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Girl/Boy Interrupted 

A new treatment for transgender kids puts puberty on hold so that they won't develop into their biological sex

Wednesday, Jul 11 2007
The breast bud popped up about six months ago, and Marty knew something had to be done. It was the slightest of puckers, just on one side, so small you wouldn't even notice it through a T-shirt. Still, boys don't get breasts, and this had the unsettling potential to blow his cover big-time.

That's because Marty was born, by conventional measures of modern science, a girl. Marty has two X sex chromosomes, like most females, and the hardware concurs. Yet ever since Marty's parents flew back from China in 1998 with their 11-month-old adopted baby, their daughter seemed to be programmed male. She refused dresses by age two and half and mastered peeing while standing by three. She would identify herself as a girl only when grilled.

When Marty was about six, doctors said she was no tomboy. She seemed to fit the diagnosis of gender identity disorder (GID), and though dubbing it a disorder whips up a maelstrom of controversy, the basic sentiment is this: not only feeling an intense discomfort with one's biological gender, but also feeling profoundly, compellingly, like the other.

Enrolled in a new school last year as a boy where only the staff knew otherwise, the nine-year-old passed without a hitch in his wardrobe of Nike trainers and T-shirts, paired with a crew cut, boyish build, and aggressive basketball moves at recess. (To keep his secret, the names of the boy and his parents have been changed.) But the days when the only outward markers of gender lie in haircuts, clothes, and personality only last so long. Deep inside Marty's brain, a time bomb known as the hypothalamus waited to stage a hormone-armed mutiny. Breasts would sprout. Hips would widen. The uterus would shed blood on a monthly basis. Marty didn't want any of it.

So when the bud appeared, his Bay Area parents hustled him to an appointment with an endocrinologist at Children's Hospital and Research Center Oakland, who said the bud might progress no further and puberty could still be a few years off, his parents recall. They were temporarily relieved. Marty treated the bump as a boy would — poking at it at the dinner table, feeling it through his button-down shirts. Waiting.

Then, in May, Marty came to his mom frantically: "Mommy, feel this lump! You have to do something!"

The other breast had budded.

His parents called Children's because now, due to the efforts of a small but growing number of doctors around the world, something actually could be done about emerging puberty. The endocrinologist agreed that Mother Nature was revving up, preparing to take Marty the way of trainer bras, Tampax, and, as his parents and doctors predicted, increasing distress as his body developed into a sex that to him seemed a cruel trick of birth. The changes would make living as a boy impossible in the present, and he'd potentially face scarring surgery to remove unwanted breasts down the road. What's more, the upsurge in estrogen would slow and stop his growth, making it harder for him to ever pass as a male. Of course, that's if Marty would end up living as a man. As boyish as Marty is, no one could know for sure.

But in the present, nature could be tricked. If they all agreed, Marty would never have to develop into a woman.

It was time to put puberty on hold.

The preferred drug for the controversial process is Lupron Depot. Slogan for the pediatric version: "Pause the child within." It's potent, yet reversible, and incredibly expensive, and for transgender kids backed by increasingly supportive parents, it's ushering in a new era. Boys who've always known they were girls won't get beards or deep voices. Girls who feel like boys will never have to grow breasts or tinker with a tampon.

Long prescribed to temporarily stave off puberty in kids who start developing too young, the drug blocks the brain's release of the compound that triggers the chain of hormonal reactions, body mutations, and moody angst. Now an unknown number of doctors in the Bay Area, the country, and across the globe are following the lead of a fledgling treatment pioneered at a Dutch clinic that's sparked debate in medical and ethical circles alike. The Dutch clinicians are suspending kids in physical childhood to buy them time to decide if they wish to begin the sexual reassignment process. If so, after a few years of continued psychological monitoring, they can start hormones to induce an "opposite-sex puberty." If not, the teen can stop taking the periodic Lupron injections and appear to develop normally, as kids treated with the drug for early puberty have for years.

Although treating transgender kids is a non-FDA-approved or "off-label" use of the drug (which is legal, and is done frequently with other medications) the treatment is fast gaining legitimacy in the medical world. The world's largest association of health professionals who specialize in transgender issues approved the procedure in its most recent treatment guidelines. A handful of doctors have touted the procedure at big-name medical conferences. More doctors are catching on.

"It's time we have something going here in the Bay Area, because we should be at the forefront of this," says Herb Schreier, a psychiatrist at Children's Hospital Oakland.

Advocates say the treatment saves kids the anguish of continuing to develop into a gender they don't identify with — reducing the risk of everything from depression to self-mutilation to suicide attempts — as well as later surgeries to undo what Mother Nature has done. By sitting out the irreversible changes of biological puberty, patients will pass more easily as the target sex, protecting them from potential discrimination and even violence. And transphobic violence is something that the Bay Area has been known for at least once, when partygoers beat and strangled 17-year-old Gwen Araujo of Newark to death in 2002 upon discovering she was a biological male living as a female. In March, the body of Ruby Ordenana, a transgender Nicaraguan immigrant, was found near a highway off-ramp in Potrero Hill.

About The Author

Lauren Smiley


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