Buying Time for Gender-Confused Kids

[IbPervert (imported)]

Personally I am not sure either way about this, but just had to pass along.

IbPervert

ABC News

Buying Time for Gender-Confused Kids

Misunderstood Procedure Delays Puberty in Children

By JOSEPH BROWNSTEIN

ABC News Medical Unit

May 21, 2008—

A procedure that some are mistakenly calling a sex change treatment for children has been drawn into the spotlight in recent days -- although it has been going on for many years.

In an interview with National Public Radio broadcast earlier this month, Dr. Norman Spack, a pediatric endocrinologist at Children's Hospital in Boston, revealed that he has at least 10 pediatric transgendered patients to whom he has been giving a hormone-blocking treatment to delay puberty.

Citing recent unwanted media attention, Spack declined, through a spokesman, to be interviewed for this article.

But other doctors say that while Spack may be the first to go public about what he is doing, he is not the first to help children delay their puberty so they can reach maturity before deciding if they would like to transition to the opposite sex..

Milton Diamond, a sexual development researcher and the director of the Pacific Center for Sex and Society at the University of Hawaii, says he knows of doctors who have done this before, "but people don't generally advertise it," he says.

He pointed to the Netherlands, where hormone-blocking therapy has been administered to transgendered youths for more than 20 years.

But Diamond says that the hormone-blocking therapy itself is not sex reassignment.

"It's a delaying tactic to allow the individual to come to terms with the direction he or she wants to go," he says. "What you're doing is allowing the individual more time to make a decision."

Is It Safe?

Jamie Newton, a spokesman for Children's Hospital, confirmed that the treatments are done in accordance with the Harry Benjamin guidelines (generally accepted clinical guidelines for treating transsexual patients), which call for fully reversible treatments for prepubescent children.

The therapy entails an injection of either luteinizing hormone-releasing hormone (LHRH) or medroxyprogesterone, which block estrogen or testosterone to delay the onset of puberty.

The regimen is typically given to children (mostly girls) who reach puberty very early, when the parents and physician opt to delay the process a few years to aid with normal development.

Medroxyprogesterone is known commercially as Provera, a drug injected once every three months as a birth control medication.

"LHRH has been used for 20 years, medroxyprogesterone probably that long, if not longer, so we know they're safe and effective," says Alan Rogol, a clinical professor of pediatrics at Riley Hospital of the Indiana University School of Medicine and the University of Virginia.

Also, he says, a child will undergo normal puberty following the hormone-blocking treatment, and it is fully reversible should a transgendered child choose not to undergo sex reassignment or transition once they reach adulthood.

"There is no question that it's reversible, and I'm unequivocal about that," says Rogol.

In addition to delaying the onset of puberty, the hormone-blocking process does help patients avoid unwanted bodily features if they do decide to undergo a sex change upon reaching adulthood. It is the changes of puberty that often cause the most distress for transgendered children.

"We're talking about things that have a profound, significant influence on the child's life," says Diamond.

Male transsexuals can avoid going through menstruation, while female patients can avoid growing body hair or developing a deep voice if they begin sex reassignment once their childhood hormone-blocking regimen ends.

Transitions and Follow-Ups

Although the treatment is reversible, Diamond says that most who reach that point will go on to transition.

"Almost all those who have gender identity disorder continue on to surgery, or at least continue on to transitions," says Diamond.

In his interview with NPR, Spack confirmed that assessment.

"My confidence comes partly because I've yet to see one change their mind and partly because we're using the psychological testing methods the Dutch have perfected, and they've yet to see one person change their mind," he says.

While the procedure allows children to more easily undergo sex reassignment upon reaching adulthood, sex reassignment surgery is controversial.

First performed in the first half of the 20th century, sex reassignment surgery gained prominence when former soldier George Jorgenson underwent the operations in Europe and became a media sensation as Christine Jorgenson.

In 1966, the Johns Hopkins Hospital announced that it was performing sex reassignment surgery through its Gender Identity Clinic. Those procedures were halted in 1979, when a study by Dr. Jon Meyer, a follow-up on patients who had undergone the operations, did not show any improvement in their wellbeing.

Dr. Paul McHugh, then the head of the psychiatry department at Hopkins, made the decision to halt the procedures, saying they destroyed healthy organs and that physicians needed to focus on healing transgendered persons' minds, rather than altering their bodies.

Many transgendered persons continue to undergo sex reassignment surgery, although a great number of them do so abroad. Because of a lack of reporting, exact numbers are hard or impossible to come by.

Since Johns Hopkins closed its clinic, no other hospital of that stature has made a public announcement of resuming the surgeries.

