Transgender identity in kids.

[Antiquehunter]

Giving hormone blockers to a pre-pubescent patient is "hormone therapy". I think you might be confusing that with "hormone replacement therapy", another form of hormone therapy which is used with more mature TG candidates who are determined to continue farther with gender reassignment.

Correct - I am making a (poorly expressed) distinction between hormone therapy to delay purberty, vs administering testosterone to a young woman to lend more masculine traits (or whatever hormones are used as part of replacement therapy).

 

[Babbylonian]

My short association with a girl "scouting" group:

I'm a straight dude and I've never had any particular interest in being or looking like a girl/woman, but in the 1st/2nd grade I was a member of the Brownies, the female equivalent of cub scouts. I joined because I talked to some of the girls who showed up to school in their uniforms and it sounded like a lot of fun. IIRC, my mom asked the lady in charge of the group if I could join and I don't remember there being any issue at all. I enjoyed the heck out of it and I might have even stayed in the group longer if we hadn't moved.

 

[ponderingturtle]

My short association with a girl "scouting" group:

I'm a straight dude and I've never had any particular interest in being or looking like a girl/woman, but in the 1st/2nd grade I was a member of the Brownies, the female equivalent of cub scouts. I joined because I talked to some of the girls who showed up to school in their uniforms and it sounded like a lot of fun. IIRC, my mom asked the lady in charge of the group if I could join and I don't remember there being any issue at all. I enjoyed the heck out of it and I might have even stayed in the group longer if we hadn't moved.

And my cub scout den had an un official female member in it, the twin sister of one of the boys.

 

[Jr1985]

Do we have any idea what causes transgenderism? I assume it has something to do with the brain development? I.e. a male brain developing in person with a female body?

 

[Soapy Sam]

As a gay man myself, I find it awkward that I'm so uncomfortable with transgendered issues, and also that I find myself perhaps on the more conservative side of the spectrum than usual.

As a boringly straight male, I share your discomfort.

Perhaps such discomfort is just a matter of unfamiliarity and has little to do with the sexual orientation of the observer?

 

[Antiquehunter]

@Soapy - oh I'm sure its unfamiliarity. Its just as part of the LGBT community myself, I feel like I'm supposed to be as familiar with these things as I am with 80's music, how to make a perfect cocktail, and unfeasibly good taste taste in bed linens.

 

[Dessi]

What I still find troubling however, is that Kim has lost full use of her genitals, before she ever really had an opportunity to take them for much of a test drive.

I can assure you, most tg women don't find that much of a problem.

And that, even with all the psychological opinionating, and no matter how sure young Kim is and was, really is troubling for me. My understanding (and please correct me if I'm wrong here) is that for m to f transsexuals, there is limited sexual pleasure derived from pentrative intercourse with the reconstructed genitals.

See Lynn Conway's page on sexual arousal in post-operative transgender women (NSFW):

Many people simply assume that the loss of the external male genitalia will result in a complete loss of sexuality. This very naive myth unnecessarily frightens many preop women, and it also furthers prejudice against postop TS women, who are often thought of by the general public as having "desexed themselves".

Certainly a typical male would suffer a catastrophic impact on body image and libido from the loss of his external genitalia. However, it has long been known that with counseling and practice, even males who have lost their genitalia to cancer can recover the capability for arousal and orgasm.

Furthermore, intensely TS women are not "regular guys". They do not suffer a negative impact on body image as a result of SRS, but instead find a greatly enhanced body image. The experiences of countless Hijra girls in India demonstrates that even primitive forms of SRS do not desex transsexual girls and in fact helps many of them. SRS has the opposite effect on intensely TS women as would the emasculation of a typical male. SRS usually releases and enhances the libidos of TS women, enabling them to frequently and fully "turn-on" and enjoy their physical sexuality and lovemaking, including achievement of orgasm during intercourse with a partner. [...]

Research subjects were instrumented with electronic sensors (using measurement techniques evolved from the pioneering work of Masters and Johnson in their early studies of orgasm), and then engaged in masturbation in a comfortable, private environment in an effort to achieve orgasm. A number of the postop TS women, including Lynn, achieved orgasm as measured directly by Rom's instrumentation. Lynn's case was particularly important, since she demonstrated that the capacity for very intense orgasms can endure for many decades after SRS (Lynn was 31 years postop at the time of this research). Dr. Birnbaum's work demonstrated scientifically for the first time what many postop women and their lovers have known all along, namely that strong orgasms can be fully enjoyed by many TS women.

Abstract: First physiologic study of orgasm in postoperative male-to-female transsexuals.

