Yesterday and today, All Things Considered, a National Public Radio syndicated program, broadcast a two part series on transgendered children. Im posting the transcripts of the two 20-minute segments below. From the web addresses listed at the bottom of each, you can link to podcasts of the original programs as well as a wide range of additional information.
The programs are well-balanced and very positive. My local NPR station broadcasts the program twice a day during both the morning and evening commute hours. I expect that thousands of people listened to these programs and considered the question of transgendered children for the first time.
I feel I got my moneys worth for my annual contribution from just these two shows. If you are not a member, you might consider adding your support for programming like this.
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Re: Support Your NPR Station
Two Families Grapple with Sons' Gender Preferences
Psychologists Take Radically Different Approaches in Therapy
by Alix Spiegel
Part one of a two-part series
I thought she was gonna hyperventilate and faint because she was so incredibly happy. ... Before then, or since then, I don't think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress.
Pam, Jonah's mother
Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would.
Dr. Ken Zucker
If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health.
Dr. Diane Ehrensaft
All Things Considered
May 7, 2008
Note: To protect the identities of these families, NPR has used only first names and has changed one of the children's names.
It wasn't until Halloween when her 2 1/2-year-old son decided to dress as Dorothy from The Wizard of Oz that Carol began to worry.
Bradley had always had a preference for girls' things. From his earliest days he had chosen girls' dolls, identified with female characters and gravitated toward female children. But Carol had never thought to care. As far as she was concerned, it wasn't a loaded gun; it wasn't a lit cigarette. She says it had really never crossed her mind to say, "I'd really rather you played with a truck."
Then, on Halloween, the calculus began to tip.
To simulate Dorothy's hair, Carol covered Bradley's blond crewcut with a brown tea towel. Bradley loved it. In fact, he became obsessed with his tea-towel hair. For months afterward he would wake up every morning and put the towel on his head. When Carol tried to remove it, he would protest.
"It was really obsessive," Carol says. "We really had to negotiate times when he just couldn't wear it anymore. ... He seemed to feel uncomfortable and nervous sometimes when he didn't have this hair, this tea-towel hair."
And as Bradley grew older, his discomfort with things male also grew. He would shun other boys he played exclusively with girls. Again, this concerned Carol, but she wasn't frantic about it.
It was a single event that transformed her vague sense of worry into something more serious. One day, Bradley came home from an outing at the local playground with his baby sitter. He was covered in blood. A gash on his forehead ran deep into his hairline.
"What had happened was that two 10-year-old boys had thrown him off some playground equipment across the pavement because he'd been playing with a Barbie doll and they called him a girl," Carol says. "So that sort of struck me, that, you know, if he doesn't learn to socialize with both males and females ... he was going to get hurt."
One Direction in Therapy
Carol decided to seek professional help. Bradley's school referred her to a psychologist in Toronto named Dr. Ken Zucker, who is considered an expert in gender identity issues. After several months of evaluation, Zucker came back with a diagnosis. Bradley, he said, had what Zucker called gender identity disorder.
Gender identity disorder is a label given to children who believe themselves to be born into the wrong biological body. This diagnostic label encompases a range of behaviors and the label itself is controversial. But, in general, what characterizes children like Bradley is that they are more than just effeminate boys, or masculine girls, who are gay. These are children who genuinely believe they are girls even though they have a male body or boys, even though they have a female body.
Zucker, who has worked with this population for close to 30 years, has a very specific method for treating these children. Whenever Zucker encounters a child younger than 10 with gender identity disorder, he tries to make the child comfortable with the sex he or she was born with.
So, to treat Bradley, Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups. Boys would find his feminine interests unappealing. Girls would want more boyish boys. Bradley would be an outcast.
Carol resolved to do her best. Still, these were huge changes. By the time Bradley started therapy he was almost 6 years old, and Carol had a house full of Barbie dolls and Polly Pockets. She now had to remove them. To cushion the blow, she didn't take the toys away all at once; she told Bradley that he could choose one or two toys a day.
"In the beginning, he didn't really care, because he'd picked stuff he didn't play with," Carol says. "But then it really got down to the last few."
As his pile of toys dwindled, Carol realized Bradley was hoarding. She would find female action figures stashed between couch pillows. Rainbow unicorns were hidden in the back of Bradley's closet. Bradley seemed at a loss, she said. They gave him male toys, but he chose not to play at all.
"He turned to coloring and drawing, and he just simply wouldn't play with anything. And he would color and draw for hours and hours and hours. And that would be all he did in a day," Carol says. "I think he was really lost. ... The whole way that he knew and understood how to play was just sort of, you know, removed from his house."
His drawings, however, also proved problematic. Bradley would populate his pictures with the toys and interests he no longer had access to princesses with long flowing hair, fairies in elaborate dresses, rainbows of pink and purple and pale yellow. So, under Zucker's direction, Carol and her husband sought to change this as well.
"We would ask him, 'Can you draw a boy for us? Can you draw a boy in that picture?' ... And then he didn't really want us to see his drawings or watch him drawing because we would always say 'Can you draw a boy?'" Carol says. "And then finally after, I don't know, a month or two, he just said, 'Momma, I don't know how. ... I don't know how to draw a boy.'"
Carol says she finally sat down and showed him. From then on, Bradley drew boys as directed. Male figures with anemic caps of hair on their heads filled the pages of his sketchbook.
Another Family, Another Approach
Three-thousand miles away, on the West Coast of the United States, another family noticed their small son's unconventional tastes.
Jonah was 2 when his father, Joel, first realized that no amount of enthusiasm could persuade his child to play with balls. Trucks languished untouched. Fire engines gathered dust. Joel says Jonah much preferred girl toys, even his stuffed animals were female.
"Like, I would always say, 'What's that guy's name?' and the response would always be, 'Oh, she's bunny, she's, you know, this or that,'" Joel says.
Like Bradley, as Jonah grew older, these preferences became more pronounced. Jonah is physically beautiful. He has dark hair and eyes, a face with China-doll symmetry, and a small and graceful frame. Occasionally, while running errands, casual acquaintances, fellow shoppers, passers-by, would mistake Jonah for a girl. This appeared to thrill him. And, Joel says, Jonah would complain bitterly if his father tried to correct them.
"What began to happen was Jonah started to get upset about that," Joel says. "Like, 'Why do you have to say anything!' I remember one distinct time when we were walking the dogs and this person came up and said ... 'Oh, is this your daughter?' and I said, 'Oh, no, this is Jonah.'... And Jonah just came running up and said, 'Why do you have to tell! Why do you have to say anything!'"
Then around the age of 3, Jonah started taking his mother Pam's clothing. He would borrow a long T-shirt and belt, and fashion it into a dress. This went on for months with Jonah constantly adjusting his costume to make it better until one day, Pam discovered her son crying inconsolably. He explained to his mother that he simply could not get the T-shirt to look right, she says.
Pam remembers watching her child mournfully finger his outfit. She says she knew what he wanted. "At that point I just said, you know, 'You really want a dress to wear, don't you?' And [Jonah's] face lit up, and she was like, 'Yes!'"
(Joel and Pam now refer to their son as "she.")
That afternoon, Pam, her sister and Jonah piled into the family car.
"I thought she was gonna hyperventilate and faint because she was so incredibly happy. ... Before then, or since then, I don't think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress," Pam says of Jonah.
Pam allowed Jonah to get two dresses, but felt incredibly conflicted about it. Even though Jonah asked, she wouldn't allow him to buy any more dresses for a year afterward, so Jonah wore those two dresses every day, nothing else, until Pam got sick of looking at them. After a year, she and Joel finally began to permit other small purchases. But every item, Joel says, provoked a crisis.
"We'd spend a few nights talking: 'Do you think the shoes are like a line that we should cross? Or, you know, the girly hat, or the girly jacket with the frills?' ... Like, what are we doing? Are we encouraging this? Are we doing something that we shouldn't be?" Joel says they would ask.
Joel and Pam also ended up in front of a gender specialist Diane Ehrensaft, a psychologist in Oakland. Joel remembers an early session when Pam talked about her concerns.
"I remember her talking to the therapist and saying something to the effect of, like, you know, 'I'd be OK if Jonah just was gay, I just don't want ... him to be transgender.' And the therapist just laughed, she said, 'You know, 15 years ago, I had people on this couch saying, 'I don't mind him being a little effeminate, as long as he's not gay,'" Joel says.
