and I had innocently tried a quick kiss on the lips. There was no way I was going to discuss any other feelings with them that had anything to do with sex, let alone the possibility of wanting to be a girl.] Even when puberty had done its thing and I was in college, I was really unhappy when a young woman and her son walked by me on the street and the son pointed at me and said 'Look, mommy, a man'. I was embarassed by my beard and guess I really didn't like being called a man. I was an emotionally abadoned child because my parents didn't know what to do with this really strange son. More than one therapist has told me this and I didn't believe it at first. I was left to grow up on my own. If I didn't keep to the masculine line, I think I must have felt that I would be totally abandoned, not just emotionally but physically, too. When I told my father, on a number of occassions, that I was different from the other boys he'd sternly reply that I wasn't to say that, I was exactly the same as them. Neighborhood kids would ask me why I was different from all the other boys and I had no clue (or at least none I could acknowledge), although I knew they were right. I had had no sexual experience with either sex. I had no concept, then, that my being different was because I was gay. So, this brings back some painful memories for me but I've got to say I'm finally, totally addressing these issues. And I feel really great about that. The article you posted gives me hope that fewer children will be rejected for who they are. It makes me happy that some parents, at least, are willing and have the courage to clearly see and accept their children for who they really are. And love them so fully that they actively seek out what is best for them.

-todd

[Phole (imported)]

I would also like to say "thank you" for this article. I remember being around the age of six and thinking I wish I were a girl. I have an aquaintance whose son annouced at the age of two, almost the first words out of his mouth that "I am a girl". This child is one of the most inteligent, and artistic young people I know. His parents have allowed him to have some play clothes that are girl clothes. He wanted a tutu and they allowed that. I know it is very difficult for the parents.

[Phole (imported)]

Here is my first attempt at placeing a link to a news story I found about a young school student that is transgendered, I hope the link works. http://www.fosters.com/apps/pbcs.dll/ar ... osnews1403

Gender identity, gender change: Stratham school child case brings issue to forefront

By Charles McMahon

[email protected]

Article Date: Wednesday, December 12, 2007

STRATHAM — Whether a girl is called a tomboy, or a boy has been told he throws a football like a girl, everyone in some way or another is affected by the issue of gender identity.

Most recently, after a letter was sent out to the parents of a Stratham Memorial Elementary School classroom regarding a student's choice to be recognized as transgendered, the frequency of the situation has surfaced as being more common than generally thought.

Unlike transsexuals, people who identify themselves as transgendered can be physiologically male or female, but feel as though they're trapped in a body of the wrong sex.

Tawnee Walling, executive director of Seacoast Outright, who has been in contact with the family of the 9-year-old student, confirmed on Tuesday that the school department sent a letter to the parents of students in one particular classroom, and that the letter addressed the student's decision to change his name in order to be recognized as a female.

According to Walling, children are able to differentiate their gender identity by the age of 3, and she herself has worked on 20 different cases this year alone involving transgendered youth in the Seacoast area.

"This isn't something to take lightly," said Walling. "It's a serious decision that has to be made related to the health and well being of the youth."

She also said that the student's parents, who do not wish to come forward at this time, have been very supportive of their daughter's choice and have done a considerable amount of research.

They also say they understand the risks entailed in the process, which is not a sex change, but a reassignment of the gender the person presents to the world.

"It's more about survival and not about gender identity," said Walling.

She added that it is imperative to the child that the issue be recognized early so that it ensures a normal upbringing and that they go through the proper pubescent stages.

"It's not easy," said Walling. "The risks of not letting them go through this is far greater."

She said that as a child gets older and their body starts to betray them, suicide rates goes up dramatically if the issue is not addressed properly. Transgendered children who are allowed to be themselves are much happier and are generally better students, she said.

Gender identity has seemingly always taken a backseat to questions of sexual orientation and preference, and Walling admits that it's part of her duty to differentiate between the two and educate the community about the difference.