[...] Results: Of the eleven postoperative male-to-female study group participants, eight self-reported orgasm and three of these eight produced orgasmic contraction episodes similar to those produced by control group participants in this study and subjects in previous physiological studies of orgasm. Furthermore, no statistically significant differences were found between contraction patterns produced by study and control groups in terms of duration of orgasmic contractions, intraorgasmic amplitude changes, number of orgasmic contractions per series, mean intervals between the first four contractions, mean intervals between all contractions, or orgasmic heart rates. Conclusions: Data from this study strongly support the hypothesis that orgasmic capacity can be retained and/or gained after sex reassignment surgery in the postoperative male-to-female transsexual.​

In other words, most tg women have sensate organs and are capable to deriving sexual pleasure at least as well as genetic women.

As a gay man myself, I find it awkward that I'm so uncomfortable with transgendered issues, and also that I find myself perhaps on the more conservative side of the spectrum than usual.

No worries. Most people never have never met (or realized they've met) a transgender. And when they do, they quickly realize they're just uninteresting as everyone else.

 

[Antiquehunter]

Well, you learn something new every day. I did some googling around, and it does appear that a significant majority of m to f and f to m transsexuals are able to achieve orgasm with a high degree of regularity post-op. Fascinating.

 

[ponderingturtle]

Well, you learn something new every day. I did some googling around, and it does appear that a significant majority of m to f and f to m transsexuals are able to achieve orgasm with a high degree of regularity post-op. Fascinating.

My understanding was the FTM genital reconstruction was more risky in this regard, so less common. See examples like the Pregnant Man who clearly did not have this procedure done.

 

[Checkmite]

I am fully against hormone blocking "therapy" for prepubescent children because it is a cosmetic medical procedure and I am opposed to all cosmetic and medically unnecessary procedures being performed on children, period. 18 or over only. I could be argued down to 16 - maybe. It's nothing to do with transgender at all; if an 8 year old girl were "adamant" that she should have breasts already, I would not support estrogen injections to force early puberty or breast implants, nor testosterone treatments for 11 year old boys who are "absolutely sure" they should have a larger penis. Obviously if the young boy is comfortable self-identifying as a girl despite his body parts, growing a gender identity is clearly not pegged to his physical appearance and rather than insisting on "fixing" such individuals with medicine and surgery, when they start to feel awkward about their bodies they need to be taught the exact same thing that every other kid who goes through that stage of his or her life is taught about learning to deal with and accept the way they look. There's not a 10 year old in the entire world who would come up with the idea of delaying puberty by himself; I'm pretty sure that if it weren't for their well-intentioned parents warning of the "dire consequences" of puberty, they would continue to accept living with male genitalia just the same as they've been for their entire lives up to that point. We can't both claim gender identity is not tied to ones biological sex AND insist that the healthy thing to do is interfere with the natural processes that come with that biological sex for the sake of "fixing" kids with a different gender identity.

Further, I independently question the assumption that using hormone blockers to delay puberty is entirely reversible. I'd like to see some case studies of children who received these hormone blocking treatments through typical puberty age, then decided to stay boys, stopped the treatment, and managed to completely develop into fully functional male adults without any complications or failure of certain organs to mature. Does the brain continue to signal the start of puberty continually until it starts, however long that takes, or does it turn off the buzzer after a certain length of time and after that whatever hasn't received the cue is stuck in a prepubescent state?

 

[Dessi]

I am fully against hormone blocking "therapy" for prepubescent children because it is a cosmetic medical procedure and I am opposed to all cosmetic and medically unnecessary procedures being performed on children, period. 18 or over only.

Cosmetic procedures, particularly the kinds to correct deformities in children, have an incredible therapeutic benefit. Case in point:

6 months old:

1 year old:

8 years old:

Many, many parents get their kids cosmetic procedures at some point in their life. Braces for teeth, acne medication, are common. Sometimes more serious issues like cleft lip and palate, ear deformities, hand deformities, burn scars, tumors. Many of these issues will never physically impair a person, only cause emotional and social distress.

It seems unnecessarily cruel, especially when medical intervention is safe and available, "sorry kid, purely cosmetic". Its like you object out of principle simply for the sake of objecting without justifying your opinion.

Obviously if the young boy is comfortable self-identifying as a girl despite his body parts, growing a gender identity is clearly not pegged to his physical appearance and rather than insisting on "fixing" such individuals with medicine and surgery

No part of this statement makes sense. Every transgender woman self-identifies as a girl regardless of their body parts, and their simultaneously interested in their physical appearance. This is true for transgender children as well: they self-identify as a member of their target gender in spite of their body parts, they nearly always adopt the social norms appropriate for their target gender and age, and they (and in general all kids) have a very strong interest in their physical appearance, their clothes their wear, their hair, etc.