In fact, Diane Ehrensaft's approach could not have been more different than the approach of Bradley's therapist. Like Zucker, Ehrensaft is a gender specialist. She says she has seen more than 50 families with children who have what Zucker would describe as gender identity disorder.
Ehrensaft, however, does not use that label. She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child's behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn't think Pam and Joel should try to cure Jonah.
"She made it really clear that, you know, if Jonah's not depressed, or anxious, or having anything go on that she would need to really be in therapy for, then don't put a kid in therapy until they need it," Pam says.
Ehrensaft did eventually encourage Joel and Pam to allow Jonah to live as a little girl. By the time he was 5, Jonah had made it very clear to his parents that he wanted to wear girl clothes full time that he wanted to be known as a girl. He wanted them to call him their daughter. And though Ehrensaft does not always encourage children who express gender flexibility to "transition" to living as a member of the opposite sex, in the case of Jonah, she thought it was appropriate.
Last year, when he started kindergarten, Jonah went as a girl. He wore dresses, was addressed as "she" by his classmates and teacher. He even changed his name, from Jonah to Jona, without the "h." It was a complete transformation.
Joel and Pam were initially anxious, but Joel says their worry soon faded.
"They have these little conferences, and, you know, we were asking, like, 'How's Jonah doing? Does she have problems with other kids?' and the teacher was like, 'God, I gotta tell you, you know, Jonah is one of the most popular kids. Kids love her, they want to play with her, she's fun, and it's because she's so comfortable with herslef that she makes other people comfortable," Joel recalls.
It was shortly after that that Joel and Pam started referring to their son Jonah as "she."
Two Families, Two Therapists, Two Approaches
The treatments practiced by Zucker and Ehrensaft are radically different and, therefore, are liable to produce radically different results. In fact, Zucker and Ehrensaft are representatives of a broader divide in the mental health community over the appropriate treatment for children like Bradley and Jonah.
This divide is so intense that there is very little common ground. There is little common ground even in the ways that the issue is conceptualized. Therapists like Ehrensaft tend to view kids like Bradley and Jonah as transgender, and see transgenderism as akin to homosexuality.
Thirty-five years ago, homosexuality was considered a mental illness a pathology so severe that it required aggressive therapeutic intervention. According to Jack Drescher, former chairman of the American Psychiatric Association's committee on gay and lesbian issues, one treatment was to try to condition homosexuals out of their sexual preference by attaching them to electrical shock machines and shocking them every time they were aroused by homosexual pornography.
Today, however, the APA's position is that therapies that try to turn homosexuals into heterosexuals are unethical. Homosexuality is now considered to be a normal variant of human behavior, so though a therapist might treat a person because they struggle with the stigma associated with homosexuality, therapists who practice in accordance with the guidelines established by the association don't treat the behavior itself.
Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker's therapy which seeks to condition children out of a transgender identity is unethical.
But that isn't how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.
"Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would," Zucker says.
If a black kid walked into a therapist's office saying he was really white, the goal of pretty much any therapist out there would be to make him try to feel more comfortable being black. They would assume his mistaken beliefs were the product of a dysfunctional environment a dysfunctional family or a dysfunctional cultural environment that led him or her to engage in this wrongheaded and dangerous fantasy. This is how Zucker sees gender-disordered kids. He sees these behaviors primarily as a product of dysfunction.
The mistake the other side makes, Zucker argues, is that it views gender identity disorder primarily as a product of biology. This, Zucker says, is, "astonishingly naive and simplistic."
Zucker has come to believe that taking the view that kids are born transgender ultimately produces more transgender people.
"By declaring the child as transgendered at, say, age 3 or age 4 or age 6, and then saying in a sense, 'Go with the flow,' ... that will impact, I believe, on how the kid's gender identity differentiates," he says.
In other words, allowing a child like Jonah to transition in kindergarten will essentially track him into becoming a transgender adult. And for Zucker, no child under the age of 10 or 11 can be definitively labeled transgender. He says that kids' gender identities are flexible. And that even a child like Jonah, who appears to be absolutely consistent from the ages of 1 and 2, can change.
But Ehrensaft says this position is too absolute. While she agrees that it's important to be very, very careful about applying a transgender label to a young child, it is at least possible. And Ehrensaft is clearly as disapproving of Zucker's form of therapy as he is of hers. She says it's wrong to take away a child's toys, to police the people he spends time with, the pictures he draws even the colors he draws with.
"To me, this is coercive therapy," Ehrensaft says. "And I don't think we should be in the business of coercing people. ... I would say all the kids I've worked with who have gone through that kind of treatment, they have not come out better; they've come out worse."
For Ehrensaft, the lessons of the early therapeutic approaches to homosexuality therapies that sought to "cure" the patient of homosexual desires are clear.
"If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health," she says.
The Problem with the Color Pink
It does seem to be the case that, at least in the short term, Carol's son Bradley is struggling in some ways with Zucker's therapy. Carol says it was particularly hard at the beginning.
"He was much more emotional. ... He could be very clingy. He didn't want to go to school anymore," she says. "Just the smallest thing could, you know, send him into a major crying fit. And ... he seemed to feel really heavy and really emotional."
Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn't go well.
"It's really hard for him. He'll disappear and close a door, and we'll find him playing with dolls and Polly Pockets and ... the stuff that he's drawn to," she says.
In particular, there is one typically girl thing now banned that her son absolutely cannot resist.
"He really struggles with the color pink. He really struggles with the color pink. He can't even really look at pink," Carol says. "He's like an addict. He's like, 'Mommy, don't take me there! Close my eyes! Cover my eyes! I can't see that stuff; it's all pink!' "
Still, Carol says, Bradley has made some progress. Today, he is able to play with boys. He has a few male friends, and has said that he now enjoys boy things. And there are other signs of change.
"I mean, he tells us now that he doesn't dream anymore that he's a girl. So, we're happy with that. He's still a bit defensive if we ask him, 'Do you want to be a girl?' He's like 'No, NO! I'm happy being a boy. ...' He gives us that sort of stock answer. ... I still think we're at the stage where he feels he's leading a double life," she says. "... I'm still quite certain that he is with the girls all the time at school, and so he knows to behave one way at school, and then when he comes home, there's a different set of expectations."
Despite these difficulties, Zucker clearly feels it's important to at least attempt change. He points out that the burden of living as the opposite gender is great, and should not be casually embraced.
"We're not talking about minor medical treatments. ... You're talking about lifelong hormonal treatment; you're talking about serious and substantive surgery," he says.
Jonah, Now Jona
For their part, Joel and his wife Pam say they are clearly happy with the choice they've made. Joel says he now thinks of Jonah as his daughter, and he says that she Jona is thriving.
"She's so comfortable with her own being when she's simply left to be who she is without any of these restrictions being put on her. It's just remarkable to see."
In terms of which of these therapies is more prevalent in the United States, Ehrensaft says there is absolutely no doubt.
"Zucker's," she says.
Ehrensaft hopes this will change. She says that professional opinion on this subject is in incredible flux that the treatment of transgender children is becoming a kind of civil rights issue, in the same way that the psychiatric treatment of homosexuals became a civil rights issue in the 1970s.
In the meantime, though, Zucker's approach continues to thrive. He says nearly 80 children are on the waiting list at his clinic in Toronto.
http://www.npr.org/templates/story/stor ... d=90247842
Psychologists Take Radically Different Approaches in Therapy
by Alix Spiegel
Part one of a two-part series
I thought she was gonna hyperventilate and faint because she was so incredibly happy. ... Before then, or since then, I don't think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress.
Pam, Jonah's mother
Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would.
Dr. Ken Zucker
If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health.
Dr. Diane Ehrensaft
All Things Considered
May 7, 2008
Note: To protect the identities of these families, NPR has used only first names and has changed one of the children's names.
It wasn't until Halloween when her 2 1/2-year-old son decided to dress as Dorothy from The Wizard of Oz that Carol began to worry.
Bradley had always had a preference for girls' things. From his earliest days he had chosen girls' dolls, identified with female characters and gravitated toward female children. But Carol had never thought to care. As far as she was concerned, it wasn't a loaded gun; it wasn't a lit cigarette. She says it had really never crossed her mind to say, "I'd really rather you played with a truck."
Then, on Halloween, the calculus began to tip.
