Transgender children are now the most controversial part of the discussions and debates that circulate around the transgender community. Quite recently, a four year old NSW preschooler began gender transition, though the birth sex of the child has not been disclosed. The number of children beginning transition has dramatically increased, with a number of children beginning the process in their primary school years. The gender dysphoria clinic at the Royal Melbourne Children’s Hospital reported that 250 children had appointments with them in 2015. In 2005 they only had one child in for an appointment.
Sex change surgery is generally not available to people under 18, however in some countries it’s available to people 16 years and over. Its rarely granted to someone underage unless there are special circumstances. Australia is the only country in the world that requires transgender children to obtain the Family Court’s permission to use gender transition medication.
The central question now is not so much whether gender reassignment is legitimate but at what age it should start. Supporters are fighting for transgender children to begin medical treatments pre-puberty whilst others believe it is far too young and children should be given a chance to develop into teenagers, have some life experiences and wait and see before making such a serious decision.
Gender Dysphoria – The belief that one’s psychological and emotional gender identity is opposite to one’s biological gender.
Social Transitioning– Non medical or operative modes of transitioning. This could include changes to name, wardrobe, hair style, activities and toys.
Puberty Blockers (Hormone Blockers)– Medication used to inhibit, pause and block the on set of puberty. Estrogen and testosterone is suppressed. Effects are reversible if a patient stops taking the medication. Guideline suggests puberty blockers should be taken from about 10-12 year old.
Hormone Replacement Therapy- Medical therapy which administers sex hormones to a transgender patient with the intent of matching their sexual characteristics with their gender identity. Guidelines suggests the commencement of this therapy at age sixteen.
Is a change of gender something that should be encouraged in children?
Should puberty blockers be used on children who insist they are the opposite gender?
At what age should is it acceptable to start hormone therapies?
Is a long term “wait and see” policy in children who claim they are transgender a better option than administering medical therapies in the short term for children who make the claim?
Australian Transgender Girl Evie (formerly Ethan) told her parents that she was a girl when she was 6 years old. She begun transitioning at age 9.
ARGUMENTS FOR EARLY MEDICAL TRANSITION:
- Puberty blockers are supported as a safe medical procedure by many specialist doctors. They allow children to pause puberty, to further explore themselves and their gender identity before making a more permanent decision. Facial structural changes, breast development, facial and body hair growth, and vocal chord changes can be very distressing to a transgender child. An added benefit of puberty blockers is that the effects are reversible.
- There are age guidelines for when to begin puberty blockers (10-12 years)and hormone replacement therapy (16 years) though it might be necessary to start therapies earlier due to the psychological and emotional effect that waiting can cause a child. A collective decision between the child, family, doctors and therapists should determine if a child is mentally and emotionally ready for medical transition.
- Research has shown that transgender children suffer from higher levels of bullying and from high adolescent suicide rates due to living a gendered life that was not meant for them. Beyond Blue estimates that 50% of trans people have attempted suicide.
- Australian Transgender advocate Catherine McGregor believes that children are usually right about their need to change gender and it’s not some temporary phase. The core belief is that they have always been the gender that they claim to be, they are trapped in the opposite gender body which is the wrong body for them to be in.
- Traditionally transgender people have transitioned in adult hood. Transitioning as a 40 or 50 year old is a much harder process as opposed to transitioning at 16 or 17. Starting earlier makes the journey of transgender life easier.
- A 2014 study from the Netherlands involved Dutch scientists running a close study on 55 young adults who were diagnosed with gender dsyphoria as children, which lead to a wide range of emotional distress and anxiety. From the age of 14 they were given puberty blockers. The study found that this intervention resulted in the participants having well functioning, emotionally stable and happy lives as teenagers and into adulthood.
- Social transitioning is another great option. This involves changing non medical changes such as name changes, changes to wardrobe and hair style, activities, hobbies and interests. This gives a child the option to experience societal roles, behaviours, and activities without any medical intervention in order to determine whether or not they are absolutely sure that they want to make further gender changes.
- Watch and wait policy is traumatic for children with gender dysphoria and is akin to the now debunked reparative therapy which was a failed attempt to turn gay children straight. It is cruel and it’s denying them the gender that they need to be. Ultimately, it is a lifesaving process. Children have rights: rights to the appropriate treatments and the right to be happy.
- Providing children with hormone replacement therapy before puberty has the benefit of reducing the need to remove so many gender characteristics which occur throughout puberty. As long as the child has the full support of a medical team and family, as in consistently monitored by a therapist.
ARGUMENTS AGAINST EARLY MEDICAL TRANSITION:
- Medically transitioning children, especially prepubescent children, is completely unacceptable. Absolutely everything is at a developmental stage in those years all the way up to late teenage hood. This process should not be tampered with. How can we expect young children who cannot identify body parts and have no clear understanding of how babies are made, let alone life experience, to make such serious decisions about their bodies and long term futures?
