Last week the Endocrine Society announced new treatment guidelines for transgender teenagers. The country’s oldest endocrinology organization recommended that transgender youth be given hormone blockers to delay the onset of the physical changes that result from puberty, and that hormone therapy should only be given to teenagers after the age of 16 so that teens can be absolutely sure that they are transgender. According to the LA Times:
Those guidelines come at a time when many of those with “gender dysphoria”–persistent distress over one’s gender at birth–are asking to begin gender reassignment hormonal therapy and/or surgery at an earlier and earlier age. While surgeons have been reluctant to do gender reassignment surgery on a patient under 18, endocrinologists often face pressure from would-be transsexuals to offer earlier, interim treatment. The new guidelines are likely to set a standard that many endocrinologists will follow in such cases.
“Transsexual persons experiencing the confusion and stress associated with feeling ‘trapped’ in the wrong body look to endocrinologists for treatment that can bring relief and resolution to their profound discomfort,” said Dr. Wylie Hembree, a Columbia University endocrinologist who chaired the committee drafting the guidelines. The new guidelines, he added in a news release, are intended to provide “science-based recommendations” for practitioners to provide “safe and effective treatment” to those diagnosed with Gender Identity Disorder.
I have mixed feelings about the treatment protocol. On the one hand, I certainly think that transgender youth deserve the opportunity to pursue their options. Dutch and British physicians have found hormone blockers to be an effective treatment for the mental health consequences of gender identity disorder. They help teens buy themselves some time – they don’t have to face the consequences of developing facial hair or breasts until they figure out what they want their gender presentation to be. All good news for the teens.
However, there is a lot of debate within the transgender community over the validity of the gender identity disorder diagnosis. Some argue that they are not mentally ill – that they have a birth defect. Moreover, there are others in the transgender community who say that they have neither a mental, nor a physical disorder – rather, they think that they have the right body but that our culture needs to broaden the definitions of gender so that people aren’t forced into rigidly constructed gender categories.
Last year I wrote a piece for The Bilerico Project about transgender youth. The article was in response to a series that NPR had done about transgender children and teenagers. There were many things that NPR got right – but the one thing they kept getting wrong was the pronouns that they used to refer to the kids in the story. Regardless of the treatment options, the one thing that all of us can do to support trans youth (and transgender folks in general) is to use the pronouns that they prefer. How hard is that?
Anyway, I’d love to get your view on the new treatment options for trans teens? Hot, or not?
For links to ABC’s series on transgender youth, check out these three clips:
Born With the Wrong Body
I Want to be Seen as Male
I’m a Girl: Understanding Transgender Children
I am certainly in the “its not the wrong body, its the wrong culture” camp. We live in a society that is so rigid about gender and gender norms that it is hard for many kids–trans and otherwise–to navigate.
I think it is good, though, that the people that might be asked to offer medical solutions to these problems are looking at them in a positive way. The treatment protocols could have just as easily went like this:
This is a psychiatric issue, leave it to the shrinks. No treatment until they are 18. Period.
In any case, I think that a good hard look at how rigid gender norms are a disservice to everyone is in order.
I’m certainly in the “it’s my body, I should have autonomy over it” camp. I’m certainly in the “I’m never going to be able to have an abortion, so I’ll never tell another woman (even a child) what they should do with their pregnant bodies” camp. This isn’t something parents come to on a whim.
A child doesn’t try to sever their penis with a pair of scissors because they’re born in the wrong culture. And claiming this is a “psychiatric issue” to be “left to the shrinks” ignores actual science pointing towards this being a type of intersex condition. Hell, Harry Benjamin said in 1965 that “Childhood conditioning and possible imprinting undoubtedly have a connection with the development and the intensity of the transsexual phenomenon, but can only be considered as contributory or as one of several possible causes. The presence of an inborn, organic, but not
necessarily hereditary origin or predisposition appears more and more probable.” The actual research does point more to that than anything else. You can find a lot of info on that over at this blog: http://aebrain.blogspot.com/2008/06/bigender-and-brain.html
And how ridiculous is it to wait until a child has already went all the way through puberty? Then they spend the rest of their life with the regret of what testosterone did to their bodies…. (in m2f kids).
Marti – I don’t disagree with your points. But I am a bit confused, since the Endocrine Society is advocating that children take hormone blockers so that their bodies don’t develop characteristics that are typical of puberty – body hair, facial hair, breasts, etc. I am obviously not transgender, so I’m never going to have to consider whether or not I want to take hormone replacement. But I think hormone blockers can stop the clock, so to speak, until someone is absolutely sure.
Well, you’re assuming it’s a one size fits all when it comes to transgender issues and kids. When it’s about their bodies, that isn’t a gender issue, but a sexual identification issue.
More than anything, I’m kind of irked by the first commenter’s tone. It’s disturbingly like MRA’s who claim to know more about women’s bodies than women do.
