Changing sex: can a child decide?

[Shana A]

Changing sex: can a child decide?

http://www.bbc.co.uk/worldservice/news/2009/10/091030_gender_reassignment_sl.shtml

When a child is born a boy, but grows up feeling that he is actually a girl, or vice versa, it is known as gender dysphoria.

In Britain, doctors are reviewing guidelines for the treatment of young people with the condition.

A key issue is the age at which they can be prescribed drugs to pause puberty.

In the UK it is currently around 16 years old, but some other countries allow it at around 12

[Miniar]

I'm gonna make myself unpopular with this view... but...

My opinion is that we should allow the brain to finish developing the centers that handle consequences and forward-thinking before asking a person to make a decision that has drastic consequences (medically alone) and is, for all intents and purposes, for life.

Translating that into a number... 20...
It's not until somewhere around 20 (18-21) that the brain finishes growing.
It's not until around that that the human brain is capable of fully processing things such as "long term" consequences and the like.

I do know, and remember from first hand experience, that most of us "know" early on, and I understand what I'm saying and yes, it makes even me a little bit frustrated with myself, but that doesn't change that I still feel we need to make sure an individual has the mental capacity to understand the choice he/she makes and a part of that is to remember that the brain's just not equipped to do it until later than we'd like to accept.

[juliekins]

I believe that puberty should not be allowed, and should be delayed by medications designed to delay it. This will give the child and his or her parents time to mature and decide what is most appropriate.

I look at the damage done by testosterone in my case and in others. Besides never be able to have a completely feminine bone structure, the cost of laser or electro, BA and much else could have been prevented. Mostly, it is the social cost of transition. Trying to live a life in the wrong gender sets you and your loved ones up for hurt and needless suffering. I think I read once that 20-30% of gender dysphoric people try suicide at one point or another- this could be avoided by early intervention.

So if 97% of GID cases are cured by SRS and living out our lives in the gender that seems most natural for us, why are we willing to take such precautionary measures for the 3% of cases? If puberty damage is allowed to happen, it's a 100% chance of f*&#ing us up throughout our lives in some way.

I applaud parents of these early transitioners. They took their children to be evaluated by credentialed doctors, after seeing firsthand the tendencies that their children exhibited. They should be recognized for taking the doctors advice to treat their children. Why would we want to delay medical intervention for a child who would be suffering for some other malady? Would we delay treatment by years so they could later decide?

[LordKAT]

I agree with Miniar about older for transitioning but do think stopping puberty early should be he standard until that child can mature and decide what route they want to take.

[Nathan.]

I agree with Miniar about older for transitioning but do think stopping puberty early should be he standard until that child can mature and decide what route they want to take.

I agree with this too, I think blockers are a must, but I don't believe in giving hormones or surgery to people under 18.

[Julie Marie]

I don't think age should be part of the equation.  I've known 18 year olds that act like 12 year olds and vise-versa.  It's not like once you reach 18 you magically become old enough, mature enough, to make a life decision any more than before you're 18 you are unable to.

Many of us can go back to our earliest memories to recall our first desire to be in the opposite gender.  There's never been a time in my life that I can't recall wanting to "be a girl".

I don't think a child can decide and I don't think the person with GID has to decide.  Our parents make all kinds of decisions that affect us for life.  They don't wait until we're 18 and let us make them.  There are certain things that must be done when we're young, too young to make the decisions ourselves.  We need help and we trust our parents and family to help us.

If all parents would educate themselves about gender related issues and how to spot them, they could begin early intervention, typically starting with therapy, and help their child be who they really are.

Most of the reluctance, IMHO, stems from our fear of being wrong.  We cherish birth gender so deeply, we just can't accept being responsible for helping change it.  And there's lawsuits too.  That keeps most physicians from getting involved with early intervention and maybe even some therapists.

When I was growing up my parents encouraged male behavior, especially my dad.  That did a lot of damage that I've had to live with throughout my life.  I know they didn't knowingly do it but it still happened.  Does that make it okay?  I don't think so.  My parents also had hopes and dreams for me that had nothing to do with what I wanted.  Is that okay?