- Though puberty blockers are reversible (not approved by FDA) , the majority of the effects of hormone replacement therapy are irreversible. Specialists also advise that it can be difficult to reverse the effects of social conditioning. This is problematic because if a child changes their mind or is wrongly diagnosed they are stuck with irreversible physical and emotional characteristics that could cause issues in their adolescent and adult life.
- Jeanette Jennings, mother of transgender youth activist Jazz Jennings (TransKids Purple Rainbow Foundation), was interviewed by Barbara Walters in 2007. Jeanette stated that many years prior Jazz asked her “Mommy, when’s the good fairy going to come with her magic wand and change, you know, my genitalia?’. Jazz was two years old at that point. That is not believable, in fact its quite suspicious. It’s now fashionable to have a “diverse” child. Parents who encourage their children to change gender are seen as socially progressive. Parents and hasty decision makers at gender reassignment clinics end up exploiting children for social and/or financial gain.
- Dr Ken Zucker, a US leading specialist on gender identity in children, believes that the huge spike in children presenting with gender dysphoria is due to the internet and media. Parents who are trying to determine where their children fit can easily find reports of gender dysphoria online.
- Many parents and their children learn about the condition via watching Dr Phil or the Oprah Winfrey Show. Hence, its far too easy to believe that a child is gender dysmorphic when they might just be going through a phase. Children have fertile imaginations. They may insist that they are an elephant, giraffe, or a lion. Just because they insist doesn’t mean that they actually are.
- Dr Zucker believes that three quarters of children who have issues with their gender are completely fine with it by adolescence and often grow up to be gay or bisexual.
- There is very little to no research out there on long term outcomes on transgender children. These treatments are more like radical experiments as opposed to rational medical procedure. The Dutch study that has been used by advocates also cautioned that anyone under the age of ten should not go through any kind of social or medical gender transition because it is impossible at that point to determine who will desist and who will persist .
- There is no information on the long term effects of children staying on puberty blockers. Doctors are concerned by the potential neurocognitive effects of puberty blockers. Testosterone and oestrogen play an important part in a child’s bone growth and neurological development. Hence, a potential risk to brain development and bone development/ density.
- Apart from many irreversible outcomes, hormone replacement therapy poses a number of potential side effects including risk of heart disease and diabetes, liver and kidney disease, blood clots (for those taking oestrogen), reduction of fertility, mood swings and severe acne,
OLD SIMO’S OPINION:
What a fascinating and divisive topic this is! I have always supported the legitimacy of the transgender movement and whilst my support is very clear cut when it comes to adults transitioning, I am a lot more cautious about the idea of children transitioning.
I can remember, as do my parents, that I claimed and insisted that I was a number of things as I child that I actually wasn’t and that I never actually became.I was convinced that I was a Conan-like barbarian. a warlock, a cowboy, and even a great white shark. I used to move around my home like a shark swimming in an ocean. My point is that we cannot take the word or the insistence of a child to be gospel when it comes to forms of identity.
This is not to say that there are cases of gender dysphoria in children that will lead to a need to transition. However the statistics from specialists in the field show that the majority of children who exhibit gender dysphoria are going through a phase. On top of that fact are all the medical risks of taking puberty blockers and hormone replacement therapy. Therefore I lean far more towards the “wait and see ” option.
I don’t think adults should be the driving force behind encouraging or pushing children to gender transition . I find that kind of encouragement and that kind of push to be highly suspicious. It makes me think the adult has vested financial and/or social interests in making the child go through that process. Instead, the child should be the primary leader in pushing that campaign for themselves with parents being supportive and finding a way to understand what their child is going through.
Though a child may, at times, have an accurate insight into their true nature,I ultimately don’t believe that they have enough knowledge or life experience to guide these very serious and often irreversible changes. I could support various forms of non medical social transition as an experiment to see what comes of it but I will not support the idea of giving hormone replacement therapy to anyone under 16 because the stats prove that many children change their minds in adolescence.
I would be very hesitant to allow a child to begin a puberty blocking regime. Yes, the effects are reversible but potential side effects to brain and bone development give me pause. I also am aware of the high anxiety and emotional distress that genuine cases go through which must excruciating but there are no tests available that can determine a genuine case. I could be swayed to allow puberty blockers in cases where the child is suicidal and highly stressed. It’s all about long term monitoring by family, doctors and therapists in my opinion.
I would be in favour of putting all children who persist with claims of gender dysmorphia under close scrutiny from the time they begin to make the claims till they are around the 15-16 year old mark. If they still insist on going through the procedure I would support it, but I think the risk of reversing pre-pubescent traits is well worth the wait as anything can change during those highly developmental years. The price one pays for “watch and wait” is more to reverse at a later stage and possible extended bouts of anxiety and distress, but I think it will ultimately be worth it.