Breaking Down Resistance to Transgender Understanding

The article discusses the challenges faced by transgender children and their families, particularly in relation to puberty-blocking drugs. The author highlights the importance of providing these drugs early on to prevent unwanted secondary sex characteristics from developing, which can lead to mental health issues such as suicidal thoughts. The article also touches on the controversy surrounding gender identity disorder, with some experts arguing that it is an innate condition while others believe it may be influenced by environmental factors.

My body is wrong'
Should teenagers who believe they are transgender be helped to change
sex? And if so, what about the four-year-olds who feel the same way? Viv
Groskop meets the parents and doctors in favour of intervention
Viv Groskop
Thursday 14 August 2008 00.01 BST
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'She was our first child," recalls Sarah (not her real name), a
mother of two who lives in the south of England. "But from age
three we knew something was wrong. She was very introverted,
isolated. When she started school at four she came home and said
she was a freak. It seemed a strange word for a four-year-old to
use. She was always quite a sad little person."
Sarah's daughter was born and grew up as a boy. Now 19, she is
far happier in a woman's body as a post-operative transsexual. It
took two years for the family to get used to calling her "she". Her
mother says her daughter experienced her childhood as mental
torture, especially during puberty. "Looking back, we could never
find any tape in the house. It was because she was taping her
genitals up every day. She said to us later that she thought it would
all go right for her at puberty, that her willy would drop off and she
would grow breasts. She said she was going completely crazy
because she knew in her head that she was a girl."
One day, when her daughter was 14, Sarah walked in on her in her
bedroom. "She was there in front of the mirror with her genitals
tucked away. She was very embarrassed. I said, 'I don't know
what's happening here but if you want to talk to me, you can.'

About 10 minutes later she came and lay on the bed next to me and
said, 'I want to be a girl. I'm not a boy. My body is wrong.
Everything is wrong.'" For Sarah, this was more than shocking: "I
had watched programmes on transgender, I'm very interested in
people, it's part of who I am to find out about these things ... But
you never imagine it's going to happen to you."
Sarah sought help from her GP - who laughed. Eventually, her
daughter got a referral to the one London clinic that deals with
gender identity disorder in children and adolescents. But obtaining
treatment on the NHS in her daughter's mid-teens was slow and
difficult. Several suicide attempts followed and the family
remortgaged their house to pay for private hormone treatment.
Once Sarah's daughter was 18, they also paid for an operation
abroad.
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The plight of children with gender identity disorder has made
headlines this year. In February an inquest was held into the death
of Cameron McWilliams, a 10-year-old boy from Doncaster, who
hanged himself. The court heard that he had asked permission to
wear makeup and girls' underwear. "It was apparent he was
unhappy and said he wanted to be a girl," his mother said. "He did
like girls' things." Later the same month Lawrence King, 15, from
Oxnard, California, who described himself as "gender non-
conforming" and was a victim of school bullying, was shot to death
in a science laboratory by another pupil.
Internationally, there is controversy over medical treatments that
could be used to help children in this situation. In May, Dr Norman
Spack, the US's leading authority on "gender-confused" children
and a paediatric endocrinologist at the Children's Hospital in
Boston, revealed on US National Public Radio that he has at least
10 paediatric transgendered patients who are receiving puberty-
blocking hormone treatment. He says that the procedures allow
children to buy time to make a decision about gender reassignment
surgery. Once they have gone through puberty - and fully
developed the body of the gender they don't want - it is much more
difficult.

Awareness of transgender children is growing. Earlier this year a
book called The Transgender Child: A Handbook for Families and
Professionals (Cleis Press) was published. "Thousands of families
face raising children who step outside the pink or blue box," says
the blurb.
But their stories rarely cross into the mainstream because families
don't want their children to be identified. Even adult transsexuals
risk ridicule (and sometimes physical abuse) when talking about
their past. The Oprah Winfrey Show first featured an 11-year-old
girl who wanted surgery to become a boy in 2004. Last year, a very
cute six-year-old girl, Jazz, appeared on the Barbara Walters show
in the US. She had been born as a boy but she identified so strongly
as a girl that her parents decided to let her be who she wanted to
be. She and her parents appeared on television under assumed
names. "We'll say things like, 'You're special. God made you
special.' Because there aren't very many little girls out there that
have a penis," said her mother Renee. They were comfortable with
identifying their child as transgender.
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Gender issues can appear as young as four (although the parents of
the aforementioned Jazz insist that their son made it clear he
wanted to wear a dress from the age of 18 months). "It usually
becomes more evident when they go to school," says Simona
Giordano, a senior lecturer in ethics and psychiatry at the
University of Manchester who is conducting an international study
into gender identity in children. "There have been reported cases of
kids who won't drink for the duration of the school day so that they
don't have to go to the toilet, and who don't want to sleep in a
bedroom with their peers."
In Britain, there is only one place where children who feel this way
can be treated: the Gender Identity Development Service at the
Tavistock and Portman NHS Foundation Trust in London, run by Dr
Domenico di Ceglie, author of a 1998 ground-breaking study on
transgender children, A Stranger in My Own Body: Atypical Gender
Identity Development and Mental Health (Carnac). He became
aware of the needs of the children with gender-identity issues when
working as a child psychiatrist in Croydon in the 1980s. His

