Little heroes? Or victims of an experiment?

Carolyn Moynihan
November 21, 2014
Reproduced with Permission

The skinny little kid rapping away on the stage has short spiky hair and baggy pants and jacket, just like a boy, and his voice hasn't broken yet so it passes as a girl's. Truth to tell, this youngster is a girl, except she thinks she's a boy, and, well, mom is cool with that and so, it seems, is everyone at else at Camp Aranu'tiq , "a camp for transgender and gender-variant youth", where she is performing her rap.

Alex can't be more than eight years old, a very early stage on the journey of discovering what sexuality means, but she badly wants to be a boy and has "always felt that way". That's what she told her mother sometime in the last year or so.

So I went to my mom that hot day in July / with a hope in my heart and a tear in my eye / Basically I said this girl is your son / and I've always felt this way and it hasn't been fun / We sat there together for a little while / I thought she was sad but then I saw her smile / She told me I was brave and that she was so proud / that I came to her so she could help me sort things out. My family and friends / were also on board / and the support that I got / just had me floored / And from that day on / I started my path /…

Camp Aranu'tiq is clearly part of that support. According to the website, those running the camps "do not formally talk about gender" but focus on "building confidence, resilience, and community for transgender and gender-variant youth and their families through camp experiences."

Confidence Alex certainly has, and why not? The Huffington Post calls the kid a "pint sized hero". Although kids at school, and even some teachers, not to mention other parents, might react against having to call a girl "he" and accept "his" use of the boys' toilets, these are all things recommended by experts and celebrated in popular media. A cultural movement that sees no essential connection between bodily sex and "gender identity" is sweeping away all objections.

Early this week the Australian public television programme Four Corners featured two children on the path to sexual transformation, and their parents, introducing them as displaying "a special brand of courage that is ultimately inspirational". A paediatrician, a psychiatrist and a judge agreed that some children should be helped along this path. Family Court Chief Justice Diana Bryant, whose court has to give permission for minors to have treatment, is convinced their condition is "innate" - that is, natural.

One child, Isabelle (formerly Campbell) is 11 and has been attending school for about a year under his chosen identity, dressed in a girl's uniform. At first there was some taunting from other children ("You've still got a [penis] even if you dress as girl") but after Isabelle wrote a heartfelt letter to the whole school it stopped. The principal of the small-town school outside of Melbourne admires the child's bravery.

Campbell told his parents (mother, Naomi, is a social worker, dad, Andrew, runs the family's bed and breakfast) just after his 10th birthday that he felt like a girl in the wrong body. That floored them. He had always rejected boys games and played girly dress-ups, so they had thought he might grow up homosexual and were prepared for, even happy about that.

Significantly, perhaps, it was their child's research on the internet that brought things to a head. Campbell found lots of websites and videos revealing that "something could be done about" his feelings, but it was American transsexual Jazz Jennings coming out on a television show that made the biggest impact. He saw an image of the happy, confident person he wanted to be and told his mother.

From a happy high, he fell quickly to a low as the family worked through the implications. He began saying he could not "see any future" for himself. "I think for me that was the point where the confusion kind of melted away a little bit and you just sort of think well God we've only got one job here and this is to help her create a future that she can live with, that she can thrive in..." Naomi told Four Corners.

Isabelle began seeing a team at the gender clinic at Royal Children's Hospital, Melbourne, headed by paediatrician Michelle Telfer. The process seems to have been led exclusively by the child, who now is anxious to start on the first stage of medical treatment, puberty blocking hormones (Gonadotropin). These will prevent Isabelle/Campbell's voice dropping and masculine hair growth, but the effect is reversible. In a few years time Isabelle could decide to be Campbell again, or go to the next stage of transformation, the "cross-sex hormones" that irreversibly feminise a male or masculinise a female, and at 18 would qualify for "sex change" surgery. The 11-year-old looks forward to both.

A growing wave

Isabelle, and the teenager, Jamie, who appeared in the same television programme - and, no doubt, young Alex in the video -- are among an increasing wave of children and adolescents receiving treatment at specialist public gender clinics around the world. Previously many would have been referred to private psychiatrists.

