Allowing minors to undergo transgendering procedures.

Great Debates
21

There is the potential irreparable harm to wrongfully starting hormone replacement at early puberty. There is also irreparable harm to wrongfully withholding hormone replacement at early puberty, when the practitioner is certain that the patient is in fact transsexual. Starting HRT before the growth plates close will allow the patient to develop a gender-appropriate skeletal structure, and will also prevent the development of inappropriate secondary sex characteristics and encourage the development of appropriate secondary sex characteristics. Ultimately the question comes down to trusting the practitioner to correctly identify juvenile transsexuals.

There are generally accepted guidelines for treating juvenile transsexuals.

It appears that the medical care practitioners in this case are following those guidelines, since they are delaying the administration of testosterone until age 16 as called for by the HBIGDA’s guidelines.

In this case, the determination that the patient is transsexual is concurred in by the patient, the patient’s legal guardian, the patient’s care providers, and an impartial judicial body. Opposing that determination, at this point, sounds to me more like an irrational attachment to outmoded theories of gender identity than any sound scientific or ethical objection to the procedure.

A lot of transsexuals know that they’re “in the wrong body” by the time they’re five. I have friends who knew they were transsexual at age two. It is not at all unreasonable that some transsexuals will be sufficiently certain in their gender identity at age 13 as to justify treatment. The HBIGDA’s collective experience is that this is the case, and they wrote their guidelines based on that experience. How many more people would you force Alex to prove his gender identity to before allowing him hormone replacement? The dozen or so he’s proven it to already apparently aren’t enough for some people.

22

Oh, another thing. Transsexuality isn’t about “social acceptance”. I’d be transsexual in the absence of all social context. The primary battle that one wages as a transsexual takes place entirely within one’s own head. The only way to win that battle is to fix the hormone imbalance that causes it. Social acceptance reduces the secondary strain that one experiences, but won’t relieve the primary problem.

23

I don’t see the problem. The child is having no procedure done until the age of sixteen, which is the legal age of sexual consent in Australia. Surgery cannot begin until the age of 18, which is when the child will become an adult. It was an excellent handling of a sensitive issue.

24

As I understand it from another article, s/he starts the hormones now, but nothing that will be irreversible until s/he is 16. No surgery until the age of 18.

25

I think there’s entirely too much talk about “decisions” made by a kid in this thread, myself. Haven’t we been through the question about “people deciding to be homosexual” enough in threads on that topic?

This young person identifies as a boy, believes himself to be a boy despite having the body form of a 13-year-old girl, and has done so since childhood. There is a disturbing factor of the father having raised him as a boy in his earliest years, which may have actually skewed his perceptions of himself. (Clarification: I’m not making a judgment on whether he is really a transsexual – I’m saying that the potential exists that instead of an inner perception, what we may have is parental conditioning leading to the same apparent perception.)

I think a 13-year-old is capable of knowing things about himself or herself. I don’t believe he or she is mature enough to make irrevocable decisions about his or her future. And I think the judge in this case ruled correctly.

As istara points out, what is being done is partial hormonal therapy only, including if my information is correct puberty-delaying drugs, pending the child coming to an age where he can consent to a full regimen of SRS and hormonal therapy. That makes immense sense given the circumstances.

26

This is a great thread, kambuckta. I wonder about this a lot as a clinician, especially about where it intersects with “coming out” issues for young gays and lesbians. I have lots of happily masculine sex-typed lesbian clients who were sure as little girls they’d be sprouting penises any minute and were crushed when they didn’t, but felt like their gender identities fell in place when they came out - sometimes not until late highschool, or, with older women, in college. OTOH, I certainly think transgenders exist & think that whatever can be done to maximize their comfort levels and adjustments is appropriate and desireable. I guess what I’m saying is that it would sure be nice if we could help distinguish between the gender fluidity that sometimes accompanies gayness and true gender dysphoria. It would also be nice if the surgery worked better for FTM…

Abbie Carmichael, I read the book you mentioned (As Nature Made Him, John Colapinto). It was devastating. The truly frightening Dr. Money aside, I do think it’s a good idea if the young person is getting some fairly intensive therapy to check things out and provide support.

