Important Ethical Question

[mrt (imported)]

Just a few minutes ago I received an email from the director of a university hospital program that is well-known for its work with the transgendered population – everything from counseling to surgery, and with an important research program as well.

What would be YOUR response to his question?

I will be sending him my response within a day or two, at most.

Understanding that the sooner a transgendered person starts on Estrogen and does not have Testosterone "conversion" it makes the question difficult to answer.

I think the age of consent is the primary point. A pre 18 kid can't consent to surgery. Correct? Can / should parents be allowed to alter a kids future? It brings to mind all the kids who had their sex selected for them based on what private parts were more developed then finding out much later that they went the wrong way.

Hate to say it but I would have to say wait. I think its a bit like 18 year olds asking for vasectomy surgery. The Uros are going to be very strongly against anyone that age making a one way decision at such a young age. A pre 18 kid? Its got to be much harder and at least with Vasectomy there are "some" reversals that work.

[daveyjones (imported)]

I remember way back when the dinosaurs roamed the earth... when I was in elementary school, there was a particularly homely girl in one of my classes. She was the target of most of the other girls, as they used to tease her that she looked like a boy. One day, a group of girls jumped her in the girls' bathroom to beat her up. They tore her clothes in the fight. Then, they all ran from the bathroom screaming. A teacher hearing the commotion ran in to find the girl crumpled on the floor. When she picked her up off the floor, she discovered that this girl was in fact a boy. She took the boy to the nurse's office. Later, we found out that the boy's mother and aunt had raised him as a girl, and he had no idea that he was a boy. In those days, They used to take the children into foster care. In high school, I went to a student science convention in Los Angeles, where I ended up meeting several people that I knew in elementary school... including that boy. He was a well adjusted, though nerdy guy who was very interested in girls and looking forward to studying engineering at Cal Tech. It turned out he was not transgendered. He was not gay. He was heterosexual through and through. I asked him what happened, and he told me that the courts had appointed his paternal grand parents as his legal guardians. Like me, he had a high school crush on Los Angeles reporter Tritia Toyota, a rather pretty Japanese-American newscaster who was proof that nerd girls can be quite attractive. That we had in common, a "liking" for asian girls, making us happy that we were studying science at Cal Tech and UCLA. So for me, knowing a boy that was brainwashed to be a girl, I would say that a boy that is several years from the onset of puberty, should be removed from the family for about a year to see if his transgender tendencies are genuine or if they were trained by the parents. Then, if they are genuine, wait until after puberty to see if he changes in the presence of the increased testosterone. If he is still transgendered at 18 years of age, then his transgender-friendly family can pay for the gender re-assignment surgery with the money they saved for the operation.

[DeaconBlues (imported)]

I have thought about this child for the past day or two.

Honestly, I do believe that even a child can make this sort of decision for him or her self. If the child is interviewed by a competent doctor, and the doc say he or she is in fact transgendered, that should end it right there. If she or he wants to delay puberty, let the child at least have his or her own body. It is after all, HER life. I think surgery should be offered at the best time for the transition process.

[transward (imported)]

There is something about this post that doesn’t smell right. Jesus is a well respected poster on this site so I don’t think he pulling anything and I assume that he knows his fiend from whom the question came, but does the doctor know the person that posed the question. Recently the trans sites have been buzzing with discussion of the treatment of trans children and the flak from the religious right has been fierce, with accusations of child abuse. The protocols for treating young trans are in a state of flux, but certain outlines have become clear. First is the Hippocratic admonition “Above all do no harm.” The age for actual SRS has dropped a bit, 16 or 17 seems the current limit, and it is now acceptable to begin hormone blockers before or with the onset of undesired puberty to prevent unwanted secondary sexual characteristics, the current battle lines seem to be about when to begin cross sex hormones. To perform irreversible surgery long before the child is capable of giving informed consent seems clearly unethical. And while there have been self mutilations by trans children trying to make their bodies conform to their self images, in almost all cases they have been untreated children and tend to attack either their penis or their whole package, not just their testicles. All the young trans people I have talked to in years or running Trans Support Groups have been more interested in getting hormones and developing breasts. This letter to the doctor just doesn’t sound right. It sounds more like someone fishing for ammo to attack us. Were the doctor to agree to the surgery, I would expect it to be all over Rush Limbaugh and his ilk..

