Trans Kid's Story Raises Controversial Issue for Parents

September 30th 2016

Lucy Tiven

The story of a young transgender girl's transition has brought up many of the difficult choices that parents of trans kids face.

On Buzzfeed, reporter Azeen Ghorayshi chronicles the upbringing of Nicole — now 9-years-old — within a conservative Texas community. (The publication declined to include last names of the family, presumably to protect their privacy.)

The story leads up to a heart warming moment when Nicole receives an American Girl doll on a birthday trip after a year of therapy socially transitioning at the Genecis clinic (a trans-inclusive health provider), and it illuminates the process of transitioning for young children and their parents.

Socially transitioning, as described in the Buzzfeed piece, involves parents letting a kid who wishes to transition live as the gender they identify with. Allowing kids to express gender however they see fit can involve wearing clothes of their gender, picking a new name and preferred pronouns, and other personal choices.

And it's certainly powerful that Kim and Andrew allowed Nicole to explore female gender, play dress up, and play with dolls at a young age. (A week and half after presenting Nicole with the doll, her parents gave her an even bigger birthday gift: they finally succeeded to get her name and gender changed on her birth certificate, the report adds.)

But Nicole's story brings up a more difficult choice her parents will face in the near future: whether and when to allow Nicole to start puberty blocking therapy — medications that suppress estrogen or testosterone production in pre-pubescent kids.

Studies have shown that supportive parents can alleviate mental health risks significantly among transgender youth, as NPR reports. And many health experts and LGBT advocates believe that support should involve offering kids these medical options.

But there's a good degree of debate amongst whether this is medically safe or wise.

Doctors like clinical psychologist Laura Kuper, who worked with Nicole and her parents, are hopeful about the options puberty blockers offer trans kids and their families.

“We have a lot of experience in pediatric endocrinology using pubertal blockers," Dr. Courtney Finlayson, a pediatric endocrinologist at Lurie Children’s Hospital, told PBS. "And from all the evidence we have they are generally a very safe medication.”

But these use of the drugs are "off label" so technically haven't been approved by the Food and Drug Administration. (Off label prescribing is, for the record, a legal and extremely common practice. This can involve, for instance, a doctor prescribing an antihistamine that makes people drowsy for insomnia rather than a sleeping pill.)

“That’s really what these pubertal blockers do,” Lurie Children’s Hospital’s Gender and Sex Development Program director Dr. Rob Garofalo told PBS. “They allow these families the opportunity to hit a pause button, to prevent natal puberty … until we know that that’s either the right or the wrong direction for their particular child.”

Others are concerned about the lack of research on stalling puberty.

"What are the benefits and adverse effects of starting young kids on these powerful [puberty blockers] and then hormones? We don't know," Dr. Frederic Ettner, a physician who has worked with transgender patients for more than twenty years, told NPR.

“I am concerned about some of the newer clinics,” Walter Bockting, co-director of the Program for the Study of LGBT Health at Columbia University Medical Center, told Buzzfeed. “We just don’t have the evidence to be confident about an approach like that, so I’m very concerned.”

Even Dr. Finlayson — despite her confident words to PBS on the safety of the drugs as tested — admitted that that puberty suppressing drugs could still have worrying side effects like amplifying a person's risk for osteoporosis.

Health professionals also disagree about when it's time to start puberty blockers.

As NPR reports, a 2008 paper "showed that only a fraction of children who felt their assigned sex was different from their gender continued feeling that way as they grew older." This has led some experts to believe that puberty blockers shouldn't be prescribed until age 16.

Others believe the mental health cost is too high to wait.

"Those years are very important developmentally, psychologically — if you wait to tell anyone about this for so long, that's going to lead to some negative psychological outcomes," Colt Keo-Meier, a Houston clinical psychologist working with transgender patients told NPR.

You can read the full report on Buzzfeed.