27

I think part of the problem is that going through puberty as a girl will necessarily result in a worse outcome when he does decide to go for SRS, a mastectomy will be necessary, and may never attain enough height or build to be a convincing man. Additionally it could be emotionally damaging for him to have periods and breasts, while feeeling strongly male.

If you’re acting in the child’s best interest, and there is NO DOUBT that he will go for SRS at some point, starting the treatment as early as possible makes good sense.

28

No, hon, tomboys are not transgender.

I was a pretty virulent tomboy in my younger years (now I’m a “tomwoman” approaching 40 all too fast). I played in the mud. I rough-housed with boys instead of playing hopscotch with girls - I mean, down-in-the-mud wrestling with boys. Climbed trees, built forts… Bows and arrows, cops and robbers, BB guns, played with daddy’s tools, went fishing with daddy. When 12 years old took my desire for woodshop and drafting to the school board because, back in those days, girls just didn’t DO those things! Definitely preferred pants to skirts (couldn’t climb trees in a skirt dontcha know). Insisted on a BOYS bike frame.

Nowadays, on a typical weekend you’ll find me greasy to the elbows working on and playing with airplanes.

I am most certainly a tomboy. Even in some aspects of mental function I tend very strongly towards the male side - when it comes to spatial relationships, for instance, an area where on average men’s ability tends to exceed that of women, I myself have abilities that exceed 99% of the men in this world. I also score pretty high in areas like agression. So even my brain has some characteristics normally described as “masculine”, despite my female plumbing.

However - I am not, and never have been, in any doubt whatsoever that I am female. (I am also as heterosexual as it is possible to be - never a fantasy or dream or anything the least bit lesiban, either) Never. I try very hard to understand the transgendered, but it is very difficult for me to comprehend their viewpoint because being a gender other than the one I was born with is not really within my mental universe. It’s something I can understand with intellect, but emotional comprehension escapes me in this matter.

A tomboy is a woman with interests and abilities that our cultural traditionally thinks of as “masculine”, but she’s definitely a woman and comfortable with being a woman. A transgender person born physically female may or may not display “masculine” behaviors (she might even go through a period of “super-feminity” in an attempt to “fix” herself), but inside her head she is NOT a woman, she is a man, and she is not comfortable in her body at all.

“Slight” difference.

You see, all I require to be happy in life is a society that allows me to play with the toys I prefer - no medication, counseling, or surgery required.

What a transgendered person requires to be happy is a different body - no matter how accepting the society they live in is of unconventional gender roles.

29

I wanted to stress that point, being myself a transsexual ftm who is only called masculine because of my haircut and my libido, otherwise I very much like behaving in a feminine/andro way. I’m also only attracted to men.
I just couldn’t stand my body.

I told my friends at 12 one day I would get rid of my breasts, followed by outing me as transsexual (I discovered I was one between 11 and 12), and then spent the next years watching my body betraying me, my breasts growing to a C cup, my hips getting wider (it’s only during the last two years that I have accepted my hips are normal for someone who had been exposed to an oestrogen-fueled puberty, in my mind they were simply deformed.), my thighs and butt getting rounder and my height stopping at 5’3. (My body reached its full developpement at 16yo). Bleeding never bothered me though.

So, in one hand I am overjoyed to see someone having a chance to escape that, and on the other hand only time will tell if Alex will pursue or not more profound body mods and keep on seeing himself as a boy.

For those interested, here’s the english translation of a news article about the treatment of trans teens in the Netherlands:
http://ai.eecs.umich.edu/people/conway/TS/Netherlands/Wrong%20Body.html
Scroll down halfway to the part called “hormones”.

30

Precisely. I spent ten years of my life trying to find a gender role, conventional or otherwise, that would suit me. I wasn’t able to. It wasn’t until I started hormone replacement, and started to see the consequences thereof, that I found any semblance of inner peace.

31

Absolutely not. Someone that young is not nearly old enough to be making such decisions. Think about all the opinions you had at that time that you reversed later. Do you really trust kids with making irrevocable decisions at that age?

It’s an interesting double-standard. The wanting for such a procedure is just as likely to be an anomaly in the mind as a true need, yet there is much support for allowing the procedure to continue. We don’t give liposuction to anorexics, even though they can claim that they “naturally” want to be th in just as convincingly as would-be transgenders want to be the opposite sex.

