Children's gives transgender tween new hope

by Melissa Jeltsen on July 21, 2010

Twins-0933

Once you’ve read this story, make sure to check out the essay by the twins’ father as he discusses what it’s like to raise a transgender child.

Although born identical twins with matching DNA, Tom* and Ryan were two immensely different children. As toddlers, Tom entertained himself with toy trucks while Ryan fawned over his girl cousin’s Barbies and Little Mermaid dolls. Photo after photo of them at that age show Ryan with a t-shirt wrapped around his head, mimicking long, flowing hair. At age 4, he asked his mom, Cecelia, a heartbreaking question: When do I get to be a girl? A few months later, while assisting his dad, Dennis, with a plumbing job, he told him that he hated his own penis. Dennis choked up. “I cried and he cried, and then his brother came in and we all hugged and cried,” he says.

When he was 6, his parents sought professional advice. A local psychiatrist diagnosed Ryan with gender identity disorder (GID) or transgenderism, a rare condition in which a biological male or female feels a strong identification with the opposite sex and is extremely uncomfortable with his or her own gender. Like Ryan, many transgender youth express disgust with their genitals from a young age, and some even believe they’ll grow up to become the opposite sex. These feelings can cause significant psychological distress, and, not surprisingly, depression, anxiety and the desire to self-harm when they become teens. Statistics on the number of transgender children are hard to estimate. In adults, where the prevalence is approximately one in 500 to one in 1,000—an elusive figure due to lack of national registries—diagnoses of GID have tripled since the 1960s. This increase is likely due to more people coming out as transgender because of growing cultural acceptance, not an increase in prevalence.

twins
Tom, who says he always felt like his twin was a girl, isn’t surprised by the twists their lives have taken so far. “I do wonder what it would be like to have a brother,” he says, smiling at Sylvia mischievously, “But I guess a sister cuts it.”

Ryan is now 12 and goes by the name Sylvia. In skinny jeans and metallic ballet flats, painted nails and pigtails, she comes off as an energetic tween girl. She’s the more gregarious of the twins, but her bubbly disposition also serves as a protective facade: Since that first therapy visit at age 6, Sylvia has been in counseling to help her cope with anxiety and depression. In a world where everything is divvied up according to gender, there’s little room for a kid who falls somewhere in the middle.

It was easy to fit in when she was younger, but elementary school brought new challenges. She grew her hair long and asked to wear dresses and skirts. When her parents tried to discourage her, Sylvia rebelled by acting out in school and at home. One day she told a teacher she wanted to die. “It was terribly hard on her, to be told repeatedly that everything she thought and felt was wrong,” says Cecelia. “We finally decided to just let her be whoever she wanted to be.”

In fifth grade, after the long summer, Ryan came back to school as Sylvia. Although she was nervous on her first day with her new name, Sylvia found the majority of her classmates warm and welcoming. “Some of my friends asked me why I had waited so long,” she says. That year, Sylvia excelled academically and was voted class vice-president. At the same time, she was being seen by Norman Spack, MD, an endocrinologist at Children’s Hospital Boston and a leading expert in GID in children and adolescents, and evaluating psychologist Laura Edwards-Leeper, PhD. Spack, along with urologist David Diamond, MD, had helped launch the interdisciplinary Gender Management Service (GeMS) Clinic at Children’s—the first pediatric academic program in the Western Hemisphere to evaluate and medically treat young transgender people.

Sylvia’s parents immersed themselves in transgender research before coming to Children’s. “We were learning everything we could,” says Cecelia. Their biggest concern was what would happen when Sylvia hit puberty. She was petrified of developing “whiskers,” and was increasingly embarrassed about her body. Some afternoons, she stared at herself in the mirror in bewilderment. “I’d look at myself from the neck up, and I’d be okay with it, but then I’d look from the neck down and I’d feel like I was one of those mismatch puzzles,” she says.

Her parents knew if Sylvia went through puberty and into adulthood as a male, she was likely destined for a life of expensive surgeries to attempt to reverse the masculine attributes and transition into a female body. But their hopes rose when they heard of another option that could help Sylvia avoid some of the irreversible physical changes, like a deepened voice, facial bone structure, a beard and broad shoulders, which would forever define her as a genetic male.

Halting puberty
Puberty is embarrassing and awkward enough, but for transgender kids, it’s the body’s ultimate betrayal. “This is the only big change in the body that they remember, and they feel it’s all going terribly wrong,” says Spack, adding that transgender youth have one of the highest suicide rates among teens in the country.

