What's Your Preferred Gender, Dear Child?

"We don't get a lot of demand for 'Fix my child', or Change my child', thankfully."
"I've had children say, 'God made a mistake', or 'When will my penis fall off', or 'When will I grow a penis'."
"It is probably safe to say that those who are most entrenched in gender expression that is different from their assigned gender are most likely to identify as trans after puberty."
"[Transgender is not an] acquired phenomenon] nor is it the result of exposure to a certain experience or abuse]. It's part of their biology."
"Why their biology turns out in that way I don't think that's known."
Dr. Stephen Feder, co-director, Children's Hospital of Eastern Ontario, gender diversity clinic, Ottawa

"[What at birth defines our gender? It's not our] externals. Do you see yourself as male or female or somewhere in the spectrum in between?"
"[It's normal for children to behave in a cross-gender play and way. [By puberty; ten to twelve for girls, twelve to fourteen for boys, that child who remains convinced] they are in absolutely the wrong body is almost certain to be transgender and is extremely unlikely to change those feelings no matter how anybody tries reparative therapy or any other noxious things."
Dr. Norman Spack, co-director, General Management Service, Boston Children's Hospital

"We don't have a lot of data that say, if we do this, stop puberty, are you happy later on."
"It's one thing to be respectful of what an adult chooses to do. But when you're dealing with a young kid, it's really murky."
Arthur Caplan, bioethicist

"I think there's an assumption that because a child wished to express their gender in a certain way that automatically meant that the kid was going to be transgender later on. That may or may not be the case."
"If a child is presenting at age three, four or five there probably is something that is biological that we haven't yet found."
Dr. Joey Bonifacio, pediatrician, adolescent medicine specialist, Toronto

Ashley was joined by her mother Terri and Matt was sat beside his mum Rachel, who both explained how their children knew at a young age they were born the wrong sex

The Province of Ontario has outlawed "reparative" therapies, occasionally referred to as "conversion", therapy that operates on the theory that a child's brain is sufficiently impressionably malleable to enable intervention at a critical time to turn them away from their possible confusion over gender conformity. In their books, a boy should be turned away from playing with dolls or wearing girly clothing and this broadens the potential for him to revert to his birth assignment anatomical sex identity.

 

The Canadian Paediatric Society, along with other related groups concerned for the well-being and welfare of transgender children, consider that approach to a growing problem unethical. A study co-authored by Dr. Kenneth Zucker reported that 80 percent of children treated for gender dysphoria, by the time they reach high school age no longer require treatment for gender dysphoria; they accept the birth gender 'assigned' to them. 

 

His controversial conclusion led to the psychologist and sexologist to be removed from his 30-year posting as director of the Centre for Addiction and Mental Health's gender identity services. An external review came to the conclusion that not all his practices appeared to be "in step with the latest thinking", according to the Centre for Addiction and Mental Health. In other words, he suffered the professional punishment meted out to practising professionals who defy current waves of practise.

Research has consistently failed to identify the cause of gender confusion among children. Some speculate about the possibility of hormone exposure while in the womb. There is little agreement, however, on any field of thought leading to the genesis of why it is that some children find their minds and their bodies ill-fitting in the tandem of co-existence. According to medical/psychological findings, gender differs from anatomical sex and from sexual orientation, describing how we view ourselves.

Some believe that puberty blockers are valuable in allowing children time for further exploration of their gender identity, slowing down the physical process whereby the body evolves into its sexual role, when that evolution turns out to be the "wrong" sex. Dr. Feder has had exposure to trans boys (female to male) wanting to cut away their breasts, or who alternately, bound them with tensor bandages. The alternate side argues that gender fully forms once a child enters and fully processes puberty.

There are questions posed by ethicists as to when children should be considered sufficiently mature to provide informed consent, or to fully understand what it is they agree to; not simply to proceed with puberty blockers which can affect bone density and later on in life, cross-sex hormones (estrogen acting to deliver a more rounded figure to the trans girl; testosterone for trans boys to develop an angular jaw and a masculine physique).

The end question is: what if they are initiated into medical transitioning and then happen to have a change of attitude. When, how and why to begin that fateful intervention with a young child? Does it represent playing with their destiny when understanding and doting parents push to intervene at an early age? At the University of Washington, Kristina Olson feels it should be appropriate to intervene in a non-medical, entirely reversible protocol through a social transition.

A drawing by a child in Professor Kristina Olson's study at the University of Washington. Olson has found that transgender and non-trans girls have an equally deep sense of their gender identity.   Courtesy of Marlo Mack

 

Her study  tracked American and Canadian transgender children to report that those who transition socially experience no higher rates of depression than non-trans siblings or an age- and gender-matched "control" group. Only slightly elevated rates of anxiety as well, in contrast to studies indicating high rates of depression, anxiety, suicidal thoughts and self-harm among teens and young adults prevented from social transitioning at a younger age.

 

"What is the impact of being allowed to live your gender identity? Nearly all transgender adults today were not allowed to live as their gender identity as kids, so we just don't know what life is going to look like for them."
"[Estimates for transgender numbers in the population?] Estimates are ALL over the map. I don't think anyone actually knows. I've seen numbers ranging from one in 300 to one in 100,000."
Dr. Kristina Olson,  psychology professor, University of Washington