Even before Bruce Jenner transitioned to Caitlin, buzz about transexuality began. This was due, in large part, I believe, to the fact that questioning gender identity taps into one of the deepest wonderings of every man and woman: who am I? Astute and loving parents are additionally burdened with wanting to help their children answer this question. It’s no wonder that many have become unsettled. Every parent wants his or her children to grow up to be happy, well adjusted and comfortable in their own skin.
I have received many questions from parents about what to say, how to respond and how to know if their son or daughter is transsexual. I thought that it was time to bring reason to this dilemma from a medical standpoint.
I classify children who say they identify with the opposite sex into two camps. First, there is a group of children who are intrigued with the opposite sex and identify with it in outward ways. They dress, act and wish to be like the opposite sex. This happens usually between the ages of 5-12. These are the girls who act like tomboys and the boys who run around the house or neighborhood in their sister’s dresses. I had such a patient. When he was 5 years old, he routinely wore his sister’s dresses. His mother let him wear them everywhere except at school. The boy grew up to be a hockey player and during one of his office visits at the age of 18, I asked him why he wore his sister’s dresses when he was young. His answer was immediate. “Oh that’s easy to answer” he said, “I was going through a phase when I detested wearing underwear and wearing dresses felt really good.”
While adults might have interpreted his behavior as gender confusion or dysphoria, he just liked the feel of wearing no underwear. This should be a lesson to zealous parents. If that young man had been 5 years old in 2016, his mother would have most likely hauled him into a psychiatrist’s office but in her wisdom, she let him play and grow past his intrigue.
Once children like this young man go through puberty and hormones surge, they go back to embracing their natal gender. This behavior is not uncommon and includes the overwhelming majority of children who experiment with gender identity.
Then there is another much smaller and more rare group of children. These are the children who, during their preschool years live with intense feelings that they are the opposite sex. They have gender dysphoria and they consistently and persistently refuse to accept their genetic (or natal) identity. Dr. Gayathri Chelvakumar of Ohio State recently wrote in Pediatric News “many youth who have gender non-conforming identity in childhood will not go on to have it in adulthood.” This is one of the reasons that I am against gender reassignment in childhood.
During their prepubertal years, these children live with deep inner conflict and confusion. They need help. But what type of help? This is the million-dollar question. Does the gender dysphoria come from hormones? Psychological issues? Social issues? The truth is, even the best and brightest of physicians don’t know. Some physicians and social scientists encourage gender reassignment and some states even go so far as to make it illegal for psychologists and psychiatrists to counsel these children to accept their genetic identity. My question is: how can we legislate against treatment of a problem where don’t know what causes it, have a difficult time even diagnosing it and certainly don’t know the best treatment outcomes? This is where political agendas need to stay out of the practice of medicine. If the treatment was proven and clear, I can see the reasoning behind legislation but when a problem like gender dysphoria is so poorly understood, the only reason the government would intervene is to enforce an agenda.
Let’s assume for a moment that indeed gender dysphoria can be completely erased with gender reassignment. That an 11-year-old boy who believes he is living in a girl’s body simply needs to accept that he is a girl, have surgery to remove his genitalia, get hormone shots and go on to live a happy life. His school administration and parents see him as a girl and pressure other adults and children to allow him to be on the girl’s soccer team, use the girl’s bathroom and have sleepovers with girlfriends. This is exactly where our culture is: the pressure is on to not only accept but advocate for youth with gender dysphoria to change to the gender they believe themselves to be. Simple, right?
What happens to the little boy when he goes to use the girl’s bathroom or change in the locker room for soccer and his girlfriends see his penis and scream? Is he no less traumatized than if he had used the boy’s bathroom with his boyfriends? Absolutely not. I submit that the only reason he is subjected to this kind of humiliation is because of adults who have an agenda to gender-neutralize our culture and use young children like him as pawns. Shame on them. If this boy were my patient, I would encourage his parents to protect him at all costs from announcing his pain to the whole world. If Bruce Jenner wants to air his struggles, have at it but every adult should keep children as far away from “outing” their struggles as they can.
It is peculiar to me that in a medical age when we point with increased frequency and focus on genes as the engines responsible for medical and psychological issues like: depression, cystic fibrosis, breast cancer, bipolar disorder, etc., that we insist that in the case of gender identity, the genes of the person don’t matter. This is a scientific contradiction that must be acknowledged.
Here’s the bottom line for parents. The overwhelming majority of children who dress and behave like the opposite sex for a while do not struggle with serious gender identity issues. Many go through stages of wanting to be like the opposite sex but come out of them usually within a year. One of the worst things that parents can do when their children do this is over react. When parents over read their children’s behaviors and feelings, they bring anxiety onto them and themselves. Don’t do this. Support your child and love him or her always. But simply because you hear about transgender issues constantly, don’t assume so quickly that one has landed in your home. And if your child lives with deep, unabating inner conflict, get him help. Protect him and never allow him to be a social pawn. Encourage your children to focus on the deep things of life: their character strengths, intellect and even their spiritual lives. Our culture is so sex-centric that we have become obsessed with sexual activity, sexual identity, sexual orientation, gender identity, gender dysphoria, etc., etc., that we all feel a little crazy. And when we feel crazy, so do our kids.