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Transgender kids get help navigating a difficult path

Amber is one of an increasing number who are getting specialized care. The 12-year-old takes puberty-blocking drugs and hopes to have gender reassignment surgery at 16.

June 15, 2012|By Anna Gorman, Los Angeles Times
  • Amber was born a boy named Aaron. Last year, she started taking medication to keep her from going through puberty. “I can be who I am,” Amber said. “I can be a girl.”
Amber was born a boy named Aaron. Last year, she started taking medication… (Arkasha Stevenson / Los…)

Amber, a soft-spoken, feminine 12-year-old who loves Hello Kitty and fashion design, lives with a secret. It is a secret most sixth-graders can't fathom, one she hides behind pink skirts and makeup. It is a secret that led to all her baby pictures being tucked away as though her childhood had never happened.

Amber was born a boy.

When she was 10, she stopped going by her given name, Aaron, and began dressing as a girl. Last year, she started taking medication to keep her from going through puberty.

"I can be who I am," Amber said. "I can be a girl."

An increasing number of children like Amber are realizing they are transgender and seeking care at clinics around the nation. Because of their age, the complex and emotional journey is as much their parents' as their own. Families are forced to make tough decisions about therapy and medication, and about what to tell friends and relatives. They are trying to give their children a normal upbringing with summer camps and sleepovers while protecting them from harm and embarrassment.

"How do you move through society with a gender-variant child?" said Nancy Quay, a psychotherapist at the University of Michigan gender services program. "What do you tell your neighbors? How do you keep your child safe?"

For Amber's parents, Michelle and Jamie, the last few years have been a roller coaster of emotions — guilt for not recognizing earlier that their daughter was transgender, grief over losing Aaron and worries about Amber's future.

The family's last name is being withheld at Amber's request. They all agreed, though, to both a video and photographs. Michelle said their family and others close to them know about Amber's transition.

Telling their story, she said, "is the right thing to do.... Hopefully it will bring more awareness and help other families."

Michelle said she believes that letting Amber take the medication and live as she wants is the only real choice. "We are confident this is her authentic self," she said.

Jamie is supportive but not quite as sure. "This is some pretty serious territory," he said. "As a parent, you are always second-guessing yourself."

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Just a few clinics around the nation serve transgender children. It wasn't until about five years ago that doctors began treating them with puberty-blocking drugs to give them time to explore their gender identity before taking hormones whose effects would be irreversible.

The medication is approved by the Food and Drug Administration for children who start puberty prematurely but not for transgender adolescents. Two professional organizations that study hormonal and gender issues recommend the drugs' use in certain transgender cases, but doctors remain divided on whether to prescribe the controversial and expensive medication.

Supporters say the drugs can prevent the devastation a transgender girl feels when she grows facial hair or her voice drops and when a transgender boy develops breasts or begins menstruating. They can reduce depression and anxiety and eliminate the need for some future surgeries, said Jo Olson, Amber's doctor and the medical director of the transgender clinic at Children's Hospital Los Angeles.

"Puberty in the right body is hard enough," Olson said. "Puberty in the wrong body is really hard."

Other doctors, however, express caution based on a lack of research. Walter Meyer, an endocrinologist and psychiatrist in Texas who works with transgender patients, said that puberty blockers are helpful for some adolescents but that knowing which ones is sometimes difficult. Not all children who identify with the opposite gender end up as transgender adults, he said, and giving medication to those may be going too far.

The drugs are administered through a surgical implant in the arm or monthly injections. They suppress the production of sex hormones, making it easier to pass as the opposite gender, Olson said. If the youngsters stop taking the drugs, they will go through puberty.

Olson acknowledged that doctors are making clinical decisions based on instincts and observations rather than research. "That's what makes this incredibly difficult," she said. Olson said she prescribes blockers only to adolescents who are in counseling and have been persistent about their gender identity.

Amber's father said he thinks of the puberty suppressors as a stopgap to "make sure everybody is 100% on board with the way it's going."

But Amber insists she never wants to be male. "Why would I have started if I am going to change my mind?"

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Aaron was a toddler when he first made his preferences clear. He didn't like cars or trucks, choosing Barbie dolls and dress-up clothes instead. Early on, he was attracted to "really glamorous, glittery, pretty things," Michelle said.

Getting dressed was a battle. He refused to wear shorts or pants, begging every day to wear his version of a dress — an oversize white T-shirt with a belt. On Halloween, he wanted a girls' costume, like Tinker Bell.

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