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发帖数: 901 | 1 A small but growing number of teens and even younger children who think
they were born the wrong sex are getting support from parents and from
doctors who give them sex-changing treatments, according to reports in the
medical journal Pediatrics.
It's an issue that raises ethical questions, and some experts urge caution
in treating children with puberty-blocking drugs and hormones.
An 8-year-old second-grader in Los Angeles is a typical patient. Born a girl
, the child announced at 18 months, "I a boy" and has stuck with that belief
. The family was shocked but now refers to the child as a boy and is
watching for the first signs of puberty to begin treatment, his mother told
The Associated Press.
Pediatricians need to know these kids exist and deserve treatment, said Dr.
Norman Spack, author of one of three reports published Monday and director
of one of the nation's first gender identity medical clinics, at Children's
Hospital Boston.
"If you open the doors, these are the kids who come. They're out there. They
're in your practices," Spack said in an interview.
Switching gender roles and occasionally pretending to be the opposite sex is
common in young children. But these kids are different. They feel certain
they were born with the wrong bodies.
Some are labeled with "gender identity disorder," a psychiatric diagnosis.
But Spack is among doctors who think that's a misnomer. Emerging research
suggests they may have brain differences more similar to the opposite sex.
Spack said by some estimates, 1 in 10,000 children have the condition.
Offering sex-changing treatment to kids younger than 18 raises ethical
concerns, and their parents' motives need to be closely examined, said Dr.
Margaret Moon, a member of the American Academy of Pediatrics' bioethics
committee. She was not involved in any of the reports.
Some kids may get a psychiatric diagnosis when they are just hugely
uncomfortable with narrowly defined gender roles; or some may be gay and are
coerced into treatment by parents more comfortable with a sex change than
having a homosexual child, said Moon, who teaches at the Johns Hopkins
Berman Institute of Bioethics.
It's harmful "to have an irreversible treatment too early," Moon said.
Doctors who provide the treatment say withholding it would be more harmful.
These children sometimes resort to self-mutilation to try to change their
anatomy; the other two journal reports note that some face verbal and
physical abuse and are prone to stress, depression and suicide attempts.
Spack said those problems typically disappear in kids who've had treatment
and are allowed to live as the opposite sex.
Guidelines from the Endocrine Society endorse transgender hormone treatment
but say it should not be given before puberty begins. At that point, the
guidelines recommend puberty-blocking drugs until age 16, then lifelong sex-
changing hormones with monitoring for potential health risks. Mental health
professionals should be involved in the process, the guidelines say. The
group's members are doctors who treat hormonal conditions.
Those guidelines, along with YouTube videos by sex-changing teens and other
media attention, have helped raise awareness about treatment and led more
families to seek help, Spack said.
His report details a fourfold increase in patients at the Boston hospital.
His Gender Management Service clinic, which opened at the hospital in 2007,
averages about 19 patients each year, compared with about four per year
treated for gender issues at the hospital in the late 1990s.
The report details 97 girls and boys treated between 1998 and 2010; the
youngest was 4 years old. Kids that young and their families get
psychological counseling and are monitored until the first signs of puberty
emerge, usually around age 11 or 12. Then children are given puberty-
blocking drugs, in monthly $1,000 injections or implants imbedded in the arm.
In another Pediatrics report, a Texas doctor says he's also provided sex-
changing treatment to an increasing number of children; so has a clinic at
Children's Hospital Los Angeles where the 8-year-old is a patient.
The drugs used by the clinics are approved for delaying puberty in kids who
start maturing too soon. The drugs' effects are reversible, and Spack said
they've caused no complications in his patients. The idea is to give these
children time to mature emotionally and make sure they want to proceed with
a permanent sex change. Only 1 of the 97 opted out of permanent treatment,
Spack said.
Kids will more easily pass as the opposite gender, and require less drastic
treatment later, if drug treatment starts early, Spack said. For example,
boys switching to girls will develop breasts and girls transitioning to boys
will be flat-chested if puberty is blocked and sex-hormones started soon
enough, Spack said.
Sex hormones, especially in high doses when used long-term, can have serious
side effects, including blood clots and cancer. Spack said he uses low,
safer doses but that patients should be monitored.
Gender-reassignment surgery, which may include removing or creating penises,
is only done by a handful of U.S. doctors, on patients at least 18 years
old, Spack said. His clinic has worked with local surgeons who've done
breast removal surgery on girls at age 16, but that surgery can be
relatively minor, or avoided, if puberty is halted in time, he said.
The mother of the Los Angeles 8-year-old says he's eager to begin treatment.
When the child was told he could get shots to block breast development, "he
was so excited," the mother said.
He also knows he'll eventually be taking testosterone shots for life but
surgery right now is uncertain.
The child attends a public school where classmates don't know he is
biologically a girl. For that reason, his mother requested anonymity. |
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