Letting girl live as boy 'the right decision'

22:17, Oct 07 2013

A medical ethics expert has praised the family of a seven-year-old girl who are backing a decision for her to live as a boy and to medically stop the onset of puberty despite criticism the child is too young to make the monumental decision.

The child, who Fairfax Media is not naming, could begin taking drugs dubbed puberty blockers in as little as two years.

It would be the first step toward hormone replacement therapy and possible surgery, should the child decide to fully transition as a male.

Dr Phillipa Malpas, a senior lecturer in clinical medical ethics at Auckland University, said the child should be taken seriously.

"If the child is adamant it is who he is we really should take it seriously. We kind of dismiss children, saying 'you don't know what you're talking about, you're too young' is not a good thing to do to children. They do know their minds," she said.

"It just seems incredibly courageous of this child as well as the parents to talk about this publicly as well."

The child's parents said they were committed to supporting their child after he started saying things such as "I'm not a girl, I think I'm a boy and I wish I was dead" last year.

"I try to guide him the safest path through, and the safest path for him is love, acceptance, tolerance and support," the child's mother said.

The family is also backing the child should the child decide to start taking puberty blockers, which would stop the body from developing as a woman's. If the injections, which are given every three months, were stopped, the body would continue its normal development.

"If he reaches 11, 12 or 13 and decides it's not what he wants, then he stops blockers and he'll go through puberty as a woman," said the child's mother.

Malpas said that allowing the child to live as a boy was a step in the right direction because it encouraged support, but it also added social pressure if the child had a different frame of mind during their teenage years.

"You've got to balance the risks and the benefits and they don't seem to be just medical, they seem quite social," she said.

"Giving this child more time to live as a boy, it seems sensible. There is still at least a couple of years for him to live as a boy with support, and to me it seems like a good thing."

The ethics of letting the child decide when to undergo treatment have been questioned by Georgina Beyer - the world's first openly transsexual Member of Parliament - who herself first identified as being transgender when she was three years old.

"There is no reason why this child can't be raised as the little child it wants to be ... but without the medical intervention at such an early age," she said.

"I've heard all the arguments about [female puberty], but this child should be making the decision when they are old enough to understand precisely what it is they're doing. I agree, don't dismiss what this child is saying."

While the ethics of whether the child is too young to decide on their gender is debated, child healthcare specialists are warning that this is not an isolated case and that there are not enough resources available for transgender youth.

Auckland endocrinologist Paul Hofman said he received calls "every week from each town in New Zealand asking for advice".

''Many of my colleagues are uncomfortable about it, I'm uncomfortable about it. But it doesn't mean to say we can deny the issue.''

Hofman said he was a ''cautious supporter'' of intervention through puberty blockers, once a youth had been diagnosed by one or more psychiatrists and counselling support.

''This is a vulnerable group of children and adolescents. It's a psychiatric condition, not medical.''

There are currently no formal services to support youngsters with gender dysphoria, which research shows is more likely to persist in girls than boys and Hofman said it was key to get more psychiatrists.

Dr John Newman, an Auckland-based specialist youth physician, said the youngest person he had treated for puberty blockers was 12. He would not comment on a child he had not treated.

"The recommendation is that they are seen by a mental health professional who is skilled in working with young people and with transgender issues, both before and during the use of blockers," he said.

"This is to ensure that there is no other explanation for their problem and that other mental health issues are being addressed as well.

"There are very few such mental health professionals in New Zealand so, more likely, they need to be seen by someone who is skilled in working with young people and is gaining experience in working with transgender."

Newman said there were hundreds of New Zealand children who identified as being transgender.