We do all kinds of steering and encouraging with our children.  Most of it has to do with what we want for them.  Isn't it time we listened to our kids and encouraged them to be true to themselves?  And gender is no exception.

Julie

[Janet_Girl]

Does an intersex baby have a choice whether to be a boy or a girl?  No, the parents make that decision for the child, in the "Best interest of the child".  What a load of horse manure!  A child can make that decision early one. 

Fore stalling puberty, is a must.  But when the child is 18, it is so late for them to go through puberty.  I am for the transitioning of a Transchild at puberty, they do know that they are different.  So their predetermined puberty should not be allowed to happen.  But they do need therapy before they begin the chosen puberty .   How many of us would have happier live if a allowed to grow up as the women and men we truly are.

But then again it is JMHO.

Janet

[myles]

I think blockers are a must and children should not have to go through puberty as the wrong sex. It is very hard to pick an age as people mature at different rates. Someone who has known since they were able to speak and still feels/knows the same way at 16 should have the right to go on hormones. While we leave it to the parent to decide this is not always the best solution. Parents have a hard time understanding and comprehending gender issues and not all educate themselves, most just put up walls and ignore it. Their children are the ones who will suffer and this has gone on for far too long.
Myles

[Keroppi]

From what I gather, both sides of have merits because on the one hand, blockers are great to prevent unwanted and irreversible secondary changes at puberty, a process that can cause great emotional distress to a child growing up in the wrong sex. OTOH, numbers have apparently shown that there's enough proportion of children that think they're the wrong sex end up happily at and after puberty as (often) homosexual adults in their birth sex, effeminate male etc, rather than transsexual.

At the end of the day, one size doesn't fit all. Not all cases should be prescribed hormones, and not all cases should be delayed. Is there a balance that can be stuck, with each case individually assessed.

For those that argued blockers but no hormones until 16/18. That just doesn't work. Delaying puberty with blockers is only healthy for a relatively short time. After a time, the child need to go through puberty and a decision need to be made to come down one side or the other. The question is how do you make that decision, and when.

[Kay]

I'll have to go along with Julie & Julie. 
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While I understand your position Miniar, I'll have to disagree.
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Waiting until the mind has completely matured...is making a decision not to make a decision.  Which essentially makes the status quo of the child's physical birth sex as the default choice...regardless of their gender.  Even when you don't choose...you choose something. 
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Given two choices: I would rather be frustrated with myself for choosing wrongly, than to be frustrated because I was given no choice at all.  (Even better would be to choose rightly, rather than to be given no choice.)
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The concern you bring up is a valid one.  When are people ready to make decisions for themselves?  Typically, current laws deem it to be 18.  Before that time, parents make the important decisions for their children.
To me, if someone can be drafted and die for their country at 18...their freedom to choose for themselves shouldn't be abridged at that age either. 
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But we're talking earlier than that, which throws this into the ring of parental consent.  There are many risky medical procedures that parents are given the freedom to choose.  Many of these could wait if need be.  cleft lip?  A child could survive with it until 18-20 before deciding on reconstructive surgery for themselves.  But why wait?  Dealing with it early can help avoid numerous problems (ear disease, dental problems, and speech issues in the case of cleft).  How many more problems arise from someone growing up in the wrong body?   If it's an issue that can be aided by early intervention...why wait?
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And to answer that question, I think the main concern is screening.  The medical community needs to come up with some sort of criteria to follow.  Yes...children definitely need to understand the long-term effects of their decisions...or their lack of a decision.    But I honestly don't think that children are as incapable of making those decisions as you seem to think.  I disagree that all people under 18-20 can't "fully process" the consequences of their actions.  The more extreme the situation the child is in...whether GID, cancer, etc...the faster that child is forced to mature...to make those decisions...to "fully process" what will happen in the future.  While your statements apply very well to sheltered children who do not have to deal with more serious themes on a regular basis, I don't think they apply as well to the subcategory that we're addressing here.  The problem, of course, is separating one from the other...those who need to...and those who don't.
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For myself, being different, I was forced to grow up rather quickly.  I think a lot of us do.  I was more mature at 12, than most people I knew later in college.  It wasn't fun, but I had to be.  Physical age isn't always a good marker for maturity. 
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As for blockers/hormones:
My opinion is that blockers should be made available early.  Hormones could wait until 14/16.  (Better to have puberty a little late, than to go through the wrong puberty first and try to correct things later...when often there is no good way to correct the changes)
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In medicine, it's all about managing risk.  There is a risk that by allowing people access to blockers and hormones, that a child who doesn't need them, will get them.  But there's a certainty that if blockers/hormones are not allowed, that those who do need them, will not get them.  The key is long-term screening (over the course of years) before HRT to minimize that risk.  Graphic, blunt, honest, communication about everything necessary and related to the issue.  And for the adults involved to help that child make an informed decision, rather than avoiding or ignoring their responsibility until it is too late....when their inaction has already caused the child numerous physical and developmental problems.  To me, it's as simple as a cleft lip...sure, it's a choice...but if you need to do it...knowing all of the social & physical consequences involved...who would choose not to?