Transward

[IbPervert (imported)]

It is my understanding that pre pub boys that are castrated never develop an understanding of sex. Almost like the hormones turn the spicket on for life.

Just because people down in Asia would not have a problem castrating any male regardless of age does not make it right!

Just in case it is brainwashing i think that the boy should live with some normal men (that are not effeminate) for a month or two just to get a whiff of a typical male lifestyle or at least some type of big brother situation where they can hang out and just be guys!

I say he because in my mind the child is still male.

If he is of high school age then he might have enough exposure and maturity to go through with it, but boys mature at a later point then girls do. I have seen 20 something boys who where not mature.

It really depends on how mature he is, how intelligent and how much wisdom he has.

[Eunuchist (imported)]

I have thought about this child for the past day or two.

Honestly, I do believe that even a child can make this sort of decision for him or her self. If the child is interviewed by a competent doctor, and the doc say he or she is in fact transgendered, that should end it right there. If she or he wants to delay puberty, let the child at least have his or her own body. It is after all, HER life. I think surgery should be offered at the best time for the transition process.

Well said, DeaconBlues.

My understanding is that in this case we may be talking about someone who might be as young as 10, ie. "

a number of years before the normal onset of puberty

")

I guess that from a mainstream/cautionary standpoint, it would be assumed that it would be better for the youngster to experience the delay of puberty first for several years and witness the possible consequences it might bring along especially in terms of social adjustment etc., then, when he/she is at least 16 and is clearly satisfied with most of the aforementioned effects, and still wants to proceed with the surgery just as strongly, then final surgery (including, if neccessary, complete SRS) ought to be seriously considered. Perhaps the greatest advantage to this approach is the fact that with the aid of modern medicine (and it's arsenal of various puberty suppressing drugs) it is today perfectly possible to undergo pre-pubertal castration/SRS at the age of majority. Such an approach would also be the only currently legally defensible option at this moment in most (if not all) Western countries.

OTOH, disadvantages to the above include, for one, the fact that a lenghty trial with chemical castration is apparently inferior to surgical in several aspects from a standpoint of someone who already made up their mind. First, depending on the drug used, there are a number of adverse side effects which long-term consequences are not yet fully elucidated. GNRH agonists have been suspected in inflicting a lasting disruption of the pituitary gland, and steroid-based anti-androgens such as Androcur have been associated with elevated liver and cancer risks. Second, chemical castration - especially lasting for several years - is rather costly and time-consuming, particularly if such a regimen would have to be combined with a costly hormonal regimen of the opposite sex.

Thus, if there is a way to know with any good measure of certainty (which is a rather moot point, ref. previous posts) that a 10-12-14 year old is fully determined in their motivations and the risk of relapse is judged to be highly negligiable, an early surgical intervention would, in my opinion, clearly be the quickest, healthiest, cheapest and the most convenient alternative. Penectomy is more of an issue in the sense that it may permanently remove the capacity for later sexual functioning, although according to my sources, during SRS, penile nerves are spared and merely relocated and incorporated into the artificial vagina, with most of the sensitive capacity largely left intact.

Nevertheless, I do not think - regardless of motivation and seal of approval from renowned specialists - that any serious attempt at genital modification (such as SRS) can take place legally until at least 16-17 years of age in most Western jurisdictions. And that, I believe, is pretty much the bottom line in the proposed scenario. I am not familiar with the Thai legislation on these matters; if it indeed allows for such surgery at younger ages, I wouldn't be surprised if it might one day become a popular destination for a number of such strong-minded individuals. BTW, I've heard of at least one TS male (US resident), now well in her twenties, who managed to obtain a clandestine orchiectomy by a qualified surgeon at the age of 14 in Mexico. Apparently she was (and still is) very satisfied with the results.

[The Lurker (imported)]

I am going to use an analogy here. It is in no way as serious an issue as the possible castration of a child but please bear with me...

Like most American males, I was circumsized as an infant. I completely and totally wish I had my foreskin back. I feel like I have been denied access to my own body part. Now I understand that most people think that circs are practical and worthwhile, and doctors think they are healthier, BUT I WISH IT NEVER HAPPENED TO ME.

