[Updated to add this absolutely excellent TED Talk by Norman Spack:]
(Previously published in March 2012, and archived here for when it might be needed as reference)
Several in the Canadian media and the general public have become interested in trans youth. 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 kids is distorted by the (perhaps 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 strong gender identity issue, undergoing puberty to become a sex that one does not feel is appropriate to them can have a tremendous negative toll on a youth’s emotional well-being. That 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 for trans youth that I’m speaking of is not “sex change” 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 whether 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 U.K. has done so as well, and there was an unconfirmed rumour that someone in Europe had full GRS at age 14, but surgery at this age is very rare, if it occurs. By the time this decision is made, a teen has typically had several years of living as their identified gender to determine if the decision is right for them.
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, in an obvious 24/7 manner, 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 accommodation 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 trigger 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 before coming to him.
As these stories break, it is sometimes alleged that parents and medical professionals are participating some kind of agenda which might influence youth to become trans. Yet the objective of transition is to do what is necessary in order for a person to be at peace with themselves — sometimes that doesn’t include surgery, and doesn’t necessarily follow a specific formula, but is for the individual to determine. Likewise, trans-inclusive equality and anti-bullying education does not “encourage” someone to become trans (unless they’ve already been experiencing a gender identity conflict in a persistent way). Instead, it acknowledges in an age-appropriate way that trans people do exist, and are deserving of the same respect afforded to anyone else. This is 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 of a decision.
National Public Radio (NPR, a semi-public broadcaster in the U.S.) previously compared aversion and affirming practices. People wanting to know more should read the contrasting accounts told in this piece.
(Crossposted to Rabble.ca)