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Photograph by Jim Allen Elizabeth, 21, New York

© 1999, Salon Internet Inc.

August 28, 1999

Teen transsexuals

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 painful existence.
       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 their practices]
       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 dysfunctional times]
       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.