Gender variance is a complex condition affecting a small number of children whose biological sex differs from the gender by which they identify. Puberty blockers are a type of medication which temporarily stop the production of the natural sex hormones which progress puberty. For a transgender child, these hormone blockers can press pause on what, to them, can be seen as a ticking time bomb.
If a child is presenting with true gender variance, it is highly unlikely that this will be a 'passing phase'. If the feelings are strong and always have been, if the child hasn't wavered from the knowledge that their true gender does not match the one that most commonly fits their biological sex, if their unfaltering aim is to live in the role of the gender with which they identify, rather than the one by which they are classified as a result of their genitals: then these hormone blockers can literally save lives.
As awareness around transgender issues has increased, there has been a move towards accepting early 'social transitioning', which enables the young child in question to identify - predominantly via clothing and behaviour - as whichever gender they feel most comfortable,
But what happens when that child, who has always identified as a boy, begins to develop breasts and their period starts? And for the child who identifies as female, how does she feel when her voice starts to break and facial hair begins to sprout? The truth is, it can be devastating.
The most important thing for young people, in whom long-lasting gender variance is suspected, is to offer to support them by delaying the so-called 'secondary sex characteristics' from developing (the primary ones being the genitals).
This is done through the prescription of hormone blockers which are designed specifically to temporarily halt their puberty: to stop the testes producing testosterone, or the ovaries producing oestrogen.
These blockers are safe and their effects are reversible, should the child 'change their mind'. Most importantly, they prevent the heart-breaking changes that society associates with the opposite gender. They 'buy time' to allow the child to mature and understand the implications of taking those hormones in the future, that will eventually enable them to develop secondary sex characteristics in line with their true gender identity.
For the record: I am in no way advocating or encouraging rash decision-making on the part of doctors, children or their support networks, nor am I suggesting for a second that children make such an important decision in isolation. I am talking about offering professional support and guidance to children and young people who are suffering, alongside the input of their wider support network who only have their best interests at heart.
The sensationalists among us paint a picture of doctors giving hormone blockers to little boys who love the colour pink and who prefer to play with Barbie dolls, or to little girls who like to climb trees and wear their hair short. This scaremongering does not help this small number of children who feel so alarmed when their body starts to change into that of the 'opposite' gender that they are prepared to go to ANY lengths to prevent this from happening.
As a GP, to ignore such suffering, to dismiss these children, to send them away with the advice that they will 'grow out of it' in the knowledge that it may lead to that child taking drastic action in the form of suicide and self-harm, goes against everything I believe as a primary care giver, let alone what I have learned during my many years of training and experience.
For my adult patients, who are seeking help for the first time, often their biggest anguish is whether or not they will 'pass'. Will they be perceived by society to be 'him' or 'her', or will they look like someone presenting in the opposite role? This human desire to be accepted can be all consuming.
So what are the key attributes that cause most distress for my adult patients? For trans women, it is the deep voice, facial and body hair, muscular shape, big hands and feet, and angular facial features - the very things that trans men yearn for. For trans men it is the breasts and the wide hips, the soft skin and delicate features - all the things that trans women wish they could develop naturally.
According to my adult patients, access to puberty blockers at a younger age would have prevented a great deal of pain and hardship borne out of having to have surgery to reverse the body shape which they went on to develop in line with their genitals, rather than their true gender.
Puberty blockers are only ever given to younger patients after a thorough assessment of their condition is carried out. This medication would never be given to a child unless it was believed that the child was suffering from true gender variance and their wellbeing was at serious risk. Even then it would only ever be prescribed with the full support of their family.
Those who oppose the prescription of hormone blockers argue that there is not enough medical evidence to say that early intervention is right. I would argue, based on feedback from the trans men and women that I speak to on a daily basis, that there is not enough evidence to say that it is wrong. I would also add that doing nothing is not the neutral option.
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