But what if you could halt puberty and stop the permanent changes from occurring? While it remains controversial, puberty suppression has been the standard treatment for transgender kids in the Netherlands since the 1990s. Since 2007, Children’s has been one of a handful of hospitals in North America to offer this treatment. Before any medical intervention takes place, psychologist Edwards-Leeper administers a rigorous series of psychological tests, forming a complete history of the child’s gender identity development. “The testing protocol we use is modeled after the Dutch clinic, which has been successfully treating and researching transgender youth for many years,” she says. Those who meet the stringent criteria for treatment are given monthly injections or a temporarily implanted drug to block their sex hormones. It’s fully reversible at any point; if they want to go through puberty as their biological sex, they can stop taking the drugs.

So far, the GeMS clinic has treated 17 patients with pubertal suppressors. “For the appropriate patients, we’ve found that the use of this therapy not only prevents severe psychological distress, but allows these young adolescents a chance to begin to blossom into their true selves,” says Edwards-Leeper. Spack scoffs at critics who accuse the clinic of fooling with nature. “I don’t think of transgender people as ‘changing genders,’” he says. “Almost every one of our patients felt that they were born with the wrong body. They’re not changing genders, they are affirming the gender they always felt they had.”

Puberty-suppressing therapy should be seen as a method that gives families and medical teams more time to think about what to do, according to Spack. “We no longer have to rush to beat the patient’s biological clock,” he says. It was the perfect choice for Sylvia. At age 11, at the first signs of puberty, she started taking the pubertal suppressors.

_CHB3501The future
On a recent afternoon, Sylvia and Tom ride their bikes in circles in front of their house, soaking up the summer heat. When they stand side by side, they’re no longer identical. After a year on the puberty-suppressing medication, Sylvia only needs to look at her brother to see the path she avoided. She’s willowy, he’s stocky. He has wispy new facial hair, while her face is clear.
Tom, who says he always felt like his twin was a girl, isn’t surprised by the twists their lives have taken so far. “I do wonder what it would be like to have a brother,” he says, smiling at Sylvia mischievously, “But I guess a sister cuts it.”

Sylvia can’t delay puberty indefinitely, and in a few years, she’ll need to make a decision. She may choose to stop the pubertal suppressors and go through puberty as her biological sex. But it is hard to imagine. It’s more probable that, at age 16, after undergoing additional rigorous medical evaluation, she will decide to physically transition to the female she has always felt she was. If so, she can start taking hormone therapy under Spack’s supervision, and will develop breasts and hips. When she’s 18, she can have feminizing genitoplastic surgery at an adult hospital if she desires. If she does go through with the full transition to a female gender, Sylvia—with a narrow frame, womanly curves and feminine voice—will be indistinguishable from a genetic female. But for now, the family is taking it one day at a time, encouraging Sylvia to enjoy her life as a kid while she can.

Of course, there have been some bumps in the road. After Sylvia faced painful bullying from a particular student in sixth grade, the family uprooted and made a fresh start in a new town. “We’re a normal family raising kids; Sylvia just happens to have this medical condition and not cancer or heart disease,” says Cecelia. “Why everyone gets so upset about it, I can’t understand.”

But the family is more cautious now. At her new school, Sylvia easily passes as a genetic female, and none of her classmates know she is transgender. Hiding her true identity isn’t ideal, but at least while she’s in middle school, it’s the route she’s decided to take. “It makes me feel like I’m not being completely honest, but my honesty got me in a lot of trouble a few years ago,” she says. Seventh grade isn’t easy: when the other girls aren’t fixating on the minute differences that set them apart—whose nose is bigger, who’s taller, who has freckles—they’re gossiping about boys. “Boys, boys, boys, it’s all these girls think about,” says Sylvia. “It’s a little hard to find someone to talk to right now.”

While her parents are nervous about the coming years, especially high school, they’re upbeat about Sylvia’s opportunity to live an adult life unrestrained by her appearance. “She will get past this and become a productive member of society,” says Cecelia. “We’re giving her the resources to become whoever she is.” Though it took Sylvia’s dad, Dennis, some time to adjust, he’s now one of her biggest advocates and works to educate other parents about transgender youth. “The key is, you have to be courageous enough to do this while these kids are young,” he says. “It’s so much harder later on. You’ve got to be brave so you can give them a chance.”

*All names have been changed for confidentiality.

Now, read a personal essay by the twins’ father, as he explains how his transgender tween has changed his outlook on manhood, acceptance and the concept of family.

