Issue:  Vol. 48 / No. 7 / 15 February 2018

TG specialists, parents ask: When is young too young?


Just a boy: 10-year-old Tucker
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Asher remembered it almost fondly, that day several years ago he deliberately destroyed a piece of his clothing in order to make his point.

"I was pretty little," he said, smiling at his past antics. "I took a pair of scissors. My mom was distracted on the phone, bragging about how beautiful I was. And I just went chop-chop" – he paused to demonstrate with hand motions – "and I chopped up my dress."

Asher, now 8, chuckled from his half-sprawled position on the carpet of the Philadelphia Convention Center on Saturday, March 4 where he spent much of the day in the designated youth room playing and socializing with other kids.

Meanwhile, across the street, 10-year-old Tucker was changing in his hotel after spending the day hanging out with teenagers. As a group gathered downstairs to go to dinner, Tucker stepped out of the elevator wearing a blue basketball suit into a lobby full of older guys who wanted to shake his hand.

"I wish I had been given the same chance," said one man who called Tucker "buddy" and "man" in a way that he seemed to know would be affirming.

In typical kids' fashion, there were the shrugs, the over-animated hand gestures to hide shyness, the quiet voices and shifting eyes that often characterize young people in conversation with adults. But there also was a rare confidence exuded by the children who gathered at the fifth annual Philadelphia Trans-health Conference earlier this month, for many of them had already made up their minds about a significant life decision: they do not identify with the gender they were assigned at birth.

"I just always knew," Asher explained to the Bay Area Reporter. "I only wanted to be a boy."

Many adult members of the transgender community – from the gender-fluid to the strictly binary-identified transsexuals – report having gender issues during childhood, and many members of the medical community agree that gender dysphoria is something that usually first emerges at a young age. But not until recently have so many young people and their parents had access to information about transgender identities and treatments.

For Tucker and Asher, the transitions from female to male thus far have been relatively easy. Even before they lived as boys, they were able to express tomboy tendencies early on without the same stigma suffered by effeminate males. Both have supportive families. Asher's mother Mary, a member of an urban queer community, was already familiar with a wide range of gender identities and knew many transgender people. Tucker's mother Betsy, a heterosexual woman, had more to learn but adapted pretty quickly.

"We just went with it and lived with the tomboy theory for years," said Betsy, who also thought her youngest child may have just been identifying with her two older brothers. But Tucker kept insisting he was a boy, she said. Anytime anything gender related came up – from his clothing to the body he envisioned for himself in the future –he very forcefully claimed male for himself and distanced himself from anything female.

Betsy eventually found a specialist across the country and a support group for parents of transgender kids online, and "a whole new world opened up," she said. Betsy and Tucker now reference transgender vocabulary and terminology like a second language.

"He doesn't identify as transgender or even FTM," Betsy explained to a roomful of physicians, therapists, and counselors who attended the conference's "Providers' Day" on Thursday, March 2. Tucker instead identifies as "MTM," she said, referring to a newer term used by many younger transgender males to indicate that they never felt or lived as female and thus their genders actually are not in transition.

When Tucker and Asher asserted their gender identities, their parents simply followed suit. Both children are now enrolled in school as boys, with support from school administration.

"My teacher knows I'm both," said Asher, referencing his female birth assignment. Rather than using "transgender," which he feels is difficult to explain, Asher sees more of himself in the Native American term "two-spirit."

But it's "not often" that he even describes himself in transgender terms, he said, noting that in most environments he lives simply as male, and he does believe he'll "probably" grow up to be a man. Asked whether he would feel comfortable disclosing his birth sex to more people, he paused and said, "I'm not really sure."

"Disclosing means telling," his mother explained.

"Yeah," he said. "I know."