Hormone blockers in transgender kids can avoid the development of secondary sexual characteristics, such as breasts in girls, lowered voice and facial hair in boys. Puberty can be absolutely horrific. Being a girl, but watching your body "man up" is the worst possible fear, its like watching your body physically mutilate itself and there's absolutely nothing you can do to stop it.

Seriously, what conceivable advantage do you gain putting anyone through that? Especially when its easy and safe to avoid?

There's not a 10 year old in the entire world who would come up with the idea of delaying puberty by himself; I'm pretty sure that if it weren't for their well-intentioned parents warning of the "dire consequences" of puberty, they would continue to accept living with male genitalia just the same as they've been for their entire lives up to that point.

Or they'll just do what 41% of other untreated transgender people do and attempt suicide.

We can't both claim gender identity is not tied to ones biological sex AND insist that the healthy thing to do is interfere with the natural processes that come with that biological sex for the sake of "fixing" kids with a different gender identity.

Yes we can. Gender identity is NOT tied to biological sex, and simultaneously hormone blockers to delay puberty and secondary sexual characteristics have an enormously positive therapeutic advantage and promote emotional health.

There are 1000s of kids who grow up into physical healthy adults as a result of hormone therapy before puberty. The Harry Benjamin Standards of Care, which are used by all endocrinologists, surgeons, and counselors who specialize in transgender health, as well as all scholarly literature on the topic indicate that the maximum therapeutic advantage occurs when it is given as early in life as possible, preferably before puberty.

Further, I independently question the assumption that using hormone blockers to delay puberty is entirely reversible. I'd like to see some case studies of children who received these hormone blocking treatments through typical puberty age, then decided to stay boys, stopped the treatment, and managed to completely develop into fully functional male adults without any complications or failure of certain organs to mature. Does the brain continue to signal the start of puberty continually until it starts, however long that takes, or does it turn off the buzzer after a certain length of time and after that whatever hasn't received the cue is stuck in a prepubescent state?

I'm at work right now and not able to search, but what you're interested in is documented in the Standards of Care:

Fully Reversible Interventions. Adolescents may be eligible for puberty-delaying hormones as
soon as pubertal changes have begun. In order for the adolescent and his or her parents to make
an informed decision about pubertal delay, it is recommended that the adolescent experience the
onset of puberty in his or her biologic sex, at least to Tanner Stage Two. If for clinical reasons it
is thought to be in the patient’s interest to intervene earlier, this must be managed with pediatric
endocrinological advice and more than one psychiatric opinion.
Two goals justify this intervention: a) to gain time to further explore the gender identity and
other developmental issues in psychotherapy; and b) to make passing easier if the adolescent
continues to pursue sex and gender change. In order to provide puberty delaying hormones to an
adolescent, the following criteria must be met:

1. throughout childhood the adolescent has demonstrated an intense pattern of cross-sex and
cross-gender identity and aversion to expected gender role behaviors;
2. sex and gender discomfort has significantly increased with the onset of puberty;
3. the family consents and participates in the therapy.

Biologic males should be treated with LHRH agonists (which stop LH secretion and therefore
testosterone secretion), or with progestins or antiandrogens (which block testosterone secretion
or neutralize testosterone action). Biologic females should be treated with LHRH agonists or
with sufficient progestins (which stop the production of estrogens and progesterone) to stop
menstruation.

 

[Tsukasa Buddha]

There's not a 10 year old in the entire world who would come up with the idea of delaying puberty by himself...

Er, I did. Puberty can be a very bad thing for a TG kid emotionally and psychologically.

 

[Rairun]

I don't see how any of the behavioral stuff (such as joining the girl scouts) is an issue at all. Let kids do whatever they want to do, let them identify however they want, and then see if it makes them happy. Most problems will be a result of other people's bigotry, and as a parent you really don't want to take their side instead of your child's.

The tough decision really is whether to transition or not. I'm not transgender, and I have little experience with transgender people, but when I was 17 I befriended a girl who was a few years younger than me. I think I was the only person who knew she craved one of two things: to become a boy, or to die. It was a difficult time. Long story short, ten years later, she is now glad she didn't transition. She seems fine presenting herself as a she , even though her gender identity isn't exactly normative. Obviously this isn't how it happens for many people, but it seems clear to me that it's better to avoid complicated medical procedures if at all possible.

