Yesterday's NPR report two transgender boys and the different ways they were being raised was accompanied by another story, this one about a controversial treatment known by some as the "Dutch protocol" that allows preteens with gender-identity issues (like transgender memoirist Jennifer Boylan, at left, once had) to delay the onset of puberty. According to NPR, "...kids who meet the criteria for gender identity disorder are given monthly injections of a medication that blocks their bodies from releasing sex hormones. This means that while the children continue to grow taller, for the three or four years they are on the medication, they are kept from maturing sexually." That's the first stage of the treatment, which occurs between ages 10-13. The second stage starts around age 16; at that point the teen is allowed to choose which gender he or she wants to become.
Dr. Norman Spack, an endocrinologist in Boston, was an early adopter of the treatment. He tells NPR, "We can make it possible [for a transgendered child to] fit in in the way they want to. It is really quite amazing." British psychologist Polly Carmichael is less gung-ho about medicating patients this way, mostly because she doesn't trust that someone so young can know themselves well enough to change genders. "You can have a child who is presenting with absolute certainty, but it may be that at a later point they will decide that is not in fact what they want and their feelings may indeed change," she says.
Jennifer Finney Boylan, for example, knew she was a woman as soon as she was old enough to recognize gender existed. In her best-selling 2003 memoir She's Not There, Boylan writes, "One day when I was about three...[I saw] my mother ironing my father's white shirt...'Someday you'll wear shirts like this,' said Mom...I didn't understand what she was getting at. Why would I ever be wearing shirts like my father's. Since then, the awareness that I was in the wrong body, living the wrong life, was never out of my conscious mind." Boylan, who was born as James, didn't have her gender reassignment until she was in her forties. I asked Boylan for her opinion on the NPR story, and got the following email in response:
I haven't heard this story, although I knew it was running...I don't think I'm going to be able to help you because I don't have any authority here.
But I can tell you that, as a general principle, the "Dutch protocol" is the one that many parents are using to treat transgender children. This involves a hormonal cocktail that delays the onset of puberty in trans children, and allows the family and the child to get used to the idea of what the future may hold, and to begin to get an understanding of what life in the new gender might mean without having to commit, at such an early age, to the irreversible process of gender shift and surgery.
It's controversial, of course. How could it not be? Some trans activists feel that the Dutch protocol stands between the child and an early, complete, and more efficient transition. Others feel that the age of consent ought to be much older, and that children aren't in any position to make these kinds of lifelong decisions.
My own sense is that the Dutch protocol is a very good choice for families and their children, that people dont' make these decisions lightly, and that they should be respected for the choices they're making. Dr. Norman Spack, at Childrens Hospital in Boston, runs the country's only clinic exclusively for transgender youth, and he employs the Dutch protocol as his standard strategy for care.
As for me, personally, I wasn't ready to make the transition any earlier than I actually made it; I wish I'd had the courage, but I didn't, and it took me nearly 40 years of living as a guy to realize that a second-best life wasn't the life for me. But I had to go through all those years to learn this. Other people make their decisions in their own time, and in their own way.
Like I said, I haven't heard the show, but I know that there are thousands of trans kids who seem to know exactly who they are and what they need. How can we not help them ?
James Bowdoin" />