Transgender kids: How young is too young for a sex change?

Delving into the often tumultuous worlds of transgender youth

Recently, clinics in North America and Europe that specialize in children with gender identity disorder have begun recommending puberty-blocking hormones as early as age 12, and cross-sex hormone treatment as early as 16. The puberty-blockers prevent breast growth in biological girls, and keep boys from developing a booming baritone and facial hair. In a world where trans people have been murdered simply for crossing the gender line, the safety of being covert has appeal.

Puberty-blockers can also reduce the need for expensive surgeries down the road—biological women won't need mastectomies; biological men won't need surgeries to shave down masculine facial structures and Adam's apples. Transgender adults who never go through their bodies' natural puberty will be able to pass more easily.

But not everyone agrees that hormone therapy is appropriate for kids. Taken long enough, puberty-blockers can create real hazards, including increased risk of certain kinds of cancer and reduction in bone density. And the changes from cross-sex hormones—including broadened shoulders, deeper voices, and facial hair in transgender men, and breast growth and body fat redistribution in women—are permanent.

Rachel Salomon
Walter Bockting, president-elect of the World Professional Association for Transgender Health
Nick Vlcek
Walter Bockting, president-elect of the World Professional Association for Transgender Health

"Families and people who encourage young people to take hormones are, in my opinion, hurting that child, and not helping them see the reality of this world," says Paul McHugh, a physician at Johns Hopkins and an outspoken critic of sexual reassignment surgery. "Your sex is in your cells—every cell in your body has either two X chromosomes or an X and Y chromosome."

And allowing a child to live as the other gender?

"Well, that's terrible," he says. "That's a form of child abuse."


WHEN MELISSA SIWEK was growing up, being transgender—or even gay—was not an option. One of a family of five, Melissa attended Catholic school in Shakopee. Before ninth grade, she'd never heard of a lesbian. She certainly hadn't heard about anyone being transgender.

Melissa had always been a tomboy. She liked to imitate her older brother. She kept her hair shaved short like a boy's and dressed like a skater, in masculine clothes—oversize T-shirts and baggy jeans. In junior high, she hung out at a skate park near her house. She couldn't keep her eyes off a confident, older, butch-looking girl with a board tucked under her arm. Around that time, her family began pressuring her to be more girl-like. Wanting to please them, Melissa tried, starting with growing out her hair.

Then she got bacterial meningitis. The illness was so severe that 13-year-old Melissa was in the hospital for two months, and she almost died. When she awoke from a month-long coma, her fingers and toes were gone, and her body was badly scarred. At that point, pleasing her parents was the last thing on her mind. "I was deformed," she says. "I couldn't care what people thought about me. I had to become okay with myself as a disabled kid."

In 10th grade, Melissa befriended a group of girls at school who dressed like her. They were lesbians, and they were fine with it, and so were a lot of their parents. Melissa had never met anyone who thought being gay was normal. Through them, Melissa found "It was like the gay MySpace," she says. She started chatting with a trans guy, who offered to bring her to District 202 in Minneapolis. The more they chatted, the more Melissa became convinced that she, too, was transgender. Her friends picked a new name for her, and in Minneapolis at least, Melissa became Julian.

Julian knew that coming out to his family wouldn't be easy. His father owned a lumberyard and was exactly the kind of guy you'd picture—Julian knew he wouldn't approve. His mother might be more accepting, but Julian couldn't figure out how to tell her.

Then his twin sister did it. It happened when they were arguing. They'd gotten into a fight in their parents' room, within their earshot. Julian blurted out something he knew would get his sister in trouble.

"Well, at least I don't want to be a boy," she retorted.

"My parents were like, 'What?'" he remembers. "I explained it to them. My mom said, 'No, you wouldn't do that to us.' My dad was like, 'That's the stupidest thing I've ever heard.'"

At school, Julian still went by "Melissa," mostly to avoid more trouble. In 11th grade, Julian told the girls on his hockey team that he was a guy. Shortly after that, he arrived to practice a little early one day, as the boys' team was coming off the rink. They accused him of hitting on their girlfriends. They punched him in the stomach and tried to pull down his pants. The next year, Julian didn't play hockey.

By the time he graduated from high school, Julian couldn't wait to get out of Shakopee and live in Minneapolis as a guy. He moved into an apartment with his twin sister. Their father paid their bills.

Julian and his dad mostly avoided talking about him being transgender. But a couple of weeks before Julian turned 19, they had a significant conversation about taking testosterone. "He knew it was something I wanted to do," Julian remembers. "He said, 'If you go any further with you wanting to be a boy, then you're going to be cut off.'"

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