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How Society Is Failing Transgender Children - A Response

15/12/2016 16:48
Stefan Muran via Getty Images

Sarah Ditum's article How society is failing transgender children, published in the New Statesman, raises some interesting points.

As a doctor specialising in gender care, I offered to take part in the NSPCC debate to which she refers. I personally was not afraid to address issues relating to gender variance and answer questions (of which there are understandably many). Though I am fully aware that in taking this metaphorical bull by the horns I am opening myself up to personal attacks and professional scrutiny. This, however, is not my main concern. My main concern is the wellbeing of these children, who are extremely vulnerable.

It is true to say that the long-term effects of hormone therapies administered medically are not well-enough known. Historically the medical care of gender variant people has perhaps not been high enough of a priority to warrant the necessary long-term research into the outcomes, an area in which I am pushing for change. We do, however, know the long-term effects of naturally having the hormone of the opposite gender to the one with which we identify: disfiguration, dysphoria, anxiety, depression, self-harm and suicide.

The article states that "puberty blockers delay the physical changes of puberty". In fact, used properly, they completely stop the development of the wrong secondary sex characteristics, giving the person time and space to consider the risks and benefits of using gender-affirming hormone therapy. Interestingly, these hormone blockers can prevent the need for much of the surgery required to 'create the desired sexual characteristics' later in life. You may be surprised to learn that, in most cases, these desired sexual characteristics are not necessarily what you might expect.

Only around 10-20% of gender variant people actually desire genital reassignment surgery, for the majority surgery is sought to correct those features that puberty blockers could have avoided, had they been prescribed at an early age - for transwomen the Adam's apple and male facial structure, and for transmen the unwanted breasts. Surgery for the potentially gender-misdefining feet, hands, waist, hips and stature, is not safely achievable, and it is these features that are preventable with timely medical intervention during adolescence.

The author speaks of her fears of chest binders and, as a doctor and mother, I share these fears but to the many transmen I have spoken to, the binder gives them great psychological peace, enabling them to hide what they see as a deformity. I wonder whether those that criticise the users have ever actually talked to a transboy, face-to-face?

The author is at pains to criticise parents for acting too quickly. She advocates a 'watchful waiting' approach, which is one currently recommended by so many politicians, authors, parents, teachers, doctors, psychologists, counsellors and nurses. What these experts do not account for is that while we watch and wait, puberty progresses mercilessly and irreversibly. Voices break, hairs sprout, muscles develop, hips form, periods start and breasts grow.

Outside of gender care, suicide in children is vanishingly rare. Within gender care it approaches 50%. Half of gender variant children attempt suicide. What else do these young people have to do to be heard?

In cases of true gender variance, we cannot afford to adopt a 'watchful waiting' approach. We must indeed rush into treatment, but that does not mean giving hormones and doing operations. It means careful assessment followed by a very safe, completely reversible injection which presses pause and gives the child, and those who support them, the time to think about the future very carefully. The urgency that these young people feel is not for a medically-induced sex change, it is to prevent the pubertal changes that have the potential to identify them as trans for the rest of their life.

The statistic that is so often quoted is that 84% of childhood cases of gender variance do not persist into adult life. This comes from a group of studies which followed a small number of children with consistent, persistent and insistent gender dysphoria (the criteria for early medical intervention) but also included children who behaved in a way which was more masculine, or feminine, than that expected by their culture.

Worse, the studies concluded that half of the children did not continue with their thoughts of gender variance into adult life, when in reality they were lost to follow-up and it is unknown what their actual outcome was. For a more in-depth overview of this topic see my earlier post: 'Let's Call an End to the 84% Myth'.

As leading gender specialist Professor Norman Spack, explains in his Ted Talk the facts, as we know them, are that if a child enters puberty with persistent feelings of gender variance from a young age then astonishingly few turn out not to persist with these feelings later into life.

I would welcome participation in a safely hosted debate, let the community join in. Let us hear first hand from those who are going through this experience. Let us ask the questions, lift the veil, hear from the experts, listen to what it actually feels like to be gender non-conforming. Without this balanced debate how can we ever truly hope to have any understanding or insight into what life is like for a member of the trans community and how can we assume any right to comment on how they should be treated?

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