Lynne is a 10-year-old girl with tons of energy and two loving parents, Albert and Leigh. She's also transgender. Her parents uprooted their family and moved cross-country to an environment they thought would be more supportive for raising their child, but their story didn't start there; first, her father had to accept who she was, and her parents had to work with her doctors to develop a treatment plan that worked for her.
If it seems like more and more stories on transgender kids are popping up in the news, it's not just your imagination. Dr. Johanna Olson of Children's Hospital in Los Angeles says that: "I see between one and five new trans kids a week. So the growth is tremendous. We've had something like a 330 percent increase over the year of 2013. It's just phenomenal."
What's going on here? Is it a sudden explosion of trans kids, a shifting society that's more accepting and open to the idea, or something more sinister? Conservative commentator Laura Ingraham thinks she has the answer: Parents are "abusing" their kids by "pigeonholing" them into treatment at a young age. In one of her trademark rants, she displayed a general lack of understanding not just about what it means to be transgender, but of the complexities of treatment for trans kids.
She drew upon her own experiences growing up as a tomboy to suggest that girls who don't feel like wearing dresses and enjoy roughhousing with boys would today be swept up in a dizzying parade of hormone treatments rather than being allowed to be themselves. She's not the only conservative commentator who thinks this way; Bill O'Reilly has also echoed the "child abuse" claim, and it doesn't stop there. Writing for the "National Post," Barbara Kay said that:
But the movement has swung too far. Some advocates now want social encouragement for anyone, even toddlers exhibiting transgender tendencies, to embrace what they believe is always an immutable trait. They feel hormonal treatment to delay puberty and later, sex-reassignment surgery, is a human right. Many universities now offer gender-reassignment surgery coverage. Several states — California, New Jersey and Massachusetts — have passed laws barring psychiatrists, even if parents request it, from attempting to re-orient children toward identification with their sex.
She goes on to cite radical feminists and notes that "many apparently transgender children accept their biological identity at puberty, and many adults express regret over their surgeries." Because radical feminists, as we know, are a nonbiased and completely reasonable source of information about transgender identities and the lives of trans children.
Ingraham, O'Reilly, Kay, and people like them don't understand some fundamental, and very important, information about how transgender children are handled when they interact with the medical community. Their commentary spreads lies and misinformation which makes it harder for trans kids to access treatment and respect, and it fuels obnoxious and persistent hatred of trans kids and their parents. And it elides the real child abuse that's involved in trying to force trans kids to be people they are not, and never will be.
“When I finally got the shirt over his head, I forced it over his head, the fight just left him,” Albert remembers, blinking back tears. “He seemed defeated. His body went limp, and he looked up at me.”
“I hate you,” Reed said.
“What I was doing, it was a form of abuse,” Albert says. “I felt helpless. I was really lost.” (source)
What happens when a child might be transgender? It starts with family members, who have to come to terms with the fact that a child in distress over gender issues is exhibiting more than gender fluidity (which is extremely common among children). Those family members, in turn, have to find mental health professionals who specialize in working with youth on gender issues.
If you believe conservative commentators, the next step is hormones, but that's not actually how it works. Instead, children and their families go through a lengthy evaluation process to explore what's going on. A little girl who likes to wear pants isn't necessarily transgender. If that same little girl insists that she's a boy, wants to be called by a boy name, and gets extremely upset when her breasts start developing, that's a sign that something more complicated is going on.
The next step is counseling. A lot of it. For both trans kids and their parents, this process slowly leads to transitioning; letting a child live as the gender she truly is, but without any explicit medical interventions. Sometimes this involves switching schools or changing communities to give a child a fresh start, or to deal with pervasive bullying. Suddenly, parents are facing issues like battles with school administrators over which bathrooms their children are allowed to use. Early transition can be incredibly tough for trans people of any age, and for children surrounded by adults who rule their lives, it can get even more complicated.
As puberty starts to approach, it's time for the conversation to get more serious. The standard of care for trans children in this situation can involve what are known as cross-sex hormones, so that puberty involves the development of secondary sex characteristics (trans boys, for example, will experience a deepening of their voices and the development of more body hair). More often, though, trans kids are put on what are known as puberty blockers.
These medications buy them time by stopping puberty before it starts. Parents and medical teams recognize that gender identity is hugely complicated, and that kids may not always be in a position to make independent decisions with potentially huge long-term implications. Starting hormone replacement therapy early can destroy fertility, for example, and lead to irreversible changes -- being on androgens, for instance, leaves a legacy that won't resolve even if a patient stops taking them.
Using blockers creates an opportunity for children to continue going to therapy, and to continue working with their care providers. Their parents are typically involved intimately in this process, and only once it's clear that a child is really ready to start medical transition do the cross-sex hormones get whipped out. They're started at low doses to give the child time to adjust and also see if they're addressing psychosocial issues. If the child progresses well on hormones, gender confirmation surgeries may be considered, though it's not uncommon for trans kids to wait until their age of majority before getting surgery.
This is not a hasty or ill-considered process, and within both the transgender and medical community, debate continues over the best way to provide care to trans children. No one wants to see kids forced to live as a gender they are not -- whether they're trans kids and their parents refuse to recognize that, or they're cis kids and their parents push too hard for transgender recognition. That's why such care is taken throughout medical evaluation and treatment to put the needs of the child first, and to draw upon the child's self-reported identity along with the experience of the care providers.
Trans kids are referred to experts in adolescent and child transgender issues for a reason. This is a highly specialized medical field that balances not just medical skills, but also psychiatric, psychological, and social ones. There's nothing about this slow, carefully-conducted process that's abusive, though.
One might argue instead that bullying trans children is abusive, as is denying their gender identity. Forcing children out of school is abusive, as is refusing needed medical treatment. Trashing transgender children on national media is abusive.
Don't worry, Laura: No one's coming after you with a testosterone-filled syringe.