"The physical sex doesn't necessarily match who they are on the inside," said Walling.

The term, "transgendered," is an umbrella term associated with any person that doesn't fit the mold of a male feeling masculine and female feeling feminine, said Walling.

She eluded to a condition known as gender identity disorder, and said she believes that the term is a misnomer in that it suggests that there is a distress involved in the condition and the individual. She said that it's everyone else that has the distress with the issue and not the people themselves.

Walling also said that she recently spoke to members of the elementary school about cultural competency training and that the school has been aware of the situation with the student for some time.

She said that the school should consider issues such as designating gender mutual bathrooms because it's very common for transgendered youth to develop bladder, liver and even kidney infections due to the uncomfortable position they are put in by having to hold it.

In addition to that, she said that the education of the youth could also be affected. Classes such as physical education pose a problem in that a transgendered student may not have the clear option on which locker room to utilize.

"Community education is essential," she said. "This issue affects all of us."

A transgender support group is offered on a monthly basis to youths, ages 13 to 20, and according to Walling, her organization is working to provide the same type of support for children under the age of 12.

"These support groups are a way to connect families dealing with similar issues and to connect people with GID with each other," said Walling.

She added that her group is available to anyone, at anytime, and that they strive to provide their youth with a safe place where they can be themselves and continue to develop into strong, secure adults, without fear of being discriminated against, harassed or disparaged.

Seacoast Outright is a support and advocacy organization that serves gay, lesbian, bisexual, transgender, questioning youth and their allies.

[Phole (imported)]

Here is another article from the newspaper

. http://www.fosters.com/apps/pbcs.dll/article?AID=/200

80113/GJNEWS_01/335083909

Transgendered Youth: School children face unique difficulties

By CHLOE JOHNSON

Staff Writer

[email protected]

Article Date: Sunday, January 13, 2008

Editor's note: This story is one in an occasional series about transgendered youth.

For a highschooler who was born female but felt, dressed and acted like a boy, it didn't feel right to use a girl's bathroom.

The teen, who recently graduated from high school and lives in the Seacoast area, asked that his name not be used to protect his privacy.

He said he knew from the age of 5 that he was a boy born in a girl's body. Playing on girls' sports teams and using the girls' locker room just felt wrong, he said. But schools didn't offer co-ed teams or let him try out for boys' teams.

Based on the way he presented himself even as a child, people would refer to him with masculine pronouns when in public with his mother. He liked it, but said his mother always corrected them.

That changed after he came out as transgendered after graduating, and she's started using those pronouns too.

Transgendered is an umbrella term used to describe people who don't fully identify with their birth gender or who were born with intersexed conditions. It can include people ranging from transsexuals who live as the opposite sex or have been surgically reassigned to someone who cross-dresses occasionally.

"Don't assume other people's gender when you're talking to them," the teen said.

His parents at first tried to reinforce the typical traits of biological girls. It was difficult, for example, to get sneakers and sweatpants he liked to wear or a short haircut, he said.

"Stressful," "uncomfortable" and "awkward" were words he used to describe a transgendered childhood.

Meeting other transgendered people through Seacoast Outright helped, he said. The Portsmouth-based organization provides support and advocacy for gay, lesbian, bisexual or transgender youth and their families.

Tawnee Walling, the group's executive director, said being transgendered is distinct from any issues of sexual orientation. A transgendered person may be attracted to men or women just like anyone else, and that sexual orientation's separate from anything done to address a gender identity conflict.

Walling said parents should take it seriously if their children bring up gender identity concerns.

Many adults underestimate the ability of a child to recognize a gender identity conflict, she said.

While there are many theories out there about why some people are transgendered, in one respect, they're not important, she said.

"It's important to accept everybody for who they are," she added.

