CHICAGO
(AP) -- A small but growing number of teens and even younger children who think
they were born the wrong sex are getting support from parents and from doctors
who give them sex-changing treatments, according to reports in the medical
journal Pediatrics.
An
8-year-old second-grader in Los Angeles is a typical patient. Born a girl, the
child announced at 18 months, "I a boy" and has stuck with that
belief. The family was shocked but now refers to the child as a boy and is
watching for the first signs of puberty to begin treatment, his mother told The
Associated Press.
Pediatricians
need to know these kids exist and deserve treatment, said Dr. Norman Spack,
author of one of three reports published Monday and director of one of the
nation's first gender identity medical clinics, at Children's Hospital Boston.
"If
you open the doors, these are the kids who come. They're out there. They're in
your practices," Spack said in an interview.
Switching
gender roles and occasionally pretending to be the opposite sex is common in
young children. But these kids are different. They feel certain they were born
with the wrong bodies.
Some are
labeled with "gender identity disorder," a psychiatric diagnosis. But
Spack is among doctors who think that's a misnomer. Emerging research suggests
they may have brain differences more similar to the opposite sex.
Spack said
by some estimates, 1 in 10,000 children have the condition.
Offering
sex-changing treatment to kids younger than 18 raises ethical concerns, and
their parents' motives need to be closely examined, said Dr. Margaret Moon, a
member of the American Academy of Pediatrics' bioethics committee. She was not
involved in any of the reports.
Some kids
may get a psychiatric diagnosis when they are just hugely uncomfortable with
narrowly defined gender roles; or some may be gay and are coerced into
treatment by parents more comfortable with a sex change than having a
homosexual child, said Moon, who teaches at the Johns Hopkins Berman Institute
of Bioethics.
It's
harmful "to have an irreversible treatment too early," Moon said.
Doctors who
provide the treatment say withholding it would be more harmful.
These
children sometimes resort to self-mutilation to try to change their anatomy;
the other two journal reports note that some face verbal and physical abuse and
are prone to stress, depression and suicide attempts. Spack said those problems
typically disappear in kids who've had treatment and are allowed to live as the
opposite sex.
Guidelines
from the Endocrine Society endorse transgender hormone treatment but say it
should not be given before puberty begins. At that point, the guidelines
recommend puberty-blocking drugs until age 16, then lifelong sex-changing
hormones with monitoring for potential health risks. Mental health
professionals should be involved in the process, the guidelines say. The
group's members are doctors who treat hormonal conditions.
Those
guidelines, along with YouTube videos by sex-changing teens and other media
attention, have helped raise awareness about treatment and led more families to
seek help, Spack said.
His report
details a fourfold increase in patients at the Boston hospital. His Gender
Management Service clinic, which opened at the hospital in 2007, averages about
19 patients each year, compared with about four per year treated for gender
issues at the hospital in the late 1990s.
The report
details 97 girls and boys treated between 1998 and 2010; the youngest was 4
years old. Kids that young and their families get psychological counseling and
are monitored until the first signs of puberty emerge, usually around age 11 or
12. Then children are given puberty-blocking drugs, in monthly $1,000
injections or implants imbedded in the arm.
In another
Pediatrics report, a Texas doctor says he's also provided sex-changing
treatment to an increasing number of children; so has a clinic at Children's
Hospital Los Angeles where the 8-year-old is a patient.
The drugs
used by the clinics are approved for delaying puberty in kids who start
maturing too soon. The drugs' effects are reversible and Spack said they've
caused no complications in his patients. The idea is to give these children
time to mature emotionally and make sure they want to proceed with a permanent
sex change. Only one of the 97 opted out of permanent treatment, Spack said.
Kids will
more easily pass as the opposite gender, and require less drastic treatment
later, if drug treatment starts early, Spack said. For example, boys switching
to girls will develop breasts and girls transitioning to boys will be
flat-chested if puberty is blocked and sex-hormones started soon enough, Spack
said.
Sex
hormones, especially in high doses when used long-term, can have serious side
effects, including blood clots and cancer. Spack said he uses low, safer doses
but that patients should be monitored.
Gender-reassignment
surgery, which may include removing or creating penises, is only done by a
handful of U.S. doctors, on patients aged at least 18, Spack said. His clinic
has worked with local surgeons who've done breast removal surgery on girls at
age 16, but that surgery can be relatively minor, or avoided, if puberty is
halted in time, he said.
The mother
of the Los Angeles 8-year-old says he's eager to begin treatment.
When the
child was told he could get shots to block breast development, "he was so
excited," the mother said.
He also
knows he'll eventually be taking testosterone shots for life but surgery right
now is uncertain.
The child
attends a public school where classmates don't know he is biologically a girl.
For that reason, his mother requested anonymity.
She said
she explained about having a girl's anatomy but he rejected that, refused to
wear dresses, and has insisted on using a boy's name since preschool.
The mother
first thought it was a phase, then that her child might be a lesbian, and
sought a therapist's help to confirm her suspicion. That's when she first heard
the term "gender identity disorder" and learned it's often not something
kids outgrow.
Accepting
his identity has been difficult for both parents, the woman said. Private
schools refused to enroll him as a boy, and the family's pediatrician refused
to go along with their request to treat him like a boy. They found a physician
who would, Dr. Jo Olson, medical director of a transgender clinic at Children's
Hospital Los Angeles.
Olson said
the journal reports should help persuade more doctors to offer these kids
sex-changing treatment or refer them to specialists who will.
"It
would be so nice to move this out of the world of mental health, and into the
medical world," Olson said.
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