Empowering conference

The Philadelphia Trans-health Conference attracted over 500 people this year from all over the country, including more than 125 social service and healthcare providers. Participants said that unlike many other LGBT conferences, the specific health focus of this event allowed for much more in-depth discussion of relevant topics. Workshops and seminars addressed hormone treatments and sexual reassignment surgeries; utilizing healthcare services during disasters and emergencies; safer sex and disclosure; spirituality; community; self-defense; and issues related to the law, economics, and wellness.

The grassroots conference has always emphasized diversity and attracted a distinctly energized and focused crowd, but this year's gathering marked the first time that so many transgender youth and their parents came together to participate, said Joe Ippolito, a licensed social worker and one of the conference organizers.

It was an empowering event for these families, many of whom hailed from regions like the South where LGBT organizing is not so prevalent. Before this conference, many of the parents said they felt alone, unconnected to other real people with similar families and histories. Some of them are still searching for appropriate providers in their region to help them navigate their children's futures; others must battle their school districts for their kids' right to wear the clothing of their choice. Many of them have been accused of being negligent or abusive for allowing their children to assert their own genders.

Those parents who allowed their children's photographs to be included in this story asked that their last names not be used and their geographical locations not be revealed. Others, like Stephanie Guinan – the trans coordinator of the Philadelphia chapter of Parents, Friends, and Families of Lesbians and Gays – rely on their own name recognition in order to continue to organize on behalf of transgender kids.

"In 1996 I gave birth to two of the most beautiful babies I've ever seen. The doctor said, 'Congratulations; you have a boy and a girl.' Everyone said I had the perfect family. But something was different," Guinan explained during "When is Young too Young?" a discussion featuring transgender youth, parents of transgender kids, and healthcare providers.

Guinan said she would take her kids to the mall dressed in pink and blue and strangers would remark, "What pretty twin baby girls." At the age of 2, Guinan's son Ryan told her he wanted a dress.

"I said, 'You're the boy. You have a penis,'" Guinan told the crowd. "Want to screw a little kid up? Teach them that who they are is because of their genitals."

As the months and years went by, "things started getting sad," said Guinan. Birthdays and holidays amounted to piles of unwrapped unwanted "boy" presents. When her son was 4 years old she walked in on him in the bathroom trying to cut off his penis with a set of nail clippers.

In first grade Ryan began to have meltdowns. The elastic in his socks could throw him into a tailspin. Gradually, his parents allowed him to wear a dress inside the house. One day while dressed in female clothes he snuck off to play by himself outside and was the happiest anyone had ever seen him. But he still was not allowed to express that side of himself on a full-time basis.

By second grade Ryan was suicidal, yet Guinan could not find a provider who would see someone struggling with gender issues so young. Finally, a specialist agreed to meet with them. Through treatment it was determined that the child was going to need live as a girl if she was to survive. Slowly, the Guinan family began to transition along with their child.

Ryan entered second grade as a boy testing at a kindergarten level and exited as a girl named Rachel testing at a fourth grade level. Because school administrators would not let Rachel wear a dress to school, Guinan worked to get a dress code of khaki pants instituted so that other girls would at least be wearing the same clothing as her daughter.

The early sex and gender roles imposed upon unwilling children, said Guinan, amounts to "kids learning who they are supposed to be rather than who they are."

"When is young too young? It's not my choice," echoed Jeanette Bloshinsky, whose 5-year-old male-born daughter began asserting her identity as a girl from the moment she was out of diapers.

"From the day she could express herself there was nothing male about this child," said Bloshinsky.

Through treatment with a gender therapist it was decided that Bloshinsky's daughter Jaron should be enrolled in kindergarten this coming August as girl. But Bloshinsky is concerned. The school principal is conservative. Community members are struggling with Jaron's female pronouns. Already some people have expressed distaste upon seeing Jaron in feminine clothing.

"Some people say to me, 'How you can let him walk around looking like that?'" said Bloshinsky. "And I say, 'Because that's what he picked out to wear today.'"

Bloshinsky does not think Jaron is ready to wear dresses in public; normal childlike behavior sometimes involves exposure of the genitals, which could pose a safety risk. But Bloshinsky does believe "we are doing something right," pointing out that her child, rather than being fixated on gender issues, simply lives a happy and well-adjusted life.

