If your child’s as­signed gen­der is caus­ing noth­ing but dis­tress, could he or she be trans­gen­der?

Your Baby & Toddler - - Front Page - BY MARGOT BERTELSMANN

From when she could speak, Jen and Gary’s son Alex* talked about “sparkly cup­cakes and shiny fab­rics,” Jen re­mem­bers. “I like to think we brought her up as a nor­mal lit­tle boy, sur­rounded by trucks and train sets that she had zero in­ter­est in.”

By three years old, Alex was ask­ing for dresses, and – con­sid­er­ing them­selves the sort of fam­ily who did not rigidly en­force gen­der roles – Jen bought her son “dress-up” dresses – “be­cause all kids have dress-up out­fits, right?” But Alex was hip to their tricks, ask­ing specif­i­cally why she couldn’t have or­di­nary girls’ clothes from the girls’ de­part­ment at cloth­ing stores.

Be­cause the ex­pressed gen­der dys­pho­ria and dis­tress was so strong, the fam­ily de­cided to take Alex to a psy­chol­o­gist. “He warned very strongly against our approach, sug­gest­ing that we were do­ing Alex’s gen­der iden­tity dam­age and that the dresses and long hair must go and male role mod­els and icons must be pro­moted,” Jen re­calls.

So be­gan an un­happy time in this Cape Town house­hold. Alex showed signs of de­pres­sion and the home was a bat­tle zone as ar­bi­trary lines were drawn and fought over: “How tight can your pants be be­fore they are for girls only, and why is a kilt okay, but not a tutu?”

When Alex was four, psy­chi­a­trist Dr Si­mon Pick­stone-tay­lor, who works with trans­gen­der chil­dren at Red Cross Chil­dren’s Hospi­tal and Groote Schuur Hospi­tal, en­tered the child’s life, and ev­ery­thing changed. “He as­sured us that an in­creas­ing body of sci­en­tific knowl­edge showed that sup­port­ing ap­pro­pri­ately as­sessed chil­dren to live as the gen­der they iden­tify as has the best out­come in terms of longevity, men­tal health, and be­havioural is­sues.” Alex was back in her dresses, and the fam­ily found peace in al­low­ing their child to ex­press her­self, and adopted a watc­hand-wait approach for later years.

BE­YOND THE BI­NARY West­ern so­ci­ety has used bi­nary op­po­sites to make sense of the world: black and white, left and right, up and down, right and wrong, gay and straight, male and fe­male, self and other. But what, asked the next gen­er­a­tion of thinkers, about all the things that are not 100 per­cent one or the other, but a lit­tle bit of both?

Fem­i­nists and iden­tity the­o­rists noted that one half of the bi­nary is usu­ally favoured. Which bi­na­ries are seen as “the norm”, and which are over­looked, or op­pressed? Which terms have more power? Look­ing at the process of con­struct­ing cat­e­gories (and de­con­struct­ing them!) is not the fan­ci­ful in­ven­tion of left-lean­ing thinkers and so­cial dis­rup­tors only. New sci­en­tific knowl­edge has forced us to collapse many of our sim­ple bi­nary op­po­sites, and con­sider that many of these oc­cur along spec­trums.

Let’s take a short de­tour through how boys and girls are made, then.

XX, XY, IS NOT THE WHOLE STORY Most of us know from school sci­ence or bi­ol­ogy classes that hu­man be­ings have 46 chro­mo­somes in their DNA. The fi­nal pair, pair 23, is two X chro­mo­somes, XX for women and XY for men. As Lise Eliot ex­plains in her book Pink Brain Blue Brain, “as sci­en­tists only re­cently dis­cov­ered, it doesn’t take the whole Y chro­mo­some to make a boy, merely one mi­cro­scopic stretch of DNA, known as SRY, sci­en­tific short­hand for ‘sex-de­ter­min­ing re­gion of the Y chro­mo­some’.” As­ton­ish­ingly, this SRY gene can “jump aboard one of the X chro­mo­somes dur­ing sperm for­ma­tion”, re­sult­ing in XX males who think, feel and act like men, though they look anatom­i­cally like women – and the re­verse, XY women with a miss­ing or mu­tated SRY gene, who know they are ac­tu­ally men in­side fe­male bod­ies.

And we are only just be­gin­ning to un­der­stand the sci­ence – there may be more sur­prises wait­ing. Suf­fice to say male/fe­male is not the un­com­pli­cated bi­nary we al­ways thought it was. There is at least a third sex – in­ter­sex – and we can ex­pect clas­si­fi­ca­tions to re­fine.

In Na­tional Geo­graphic’s Jan­uary 2017 is­sue de­voted to gen­der, Robin Marantz Henig writes, “Ge­netic vari­a­tions can oc­cur that are un­re­lated to the SRY gene, such as com­plete an­dro­gen in­sen­si­tiv­ity syn­drome (CAIS), in which an XY em­bryo’s cells re­spond min­i­mally, if at all, to the sig­nals of male hor­mones.

