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There’s a huge difference between a little girl dressing up as a boy and a little boy believing he is actually a girl, and according to three reports in the journal pediatrics, and increasing number of kids are falling into the latter category.

Gender identity disorder is the psychiatric diagnosis these kids are often labeled with, but doctors like Norman Spack, author of the reports and director of one of the nation’s first gender identity medical clinics at Children’s Hospital Boston, believe in emerging research that suggests these kids may have brain differences more similar to the opposite sex. Spack told Time magazine 1 in 10,000 children may have this condition.

An 8-year-old patient in Los Angeles is discussed heavily in the report. The child, who was born a girl, reportedly announced that she was a boy at 18 months and has stuck with that thinking ever since. The family is now waiting for the first signs of puberty to begin treatment and the mother says when her child found out they could give drugs to block breast development, “he was so excited.”

According to Spack, if kids start drug treatments early they’ll more easily pass for the opposite sex and will require less dramatic treatments later. He also says the drugs used by the clinics, which are reversible, are approved for delaying puberty in kids who start maturing too soon. The idea, he says, is to give children time to mature emotionally and make sure they want to proceed with a permanent sex change. According to him, only 1 of the 97 children discussed in the report opted out of permanent treatment.

But this work is not without ethical concerns. Dr. Margaret Moon, a member of the American Academy of Pediatrics’ bioethics committee, said the motives of kids and their parents need to be examined before beginning treatment in patients under the age of 18. She says some kids may get a psychiatric diagnosis when they are just uncomfortable with narrowly defined gender roles; or others who are gay may be coerced into treatment by parents who are more comfortable with a sex change than having a homosexual child.

But while she says receiving sex-change treatment too young can be harmful, others think not having treatment is more harmful, citing self-destructive behaviors the kids often develop such as cutting and suicide attempts, not to mention the stress and depression. Boston Hospital seems to prove that this service is one both gender-questioning kids and their parents want. Since opening it’s gender service management clinic in 2007, they’ve seen a four-fold increase in patients, and according to Spack:

“If you open the doors, these are the kids who come. They’re out there. They’re in your practices.”

What do you think about gender identity disorder? What age do you think is too young to begin gender reassignment therapy?

Brande Victorian is a blogger and culture writer in New York City. Follower her on Twitter at @be_vic.

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