To simulate Dorothy's hair, Carol covered Bradley's blond crewcut with a brown tea towel. Bradley loved it. In fact, he became obsessed with his tea-towel hair. For months afterward he would wake up every morning and put the towel on his head. When Carol tried to remove it, he would protest.
"It was really obsessive," Carol says. "We really had to negotiate times when he just couldn't wear it anymore. ... He seemed to feel uncomfortable and nervous sometimes when he didn't have this hair, this tea-towel hair."
And as Bradley grew older, his discomfort with things male also grew. He would shun other boys he played exclusively with girls. Again, this concerned Carol, but she wasn't frantic about it.
It was a single event that transformed her vague sense of worry into something more serious. One day, Bradley came home from an outing at the local playground with his baby sitter. He was covered in blood. A gash on his forehead ran deep into his hairline.
"What had happened was that two 10-year-old boys had thrown him off some playground equipment across the pavement because he'd been playing with a Barbie doll and they called him a girl," Carol says. "So that sort of struck me, that, you know, if he doesn't learn to socialize with both males and females ... he was going to get hurt."
One Direction in Therapy
Carol decided to seek professional help. Bradley's school referred her to a psychologist in Toronto named Dr. Ken Zucker, who is considered an expert in gender identity issues. After several months of evaluation, Zucker came back with a diagnosis. Bradley, he said, had what Zucker called gender identity disorder.
Gender identity disorder is a label given to children who believe themselves to be born into the wrong biological body. This diagnostic label encompases a range of behaviors and the label itself is controversial. But, in general, what characterizes children like Bradley is that they are more than just effeminate boys, or masculine girls, who are gay. These are children who genuinely believe they are girls even though they have a male body or boys, even though they have a female body.
Zucker, who has worked with this population for close to 30 years, has a very specific method for treating these children. Whenever Zucker encounters a child younger than 10 with gender identity disorder, he tries to make the child comfortable with the sex he or she was born with.
So, to treat Bradley, Zucker explained to Carol that she and her husband would have to radically change their parenting. Bradley would no longer be allowed to spend time with girls. He would no longer be allowed to play with girlish toys or pretend that he was a female character. Zucker said that all of these activities were dangerous to a kid with gender identity disorder. He explained that unless Carol and her husband helped the child to change his behavior, as Bradley grew older, he likely would be rejected by both peer groups. Boys would find his feminine interests unappealing. Girls would want more boyish boys. Bradley would be an outcast.
Carol resolved to do her best. Still, these were huge changes. By the time Bradley started therapy he was almost 6 years old, and Carol had a house full of Barbie dolls and Polly Pockets. She now had to remove them. To cushion the blow, she didn't take the toys away all at once; she told Bradley that he could choose one or two toys a day.
"In the beginning, he didn't really care, because he'd picked stuff he didn't play with," Carol says. "But then it really got down to the last few."
As his pile of toys dwindled, Carol realized Bradley was hoarding. She would find female action figures stashed between couch pillows. Rainbow unicorns were hidden in the back of Bradley's closet. Bradley seemed at a loss, she said. They gave him male toys, but he chose not to play at all.
"He turned to coloring and drawing, and he just simply wouldn't play with anything. And he would color and draw for hours and hours and hours. And that would be all he did in a day," Carol says. "I think he was really lost. ... The whole way that he knew and understood how to play was just sort of, you know, removed from his house."
His drawings, however, also proved problematic. Bradley would populate his pictures with the toys and interests he no longer had access to princesses with long flowing hair, fairies in elaborate dresses, rainbows of pink and purple and pale yellow. So, under Zucker's direction, Carol and her husband sought to change this as well.
"We would ask him, 'Can you draw a boy for us? Can you draw a boy in that picture?' ... And then he didn't really want us to see his drawings or watch him drawing because we would always say 'Can you draw a boy?'" Carol says. "And then finally after, I don't know, a month or two, he just said, 'Momma, I don't know how. ... I don't know how to draw a boy.'"
Carol says she finally sat down and showed him. From then on, Bradley drew boys as directed. Male figures with anemic caps of hair on their heads filled the pages of his sketchbook.
Another Family, Another Approach
Three-thousand miles away, on the West Coast of the United States, another family noticed their small son's unconventional tastes.
Jonah was 2 when his father, Joel, first realized that no amount of enthusiasm could persuade his child to play with balls. Trucks languished untouched. Fire engines gathered dust. Joel says Jonah much preferred girl toys, even his stuffed animals were female.
"Like, I would always say, 'What's that guy's name?' and the response would always be, 'Oh, she's bunny, she's, you know, this or that,'" Joel says.
Like Bradley, as Jonah grew older, these preferences became more pronounced. Jonah is physically beautiful. He has dark hair and eyes, a face with China-doll symmetry, and a small and graceful frame. Occasionally, while running errands, casual acquaintances, fellow shoppers, passers-by, would mistake Jonah for a girl. This appeared to thrill him. And, Joel says, Jonah would complain bitterly if his father tried to correct them.
"What began to happen was Jonah started to get upset about that," Joel says. "Like, 'Why do you have to say anything!' I remember one distinct time when we were walking the dogs and this person came up and said ... 'Oh, is this your daughter?' and I said, 'Oh, no, this is Jonah.'... And Jonah just came running up and said, 'Why do you have to tell! Why do you have to say anything!'"
Then around the age of 3, Jonah started taking his mother Pam's clothing. He would borrow a long T-shirt and belt, and fashion it into a dress. This went on for months with Jonah constantly adjusting his costume to make it better until one day, Pam discovered her son crying inconsolably. He explained to his mother that he simply could not get the T-shirt to look right, she says.
Pam remembers watching her child mournfully finger his outfit. She says she knew what he wanted. "At that point I just said, you know, 'You really want a dress to wear, don't you?' And [Jonah's] face lit up, and she was like, 'Yes!'"
(Joel and Pam now refer to their son as "she.")
That afternoon, Pam, her sister and Jonah piled into the family car.
"I thought she was gonna hyperventilate and faint because she was so incredibly happy. ... Before then, or since then, I don't think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress," Pam says of Jonah.
Pam allowed Jonah to get two dresses, but felt incredibly conflicted about it. Even though Jonah asked, she wouldn't allow him to buy any more dresses for a year afterward, so Jonah wore those two dresses every day, nothing else, until Pam got sick of looking at them. After a year, she and Joel finally began to permit other small purchases. But every item, Joel says, provoked a crisis.
"We'd spend a few nights talking: 'Do you think the shoes are like a line that we should cross? Or, you know, the girly hat, or the girly jacket with the frills?' ... Like, what are we doing? Are we encouraging this? Are we doing something that we shouldn't be?" Joel says they would ask.
Joel and Pam also ended up in front of a gender specialist Diane Ehrensaft, a psychologist in Oakland. Joel remembers an early session when Pam talked about her concerns.
"I remember her talking to the therapist and saying something to the effect of, like, you know, 'I'd be OK if Jonah just was gay, I just don't want ... him to be transgender.' And the therapist just laughed, she said, 'You know, 15 years ago, I had people on this couch saying, 'I don't mind him being a little effeminate, as long as he's not gay,'" Joel says.
In fact, Diane Ehrensaft's approach could not have been more different than the approach of Bradley's therapist. Like Zucker, Ehrensaft is a gender specialist. She says she has seen more than 50 families with children who have what Zucker would describe as gender identity disorder.
Ehrensaft, however, does not use that label. She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child's behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn't think Pam and Joel should try to cure Jonah.
"She made it really clear that, you know, if Jonah's not depressed, or anxious, or having anything go on that she would need to really be in therapy for, then don't put a kid in therapy until they need it," Pam says.
Ehrensaft did eventually encourage Joel and Pam to allow Jonah to live as a little girl. By the time he was 5, Jonah had made it very clear to his parents that he wanted to wear girl clothes full time that he wanted to be known as a girl. He wanted them to call him their daughter. And though Ehrensaft does not always encourage children who express gender flexibility to "transition" to living as a member of the opposite sex, in the case of Jonah, she thought it was appropriate.
Last year, when he started kindergarten, Jonah went as a girl. He wore dresses, was addressed as "she" by his classmates and teacher. He even changed his name, from Jonah to Jona, without the "h." It was a complete transformation.
Joel and Pam were initially anxious, but Joel says their worry soon faded.
