"Flower
boy" (on the right) - In 70-80% of cases, gender confusion will clear up
on its own (Wikicommons: Recoplado).
I
remember feeling some attraction to girls in Grade 2, but it really wasn't
until Grade 8 that everything fell into place. I'm talking about puberty.
Before high school, I was a boy and not a young man.
I
didn't consider myself abnormal. Yes, many boys in Grade 8 had deeper voices,
as well as signs of facial hair, but just as many did not, and a few would not
have been "sexually functional." As for the earlier grades, certainly
before Grade 7, most of us could have passed for little girls—just change the
clothing, the hairstyle, and voilà!
Today,
puberty is starting earlier. Ontario schools will begin explaining it in ...
Grade 4. This falling age is largely due to the changing ethnic and racial origins
of the student population, as well as things like overeating (in the case of
girls) and perhaps our more sexualized culture.
Nonetheless,
a lot of boys remain pre-pubertal throughout most of primary school, and some
may have trouble coming to terms with their male identity. They experience what
is called “gender confusion.” This is hardly surprising. Testosterone levels
are low before puberty, and some boys, especially the ones who have been less
androgenized in the womb, may genuinely feel like a girl. I also suspect that
modern culture makes things worse by creating expectations that even adult
males have trouble meeting. Go to any fitness center and you'll see plenty of
young men trying to bring their bodies into line with the "rippled
look."
Gender
confusion, known medically as gender
identity disorder, affects children of both sexes but boys much more so, at
least in North America. One clinic reported a ratio of 6.6 boys for each girl,
the sex imbalance being attributed partly to greater intolerance of feminine
behavior in boys (Zucker et al., 1997). This disorder seems to be partly heritable,
although we face a similar problem of perspective here as with the referral
statistics (Heylens et al., 2012). To what degree does the heritable component
reside in how these children objectively behave, and not in one behavior that may or may not alarm another person, usually
a parent? In practice, it’s the latter. It’s whatever
behavior that makes a parent bring the child to a clinician’s office.
Gender
reassignment
We
now come to the issue of medical treatment, specifically "gender
reassignment." This treatment has recently been condemned by Dr. Paul
McHugh, the former psychiatrist-in-chief for Johns Hopkins Hospital:
Then
there is the subgroup of very young, often prepubescent children who notice
distinct sex roles in the culture and, exploring how they fit in, begin
imitating the opposite sex. Misguided doctors at medical centers including
Boston's Children's Hospital have begun trying to treat this behavior by
administering puberty-delaying hormones to render later sex-change surgeries
less onerous—even though the drugs stunt the children's growth and risk causing
sterility. (McHugh, 2015)
Is
treatment really necessary? McHugh points out: "When children who reported
transgender feelings were tracked without medical or surgical treatment at both
Vanderbilt University and London's Portman Clinic, 70%-80% of them
spontaneously lost those feelings."
McHugh
has been accused by the transgender community of misrepresenting the facts:
McHugh
also mischaracterizes the treatment of gender nonconforming children. As McHugh
states, most gender nonconforming children do not identify as transgender in
adulthood. However, those who receive
puberty blocking drugs do not do so until puberty, when trans identity is
likely to persist. These drugs allow adolescents and their parents to work with
doctors to achieve the best outcome. This approach was demonstrated to be
successful in research in the Netherlands before being adopted widely in the
U.S. (WPATH, 2015)
The
above text is disingenuous in two ways. First, puberty-blocking drugs are not
administered until puberty for an obvious reason: they would be ineffective earlier.
The decision to use them, however, is made at an earlier time and often much
earlier. Second, these drugs keep hormonal levels from rising, thus maintaining
the boy or girl in the same hormonal state and possibly in the same state of
gender confusion. Logically, one should wait a few years to see what effect
puberty might have.
Is
the use of these drugs legitimate? We’re talking about a radical intervention
in the normal process of maturation, and this intervention begins before the
age of consent, i.e., 16 years of age in most Western countries. Moreover, the
eventual gender reassignment will never be complete. Although it’s possible to turn
a male into a semblance of a female, such a “female” can never bear children.
This isn’t a minor point, given that many male transsexuals wish to maintain a male
heterosexual orientation, even to the point of marrying and becoming fathers.
For
all these reasons, use of these drugs should be delayed until adulthood, when
consent becomes morally defendable, when the risks of sterility are lower, and
when the gender confusion may prove to be transitory.
A boy is not a
little man
The
transgender community likes to talk a good talk about "gender fluidity."
Ironically, such fluidity is reduced by gender reassignment, which imposes a
relatively unchanging adult dichotomy on pre-pubertal individuals who are going
through rapid physical and psychological change. This brings us to a second
irony. The transgender community complains about how it was once medically pathologized.
Yet here it is pathologizing cases of gender confusion that are not unusual
among young children and that are consistent with normal child development.
We
should remember that both sexes begin with a body plan that is more female than
male. This plan is modified at two points of the life cycle: first, in the
womb, when the body’s tissues are primed by a surge of androgens or estrogens;
and then at puberty, when boys and girls diverge in the levels of their
circulating sex hormones, which in turn trigger profound changes in growth and
development.
This
truth was known to our ancestors. As late as the early 20th century, people accepted
that little boys are more akin to little girls than to grown men. This was why both
sexes would be dressed in female clothing until school age, and a mother would
often boast that her little boy was as pretty as a girl.
