Too young to change genders?

When a child demands to live as the opposite sex, parents face a controversial decision.

Published October 16, 2008 1:40PM (EDT)

If confronted with a child who wants to dress as the opposite gender, many parents will allow it but restrict gender experimentation to the privacy of their home. But say your son not only click-clacks around the house in heels but persistently expresses a desire to be a girl -- to be referred to as "she," take on a feminine name and use the girls restroom at school. What if his desire to live as a girl is so extreme that he talks about cutting off his penis? This month's Atlantic takes an exhaustive, well-researched look at those very questions.

The scientific jury is still out on whether transgenderism is a result of nature or nurture. The Atlantic article cites a study of identical transgender twins as evidence that it is hard-wired, but author Hanna Rosin quickly counters that the study is unpublished and has not been corroborated by other research. Another study supporting a biological cause is heaped with proverbial salt: "The sample size was small, and the subjects had already received significant feminizing hormone treatments, which can affect brain structure."

However, there is evidence that what appears to be transgenderism in young children most often is not. Some studies have found that "only 20 to 25 percent [of children with gender-identity disorder] still want to switch gender at adolescence." A 15-year study -- which the article calls "the most extensive study on transgender boys" -- followed 44 boys who "exhibited extreme feminine behaviors," as well as a control group. According to the Atlantic: "Three-fourths of the 44 boys turned out to be gay or bisexual ... Only one became a transsexual."

Dr. Richard Green, the lead researcher, said: "We can’t tell a pre-gay from a pre-transsexual at 8." He continued, "If everyone is caught up in facilitating the thing, then there may be a hell of a lot of pressure to remain that way, regardless of how strongly the kid still feels gender-dysphoric." So some say it's reckless to allow a young child to transition to the opposite gender when he or she might simply be gay or lesbian.

Clearly, this "wait and see" recommendation is of little consolation to parents with a child they strongly believe to be transsexual. And, certainly, some parents will question whether their child is part of that 20 to 25 percent, and wonder whether it wouldn't be better to transition earlier. Others might look at the evidence against early transitions and ask: What if they aren't "cured" but, rather, culturally conditioned against those early feelings? Or: Even if my child is gay, as opposed to transsexual, why shouldn't he be allowed to wear dresses, if that's what he desperately desires?

There simply isn't any one right answer. I finished the article thinking, "I don't know what I would do." But I also walked away thinking, "I know what I wouldn't do," and that's treating gender-identity issues as a disease to be cured.

Dr. Kenneth Zucker, head of the gender-identity clinic at the Center for Addiction and Mental Health in Toronto, describes gender dysphoria as a result of "family noise." As the Atlantic explains, this means "neglectful parents who caused a boy to over-identify with his domineering older sisters; a mother who expected a daughter and delayed naming her newborn son for eight weeks." With therapy, Zucker believes children can overcome gender dysphoria.

Indeed, Zucker's patients have reportedly largely left it behind -- only, as the article points out, it "doesn't mean they were happy." Rosin writes: "I spoke to the mother of one Zucker patient in her late 20s, who said her daughter was repulsed by the thought of a sex change but was still suffering -- she’d become an alcoholic, and was cutting herself. 'I’d be surprised if she outlived me,' her mother said."

In the article, Rosin visits one of Zucker's success stories -- John, who started the therapy at age 4 (and is presumably a teenager, although the article doesn't say). Under Zucker's advisement, John's parents "boxed up all of John’s girl-toys and videos and replaced them with neutral ones." Rosin writes:

Whenever John cried for his girl-toys, they would ask him, "Do you think playing with those would make you feel better about being a boy?" and then would distract him with an offer to ride bikes or take a walk. They turned their house into a 1950s kitchen-sink drama, intended to inculcate respect for patriarchy, in the crudest and simplest terms: "Boys don't wear pink, they wear blue," they would tell him, or "Daddy is smarter than Mommy -- ask him." If John called for Mommy in the middle of the night, Daddy went, every time.

What do you know, now John is dressing like a dudely dude, wearing Abercrombie & Fitch, and playing video games. Cured! Except, Rosin explains, "recently, John was in the basement watching the Grammys. When Caroline walked downstairs to say good night, she found him draped in a blanket, vamping. He looked up at her, mortified." Caroline says the therapy is "not a cure; this will always be with him."

A year ago, John told his parents he was gay. Could this be an example of a gay child who might otherwise have mistakenly transitioned to life as a girl? Or is it an example of a transgender child who was trained to suppress his discomfort with being a boy? It's impossible to say for sure, but the therapy certainly is frighteningly reminiscent of past attempts to "cure" homosexuals.

By Tracy Clark-Flory

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