"They have these little conferences, and, you know, we were asking, like, 'How's Jonah doing? Does she have problems with other kids?' and the teacher was like, 'God, I gotta tell you, you know, Jonah is one of the most popular kids. Kids love her, they want to play with her, she's fun, and it's because she's so comfortable with herslef that she makes other people comfortable," Joel recalls.
It was shortly after that that Joel and Pam started referring to their son Jonah as "she."
Two Families, Two Therapists, Two Approaches
The treatments practiced by Zucker and Ehrensaft are radically different and, therefore, are liable to produce radically different results. In fact, Zucker and Ehrensaft are representatives of a broader divide in the mental health community over the appropriate treatment for children like Bradley and Jonah.
This divide is so intense that there is very little common ground. There is little common ground even in the ways that the issue is conceptualized. Therapists like Ehrensaft tend to view kids like Bradley and Jonah as transgender, and see transgenderism as akin to homosexuality.
Thirty-five years ago, homosexuality was considered a mental illness a pathology so severe that it required aggressive therapeutic intervention. According to Jack Drescher, former chairman of the American Psychiatric Association's committee on gay and lesbian issues, one treatment was to try to condition homosexuals out of their sexual preference by attaching them to electrical shock machines and shocking them every time they were aroused by homosexual pornography.
Today, however, the APA's position is that therapies that try to turn homosexuals into heterosexuals are unethical. Homosexuality is now considered to be a normal variant of human behavior, so though a therapist might treat a person because they struggle with the stigma associated with homosexuality, therapists who practice in accordance with the guidelines established by the association don't treat the behavior itself.
Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker's therapy which seeks to condition children out of a transgender identity is unethical.
But that isn't how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.
"Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would," Zucker says.
If a black kid walked into a therapist's office saying he was really white, the goal of pretty much any therapist out there would be to make him try to feel more comfortable being black. They would assume his mistaken beliefs were the product of a dysfunctional environment a dysfunctional family or a dysfunctional cultural environment that led him or her to engage in this wrongheaded and dangerous fantasy. This is how Zucker sees gender-disordered kids. He sees these behaviors primarily as a product of dysfunction.
The mistake the other side makes, Zucker argues, is that it views gender identity disorder primarily as a product of biology. This, Zucker says, is, "astonishingly naive and simplistic."
Zucker has come to believe that taking the view that kids are born transgender ultimately produces more transgender people.
"By declaring the child as transgendered at, say, age 3 or age 4 or age 6, and then saying in a sense, 'Go with the flow,' ... that will impact, I believe, on how the kid's gender identity differentiates," he says.
In other words, allowing a child like Jonah to transition in kindergarten will essentially track him into becoming a transgender adult. And for Zucker, no child under the age of 10 or 11 can be definitively labeled transgender. He says that kids' gender identities are flexible. And that even a child like Jonah, who appears to be absolutely consistent from the ages of 1 and 2, can change.
But Ehrensaft says this position is too absolute. While she agrees that it's important to be very, very careful about applying a transgender label to a young child, it is at least possible. And Ehrensaft is clearly as disapproving of Zucker's form of therapy as he is of hers. She says it's wrong to take away a child's toys, to police the people he spends time with, the pictures he draws even the colors he draws with.
"To me, this is coercive therapy," Ehrensaft says. "And I don't think we should be in the business of coercing people. ... I would say all the kids I've worked with who have gone through that kind of treatment, they have not come out better; they've come out worse."
For Ehrensaft, the lessons of the early therapeutic approaches to homosexuality therapies that sought to "cure" the patient of homosexual desires are clear.
"If we allow people to unfold and give them the freedom to be who they really are, we engender health. And if we try and constrict it, or bend the twig, we engender poor mental health," she says.
The Problem with the Color Pink
It does seem to be the case that, at least in the short term, Carol's son Bradley is struggling in some ways with Zucker's therapy. Carol says it was particularly hard at the beginning.
"He was much more emotional. ... He could be very clingy. He didn't want to go to school anymore," she says. "Just the smallest thing could, you know, send him into a major crying fit. And ... he seemed to feel really heavy and really emotional."
Bradley has been in therapy now for eight months, and Carol says still, on the rare occasions when she cannot avoid having him exposed to girl toys, like when they visit family, it doesn't go well.
"It's really hard for him. He'll disappear and close a door, and we'll find him playing with dolls and Polly Pockets and ... the stuff that he's drawn to," she says.
In particular, there is one typically girl thing now banned that her son absolutely cannot resist.
"He really struggles with the color pink. He really struggles with the color pink. He can't even really look at pink," Carol says. "He's like an addict. He's like, 'Mommy, don't take me there! Close my eyes! Cover my eyes! I can't see that stuff; it's all pink!' "
Still, Carol says, Bradley has made some progress. Today, he is able to play with boys. He has a few male friends, and has said that he now enjoys boy things. And there are other signs of change.
"I mean, he tells us now that he doesn't dream anymore that he's a girl. So, we're happy with that. He's still a bit defensive if we ask him, 'Do you want to be a girl?' He's like 'No, NO! I'm happy being a boy. ...' He gives us that sort of stock answer. ... I still think we're at the stage where he feels he's leading a double life," she says. "... I'm still quite certain that he is with the girls all the time at school, and so he knows to behave one way at school, and then when he comes home, there's a different set of expectations."
Despite these difficulties, Zucker clearly feels it's important to at least attempt change. He points out that the burden of living as the opposite gender is great, and should not be casually embraced.
"We're not talking about minor medical treatments. ... You're talking about lifelong hormonal treatment; you're talking about serious and substantive surgery," he says.
Jonah, Now Jona
For their part, Joel and his wife Pam say they are clearly happy with the choice they've made. Joel says he now thinks of Jonah as his daughter, and he says that she Jona is thriving.
"She's so comfortable with her own being when she's simply left to be who she is without any of these restrictions being put on her. It's just remarkable to see."
In terms of which of these therapies is more prevalent in the United States, Ehrensaft says there is absolutely no doubt.
"Zucker's," she says.
Ehrensaft hopes this will change. She says that professional opinion on this subject is in incredible flux that the treatment of transgender children is becoming a kind of civil rights issue, in the same way that the psychiatric treatment of homosexuals became a civil rights issue in the 1970s.
In the meantime, though, Zucker's approach continues to thrive. He says nearly 80 children are on the waiting list at his clinic in Toronto.
http://www.npr.org/templates/story/stor ... d=90247842
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Re: Support Your NPR Station
Parents Consider Treatment to Delay Son's Puberty
New Therapy Would Buy Time to Resolve Gender Crisis
by Alix Spiegel
Part two of a two-part series
A lot of times shed come out and say, 'I'm a girl.' No, at first it was, 'I want to be a girl,' then it's like 'No. I am a girl.' And shed ask if me if I [thought] she was crazy and I'd say, 'No, honey, you know, it's OK.' And in the front, you know, I'm driving going ... 'Oh my gosh, what is this?'
Danielle, Armand's mother
If you can block the gonads, that is the ovary [in women] or the testis [in men], from making its sex steroids, that being estrogen or testosterone, then you can literally prevent ... almost all the physical differences between the genders.
Dr. Norman Spack
All Things Considered
May 8
is family, NPR has used only first names.
Robert and Danielle instituted an "only-in-the-house" rule when their son Armand was around 5, a modest effort to save him from himself.
By that point, Robert and Danielle were exhausted. They had tried for years to steer Armand away from female clothing, fearing their young son would become the object of neighborhood ridicule. But nothing they said or did seemed to make any difference. There was no dissuading him, and so the only-in-the-house rule seemed like reasonable compromise.
Armand agreed he even seemed comfortable with it. He spent hours in the basement and backyard, playing with his sister's cast-offs.
But one day, Robert came home early and found Armand out front in the middle of their cul-de-sac. He was wearing a poodle skirt, swaying back and forth, singing. Wanting, Robert says he thought, the whole world to see.
"That caught me by surprise," Robert says. "There was worry."
A Minnie Mouse Dress and a Temper
This obsession with female clothing had started early, when Armand was around 2. He had found an old Minnie Mouse dress the family had gotten at Disneyland. He put it on and then refused to take it off.
"It was like, 'NO!' " Danielle says. "Feet in a stance, a strong stance, just standing there.... She pretty much from that point slept in it, stayed in it all day."
(Danielle and Robert now refer to their son as "she.")
Any effort to remove the dress would provoke an outburst. In fact, the more Robert and Danielle tried to limit Armand's behavior, the more explosive their son became. And it only got worse as Armand got older.