[Miniar]

I wasn't arguing for a "no choice" but the choice to try and make sure that the child/person is making the choice, not the parent, not society, and not the medical community. And to make sure that that choice is made from an informed standpoint with full understanding of the implications of the choice.
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I'm not referring to psychological maturity, but biological maturity.
Without the neurological maturity of the brain itself, the hardware to support certain functions is just not there.

I was more psychologically mature at age 12 than most, if not all, of the 20 year olds I've ever known. I am consistently more mature than those who are "my age".

That doesn't change when the biological components became "fully grown".
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And yes, I do believe blockers should be used to some extent, as much as is "viable" in regards to health and the like.

[Kay]

I wasn't arguing for a "no choice" but the choice to try and make sure that the child/person is making the choice, not the parent, not society, and not the medical community. And to make sure that that choice is made from an informed standpoint with full understanding of the implications of the choice.
== I understand the intent, though the effect is a "no choice" until X age.  I also understand that there are a lot of overbearing parents out there...medical personel that mean well but may push too much one way or another...etc...  But I also think most parents/doctors would tend to discourage such a path.  I guess we disagree on the balance of risk vs. reward of allowing people to choose sooner. 
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I'm not referring to psychological maturity, but biological maturity.
Without the neurological maturity of the brain itself, the hardware to support certain functions is just not there.
I was more psychologically mature at age 12 than most, if not all, of the 20 year olds I've ever known. I am consistently more mature than those who are "my age".
That doesn't change when the biological components became "fully grown".
==And this would appear to be the source of the disagreement. I guess I'm curious as to what functions you feel are "just not there" due to biology?  I have studied biology and developmental psych, so it's not an area completely unknown to me.  I'm usually of the school of thought that "it's not about how complex your cell phone is...it's about whether you know how to use what you have that counts."  Could just be that we come from different schools of thought on the matter.  Generally when I've seen brain development spoken about, they speak in terms of psychological maturity (because it varies so much after a certain age), and rarely in terms of the biological (except during the first few formative years of life).  While I have seen studies of teens vs. adults, usually they focus on impulse behavior and on how others influence teens easier...not on absent functionality.
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Mind elaborating a bit?  I understand the argument on the basis of psychological maturity.  But I honestly don't know where you're coming from taking the biological stance.  I guess I'm curious as to whether this is just a disagreement of philosophy/values, or whether I'm really missing your perspective completely.

[Alyssa M.]

Miniar, I agree with your intent and your concerns, just not your conclusions. I think it would be perfectly sufficient to start blockers before puberty and start hormones after, say, five years (to choose a number out of the air) after beginning to live full-time in the desired gender role, with a minimum age of, say, 14. I think that is long enough to ensure that the long-term consequenses sink in, even for a young brain.

