CHICAGO — 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.
It’s an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.
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.