Transgender reversal: It's not so easy to become a girl again

Carolyn Moynihan
May 2, 2017
Reproduced with Permission

A 21-year-old girl was given nearly 600 column centimetres in last weekend's edition of New Zealand's largest newspaper. That's almost two full pages, including photos, of the broadsheet format used by the NZ Herald on Saturdays. What had she done? Sailed solo around the world? Won an international fashion prize? Joined the Trump administration as youth adviser?

None of the above. Zahra Coope r has done something extremely rare, according to the Herald's research with, admittedly, rather sketchy statistics: after transitioning to male, she has reverted to female, though not without seemingly permanent effects from the testosterone she took for eight months. Her male voice surprises people when she "dresses female". She would "love to be seen more as a female" but…

Hers is a cautionary tale about childhood problems, self-diagnosis via YouTube, wrong professional diagnosis and inadequate professional care. Yet -- though she warns against applying the obvious lessons more widely - her experience could help other young people to avoid a step they may regret for the rest of their lives.

Zahra was born in a rural New Zealand town. Her family split up when she was young. She was shy and struggled to make friends at school. Always a tomboy, she hated the changes to her body that came at puberty and thought she was lesbian. Looking for clues on the internet she came across videos about transgender people and became convinced she was "trapped in the wrong body". Meanwhile she was bullied at school and online for being "weird".

At 18 she asked her family to start calling her "Zane" and use male pronouns. By then she was living with her grandfather, Victor Rakich, a retired farmer who had "taken her in" four years earlier. He told her straight that he could not cope with treating her as a male, although it would not make any difference to his love for her and support.

At the same time Zahra took steps to "transition", first approaching a family doctor who turned her down flat, saying, "…you were born female, I pulled you out of your mother." She calls him "transphobic". She then went to a counsellor who referred her to another GP, who in turn referred her to an endocrinologist. Since all this was taking place in the public health system it was eight months before she saw this specialist. Meanwhile she was obliged to see a psychiatrist, who, after questioning her about her childhood and how long she had been dressing as a male, diagnosed her with gender dysphoria, thus opening the way for hormone treatment.

In December 2015 Zahra began taking testosterone - first pills then injections. But they did not work the required magic. She was supposed to feel elated (as in YouTube videos?), instead, the testosterone just made her feel angry. Then she became depressed, then, as her voice deepened and facial hair appeared, increasingly anxious. "I didn't feel like myself," she told the Herald. She fought with her family. Eight months in, she attempted suicide with an overdose - twice. Her grandfather found her.

Victor had been watching her decline with increasing concern, especially since she'd had no further specialist attention. He pushed for her to see another mental health specialist, who decided that Zahra has borderline Asperger's syndrome. "That's when everything clicked," says Zahra. "And that's when I started doing some deep thinking."

She also consulted Dr Google and discovered that, the Herald reports, "Asperger's people commonly struggle with gender identity issues … often landing on gender dysphoria as an answer" to why they don't fit in.

Zahra thought deeply about this for a month and realised that she wanted to "go back", despite the complications it meant for her relationship with a transgender boy (Tyson, 17) and the risk of letting the transgender side down.

Though she is much happier now, she is slowly coming to terms with the fact that her gender might always confuse some people. She tried going "girly" but has decided she is just not that kind of girl. She does "dress female" but her voice lets her down. It shocked the store assistant when she went to buy a bra, and at The Warehouse they call her "sir … even though I'm dressing as a girl."

It is frustrating for her to think that her mild autism might have been picked up earlier, that she might have had special help and not failed school. "I would have understood myself more."

A psychiatrist dealing with gender dysphoria who was up to date with his or her reading should be aware of the mounting evidence of a link between autism spectrum disorder (ASD) and gender dysphoria or variance (GV) and refer a young person for testing. A diagnosis of GV on the basis of one interview, which provides a blank cheque for sex change therapy, seems grossly inadequate.

Another probable source of pathology in Zahra's life is the broken family background that led to her grandfather eventually "taking her in" at the age of 14. Parental separation is a well-known disrupter of children's happiness and wellbeing, but is this taken into account in the psychiatrist's office?

At least one New Zealand district health authority has guidelines requiring "a high standard of consent" for those wanting to transition to male, given that many changes caused by testosterone are irreversible -- including a lower voice and potential infertility. The guidelines also urge ongoing monitoring of side effects, particularly in young people, suicidality being a particular concern. But none of this is compulsory, and in any case there is an underlying acceptance that sex change can be good medicine, even for an adolescent.

Auckland University adolescent health researcher Theresa Fleming concedes that some young people who seek services "are just wondering," and that just because they question their gender does not mean they are trans. But she worries about "people who are transphobic" who "will see cases like this and think that liberal health services are pushing kids who ask questions to be trans. That's not true."

Dr Fleming says adolescents who are questioning need "generalists" who understand "adolescence and gender identity and mental health", rather that specialists. Clearly, she means professionals who accept current ideas about gender and sexuality being "on a continuum".

What nobody in all those column centimetres mentions is evidence that most adolescents who experience discomfort with their birth gender are likely to eventually accept their birth sex after puberty. Nor is there mention of the high rates of depression and suicide among transgender adults, despite these risks being widely known.

"I hate seeing young lives wrecked," says Victor Rakich. "You've got to give them more attention, not just medicine." His own grand-daughter's life, it seems, if not entirely wrecked, will never be what she now wants it to be - the unambiguous life of a woman. It is very sad, but it is far from certain that health professionals will driven by the case to do the kind of deep thinking about gender that Zahra Cooper has been forced to do.