Dr Telfer points out that referrals to the Melbourne gender clinic have grown from one in 2003 to 100 new referrals this year. "And this is replicated across the Western world, so the same numbers are being seen across America, across Europe."

The Dutch team at VU University in Amsterdam - leaders of the current "free to be" approach to children with gender variant behaviour - saw an average of 40 children and 40 adolescents a year between 2004 and 2009 - up from just a couple when they started their first gender clinic for children in Utrecht in 1987.

The very existence of such centres, aided by the internet with its tales of gender anguish and rosy - or dark -- resolutions, and by cultural messages about the normality and even desirability of gender diversity, could account for the increasing numbers coming forward. Because of "social change" they feel safer about doing so, says Telfer. "[T]hey are becoming aware that we have treatments that can help them."

The latest edition of the psychiatric "bible", the DSM-V, has helped things along by discarding the diagnosis, gender identity disorder (GID), which implied mental ilness, in favour of gender dysphoria -- feeling unhappy about one's femininity or masculinity. Formerly a symptom of the underlying GID, gender dysphoria is now the only thing that health professionals should be interested in. The new manual says:

It is important to note that gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.

Does treatment really help?

But whether treatments based on the belief that transsexualism is just another point on the gender "spectrum" help individuals like Isabelle in the long run is by no means certain. A review of the literature published in the American Journal of Psychiatry in August 2012 points out that there are no randomised controlled studies of outcomes for any form of treatment, and that in the absence of such studies "the highest level of evidence currently available … is expert opinion."

One school of expert opinion, based on the traditional view that (GID) is a mental illness, would have encouraged Alex's mom and Isabelle's parents to seek professional help a lot earlier, when therapy could have helped resolve the problems giving rise to their child's identification with the opposite sex.

Dr Kenneth Zucker, a psychologist and head of the gender identity service at the Centre for Addiction and Mental Health in Toronto, in collaboration with psychiatrist Susan Bradley, has worked with over 500 preadolescent gender variant children. His therapy aims at reconciling children with their given sex through dealing with any family pathology and encouraging same-sex friendships. In his studies, he told the New York Times , 80 percent of these children grow out of behaviour like cross-dressing, while 15 to 20 percent continue to be distressed about their gender and may ultimately have sex change surgery.

His approach, Zucker believes, is kinder to the children because it protects them from isolation, unhappiness and low self-esteem until they are old enough to make their own decisions. Of course, if it is possible to make society affirm transsexualism that might achieve the same end.

Dr Paul McHugh of Johns Hopkins University is another prominent psychiatrist with long experience who insists that treatment geared to sex change does not help children. He would go further than Zucker and say that mutilating nature to relieve a mental illness does not help anyone , but rather harms them by reinforcing a delusion.

The risk of suicide

The Melbourne gender clinic team say they make their decisions by weighing the risks and benefits for each child. The risks they refer to are suicide and self harm among adolescents not treated, and regret among those who are treated. They cite very high odds of attempted suicide among those untreated (30 percent) and self harm (50 percent), and very low odds of regret after surgery: less than 0.5 percent.

It is not clear where the figures come from, although a 2012 study of LGBT youth mentions 30 percent. In any case it is believable that some adolescents with unrelieved gender dysphoria might attempt suicide, and the idea that his child might certainly helped the father of Isabelle to make up his mind about treatment.

On the other hand, a regret rate of 0.5 can hardly be taken at face value. Reviewing surgery cases at Johns Hopkins, McHugh found that most of these patients "described themselves as 'satisfied' by the results, but their subsequent psycho-social adjustments were no better than those who didn't have the surgery."

In his recent article he also pointed to a reasonably robust Swedish study published in 2011 which found that the suicide rate among people who had sex-reassignment surgery was 20 times higher than the non-transgendered population. The authors' conclusion confirms McHugh's own findings:

Even though surgery and hormonal therapy alleviates gender dysphoria, it is apparently not sufficient to remedy the high rates of morbidity and mortality found among transsexual persons.

It is a common mistake to give children and adolescents what they want rather than what they need. It might make them happy for a while but they are the ones who will have to live with the consequences of getting the wrong remedy. The Alexes and Isabelles of today are only children. They deserve better from adults than to become pawns in what is basically an experiment to prove a point about gender - an experiment with no risks at all for the adults themselves.