About a Boy : Transgender surgery at sixteen.
Margaret Talbot
In America, doctors didn’t talk openly about the feasibility of sex-change operations until after the Second World War. In 1949, a psychiatrist named David O. Cauldwell began using the term “transsexual” to describe people so alienated from their biological sex that they wished to change it. The endocrinologist Harry Benjamin took the lead in promoting this idea, wresting gender discontent away from the psychoanalytic realm, where it was diagnosed as a disorder of sexual desire (curable through will power and talk therapy), and defining it as a problem of having been born in the wrong body (fixable through hormones and surgery). Benjamin helped establish a protocol requiring patients to receive a diagnosis of gender-identity disorder from a physician before taking hormones or undergoing surgery. Many transgender people have resented this kind of medical gatekeeping—and particularly the implication that they suffer from a mental illness. In 1973, homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders, and some trans activists worked for years to get “gender identity disorder” expunged, too. Recently, they succeeded: in the next edition of the manual, which comes out in May, the term is replaced by “gender dysphoria”—a less pathologizing alternative that describes patients who report distress about their biological sex. (A diagnosis has its virtues—it allows some insurance plans to cover the transition process.)
The first American to go public about a gender reassignment was Christine Jorgensen, a glamorous twenty-six-year-old who, in 1952, had been obliged to travel to Copenhagen for the procedure. (When Jorgensen returned home to New York, the headline in the Daily News said, “EX-G.I. BECOMES BLONDE BEAUTY.”) In the sixties, American medical centers, beginning with Johns Hopkins, started to perform gender reassignments. From the outset, clinicians sought acceptance for the surgery by downplaying sexuality and emphasizing the “born in the wrong body” narrative. The patients most likely to be accepted for surgery were men who, like Jorgensen, seemed as if they could successfully live as straight women and not upset traditional roles all that much once they made it to the other side.
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In recent years, the most striking change for trans people is the possibility of switching gender at younger and younger ages. Some children have been encouraged to socially transition as early as preschool. And, according to some estimates, thousands of American adolescents are taking hormones that forestall puberty until they decide whether they want medical or surgical interventions to change their biological sex. Starting in the late seventies, doctors began prescribing these drugs for children who suffered from extremely precocious puberty. In 2000, a clinic in Holland began administering the drugs to kids who were struggling with their gender identity. The patients had to be at least twelve and had to have begun puberty; the drug put their sexual development on hold. At sixteen, patients could stop the hormones, allowing puberty to resume its course, or they could start a regimen of cross-gender hormones, whose effects are generally not reversible. Puberty suppressors gave patients the advantage of not fully developing certain features, such as breasts and a menstrual period, for F.T.M.s, and facial hair, a prominent Adam’s apple, and more masculine facial structure, for M.T.F.s. Puberty suppression and early surgery made for more convincing-looking men and women. The Dutch researchers Baudewijntje P. C. Kreukels and Peggy T. Cohen-Kettenis observed, “Early intervention not only seemed to lead to a better psychological outcome, but also to a physical appearance that made being accepted as a member of the new gender much easier, compared with those who began treatment in adulthood.”
The first American medical center to offer trans kids puberty blockers was Boston Children’s Hospital, in 2009. Clinics in several other cities, including Los Angeles, San Francisco, New York, and Seattle, soon followed. When I spoke recently with Norman Spack, an endocrinologist who runs the Boston program, he said that doctors in half a dozen more cities—among them Chicago, Cleveland, and Philadelphia—planned to adopt the puberty-suppressing protocol. (…)