Can a child possibly be sure that he or she inhabits ‘the wrong body’? Philip Leone-Ganado explores the issue following the controversy surrounding eight-year-old transgender girl Willa.

The much-publicised advances in Malta’s gender identity law have made it possible for transgender children to be recognised and live their lives with a gender identity that does not correspond to their biological sex – but to many, the notion of a young child making that sort of decision is instinctively an uncomfortable one.

Evidence of this gap between legislation and perception came with the story of eight-year-old Willa Naylor, a transgender girl who found herself in the spotlight this month after publishing a self-written book about her experience and transition, aimed primarily at other children.

While many, including Civil Liberties Minister Helena Dalli, praised Willa’s initiative and activism, others questioned whether a child of that age (Willa was just five when she began transitioning) was too young to ‘know’ that she was transgender.

Pauline Miceli , the Children’s Commissioner, was among a number who said that it was potentially harmful for Willa to become a “symbol of the situation of transgender children” (see below).

Explaining how gender dysphoria can affect children even at a very young age, clinical psychology practitioner and sexologist Nicholas Briffa distinguishes between two sets of children.

Some, he told The Sunday Times of Malta, may present gender atypical behaviour – a boy, for example, may prefer to wear pink and play with girls – but never mention a desire to change gender.

Being male or female is complex and about a lot more than stereotypes

“Many of these children don’t end up changing their gender and conform with their natal sex,” he said. “As long as there is an open and supportive relationship with the parents, this is only an issue in terms of whether it negatively affects their social life, which often comes down to the judgement of others.”

A second group, however, will consistently express the feeling that they are in the wrong body. “This tends to start at a very young age and be very consistent,” Dr Briffa said. “Consistency is the key factor, and again, this can only emerge from a strong relationship with parents.”

For children such as these, many of who may go on to change their gender, transitioning early in life may actually be a positive.

“A lot of transgender people experience higher levels of anxiety and depression,” Dr Briffa said. “Research shows that those who had a supportive relationship with their parents have lower levels and those who changed their gender at a younger age were among the happiest. Socially, it’s very difficult to transition as an adult.”

Stressing that the topic was still a subject of debate among psychology professionals, Dr Briffa said all parents should above all foster an open and communicative relationship and give their children space – affirmative and non-judgemental – to develop.

“We should educate children about gender beyond the idea of a gender binary,” he said. “Being male or female is complex and about a lot more than stereotypes; we need to critique the idea that there are just two genders.”

Following the pioneering Gender Identity Act introduced last year, transgender people can have their gender identity recognised without the need for any medical procedures, effectively allowing children to benefit from such recognition for the first time.

Children who identify as transgender do not undergo sex reassignment surgery until much later in life, should they eventually choose that option, and international guidelines for hormone therapy typically also do not recommend its use before age 16.

Recent medical developments have allowed for the use of ‘puberty blockers’, a reversible treatment, at a younger age, although some question marks remain around the treatment.

Alex Mangion, who became Malta’s first transgender elected official last year, said his personal experience showed that the feeling of being different to others can begin at a very young age.

“I didn’t know the term ‘transgender’ existed, so I thought everyone was like me until I started speaking to close friends and telling them how I felt at a young age. I then came to terms with the fact that I was the different one,” he said.

“It was a very dark and confusing time, as the moment I came to terms with it, I felt all possible sorts of emotions and confusion. I had close friends telling me it was just a phase, while others were supportive about it.”

But Mr Mangion believes the increased visibility and understanding of transgender issues could make things simpler for the next generation.

“It will help a transgender child come to terms with the situation quicker and get help, ideally talking to the right people, who can guide them accordingly,” he said.

“I can assure you that it is not a one-month thing, but entails a lot of understanding”. ­

Should transgender children be shielded from the public eye?

After Willa’s story hit the media this month, Children’s Commissioner Pauline Miceli said the exposure could be harmful to the girl and her family, because despite the positive outcome of the case, she would still be psychologically vulnerable.

“It might also hinder the possibility of the child rediscovering later on in life his or her original gender identity as his or her own, something that is known to happen in some cases,” Ms Miceli said.

Gender Liberation, an advocacy group of which Willa forms a part, questioned why a child, with the same fundamental right to expression as any adult, should have her credibility questioned solely because of age.

“The Commissioner must do more to increase child participation within the efforts of civil society, especially concerning issues that directly affect their well-being,” said George Douglas Saliba, a group spokesman.

“By saying Willa’s activism is admirable but asking for it to be kept private because of her age, a dangerous mixed message has been sent, which runs contrary to the Commissioner’s ostensible role of empowering children in all their rights, including their freedom of expression.”

Alex Mangion, a transgender man and local councillor, recalled that as a child, the spotlight was the last thing he wanted, as children in that situation already had a lot of issues to face.

However, he “admired and supported” anyone who put themselves forward in that way. “It is always healthy to have someone to relate to, for the simple fact that you would know that there are others like you out there,” he said.

Children’s Commissioner Ms Miceli was however “very sceptical about this sort of role modelling”. “It’s a very small percentage of children who are transgender, and I think people could have other agendas,” she said.

“Their cases should be looked into but there are already the legal structures, so there is no need for this particular child to be so exposed.”