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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
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"If you have someone who's 6-3, with broad shoulders like a football player and a deep voice, there's no amount of surgery or hormones in the world that's going to allow that person to pass and be safe," says Nick Gorton, a doctor who treats transgender patients at Lyon-Martin Women's Health Services in San Francisco. "If you treat them [young] then maybe at 25 they won't get raped, beaten, and killed."

So far, none of the 60 or so teens choosing to delay puberty at the Dutch clinic have turned back. None have reportedly had regrets. Yet no matter how happy the patients seem, put "delay" and "puberty" in the same sentence, add in a little-understood condition like GID for which science still cannot pinpoint a cause, and, well, people start talking.

Some doctors say kids need to experience puberty to truly know if they're misplaced in their bodies, and warn that the long-term side effects of diverting nature's route are still unknown. A few doctors believe medicine should never intervene to change a person's body to match gender identity, no matter the age — what one transwoman doctor dubbed the "you should be what God made you regardless of how miserable you are" camp. Paul McHugh, the psychiatrist who spearheaded the closure of the sexual reassignment clinic at Johns Hopkins Hospital in the 1970s, is an appointee to the President's Council on Bioethics. He calls the Lupron treatment "a modern form of child abuse."

Indeed, some U.S. doctors don't seem to be clamoring for attention. Norman Spack at Children's Hospital Boston, who has supported the treatment in a medical article and on ABC's 20/20, declined to comment for this story. A doctor at Kaiser Permanente identified by a Bay Area family as their son's provider of the Lupron treatment also would not speak. But Schreier of Children's Hospital Oakland says he's not worried: "What we're doing is based on data, not based on emotions or religious beliefs."

All seem to agree on one issue: No matter how reversible Lupron may be, when studies indicate that the vast majority of kids with some gender-variant behavior in childhood will grow out of it, how do you block puberty in the right kids?

Marty's parents say they are 99.8 percent sure that his identification as a boy is here to stay. Though they accept that now, it was certainly not their expectation, let alone their choice. Actually, checking "girl" on the adoption forms was a no-brainer for the middle-aged lesbian couple. As ardent feminists, the attorney and child psychologist felt equipped to raise an independent-minded girl, and Marty seemed to be right on track.

When she saw an astronaut, politician, or athlete on the TV, she said, "I want to do that!" "Of course you can!" the mothers would answer. She ignored dolls, but loved trucks. Somewhere around age two and a half, Marty refused to raise her arms when her mother tried to put a dress on her, the first time she'd ever rejected an outfit. One day out of the blue, she looked her mother in the eye and asked, "When is it my turn to be a boy?"

The mothers grew puzzled. Maybe she was just trying to set herself apart from her newly adopted little sister. They certainly didn't want to overreact. If Marty would only wear drab clothes from Target's boys department, why waste money on skirts? If she was proud she could pee like the boys at preschool, planting her feet together and arching her back to hit the pot, well, at least she was potty-trained. But they also didn't want to fan the flames.

"I was aware to not pin him to a decision he made at the age of two," says Margaret, the child-psychologist parent. "I didn't want to build it in as a permanent part of his personality."

Marty became increasingly self-conscious about being identified as a girl. With her bob haircut, she let kids at school assume she was a boy, and avoided the bathroom all day so she wouldn't have to pick one. She refused to change her swimsuit in the girl's locker room at the YMCA.

At age five, the discord between her identity and body seemed to take its emotional toll. At times she would play recklessly, and at other times, seem withdrawn and preoccupied. Marty's parents took her in for a psychiatric evaluation, and she was prescribed antidepressants. She told Margaret that if she had to be a girl, she'd rather die.

But one topic seemed to cheer the kid up. One day, Janet, the attorney, told her that a friend's daughter had started transitioning to manhood in her 20s. Marty lit up, pelting Janet with questions. How? It involved hormones and a surgery. Can I have it now? Can I get my penis? Janet said they would support her in whatever she decided, but that she would have to wait till she was older.

But the parents soon learned that interventions can start much earlier than that. Marty's pediatrician pulled the mothers in after the child's annual checkup: We all see what's going on here, don't we? Every year, the girl was presenting more and more like a boy. The doctor said the parents should find an endocrinologist who delays puberty for transgender kids. When puberty hit, the family didn't want to be caught off-guard.

Janet was skeptical. Although she'd trumpeted lesbian causes for years, she knew little about transgender people. How permanent could this really be in a seven-year-old kid? She and Margaret started attending a support group for parents of gender-variant children, and discovered one couple was calling their son "she." Janet thought it was a little odd.

"You would think of all people, I, who came out and went through all of this hullabaloo with my parents, would have the consciousness to understand people are who they are," Janet says. "But for me, with Marty, it didn't translate."

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Lauren Smiley

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