Trans children, what’s the correct course?

There was recently aired a BBC program on the debates around properly treating trans kids. I’ve read reviews, but the program itself can’t be seen outside the UK. However, we can talk about the subject without getting too deep into a program.

On the one side is the thought that a gender dysphoric kid should always be normalized into their target gender. The notion of anything that would impede that transition is seen as cruel, unwise and very backward. Yet the fact that a significant percentage of these children do not reach adulthood with a transgender identity (usually identifying as gay or bi) indicates that the principal of first doing no harm is important here.

The mainstream medical community deals with this by not having any sort of permanent intervention for children. No hormones and no surgery. This is clearly the right thing to do until such a time that we can reliably predict which children will grow up with gender dysphoria. Until such a time that we can do so, we may irreparably damage a growing child.

As far as I’m aware, no surgeon will perform reassignment surgery on a child. The minimum age is somewhere around eighteen. In the meantime the child will be given puberty blockers until that time. It is incredibly important that the young adult be at an age to make a well informed consent themselves.

Zucker, who was the focus of the BBC program (as I understand it), was controversial. There is an article in the New Yorker that  calmly discusses Zucker’s portrayal in the piece. The piece itself let’s Zucker speak directly. The problem is that there is so much controversy that getting an unbiased view, including from Zucker himself, seems almost impossible.

Whatever views Zucker espoused, it is important to think about what transition means for a child, or for that matter, an adult. A parent needs to weigh the social stigma of being trans, being caught up in national debates that will might damage their self image, and possible ostracism by peers and their friends and relations, against the good of acknowledging the child’s gender identity.

But not taking any action, or not allowing the child a social transition after organic causes are ruled out, and the persistence of their dysphoria well established is cruel. Deciding where that dividing line is ought to be the debate.

We also have to guard against confirmation bias and implied causality from viewing things in the wrong way. Adults who are transgender very often (true for me) say their first memories of feeling misplaced was in early childhood. This correlation rings true of course. But a child who feels transgender may not end up being that adult. The debate about the percentage is almost beside the point, even 10% not being transgender as adults would be an excellent reason to wait as long as possible, and this is the  justification for no permanent procedures without the child being old enough to offer informed consent.

Last, there really are organic problems like schizophrenia that can present as a gender dysphoria. Not having a child worked up for other mental health problems is clearly a mistake. As a transwoman the last thing I want to see is an equating of  transgender and mental disorder, but doesn’t mean it isn’t ever true.

Parents need to love and support their children. For transgender children what they need to do isn’t always clear. We can hope that future  advancements will provide more solid information for their decisions than are currently available. In the meantime, we have to do the best we can while avoiding harm. A difficult line to walk for any parent and any caregiver.

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3 thoughts on “Trans children, what’s the correct course?

  1. Your post (as always is very thoughtfully and well written). What you write is true. i know i was gender dysphoric when i was 5. i am 58 and though i am not brave i have yet to do anything about it. My feelings of being a girl/woman simply won’t go away. Far too often i look back and think i wish that i had support when i was 14 and actually found out that i wasn’t alone. For too long i hated myself and tried to run from me. For the last 20 years i have grown to love me…………………..sigh.
    Please keep writing.

    Liked by 1 person

  2. It is interesting that this programme is not view-able outside the UK. It was made by BBC World and featured comments from Canadian ‘experts’. It did give the impression that both surgery and hormones were available to children and never made the true facts explicit. Whilst I believe it is valid for a public service broadcaster to make a programme about a minority view ‘discredited’ expert, it is not OK to broadcast it within the UK without a clear and un-ambiguous statement on current policy which is that as you say no one under 18 will get surgery, children, 16 for hormones; under 16 children may get puberty blockers but will have been closely assessed by psychiatrists and other medically qualified folk.

    Like

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