Society has made great leaps in its acceptance of transgender people. Science has a big part to play in keeping the momentum going

Neuroscience may eventually help guide children unsure about their gender identify Cloe Willetts/ Kapiti News/ NZ Herald

OLLIE MAIHI, a 6-year-old from New Zealand, made headlines last week when her parents and school supported her request to live as a girl. Ollie (above) is anatomically male but identifies as female.

The decision was newsworthy because many psychologists discourage “social transitioning” at such a young age. Only around 25 per cent of young children who question their gender identity still question it by the time they reach puberty.

The New Zealand Herald also reported that once she turns 10, Ollie will start taking hormones to suppress puberty. That is a fairly common procedure for transgender children who are about to enter adolescence. The drugs buy time to decide whether to commence irreversible sex reassignment therapy, typically at 16. They also prevent the children from going through what endocrinologist Wylie Hembree at Columbia University in New York has called “the worst time of their life”, as their bodies develop in ways they find alien and distressing.


Nonetheless, it can be an agonising decision. The puberty-suppressing treatment is reversible, but its physical and psychological effects are not clear.

These decisions would be a lot easier if there were biological markers that could help identify people who would benefit from early treatments. One interesting avenue of research is neuroscience, and an early study shows that the brain’s response to touch, for example, may differ between trans and non-trans individuals (see “Brain scans show trans people feeling at odds with their body“). Such techniques may eventually be able to help guide children, parents and doctors when deciding what intervention, if any, to take – though a brain scan would never be the only factor.

“There could be tens of thousands of transgender children in US middle schools alone“

Other avenues may open up. Earlier this year, Nature reported that the US National Institutes of Health was ramping up funding for research on the health of trans people, including the effects of blocking puberty. This, too, could lead to better-informed decisions.

The need for such a push is clear. A recent survey in New Zealand found that 1.2 per cent of children in high school identify as trans and 2.5 per cent say they are unsure about their gender. A survey of US middle school pupils reported a figure of 1.3 per cent identifying as trans. Other studies have found that these young people have higher rates of depression, self harm, eating disorders and suicidal thoughts.

The prevalence figures are from small samples and must be considered provisional, but if they are right then there are tens of thousands of trans children in US middle schools alone. For many of them, the issue isn’t as simple as whether to transition to the gender they identify with. Trans children also include those who feel that their gender is somewhere between male and female, or entirely separate from the traditional binary. Their needs and the health issues they face must also be part of the surge in research interest.

Things are getting better for trans people. Stories like that of former Olympic decathlon champion Caitlyn Jenner, who last year came out as a trans woman, have helped to raise awareness and acceptance. Another trans 6-year-old, Coy Mathis, recently won the legal right to use the female bathroom at her school in Colorado. Progressive cultural and social change of this kind is thin on the ground at the moment. Science has a really big part to play in keeping the momentum going.

This article appeared in print under the headline “Beyond the binary”