colleague Polly Carmichael, a consultant psychiatrist, explains: "We
get 60 to 80 referrals a year and our referrals are going up. We see
children from as young as six up to aged 18."
Not every child diagnosed will go on to have gender reassignment
surgery. Ultimately, about a quarter do. Others may experience
discomfort about their gender for reasons connected to traumatic
events in their life. In Di Ceglie's case notes, he recalls the story of
a five-year-old boy whose grandmother died. She had been his main
carer. He identified with her so strongly that after her death he
began to play with dolls, dress up in his mother's clothes and play
wedding games, in which he was always the bride. Once he had
counselling and was able to express his grief about losing his
grandmother, his behaviour changed.
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Linda (also not her real name) is the mother of a child who
experienced gender identity disorder and now helps run Mermaids,
which was set up in 1994 and remains the only UK support group
for children with gender identity disorder. (Pete Burns raised funds
for the organisation when he appeared on Celebrity Big Brother in
2006.) It has some members as young as seven and a special
mailing list for adolescents aged 12 to 19.
Linda receives a couple of inquiries a week: "We get a lot of calls
from parents who have five- to nine-year-olds. There seem to be
more boys than girls affected at that age," she says, "Which is
probably because it's more acceptable for girls to be tomboys. If
you have a little girl who wants to cut her hair short or play
football, that is seen as normal. But if you have a boy who wants to
draw mermaids or dress up as a princess, they get made fun of."
Once puberty hits, the numbers even out and there are as many
girls as boys seeking help. For some children, it is a passing phase,
she says. "For others it is likely to go on for some years and will
cause a lot of problems." This is something of an understatement.
A conference to discuss gender identity disorder in adolescents will
be held in October at the Royal Society of Medicine. Some parents
whose children have gender identity issues are already angry about
the fact that few professionals have been invited from abroad. They

see the UK as lagging behind developments in other countries.
Treatment centres in Australia, Belgium, Canada, Germany,
Norway, the Netherlands and the US all offer medication to
suspend puberty. Not enough is known about this in the UK,
according to the Gender Identity Research and Education Society
(Gires), and only two of the 15 presenters at the conference are
from overseas.
Terry Reed, a trustee at Gires and the mother of a transgender
adult, says that many British specialists are "transphobic". "As far
as they're concerned, a trans outcome is bad. They are hoping that
during puberty the natural hormones themselves will act on the
brain to 'cure' these trans teenagers. What we do know is what
happens if you don't offer hormone blockers. You are stuck with
unwanted secondary sex characteristics in the long term and in the
short term these teenagers end up suicidal."
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Reed has a transsexual daughter who had reassignment surgery at
the age of 19. "The only indication I did have when she was a child
was that she showed an interest in female clothing - not wearing it,
but just having some in her room. I said, 'You mustn't take your
sister's clothes,' and then forgot about it. I was completely amazed,
shocked and frightened when I did find out some years later what
was happening. But I have always felt that people have a right to be
who they are. I felt that whoever this person was, I was her parent
and I wanted to support her." She and her husband set up Gires in
1997: "We have run 11 family workshops and seen over 200
individuals in family situations. I like to think that we have helped
an enormous number of people to get over that first shock of
rejection and, sadly, sometimes, revulsion."
Part of the organisation's mission is to break down resistance to the
idea that gender identity confusion is a problem. "We call it gender
variance - not gender identity disorder," explains Reed, "because
that is pathologising it." She also wishes people would understand
that it is not something transgender people choose. "When you live
with it, it is so obvious and so extreme. Some of these children are
saying from a very early age, 'This is what I am. Why doesn't