How Do You Know?

The closing of the Hopkins clinic led some to question how to tell when someone is truly transgendered, particularly children, who may simply have interests more often associated with the opposite sex.

"That always involves clinical judgment," says Diamond. "How do you know, when you're talking to a friend if he's pulling your leg? The more you know about a person, the more you can judge if he's lying or not. You don't make those decisions on one interview."

The important thing, says Diamond, is to be careful and aware that errors can be made in treatment.

"You have to be a little bit humble and realize you may make a mistake," he says.

But, he says, when used properly, delaying puberty until they are adults may be the best way to help a number of transgendered children grow into successful adults.

"If I thought it was appropriate, I wouldn't have hesitation in doing it," says Diamond. "I think it's a worthwhile practice, but like everything else, it has to be used judiciously."

Copyright © 2008 ABC News Internet Ventures

[mrt (imported)]

I think this is more proof that their should be an honest rethink about how to deal with TS kids. Is 18 too late? From the people who have been allowed to transition earlier it clear that the results are better and the anguish level lowered. But how do you avoid making mistakes? If this is true and they have 100% correct diagnosis? Seems like they are on the right path.

[Paolo]

Hell, why delay puberty for JUST the TS kids?

There should be a law that says you can't have puberty until you've graduated from college with your masters degree!

[OneBallBoi (imported)]

Hell, why delay puberty for JUST the TS kids?

There should be a law that says you can't have puberty until you've graduated from college with your masters degree!

But you never graduated from college with a masters degree. So we'd have to delay puberty for you forever. HeHeHe.

[Paolo]

With the way things turned out later on thereafter, it would probably have been a good idea!

[twaddler (imported)]

"

Hell, why delay puberty for JUST the TS kids?

There should be a law that says you can't have puberty until you've graduated from college with your masters degree!

"

Yay! My wonderful GED might have guaranteed me a lifetime of pre-pubescence!

[Danya (imported)]

I think this is more proof that their should be an honest rethink about how to deal with TS kids. Is 18 too late? From the people who have been allowed to transition earlier it clear that the results are better and the anguish level lowered. But how do you avoid making mistakes? If this is true and they have 100% correct diagnosis? Seems like they are on the right path.

I agree with MrT. The more I read about issues for transgender and transsexual children, and going from my own experience, I have to conclude that there needs to be an open, enlightened conversation on this topic.

For male to female transsexuals, unhindered testosterone-mediated puberty brings about permanent changes to the shape of the face, the brow ridge, growth of beard, size of hands and feet, size and shape of the hips and so on. There are other issues for those identifying as female to male.

It is really difficult for many to transition past puberty. Many decide they cannot because there is little chance of them successfully 'passing' in the new gender. The expense can be enormous to become more passable for some who clearly have very masculine features. Electrolysis alone for beard removal can be more costly than GRS. Being passable is not simply a matter of vanity for many, it is something crucial for their self-esteem. They need to be accepted by those around them for who they are, not who they appear to be.

The are a number of lines of research that point to the separation in time of fetal development of the genitalia and brain gender. Trying to tell someone who looks male but has a female brain that they are indeed male because of their body is like trying to convince them they are not cold when they say they are.

An idea persisted at least into the 1990s, in the face of much scientific evidence to the contrary, that it was the conditions under which the child was raised that solely determined their self-perceived gender. This idea has been left by the wayside by most gender professionals.

The only people who can tell us their true gender are the individuals themselves. This has become clear not only for adults, but for children, too. That does not mean that great care does not have to be taken in the consideration of treatment options for children (and adults) who self-identify as transgender. That is a given.

[chilliwilli (imported)]

I agree something needs to be done. Anything is better than nothing when individuals sexual idenity and maturity are involved.

Ultimately we must live with the decisions that we and others make for us anyway. It just seems that many more would be served with a judicious system that screened and provided gender counsling and services rather than system that works to promote and protect "normalcy".

on a high horse

chilli-

[JesusA (imported)]

I will try to put together a proper post on the Dutch experience (some of which has now been published in medical journals). They are willing to give puberty blockers to children as young as 12 who have been diagnosed with GID and then to provide intensive counseling for the child and his or her family. Nothing irreversible is done until 16 or later, after the child has had ample opportunity to consider all of the options for treatment.

This has been going on for several years now and there are many children who have had SRS and who are now adults. Thus far, not a single one has regretted the decision to transition. All have been spared the pain of puberty in the wrong gender.

[joydivision_27 (imported)]

Personally, I'd like a puberty-change operation.

I think I could do it better the second time.

(Although, I may have to go abroad for the zit-implants) ....

joey