Notes on transgendered children

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I recently read Hanna Rosin's piece in The Atlantic about transgender children. The subjects of the piece are children who, from a very young age (< 5) insist that they are—or want to be—the other gender. Even for parents who are basically cool with the concept of the transgendered, this seems to still require some pretty difficult decisions. My take home points from the article go something like this:
  • The current state of sex reassignment (yes, I know that some trans-people prefer the term "gender confirmation surgery", but as far as I know, sex reassignment is still the standard term) technology isn't that great. Certainly, a post-treatment female (i.e., someone who was born male) isn't as much like a biological female as you would like.
  • Sex reassignment treatment works a lot better if you haven't gone through puberty yet.
  • It seems fairly problematic to let children this yound make judgements about something as irreversible as having their genitals reconstructed. Moreover, according to this Endocrine Society review, a significant fraction of children diagnosed with Gender Identity Disorder (GID) experience spontaneous remission post-puberty.
  • There are treatments available which will block/delay puberty, so at least the children are old enough to have a better chance of making their own decisions, though if it's puberty itself that realigns the child's psychological identity with their biological identity, it's not clear that helps as much as you would like. Anyway, if that happens, you can just stop the hormone blockers and let puberty proceed normally.
  • The children in question seem much happier when they're allowed to dress and act as the gender they want to be.
  • There are some psychological treatments which may (or may not) increase the chance that the child will become happier with their biological identity, but they sound pretty uncool (e.g., encouraging extreme traditional gender roles), and after reading the Atlantic article, I came away with the impression that the treated children weren't that happy as adults. But this seems inconsistent with letting them assume their desired gender roles in the interim.

One more note: some of the children in this article seem to have adopted stereotypical opposite sex behaviors incredibly early (like 2-3 years old.) I don't know what that tells us about how preferences for such behaviors get determined, but it's interesting.

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