"How young is too young?" Bloshinsky asked again. "I don't think it's ever too young to be who you are. At this point what's the worst that could happen? If she changes her mind, we'll transition back."

Long-term decisions

Some parents are already faced with a different set of challenges. As Tucker and Rachel approach the onset of puberty, they may continue to ask for hormonal and/or surgical interventions, and Betsy

From left, mothers Stephanie Guinan, Betsy, and Jeanette Bloshinsky at a conference panel. Photo: Zak Szymanski
and Guinan must help them decide what is appropriate and when.

Therein lies some of the more significant issues for parents of transgender kids – when to allow a child to obtain medical interventions that could permanently affect his or her body. Some transgender conference attendees, as thrilled as they were to see transgender kids, expressed concern at the idea of early hormonal treatment. After all, many gender-variant kids grow up to be non-transgender, and many people decide to live as transgender without being transsexual.

Physicians in attendance said that it's still difficult to know if and when medical transition is right for young people, given that there is a lack of trans-specific research, particularly when it comes to kids.

"I don't have the answers," said featured panelist Dr. Robert Winn of the Mazzoni Center, Philadelphia's LGBT healthcare center.

Winn noted that while once it was more commonplace to refuse transsexual treatment to anyone under 18, even the conservative Harry Benjamin International Gender Dysphoria Association Standards of Care make a case for hormones in kids as young as 16, and he prefers to deal with people on a case-by-case basis, operating from a variety of health models, including harm reduction.

Many public health experts have recognized that minors determined to go on hormones will do so unsafely – getting them off the street or sharing needles in the process – rather than wait for entrance into a monitored medical program. Such risks suggest that it is better to assist young people rather than turn them away. Still, there are very few models for early transgender-specific treatment.

"The reality is we treat people based upon literature, research, and evidence," Winn said. More providers must be able to recognize transgender issues in kids, he said, and "we need to work together" so that there is more data to help influence medical decisions.

Some parents said their doctors have advised them that their best options, assuming their children consistently express a desire for physical transition, is to allow some natural development but administer hormone blockers to delay puberty. Such a process leaves fewer undesired gender traits to overcome later in life without causing permanent effects, and for FTM boys, allows that often-desired extra height since testosterone can be administered at an older age but before the bones are closed.

Specialists like psychiatric physician's assistant Marlyn L. Yassen, however, said that parents' decisions to allow or delay physical transitions would not, in the long run, matter as much to a child as parents who handle the process in a loving and accepting manner.

"The most critical thing is less about hormones and surgery and more about compassion and love," said Yassen, who believes "there is more than one cause to an effect" when it comes to identity and that the "mind, body, soul, and spirit cannot be disconnected" in such a discussion.

Eight-year-old Asher at the conference. Photo: Zak Szymanski

Decisions cannot take place in vacuum, said Yassen, who always consults with colleagues, looks at the full family dynamic, and works from the perspective of a team approach when evaluating future steps for transgender children. She is careful to let parents know that there are indeed little girls who may like their penises, and that people can occupy a range of embodiments and identities and still be happy.

Ahzjane Silver, a featured youth panelist at the conference, agreed that the family environment really makes a difference.

Born male, Silver was not supported for his more feminine gender expressions as a child and as a teenager resorted to getting estrogen off the street. Now 19, Silver recently decided to stop using hormones and has realized s/he is not a woman but rather, an "inter-gendered" individual.

"I thought to myself, 'I like boys. I like Barbies. I should be a girl.' But that was really about my atmosphere," said Silver. "I was told, 'Men do this, and girls do this.' Now I don't identify as either. I feel it's too restrictive."

In some ways starting the transition process allowed Silver to realize who s/he was and how s/he wanted to live. But the question seemed to remain whether Silver would have sought transition at all if s/he was celebrated early on for having a variety of gender expressions.