Marti, I’m definitely not advocating a one-size-fits-all mentality. Obviously the term transgender gets interpreted to mean a myriad of things by different people. I tried to convey that some people feel just fine leaving their bodies as is, some people want surgery and/or hormones, some people accept a mental health diagnosis, while others reject it, and that the attitudes about all of these beliefs are constrained by cultural beliefs about what it means to be a man or woman.
The reason that I think hormone blockers are a good treatment option is because I think that people need to take time to consider the consequences of taking hormone replacement therapy. I also think that they need to be absolutely sure that they want to go ahead with surgery. I am not advocating that people need to make sure they’re transgender. In my experience of talking to trans folks, they already know that. But the trans folks I know also have gone back and forth on the issue of hormones and surgery. The option of taking hormone blockers to prevent the body from physically developing secondary sex characteristics, like hair and boobs, seems to be a good middle-of-the-road solution until a person has a chance to make up their mind about what they want.
Moreover, surgery and hormones can be expensive. It seems like hormone blockers would allow someone to save up for surgery without having to continuing physical development post-puberty.
I’m in the “my body, my choice; your body, your choice” camp. As a trans guy person I do not believe that I have a mental disorder or physiological abnormality BUT I also believe that the means by which I make sense of the world and my location in it don’t work for a lot of other people. I guess what I am trying to say is that I respect other people’s truths and believe that what is true for me isn’t true for everybody else.
My initial reaction to hormone blockers is that it is the route that trans children should go. After reading the conversation here I realize that my “camp” and my opinions about the options that should be made available to trans kids contradict each other: I claim control of my body but think that kids shouldn’t have full control. This discussion has amended my original thoughts about kids and hormones. I think that hormone blockers are good for those who want them and a step towards letting children control their own bodies but that other options should be available AND that we should trust trans kids and their decisions. But I say all this as a person who is not a parent nor plans on being one. What options can be made available that don’t fuck with development? What happens if a preteen starts T? I realize that I am incredibly uncomfortable with the implications of the belief that adults AND children should have the ability and means to do what they want with their bodies. This uncomfortability (is that a word?) shouldn’t have an impact on other people’s lives. Sorry that this is rambly; i’m sort of thinking outloud about my own beliefs.
freewomyn, I’m all for making this available, but for a minute replace “transgender” with “woman seeking abortion”. I’m all for making informed decisions knowing all the consequences. But it seems like you’re kinda implying that a child (with a parent’s consent), shouldn’t be allowed to begin HRT if that’s what the family decides. I don’t know of any parent that would run into this full force without thinking long and hard about it.
As someone who works directly with pre-pubertal transgender children and their families, I can tell you that for many these kids it’s not about the feminist or cultural or sexual or gender politics that so many adults get hung up debating.
For these kids, it’s about getting on with their lives in a way that allows them to mature along with their same gender peers and that prevents them from having to suffer through the horror of pubertal changes that don’t match their gender identity. Changes that might negatively affect their quality of life for the remainder of their lives.
As an organization, we not only support the use of puberty blockers, but the administration of cross-gender hormones at the appropriate time (prior to age 16), assuming that the child/youth has been persistent and consistent in the expression of their trans identity and that there are no other medical contraindications.
Jenn Burleton
Executive Director
TransActive Education & Advocacy
A man can’t wear a dresss in public or display traits which are deemed “too feminine” without getting ridiculed, harrassed, or worse. That’s the “culture” we live in today. Seems reasonable to wonder if so many men would still consider themselves “born in the wrong body”, if the body they were born with was allowed every category of expression. Right now their only “choices” are to suppress their true selves or go through all kinds of treatment in order to pass as a member of the ONLY designated class which is allowed to express “feminine” traits.
For thousands of years, men have had to force themselves into tight gender roles or be oustracized. Would be great if we could finally just accept individuals for who they are, as individuals.
As a mother of a transgender teen I have to say I am torn. Right now we are dealing with binders and such and the hatred of a body that even at the age of 13 is getting the tell-tale curves of a female. To do blockers at this point isn’t going to stop what has already begun. However still don’t think I know enough about the hormone treatment to jump into it for my child. I think that the option should be available if that is what decided after an appt with a doctor who can give all the pros and cons of the treatment and its total effect on a teenager of her age. I have to say I told my child we would look into it and still intend to do just that and support her in any way I can
Amy, you’re an awesome mom for supporting your teenager. Good luck with your research. Depending on where you live, there may be a trans support group to help you all weigh the treatment options. For example, in the So Cal area, there is the FTM Alliance. And in Tucson, there is SAGA, which is a program of the Wingspan Community Center. In Phoenix, there is a group called Transgender Harmony.
http://www.ftmalliance.org/
http://www.wingspan.org/content/SAGA.php
http://www.tgharmony.com/
I hope those links are helpful!