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Turning point for sex-change teens
From
http://www.smh.com.au/national/health/turning-point-for-sexchange-teens-20120210-1sic4.htmlJulie Robotham
February 11, 2012Quote:A new case may review approval for treatment in adolescents, writes Julie Robotham.Jamie will be 12 in May. She lives with her parents and twin brother somewhere in Australia and is, according to a Family Court judge’s description, ”a very attractive young girl with long blonde hair”.
Her penis and testicles, which had begun to enlarge, are now suspended in an early adolescent state courtesy of puberty-blocking drugs approved by the court last year.
Her breasts, for now, remain a matter for a future court ruling. Justice Linda Dessau reserved a decision over whether and when Jamie should be allowed to start the female hormones needed to make them grow, to take account of ”circumstances that may not be predicted when the child is … still only 10”.
Advertisement: Story continues below Jamie, who was a toddler when she began insisting she was a girl and has lived as one since the age of eight, is the sixth child in a decade to seek the court’s approval to begin sex-change treatment after a diagnosis of the psychiatric condition gender identity disorder – which may lead to major depression and even suicide if left untreated.
She is also the sixth to win it; the court has never declined an application. But she is the only one who must return to court for the second pre-surgical phase of therapy – an order her parents are now appealing, saying they should be able to decide when the time is right to initiate oestrogen tablets.
Those extra conditions may be a turning point in access to pre-surgical treatment of transsexual children (surgery is not considered until the age of 18).
Justice Dessau’s decision was partially shored up last week by the court’s appeal bench, which agreed to allow new submissions because of the potential implications for other children if Jamie’s parents’ authority is extended.
Opponents suggest Jamie’s case could be the start of a more general braking on permission for sex-change therapy in children, amid concerns about inflexible gender expectations and possible side-effects from the powerful drugs.
But supporters are just as adamant treatment should be more readily available to children whose psychiatric diagnosis and family circumstances warrant it.
”I hope [the decision] means there are some misgivings,” says Sheila Jeffreys, a professor of sexual politics at the University of Melbourne.
Jeffreys says children upset about their ”wrong” genitals should be helped to see that sex need not define personal or social characteristics, and should not be collateral in what she considers an adult debate.
A ”horror of homosexuality” underlies some gender dysphoria or transsexualism in adults, Jeffreys says. Widening to children the notion that gender dissatisfaction is a psychiatric disorder lets adult transsexuals claim it is innate and immutable – bolstering claims for legal recognition and subsidised treatment.
”There’s a whole industry in transgendering,” she says, including work for endocrinologists, whose hormone replacement treatment of menopausal women has been dented by health scares.
Australian hormone specialists last year quietly endorsed the conclusions of a United States guideline that set out a standard treatment regimen while acknowledging artificially delayed puberty might cause future health problems, such as osteoporosis from interrupting bone development.
But its authors have been criticised as over-eager cheerleaders for sex reassignment. Norman Spack from the Children’s Hospital Boston, wrote in the foreword to a recent book that doctors were, ”salivating at the prospect of applying … pubertal suppression, yet without permission from health insurers to pay for the expensive drugs”.
Two of Dr Robert Lyons’s adolescent patients, who would otherwise begin the transition to their preferred sex, are holding back because of concerns about bone growth.
But at least as many are putting off treatment because they cannot afford the court fees, estimated between $20,000 and $35,000, says the Adelaide psychiatrist and president of the Australian and New Zealand Professional Association for Transgender Health. The association will lobby state and federal attorneys-general to end the requirement for individual court approval.
Proposed patients should have long-standing gender dissatisfaction and be under a psychiatrist’s care, Lyons says. They should have, ”the character or ego strength to cope with the transition through to adulthood”, and their parents should be supportive. ”I do understand the necessity of protecting children,” he says.