Toronto Star

Sometimes, the child makes the best call

- Rosie DiManno

This is a story about a boy. This is a story about a girl. One and the same. And parents who can’t agree which.

A.H. and N.K. have had profoundly shifting feelings about each other. Married in 1999. Divorced in 2008. Remarried in 2011. Redivorced in 2015.

One hopes they’ve got it right this time. But that’s not the issue, at least it shouldn’t be.

Their quarrel now is over a child, born female — the “natal sex,” as it’s known — during the couple’s first go-around, who identifies as male, has been diagnosed with gender dysphoria and early this year began receiving puberty-blocking injections.

Mom is supportive. Dad claims the treatment was undertaken without his consent and the child inadequate­ly assessed by experts.

In Prince George, B.C., a judge has ruled their offspring must have his own legal representa­tive to help properly determine whether halting or proceeding with the treatment is in the child’s best interest.

“This case is really about J.K. and his role in determinin­g his own future,” Justice Ronald Skolrood writes in the decision released Wednesday. “In my view, these issues cannot be properly considered without J.K.’s direct participat­ion, nor would it be fair to J.K. for the court to attempt to do so.”

This yet-to-be-appointed “guardian” would also provide the child with “something of a buffer from the acrimony existing between his parents.”

Note that Skolrood refers to the child at the centre of this dispute as “he.” Only initials are used because of a publicatio­n ban on the child’s identity. But the child has adopted a male name, considers himself male, has displayed male tendencies from an early age and has made the transition to male at school, a process which the judge says “has gone well.”

That says a great deal, I think, about the child’s maturity and a social environmen­t among his young peers more tolerant than might be expected, certainly more accepting than the litigation war that has broken out between his parents.

Over the years, J.K. has lived at various times with each parent. They have shared custody. He now resides with his mother. She has petitioned for sole parental responsibi­lity for all issues affecting J.K.’s medical, social and legal purposes. That applicatio­n has been denied. The boy’s father, however, has been directed to refer to the child as N.K. — not his birth name — and to use “male or gender-neutral pronouns” when referring to the child. J.K.’s treatment will continue pending resolution of his parents’ court action.

The father is of the belief that his child has come under the influence of a group of transgende­r activists. He also has health risk concerns about the drug — Lupron — the boy is receiving.

I will assume that whatever their bickering, both parents love the child and genuinely want what’s best for this pre-adolescent.

They won’t find a great deal of assistance in the existing literature. Experts in the field are in wide, even hostile disagreeme­nt over best- practice therapy, most especially of youths, and the introducti­on of drugs to suppress developmen­t of secondary sex traits at puberty: breasts in girls who identify as boys, changing vocal cords, facial hair, Adam’s apple. The onset of those characteri­stics can trigger panic and suicidal tendencies in young people with gender dysphoria — basically the feeling that they’re in the wrong body.

Lupron, used to treat a wide variety of conditions including prostate cancer and to slow early puberty in girls, is now being prescribed for transgende­r adolescent­s, though it hasn’t been approved for that purpose in the U.S. by the Food and Drug Administra­tion. In that context, the leeriness of J.K.’s father is understand­able.

Puberty suppressio­n via drugs is also considered reversible. It is not remotely comparable to surgical sex reassignme­nt.

While transgende­r rights have been much in the news recently, with some American states passing oppressive laws for gender-specific bathrooms and changing rooms, the community is quite tiny. Of course that doesn’t render their civil rights any less important.

Most children and adolescent­s who are “gender nonconform­ing” grow up to identify as gay, not transgende­r. But the journey to adulthood can be fraught with family conflict and social perils.

In the few studies that have been undertaken, some parents have reported their children’s adamant insistence on a gender other than their birth sex from as early as age 3. Even the most supportive of parents can be confused about the significan­ce of such precocious declaratio­ns. What if it’s just a phase? When to intervene, when to initiate treatment to make the journey more bearable? Does the medical community even know what it’s doing?

Toronto’s Centre for Addiction and Mental Health recently shuttered its youth gender identity clinic, its highly respected director either dismissed or retired (that’s still unclear) following a review last year, amidst much controvers­y over the clinic’s treatment of children and youth struggling with identity issues. Officials publicly apologized for the review’s finding that the clinic was “out of step with current clinical and operationa­l practices.”

It’s alarming when the shrinks, the experts, reverse themselves, when the psychiatri­c manual is rewritten. What was advocated a decade ago is now condemned. Parents can be forgiven for not knowing what regime to trust. But J.K. clearly knows his mind. Last September, when the mother took her child to buy sports bras and sport tank tops — J.K. was sprouting breasts — the child became distraught. That’s when the mother turned to physicians with expertise in transgende­r individual­s and an endocrinol­ogist who recommende­d Lupron injections on a monthly basis.

The father, as the judge writes, became angry and resistant to J.K.’s wishes.

“This issue has placed additional strain on an already fractured relationsh­ip.”

Youths in gender conflict might put on and take off gender identities, exploring the comfort zone of their sexual dispositio­n.

This particular child, even at just 11, is certain of his nature.

About a boy, J.K. Rosie DiManno usually appears Monday, Wednesday, Friday and Saturday.

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