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