Transgender Youth: How Early is Too Early for Treatment?

Health Writer

While being a transgender youth is probably nothing new, talking about it, understanding it and accepting it is. It is only in recent years that we have started public and private conversations about being transgender. For many people, these discussions are "what-if" types of conversations and speculations on what we would do if faced with the situation in our family. In these cases, it is easy to pass judgement and insert our own views and perspectives into the lives of "other people." But for some families, this conversation is personal and confusing.

Can young children be transgender?

Sometimes, children start expressing that they identify with a gender different than the one they were born into as young as three years old. When parents allow them to express themselves, they are often met with resistance. Schools fight young boys wearing dresses or using the girl's bathroom. While girls who identify with boys are generally more accepted because they are seen as "tomboys" there is often still discrimination. Other parents are quick to criticize or blame the parents for allowing "abnormal" behavior. Because of a lack of information (thankfully this is beginning to change), parents are left to figure out what to do on their own and frequently feel alone.

A recent study backs the idea that young children can, and do, have strong gender identity and this identity is consistent and apparent as young as five years old. Researchers looked at children whose expressed gender was different than their birth gender and compared the results to children who expressed the same gender as their birth gender. Transgender children were found to identify closely with "assumed" roles for each gender, for example transgender girls (born male but identify with female) preferred the company of other girls and played with toys and ate foods associated with girls. The study concluded that "transgender children do indeed exist and that this identity is a deeply held one."

Treatment to stop puberty

Going to a doctor doesn't mean that you will get more definitive answers. Some doctors believe children should be free to express the gender they identify with, others believe it is better to receive therapy to help children accept their birth gender. Even those doctors who accept and treat gender identity issues are at odds with what the best course of action is.

Hormone-blocking treatment is used to delay the onset of puberty in both boys and girls. This treatment stops girls, who identify with the male gender, to not develop breasts and start menstruating. For boys who identify with the female gender, the hormone blockers will stop the voice from deepening, broad shoulders from developing, stop facial hair and other bodily changes that occur during puberty. If the treatment is stopped, natural puberty begins. This treatment is sometimes used in children as young as eight years old.

This treatment allows a child more time to determine whether changing gender is the best outcome. Critics of this type of treatment worry that there isn't  enough research on the treatment and that we don't yet know what the long-term effects of the treatment are and that children this age can't possibly be able to make life-changing decisions such as a change of gender. Advocates claim this treatment gives individuals and families the needed time to decide what is best in the long-term and gives those who do opt to change genders a better outcome because it is more difficult to change genders after having gone through puberty.

So what are parents to do?

Because of the lack of research in this area, experts are more apt to tell parents what not to do. Ignoring the situation doesn't help. Eli Coleman, who helped update treatment guidelines for the World Professional Association for Transgender Health points out that not addressing it can cause psychological problems. And the American Psychological Association states, "It is not helpful to force the child to act in a more gendfer-conforming way." This can lead to depression and behavioral problems.

Dr. Norman Spack, who treats transgender children at Boston's Children's Hospital, believes there are too many potential problems when someone wants to change their gender but can't because of lack of support. When he treats transgender youth, he refers them to counseling, which they continue anywhere from several months to a year. Counseling isn't used to try to dissuade the youth from wanting to change or to make them conform to their birth gender. It is to help them determine what they want and if they are ready for treatment. Once the counselor believes a child is ready, Spack runs a series of tests and does another counseling assessment. Only after he is convinced the teen is ready, does he prescribe hormones to start the transition.

Deciding to change your birth gender isn't an easy decision, and it doesn't happen overnight,. Some might decide to forego gender reassignment surgery Others decide it is worth it. We don't yet have long-term data to know whether those that have undergone this type of surgery regret their decision. Each person, with the help of their family, must make the decision that is right for him or her.