"The terrible twos became terrible threes and fours and horrible fives and intolerable sixes," Robert says. Armand "seemed on edge all of the time."
There were two-hour tantrums. Tornadoes of tears and screaming that left the family exhausted. Any comment could set Armand off, and, once triggered, there was no controlling him.
"One night I remember it got so bad, where she was so out of control ... I literally walked her out the front door and said, 'You need to stay,' " Robert says. "And it was probably at eleven o'clock at night. And I walked her out the front door, closed the door, because I didn't know what to do."
Robert remembers standing with Danielle beside the door, listening to his 6-year-old son scream.
"She was pounding on the door and my wife and I looked at each other and said, 'What is happening? Why is this child so unhappy? What have we done?' " Robert says.
Doctors and More Doctors
The family consulted mental health professionals with all kinds of initials after their names. They passed out diagnoses with even more initials: ADD (attention-deficit disorder), OCD (obsessive-compulsive disorder).
"I mean, every conceivable diagnosis," Robert says. "But no one could put their finger on it."
Still, while the doctors were unable to find the right label, their son seemed to understand what was going on. Danielle says that during quiet moments, like the ride from school, her child would confess what was causing so much trouble.
"A lot of times she'd come out and say, 'I'm a girl.' No, at first it was, 'I want to be a girl,' then it's like 'No. I am a girl.' And she'd ask if me if I [thought] she was crazy and I'd say, 'No, honey, you know, it's OK.' And in the front, you know, I'm driving going ... 'Oh my gosh, what is this?' " Danielle says.
Gender Identity Disorder
After many years, the family found a psychologist who had experience with gender issues. At the end of a two-month evaluation, the therapist gave them a diagnosis:
the label most psychiatrists and psychologists give
It involves a range of behaviors, but on one end of the spectrum there are children like Armand: kids who are more than effeminate boys or masculine girls who may turn out to be gay in adulthood
The doctor explained that their son would, in all likelihood, grow up to be transgender someone who lives as a member of the opposite sex.
Robert and Danielle say that at this point the diagnosis was more of a relief than a shock. They decided almost immediately to stop trying to force their son to live as a boy. And then looked, with some anxiety, to the future. Armand was close to 11 years old.
"We knew that puberty was around the corner and we needed to start looking into ... what do we do," Robert says. "How do we help this child, you know, develop in a way that is consistent with who she is."
A New Treatment
Robert and Danielle soon came to find out about a new, highly controversial, treatment for preteen kids with gender identity issues. The treatment allows kids to postpone puberty and avoid developing the physical attributes of the sex they were born with.
The treatment has been offered in the United States only for around four years. Essentially, kids who meet the criteria for gender identity disorder are given monthly injections of a medication that blocks their bodies from releasing sex hormones. This means that while the children continue to grow taller, for the three or four years they are on the medication, they are kept from maturing sexually.
Norman Spack, an endocrinologist at Children's Hospital in Boston, was one of the earliest practitioners of this treatment in the United States. He explains that doctors have actually been able to block sex hormones for decades the technique has been used to treat everything from prostate cancer to fibroids but it was only about 10 years ago that a medical group in the Netherlands decided to use it on kids like Armand.
"They had the idea. ... They decided to see what would happen if they took such a child that was in such distress over their body, [and stopped their body from] taking the form that they feared," he says.
To put off puberty, children - usually between 10 and 13 are injected with hormone blockers once a month. Spack explains that the blockers only affect the gonads, the organs responsible for turning boys into men and girls into women.
"If you can block the gonads, that is the ovary [in women] or the testis [in men], from making its sex steroids, that being estrogen or testosterone, then you can literally prevent ... almost all the physical differences between the genders," Spack explains.
Without testosterone, boys will not grow facial or body hair. Their voices will not deepen. There will be no Adams apple, and height growth will slow. Without estrogen, girls will not develop breasts, fat at the hip, or menstrual periods. And since most growth happens before puberty, if you block estrogen and therefore puberty girls will grow taller, closer to a typical male height.
The hormone blockers are the first stage of the treatment, but there's a second stage that's possible. Once children have postponed puberty for three or four years, at around age 16 they can choose to begin maturing sexually into the opposite gender, the gender they want to become. To do this, they begin taking the hormones of the opposite sex. For males, taking estrogen at this point will bring on breast and hip growth and all the attributes physical and emotional of females. The reverse will happen for girls who take testosterone. Spack says this treatment can help make an adult transgender male almost indistinguishable from a biological male in terms of physical appearance.
"We can make it possible that they can fit in in the way they want to. It is really quite amazing," he says.
If, however, puberty is not blocked if it is allowed to happen naturally and sexual maturity takes place on time fitting in as a transgender adult is more difficult. An adult man who chooses to become a woman by taking estrogen will still tower over other women. He'll have larger hands and feet, a pronounced brow, and facial and body hair that will need to be removed. These are physical attributes that can set a transgender person apart and make day-to-day life more difficult.
This is exactly the fate that Robert and Danielle hope to help Armand avoid. Armand will soon start the hormone blockers, but in the meantime, he is already living as a girl. Danielle says she and Robert decided to allow Armand to transition after they got the official diagnosis.
"Once we officially knew that [Armand] was transgender it was like, 'What do you need? You tell us.' We weren't going to try to control anymore; we'd been doing that for years. So it was like, 'What do you need? What do you want?' " Danielle says.
Armand was clear. He wanted to be called Violet, not Armand. He wanted to be known as their daughter, not their son. He wanted his parents to call him a "she."
Robert and Danielle agreed. The first official day of Violet's new life was Aug. 19, 2007. It was the first day of a family vacation. Armand now Violet was 10. And Robert says her emotional transformation that day was nothing short of astonishing.
"It was the happiest kid I'd ever seen. Just lit up. Just ... brilliant and funny and these things that we caught glimpses of that weren't always there," he says.
Since the transition there has not been any real outburst. Still, there have been challenges. Last September, Violet returned to school, this time as a girl. Though the school was supportive, Robert says he and Danielle were terrified.
"You know just that walk from the car to the front doors of the school was the longest walk of our lives," he says. "Violet broke my heart and I was proud of her all at the same time," Robert says.
He says when Violet got out of the car she immediately put a on long coat and put her hood up. She started walking behind her father and mother. "We said, 'No!' You are not going to do this. You're not going to walk behind anybody. We're going to walk together. And we held hands and we marched right up the sidewalk into those doors. Into an extreme unknown," he says.
And their worst fears of ridicule, of violence were not realized. At the end of the day, Violet skipped to the car and reported she had had a great day.
Robert says that since the family event, and Violet's transition, there's been a new level of peace in his household, a liberating clarity. "There is no doubt at this point in our lives that we have a transgender child. ... And there is no doubt in our mind that we are going to do what we can to help her," he says.
A Side Effect of Treatment
But not everyone believes that it is possible to know with this level of certainty that a child is transgender. There are two views in this debate.
Polly Carmichael, a British psychologist who works at the Portman Clinic in London, which has a unit specifically dedicated to gender identity, says the identity of most children this age is in constant flux.
"You can have a child who is presenting with absolute certainty, but it may be that at a later point they will decide that is not in fact what they want and their feelings may indeed change," Carmichael says.
The Portman clinic has treated 124 kids since 1989. It requires children to live as the gender they were born with. And 80 percent of its patients once grown chose as adults to keep their biological gender.
The opposite outcome was seen by the researchers in the Netherlands who first developed the hormone-blocking treatment. They have treated 100 patients and all chose as adults to live as the opposite sex.
So the verdict is still out about how many kids
will choose sexual reassignment as adults that is, to live as a member of the opposite sex by changing physical appearance or by having a sex change operation. This makes deciding on treatment very difficult, because there is one very serious side effect to the second part of the treatment.
Taking testosterone or estrogen immediately after blocking puberty will make a teenage patient sterile.
Spack, the endocrinologist at Children's Hospital in Boston, says that because the gonads do not mature before they are exposed to the hormones of the opposite sex, the gonads become too damaged to produce either viable eggs or viable sperm.
"This is one of the most controversial aspects of this. At what age can a young person fully understand the implications of doing something that will make fertility for them, by today's technology, virtually impossible?" he says.
Spack, however, is quick to point out that there is no risk of infertility from the hormone-blocking treatment alone. Infertility only comes when the hormone-blocking treatment is paired with Stage 2, the use of opposite-sex hormones. And so, Spack says, hormone blockers should really be seen simply as a treatment that gives families more time to think about what to do.
