Life as a trans­gen­der kid

A new doc­u­men­tary ex­plores the agony of what it’s like to be a trans­gen­der child

YOU (South Africa) - - CONTENTS - BY PI­ETER VAN ZYL

LOOK­ING at the kid do­ing cart­wheels on the lawn, you see a happy lit­tle girl. But nine-year-old Warner was in fact born a boy. “I think God made a mis­take,” Warner had told his par­ents. In­stead of be­ing shocked or try­ing to force their child into a gen­der role, it’s they who’ve done the adapt­ing: they’ve ac­cepted that in­stead of a son they now have a daugh­ter. They re­fer to their child as “she” and sup­port all her choices. She likes to wear her hair long and has a pref­er­ence for sparkles and the colour pink, ex­plains her mother, Melissa, from Ot­tawa in Canada.

Warner is just one of the chil­dren fea­tured in the new BBC doc­u­men­tary Trans­gen­der Kids: Who Knows Best? which is air­ing on DStv. They talk about what it’s like to be a trans­gen­der child and ado­les­cent, and feel­ing trapped in the wrong body.

The doc­u­men­tary fo­cuses on the trans­gen­der chil­dren and ado­les­cents who ex­pe­ri­ence gen­der dys­pho­ria – in other words, they ex­pe­ri­ence con­stant dis­com­fort and distress be­cause their gen­der iden­tity doesn’t match the gen­der as­signed to them at birth.

“There’s noth­ing wrong with be­ing a boy, but I don’t en­joy be­ing a boy,” Warner ex­plains. “I’m not the full puz­zle – there are a cou­ple of pieces miss­ing. My life’s jour­ney is to find the miss­ing pieces.”

But it’s not go­ing to be easy. Some­where down the road she’ll need to de­cide if she wants to be placed on treat­ment that will pause her pu­berty process – if she chooses this route it will mean her de­vel­op­ment will be de­layed so she won’t de­velop dis­tinc­tive male fea­tures such as a prom­i­nent Adam’s ap­ple, fa­cial hair, mus­cles and a deep voice.

This will buy her time while she de­cides whether she wants to start oe­stro­gen ther­apy to fully tran­si­tion.

Al­though pu­berty paus­ing (or hor­mone block­ers) may sound like a rad­i­cal step it can pre­vent a lot of trauma down the line.

“It’s im­por­tant not to ex­pose trans­gen- der ado­les­cents to the wrong pu­berty,” says Dr Anasta­cia Tom­son, a med­i­cal doc­tor from Johannesburg who her­self is trans­gen­der and has writ­ten a book, Al­ways Anasta­cia, about her ex­pe­ri­ence.

The prac­tice of pu­berty paus­ing is prac­tised the world over in­clud­ing in South Africa. This is be­cause ex­perts now ac­knowl­edge that if a child with gen­der dys­pho­ria isn’t al­lowed to ex­plore their gen­der iden­tity through play and clothes, for ex­am­ple, it could lead to psy­chi­atric is­sues such as anx­i­ety, de­pres­sion and sui­cide later on.

The med­i­ca­tion, which is im­planted in the child or in­jected ev­ery three, four or six months, costs around R2 500 a month and there are risks in­volved.

But stud­ies have also shown that de­lay­ing pu­berty may have an im­pact on

bone min­er­al­i­sa­tion and there’s a chance it might af­fect so­cial de­vel­op­ment – chil­dren might feel iso­lated be­cause their peers are ex­pe­ri­enc­ing pu­berty while they aren’t.

But Dr Si­mon Pick­stone-Tay­lor, a psy­chi­a­trist from Cape Town, says the pros far out­weigh the cons.

An es­ti­mated 41% of trans­gen­der peo­ple try to com­mit sui­cide and the group with the high­est risk is 10- to 19-yearolds, ac­cord­ing to the South African De­pres­sion and Anx­i­ety Group (Sadag).

Pick­stone-Tay­lor adds that if a trans­gen­der ado­les­cent de­cides to stop the tran­si­tion process and chooses to live as their bi­o­log­i­cal gen­der, treat­ment with hor­mone block­ers is com­pletely re­versible.