[Julie Marie]

We all know what waiting does, allow birth gender hormones to make irreversible changes.  And we all know there's a major cost of trying to mask or undo those changes.  In MTF, GRS is unavoidable.  But with FTM, early hormone intervention could result in the development of a phallus.

For the MTF who has gone through male puberty:
·   Electrolysis - long term treatments that are painful and costly, upwards of $20K-$40K.
·   Hair Replacement - Not all require it but if needed could be over $10K
·   FFS - Again, not all need it but costs typically in the $30K+ range.
·   BA - Once the body passes a certain age, hormones have little effect.  Cost in the $5K to $10K range.
·   Bone structure - could gender one male no matter how successful above treatments are
·   Voice - Vocal surgery iffy at best so it becomes a lifetime of voice training and awareness.  Some may never be recognized as female.

Add to all this the emotional distress and I can't see how waiting for a person to reach a certain age is beneficial.  If the only concern is to avoid the occasional wrong gender diagnosis, it has to be considered an acceptable risk when you look at all those who are now guaranteed having to go through all or some of what I mentioned above.  And that was just for MTFs.  I don't know offhand what FTMs have to endure.

We can't wait until we have a diagnosis method that is 100% correct because too many people are suffering needlessly right now.

Julie

[Miniar]

Neurologically speaking, The prefrontal cortex goes through most of it's development through adolescence and doesn't finish it's development 'till early adulthood.

The prefrontal cortex sits just behind the forehead. It is particularly interesting to scientists because it acts as the CEO of the brain, controlling planning, working memory, organization, and modulating mood. As the prefrontal cortex matures, teenagers can reason better, develop more control over impulses and make judgments better. In fact, this part of the brain has been dubbed "the area of sober second thought."

Based on neuroimaging evidence that the development and maturation of the prefrontal cortex (PFC) continues beyond adolescence, and is completed only in early adulthood, this study was undertaken to determine if these functional differences in the human brain are evident in commonly used behavioral measures of PFC functioning. To this end, two age groups were tested. The 18-year-old participants represented the continuation of brain development, and the 22-25-year-old participants represented the completion, or near completion, of brain development. In support of the central hypothesis, the older group outperformed the younger group on PFC measures. The study also analyzed age differences in terms of tasks predominantly tapping the dorsolateral PFC (DLPFC) and the ventromedial PFC (VMPFC). The hypothesis of larger age differences for the DLPFC, due to its later maturation, was not supported. A final purpose of this study was to examine if life stress could be a mediating factor in the cognitive maturation of the PFC. Results revealed that negative stress scores were the best predictors of PFC functioning, but that there was no strong systematic relationship between life stress and PFC functioning in the age groups tested.

And my primary concern isn't whether or not someone might be put through gender reassignment when they are not transgendered, although the idea of creating a situation where a person has to transition twice with all that that entails is, in mind, just disgusting.

My primary concern is the simple fact that I believe that the one person that should have final say on whether or not they want to transition is the person who transitions.
And I, personally, feel, that it's important to make sure that the decision is, not only truly theirs, but also fully understood.

(I'm not trying to talk anyone into agreeing with me, I'm just trying to clarify.)

[Alyssa M.]

And my primary concern isn't whether or not someone might be put through gender reassignment when they are not transgendered, although the idea of creating a situation where a person has to transition twice with all that that entails is, in mind, just disgusting.

Absolutely. But what are the chances of that happening? It's a matter of weighing the potential costs and benefits of transitioning versus waiting. And I think a five year RLT is plenty of time even for a child to reduce the probability of detransitioning to an acceptably low level, given the benefits of transitioning.

[Dorothy]

I agree with the two Julies (Juliekins & Julie Marie).  the earlier a person transitions & has surgery, the better are the chances for assimilation not only physically bur psychologically too. 

[Kay]

Thanks for the clarification Miniar.  I still respectfully disagree (we appear to interpret the cited studies differently, and value the importance of the physical vs. psychological in different measure.), but I understand where you're coming from now.  Thanks.