This page has been created as "fair usage" entirely to allow assessment and
appreciation, by those concerned with the subject, of the unique portrayal
of transsexuality in young people in the article, especially by young people
affected themselves, their relatives, friends, medical personnel, policy
makers and academics. All copyrights are wholely acknowledged.
Link to original article
|Photograph by Jim Allen
Elizabeth, 21, New York
© 1999, Salon Internet Inc.
August 28, 1999
When do children have a right to decide their gender?
by Maria Russo
Associate editor of Salon Books
Ina's story may be unusual but it's no longer guaranteed
to shock. During an isolated childhood in rural Oklahoma, Ina knew she was
a girl from her early years, even though her body seemed to be a boy's. "It
was always clear to me that this boy identity and body were incorrect." She
remembers a childhood spent "tending to my inner awareness of myself and
avoiding other people a lot of the time."
Then puberty hit: "That was the hardest.
My own body was staging a mutiny, even." At 16, after an eating disorder
had brought her to several psychiatrists, Ina finally confessed her secret.
The doctor gave her a book about gay and lesbian youth, which Ina found
devastating. Having finally worked up the courage to talk about it, she was
still misunderstood. She soon found another doctor who explained the particulars
of "transitioning" from one sex to the other. But he wouldn't help her. Eighteen
is the accepted age for beginning to transition
[NOTE - Salon's writer is misinformed here - there is no "accepted age to
transition", if you have to transition, you transition; in most places there is no
law against it, just social or family pressures], and she was just shy of
17. Synthetic hormones, the first step to altering the course of sexual
development, became her holy grail. "I knew I couldn't be happy letting my
body masculinize on and on. And so at 17 I graduated from high school and
found hormones on the street."
Things turned out OK for Ina: She's
now 24, post-op and a graduate student in American studies living in a small
Oklahoma city. But the years she endured living as a burgeoning adult in
the wrong body still seem like an unnecessary burden added to an already
If Ina were 17 today and near a big
city, she'd probably be able to find a doctor willing to make her an exception
to the 18-year-old threshold for hormones. The treatment protocol of the
Harry Benjamin International Gender Dysphoria Association, the standard-bearing
organization for transgender medicine, allows exceptions in cases of "clear
maturity." At the very least, Ina would be prescribed hormone blockers, which
would stop the path of testosterone without giving the feminizing effects
of estrogen. This way, in case she changed her mind, permanent alterations
wouldn't have taken place. (Estrogen produces breast and hip development,
while testosterone brings facial and chest hair and increased muscle mass.)
[NOTE - Again Salon's writer is misinformed - there is no "18-year-old
threshold for hormones", the protocol mentioned says sixteen for estrogen
or testosterone, and eighteen for reassignment surgery. But "blocker" hormones are
allowed at the first sign of puberty, in suitable cases, however it is common for
local professionals to ignore those ages, rarely honestly explaining or justifying
No one compiles official statistics
on transgender youth, but those who work with them agree that their numbers
are rising. In the last year, for example, the number of transgender people
under 22 in the "gender reassignment" program at New York's Michael Callen-Audre
Lorde Community Health Center has tripled. Partly this is the result of increased
access to information. A kid today with "gender dysphoria," the catch-all
term for disconnect between body and gender identity, will likely know about
transsexualism from puberty or younger. Eighteen-year-old Christian, a college
freshman in western Pennsylvania who was born female but is just starting
to live as a male, is a typical example. At 16, after learning from the Jerry
Springer show that there was a name for the way he felt, he "went online
and looked up anything and everything about transsexuals." To his astonishment
he found chat rooms filled with "people just like me." Recently he met his
first fellow transsexual in person -- a 21-year-old he'd met in a chat room,
who lives two hours away and has introduced him to a group of trans guys
who meet regularly.
As more young transsexuals push to begin
transitioning at a younger age, the social workers and medical providers
who work with them are confronting a new frontier in gender ethics. What's
the best way to help kids who say they want to switch sexes? Should we make
them wait as long as possible, to be sure their decisions are not simply
adolescent rebellion? Or take them at their word and let them begin hormones
during puberty? "Every day, I feel torn between wanting to empower my patients
and wanting to be sure not to harm them," says Jayne Jordan, a physician
assistant in the Callen-Lorde Center's transgender medicine program.
Ina and Christian are part of a new
generation of transsexuals who are taking their fate into their own hands
and changing the face of gender shifting. Transgender pioneers like Renee
Richards, whose sex change in 1975 made headlines around the world, had navigated
the mental health system for years before transitioning. While those agonizing
years (or decades) were full of suffering, they also guaranteed that the
decision to transition was not a whim or an act of passing rebellion.
