What Do You Think?

For transgender children there are two diametric opposed treatment, one is to allow the child to explore his or her own gender and the other is to force the child back into their birth gender. This article is about a child’s journey into their gender identity.

When boys would rather not be boys

Kids are being diagnosed—and identifying themselves—as transgendered younger than ever before
MacLeans
by Roberta Staley
August 12, 2011

Cormac O’Dwyer entered Grade 8 in Vancouver as a girl named Amber. All traces of femininity stopped with the name; Amber looked, dressed and acted like a boy. “It was awkward,” admits Cormac, sleeves rolled up to reveal downy, muscular arms, elbows resting on the kitchen table in the family’s immaculate home in upscale Kitsilano. From the other end of the table, Cormac’s mother, Julia, pipes up. “People would use the male pronoun,” she recalls. Usually Julia felt obliged to correct the error, leaving new acquaintances flustered and confused.

But solecisms were the least of Cormac’s worries during the transition from female to male. Becoming a boy involved wearing a breast-flattening binder, changing for phys. ed. in the teachers’ change room, declining invitations to go swimming, and carrying a cellphone to call for help in case of bullying. And then there was the therapy: testosterone injections, counselling and surgery that removed his breasts and contoured what remained into the flat, square planes of a male chest.
[…]
Treatment of GID [Gender Identity Disorder] is highly controversial. Some experts believe that the best way to help children and teens is to convince them to accept their bodies and not undergo the therapies that will cause dramatic physical changes. …Metzger [Cormac’s pediatric endocrinologist] believes that the best course of treatment for teenagers diagnosed with GID is hormone therapy: either blockers to stop puberty or, if post-pubescent, hormones that physically alter the body in a way that reflects their chosen gender. For some teens like Cormac, who are confident, psychologically stable and have family support, this transformation can be complemented further with cosmetic surgery.

There in lives the riff, to force the child into a box or to allow them the freedom and safety to explore their true gender. Some may find out that they are transgender, others might find out that they are gay and other might find out that they were neither.

Without treatment, Metzger argues, the path to adulthood for GID teens can be torturous, as evidenced by shockingly high suicide rates: 45 per cent for those aged 18-44, in comparison to the national average of 1.6 per cent, according to the U.S. 2010 National Transgender Discrimination Survey Report on Health and Health Care. Cormac carefully considers what life would be like today if he were still Amber. He pauses for a few seconds then gravely announces, “I think that would push me to be suicidal.” He is much more calm now, he says, free from his obsession with wanting to be a boy. “Before I transitioned I thought about it a lot, like, every minute. Now, I feel like I have so much extra brain space,” says Cormac, who is an honour roll student.

While Cormac has found inner peace, the professional therapists are arguing over what is the “best practice” for transgender clients.

Transgender experts like Harvard Medical School professor and endocrinologist Dr. Norman Spack, co-director of Boston Children’s Hospital’s clinic for disorders of sexual differentiation, speaks highly of the B.C. Transgender Care Group. In fact, Spack deems the B.C. program one of the more progressive in the world. While progressive, the B.C. Transgender Care Group is not radical. The group’s psychology or psychiatry transgender specialists will ensure that an adolescent who is diagnosed with GID is mentally healthy before referring them to Metzger for hormonal therapy. If a child has GID in combination with depression or anorexia—which can occur in youngsters trying to cope with the stress of GID—then the hormonal cocktail that transforms their sexual development is delayed…

Some specialists question whether such a metamorphosis is appropriate for young patients. Psychologist Kenneth Zucker, who heads Toronto’s Gender Identity Service in the Child, Youth, and Family Program at the Centre for Addiction and Mental Health, leans toward counselling to get his patients—especially the younger ones—to accept their birth sex. He worries that the Internet, which has opened up a world of information for children and teens confused about sexual orientation, may be making “transgenderism fashionable: it’s kind of cool to be transgender, as opposed to being gay or lesbian,” says Zucker, who sees at least 50 new GID cases a year, a “quadrupling compared to 30 years ago.” To illustrate his point, Zucker describes one 15-year-old female patient as a “tomboy” who is attracted to other girls—but interprets the attraction as transgenderism. Such “internalized homophobia” can emerge in homes or cultures that oppose homosexuality, Zucker says. The teen thinks, “It would be easier if I were a boy attracted to girls, because then I wouldn’t be teased for being a lesbian.”

“Transgenderism fashionable”, yeah right! It is fashionable because being transgender is finally being recognized that it is natural, that it is no longer being hidden in the closet. Also, how narrow minded of Dr. Zucker to believe that a person only wants to transition because they can’t face being homosexual. He totally ignores all trans-people who love a person of the opposite gender of their birth gender. Ask yourself this, which is better for the child, to be treated as there is nothing wrong with their feelings or to be treated as it is totally wrong with what they are feeling.

Nonetheless, the mental health experts with the B.C. Transgender Care Group are cautious when it comes to approving the irreversible, final step of GID treatment: sex-reassignment surgery. Cormac O’Dwyer’s surgery was one of only about five that have been approved for adolescents by B.C.’s Medical Services Plan (MSP) in the past 20 years, says Dr. Gail Knudson, one of the group’s psychiatrists…
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In Toronto, Kenneth Zucker treats children as young as five who exhibit early signs of GID. These include, he says, unconventional play behaviour: a little boy might prefer dolls instead of Bionicles and tiaras instead of hockey helmets. Such cross-gender play should be discouraged, says Zucker, or it might become permanent in adolescence. “They just have an easier life—they don’t have to go on lifelong therapy or have these incredibly invasive surgeries,” he reasons. About 80 per cent of his preadolescent patients outgrow their cross-gender behaviour by puberty, he claims, which supports the rationale for a highly conservative approach to therapy.

OK, Dr. Metzger clinic found “one of only about five that have been approved” that equals 20% go on to surgery and Dr. Zucker says that 20% of his patients go on to surgery… so what do you think is better for the child? Being forced into a gender role that creates harmful stress or being able to choose your own true gender. As Cormac said about not being able to transition, “I think that would push me to be suicidal.” What I would like to see is a long term study of the effects of Dr. Zucker’s Reparative Therapy and letting the child explore their gender, how does it affect their quality of life.

The American Psychological Association (APA) is in the process of changing their guide for therapists called the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) and one of the changes that they are looking into is changing the Gender Identity Disorder diagnostic criteria or remove it all together. However, one of the major obstructions to reform is the fact that the chair of the committee is Dr. Zucker who does not want the criteria to change. You can read more about the DSM reform movement here.