A small but growing group of teenagers and even younger children who feel they were born the wrong sex are getting support from their parents and doctors for treatment and change of gender, according to reports in the medical journal Pediatrics.
It is an issue involving ethical issues, and some experts are questioning the use in children of drugs and hormones that block puberty.
A girl of eight years in Los Angeles is a typical patient. At 18 months, announced “I’m a man” and has remained with that belief. The family was shocked but now refers to her as a child and are aware of the first signs of puberty to begin treatment, her mother said.
Pediatricians need to know how these children are and whether they deserve treatment, said Dr. Norman Spack, author of one of the three reports published on February 20, 2012 and director of one of the first gender identity clinic at Children’s Hospital Boston.
“If you open the doors, these are the guys who come. Are out there are in our practices,” Spack said in an interview.
Changing gender roles and occasionally pretend to be of the opposite sex is common among children. But these children are different. They are certain that they were born in the wrong body.
Some are labeled with “gender identity disorder”, a psychiatric diagnosis. But Spack is one of the doctors who think it is a misnomer. Research suggests that they may have more brain differences similar to those of the opposite sex.
Spack estimated that one in 10 000 children have this condition.
Offering a sex-change treatment for children under 18 carries ethical concerns and the reasons parents need to be carefully examined, said Dr. Margaret Moon, a member of the bioethics committee of the American Academy of Pediatrics. She did not participate in any reports.
Some children may have a psychiatric diagnosis only when they are very uncomfortable with the definition of gender roles, or some might be gay and are forced to receive treatment because parents are more comfortable with a sex change that with a gay son, Moon explained.
It is harmful “to have an irreversible treatment too soon,” she added.
Physicians say they are treating delay it would be more harmful.
These children sometimes resort to self-mutilation to try to change their anatomy, the other two reports in the daily stress that some face physical and verbal abuse and are prone to stress, depression and suicide attempts. Spack believes that these problems disappear almost always in children who have been treated and allowed to live as the opposite sex.
The Endocrine Society guidelines advocate transgender hormone treatment, but note that should not be given before the start of puberty. At that point, the rules recommended medications to prevent puberty until age 16, then Lifetime hormones sex change while monitoring potential health risks. The mental health professionals should be involved in the process, say the guidelines. Society members are physicians who treat hormone conditions.
These guidelines, along with YouTube videos of teens who are changing sex and communication media attention, have helped increase awareness of treatment and caused more families seek help, said Spack.
Spack reports detail that has quadrupled the number of patients in the hospital in Boston. The clinic Gender Management Service, which opened in the hospital in 2007, is averaging 19 patients per year, compared with almost four treated annually on gender issues in the hospital in the early 1990.The report details that 97 children were treated between 1998 and 2010, the youngest was four. Those that are too small and their families receive counseling and are followed until the first signs of puberty, usually between 11 and 12. Then the kids get drugs to block puberty with monthly injections that cost $ 1,000 or implants in the arm.
The effects of drugs to block puberty are reversible and the idea is to give children time to mature emotionally and to be sure that they want a permanent sex change. According to Stark rejects only one of 97 permanent treatment.
Sex hormones, especially in high doses and used for a long time, can have serious side effects including blood clots and cancer. Spack says he uses safe dose but patients should be monitored.