Buying Time for Gender-Confused Kids

A procedure that some are mistakenly calling a sex change treatment for children has been drawn into the spotlight in recent days -- although it has been going on for many years.

In an interview with National Public Radio broadcast earlier this month, Dr. Norman Spack, a pediatric endocrinologist at Children's Hospital in Boston, revealed that he has at least 10 pediatric transgendered patients to whom he has been giving a hormone-blocking treatment to delay puberty.

Citing recent unwanted media attention, Spack declined, through a spokesman, to be interviewed for this article.

But other doctors say that while Spack may be the first to go public about what he is doing, he is not the first to help children delay their puberty so they can reach maturity before deciding if they would like to transition to the opposite sex..

Milton Diamond, a sexual development researcher and the director of the Pacific Center for Sex and Society at the University of Hawaii, says he knows of doctors who have done this before, "but people don't generally advertise it," he says.

He pointed to the Netherlands, where hormone-blocking therapy has been administered to transgendered youths for more than 20 years.

But Diamond says that the hormone-blocking therapy itself is not sex reassignment.

"It's a delaying tactic to allow the individual to come to terms with the direction he or she wants to go," he says. "What you're doing is allowing the individual more time to make a decision."

Is It Safe?

Jamie Newton, a spokesman for Children's Hospital, confirmed that the treatments are done in accordance with the Harry Benjamin guidelines (generally accepted clinical guidelines for treating transsexual patients), which call for fully reversible treatments for prepubescent children.

The therapy entails an injection of either luteinizing hormone-releasing hormone (LHRH) or medroxyprogesterone, which block estrogen or testosterone to delay the onset of puberty.

The regimen is typically given to children (mostly girls) who reach puberty very early, when the parents and physician opt to delay the process a few years to aid with normal development.

Medroxyprogesterone is known commercially as Provera, a drug injected once every three months as a birth control medication.

"LHRH has been used for 20 years, medroxyprogesterone probably that long, if not longer, so we know they're safe and effective," says Alan Rogol, a clinical professor of pediatrics at Riley Hospital of the Indiana University School of Medicine and the University of Virginia.

Also, he says, a child will undergo normal puberty following the hormone-blocking treatment, and it is fully reversible should a transgendered child choose not to undergo sex reassignment or transition once they reach adulthood.

"There is no question that it's reversible, and I'm unequivocal about that," says Rogol.

In addition to delaying the onset of puberty, the hormone-blocking process does help patients avoid unwanted bodily features if they do decide to undergo a sex change upon reaching adulthood. It is the changes of puberty that often cause the most distress for transgendered children.

"We're talking about things that have a profound, significant influence on the child's life," says Diamond.

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