Transsexual Children with Gender Identity Disorder

Transsexual children are often viewed as odd or deviant even from early childhood. In this paper, I will discuss the sociological and psychological impact of this deviance on transsexual children, treatments for transsexuality, and theories about transsexuality. My research was drawn from scientific and sociological articles from professional journals and sociological texts.

Transsexuals are those who wish to change the sex of their body and are generally said to have Gender Identity Disorder (Meyerowitz, 2002). Gender Identity Disorder (GID) is a term covering a range of cross-gender identifications that may because the mind and body seem to be of different sexes (Meyerowitz, 2002). There are no clear statistics to determine how common GID is among children, but many adult transsexuals report that even from a young age they felt they were "in the wrong body" (George, 2007:16). Adult transsexualism has been estimated at an incidence of about 1 in 30,000 for female-to-males and 1 in 12,000 for male-to-females, and transsexual lobby groups say the actual statistics may be far higher (George, 2007).

Research and theories conflict as to the cause of transsexual children, bringing back the old nature versus nurture debate. Early researchers originally looked for biological causes for transsexuality (Brown & Rownsley, 1996). While some transsexuals had irregularities in their hormones, chromosomes, and genital reproductive organs, researchers concluded that "these were the exception rather than the rule, and that the average transsexual was remarkably similar to the average non-transsexual in these areas" (Brown & Rownsley, 1996:22).Today many medical researchers prefer the prenatal neurohormonal explanation for GID and propose that gender is determined long before we are born. They theorize that transsexuality is a result of"a disturbed interaction between the developing brain and the sex hormones" (Brown & Rownsley, 1996:22). Human sex organs do not differentiate between male and female until the twelfth week of pregnancy, but the gender identity portion of the brain forms in the sixteenth week of gestation (Brown & Rownsley, 1996). Some medical researchers have theorized "that if certain hormones are not present or if there is a hormonal imbalance during this critical four-week period, gender identity may not develop or differentiate along the same lines as the genitalia. In those cases, the child may be more likely to be gender dysphoric" (Brown & Rownsley, 1996:25).

In contrast, some mental health professionals consider GID a psychological condition that may have been triggered by events in early childhood; some psychoanalytical theories propose that an overbearing mother figure or a weak or absent father figure could be an underlying cause for GID (George, 2007; Brown & Rownsley, 1996). Combining theories of nature and nurture, some propose that nature may in certain instances provide a genetic predisposition toward incongruous gender (Brown & Rownsley, 1996). Thus, if certain socialization factors occur for a child with a biological predisposition GID may develop (Brown & Rownsley, 1996).

Mildred L. Brown, clinical sexologist, therapist and professor of clinical sexology at the Institute for Advanced Study of Human Sexuality in San Francisco states that most children, both with and without GID, are fully aware of their sex and its accompanying socially acceptable gender roles by the age of 5, and that 85% of her transsexual patients recognized their GID by the time they began grade school (1996). Childhood is often full of problems for some children, but most children never have to worry about what sex they are. Unfortunately, in addition to other childhood problems, children with GID are suffused with doubts and confusion, because they self-identify as a gender that doesn't match their biological sex (Brown & Rownsley, 1996). Brown states that all of her patients "report that their childhood years were torturous experiences" due to their GID (Brown & Rownsley, 1996:30).

Many children with GID don't fit in with either boys or girls, and they have difficulty relating to people (Brown & Rownsley, 1996). According to Brown and Rownsley, transsexual children tend to have an affinity for mannerisms, games, and activities that are more typical of the opposite gender, and therefore are regular targets for bullying and abuse (1996). Since "tomboy" carries significantly less stigma than the "tomboy" label, transsexual boys get the brunt of the bullying, with many reporting that they got beaten up on a regular basis (Brown & Rownsley, 1996).

Because transsexuals feel that they are actually the opposite sex, they perceive they are being bullied and mocked simply for being who they are (Brown & Rownsley, 1996). As a result, transsexual children often begin hiding their true selves to try to gain acceptance and approval; they learn to pretend and then end up feeling like phonies and have difficulty finding anything about themselves about which they can take pride or feel confident (Brown & Rownsley, 1996). Because they don't fit in and become frequent targets, transsexual children frequently become loners and spend much of their childhood in isolation (Brown & Rownsley, 1996). "Children who grow up with gender confusion almost always have serious self-image and self-esteem problems because they don't feel comfortable with their bodies and don't fit in with their peer group" (Brown & Rownsley, 1996:47).

Domenico Di Ceglie, head of the Gender Identity Development Service for children and adolescents at the Tavistock Clinic in London, states, "For children with atypical gender development, puberty can be a very intense and distressing experience" (George, 2007:16). Brown and Rownsley report that "the sense of betrayal is a common theme among these teenagers" (1996:50). Until puberty, boys with GID often believe their penis is disgusting and will someday disappear and girls often believe they will grow a penis and eventually turn into a man (George, 2007). "With the arrival of puberty, the trans teens must face the harsh reality of nature's cruel trick-that their bodies are finally changing, but the changes are all the wrong ones" (Brown & Rownsley, 1996:50). It is typical for transsexual children to have a strongly negative body image (Brown & Rownsley, 1996). It is difficult, if not impossible, for them to value a body that is so blatantly different from the one they want or think they should have" (Brown & Rownsley, 1996:51).