Now bump that concept up to the level of TESTICLES. As well meaning and concerned as all of the adults are in the situation, THOSE NUTS BELONG TO THAT KID AND NO ONE ELSE. He loses all possibility of reproduction as well as much of his possible sexual enjoyment. I don't care about religion, or the conservative right. All I care about is that kid's FUNDAMENTAL RIGHT to self determination. If he wants to have SRS when he's a teen, so be it, but as a fully intact prepubescent, there is no reason to modify him in any way.

The thing is, this board is supported by many people who wish they were castrated but cannot find a doctor willing to do the job. This is surely coloring some of the responses in this thread. ie: "If only my parents had the forthought to nut me at 6 years old..." except that kid is not you, he is his own person not yet knowledgeable enough to make such a drastic and permanent decision.

[Paolo]

A number of weeks ago, I received an e-mail message from a parent of a young biological male (I will omit the age, but let's say a number of years before the normal onset of puberty) who is described as transgendered...this youngster appears to be living in a family that is part of what I might call the subculture of "transgender affirming" families. As far as I can tell, this youngster showed very early cross-gender behavior and has, more or less, been living as a girl since preschool, with very clear familial and professional support in so doing.

Apart from considering puberty blocking treatment, this parent asked me about the possibility of a bilateral orchidectomy (castration).

So, here is my therapeutic/ethical question: would anyone recommend castrating this youngster? If so, why? If not, why?

Always before, my thoughts on this issue would have been answered with a definite “No”. And after much consideration, I have not changed my mind.

Several things about this stand out:

First, the source that Jesus cites as having received this email from is a closed professional list. You cannot look it up, you cannot register there, and you do not post unless you are “in the profession”. It is not open to the public, therefore, it is a valid question posed to a group of valid professionals.

Next, the author stated: “

this youngster showed very early cross-gender behavior and has, more or less, been living as a girl since preschool.

”

OK, how early is “very early”? Age 2? Age 3? When language first formed?

Next – “

more or less, been living as a girl.

” Sorry, “more or less” don’t get it, pal. This raises SOME doubt on the issue. Now, if said child was resolutely convinced that said child IS a girl, no questions asked, then we could eliminate this. Based on this wording, however, the child is aware of differences between boys and girls and tends to hover between both genders of M and F. Having helped raise 5 boys, I can tell you, there isn’t room for waffling here. Mine all identify as MALE, no questions asked. BUT this kid IS asking questions, in the form of “more or less” – you can’t do the “more or less” thing. You can’t be a girl one day and a boy the next. This needs to be pointed out to the parents and the professional posting the question.

My next issue is with family environment, described as “

what I might call the subculture of "transgender affirming" families.

” My problem with this is how much the openness of the family – which is a GOOD thing, don’t get me wrong – has influenced this child’s behavior and thinking. I was raised by heterosexual males, when they were around. I knew no gay, trans, or other type-genders when I was a boy. There were men and women. The men were straight. However, this is where a slight glitch comes in – I thought I was straight, sort of went into bi-leanings for a while, then finally settled on asexual with seriously gay leanings. How’s that for a ride? Where’d I get that from?

Who knows?

It wasn’t from roll models.

However, what has this child gotten from the role models already? How much have they – and HAVE they intentionally – influenced the child to date, in thinking that it is OK for him to be a girl? Were this child to be put in a “typical” male/female parent family and exposed to “boy activities” for say, a period of one year with no talk or acting of transgendering, what would the outcome be? How would the behavior change? Would it?

It’s nice to know that a child can be raised in such an open environment on such an issue, but I cannot help but think that this is a heavy influence. The fact that being raised in the presence of heterosexuals didn’t assure that I would turn out that way notwithstanding…I cannot use myself as the sole justification. However, the parenting / socialization in such must be considered in this case, I think.

Finally, the issue of castration vs. other options.

Others here have already covered the options, and we’ve already read about the pros and cons of natural puberty, no puberty (blocked), and puberty of the opposite gender brought on by – in this case – estrogen treatments. We don’t need to rehash it. Other than perhaps dependency upon male HRT later in life, should the child have a change of mind, all of these options are reversible.

Castration is NOT.

