Transgender Children

Rixt’s Story

In 2007 my second child was born, and until the ultrasound at 18 weeks clearly showed it was a girl, I was convinced of having another boy.

This child resisted wearing dresses and ponytails from the moment he could and at age 2 made it clear he was a boy

At age 5 every piece of clothing with glitter and pink from the girl aisle was donated and in 2nd grade he went to school as a boy with a boy name and pronoun.

Now I happen to be an obstetrician-gynecologist with a specialty in Transgender Healthcare so I let my child be who he wants to be, a boy, and we take it day by day.

Transgender Children

According to the American Academy of Pediatrics, “A child’s awareness of being a boy or girl begins in the first year of life. Their gender identity is stable by age 4 and they know that they will always be a boy or a girl.” Gender identity is not a learned behavior, it is the sense of who we are from birth and we think that it’s development starts during pregnancy in the mother’s womb.

Sexual orientation is different then gender identity and does not mean that your child will grow up to identify as gay, lesbian or bisexual. Sexuality develops during adolescence from hormones and physical changes.

In 2012, The Human Rights Campaign held a survey of more than 10,000 LGBT-identified youth ages 13-17.

Findings show that these kids feel much less happy, do not feel like they fit in, have in less then 50% an adult to talk to, 70% are not accepted by family, 40% are bullied in school. This confirms findings of significant mental health issues including depression, suicide, anxiety, body image issues, substance abuse and post-traumatic stress disorder in transgender youth.

Treating Transgender Children

As parents we need to know this is not our fault, accept our child, get informed and be an alley. Help them transition if they want to; socially or medically:

Treatment is available. Making informed decisions to medically intervene is essential to our child’s mental health and wellbeing.

Social transitioning (outward gender presentation, clothes, hair, name and pronoun) is reversible.  Many times, when a child is allowed to express them selves in their perceived gender full time, issues like bad behavior, shyness, illness and discomfort improve or even disappear.

Medicine has made it possible to delay the onset of puberty, which can be devastating in transgender children.  Making the decision for medical transition is highly individual and may require input from the child, parents, medical and psychological professionals. Some emotional maturity is needed especially when it comes to discussing cross hormones, hormones that will change a boy into a girl and a girl into a boy.

Therapy is recommended to make sure that transgender youth have the support they need and a safe place to explore their identities and process the transitioning experience, not because they are mentally disturbed.

The first step in therapy for transgender adolescents is confirmation of the diagnosis by either a mental health therapist or doctor. The most used guidelines for the diagnosis and treatment come from the World Professional Association for Transgender Health, the Vancouver Coastal Health, Amsterdam Gender Clinic and Endocrine Society.

It can be difficult to find these services (cost, lack of insurance coverage and lack of research) but research at the Amsterdam Gender Clinic has shown that treatment is safe and most important leads to happier adolescents and decrease in suicide attempts.

Puberty in Transgender Children

The onset of puberty brings increased unhappiness over one’s body and development of depression, anxiety, drug use, high-risk sexual behavior and increase in suicide rate.  

Suppression of puberty with gonadotropin-releasing hormone (GnRH) analogues blocks puberty of their birth gender. This is reversible and means that more time is “bought”: more opportunity to explore the wish for transitioning and no stress of puberty and irreversible changes that happen with that (deepening of the voice, facial hair, breast development, menses) and also prevents bullying.

Therapy is started between age 11-15 depending on signs of puberty and blood tests.

Risks and benefits are discussed and a consent form is signed by both parents (if indicated). Blood tests need to confirm the patient is in puberty and liver, kidneys and other tests are normal. Height and weight are measured every 3 months.

GnRH analogues are given intramuscular. After 3 months labs show pre-puberty range of hormone levels and confirm that puberty is blocked.

We start cross hormones (testosterone, estrogen or testosterone blockers) at age 14-16 depending on the desire of the adolescent and the parents. We then also discuss fertility because hormones are not entirely reversible.

Loving our Transgender Children

Overall, of most importance is that we parents affirm our child’s gender identity expression to boost their self-esteem, and show them that we accept and support them completely. Difference is not wrong, it just is.  Besides that, what’s worse? Accepting your child’s gender identity? Or burying them because you couldn’t?

Refuse to be your child’s first bully.

References:

This article originally appeared in the Q Salt Lake magazine on November 19, 2015
Treating our Trans*Children by Rixt Luikenaar

Transgender Health for Children and Adolescents – Protocols & Guidelines (PDF)
by Rixt Luikenaar