"I had to come to accept myself," said Silver. "It makes my heart feel good to see people who care about their children."

Fewer TGs?

The parental acceptance was heart warming, but for older transgender people who struggled with their identities or first came out as lesbian or gay it brought up inevitable questions.

As more transgender kids are allowed to be simply "male" or "female," will such an early gender socialization mean a gradual loss of transgender-identified people?

"It just makes me think about whether I would have grown up to be a straight male instead of a queer trans guy who dates queer women," said A.J., an FTM transgender person and conference participant who asked that his last name not be used. "I love being queer and I love dating queer femmes, so I would hope I would have turned out the same."

Many transgender people live heterosexual lives. But just like many non-transgender people, some transgender people maintain queer identities even if they have opposite sex partners and are perceived as straight. In many cities, "queer" communities distinguish themselves from "gay" communities by their multiple sexual orientations and gender identities.

But if more trans kids are encouraged to be "normal" and find heterosexual partners rather than partners familiar with dating transgender people, will queer communities maintain their roles as the trans-inclusive forces that they have become in larger LGBT populations?

Additionally, do some parents who support a child's transition remain committed to gender conformity, and would they be uncomfortable with the possibility that their male-born child could transition into a butch lesbian or remain an effeminate man? If so, can this actually be considered gender progress?

Winn addressed some of these points with parents at the "Trans-youth Medical Update" session on Saturday, March 4.

He expressed some concern, strictly from a healthcare perspective, about the consequences of trans kids who are able to grow up without necessarily thinking of themselves as transgender.

A pre-operative transman who completely avoids female socialization or transgender community ties, for instance, may be even more likely than other transmen to forgo necessary medical screenings related to Ob/Gyn care. From that perspective, trans individuals who don't identify as transgender still must be willing to accept that they have special medical needs, said Winn.

"Society doesn't need to know the specifics of a transgender person's body," said Winn, "but from a clinical and personal perspective, one does need to know that."

Winn also told parents to be cautious when it came to thinking about things in terms of "male" and "female" categories, since both males and females express their genders in a variety of ways.

"What we don't necessarily know about pre-pubescent individuals is what their sexual orientation is or what their behaviors are going to be," said Winn. "Many parents speak about things in 'boy' and 'girl' categories, and I can understand why they do that. But they need to understand that when their child turns 15 he or she could go in a million different directions. Parents might be raising a transgender gay son [an FTM who partners with other men] and they need to be prepared for that."

As the conference wrapped up, one transgender man introduced his girlfriend to some of the parents of the trans youth. One of the mothers was visibly relieved by the girlfriend's striking appearance. Like many parents might, the woman expressed optimism that her son, too, would grow up to "find a pretty girl."

Speaking to the B.A.R., however, most parents emphasized that their role was not to become overly invested in their children's identities, but to follow their lead and help them get to the place they need to be.

"I think he likes girls," Betsy observed matter-of-factly of her son Tucker. She tended to speak of her son in terms of possibilities, not givens. If Tucker turned out to be someone other than a straight male, she said, raising a masculine girl or someone who is gender-fluid would be fine with her.

"He does seem to be at the extreme male end of the spectrum," said Betsy. "But I'll let him tell me who he is."

Asher's mother Mary jokingly lamented the fact that her son may grow up to be straight, noting that he was appalled when she asked him about possibly liking another boy and that he recently went through "a super macho" phase. But homophobia and aggressive behavior is something Mary would discourage in any children of hers, she said, no matter their gender or sexuality.

Guinan, summarizing the position of many parents in attendance, said it's first and foremost about acceptance.

"I do this work because I don't want one other child to have to be validated and identified by their genitalia," said Guinan.

Bloshinsky agreed.

"I'm trying to leave the door open and I'm checking in with her feelings," she said. "I worry about today and tomorrow I'll worry about tomorrow."

For more information on transgender family support, visit or Information about the annual Trans-health conference is available at

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