"It's a lot different to be talking to a 14-, 15-, 16-year-old about the implications of this than a 10- to 12-year-old," he says. "And so it buys you time ... without the tremendous fear of their body getting out of control."
Heading into the Future
Robert says he, too, sees the hormone blockers as a way of buying time. And he remains absolutely certain that Violet is genuinely transgender. In fact, he finds himself almost offended when people suggest that he and his family have been too quick to embrace a transgender identity.
"It puzzles me because we even have well-intentioned parents who we care about and who know us ... say, 'Well she's too young to know!' Well, when did you know you were a girl? When did I know I was a boy? I knew my whole life, I can't tell you exactly when, but it wasn't like I was 10 and realized, 'Oh gee, I must be a boy!' " Robert says. "What people fail to realize is they made that decision way earlier than that. It just happened that their gender identity and their anatomy matched."
In terms of how Violet thinks about hormone blockers, her older sister, Melina, says that the problem of puberty is very much on her mind. "She's getting hair in some places and stuff and ... every day she says that she feels a little bit more manly. Which is really hard for her."
Melina, who is 14, says she sometimes thinks about what it would be like if she woke up every day to a body that was slowing turning male. If she were growing in ways that felt alien and frightening.
"To go through the process of the gender that you're really not ... that must be the most scariest most disgusting thing ... I can't even imagine what that's like," she says.
73278
New Therapy Would Buy Time to Resolve Gender Crisis
by Alix Spiegel
Part two of a two-part series
A lot of times shed come out and say, 'I'm a girl.' No, at first it was, 'I want to be a girl,' then it's like 'No. I am a girl.' And shed ask if me if I [thought] she was crazy and I'd say, 'No, honey, you know, it's OK.' And in the front, you know, I'm driving going ... 'Oh my gosh, what is this?'
Danielle, Armand's mother
If you can block the gonads, that is the ovary [in women] or the testis [in men], from making its sex steroids, that being estrogen or testosterone, then you can literally prevent ... almost all the physical differences between the genders.
Dr. Norman Spack
All Things Considered
May 8
is family, NPR has used only first names.
Robert and Danielle instituted an "only-in-the-house" rule when their son Armand was around 5, a modest effort to save him from himself.
By that point, Robert and Danielle were exhausted. They had tried for years to steer Armand away from female clothing, fearing their young son would become the object of neighborhood ridicule. But nothing they said or did seemed to make any difference. There was no dissuading him, and so the only-in-the-house rule seemed like reasonable compromise.
Armand agreed he even seemed comfortable with it. He spent hours in the basement and backyard, playing with his sister's cast-offs.
But one day, Robert came home early and found Armand out front in the middle of their cul-de-sac. He was wearing a poodle skirt, swaying back and forth, singing. Wanting, Robert says he thought, the whole world to see.
"That caught me by surprise," Robert says. "There was worry."
A Minnie Mouse Dress and a Temper
This obsession with female clothing had started early, when Armand was around 2. He had found an old Minnie Mouse dress the family had gotten at Disneyland. He put it on and then refused to take it off.
"It was like, 'NO!' " Danielle says. "Feet in a stance, a strong stance, just standing there.... She pretty much from that point slept in it, stayed in it all day."
(Danielle and Robert now refer to their son as "she.")
Any effort to remove the dress would provoke an outburst. In fact, the more Robert and Danielle tried to limit Armand's behavior, the more explosive their son became. And it only got worse as Armand got older.
"The terrible twos became terrible threes and fours and horrible fives and intolerable sixes," Robert says. Armand "seemed on edge all of the time."
There were two-hour tantrums. Tornadoes of tears and screaming that left the family exhausted. Any comment could set Armand off, and, once triggered, there was no controlling him.
"One night I remember it got so bad, where she was so out of control ... I literally walked her out the front door and said, 'You need to stay,' " Robert says. "And it was probably at eleven o'clock at night. And I walked her out the front door, closed the door, because I didn't know what to do."
Robert remembers standing with Danielle beside the door, listening to his 6-year-old son scream.
"She was pounding on the door and my wife and I looked at each other and said, 'What is happening? Why is this child so unhappy? What have we done?' " Robert says.
Doctors and More Doctors
The family consulted mental health professionals with all kinds of initials after their names. They passed out diagnoses with even more initials: ADD (attention-deficit disorder), OCD (obsessive-compulsive disorder).
"I mean, every conceivable diagnosis," Robert says. "But no one could put their finger on it."
Still, while the doctors were unable to find the right label, their son seemed to understand what was going on. Danielle says that during quiet moments, like the ride from school, her child would confess what was causing so much trouble.
"A lot of times she'd come out and say, 'I'm a girl.' No, at first it was, 'I want to be a girl,' then it's like 'No. I am a girl.' And she'd ask if me if I [thought] she was crazy and I'd say, 'No, honey, you know, it's OK.' And in the front, you know, I'm driving going ... 'Oh my gosh, what is this?' " Danielle says.
Gender Identity Disorder
After many years, the family found a psychologist who had experience with gender issues. At the end of a two-month evaluation, the therapist gave them a diagnosis:
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm gender identity disorder.
Gender identity disorder is
the label most psychiatrists and psychologists give
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm to children who believe themselves to be born into the wrong biological body.
It involves a range of behaviors, but on one end of the spectrum there are children like Armand: kids who are more than effeminate boys or masculine girls who may turn out to be gay in adulthood
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm . These are children who genuinely believe they are girls even though they have a male body or boys, even though they have a female body.
The doctor explained that their son would, in all likelihood, grow up to be transgender someone who lives as a member of the opposite sex.
Robert and Danielle say that at this point the diagnosis was more of a relief than a shock. They decided almost immediately to stop trying to force their son to live as a boy. And then looked, with some anxiety, to the future. Armand was close to 11 years old.
"We knew that puberty was around the corner and we needed to start looking into ... what do we do," Robert says. "How do we help this child, you know, develop in a way that is consistent with who she is."
A New Treatment
Robert and Danielle soon came to find out about a new, highly controversial, treatment for preteen kids with gender identity issues. The treatment allows kids to postpone puberty and avoid developing the physical attributes of the sex they were born with.
The treatment has been offered in the United States only for around four years. Essentially, kids who meet the criteria for gender identity disorder are given monthly injections of a medication that blocks their bodies from releasing sex hormones. This means that while the children continue to grow taller, for the three or four years they are on the medication, they are kept from maturing sexually.
Norman Spack, an endocrinologist at Children's Hospital in Boston, was one of the earliest practitioners of this treatment in the United States. He explains that doctors have actually been able to block sex hormones for decades the technique has been used to treat everything from prostate cancer to fibroids but it was only about 10 years ago that a medical group in the Netherlands decided to use it on kids like Armand.
"They had the idea. ... They decided to see what would happen if they took such a child that was in such distress over their body, [and stopped their body from] taking the form that they feared," he says.
To put off puberty, children - usually between 10 and 13 are injected with hormone blockers once a month. Spack explains that the blockers only affect the gonads, the organs responsible for turning boys into men and girls into women.
"If you can block the gonads, that is the ovary [in women] or the testis [in men], from making its sex steroids, that being estrogen or testosterone, then you can literally prevent ... almost all the physical differences between the genders," Spack explains.
Without testosterone, boys will not grow facial or body hair. Their voices will not deepen. There will be no Adams apple, and height growth will slow. Without estrogen, girls will not develop breasts, fat at the hip, or menstrual periods. And since most growth happens before puberty, if you block estrogen and therefore puberty girls will grow taller, closer to a typical male height.
The hormone blockers are the first stage of the treatment, but there's a second stage that's possible. Once children have postponed puberty for three or four years, at around age 16 they can choose to begin maturing sexually into the opposite gender, the gender they want to become. To do this, they begin taking the hormones of the opposite sex. For males, taking estrogen at this point will bring on breast and hip growth and all the attributes physical and emotional of females. The reverse will happen for girls who take testosterone. Spack says this treatment can help make an adult transgender male almost indistinguishable from a biological male in terms of physical appearance.
"We can make it possible that they can fit in in the way they want to. It is really quite amazing," he says.