anyone understand that my name is Bob and I am not a girl.'
Sometimes it's as soon as they can talk - at age two or three."
But Gires' current fight is to make the puberty-blocking drugs more
available to this minority of desperate children who, they argue,
show obvious signs of needing them. At present, these drugs are
usually prescribed at 16 at the earliest in the UK (in the
Netherlands, for example, they are given as young as 12 or 13). Dr
Giordano says: "The UK stance on puberty-suppressing drugs is
completely unreasonable. In other countries they are provided as
soon as puberty has commenced. But obtaining this treatment -
which suppresses oestrogen in girls and testosterone in boys - is
very difficult in this country." From the late 1990s the Dutch have
been monitoring a group of around 350 adolescents with "gender
divergent identity": a small number of these have had access to
puberty-suppressing drugs and are planning to go on for surgery.
In Dr Giordano's opinion these drugs are safe: "It is a temporary,
reversible intervention. If the child changes their mind, they can be
interrupted. They are entirely benign with no known side effects."
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Parents who want the puberty-blocking treatment argue that their
children's lives are at risk if they don't get it. Some are already
seeking help abroad. Although some doctors are concerned that the
complicating factor with gender identity disorder is that it shows
up in different ways in every individual, advocates of the treatment
say it is possible to draw up clear guidelines so that the right
people are identified early and quickly. Giordano explains: "At
puberty the problem becomes more distressing." Once transgender
children start going through puberty and acquire secondary sex
characteristics, their reassignment surgery will be much more
complicated - and less likely to be wholly satisfactory. There is a
challenge in identifying those who need treatment, she concedes,
"but there are cases that are very clear where the disorder is
strong and persistent".
Dr Carmichael of the Gender Identity Development Service argues
that the Dutch trial is far from complete. "The Dutch data looks
promising. But they have not been doing it for so many years that
you have long-term follow-up.The data is not over a long enough

period of time and that concerns endocrinologists." There is also
concern in the medical comm-unity that not enough evidence exists
on the effects of puberty-blocking treatment on bone mass or on the
brain. "The question is, if you halt your own sex hormones so that
your brain is not experiencing puberty, are you in some way
altering the course of nature?"
There is also fierce debate about the origin of gender identity
disorder. Understandably, many parents of transgender children,
as well as many transsexual adults, are convinced it is innate.
Studies such as The Praeger Handbook of Transsexuality by Rachel
Ann Heath (Greenwood) explore a potential biological basis for the
condition. Others are yet to be convinced. "There is a small amount
of evidence for differences in the brain," says Dr Carmichael. "That
is a very interesting finding but it is not robust enough to say that it
is definitely the only reason and that it is an innate condition. It is
most likely multifactorial." She acknowledges, however, the
strength of feeling that these children experience: "Feelings are
very intense and it is very difficult for families and young people to
cope with the uncertainty. They are very strong in their conviction
that they are in the wrong body."
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Because of the misunderstanding and stigma surrounding gender
identity, children are often horrifically bullied, even in their own
families. Another of Di Ceglie's case studies is Mark, 16. He
identified as a girl from the age of three. At the age of seven, he
was raped by his father - which confirmed his belief that he was
female. He has just gone into therapy. The doctor advised waiting
until he was 18 to decide on a course of action.
When Sarah's daughter started dressing as a girl for the first time
at the age of 16 on her walk to school, people would shout from
their cars: "Girl with a cock!", "Tranny!" and "Man-beast!". "At her
school they were shocked but they were wonderful," remembers
Sarah. "It was explained to all the year groups that it was a
condition and not a choice. They explained the effect it had on her
and that bullying would not be tolerated. The kids were great. It
was the parents saying they didn't want a freak in school with their
child."

Sarah believes that anyone watching a teenager go through this
process would want them to have the drugs as soon as possible.
Her daughter was denied them until the age of 16, by which point
she already had an adam's apple, a deep voice and facial hair. She
understands all this is hard for people to take in; at the age of 11
her second child had to process the fact that his brother was
becoming his sister. Family friends still forget what has happened
and ask, "How are the boys?" "It takes a long, long time to come to
terms with. It took us about two years to stop crying for our loss
and also for the pain that we knew our child was going to have to
go through. No one would choose this. It's too hard. I've asked my
daughter, 'If this condition was known about in 1989 when I was
pregnant and there was an option to have a termination, would you
have wanted me to?' She said yes. And I agree. If I had known what
it would be like for her, I would have done it. That's how bad it is."
Her daughter eventually got the outcome that felt right - but she is
still getting over the events of the last six years. "She is still young
and everything is raw for her. She hates the label 'transsexual'. She
is just a girl who happened to need the surgery to make her
genitals right".
· Mermaids: Family Support Group for Children and Teenagers with
Gender Identity Issues can be reached at mermaids.freeuk.com
· The Gender Identity Research and Education Society is
at gires.org.uk