It is becoming more common to see
gender dysphoric children, or children who believe their biological sex
does not match their psychological gender identity, in society. The TLC
reality show “I Am Jazz” details the life of Jazz Jennings, a
transgender teenage girl, and has helped bring transgender children into
mainstream TV. Recently, a viral video surfaced of a mother surprising
her daughter with hormones in order to begin her gender transition. The
emotional reaction from the daughter depicted the gratitude many
transgender individuals have when they are finally able to transition.
However, there is still a lot that is
not known about the benefits and drawbacks of allowing prepubescent
children to block hormones necessary for puberty when they feel that
they are the wrong gender.
Ball Bearings discussed this issue with Teri Schulz, a general practice pediatrician of 26 years at the St. Vincent Medical Group in Anderson, Indiana. Schulz provides her insight on the potential consequences of allowing a child to transition before puberty.
Ball Bearings: What are the purely physical health advantages or disadvantages of transitioning before children begin puberty?
Schulz: With kids that have something called gender dysphoria before puberty, there’s a fairly high percentage of them that do not have gender dysphoria after or during puberty. The studies vary, but only around 20 to 25 percent of kids that state before puberty that they feel like they have gender dysphoria will actually go on to feel that way post-puberty. Kids that feel very strongly that way are more likely to carry it through after puberty.
To me, it’s potentially a little dangerous to use medications or hormonal treatments prior to puberty, especially when there’s such a high percentage of kids just in the few studies that have been done, that no longer have those feelings after puberty and say it’s a transient feeling. To me, unless you had strong evidence from a psychologist, endocrinologist, or a psychiatrist that this is something that’s really going to persist, I think there’s potential danger in doing those type of medications. I know one of the newer kinds of things that they talk about in the literature is actually not doing the whole hormonal transferring, but using things to try to stop them from going into puberty; that’s different from hormonal therapy. A lot of people, if they are thinking that this is something that is going to persist, will start those medications pre-puberty to try to prevent them from going into natural puberty. They’re the same kind we give kids who start early puberty, that is, earlier than we would want them to. That can be used from around 5 to 7 years, and it halts your body from going into natural puberty which would give you a chance to assess whether you think this is really a more permanent feeling or just a transient one. In my opinion, there’s a big risk in giving hormonal treatment to someone pre-puberty unless you’re very convinced that this is not something that’s going to go away.
Now, it if it’s a pubertal child that starts saying they have a gender dysphoria, there’s a really high percentage of those people that say those feelings persist, so that’s a completely different issue.
BB: What are the emotional/social/psychological pros and cons of transitioning before puberty?
Schulz: Transitioning before puberty might help them feel like they’re fitting in better, and would possibly help with other people accepting them as the gender they’re identifying as, so there could be some psychological benefits. On the other hand, they’re not easily reversible decisions, so you have to be very comfortable with what you’re doing. If you felt like they’re going to stay in the gender that they’re identifying with, there could be some psychological advantages to treating them prior to puberty, but that’s a pretty significant decision. It can’t be taken lightly.
The trend now is to try to just delay puberty, and if you do that early enough, there aren’t going to be a lot of physical signs. Prior to puberty, a biological female who feels like she’s a male will not have a lot of breast development so it would be hard to tell when she dressed like a male. So halting puberty is a lot of times the safer route to go.
Clearly all of those kids have psychological issues that need to be looked at in terms of bullying, feeling like they don’t fit in, depression – there’s a very high rate of suicide in transgender kids in general. You do have to look at that and it takes a team approach to decide what the best option is. I’m not sure that taking the step of hormonal therapy is what I would normally recommend, but I would always get someone who has more experience involved.
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