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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

Page 3 of 6

But that would change after two years of the support group, a barrage of books, Internet searches, and an Oprah episode on transgender kids that Marty watched a dozen times. When Schreier, the support group's psychiatrist, explained there was no way that parents could have made their kid this way, any last remnants of guilt dissolved.

"Look, we're a lesbian couple," Margaret says. "Even if we didn't think we did, I know a lot of other people would think we influenced his gender identity."

Finally last summer, at age eight, Marty said she wanted to be considered "he." A boy. Their son.

"I finally got it," Margaret says. "This is an identity."

They were both sad to part with their idea of a daughter, but any final doubts faded after seeing how Marty seemed to glow in his new role, going to a new school as one of the boys.

But puberty?

The mothers had heard talk of "blockers" flung around in the support group, and had done some initial Googling on treatments. They attended a seminar this spring where Spack, the doctor from Children's Hospital Boston, explained the treatment for delaying puberty. Having been prescribed Lupron herself for fibroids years before and ballooning 50 pounds in four months, Margaret wasn't thrilled about the drug choice. (Indeed, women prescribed the drug for the approved uses for endometriosis or fibroids fill Internet message boards with complaints of hot flashes, mood swings, memory loss, and pain.) But the most common side effect in kids is irritation, sometimes including a sterile abscess, at the site of injection.

The idea of the injections was initially a relief to the parents. Something could be done, and with Janet's salary as an attorney, they could afford the approximately $1,800 shot four times a year even without help from insurance, if need be. But the option also added pressure. With Marty too young to fully grasp the implications, the decision to start was going to fall on them. The mothers knew they had altered the course of Marty's life the day they adopted him, changing his status from a Chinese orphan to an adopted Chinese-American child of gay parents. Now they faced taking the first step in what could become a transition to an identity even further from the mainstream: transman. All along, they had figured that decision would still be some years off.

But Marty turned nine and his breast buds demanded attention.

Give Marty a couple years without the shots and he might look something like the girl who sat before Dr. Henriette Delemarre-van de Waal at the Free University Medical Center in Amsterdam in 1986. Referred by a psychologist who diagnosed GID, the 12-year-old ace student was depressed about her growing breasts, which she had been binding to her chest to disguise. She wanted to be a boy.

The endocrinologist had never worked with a patient with GID, but a drug known as a GnRH blocker, the same compound as Lupron, had recently gone on the market and was being used to delay puberty for kids who developed too soon. The solution seemed obvious.

"She was crying for help, so I thought, let's try," Delemarre-van de Waal says. The treatment greatly alleviated the patient's distress, according to the doctor. At 17, the patient began taking testosterone, and later underwent sexual reassignment surgery. He is now a veterinarian.

That positive outcome seemed to agree with follow-up studies of Dutch adolescents that indicated those who started hormone therapy between 16 and 18 were more satisfied with their sexual reassignment surgery and had fewer psychological problems than people who started transitioning in adulthood. Meanwhile, Dutch psychologist Dr. Peggy Cohen-Kettenis was seeing younger and younger patients with GID, many of whom were so distraught that they couldn't start hormones until 16 that therapy couldn't reach them.

So about seven years ago, the Amsterdam Gender Clinic became the first in the world to regularly block the early and still reversible stages of puberty, provided that the patients met strict requirements: Their GID had persisted since an early age, they were otherwise psychologically stable, and had a supportive family.

The clinic has treated around 60 adolescents between the ages of 12 and 16 so far with the GnRH blocker, about half of whom were referred early enough to start shortly after the onset of puberty. For those who had reached the middle stages of puberty, the drug could slightly reverse and stop any further development. All patients decided to start hormones of the target sex once they became eligible at age 16.

Ever since the first forays into treating humans with cross-sex hormones in the 1930s and '40s, men taking estrogens and women testosterone has brought on expected changes. But by blocking puberty first, the changes can start on a blank canvas, resulting in a closer replication of the opposite sex's development. With estrogens, biological boys grow breasts, and fat will collect on the hips and thighs to create an hourglass shape. By blocking the growth-spurt-inducing testosterone of male puberty, they'll likely end up shorter — a plus if wanting to pass as a woman. The penis and testes will remain at a pre-puberty size, the voice will not drop, and no Adam's apple will jut out. The face will not grow rugged ridges like that of a man's, although the clinic will take pictures every three months to determine the exact effects on bone structure.

With testosterone, biological girls gain muscle in the shoulders and grow male-pattern body hair. Their voice will drop, an Adam's apple pops out, and the clitoris lengthens a few centimeters. Since they've held off female puberty's estrogen, which tapers off bone growth, they gain time to put on some inches. Height can be further enhanced by growth-stimulating hormones along with the GnRH blocker, and is given one final push by the testosterone-fueled growth spurt. The Dutch doctors say the interventions have been able to add or subtract up to five to seven inches from patients' predicted heights.

About The Author

Lauren Smiley


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