There are no tests to es­tab­lish whether a child is trans­gen­der. Care­ful ob­ser­va­tion over an ex­tended pe­riod of time by ex­perts and loved ones is the best way to de­ter­mine the ap­pro­pri­ate next step.

Pu­berty usu­ally oc­curs around the age of 13 but it dif­fers from child to child. Hor­mone block­ers de­lay this process, al­low­ing the child more time to de­cide if they wish to fully tran­si­tion in more per­ma­nent and ir­re­versible ways through, for ex­am­ple, gen­der-af­firm­ing op­er­a­tions.

If they choose to do this they’ll then be spared costly sur­gi­cal pro­ce­dures to re­move un­wanted gen­der char­ac­ter­is­tics such as an Adam’s ap­ple or breasts.

Tran­si­tion­ing would include the use of oe­stro­gen and testos­terone to help them de­velop fur­ther in the right di­rec­tion. Later, they can have gen­der-af­firm­ing op­er­a­tions in or­der to com­plete the process.

‘ICAN fi­nally look in the mir­ror and see a girl look­ing back at me,” 17-year-old Ella says in the doc­u­men­tary. She was born a boy but started feel­ing un­happy about her body from age four.

Ella be­gan tak­ing hor­mone block­ers at age 12 and two years later started tak­ing oe­stro­gen.

She had gen­der-af­firm­ing surgery at 16. Surgery at such a young age isn’t com­mon –18 is usu­ally the ac­cepted age for ir­re­versible gen­der-af­firm­ing in­ter­ven­tions.

The doc­u­men­tary also fea­tures Dr Ken­neth Zucker, a Cana­dian psy­chol­o­gist whose con­tro­ver­sial ap­proach with trans­gen­der chil­dren led to him be­ing fired from a Toronto gen­der-iden­tity clinic in 2015.

“A four-year-old might say that he’s a dog – do you go out and buy dog food?” Zucker says in the doc­u­men­tary, a com­ment that un­leashed wide­spread crit­i­cism from ex­perts.

“Kids as young as two know what their gen­der is,” Pick­stone-Tay­lor coun­ters. “This is of­ten the time trans kids first start loudly mak­ing this clear to the world.”

‘I can fi­nally look in the mir­ror and see a girl look­ing back at me’

He says the best thing par­ents can do is of­fer their sup­port and al­low their child to ex­press them­selves as they nat­u­rally and au­then­ti­cally ex­pe­ri­ence them­selves to be.

He started a gen­der iden­tity de­vel­op­ment ser­vice within the Red Cross chil­dren’s hospi­tal in Cape Town. Work­ing with Ron­ald Ad­di­nall, a clin­i­cal so­cial worker and trans­gen­der spe­cial­ist, he’s helped trans­gen­der kids in more than 20 schools in the Western Cape suc­cess­fully so­cially tran­si­tion.

Pre­vi­ously it was rare for some­one as young as 16 to have gen­der-af­firm­ing hor­mones, Ad­di­nall says, but it’s be­com­ing more com­mon.

In­ter­na­tional stan­dards rec­om­mend 18 as the age of con­sent for per­ma­nent gen­der-af­fir­ma­tive surgery but there’s room for in­di­vid­ual cir­cum­stances, which is why surgery has been done on teens younger than 18.

But not ev­ery­one who ex­pe­ri­ences gen­der dys­pho­ria as a child go on to tran­si­tion.

In fact, stud­ies in Europe and North Amer­ica have shown that around 80% of th­ese chil­dren go on to ac­cept their birth gen­der later on in life.

Only those still wish­ing to be the op­po­site sex in Tan­ner stage 2 of pu­berty (a scale of phys­i­cal de­vel­op­ment in chil­dren, ado­les­cents and adults) – about 20 to 30% of the chil­dren – go ahead with the tran­si­tion by start­ing to take hor­mones and an even smaller per­cent­age com­plete the process with surgery.

“I don’t en­joy be­ing a boy,” nine-year-old Warner says in the BBC doc­u­men­tary Trans­gen­der Kids: Who Knows Best?

LEFT and RIGHT: From a young age Warner has iden­ti­fied with the op­po­site gen­der and can’t wait to fully tran­si­tion.

RIGHT: Ella was born a boy, but took hor­mone block­ers and had gen­der­af­fir­ma­tion surgery.

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