Now, we do not know the age of this child. We don’t know if the child is very intelligent, highly intelligent, average, or a total dumbass. HOWEVER, let’s say the child is 6, making a wild guess on clues given. Maybe 7.

We have always been open about allowing the boys here to make their own decisions on what to wear, haircuts, etc., but nothing any more permanent than having pierced ears. The worst case – a bad haircut that ended in a buzz and pierced ears left to heal over. When one of them was 9, he kept his head shaved with a razor for a year. He liked it. We let him. But hair grows back. Testicles do not.

It is my opinion that a child of this CANNOT, under ANY circumstances, understand all of the issues that WE KNOW comes with castration. WE know what will happen, because we are rational adults. It is not the end of the world to us when we don’t get our way – but to a child, THAT is. How many screaming-mimi fits have you all seen in public by kids up to, say, age 12, even?! Think about it. The rationality is NOT there. It’s a fact.

The answer, in my opinion, is still NO.

This child, or any child, is not able to comprehend the ramifications of castration.

I would make one and only one concession in this case or one like it – if the child is intelligent, and can display understanding of the effects of surgery, then surgery of any kind – up to GRS or just castration – would NOT take place for any reason until the age of 16 at the MINIMUM.

In closing, I am bothered that a parent brought this up to a professional.

I am bothered by the said environment that MIGHT be encouraging it.

I am also bothered by the “more or less” attitude of being a full-time girl.

I am bothered by the age of “girl onset”, so to speak – just before preschool?

How would I deal with it, then?

Treat the little XY as a full-time girl. Period. End of story, hardass conformity.

No boy haircuts. No boy clothes. No boy toys. No boy activities.

The child lives full time as a girl, no exceptions, no excuses.

See how long it lasts.

Commitment to the cause there is a MUST.

There can be NO waffling on the issue of gender.

Now, like I said, if the child can do it as a girl until age 16, +/-1 if very intelligent, then she gets my blessing. I’m even for the lupron approach to avoid male puberty.

But at the first big setback or backslide into the “I’m a boy!” mindset, then the party is over. He’s a boy. Surgery before then is NOT an option.

[Uncle Flo (imported)]

So far this is one of the most interesting coversations we have ever had on the boards. --FLO--

[jemagirl (imported)]

There have been so many thoughtful response to jesus' post. Naturally as individuals are all coming at this from different points of view, and so even though we are looking at the same thing, we all see it a different way.

One of the things I would like to bring to this discussion is the idea that the old binary gender paradigm plainly is false. I know this because I don't fit well in the "M" or the "F" box. I'm really some where in between M & F and there are people here in the EA who are in the "E" box which is not to be found any where in between F or M. So even at this point we can see that gender can not be described accurately using binary opposites. Perhaps a triangular arrangement might be more appropriate?

If only we could leave said discussion here, we could get away with only the two dimensions x and y ( or even XXY or even XYY or XXYY or XXX also known as triplo-X ) but even that would still leave sexuality out of the picture, and we all know sexuality is all about F*©#ing, so the two dimensional model is well... you get the idea. So now you need to add a third dimension... Zz DOH!

Well perhaps a cube then... Ah yes, then we could describe every one's sex and gender using the Cartesian coordinate system. René Descartes would probably be very happy with that arrangement, and after a ten thousand years of cataloging every living person's sex and gender he would only be able to tell us that.... ( drum roll please ) gender and sexuality combine to form a very complex and amorphous matrix that defies simple descriptions.

One may as well ask "What shape is the air?" It's a simple question any child might ask a parent, and you might be inclined to answer that the air is the shape of the room you are in, but then you have to start making exceptions for all the objects in the room. Things get very complicated very quickly defeating any simple geometric shape that comes to mind, and the world doesn't stop at your doorstep either. So as soon as you step outside into the real world you are lost. Suddenly air is round like the planet... minus a few small details like the Rocky Mountains of course. What is the point here? Air is what ever shape it needs to be, regardless of what shape you might like to think it is, and so it is with gender and sexuality.

Having said all that I expect the old gender paradigm to remain in popular usage for a long time to come. After all it is well worn and comfortable like an old pair of blue jeans. I also expect to catch plenty of grief for busting out all the seems, cutting off the legs and wearing those jeans like a pair of Daisy Dukes!!! LOL