Male gen­i­tals don’t de­velop. The baby looks fe­male, with a cli­toris and vagina, and in most cases will grow up feel­ing her­self to be a girl. Which is this baby, then? Is she the girl she be­lieves her­self to be? Or, be­cause of her XY chro­mo­somes – not to men­tion the testes in her ab­domen – is she ‘re­ally’ male?”

Other ge­netic vari­ants include XXY, XYY, sin­gle X, and other, more rare, com­bi­na­tions. Sex just re­ally isn’t an ei­ther/or any­more.

MYTHS BUSTED You can let your tomboy daugh­ter climb trees and your boy child paint his toe­nails with­out wor­ry­ing that they are show­ing signs of gen­der iden­tity con­fu­sion. “All chil­dren ex­plore gen­der. There are even gen­der­fluid or gen­der non­con­form­ing chil­dren,” says Ron­ald Ad­di­nall, a UCT aca­demic, clin­i­cal so­cial worker and sex­ol­o­gist, who vol­un­teers at the Tri­an­gle Project, a LGBTQIA+ sup­port or­gan­i­sa­tion. “There is no ev­i­dence that be­ing trans­gen­der is caused by cold moth­ers, or ab­sent fathers, or any other so­cial causes.”

There are not sud­denly more trans­gen­der peo­ple around, ei­ther – it’s not the fault of food ad­di­tives, hor­mones in the wa­ter or vac­cines (yes, those are real the­o­ries!). Rather, peo­ple are more likely to dis­close their iden­ti­ties in a more wel­com­ing en­vi­ron­ment, whereas in pre­vi­ous gen­er­a­tions they may have stayed silent and en­dured their se­cret alone. (It’s worth not­ing sui­cide risk – al­ready high in teenagers – is even higher among teens bat­tling gen­der iden­tity is­sues in an un­sup­port­ive en­vi­ron­ment.)

“We do still live in a bi­nary so­ci­ety and the ma­jor­ity of in­di­vid­u­als do still find a fit in­side the bi­nary,” says Ad­di­nall. “Usu­ally,” he adds, “a child is as­signed a gen­der, and then all the so­cial scripts are en­acted with re­gard to the ex­pected gen­der of the child. And for the ma­jor­ity of the pop­u­la­tion this is a good fit. But what we know to­day is that there is a sig­nif­i­cant pro­por­tion of peo­ple for whom their nat­u­ral gen­dered­ness and gen­der ex­pres­sion does not fit the gen­der as­signed to them. So they re­sist the toys and clothes and ac­tiv­i­ties they are ‘sup­posed’ to en­joy.”

INSISTENT, PER­SIS­TENT, CON­SIS­TENT Cru­cially, says Ad­di­nall, the child’s claim that they are not the sex their par­ents tell them they are must meet three assess­ment cri­te­ria, as ar­tic­u­lated in the stan­dards of care guide­lines for trans­gen­der chil­dren drawn up by the World Pro­fes­sional As­so­ci­a­tion for Trans­gen­der Health (WPATH): their dis­tress with their as­signed gen­der must be insistent, per­sis­tent and con­sis­tent.

But if your child is un­happy, and is insistent, per­sis­tent and con­sis­tent about ac­tu­ally be­ing a boy (or a girl), it’s time to lis­ten. “Gen­der iden­tity is un­al­ter­ably es­tab­lished by two or three years of age,” says Ad­di­nall, “and it is not un­com­mon for trans­gen­der chil­dren to ar­tic­u­late that they are not a boy (or a girl) at three or four years old.”

WPATH’S stan­dards of care rec­om­mends that pre­pubescent chil­dren who have been ap­pro­pri­ately as­sessed by a pro­fes­sional should be allowed to so­cially tran­si­tion and live as their pre­ferred gen­der. This means, says Ad­di­nall, that they choose a gen­der-ap­pro­pri­ate name and use ap­pro­pri­ate pro­nouns.

When they reach pu­berty, they can then ex­plore pu­berty paus­ing with a pae­di­atric en­docri­nol­o­gist. Surgery is only avail­able to adults over 18.

A NEW ME In Alex’s case, she chose to be­come known as and re­ferred to as a girl around age four to five. Her par­ents com­plied: they found a school where Alex, now in grade 1, could at­tend as a girl and use the girls’ or uni­sex bath­rooms. “She went in ‘stealth’, mean­ing only the teach­ers knew she was a trans­girl,” says Jen. “But within days she was ask­ing to tell her friends, so we ar­ranged a meet­ing with par­ents and ex­plained our sit­u­a­tion.”

Alex’s par­ents have ap­plied for a name change in her birth cer­tifi­cate at Home Af­fairs. “Chang­ing the gen­der in her birth cer­tifi­cate is a bit more com­pli­cated,” says Jen. South African ID num­bers have a sex marker, and au­thor­i­ties need to see sup­port­ing let­ters from doc­tors to change the sex, so chang­ing Alex’s ID “will prob­a­bly only be pos­si­ble once she has hor­monal treat­ment in her teens, but is at least legally pos­si­ble in South Africa.”

“Alex is al­ways free to change her mind, but every day it be­comes clearer that she is a girl and that isn’t go­ing to change any time soon, just as it hasn’t for me or any­one else I know.” YB

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