Girl/Boy Interrupted

The younger the patient, the more likely that the child will change his or her mind, says Ken Zucker, a psychologist who has treated 500 gender-variant children and serves as head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto.

"I just haven't seen these kids where at age 10 I'm convinced that this is the way they're going to be." Zucker says. "Doing this type of endocrine treatment seems pretty cool, but it tends to ignore the possibility that psychological therapies can help kids resolve their gender identity confusion."

So it comes down to an ethical dilemma of choosing the lesser evil: wrongly suppressing puberty in kids who will grow out of their gender variance or refusing treatment to all. Peter Lee, a professor of pediatrics at Penn State College of Medicine who has treated three young transgender teens with Lupron, knows on which side he'd rather err. Twenty years ago, a biological female who identified as male came to him in late adolescence with "so much pain and agony with her development in the wrong direction" that she later committed suicide.

"So you're balancing that against the risk [of wrongly putting someone on Lupron]," Dr. Lee says, because with Lupron, "sooner or later in this realm, if you deal with enough individuals, you will make a mistake, and will have judged incorrectly."

Few of the transgender adults interviewed for this story said they had the consciousness at such a young age to know what transgender was in the days before Internet communities and Oprah specials, let alone that they would assume this identity. While many concede that kids who receive this treatment will have an easier time in puberty and passing in the years beyond, some question how transitioning so early will change a community where having lived on both sides of the gender line is part of a collective identity.

After living 17 years as a male, followed by years of hormones to transition, Alexis Rivera of the Transgender Law Center says she decided to go off hormones and settle into a space somewhere between male and female, and now at 29, has proudly done so.

"If medical technology keeps advancing, are we going to eradicate transgenderism?" Rivera asks. "The younger the transition starts, the younger you start socializing a biological female as a boy, they're not going to have that transgender identity. They're not going to have to walk this earth as their genetic sex."

Juan struts across the parking lot with the lumbering gait of a macho guy in training, with an eighth-grade graduation gown flung over his shoulder and a rhinestone glistening in one ear. He slaps five and curls fingers with a friend and then hugs a pretty classmate in heels who poses over Juan's shoulder so his mom can snap a photo.

"She's taller than you," blurts out Juan's seven-year-old niece.

Not what a 14-year-old guy wants to hear, but Juan doesn't flinch. In this life, at this South Bay school, his identity is solid, his male status a commonly held truth. But just blocks and three years away sits Juan's old elementary school, where the truth was different. There, kids knew him by another name. There, kids knew him as a girl.

Juan has been on Lupron for two and a half years, sometime after he took down the pictures in the house where he appeared as a girl, said goodbye to his fifth-grade classmates for good, and showed up for sixth grade with a new identity.

Without the monthly Lupron injections, Juan would have breasts by now. He would most likely be shaving his legs, whereas they still only have the slightest whisps of hair. Without the nightly shot of the growth-stimulating hormone, he would likely be shorter than he is, and he's still only 5-2, just taller than his mom. But because of Lupron, he passes as 100 percent boy, and for now, everything rests on nobody knowing any differently. (His name has been changed for this story.)