Where the children lead

Marti Abernathey picks a way through the panic, confusion and maltreatment that surrounds transgender children.

Cole, one of the children featured in Louis Theroux’s BBC 2 documentary 'Transgender Kids'. Freddie Claire, BBC Photo Library.

‘At age three my child, who I understood to be a boy, began expressing a preference for all things girly,’ recalls Catherine, mother of 16-year-old Becca.

‘We were hoping this was a phase and something we could influence. So we sought treatment and were told we could “encourage boy play” and “discourage girl play”.’

Catherine followed that advice but by age six Billy was threatening suicide.

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‘So we went back to treatment; we were horrified that our child was so unhappy. We were told Billy was depressed and anxious, but gender identity was never discussed.’

Now she reckons: ‘What we did to Billy as a young boy was the equivalent of reparative [or ‘conversion’] therapy and it was disastrous. Our child went to a very dark place.’

There were ‘suicide attempts, cutting, self-medicating until we figured out what this was’.

When Billy was 15, her parents allowed her to transition to Becca.

‘Since then, slowly, we have been rebuilding our family cohesion and Becca’s self esteem, now that we have finally accepted our child for who she is.’

Children like Becca are said to suffer from ‘gender dysphoria’ – which is defined by the American Psychiatric Association in the following way:

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‘For a person to be diagnosed with gender dysphoria, there must be a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months. In children, the desire to be of the other gender must be present and verbalized. This condition causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.’

The media glare

Trans children are increasingly in the media spotlight. But there remains much confusion, misunderstanding and mis-representation. Often transgender and gender nonconformity are conflated.

Kelley Winters, author of Gender Madness in American Psychiatry, comments: ‘Lots of kids are gender nonconforming, and the great majority are not distressed by their bodies or birth assignments. Only a small portion of gender nonconforming kids are gender dysphoric, and consistently, persistently and insistently express distress with their birth assignments or physical characteristics.’

Sometimes articles about pre-pubescent trans children refer to gender reassignment surgery or cross-gender hormone therapy, as though these were appropriate treatments for trans children.

Professor Dan Karasic at the Department of Psychiatry at the University of California San Francisco, a world-leading institute for transgender research, explains: ‘No medical intervention is done before puberty.’

He adds: ‘Those whose desire to live in another gender persists into puberty may be put on blockers, which allows for time for confirmation of this identity, while also being reversible. Dutch studies have shown that using this protocol of puberty blockers; hormones later in adolescence; and then surgery for those that are transgender, results in well-adjusted trans adults.’

So treatment for young people with gender dysphoria looks like this:

• prepubescent children – therapy for self-acceptance

• pubescent children – hormone blockers to delay puberty

• young adults – cross-sex hormone therapy.

Another charge that is levelled against parents and therapists who take seriously or try to help trans children is that they are in some way experimenting on them.

This view was expressed by Brendan O’Neill writing in the The Spectator earlier this year. His piece was entitled: ‘Trans activists are effectively experimenting on children. Could there be anything more cruel?’1

‘My child went from being sad, depressed and reclusive to the happy, bright and laughing woman I see today’

O’Neill was reacting to a generally sensitive BBC documentary by Louis Theroux on trans kids in the US.

The film, O’Neill fulminated, ‘introduced us to Camille, a five-year-old, pink-loving, Gaga-admiring boy who daftly thinks he is a girl, and even more daftly is indulged by psychologists and his parents...’

He went on: ‘The treatment of nonconforming or plain funny kids as “transgender” strikes me as a stunning abdication of adult responsibility. It is the job of adults to correct childish confusions, to guide kids through weird or rough patches… But now, the cult of relativism runs so deep that adults even balk from making that most basic of all judgements – that a child with a penis is a boy and a child with a vagina is a girl – and instead we accommodate to the child’s own fads and silliness.’

Happy, bright, laughing…

The suggestion, made by some critics of therapy, that parents are somehow imposing trans identities on their children strikes Camille, mother of a seven-year-old transgender daughter, as ‘strange’.

‘No parent would choose this for their child. It is a struggle your child has to deal with on a daily basis and on so many levels. It’s not like they change their name and put on a skirt or a pair of Star Wars pyjamas and bam! Life is sunshine!’

Camille says she knows that the road ahead for her daughter may be difficult. ‘Puberty blockers, starting hormones, infertility, who to trust, who to love, depression rates, suicide rates, violence, bigotry, misunderstanding, fear, surgery. Who would choose this for their child? This just shows a complete lack of understanding of the condition…’

Evidence shows that children who are criticized, demonized or shamed with regard to their gender non-conformity are far more likely to suffer increased rates of depression and anxiety.

Conversely, a recent study published in Pediatrics, the official journal of the Academy of American Pediatrics, shows that once gender dysphoria has been resolved, the transgender child’s wellbeing is comparable with that of gender conforming children their own age.2

Dawn, mother of a 16-year-old trans girl, confirms this. ‘At first we did nothing. Pretended it was a phase and she would move on to the next thing.’ But her daughter continued to struggle. The parents put the girl into therapy with a professional who was ‘slightly familiar with the issue’ and things began to get better. Then she saw another therapist ‘who specializes in working with transgender clients, [and] really helped her understand who she was’.

Dawn adds: ‘All I know is that my child went from being sad, depressed and reclusive to the happy, bright and laughing woman I see today.’

There are three possible options for parents of gender nonconforming children:

• gender conversion/reparative therapy

• gender therapy

• do nothing.

Many now view gender conversion or reparative therapy as unethical. But it still has its proponents, notably Kenneth Zucker and Susan Bradley, who wrote Gender Identity Disorder and Psychosexual Problems in Children and Adolescents in 1995.

Since the suicide of Leelah Alcorn, a US trans teen – and transgender reparative therapy patient – in December 2014, there have been mounting calls to outlaw trans reparative therapy.

Valerie Jarrett, a senior adviser to President Barack Obama, said: ‘The overwhelming scientific evidence demonstrates that conversion therapy, especially when it is practised on young people, is neither medically nor ethically appropriate and can cause substantial harm.’

She continued: ‘As part of our dedication to protecting America’s youth, this administration supports efforts to ban the use of conversion therapy for minors.’

The best chance of success and health for a trans child is gender therapy. Shaming or ignoring the problem is not only damaging but in some cases life-threatening.

If the end result we’re searching for is happy, well-adjusted adults, then shouldn’t we follow where the children (and the science) lead us?

Marti Abernathey is a US trans activist, political strategist and media pioneer. She writes and edits blogs for transadvocate.com

This article is from the October 2015 issue of New Internationalist.

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