42 comments

  • Christina

    This is going to be a long and difficult path but it’s clear how strong you are. With family support, you can do anything.

    You go girl!

  • troubadour

    I think it’s great that these children are offered options. The misery and isolation they must feel, not knowing why, how, when, if they will ever feel at home in their bodies. Or if they will be accepted by society. Given the choice at an early age to transition, to be able to avoid the awkward (and sometimes dangerous) attention that they may attract if they are forced to go through puberty while trying to pass as the opposite sex (either then or later), is a wonderful option for them. It is my hope that we can all be open minded and loving enough to accept people for who they are and not who we think they should be.

  • Andrew

    I really love how this came out — it’s so sensitively done, — and informative. I’ve posted it to Facebook and such. Thanks for writing this!

  • Dave Parker

    A well-done commentary. My wife and I have been supporting these children – and, of course, Dr. Spack – for several years. It is wonderful that transgender children are not forced to go through puberty, allowing them to develop more appropriately for their inherent gender.

  • Sloan

    This is such a fabulous story. My older sister waited to transition until long after puberty and, despite all of the happiness and success she’s found in recent years, I know that having parents like these would have made her transition much easier.

    It warms my heart to know that the world is starting to change for the better, family by family, heart by heart. Kudos to this family and these doctors.

  • Tami L

    While I love my parents, I wish they were as understanding at this family. I had to wait till later in life to transition. As a nurse and a former missionary I can say I am very very happy with my decision to transition. I just wish I could have saved a lot of grief and transitioned at Sylvia’s age…..

  • C.

    “Hiding her true identity isn’t ideal, but at least while she’s in middle school, it’s the route she’s decided to take.”

    This brave girl is LIVING her true identity, not hiding it. She’s a girl, throughout, and statements like this make it seem like she’s deceiving someone, or like she’s really a boy.

  • Zanzi

    This really makes me smile! It’s so great that she has parents who understand and accept her. I wish her all the best in her life :)

  • Joni1111

    Blessings…the world is getting better and this family will light the way.

  • CC

    “It makes me feel like I’m not being completely honest, but my honesty got me in a lot of trouble a few years ago,” she says.

    I don’t understand what Sylvia feels dishonest about. If she really feels she was meant to be a girl, then there is nothing to feel dishonest about.

    “Boys, boys, boys, it’s all these girls think about,” says Sylvia. “It’s a little hard to find someone to talk to right now.”

    Talking about boys in the 7th grade is very typical of girls. It sounds like Sylvia doesn’t want that part of girlhood.

    To me, based on this article, it sounds like she is still very psychologically unsettled about who she is or who she wants to be. I hope this will be a very happy ending for her, but I’m not convinced it will be.

  • Sheila

    Part of talking about boys or girls is related to female hormones jump starting a whole slew of changes.
    There is a huge chance that this will change as she starts a hormone regimen. My personal opinion is to gradually start them as soon as possible, once the protocol conditions are met satisfactorily. At least the stone age is slowly passing in the United States, at least in Boston.
    Unlike Dr. Zucker in Toronto, who in my personal opinion is torturing the children in his care. He publishes no statistics or tracking of his patients and yet he has a long waiting list.
    Were it up to me, I’d yank his license.
    The protocol developed in the Netherlands has a 100% success rate the last time I checked.
    You don’t even get that with normal kids.

  • Truth

    Sylvia has a Y chromosome. As all human beings with this chromosome, he developed a penis and testicles in his mother’s womb. At puberty, his hypothalamus will release (predominately) testosterone (over oestrogen) into his body, causing sperm production. He is a member of the male sex.

  • Dad and Doc

    “Boys, boys, boys,”…

    Sylvia’s gender identity as female has little to do with who she is as a sexual being. Her “difference” in thought and focus on “boys boys boys” could be seen as a variance in her pubertal development or in her sexual orientation. With time, hormonal exposure and a supportive environment clarification will come.

    Assuming a persons orientation simply based on their gender – anatomically matched or not – is as limiting for Sylvia as it is for a child who’s anatomical and internalized gender are in synch.

  • Dad and Doc

    “You don’t even get that with normal kids”

    Normal, as I tell my own kids and anyone else who will hear it, is simply a setting on our washing machine. When discussing anything as complex, important, and variable as human sexuality and gender the term normal has very little value, in my opinion.

  • Dawn1257

    Y chromosomes show up in females born with AIS, Androgen Insensitivity Syndrome also and they do not produce sperm! Chromosomes do not define your gender! In Sylvia’s case when she begins her hormone regimen, in time her testes will shrink and sperm production will become next to nil or not at all. And, by the way, go back and read the article a little slower. She is on puberty blockers. That means she will not go through puberty in the way that her body would have minus the blockers. One more thing, She is a member of the female gender and will be female sex.