[…]
infants and small children had for hundreds of years been dressed alike, in
frocks, so that family portraits from previous centuries made it difficult to
tell the young boys from the girls. “Breeching,” as a rite of passage, was a
sartorial definition of maleness and incipient adulthood, as, in later periods,
was the all-important move from short pants to long. Gender differentiation
grew increasingly desirable to parents as time went on. By the closing years of
the twentieth century the sight of little boys in frilly dresses has become
unusual and somewhat risible; a childhood photograph of macho author Ernest
Hemingway, aged almost two, in a white dress and large hat festooned with
flowers, was itself the focus of much amused critical commentary when
reproduced in a best-selling biography—especially when it was disclosed that
Hemingway’s mother had labelled the photograph of her son “summer girl.” (Garber, 1997, pp. 1-2)
Hemingway
hated those baby pictures, as well as the stories about how his mother would
call him “Ernestine” and tell strangers that he and his sister were twin girls.
During her declining years, he threatened to cut off his financial support if
she ever gave an interview about his childhood (Onion, 2013; Winer, 2008). He
saw her as the typical Victorian mother who sought to momify and symbolically
castrate her male offspring. With other writers of his time, particularly
psychologists and advice columnists, he helped bring about a reform of sexual
conventions that, among other things, would sweep away the custom of cross-dressing
little boys.
I
remember how I felt seeing such photos when doing research on my family tree. What the?? Today, I feel differently:
this cross-dressing strikes me as being healthy, even beautiful in its own way.
It avoids the problem of imposing male identity too early in life and thereby forcing
slower-developing boys to choose between the identity imposed by society and
the one generated by their own mental state—which may still be insufficiently male.
It is this situation, and the resulting gender confusion, that is now putting
many boys at risk of gender reassignment. Yet there’s nothing wrong with most
of them. They just need more time to grow up.
As
an extreme example, let’s take the case of "pseudohermaphrodites"—males
who look female at birth because their penis resembles a clitoris and because
their testes remain inside the body. They are typically raised as girls until
puberty, at which time the penis grows in size, the testes descend into the
scrotum, and they become like men physically and psychologically. When 18
pseudohermaphrodites were studied in the Dominican Republic, it was found that
16 of them had made the transition from girlhood to manhood with no evidence of
psychosexual maladjustment (Imperato-Mcginley et al., 1979). A similar
situation often arose among Canada’s Inuit whenever a newborn received the name
of a deceased relative. If the child was a boy and the relative a woman, it
would be raised as a girl until puberty and as a man thereafter. Such
individuals became not only husbands and fathers but also respected shamans
(Saladin d'Anglure, 2005).
In
short, gender confusion in childhood poses no threat to normal child development.
Indeed, whether we acknowledge it or not, all boys start off being more like
little girls than the men they will become. This “early girlhood” may actually
play a key role in their psychosexual development, and our ancestors might have
had good reasons to believe that boyhood begins later. But that raises a
troubling question: by trying to masculinize this early phase of life, have we
opened the door to unknown consequences?
So
if you have a young boy who’s confused about his gender identity, the chances
are very good that he’ll successfully transition to manhood ... as long as he’s
not given puberty-blocking drugs. This is not a medical condition that needs
treatment.
References
Garber,
M.B. (1997). Vested Interests:
Cross-Dressing and Cultural Anxiety, Psychology Press.
https://books.google.ca/books?id=eeASHasS0oUC&printsec=frontcover&hl=fr&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
Heylens,
G., G. De Cuypere, K.J. Zucker, C. Schelfaut, E.Elaut, H. Vanden Bossche, E. De
Baere, and G. T’Sjoen. (2012). Gender identity disorder in twins: A review of
the case report literature, The Journal
of Sexual Medicine, 9, 751-757.
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02567.x/abstract
Imperato-Mcginley,
J., R.E. Petersen, T. Gautier, and E. Sturia. (1979). Male
pseudohermaphroditism secondary to 5a-reductase deficiency—A model for the role
of androgens in both the development of the male phenotype and the evolution of
a male gender identity, Journal of
Steroid Biochemistry, 11,
637-645.
http://www.sciencedirect.com/science/article/pii/0022473179900931
McHugh,
P. (2015). Transgender surgery isn't the solution, The Wall Street Journal, June 12
http://www.wsj.com/articles/paul-mchugh-transgender-surgery-isnt-the-solution-1402615120
Onion,
R. (2013). Pages from Hemingway’s baby books, Slate, July 23
http://www.slate.com/blogs/the_vault/2013/07/23/hemingway_scrapbooks_grace_hemingway_s_records_of_son_ernest_hemingway_s.html
Saladin
d'Anglure, B. (2005). The 'Third Gender' of the Inuit, Diogenes, 52, 134-144.
http://dio.sagepub.com/content/52/4/134.short
Winer,
A. (2008). Why Hemingway used to wear women’s clothing, Mental_floss, December 18
http://mentalfloss.com/article/20396/why-hemingway-used-wear-womens-clothing
WPATH
(2015). Wall Street Journal Editorial Critiques Transgender Health July 2, 2014
http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1635&pk_association_webpage=4905
Zucker,
K.J., S.J. Bradley, and M. Sanikhani. (1997). Sex differences in referral rates
of children with gender identity disorder: some hypotheses, Journal of Abnormal Child Psychology, 25, 217-227.
http://link.springer.com/article/10.1023/A:1025748032640#page-1
