At 16, this girl became the youngest in the world to have a life-changing operation... can you guess what it was?

Jackie Green, 19, was born a boy named Jack



After seven attempts to kill herself and two years on suicide watch her parents let her become a girl



On her 16th birthday she became the youngest person in the world to have a gender reassignment surgery

Many little girls dream of growing up to be someone like Jackie Green. An aspiring model, the 19-year-old’s cascading chestnut hair, porcelain complexion and aquiline nose are reminiscent of a pre-Raphaelite muse, or maybe one of the Downton actresses.

Today, the former Miss England finalist is dressed in this season’s Seventies-style prints and a statement necklace. ‘Topshop,’ she smiles when I ask about the designer.

Her adoring boyfriend of two years, also 19, is with her when we meet at a gastropub in North London – and she exudes confidence, which no doubt helps in her job as a hostess at the Burberry store in Bond Street. Yet the road to becoming the self-assured young woman she is today has not been easy – for Jackie was born male.



Happier than ever: Jackie Green, now 19, became the world's youngest person to undergo gender reassignment surgery at the age of 16

Aged just four, and then named Jack, she told her mother Susan: ‘God has made a mistake, I should be a girl.’



Trapped in a body she hated, Jackie first overdosed aged 11 and made six more suicide attempts before she was 15. Medicines were locked in a safe and knives had to be hidden away. She threatened to mutilate her genitals.

And so, aged 16, Jackie Green became the youngest person in the world to undergo transgender surgery. ‘Without that surgery, I wouldn’t be here now,’ she says bluntly. ‘I’m a girl, I always have been – there’s never been any doubt in my mind about that. It’s just that my body didn’t match because, as far as I’m concerned, I had a birth defect.’

Jackie, who is the subject of a BBC documentary to be screened later this month, was diagnosed with gender identity disorder (GID) aged five after being referred by her GP to the Tavistock and Portman NHS Foundation Trust. The same child psychiatric unit came under scrutiny earlier this year when it was revealed that another five-year-old, Zach Avery, was diagnosed with GID by its experts.

The case elicited concern that medics were pathologising normal childhood curiosity – after all, children often experiment with dressing up as the opposite sex. But the difference was that Zach, like Jackie, had threatened to mutilate himself after tearfully insisting for months he was the wrong sex.

As unusual as they are, experts say both cases highlight the growing medical, and perhaps wider social understanding of GID and transgender. The number of children referred for a GID assessment at the Tavistock has increased from 97 in 2009 to 208 in 2011, and more are expected this year.

Born a boy: Jackie as Jack on a family holiday when she was three years old But at present, it is not known why some people who are chromosomally one sex feel they are the other. ‘It has been observed that areas in the brains of some transgender people are structurally the same as the sex they feel they are,’ says Dr Polly Carmichael, director of the Gender Identity Development Service at the Tavistock.

‘We don’t have a definitive answer, but it’s likely to be a combination of environmental, genetic and biological factors.’ What is certain, however, is that transgender people often have tremendously difficult lives. One survey in the United States found almost half of transgender people have attempted suicide, and they are twice as likely to be unemployed as the rest of the population. Jackie’s situation, at least for now, could not be more different. Could her age be the key? Thanks to her astonishingly supportive parents, she was started on hormone drug treatment at 14, which meant she never underwent male puberty, her voice never deepened, and she never grew masculine proportions or features.

Based on her early rate of growth, doctors estimated she may have reached 6ft 4in, and today she stands a statuesque 6ft. It’s just that my body didn’t match because, as far as I’m concerned, I had a birth defect.’ ‘A lot of transsexuals have distinctive features, because they haven’t been able to take the blockers early like I did. This makes them stand out, making it much harder to fit into society, especially when it comes to a job,’ says Jackie. Although medicines are only effective if taken from the first signs of puberty, until recently they were not authorised for use in those under 16. Now the Tavistock, in collaboration with University College London, is carrying out trials into such treatment in children from the age of 12. It seems terribly young. But Susan, a 44-year-old IT manager, was in no doubt by the time her daughter started hormone therapy. ‘As a toddler, Jackie always headed for the dolls in toy shops. Initially, I did think it was a phase but Jack, as she was then, became disruptive in class, ran away from school, loathed having her hair cut and would rip off her school uniform and put on girls’ clothes when she got home.’ Aged eight, Jackie sent an email to everyone at her primary school saying she was a girl trapped inside a boy’s body. After that, she started going to school dressed as a girl.

Susan recalls: ‘Jackie was so much better after that, more content than I’d seen her in years.

'Of course I knew not everyone would respond well and one mother used to sit outside the school in her car shouting “Freak” and “Tranny” at her. I had to call the police to get her to stop. ‘Despite that, her last year of primary school was brilliant. Unfortunately, when she went to secondary school everything fell to pieces and I spent the next two-and-a-half years on suicide watch.’

Change: Jack/Jackie pictured in December 2003 aged nine when she had started dressing as a girl

Jackie was bullied mercilessly and took an overdose. Fearing her attempts might succeed, Susan found her a place at a Specialist Inclusive Learning Centre for children with health problems.

‘No one knew me so I could go along as a girl and life was a bit happier again for a while,’ says Jackie.



‘Around the age of ten, I remember telling my mum that if I started turning into a man, I would kill myself.



'I was aware that puberty was approaching and that, coupled with the bullying, was too much. I took an overdose of paracetamol and ended up in hospital. Looking back, it was more a cry for help.’

With NHS doctors unable to prescribe puberty-delaying drugs or ‘blockers’ as they are known, Susan found Dr Norman Spack, a US-based specialist in gender dysphoria, via the internet.