  • Sheila

    I stand corrected. You are right and I used an unfortunate choice of words.
    I really know better.
    Thank you for the reminder.

  • http://ubuntulinuxtipstricks.blogspot.com Anonymous

    Since she’s not going through puberty at this stage, it makes sense that she’s not having sexual feelings toward any particular gender at the moment. Additionally, she could be a lesbian or even asexual. Since when is attraction to boys a requirement to be a girl?

  • http://ubuntulinuxtipstricks.blogspot.com Anonymous

    PS, I’m a cisgender woman, and I had no interest in boys when I was in 7th grade. I thought just the same way as she does. That didn’t change til shortly before I started university. I’m still not very interested in “boys, boys, boys” (more like “computers, sewing, languages, and maybe one boy”).

  • Skull Squid

    Why is that any of your damn concern? Does Sylvia living the way that she does to make herself happy and secure somehow infringe on your precious privileges?

  • Kate

    “It makes me feel like I’m not being completely honest, but my honesty got me in a lot of trouble a few years ago,” she says.
    Such a poignant statement! Yes, dear, sometimes in life honesty is a dangerous thing. What a courageous girl and parents!

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  • Alex

    This is an amazing story. I wish, so so much, that my friend’s parents were like this. It would make him so much happier.
    It’s too bad that so many transgender people don’t have stories like this, but instead of hiding their true selves from society, and sometimes growing up to hate themselves. Whenever I think about it, I just wish I could do something to make it better for them. No one should have to go through that.

  • just another trans girl

    This is a beautiful story. It brings tears to my eyes. I only wish my family had let me transition earlier and seen the signs instead of rejecting them. While the tendency in the article to focus on normative genders and surgical procedures is disconcerting (why not encourage sylvia to think she is not a mismatched puzzle but can create whatever gender she wants?), still the fact that there are more options for trans kids today is truly heartwarming. Thank you.

  • AJ

    You, sure, are an insentivive jerk. We’re talking about Gender, not sex. They’re two completely seperate things.

  • Rose

    WOW! First and foremost, let me say that I am IMPRESSED! I do not have any TG children of my own, HOWEVER, I have a son who is Bi, and I know a young man who at 11 yrs old KNOWS that he is gay. I am SO very proud of my son and I would do ANYTHING to show him that I support who he is. MAJOR PROPS to Sylvia’s parents, and as to her twin brother, Darlin, You are a wonderful person, who will grow up to be an AMAZING man. Thank you so very much for sharing yopur story with all of us, and I hope that your adventure through this maze that we call life, is as positive and as strong as ya’ll are. Much love from a parent who understands.

  • Zoe_Brain

    “A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis.” — J Clin Endocrinol Metab. 2008 Jan;93(1):182-9.

    @Truth, despite what you might have been taught in grade school, it’s not that simple. There are exceptions – some obvious, as when woman gives birth – and some not so obvious, when a girl is born with a masculinised body.

    This almost superstitious belief in “male chromosomes” has done great harm.

    It’s true that most men have 46,XY chromoomes, and most women have 46,XX. But there are exceptions – one in 500 men are 47,XXY for example. It’s also true though that most men are taller than most women. Would you judge someone’s “real” sex based solely on how tall they are? So why judge it solely on presence or absence of a Y chromosome?

  • Jennifer

    Good for her — and bravo to her family for trusting their daughter’s truth and supporting who she truly is. They are to be commended. I hope they know how many people support them for the wise and compassionate choices they’re making.

  • Brianna

    WOW!
    wish this was available when I was her age. Would have made my transition and life SO much simpler and nicer!

  • lad960

    This article is SO uplifting and inspiring. Beautiful!! Thank you so much for sharing this story. Best wishes to Sylvia and her family–we need more families like this in the world.

  • Delina

    Her gender is female. Sex is biological/genetic, but gender is in the mind. It is not a choice. By your rationality, women with CAIS (intersexed condition where women are biologically/genetically male but look eternally female and often identify as female) are “male.” I double dare you to call one of these women “he” or “him.” Anyways, again, she can’t change her genes, but she has a female mind and so she should be referred to as such. Gender, no, humans, are more complicated than their biology/genes. Please educate yourself about gender dsyphoria/gender identity disorder and do not let your discomfort make you disrespectful and close-minded.