If, however, puberty is not blocked if it is allowed to happen naturally and sexual maturity takes place on time fitting in as a transgender adult is more difficult. An adult man who chooses to become a woman by taking estrogen will still tower over other women. He'll have larger hands and feet, a pronounced brow, and facial and body hair that will need to be removed. These are physical attributes that can set a transgender person apart and make day-to-day life more difficult.
This is exactly the fate that Robert and Danielle hope to help Armand avoid. Armand will soon start the hormone blockers, but in the meantime, he is already living as a girl. Danielle says she and Robert decided to allow Armand to transition after they got the official diagnosis.
"Once we officially knew that [Armand] was transgender it was like, 'What do you need? You tell us.' We weren't going to try to control anymore; we'd been doing that for years. So it was like, 'What do you need? What do you want?' " Danielle says.
Armand was clear. He wanted to be called Violet, not Armand. He wanted to be known as their daughter, not their son. He wanted his parents to call him a "she."
Robert and Danielle agreed. The first official day of Violet's new life was Aug. 19, 2007. It was the first day of a family vacation. Armand now Violet was 10. And Robert says her emotional transformation that day was nothing short of astonishing.
"It was the happiest kid I'd ever seen. Just lit up. Just ... brilliant and funny and these things that we caught glimpses of that weren't always there," he says.
Since the transition there has not been any real outburst. Still, there have been challenges. Last September, Violet returned to school, this time as a girl. Though the school was supportive, Robert says he and Danielle were terrified.
"You know just that walk from the car to the front doors of the school was the longest walk of our lives," he says. "Violet broke my heart and I was proud of her all at the same time," Robert says.
He says when Violet got out of the car she immediately put a on long coat and put her hood up. She started walking behind her father and mother. "We said, 'No!' You are not going to do this. You're not going to walk behind anybody. We're going to walk together. And we held hands and we marched right up the sidewalk into those doors. Into an extreme unknown," he says.
And their worst fears of ridicule, of violence were not realized. At the end of the day, Violet skipped to the car and reported she had had a great day.
Robert says that since the family event, and Violet's transition, there's been a new level of peace in his household, a liberating clarity. "There is no doubt at this point in our lives that we have a transgender child. ... And there is no doubt in our mind that we are going to do what we can to help her," he says.
A Side Effect of Treatment
But not everyone believes that it is possible to know with this level of certainty that a child is transgender. There are two views in this debate.
Polly Carmichael, a British psychologist who works at the Portman Clinic in London, which has a unit specifically dedicated to gender identity, says the identity of most children this age is in constant flux.
"You can have a child who is presenting with absolute certainty, but it may be that at a later point they will decide that is not in fact what they want and their feelings may indeed change," Carmichael says.
The Portman clinic has treated 124 kids since 1989. It requires children to live as the gender they were born with. And 80 percent of its patients once grown chose as adults to keep their biological gender.
The opposite outcome was seen by the researchers in the Netherlands who first developed the hormone-blocking treatment. They have treated 100 patients and all chose as adults to live as the opposite sex.
So the verdict is still out about how many kids
will choose sexual reassignment as adults that is, to live as a member of the opposite sex by changing physical appearance or by having a sex change operation. This makes deciding on treatment very difficult, because there is one very serious side effect to the second part of the treatment.
Taking testosterone or estrogen immediately after blocking puberty will make a teenage patient sterile.
Spack, the endocrinologist at Children's Hospital in Boston, says that because the gonads do not mature before they are exposed to the hormones of the opposite sex, the gonads become too damaged to produce either viable eggs or viable sperm.
"This is one of the most controversial aspects of this. At what age can a young person fully understand the implications of doing something that will make fertility for them, by today's technology, virtually impossible?" he says.
Spack, however, is quick to point out that there is no risk of infertility from the hormone-blocking treatment alone. Infertility only comes when the hormone-blocking treatment is paired with Stage 2, the use of opposite-sex hormones. And so, Spack says, hormone blockers should really be seen simply as a treatment that gives families more time to think about what to do.
"It's a lot different to be talking to a 14-, 15-, 16-year-old about the implications of this than a 10- to 12-year-old," he says. "And so it buys you time ... without the tremendous fear of their body getting out of control."
Heading into the Future
Robert says he, too, sees the hormone blockers as a way of buying time. And he remains absolutely certain that Violet is genuinely transgender. In fact, he finds himself almost offended when people suggest that he and his family have been too quick to embrace a transgender identity.
"It puzzles me because we even have well-intentioned parents who we care about and who know us ... say, 'Well she's too young to know!' Well, when did you know you were a girl? When did I know I was a boy? I knew my whole life, I can't tell you exactly when, but it wasn't like I was 10 and realized, 'Oh gee, I must be a boy!' " Robert says. "What people fail to realize is they made that decision way earlier than that. It just happened that their gender identity and their anatomy matched."
In terms of how Violet thinks about hormone blockers, her older sister, Melina, says that the problem of puberty is very much on her mind. "She's getting hair in some places and stuff and ... every day she says that she feels a little bit more manly. Which is really hard for her."
Melina, who is 14, says she sometimes thinks about what it would be like if she woke up every day to a body that was slowing turning male. If she were growing in ways that felt alien and frightening.
"To go through the process of the gender that you're really not ... that must be the most scariest most disgusting thing ... I can't even imagine what that's like," she says.
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm http://www.npr.org/templates/story/stor ... toryId=902
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YankeeClipper (imported)
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Re: Support Your NPR Station
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? ... I don't think we would.
Dr. Ken Zucker
His response is sickening. The analogy is so obviously pathetic as to be laughable, if not for the devistating results that can occur because of that type of thinking.
It is again back to forced "body over mind". 1950 & 60's all over again.
How can one possibly succeed with course of "therapy," that includes the banning of the color pink.
How would he treat an adult MtF or FtM. This attitude is exactly the wrong-headed attitude that professionals had 15 to 20 years ago about adult MtF and FtM patients. How many of his patients have to wait the age of consent until they have reverse the effects (those effects that can be reversed) on the body that puberty has wrought through extensive and expensive surgery. There is no harm caused by simply postponing puberty until the child is truly certain about the decision they are making. Their own claim is 80%, meaning that at least 20% of the patients have to suffer going through the most profound life-changing period of their live trapped in the body of the wrong sex.
And that is by the use of coercion, which is an excellent method of causing extreme disruption within the family unit. His claim is 80% if also inaccurate (too high) because if fails to take into account those individuals that don't go through SRS because of the cost and time involved, or those that go on living as trans-gendered in the sexual body they are are trapped in through extended therapy. Further, his method of using coercion is in direct opposition to the generally accepted view that coercion is an unacceptable form of treatment when known therapies that are not coercive are available, particularly with a lower failure rate.
The fact the his claimed rate of 80% with coercion, and the Dutch process the has a 100% rate without the use of coercion, allowing the child to continue to mature in either the original sex of the body, shows the inappropriateness of his approach.
Zucker's approach can have very severe mental health issues later in life. The opposing approach allows for the child to determine what the best for them at a time when they are old enough to make their own decision on their own, rather that having it made for them. The use of coercion for this type of children presenting trans-gender behavior should be treated the same way that adults are. If puberty can be post-ponded, it gives the professional and the the child several years to live as the opposite sex during stage one, while still allowing for fertility if the child to elect out.
That children are presenting at such a young age is surely a very clear indicator of the need to allow puberty to progress is irrational. What is so important and critical about puberty that requires that it be allowed to progress at its usual schedule before ANY action be taken to postpone it, shows the irrationality of
I can't even imagine what that's like," she says."JesusA (imported) wrote: Fri May 09, 2008 5:50 pm that position.
I think these sum it up very well:
"Melina, who is 14, says she sometimes thinks about what it would be like if she woke up every day to a body that was slowing turning male. If she were growing in ways that felt alien and frightening.
"To go through the process of the gender that you're really not ... that must be the most scariest most disgusting thing ...
Ms. Carmichael's own statement provides the best
all chose as adults to live as the opposite sex.JesusA (imported) wrote: Fri May 09, 2008 5:50 pm reasoning possible that delaying puberty is critical:
Polly Carmichael, a British psychologist who works at the Portman Clinic in London, which has a unit specifically dedicated to gender identity, says the identity of most children this age is in constant flux.
"You can have a child who is presenting with absolute certainty, but it may be that at a later point they will decide that is not in fact what they want and their feelings may indeed change," Carmichael says.
The Portman clinic has treated 124 kids since 1989. It requires children to live as the gender they were born with. And 80 percent of its patients once grown chose as adults to keep their biological gender.