The Minnesota-based World Professional Association for Transgender Health estimates that 1 in 11,900 people born male and 1 in 30,400 people born female are transsexual. The association says the prevalence may be higher, however, with other estimates as high as 1 in 2,500. [emphasis added ---JA]

Walling said she expects more children to voice their situation as more people understand the issue.

There have been several cases in New Hampshire in which schools have been told a student was transgendered and been asked to make adjustments. In some cases, it's been clear educators have some learning to do, she said.

"When schools are open to becoming better educated, they're doing the right thing," she said.

Schools have been making an effort to protect transgendered children and their right to an education. But it would help if more schools adopted policies and procedures in anticipation of transgendered children coming out, she said.

At Stratham Memorial Elementary School this school year, a 9-year-old student asked to be called a different name to be recognized as female.

Arthur Hanson, superintendent of School Administrative Unit 16, which includes Stratham, called the case a first, but said the school's staff simply applied the same philosophy they do for all children.

"We feel it's our obligation to educate all students to best of our ability," he said.

That applies regardless of gender identity or anything else, he said.

The staff decided to be as upfront as possible with parents and students and tried not to make a greater issue of it, he said.

"We live in a society full of diversity," he added.

Certain accommodations were made along with the name change, including letting the child use staff bathrooms.

Anne Boedecker, a psychologist and gender specialist in Bow, said peers are more understanding when a child transitions at a young age. Still, sometimes teachers and older people find it a challenge to accept, so parents need to work with schools when a change happens.

She said transgendered children often get teased, bullied or harassed, particularly in middle school. They often change schools when this happens, but they carry over a "sense of always trying to hide," she said.

Gender neutral bathrooms need to be established, because bathrooms are where children are going to get the most harassment, she said.

Schools also need to honor name changes, she said, whether they are legal or just preferred.

Children should have the freedom of gender expression, including the right to wear the clothing they want within the dress code or to have short or long hair, she said.

Not all children who have gender identity issues ultimately transition to living as the opposite sex, she said, so there is a need for flexibility.

"You don't have to rush to assign kids a gender," she said. "It really needs to be driven by the child."

[DonFL (imported)]

rarely there is an article i can blanket agree with, this is one of them...

[NaziNuts (imported)]

First, I am not a Nazi, just fascinated by studying them.

Second, I just stopped in here to give someone who gave me some positive reputation points some back. Now that I've read the posts here, I have more awesome respect for all of you.

I come to the site because of a TG GF who I then started to move away from because of like-wow hormonal mood swings. I will always love her and her friends. She likely will read my posts, and I always want her to know that.

So, I wish you all well.

FromNeinNaziYahSleightlyNuts

[Phole (imported)]

Here is another in the same series of articles. I have read other accounts of the onset of puberty being delayed, but those articles were in big town newspapers or internet stories from foreign locals. It is encouraging to me that a small town newspaper, in still very conservative NH would do a series of articles on transgendered youth

. http://www.fosters.com/apps/pbcs.dll/article?AID=/200

80127/GJNEWS_01/205304745

Transgender teens: Doct

ors refine hormone, other therapies

By Chloe Johnson

Staff Writer

[email protected]

Articl

e Date: Sunday, January 27, 2008

Editor's note:

This is one in an occasional series about transgender youth.

Puberty can be scary for many children, but doctors say it's absolutely terrifying for transgender youth.

"If they're not terrified of it, they're not trans," said Dr. Norman Spack, clinical director of the endocrine division of Children's Hospital in Boston.

The hospital opened a transgender clinic for children nearly a year ago, the first in the nation like it, according to Spack.

At the onset of puberty, children begin to feel the effects of their gender assigned at birth and develop the related secondary sex characteristics, such as breasts. That's especially difficult for transgender youth who identify with a gender oppos

ite of the body in which they were born.

Transgender is an umbrella term used to describe people who don't fully identify with their birth gender or who were born with intersexed conditions. It can include people ranging from transsexuals who live as the opposite sex or have been surgically r

eassigned to someone who cross-dresses occasionally.

