Several in the Canadian media and the general public have become interested in trans youth -- most recently following a February 2012 story in the UK about a child who at 5 years of age became what is believed to be the youngest person ever diagnosed with Gender Identity Disorder [1] (GID, also known as Gender Dysphoria). It’s probably inevitable that many opinions and emotions have circulated as a result. I’m concerned that some of the attention surrounding trans youth and kid’s risks loses perspective by the (often unintentional) omission of some important distinctions.
The medical profession has long recognized that gender dysphoria often first occurs in youth and childhood, and formalized this in the Diagnostic and Statistical Manual (DSM-III) in 1980 with a specific diagnosis for adolescents. Treatment at that time often took the form of aversion-type therapies, but because these seemed to result in increased distress and self-harm (and not unusually transition in adulthood, anyway) it became necessary for that treatment to be rethought. As years passed, it became increasingly obvious that when there is a gender identity variance, undergoing puberty to become a sex that one does not feel is appropriate to them has a tremendous negative toll on a youth’s emotional well-being. Puberty is also accompanied by major body changes, some of which could be impossible to overcome in adulthood if that person inevitably transitions.
It’s important to recognize that the process I’m speaking of for trans youth is not "sex changes" and surgery. This is often the conclusion that people jump to, but the reality is that newer treatments merely delay puberty until it is certain that further changes like hormone therapy must be undertaken, typically after age 14. German singer Kim Petras is thought to be the first youth to have undergone surgery at the age of 16, in 2009. Since then, a youth in the UK has done so as well [2], and there was an unconfirmed rumour that someone in Europe had transitioned at age 14, but surgery at this age is still rare. By the time this decision is made, a teen has typically had several years to assess if they need to make this life-changing decision for themselves.
Youth transition does not start simply because a child wants to crossdress on occasion or because they like dolls or trucks. It happens when there is a strong and persistent identification that clearly indicates that there is something deeper than the usual experimentation phase which most kids go through. If a child or youth exhibits a clear and persistent identification to express themselves as a gender contrary to their birth sex with an obvious 24/7 drive, then arrangements are made to allow the child to live accordingly. Although this social transition and accommodation in schools is gleaning much of the attention, the fact is that this aspect is really not a new phenomenon.
What is new is the use of puberty-delaying drugs, which is credited as having been pioneered by Dr. Norman Spack, at the Children’s Hospital Gender Management Services Clinic in Boston, in 2007. If accommodation proves to be an appropriate way to alleviate emotional distress, parents and doctors might then consider pharmacologically delaying the effects of testosterone or estrogen which would otherwise typically occur at puberty. Even at this stage, everything is reversible, in the event that a youth changes their mind. It isn’t until hormone therapies are started that changes occur, and that generally happens after there has been much time to consider the consequences, and the youth is able to make a mature and informed decision.
This process is undertaken carefully, with a desire to approach things in a balanced way that neither encourages someone to follow a path if they don’t need to, nor waits until a self-destructive event occurs to prove necessity. Even so, Dr. Spack states that nearly a quarter of his patients have already engaged in serious self-harm [3] before coming to him.
As these stories break, it is sometimes alleged that parents and medical professionals are participating in some kind of agenda which might influence youth to become trans. Speaking for myself as a trans advocate, my advice to trans people is actually to do what is necessary, in order for a person to be at peace with themselves - and I don’t believe that "what is necessary" follows a specific formula, but is for the individual to determine. I actually take issue with anything that could lead to transition by coercion. Anything that could induce a gender identity conflict where none had previously existed is in fact something that I would vocally oppose. I do not, however, see equality and anti-bullying education as "encouraging" a gender identity conflict. What I support in regard to education is acknowledgement in an age-appropriate way that trans people do exist, and are deserving of the same respect afforded to anyone else. I support this for the benefit of those trans youth who do exist - either openly or in hiding - and who need to know that they are not alone, nor are they "freaks" of some kind.
The same is typically true of parents and medical professionals, who usually don’t come to a decision to assist a child to transition very easily. Parents and doctors who form a transitioning youth’s support network are very much thinking about the needs of the child when they make that wracking decision.
National Public Radio (NPR, a semi-public broadcaster in the US) recently compared reparative / aversion and affirming practices. [4] People wanting to know more should read the contrasting accounts told in this piece.
