Medical Treatment for Transgendered Kids: Is it Ethical?

As many as half of transgendered teens attempt suicideNine-year-old Angel loves "shoes and fashion," playing dress up in princess costumes, and the colors pink and purple. Angel feels like a little girl but has the body of a little boy. "I'm very happy now," Angel says on a video produced by the support and educational outreach organization, Trans Youth Family Allies (TYFA), "because my family loves me for who I am."

Angel is lucky. Many families of transgendered kids don't accept that their child feels like they were born the wrong sex or, worse, berate, abuse, and reject them. According to a study in the most recent issue of the journal Pediatrics, kids whose interests "fall outside of those typically expressed by their biological sex" are more likely to experience physical and emotional abuse and suffer from post traumatic stress disorder nearly twice as often as others in young adulthood. And while school may be hell for these kids, its not playground bullies who are at the heart of the problem: "The abuse we examined was mostly perpetuated by parents or other adults in the home," says lead author Andrea Roberts of the Harvard School of Public Health in a press release.

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Pediatrician Dr. Jo Olson, director of the Transgender Clinic of Children's Hospital Los Angeles, one of the few facilities set up for children and adolescents in the world, estimates that up to fifty-eight percent of transgendered teens have attempted suicide. "We see some cases of girls who try to kill themselves every month when they get their period," Olson told Yahoo! Shine. At Olson's clinic, as well as at the Children's Hospital Gender Management Services Clinic in Boston, some kids with Gender Identity Disorder (GID) are being treated with puberty blocking drugs to delay the onset of sexual maturation.

Olson makes clear that some recent media reports are getting it wrong. "People see puberty blockers as sex reassignment for kids," she says, "but that's not happening." She explains that puberty blockers are completely reversible. They give a young person breathing space to decide whether or not they may want to move ahead with cross sex hormones later. This treatment can eliminate the need for costly and often unsatisfying surgery in the future. For instance, girls don't develop breasts while on puberty blockers and boys don't grow an "Adam's Apple" or facial hair. Olson says the delay also gives patients some time to start "developing a toolbox" for all the challenges they will likely encounter as adults.

Another study in Pediatrics, Children and Adolescents with Gender Identity Disorder Referred to a Pediatric Medical Center, supports Olson's medical protocol. Lead author, Dr. Norman P. Spack and his team evaluated nine-seventy patients at his clinic and found that medical intervention starting in early puberty helped offset the intense psychological distress so commonly associated with gender dysphoric kids. The study also emphasizes the "importance of educating pediatricians and guidelines for children and adolescents with GID." Olson calls the two papers "revolutionary" because they are in a widely read publication. She adds that when the subject of transgendered kids came up in the medical community ten years ago, "you heard crickets." Still, she points out, there are no insurance codes for the medical treatment for children and adolescents, only mental health codes which can add to both the cost and the stigma.

It's important to note that for young children, the notion of gender is fluid and the vast majority of kids who show gender non-conforming behavior such as little boys dressing up in girls clothing or little girls preferring to play with trucks grow up into heterosexual adults who feel comfortable with their natal sex. Spack estimates that only one in 10,000 people is transgendered.

His report offers parents some "clues." Girls who prefer male underwear, swimsuits, and bind their breasts may have GID. For boys, a strong preference for female clothing, sitting to urinate, the desire for long hair, and exclusive play with female toys are all indicators. Olson says toddlers may assert their identity by demanding "call me a boy [when they were born a girl]," choosing a different name, or hiding their genitals. "Kids at three aren't choosing," says Olson, "they are just drawn to those things. If a parent says, 'that's not okay,' or abuses them, kids internalize it," which can lead to self-destructive behavior later.

In another video produced by TYFA, Ron and Heidi, parents of Jordan who was born a girl but identified as a boy by age three, describe a path that went from telling Jordan "that God loves him and made him a girl," to accepting that he was transgendered as young teen. "One night, when I put him to bed, he said he was going to kill himself," says Heidi. The family had a meeting a decided then and there "he's going to be a boy now." Jordan's depression lifted and he stopped talking about suicide. "We've dealt with prejudice and people who tell us we are sinning...but we have our child back."

Olson recommends that families whose children are experiencing gender identity issues reach out to TYFA, Spack's Boston clinic or her clinic at the Children's Hospital of LA.

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