[NOTE - An incorrect assumption, as Renee Richard's
history, switching back and forth between genders, unfortunately shows. If someone
has always been very clear about their gender they are far more likely to be right
than someone who is unclear for years, who is likely to remain unclear]
But adolescents are, well, adolescent.
Adults often have difficulty interpreting their behavior. A teenage would-be
transsexual's anguish and determination may look like standard-issue rebellion
in an extreme version. [NOTE - Hardly a resonable
worry - asking for one's body to be changed to the other sex, consistently over
a long period is not usual teenage rebellion at all, and it would be the worst
nightmare for anyone other than a transsexual person]
Now that tattooing and piercing have lost their shock
value, couldn't transsexualism turn out to be the ultimate way to etch defiance
onto one's body? There's the nightmarish prospect of a teenager going through
with a sex change and deciding later that it was a mistake. Jayne Jordan
knows of one such case -- a biological male who identified as female and
had taken estrogen from age 16. He had breast implants and was surgically
castrated, then decided he wanted to go back to being male. He had the implants
removed -- but since he has no testicles, he'll be taking testosterone for
the rest of his life.
So at what age should children wield
the power to change their sex? It's one thing to experiment with homosexuality;
people can always change their minds later on. But by law a minor cannot
undergo any voluntary medical procedure without parental consent, except
STD-related care, contraception and (in some states) abortion. There are
ways around this; an emancipated minor, or someone who claimed she would
be abused if she confronted her parents, can make medical decisions
independently. Should there be laws preventing all minors from putting themselves
through sex reassignment? Should more be done to stop transgender kids from
getting hormones illegally?
Ina acknowledges the potential for mixed-up
teenagers to do themselves harm, but she maintains that for the most part,
slowing the transition process for minors serves mainly to make the adults
involved more comfortable. It is true, after all, that sex-changing hormones
have a mood-stabilizing, antidepressant effect on transgender people, who
have astronomic suicide rates. Given such high stakes, Ina assails the belief
that "there's nothing you can do but endure puberty until you're all grown,
and if you don't kill yourself by then, knock wood, many opportunities will
magically become available and you'll have a lovely life."
The very turbulence of adolescence should
make transitioning a more natural concept, she says. The "normal" life passages
from boy to man, girl to woman, she argues, "are also gender transitions,
and just as disruptive and traumatic as the transgender experience." Why
let puberty run its course knowing that it will require several expensive
surgeries, not to mention electrolysis, to undo it?
[NOTE - Some developments of puberty cannot be undone; a male frame,
great height, large hands and feet, a broken voice, the missed opportunities and
Ironically, Ina's position faces some
unlikely opposition. Gay and lesbian advocates, who have been at the forefront
of the transgender rights movement, often find it troubling to think that
people may choose transsexualism as an alternative to being gay. As a lesbian,
Jayne Jordan says, "it crosses my mind a lot that some of my patients may
choose sex changes out of internalized homophobia."
Some gay advocates argue that in a society
in which gender roles were not policed with such vehemence, transgender teens
would not feel the need to transition at all. These activists seem hopeful
that sex changes will become a relic of a less enlightened era, that transgender
people -- and everyone else -- will be able to live in the bodies assigned
them by nature and inhabit whatever gender feels right at any given moment.
Some transgender youth do say they're comfortable in an ambiguous, sliding
place in the gender spectrum. Twenty-one-year-old Angelica, for example,
only does hormones. "I don't fully identify as female, but rather a feminine
androgynous male -- no surgery for me."
Perhaps even more troubling than these
ideological issues is the fact that many of the teenagers who show up on
the doorsteps of sex-change organizations are street kids. Lost, broke and
helpless, they may be looking for a magical escape from their loneliness
and poverty as well as their gender alienation. "Some young male-to-female
patients actually believe they'll be able to get pregnant," says Jordan.
Often, she says, transgender street kids come in thinking all their problems
will go away and they'll be accepted as women or men. She has to explain
that they'll probably face discrimination their whole lives.
[NOTE - Transsexual people should BEWARE lesbian physician assistant
Jayne Jordan at the Callen-Lorde Center in New York, on the basis of her
statements in this article]
But as compelling as it may be to think
of eliminating the need for sex reassignment, many transgender people just
want to get safely to the other side of the gender dichotomy. As Ina puts
it, "at a certain point I just wanted to take off my costume and go home."