32

In case you didn’t notice, the decision wasn’t made by the child alone. It was made by a team of people including the child, his legal guardians, his medical care providers, and a judge. Frankly, I think that collective is competent to make such a decision. Why do you think they’re not?

Please produce your evidence for this assertion. While you’re at it, present it to the Harry Benjamin International Gender Dysphoria Association, since it would contradict what they’ve learned in the past 25 years (and in the years preceding as the Erickson Educational Foundation).

33

KellyM - asking this as an honest question: Gender Dysphoria occurs from birth, right? Likewise other transgender conditions that can be detected during a patient’s lifetime (unlike dysphoria, which as mentioned above, is only detectable at post-mortem).

We know that no amount of counselling or training can make a male brain a female brain, and vice versa.

BUT - if Alex’s transgender issues result from nurture (father raising Alex as a boy not a girl) and not from nature (dysphoria) would years of proper counselling be able to correct the situation? And help Alex identify as a girl?

I fully understand that Alex may be genuinely dysphorian, but the father’s raising of her as male is a worrying coincidence.

I know there are transexuals that actually don’t want to change their bodies, but want to live as the opposite gender. Which at least gives them the option in years to come of being a bio-parent.

34

Athelas
It’s times like this I wonder if anybody reads my posts.

Again the Benjamin standards of care already require counseling and a waiting period. There are procedures designed to prevent patients who don’t have gender dysphoria from getting srs. There is plenty of red tape and many hoops to jump through. For example, patients like Lazz and KellyM still have problems convincing doctors that they should be allowed to transition as they are attracted to the gender they want to be assigned. Many doctors think ‘You’re a man. You’re attracted to women. Why do want sexual reassignment?’. (The answer is that while Madonna may joke about being a gay man trapped in a woman’s body, Lazz really was.). Lazz likely had additional difficulties because he had behaviors that are classified as feminine. Many doctors don’t think a patient has gender dysphoria unless they dress and behave in stereotypically masculine or feminine manner.

35

Transsexualism, to the best of our understanding, is a congenital defect that arises prior to birth. However, it is detectible pre-mortem through its psychological effects. There is no known physical test for transsexualism, pre- or post- mortem, that reliably detects transsexualism.

Transsexualism (in my opinion) is a form of intersexualism. Many, but by no means all, intersexual disorders are apparent at birth; others become apparent as the individual grows.

Given what we know about gender and gender role acquisition, it is unlikely, if not impossible, for someone to acquire gender dysphoria through any form of postnatal treatment. There are a few documented cases of people subjected to child abuse (boys forced to be girls, girls forced to be boys) who have started down the pathway to reassignment, but all of the ones I’ve read of bailed out before surgery and most bailed out by the time they’d been on hormones for a short time. (Hormones are a good test of transsexuality: a transsexual will generally experience a long-term improvement in mood, while a nontranssexual will almost always experience a significant decline.) Similarly, the forcible infant reassignment cases have shown that inherent characteristics, rather than environment, determine gender very strongly, or at least do so in many cases.

As to the accuracy of the selection mechanisms called for by the Standards of Care: the rate of satisfaction reported by post-ops is in the upper nineties. The rate with which people request rereassignment is extremely low, and in most cases where rereassignment is requested a review has shown that the Standards of Care have not been followed. Experience has shown that the Standards of Care are very effective at keeping people who believe they might be transsexual but actually are not from obtaining reassignment or even hormone therapy.

DocCathode’s representation regarding the behavior of some doctors is true, but fortunately such behavior is on the decline. Probably the worst example of such malpractice is at the Clarke Centre in Toronto; they have many many rules that one must follow in order to qualify for treatment through their clinic (two that immediately come to mind are you must wear unambigious clothing to all appointments and you must choose a name that cannot be mistaken for the opposite gender). They have close professional ties to F. Michael Bailey, the Northwestern professor who recently published a very inaccurate and widely decried book basically setting forth the opinion that transsexuality is a paraphilia (and the clinic at the Clarke is run by the same people who run their sex offender and addiction clinic). Charing Cross, in London, is also quite bad, from what I’ve heard, although the main problems there seem to be funding. I personally haven’t had much trouble with my caregivers (they seem to understand that being a lesbian is not incompatible with being transsexual), but I was rather lucky in my draw.