The opposite outcome was seen by the researchers in the Netherlands who first developed the hormone-blocking treatment. They have treated 100 patients and
What does Ms. Carmichael have to say to that 20% (or greater) that had to go through puberty in the wrong body? This type of testing with such a significant failure rate on a group of people that will have to live in the wrong body for the rest of their lives, because of her decision about the needs for the young patient is wrong, is both unethical and highly disgusting.
What other area of mental health allows a method of treatment with a 20% failure rate when an alternate method with 0% rate is available? And that the initial choice of the doctor and parents is later determined be that the decision is wrong.
The higher success rate speaks for itself. A 20% failure rate, when an alternate course of action is available with a 0% failure, the use of coercion and forced puberty is an unethical process.
What is is most saddening and tragic about this how many patients are treated by professionals like Zucker's and Carmichael, who will continue this method until their retirement, even though it will run contrary to updated Standards of Care.
There are several threads that need to become collected into one cohesive core for efecective input into both the SoC and DSM-V.
-YC
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Danya (imported)
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Re: Support Your NPR Station
I am a 56-year old male to female transsexual about to start transitioning. Delaying puberty for children who are so clearly distressed by the sex of the body they happen to find themselves in makes sense to me. Of course, there need to be precautions but I don't have time to discuss those now.
I am happy that the ethical, caring treatment of children who are clearly transgender is getting more press. Unfortunately, I don't think there are many parents even today who are able to reach the point of allowing their children to be who they really are. That situation will improve as more adults are made aware of what children, such as Violet, go through.
Transgender children handle their situation in a variety of ways. Their paths can be very different and I suspect part of this is due to personality differences that may be unrelated to their true brain gender. I knew from a young age I wasn't a boy at least to the extent that I didn't connect with any of them in any way, ever. I also engaged in cross-gender behavior at a young age that was severely repressed by my parents when they found out. My reaction was to withdraw into myself. I didn't play with boys or girls after being discovered by my parents. I never wanted to play with the boys and the thought of doing that was repelling to me. I became the 'child' my parents wanted, at least to the extent of burying my desires, at the cost of my childhood. I was never a child and the person I was during those years was severely depressed. My parents knew, at least on some level, I was desperately unhappy. They were unable or unwilling, or both, to look at what might really be going on in my life. When puberty hit, I was horrified and when I looked at the older boys around me I was appalled that I was becoming, in body at least, one of them. I did everything that I could to hide the effects of puberty for many years after it started.
Violet's strong sense of self enabled her to persist in her insistence, whether through dress or words, that she was indeed a girl. I truly hope that more parents become aware of what is really going on with children like Violet, and others like me: the 'adult' person I was forced to become to survive at the age of 4 or 5. Or at least willing to put aside their own attitudes and prejudices to actively seek out information on why their child is behaving in ways that differ from society's, and hence their own, expectations. Then, perhaps, they will be ready to allow, encourage and enable their children to be who they really are.
I am happy that the ethical, caring treatment of children who are clearly transgender is getting more press. Unfortunately, I don't think there are many parents even today who are able to reach the point of allowing their children to be who they really are. That situation will improve as more adults are made aware of what children, such as Violet, go through.
Transgender children handle their situation in a variety of ways. Their paths can be very different and I suspect part of this is due to personality differences that may be unrelated to their true brain gender. I knew from a young age I wasn't a boy at least to the extent that I didn't connect with any of them in any way, ever. I also engaged in cross-gender behavior at a young age that was severely repressed by my parents when they found out. My reaction was to withdraw into myself. I didn't play with boys or girls after being discovered by my parents. I never wanted to play with the boys and the thought of doing that was repelling to me. I became the 'child' my parents wanted, at least to the extent of burying my desires, at the cost of my childhood. I was never a child and the person I was during those years was severely depressed. My parents knew, at least on some level, I was desperately unhappy. They were unable or unwilling, or both, to look at what might really be going on in my life. When puberty hit, I was horrified and when I looked at the older boys around me I was appalled that I was becoming, in body at least, one of them. I did everything that I could to hide the effects of puberty for many years after it started.
Violet's strong sense of self enabled her to persist in her insistence, whether through dress or words, that she was indeed a girl. I truly hope that more parents become aware of what is really going on with children like Violet, and others like me: the 'adult' person I was forced to become to survive at the age of 4 or 5. Or at least willing to put aside their own attitudes and prejudices to actively seek out information on why their child is behaving in ways that differ from society's, and hence their own, expectations. Then, perhaps, they will be ready to allow, encourage and enable their children to be who they really are.
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mrt (imported)
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Re: Support Your NPR Station
I think doctors have to deal with a lot of built in "issues" to be able to properly deal with their patients. I know I've had to deal with one that made me sit down and ponder if "I" was goofy or if this was his issue. Thankfully I had a good GP who was able to help me understand that doctors are human and flawed. Some are just more flawed then others. And troubled people should not be the ones you ask to do surgery on you. 
Race / Transexual issues? Is this the perfect case of Oranges vs Apples? Truly a foolish argument. I'm glad this came out because I think rational people need to think about these things and realize how goofy the con side really is.
Race / Transexual issues? Is this the perfect case of Oranges vs Apples? Truly a foolish argument. I'm glad this came out because I think rational people need to think about these things and realize how goofy the con side really is.
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Danya (imported)
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Re: Support Your NPR Station
I want to point out that my life today is one of unexpected happiness of finally coming home to who I truly am. It would have been so much better if I'd been allowed to be myself as a kid but that wasn't the reality of my life. So I work with what I've got today, which is still a whole lot of very good things now that I am free to be myself.
I definitely relate to this from the story quoted by Jesus:
"“
Pam, Jonah's mother"
I never could conceive before of what being truly happy would be like. Now I know.
I definitely relate to this from the story quoted by Jesus:
"“
JesusA (imported) wrote: Fri May 09, 2008 5:49 pm I thought she was gonna hyperventilate and faint because she was so incredibly happy. ... Before then, or since then, I don't think I have seen her so out of her mind happy as that drive to Target that day to pick out her dress.
Pam, Jonah's mother"
I never could conceive before of what being truly happy would be like. Now I know.
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FianceeUvBigGuy (imported)
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Re: Support Your NPR Station
I'm happy to say I give to both NPR and PBS. That said, I don't care for what I perceive to be a liberal slant on both, but I do enjoy the music and theatre featured thereon.
I LOVE "Click and Clack, The Tappet Brothers" car show and "The Prairie Home Companion" with Garrison Keillor (although sometimes I'd like to wring his Bush-bashing neck,) on NPR.
Be it known, however, that there are some shows on PBS I cannot stomach. Let's just say "A little Lawrence Welk goes a lonnnnnng way!" Y'see, if I'm visiting Mom, Dad, annnnnnnnnnnnd...the Grandparents and Welk's reruns are on...I'm stuck:(
Well, I'd add another 2 cents worth but then I'd have to deduct that from my charitable giving
Almost 1 AM and I still haven't swum my laps...off to the puddle!
Luv,
Yoli
I LOVE "Click and Clack, The Tappet Brothers" car show and "The Prairie Home Companion" with Garrison Keillor (although sometimes I'd like to wring his Bush-bashing neck,) on NPR.
Be it known, however, that there are some shows on PBS I cannot stomach. Let's just say "A little Lawrence Welk goes a lonnnnnng way!"
Y'see, if I'm visiting Mom, Dad, annnnnnnnnnnnd...the Grandparents and Welk's reruns are on...I'm stuck:(Well, I'd add another 2 cents worth but then I'd have to deduct that from my charitable giving
Almost 1 AM and I still haven't swum my laps...off to the puddle!
Luv,
Yoli
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Uncle Flo (imported)
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Re: Support Your NPR Station
I find the liberal slant of NPR and PBS to be a nice counterbalance to the conservative slant of all the other major media in the United States. --FLO--
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FianceeUvBigGuy (imported)
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Re: Support Your NPR Station
Uncle Flo (imported) wrote: Wed May 14, 2008 5:25 am I find the liberal slant of NPR and PBS to be a nice counterbalance to the conservative slant of all the other major media in the United States. --FLO--
Tio Floberto,
Oh yeah? Welllll...I find YOUR slant to be a nice counterbalance to MY slant!
Y
.o
...l
....i
Now see what you've done? I'm all slanty!