Far from making a political statement or changing the world, she simply yearned
to feel comfort and pleasure in her body. "I thought I would never have that,"
Ina says. "Many times I still don't. But there are certain things about the
physical body that are rewarding, and I can say, OK, yes, this was worth
the pain I had to go through to get here."
The more I talk to transsexuals about
what adolescence was like for them, the more my own transformation from scraggly
tomboy to woman comes back to me. But as I watched my body turn into something
new and strange, I found social roles and cultural images that I could use
to create a future version of myself. What would it feel like to grow up
without those images? Or with images that seemed everyday to become more
distant as your body develops? As Ina and I talked over the course of several
weeks, I began to believe that our routes to womanhood followed parallel
roads. Mine, of course, was paved and well lit; I was spared the most
excruciating and dangerous aspects of her journey.
If gay people have shown how preconceived
gender and sexual categories don't correspond to human multiplicity, transsexuals
have something else to teach us: Beginning in adolescence, we put together
a sexual and gender identity that is part body, part behavior, part inner
sense of our outer roles.
And while the youngest transsexuals
[NOTE - the writer doesn't seem aware that her interviewees
are by no means the youngest of transsexuals, since many are clearly transsexual
at two or three years of age] challenge us with the most difficult ethical
questions, the very flexibility of their youth may well shift our cultural understanding of transsexualism.
Twenty-one-year-old Elizabeth, for example, has a life no one would envy
-- but her self-possession and her comfort making her own rules make her
future look surprisingly promising.
Two years ago, after a blowup with her
family in Compton, Calif., when she told them she'd decided to become a woman,
Elizabeth escaped to New York City and ended up on the street. She's been
living at Covenant House, Manhattan's homeless youth center, ever since.
Her stories of the struggles of the last few years -- from life as a gay
teenage boy with a macho father to her days hustling on the street, negotiating
tricks with predatory old men -- are not pretty.
Yet Elizabeth seems deeply resilient,
determined to find her own dignified way despite her life's tumult. She doesn't
buy the "woman born in a man's body" model of transsexualism. Rather, she
describes her choice in pragmatic terms. "I decided I'd rather be a woman
than an effeminate man," she says. "People are really hard on men who don't
live up to the male image." Seemingly unaware that her decision might look
like a last-ditch escape from a life of not measuring up, Elizabeth doesn't
couch her life story in mystical inevitability or psychological excavation.
She's not all that interested in figuring out why she turned out this way;
she simply knows that becoming a woman was the right decision.
Elizabeth concedes that there's more
to being a woman than she had anticipated. Men don't always treat her with
the respect she thinks a woman is due. She worries a lot more now about how
she looks, how she smells, how she walks. She still faces indignities every
day -- people making disparaging comments about her body or refusing to refer
to her with feminine pronouns. "It's more personal now when they're cruel,"
she says. They're making fun of Elizabeth's most intimate hopes, ridiculing
the self she is busy creating.
But she's wary of seeming to try too
hard. Passing is a huge deal to most transsexuals, and in their quest to
be taken as "real" women, Elizabeth says, many trannies overdo things. "I
don't wear much makeup" she says proudly. In the low light of Tiffany's,
a West Village diner where we had dinner, she looks lovely, with large brown
liquid eyes and luminous olive skin. In the dim light, the shadow of her
facial hair barely shows, but she comments on it anyway. "I really hate that
I have to shave. What man wants to wake up next to a woman with a 5 o'clock
shadow?" Surgery to redo her genitals is still a faraway, expensive dream,
but so far she's "happy with the results of the estrogen."
Three months after our first meeting,
Elizabeth's life has improved. She has a new job as an assistant at a Chelsea
hair salon with a boss who accepts her. Her mother has since made up with
her and given her a new middle name. "I'm now Elizabeth Marie," she says
with a smile -- still trying it on. Every once in a while, she says, the
wind in her newly shoulder-length hair or an admiring look from a man will
give her a little wave of ecstasy. "For the first time in my life," she says,
"I feel peaceful inside a lot of the time."
It will always be difficult to figure
out where laws and medical protocols should end and an individual's life
-- and sexual identity -- must be left to shape itself. At a certain point,
rules must melt away. As Elizabeth's newly forged version of transsexualism
suggests, all people can ultimately become their own genders, the product
of their own dreams. The night before we first met, Elizabeth dreamed she
walked into her room at Covenant House and there was a big cocoon hanging
over her bed. As she watched, it opened up and she floated out, naked, her
body perfect, beautiful, female.