36

WOW!!!
I don’t know any females that are particularly happy about menstration, except those who are afraid of pregnancy.

If she was in the US would she have to sign up for selective service, what about sex change opps later in life (f>m)???

Anyway my take on it is WTF is wrong with a female that likes male activities??? or for that matter a male that likes female activities??? Why must they try to change themselves to the other, why can’t they just be who they are???

Why can’t society accept that not all girls will do girly things, and not all boys will do manly things. I would say society with their sterotypes are causeing these people to be forced into mutulating themselves to fit in.

I’ll now go crawl back into the hole whence I came.

37

Selective Service in the US is based on birth sex; thus, a FtM is prohibited from registering for the draft (several have tried), and a MtF must register even if transition is complete before the 18th birthday (which should never happen anyway).

A post-op MtF would be ineligible to be drafted for “gross genital defect”, of course, and a pre-op MtF would likely be ineligible for psychological reasons as well.

Reassignment isn’t about liking “female activities” or about stereotypes; it’s far more fundamental than that. Please go read some of the earlier comments in this thread, or some of the other threads about transsexualism (there are quite a few) to get a better understanding. As I’ve said many times before, I would be transsexual in the absence of all social context.

38

Thanks KellyM

I have, but one thing I think you are missing is the battle in you head was just possibly formed by your experences. How you perceived men and women, perhaps as a baby. Perhaps how you perceived something was somehow ‘distorted’ by the way your mind works, but it was still forming your reality. I would say people somehow learn that they are the wrong gender from society, if they were truly absent from society they would be more concerned about survival then if they have a willy hanging between their legs or not.

39

Well, I think most of us here are in agreement with that statement. And it’s not just a matter of the person concerned changing - as I mentioned, I am a very heterosexual female who is quite comfortable being female who nonetheless likes many traditionally male activities.

I lost count of the number of times I was accused of being a dyke while in flight training and after - and the number of times I was accused of providing sexual favors for male instructors and, on one occassion, a FAA designated examiner. Now, those who know me at all know that it’s all completely bunk. Nonetheless, there always seems to be some lackwit in a crowd who has to throw that into the mix.

I do know there are men out there who somehow got it into their heads that to be bested at anything by a woman - no matter how inexperienced they are, and no matter how well-trained and experienced the woman is - is to risk their manhood shriveling up and dropping off. If they can’t attack your expertise (and they will try) they will attack your sexuality. I once confronted one of these idjits and told him to make up his mind - was he going to call me a dyke, a whore, or bisexual? I was getting tired of keeping track of it all.

Then they catch me doing something really feminine like crocheting a baby blanket for a friend - you can watch the mental gears seize up and smoke come out of their ears. It’s truly amazing to watch.

It’s like they’re threatened because I’m comfortable with myself - maybe they’re not comfortable with their own selves? It does puzzle me, I just don’t understand why folks get so bent over these things.

Fortunately, all this seems to be less and less common as time goes by, and most folks seem to live and let live these days. Or maybe I’m hanging out with better quality folks. But if that’s what I, a sexually conventional, married and monogamous het girl has to put up with I can only imagine the gay/bi/transgendered have it far, far, FAR worse than I have.

40

I find that people have problems with anything that doesn’t fit with the way they categorize the world. As you said, some men can’t accept that a woman is superior to them. Their world is based on a belief that women are inferior. As somebody once said “You know the very powerful and the very stupid have one thing in common. They don’t alter their views to fit the facts. They alter the facts to fit the views. Which can be uncomfortable if you happen to be one of the facts that needs altering.” Siince they refuse to accept that you could be a better mechanic, they try and fit you into another category-like lesbian, or tomboy. If they have classified you as a tomboy, seeing you crocheting requires that they reclassify you.

Since one of the most basic classifications people use is male/female, transgendered and intersexed people suffer a lot of abuse.

I can’t believe nobody has posted the best argument for going forward with treatment- Brandon Tina. Brandon was an ftm. When his friends found out that Brandon was ‘really a girl’, they raped and killed him. Why does Alex wear diapers rather than use the school bathroom? Using the girl’s bathroom would give away his secret. Using the boy’s bathroom is risky as well.