I went to a talk tonight by Dr. Norman Spack, a leader in the field of medical treatment of transgendered adolescents. A somewhat new practice (at least here in the US) is to suppress puberty for a few years in children who have expressed confusion about their gender identity. Because hormone therapy for transsexuals damages developing gonads, transitioning a 10 year old, for example, would render them infertile, and there are legitimate concerns that 10 years old is too young to be committing to such an irreversible course. However, if you allow puberty to proceed, and the transgendered child grows into a transgendered adult, reversing the effects of puberty so as to allow an individual to blend in their preferred gender can cost upwards of $250,000. Electrolysis alone can be $120,000. And some things are irreversible - the widening of a woman's hips or the deepening of a male voice are dead giveaways that are not just uncomfortable and embarrassing problems, but can be life-threatening, given the level of violence often directed toward transgendered individuals.
Another reason to delay puberty is that many transgendered adolescents begin to decompensate when their bodies, in their view, perpetrate the ultimate betrayal. I know some cancer patients feel like the tumor is "other", not them at all. But others feel as though their bodies have betrayed them. Girls, can you imagine waking up one day and realizing that you had hair growing on your face? Or boys, that you were getting your period? And even before puberty these children are extremely distressed by their mismatched genitals; in one case we discussed a 5 year old genetic boy who tried to cut off his own penis. Cutting, suicidal ideology, and suicide attempts are rampant in this community, particularly in systems where pubertal delay is unavailable. In the clinic at Children's Hospital, the only clinic for transgendered adolescents in the US, doctors have had not one case of suicidal ideation post-evaluation. In the UK, where pubertal delay is not allowed, some data shows that suicide attempts actually increase once the kids enter "treatment".
By delaying puberty until the child is a bit older, say 16 or so, you give them time to mature emotionally and cognitively before finally deciding one way or the other. But you can't put the decision off for all that long. Aside from the social issues that would complicate a prepubertal college life, bones grow until the sex hormones force the epiphyseal plates to close. Incidentally, that is one reason women tend to be shorter - earlier puberty. And that rather ironically means that male to female transgendered kids may have less time to decide. They need to stop the growth before surpassing a typical female height.
In any case, what most touched me about these kids, and the adults they will become, is how courageous they are. I can't wrap my head around what it would take to stand up to all external evidence and just say "I am going to be me, because I know who I really am." The kids who do that, and particularly those whose families support them in their choice, thrive. To accept yourself in all your muddy glory is the key to happiness. To say that is easy...to do it, not so much. Maybe it's just easier when you're a kid and you don't know any better.
