Youngest-Ever Sex-Change Patient

The intervention may have also come at a critical time for the child. In most cases, hormone therapy in preparation for sexual reassignment surgery occurs at a much later age. However, there were concerns that the lower voice and facial hair growth that come along with male puberty could have been traumatic for Kim.

"If the family is noticing some extensive concern on the child's part with experiencing secondary sex characteristics, such as a deepening voice and facial hair, then that is a strong sign as well," says Michele Angello, a clinical psychologist who works with adolescents who also experience transgender tendencies.

"It becomes a problem when they are close to puberty and they begin to exhibit anxiety, depression or suicidal ideations."

Biology or Psychology?

Along with igniting a debate over the propriety of beginning the path toward sexual reassignment in such a young patient, Kim's case has also fed the discussion over whether gender preferences are in the mind or in the hormones.

"That's the $64,000 question," Reeve says, adding that recent studies have suggested that biology or genes might play an important role.

"But I'm unaware of any discovery of a clear-cut, uncontested genetic marker, such as an anomaly in brain development, that would account for this," Reeve says. "In other words, there are probably some environmental factors, but it's impossible to say without more information."

It is also likely that on some level, psychology plays an important role.

"The complicated but simple answer is that it is probably an interplay between the two, though certainly the impetus is probably something endocrine," Angello says.

But one thing is certain with regard to the therapy -- medical ethicists and the public will continue to debate whether such treatments should be allowed for young patients.

"I think that there will continue to be a great deal of controversy around this sort of procedure, regardless of the outcome here, for some time to come," Reeve says. "This is just because of the uncertainty within the field regarding the true roots of gender identity."

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