Girl/Boy Interrupted

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

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.

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10 comments
Josephineshaffer
Josephineshaffer

When i was a boy 10 years old i wanted to be identified as a girl i would put on dresses, skirts, panties, pantyhose i look great wearing a dress.

Martin H Goodman
Martin H Goodman

I am one who has been interested (for both personal and professional reasons) for decades in issues of sexuality and gender, and I'm also a physician. I'd like to thank Lauren Smiley for writing one of the single most honest, intelligent, informative, entertaining, and compassionate articles on an issue of gender that I've read in many years... perhaps ever. I'd like to thank the SW Weekly for pubishing it. Both have performed a very valuable service to the community ("the community" = all humans of good will). ---marty

Cristasphoto
Cristasphoto

What you all are reffereing to is what is called inrtrsexed..AKA PsuedoHermamorprodtismYes One wordThere a MANY version of thisIwas diagnosed with one of them But Identify asFemale...We are a rare bunchMale and Female are the norm I admit that...You can NOT blame this on Society rather Geneticsor Defects ThereofIf I ahd a Child born Like me Iw ould probaly have it Euhanized as its no easy life...ut to 1000 thousand percent Choose this life like MTF FOlks dowell its not called Gender Indentity Disordr fo nothingAfte alll the NAil that stcks out is the nail that WILL get hammered PERIODSO I cant say I support these parents for encouraging this Behavior its rather sadThese kids are going to end up Welfare casescause NO ONE is gonna Hire them EtcSAd Really SAd

Julie
Julie

The most heartbreaking line in this article is Dr. Gorton's "If you treat them [transgender youth](young) then maybe at 25 they won't get raped, beaten, and killed."

It's deeply disturbing to me that parents and children would feel pressure to "decide" upon a gender when a child is such a young age, literally under pain of death. Hopefully along with developing technology to give persons who transcend the gender-box more time to make decisions about their physical selves, we will work on creating more cultural space for people to question their gender.

TWJohnson
TWJohnson

Humans seem to always want to place everything into neat pigeonholes � in this case, �male� and �female�. Reality is far more complex, however.

At the basic level of sex chromosomes, there are the standard XX and XY variants, but there are also people out there who are XO, XXY, XYY, etc. For the external plumbing system that is used at birth to assign sex category, there is a range of variation with about one baby in 2,000 so close to the middle of the range that the doctor can�t decide if it is a �he� or a �she�. The internal plumbing system can be even more complex and need not match the external.

Then, we get to the complexity inside the head. Even the wiring of the brain is affected by the mother�s hormonal surges during pregancy, environmental pollutants (e.g, estrogen analogues), gene expression, etc.

With all the possible factors, there are more theoretical combinations of sex and gender than humans who have ever lived. Most, but not all, can be pushed into the pigeonholes of �heteronormative� males and females. Some cannot, and it�s time to recognize and deal with the real differences. This is one baby step toward recognizing the very real diversity of humanity. Someday, we may even celebrate it.

Male
Male

I cant wait until cloning occurs so we can put all this junk science about how we were born. I just want to see someone who is supposed "born gay" cloned put into a different environment and see that person exemplify the environment they are in. I am sick and tired of the media trying to brainwash that were born a certain preference. I know we are all born a blank slate and are capable of being stimulated by either sex. I think this is all just political to gain certain rights for people who have certain preference or way of life. Who cares who is with whom?

neptune
neptune

I think it's just evolution. We're moving beyond two part gender. It'll just take a while. I don't know that there's a real "solution" for the interim. Eventually, there will be one dual gender. The social constructs will have broken down and the brain differences, hormonal differences, physical differences will have fused.

Cristasphoto
Cristasphoto

If Only we can we get more studies into Why and how Folks like myself are born with intersexed conditions,WHat ccauses a Boys brain to want to be a a girls Etcis it our parents ,diets genes,Pollution???Can we prevent these disorders so that there can be less Confused folkshence, less problems like suiciced, homicides Homelssnes etcas the problems WILL be in these children's livesas after all the nail that sticks out is the nail that gets hammered.Im that nail so I can say that... LOLCrista

rupunzel
rupunzel

As a child who grew up gender different and not knowing what was wrong, it caused an enormous amount of suffering until I transitioned in my late 30's. I have been post transitioned nearly 10 years now with no regrets. What some parents are doing by supporting their gender different children is very couragious and says a lot about allowing and supporting their child to discover who they really are. This also stops an enormous amount of suffering gender different children endure if not treated.

Individuals like Ken Zucker are part of the "old boy" pshrink network of Ray Blanchard, Michael Bailey, Paul McHugh, John Money and others who have so much suffering among those who are born gender different. They have been responsible for setting up many of the current medical protocalls and treatment plans that is responsible for gender different individuals and why it has been so difficult for gender different individuals to get proper medical treatment and denial of health care insurance coverage of gender related proceedures (hormones, surgery and etc). These individuals are "sex obessed" with their theories of gender different individuals. These are the same group of individuals who believe gender differnt ans children should be forced into the gender they were physically born with. They also believed intersex infants must be surgically corrected so they can develop into their expected gender roles. They cannot seem to understand incongrunce can exhist between gender idenity, sexual orientation and genitalia. Gender different children are a fact and reality, at the rate these children are progressing, gender differnt individuals who transition later in life will be a rarity. More and more doctors are taking gender differnt youth seriously and are beginning to treat them medically as required (therapy, hormones, hormone blockers and surgery). One day the time will come when individuals like Ken Zucker and others will be known for their incorrect treatment and theories regarding gender different individuals. To this day, they are sticking to their beliefs and not listening or seriously considering sucessful treatment of gender different youth and individuals. They appear to be too economically vested and arragont in their beliefs to hear otherwise.

Being born gender differnent appears to be far more common than is generally believed. The numbers can be as high as 1 in 500 individuals.

 
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