Dr Spack, of Boston Children’s Hospital, says: ‘With blockers, you can keep children in a pre-pubescent state, which allows them time to decide if they want to pursue full gender reassignment.’

Jackie, who was 13 when she first travelled to Boston, recalls: ‘I had to have blood tests and psychological testing. There was no uncertainty for me, and Dr Spack agreed I needed to be the girl physically that I was mentally.’

The first stage of treatment involved an injection of a drug that blocks the production of the male sex-hormone testosterone. Next, tablets containing a synthetic version of the female sex-hormone oestrogen were given – a process known as cross-hormone therapy. ‘The first time I noticed my body changing was about six months after I started taking the blockers. My breasts started to develop, my face began to get thinner and I began to get a more feminine shape,’ says Jackie.

Finally free: Jackie says she considered her gender a 'birth defect' which needed to be treated

Dr Carmichael believes that we may see more cases like Jackie’s emerge. ‘We are now offering [blocker] treatment to a carefully selected group of people under 16. The physical and psychological outcomes will be assessed so we will gain a better understanding of the benefits and risks. It isn’t offered to anyone under 12.’

Yet the area is undeniably fraught with ethical dilemmas. Last week, 18-year-old Ria Cooper, from Hull, went on national television to say she regretted beginning hormone therapy at 17.

So how do doctors decide whether a person is a candidate for this treatment?

GID is diagnosed if a child displays several characteristic behaviours, including repeatedly stating the desire to be, or insisting he or she is, the other sex. Most pertinently, many children with GID become increasingly distressed – to the point of depression – as they get older, especially approaching puberty. Typically, they express disgust at their genitalia.

Evidence suggests that four in five pre-pubertal children diagnosed with GID do not go on to experience the condition in adulthood. Of those who fulfil the criteria for GID at puberty, one in five becomes happy in the gender they were born.To add to the confusion, many children originally identified with GID turn out to be homosexual instead. It would seem there is a problematic grey area in differentiating so early between sexuality and gender identity. However, Dr Carmichael believes there is a strong case for treating these children.



‘There is a misconception that if you take a child who says they are the wrong sex seriously, they are on an inevitable path to physical changes. In fact, exploration of feelings is important. In some cases, drug treatment is needed. But we work hard at trying to keep children open to all possibilities.’ Still, it must present a conundrum to doctors – on one hand, there is the admirable desire to help children in psychological distress; on the other, the physical ramifications of drug treatment.

Dr Spack admits: ‘When young people halt their puberty and take cross-hormones for a few years, they are likely to become infertile. You have to explain to patients that if they go ahead, they may not be able to have children. When talking to a 12-year-old, that’s a heavy-duty conversation.

‘But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.’

After gender reassignment, blockers are no longer needed, although transgender people must take cross-hormones for life. Susan, who lives in Leeds, took Jackie to Boston every six months for treatment until she had her surgery at 16. ‘I’d get her blood tests done here, and then take the results to Boston. I would order the blockers online from a pharmacy in Canada with Dr Spack’s prescription.’ Jackie’s treatment and trips to the US over three years cost £15,000, which, along with the £13,000 gender-reassignment surgery, meant Susan had to use equity in her home to pay for it.

Confidence: The statuesque teen, far right, dreams of becoming a model and reached the finals of Miss England

‘Having the anatomy of a boy was a constant reminder that she still wasn’t who she wanted to be,’ says Susan.

‘Physical relationships were impossible and I knew that if it was me, I’d want to be able to take that final step and have surgery. Jackie fully understood she’d never have children but there was no doubt in her mind it was the right thing to do. And if she wants to have a family, she can always adopt.’

In the UK, gender reassignment cannot be performed until the patient is 18, but Susan discovered a surgeon in Thailand willing to do the operation when Jackie was 16 (Thailand has since adopted the international guideline of 18). Eighteen months of discussions with the surgeon followed and on her 16th birthday she underwent a seven-hour operation. ‘It’s hard to find words strong enough to describe how I felt when I woke up,’ she says. ‘It was like, “Wow, my life really does start now.” I cried tears of joy.’

‘Without that surgery, I wouldn’t be here now,. I’m a girl, I always have been.'

Jackie was virtually bed-bound for the first five days. For the following three weeks, she stayed in a hotel near the hospital, with nurses visiting her twice a day.

‘When I went home, I had a 16th birthday party but for me it was my first birthday as the woman I should always have been.’

She returned to Thailand when she was 18 for £2,000 breast augmentation surgery, and now has a body she is delighted with. Shortly after her operation, she entered Miss England, making it to the semi-finals. She intends to enter again next year.

Jackie has been dating her boyfriend for two years and says: ‘We’d been together a month when I told him about my surgery, but he was fine about it. He told me he already loved me and I was very much a girl as far as he was concerned.’

While acknowledging the need for caution by the medical establishment, Jackie says: ‘I know there is a lot of controversy about GID and blockers, but I think children need more credit for knowing who they are than doctors give them. Going on blockers doesn’t mean life-changing decisions. There’s plenty of time to change your mind if you want to.’

Dr Carmichael agrees: ‘It is important to monitor and support these young people and their families. Certainly, their feelings about their gender should be respected.’

Susan knows that she and Jackie made the right decision. ‘It’s wonderful to see how happy she is with her life now.’

Jackie adds: ‘I think I’m a good face for transgender. After years of heartache, I want people to understand that we are not weirdos or freaks or any of the other horrible terms thrown at us. As far as I’m concerned, I’m just a normal girl with a bit of an interesting history.’