There is limited and varying data on the number of transgender people in the nation, according to the Human Rights Campaign in Washington, D.C. A report issued last year by a University of Michigan professor estimates the frequency of male-to-female transsexualism is in the range of 1 in 500 to 1 in 2,000.

There are medical options for transgender youth, but opinions differ on the best time to intervene, doctors say.

One option, practiced in the Netherlands, is to delay puberty by prescribing hormone blockers in an early stage of development called Tanner 2, Spack said. He said this is between the ages of 12 and 14 for boys and 10 to 12 for girls on average. The blockers extend the time doctors have to evaluate the child and make a diagnosis, while the child continues to gain the reasoning skills to help make up his or her mind.

Development continues normally if blockers are discontinued. But should the child not have a change of mind, they can change development by taking cross hormones next, Spack said.

He said a young person can develop like the gender they identify with this way and possibly achieve a result more convincing to others and personally satisfying than if they had transitioned later in life. For example, a transgender female will then never grow facial hair, and a transgender male will never grow breasts.

The other belief, common in England, is that the natural progression of puberty is necessary for brain development, Spack said. He said they do not allow transitions before the age of 16.

He added that many transgender children without treatment make attempts to end their lives before reaching that age.

Medical treatment of gender identity conflicts is in an early stage, and there is not yet a general consensus on the best way to proceed, he said.

"This is still somewhat of an experiment," he said.

For a parent of a young transgender woman in the Seacoast area, reversing the effects of puberty made all the difference. He asked to remain anonymous to protect his daughter's identity.

The parent said his child started with hormone blockers, then took cross hormones and more recently underwent sexual reassignment surgery.

"She's the same, but not," he said.

When it's time to make a gender change, he said, it's the sooner, the better.

"You want what's inside to come out," he said.

Anne Boedecke

r, a psychologist and gender specialist in Bow, said children begin to understand gender around the age of 3, and most with gender identity issues report them around 4 or 5 years old.

She said some children express that they want to be the opposite gender when they "grow up," since they have a sense of

development as being a fluid process.

Others are envious of the body parts of those of the opposite gender and don't understand why theirs are different.

Boedecker said some people are born gender variant, and the fact that young children express this long before they express their sexuality proves that.

The proper response at that age, Boedecker said, is to give it time.

"It's a gradual process for adults, and it takes even longer for kids," she said.

Doctors use the s

tandards of care for gender identity disorders by the

World Professional Association for Transgender Health, formerly known as the Harry Benjamin International Gender Dysphoria Association.

After acknowledging and accepting a gender conflict, the standard is to begin with a complete psychiatric assessment and therapy to reduce distress.

The standards put physical intervention into three categories — fully reversible, partially reversible and irreversible — and say they should progress gradually in that order.

Boedecker said the fully reversible hormone blockers help delay the development that can be "horrifying" for transgender kids, and give them time to make their decision. She added that it's

important not to make any permanent changes too soon.

"You don't have to rush to assign kids a gender," s

he said. "It really needs to be driven by the child."

However, she said, the younger children transition, the more likely their peers will accept the change.

Dr. Edgardo Menvielle, director of the gender and sexuality development program at the Children's National Medical Center in Washington, D.C., said biological girls tend to express their gender variancy later than boys.

That may be because girls seen as "tomboys" find more social acceptance than a boy seen as effeminate, he said.

His program provides evaluations and therapy for children with a range of gender issues, as well as education and advocacy. It has focused on younger children, since there already are more programs available to help teenagers, he said.

Menvielle said he uses a clinical judgment to determine a genuine gender identity disorder in young children by speaking with them and parents about the degree of discomfort and the history of how the issue evolved, for instance.

He said it would be ideal for children to wait until puberty to make a final decision regarding their gender change.

But, he said, "the real world is not ideal."

He said many children are in such severe psychological distress over their gender identity conflict that it might not be humane to wait.