In other words, if I wanted to have children and he or she was transgender, I wouldn't know what to do--so I can't think of a better idea than delaying puberty. That would give them more time to make the decision. It might not be enough time for some (it wouldn't have been for my friend), but it's still something. It might well be enough for many people.

 

[BobTheCoward]

Seriously, what conceivable advantage do you gain putting anyone through that? Especially when its easy and safe to avoid?

What criteria do we use to identify what is the appropriate path for treating a disorder? In the case of Hallucinations, society chooses to suppresses them. In the case of gender identity disorder, society chooses to encourage it.

That is the part that makes no sense to me. Is it the right course or merely the most convient? If a pill came out tomorrow that suppressed gender identity disorder is that any more or less more moral/ethical than current procedures?

 

[Gazpacho]

What criteria do we use to identify what is the appropriate path for treating a disorder?

The same criteria that are always used: the patient's prognosis and quality of life. If a TG is already making suicide attempts, it would be stupid to deny him or her the choices that might put a stop to that.

In the case of Hallucinations, society chooses to suppresses them. In the case of gender identity disorder, society chooses to encourage it.

In the case of hallucinations, doctors typically find that the patient's quality of life is improved by suppressing what their body does naturally. In cases of gender dysphoria, doctors often reach the same conclusion. That's not really inconsistent, is it?

 

[Babbylonian]

That is the part that makes no sense to me. Is it the right course or merely the most convient? If a pill came out tomorrow that suppressed gender identity disorder is that any more or less more moral/ethical than current procedures?

Is a pill like that scheduled to come out tomorrow? Next week? In the next 10 years?

How much misery should someone with this problem have to suffer while deferring treatment until something "better" comes along? To me, this is no different than suggesting someone with a tumor should wait until a pill comes along to destroy the tumor instead of having a surgeon take it out.

 

[BobTheCoward]

Is a pill like that scheduled to come out tomorrow? Next week? In the next 10 years?

How much misery should someone with this problem have to suffer while deferring treatment until something "better" comes along? To me, this is no different than suggesting someone with a tumor should wait until a pill comes along to destroy the tumor instead of having a surgeon take it out.

I agree. That is why I didn't suggest that. Its a serious question about how society constructs and treats mental health.

I would expand it to homosexuality. Certainly, being homosexual creates mental stresses for youths and probably meets the criteria of mental disorder.I agree with society's current course of recognizing equal status to LBGTQ humans.

But these ideas of treating transgender issues with medication to achieve the transgender's wishes brings some interesting questions. What if we could treat the mental disorder of homosexual teen distress with a pill but that pill made them heterosexual? It certainly achieves the same results as anti-hallucination medicine and the transgender hormone therapy. So many philosophical questions.

 

[Babbylonian]

I agree. That is why I didn't suggest that. Its a serious question about how society constructs and treats mental health.

While [US] society has a role in how it supports mental health and pays for treatment of problems, treatment isn't strictly its purview, which is why your serious question seems fairly meaningless. If such drugs existed, their use, once the FDA certifies safety and efficacy, would be handled by doctors and patients. Unless a particular member of society falls into one of those two groups, it's none of society's business.

 

[Rairun]

But these ideas of treating transgender issues with medication to achieve the transgender's wishes brings some interesting questions. What if we could treat the mental disorder of homosexual teen distress with a pill but that pill made them heterosexual? It certainly achieves the same results as anti-hallucination medicine and the transgender hormone therapy. So many philosophical questions.

I don't think we, as a society, would have to make a choice at all. Health and disease are arbitrary constructs--a heart, for example, isn't "designed" to pump blood. Pumping blood is simply what it does most of the time (which can be explained by evolution, but not justified in a "should" or "should not" sense). In short, we only consider a beating heart a good thing because most of us don't want to die.

Things are more complicated with transgenderism because there is no widely accepted set of values or desires (like "I don't want to die"). Some people might view their transgender identity as flawed; other people might see their bodies as the real problem. There's no right or wrong answer. If someone thinks it's better to undergo a personality change, they should get that (if we had the technology). If they cherish their personality, they might consider a transition a better option. I don't think it's up to us to decide what is a disorder and what isn't.

 

[BobTheCoward]

Unless a particular member of society falls into one of those two groups, it's none of society's business.

I am less concerned with how society should respond and more concerned with how it does and will respond. If it was just as you described it between a doctor and a patient, there would be no pro-life movement. There is a transgender community. There is a homosexual community. There isn't a auditory hallucination pro-rights community (that I know of).