Suppressing puberty with a view to sex-change surgery

Actors Kevin Zegers (left) and Felicity Huffman in a scene from 2005 movie There is currently a debate as to whether or not “transsexual” children as young as 11 years of age should be administered drugs which suppress puberty. These children are profoundly unhappy with the sex with which they were born and obsessed with the idea of living as the other sex. The Dutch team of Cohen-Kettenis and Goozen has already treated over 70 children with gonadotrophin-releasing hormone (GnRH) blockers -- drugs that suppress puberty. They argue that once a “transsexual” child has passed through puberty, the characteristics of the unwanted sex are more difficult to disguise, even with hormones and cosmetic surgery.

Therefore, since these children are on the path to “sexual reassignment surgery (SRS)” why not start earlier? Why not prevent puberty and allow the child to live as the other sex, and then, at age 16, begin administering hormones of the desired sex. At age 18 one can proceed with surgical alterations, including removal of the male or female sexual organs and the girls’ breasts, and creation of an artificial vagina and breast implants for the boys. The creation of pseudo male parts for girls is usually delayed since the plastic surgery for this operation is not yet perfected.

Those recommending puberty-suppressing drugs insist that such drastic measures are the only means available to relieve the suffering of adolescents who believe they were “born in the wrong sex body.”

When the surgical solution was seen as something to be avoided, most pre-adolescent children who believed they were or wanted to be the other sex eventually accepted the reality of the sex they were born with. Only a tiny percentage grew up to demand surgical alteration. Today, however, in places like the Netherlands, rather than trying to help these children accept their biological sexual identity, certain experts encourage parents and schools to allow the children to present themselves in public as the other sex. The very availability of these procedures convinces these adolescents that if they resist the therapist probing into the causes of their delusions and desires, if they keep insisting they were “born in the wrong body,” they will be allowed to access to hormones and surgery they desire and be able to live their fantasy.

Some have opposed this course of action. Kenneth Zucker and Susan Bradley, experts in the treatment of children with sexual identity problems, argue that if treatment begins early and if the parents cooperate the problem can be resolved and the desire to be the other sex usually disappears.

However, adolescents whose problems have not been addressed early are difficult to treat. According to Zucker and Bradley, “Seeking sex reassignment surgery is a defensive solution and a mechanism for control of anxiety.” (Gender Identity Disorder and Psychosexual Problems in Children and Adolescents, 1995) These adolescents resist working with therapists and demand an immediate transition. The question is: Should medical professionals give in to these demands?

This debate ignores a more basic fact: In reality it is impossible for a person to change their sex. Our sex – male or female is written on every cell of our body. George Burou, a surgeon who performed over 700 SRS operations, admitted: “I don’t change men into women. I transform male genitals into genitals that have a female aspect. All the rest is in the patient’s mind.”

It should be noted that there are a tiny number of people with genetic, hormonal and congenital disorders which may make determining sexual identity difficult, but those seeking surgical “change” are virtually all biologically normal males or females.

There is no denying the suffering of those with such delusions or desires, but these are problems of the mind not the body. Not all Dutch therapists agree with SRS as the treatment of choice; one commented that “the scalpel should not be used to reconcile fantasy with reality”. Dr. Paul McHugh, who encouraged Johns Hopkins University to cease performing such operations, wrote: “We don’t do liposuction of anorexics. So why amputate the genitals of these patients.”

Starting treatment at age 11 presents many problems. Is a child of that age able to give truly informed consent to the risks involved in numerous surgeries required, to the burden of life-long hormone treatments needed to sustain the illusion of the other sex, and to the permanent loss of the ability to have children? Those who have undergone these procedures often hide the fact that their birth sex is different from the one they are currently presenting from friends, employers, sexual partners, and even potential marital partners. They demand that birth certificates and other documents be changed and that they be allowed to marry a person of the same sex.

Puberty does not just change the sexual organs; it also affects brain development, bone and muscle development. No one knows all the potential side effects of administering puberty-delaying hormones on children; it constitutes human experimentation.

It is also possible that the desire for SRS is a symptom of other psychological problems, such as schizophrenia, personality, mood dissociative, and psychotic disorders. In one case reported in the American Journal of Psychiatry by Joost à Campo and associates, a man was administered female hormones for a number of years while awaiting SRS. These caused breast enlargement and atrophy of his genitals. Later he was correctly diagnosed with schizophrenia, administered proper drugs and his belief he was the other sex disappeared. He now deeply regrets the hormone treatment.

The Dutch team Cohen-Kettenis and Goozen admit problems. In an article entitled “Sex Reassignment of Adolescents”, they write: “Relief of gender dysphoria, however, does not necessarily mean relief of unhappiness in general. For example, for the women desiring to be male ‘living as a man without a penis’ presents problems when showering after athletic activities and being frustrated because of the impossibility of having ‘real sex’ with one’s girl friend.”

Persons who present themselves as the other sex, whether or not they have undergone surgical alteration, are demanding that others address them using the name and pronouns of their chosen sex rather than their birth sex. This presents real problems for those who don’t want to participate in this fantasy solution. The Catholic Church does not accept the claim of a sex change and will not allow alteration of baptismal records, marriage or ordination for those who have undergone such procedures. Many Evangelical churches have similar policies.

There is opposition from radical feminists and lesbians, some of whom feel that a person who is born a man cannot really understand what it means to be a woman and object to the ways in which men who claim to be women stereotype female behavior. There are also feminist concerns about women who want to be men “going over to the enemy”. As a result, some feminist groups restrict admission to gatherings to “women born as women and living women”.

Exploiting the gains made by gay activists, “trans” activists are pushing to have “gender identity” added to anti-discrimination legislation and want to make “transphobia” (the supposed irrational fear of persons presenting as the other sex) the equivalent of racism. It has become routine to link “Gay, Lesbian, Bisexual, Trans (gender or sexual) and Queer -- GLBTQ or LGBTQ -- together as sexual minorities who have a right to special treatment.

Pushing vulnerable adolescents down the road to surgery will make it difficult for them to change their minds and avoid mutilating surgery.

Dale O’Leary is a US writer with a special interest in psycho-sexual issues and is the author of two books: One Man, One Woman" and The Gender Agenda. Her last article for MercatorNet was “Coming out puts adolescents at risk,” published November 10, 2008


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