  • Dilalia

    Not being interested in the opposite sex has absolutely nothing to do with gender identity. I am biologically/genetically female and asexual and while I find men and women aesthetically pleasing, I am not sexually attracted to anyone. Never had a “boys, boys, boys” phase and I’m sure I wouldn’t have had one even if I was sexual. Girls aren’t going to be a part of every stereotypical part of girlhood because girls aren’t stereotypes, so that makes sense. I am not getting any vibes that she is psychologically unsettled. (Where are you seeing this?) I think this will end up being a good story if her family continues to be supportive of her and she grows up around other supportive people.

  • Historyoftheseagull

    It makes me wonder, if the clinic has only treated 17 patients since 2007, if it is the lack of support for the youth, or the clinics strict guidelines that keep the number to low. I wish this had been around when I was younger, but I think I would not have been allowed in the program with my family opposing it. I am happy “sylvia” has such wonderful parents and a caring brother. Family support means everything at this stage in life (because of her age and her gender developement) and I am happy she will not have to live life without her families support!

  • Karolframe

    I raised my children to be kind, giving, loving, strong and couragous. I raised them to be their own person. Although we were shocked by our son’s decision to be transgender, we accept and support his decision. My husband is less open, less verbal. He said he supports him but that he will live a hard life, and that worries him. He said society will be hard and that is not what he wanted for his children. They fear what they do not understand. We love our children unconditionally, even at times we do not always agree on their decisions, we learn to accept their decisions. We just want them to be happy being who they are, with values of kindness, strength and to pursue their own dreams. Life is hard, anyway, but society is no longer living in the dark ages and someday, transgenders will be the norm. Kids do not need to be told whether they should be one gender or another. they are people, with feelings, with opinions and with dreams. It shouldn’t matter what their gender, their sexual perferances, or whether they are straight. What matters is the type of person they are, what they can accomplish and if they are happy. Acceptance, unconditional love, and supporting your child in whatever they choose is our job as a parent. Life is changing, values change but love and support never do. Society believes in dark age philosphy, meaning if one goes against one rule, than it is wrong. Transgender children are looked upon, in these values of going against God. It has nothing to do with religion. It has everything to do with how one is seen. We, as a society, have to change and learn to accept what is. Religion aside, acceptance of tansgender/gay indivuals will make our society better. No longer are we living in the dark ages, no longer should we accept this a a taboo subject. I am a fifty year old who has seen and heard more than my share over the years but I have learned to accept the loss of the son I gave birth to and to accept the “birth” of the daughter he has become. Unconditionally. It is nice knowing that both men and women can support their children. They just sometimes do it silently…

  • Ash

    I have just finished reading Sylvia’s story and I am glad that she has her parents and her brother backing her up at this time in her life. I know what problems that she could have without their help and understanding. GID is something that I suffer with and have over the years but unlike Sylvia I didn’t have anyone to help me. I hope that her family will keep on supporting her as she goes through her growing years.

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  • dit

    These parents are as ignorant as the homophobic male medical machine murdering their child. A sick, sad shame they are more interested in maintaining the gender straight jacket than allowing their son to be himself.

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    dirt

  • Janet

    “…. allowing their son to be himself ….?  What they are doing is “allowing their daughter to be herself.”  You need to get some information on how the brain is gender-typed and then maybe, just maybe, you could speak from an intelligent point of view.  Forcing this child to live as a male would likely lead to an early death.

  • dominic

    Child abuse.

  • http://profile.yahoo.com/TCCV5LZQQ77KPJ45QNGIGNGP7M iammello2

    To the parents: It would be easy for me to say that i dont agree with this because its only words to me. In all reality I am not in your shoes and if I dont agree that’s my problem. so regaurdless of what I or other people who disagree with this think it’s great that you are working so hard to raise your twins the best you know to and putting so much tlc into it.  I also love the fact you kept their identity a secret and yet shared your story. I  hope you arent discouraged by peoples cruel comments but instead are getting more comments that make you proud of yourselves. Thank you, for sharing your story!
                              -your friend from the other team Manda

  • http://www.facebook.com/CerezaVarela Cereza Varela

    Read it, sobbed my heart out…  Nobody helped me stop my puberty.  Nobody listened when I tried to live as a boy.  I’m glad Sylvia has a supportive family, but I can’t say I’m not jealous of her.

  • robert

    i have gender dysphoria and it hurts alot i have attempted suicide and self surgery i have been self harming alot i just wish i could have done something before i turn a teenager

  • Raymi Lauren

    This is so super amazing. What a moving piece.

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