Since some children with GID feel so isolated and desperate, the desperation may manifest as rebellion, social problems, and self-destructive, abusive, or criminal behaviors (Brown & Rownsley, 1996). Many transsexual teens turn toward drugs and alcohol as a psychological crutch (Brown & Rownsley, 1996). "Their early tendencies toward substance abuse may set the stage for destructive behavior patterns that may set the stage for destructive behavior patterns that will extend well into their adult years" (Brown & Rownsley, 1996).

For some transsexual teens, gender conflict may "escalate to the point where it leads to debilitating depression and despair, resulting in self-mutilation of the genitals and breasts, or even suicide (Brown & Rownsley, 1996). The suicide rate of transsexuals is significantly higher than that of the general population. Brown estimates that 20% of transsexuals attempt suicide and states that 70% of her transsexual patients admitted considering suicide (Brown & Rownsley, 1996). "I have little doubt that in a large number of unexplained teenage suicides...the victim is either secretly gay or transsexual" (Brown & Rownsley, 1996:76)
Treatment for GID is necessary to help these children and has changed considerably over the years. In 1962 doctors in the Department of Psychology at UCLA established the Gender Identity Research Clinic (GIRC)-a formal gender identity program to teach gender roles to children and parents (Meyerowitz, 2002). Rather than recommending or offering transsexual surgery, they focused on their explicit goal of prevention of transsexuality by working to instill traditional gender roles in children (Meyerowitz, 2002). As the GIRC gained a reputation for fighting the threat of changing gender roles in the time of the rising feminist movement, and portraying transsexuality as a "'malignant' outcome", other institutions and large clinics followed their lead and created their own gender identity programs (Meyerowitz, 2002:126).

Over the years, treatments for transsexuality evolved dramatically. Changing the body through the use of hormones, hormone blockers, and surgery is the treatment of choice for many transsexual adults today, but for transsexuals under age 18, that has not been an option until recently (George, 2007). However, now a few doctors are even treating adolescents from the age of 12 with hormone blockers and hormones, even for a few children as young as 12 (George, 2007). Since some studies show that approximately 20% of children who experience GID as children grow into adults who are happy with their original sex, underage treatment of GID is controversial, difficult, and not yet the norm. (George, 2007).

Cohen-Kettenis and hormone specialist Henriette Delemarre-van de Waal, leaders of a Dutch group at the Free University Medical Centre in Amsterdam, are considered the world leaders in sex change treatments for the young (George, 2007). Fifteen years ago, GnRH blockers were already being used to delay puberty in children who began puberty prematurely, and it had been noted that "when the drugs [were] stopped, puberty resume[d] with no apparent side effects" (George, 2007:16). Doctors administering these hormone blockers to children "believe that putting puberty on hold can give a valuable respite to teenagers in great anguish over their rapidly changing bodies" (George, 2007:16). In a pioneering move, the Dutch team began treating their transsexual patients with these hormone blockers in an attempt to reduce their distress about impending puberty. The first of these children was only 12 and went on to get testosterone therapy at age 17, and eventually a surgical sex change operation. The Dutch team continued began to treat transsexual children over the age of 16 who "met a strict set of criteria. Most importantly, the teenagers had to undergo intensive psychological assessment to check they had profound and persistent GID, were otherwise psychologically stable, and had supportive families" (George, 2007:16).Six years ago the Dutch team again began to treat children under age 16 with GnRH blockers with the understanding that the effects are reversible. At age 16, the transsexual children are able to go through "an artificial 'trans' puberty" by taking the sex hormones of their target gender (Geroge 2007:16). The doctors report that their transsexual patients fare better psychologically than those transsexual children required to experience puberty in their original gender (George, 2007). The Dutch team reports that of 60 transsexual children under the age of 16 who have been treated with GnRH blockers, not a single patient has regretted their decision (George, 2007). While debate about the best approach is still fierce, not intervening on behalf of transsexual children has irreversible consequences. As Norman Spack, hormone specialist at Children's Hospital in Boston points out, "waiting until puberty is almost completed 'means they have to have more surgery to remove body parts, and there are some things about their physique that can't be changed'" (George, 2007:16).

According to Monro, professor in the Department of Sociological Studies, University of Sheffield in the United Kingdom, a postmodernist analysis can be used to understand gender plurality, post-structuralism can be used when considering the construction of gender, and "an analysis of social structure provides grounding in the `real' world. The fluid possibilities posed by trans[sexuality] call for social structuring based on the principles of equality, diversity and the right to self-determination" (2000:43). Transsexual children have a unique path ahead of them-one from which society can learn much about the social construction and fluidity of gender.
References

Brown, Mildred L. and Chloe Ann Rounsley. 1996. True Selves: Understanding
Transsexualism-For Families, Friends, Coworkers, and Helping Professionals.

San Francisco, CA: Jossey-Bass Publishers.

George, Alison. 2007. "Body swap." New Scientist 193:16.

Meyerowitz, Joanne. 2002. How Sex Changed: A History of Transsexuality in the United

States. Boston, MA:Harvard University Press.

Monro, Surya. 2000. "Theorizing Transgender Diversity: Towards a Social Model of

Health." Sexual & Relationship Therapy 15:33-45.