Buying Time for Gender-Confused Kids

Male transsexuals can avoid going through menstruation, while female patients can avoid growing body hair or developing a deep voice if they begin sex reassignment once their childhood hormone-blocking regimen ends.

Transitions and Follow-Ups

Although the treatment is reversible, Diamond says that most who reach that point will go on to transition.

"Almost all those who have gender identity disorder continue on to surgery, or at least continue on to transitions," says Diamond.

In his interview with NPR, Spack confirmed that assessment.

"My confidence comes partly because I've yet to see one change their mind and partly because we're using the psychological testing methods the Dutch have perfected, and they've yet to see one person change their mind," he says.

While the procedure allows children to more easily undergo sex reassignment upon reaching adulthood, sex reassignment surgery is controversial.

First performed in the first half of the 20th century, sex reassignment surgery gained prominence when former soldier George Jorgenson underwent the operations in Europe and became a media sensation as Christine Jorgenson.

In 1966, the Johns Hopkins Hospital announced that it was performing sex reassignment surgery through its Gender Identity Clinic. Those procedures were halted in 1979, when a study by Dr. Jon Meyer, a follow-up on patients who had undergone the operations, did not show any improvement in their wellbeing.

Dr. Paul McHugh, then the head of the psychiatry department at Hopkins, made the decision to halt the procedures, saying they destroyed healthy organs and that physicians needed to focus on healing transgendered persons' minds, rather than altering their bodies.

Many transgendered persons continue to undergo sex reassignment surgery, although a great number of them do so abroad. Because of a lack of reporting, exact numbers are hard or impossible to come by.

Since Johns Hopkins closed its clinic, no other hospital of that stature has made a public announcement of resuming the surgeries.

How Do You Know?

The closing of the Hopkins clinic led some to question how to tell when someone is truly transgendered, particularly children, who may simply have interests more often associated with the opposite sex.

"That always involves clinical judgment," says Diamond. "How do you know, when you're talking to a friend if he's pulling your leg? The more you know about a person, the more you can judge if he's lying or not. You don't make those decisions on one interview."

The important thing, says Diamond, is to be careful and aware that errors can be made in treatment.

"You have to be a little bit humble and realize you may make a mistake," he says.

But, he says, when used properly, delaying puberty until they are adults may be the best way to help a number of transgendered children grow into successful adults.

"If I thought it was appropriate, I wouldn't have hesitation in doing it," says Diamond. "I think it's a worthwhile practice, but like everything else, it has to be used judiciously."

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