Monthly Archives: January 2016

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Difficult Conversations

I’m not sure how other families steer their kids through social norms and conversational appropriateness, but in our house we talk pretty openly, though we try hard to keep things age-appropriate.  The word “transgender” floats through our house frequently, and Mike and I often find ourselves having discussions with the kids that I suspect aren’t the norm in other households. Our children are mature for their age, but they’re also ten-year olds. While the topic list is open, we take great pains to remember their age and maturity level.

Our kids have always been precocious, and we learned very early to only answer the question asked. Here’s an example:

Kids (as kindergartners): Where do babies come from?
Me: Babies come from a special area in a woman’s body close to her tummy where they grow until they are ready to come out.
(Kids are satisfied; mommy is relieved and thanking her friend Christina for the great advice about only answering exactly what was asked)

Kids (as first or second graders): How are babies made?
Me: Babies are made when a seed and an egg come together.
(Again, shockingly, kids are satisfied and mommy is once again relieved and silently thanking her friend Christina).

It took until last year for them to finally put the pieces together enough to ask for the details. I’d like to point out that Mike has never been around for these conversations.

Kids (because they are always together when these questions come up): But how does the sperm GET to the egg?
Me (inwardly cringing and cursing my husband for, once again, missing this important life event): Well (sigh), for most couples, that means the man puts his penis in the woman’s vagina and then the sperm comes out. That’s called sex.
(Dead silence for a solid ten seconds as they process this unexpected information)

Kids: WHAT?? EEWWWW! YOU DID THAT?? DAD DID THAT? OH GROSS!  (barf noises and peals of laughter for several minutes from them, uncomfortable silence from me)

Then followed a conversation about how some couples (same sex couples, couples with fertility concerns, single parents) don’t make babies this way and have to have help from doctors. Of course we also covered how these conversations are for home only and how it’s inappropriate to talk about these things with friends, etc, etc, etc.

And then I called Mike and railed against the injustice that these conversations always fell to me and how he owed me big time. I think I got flowers and chocolate that night. I was only slightly mollified.

That’s an example of how we’ve handled typically difficult conversations as they’ve grown up. I say difficult topics not because I think we shouldn’t talk about them (because I feel strongly that we SHOULD have these conversations), but because many adults have strong opinions on when, how, and what these conversations will look like.

All of that said, we have had to navigate through some pretty adult conversations in this house. Conner had her first endocrinology appointment a few months ago. This was to establish some ground work, meet the physician, talk about the process of going on hormone blockers and possibly cross-gender hormones (when and if appropriate, down the line, at the appropriate age), and for the physician to meet us, meet our child, and determine all of our wishes for hormone treatment. It was a really tough appointment for all of us for very different reasons and it’s taken me a few months to be ready to talk about it.

I talk to lots of parents of transgender and gender non-conforming kids. We’re all in different places of acceptance and readiness for the next steps. Mike and I had begun to feel like pros in navigating these waters because we’ve done it for so long. Conner has presented as a female for longer than she presented as a male. She doesn’t say that she feels like a girl, she says that she is a girl. That’s an important distinction when we start talking about hormone blockers and cross-gender hormones.

There was a recent article in Slate magazine from researchers who are leading a long-term study to observe the development and mental health of children who describe themselves as gender non-conforming and transgender. It’s a great article that describes some of the nuances between gender non-conforming children (children who don’t fit expected gender norms but don’t necessarily say that they ARE a different gender) and transgender children (who usually state or feel that they ARE a different gender).

Even medical professionals struggle to put the appropriate amount of emphasis on these definitions while still trying to maintain consistency with a diagnosis. The bottom line in all things stems from a child’s level of gender dysphoria, or their discomfort between the differences between their gender identity and their physical anatomy. It is really important to understand that everyone’s identity is individual and personal. One person’s definition of their transgender or gender non-conforming identity is likely to be different from another. Just as my self-identify as a woman is different from my sister’s. This is why blanket statements are pointless and harmful.

When we first put the pieces together when our daughter was 4 and had been asking us for months when her penis would go away, the distinctions between gender non-conforming and transgender were very important to us. We were desperate to try and figure out what we should do, foresee the future, and not make a wrong decision. We were asked by other parents if our child was transgender or gender non-conforming and it felt like we had to have a diagnosis to know what the next steps were. I’ve since realized that at the age of four, when no decisions are permanent, this was unnecessary stress.

Once the decision had been made to support her, trying to figure out if she was transgender or gender non-conforming didn’t weigh as heavily. We had access to few resources, contradictory studies, and no firm guidelines. What we did have was a gut feeling that told us that supporting our depressed and anxious child could not possibly be a wrong decision. The rest of the details would make themselves clear as we moved forward. And they did. Conner blossomed, we continued to educate ourselves, and life moved forward.

Conner has always been steadfast that she is a girl. In the very beginning of social transition, there were a few comments about being both a boy and a girl. I don’t want to hide that because I hear it from other parents and it tends to cause stress as mom and dad start second-guessing the decision to allow their child to transition. We took the stance that our daughter could be whomever she needed to be to experience happiness. Did she say a few times in those first few weeks that she was both boy and girl? Yes. Did she ever dress like a boy again or ask to go back to male pronouns?  No. She was adamantly opposed to wearing boys clothes or having male pronouns and would visibly suffer when forced to comply with those gender norms. We encouraged her to do what made her happy, provided clothes and toys of both genders, and allowed her to lead us.

I give this backstory because we are coming up on the age when the differences between transgender or gender non-conforming, and the level of gender dysphoria gets more important. If you stopped to read the Slate article, it was pointed out that there is a statistic that states that 80% of of gender non-conforming children do not grow up to identify as transgender. There are many layers to this very general statement and it annoys me that it gets tossed around by people who don’t understand research, don’t understand where that number comes from, and use it as the definitive answer for why children shouldn’t socially transition. Please read the article to understand why you shouldn’t just stop educating yourself at the 80% statistic.

If your child is experiencing gender dysphoria, there is a medically acceptable path. As pointed out by our endocrinologist, puberty blockers do just that: block puberty. They have been used in children who experience early onset of puberty and can be safely used in transgender children. There are medical risks such as bone density concerns that must be considered. There are also risks in denying puberty blockers to a transgender child whose body starts to go into the puberty of the wrong gender. Even for a medication that has been used safely in other children, there are things to consider in both giving and withholding this medication.

If a child persists in their statement that they are a gender different with their anatomy, and they are of a medically acceptable age, then the next step is to start cross-gender hormones.There is some debate on what this age is as standards of care are being established, but fourteen and sixteen are the two ages I see most frequently cited. Fourteen is the age when endocrinologists step in to give medications for delayed puberty which is why many parents of transgender children advocate for it.

There’s a lot more to consider once you start talking about cross-gender hormones. Up until this point, everything has been reversible. Hair can be cut (or grown out), clothes can be switched, pronouns and names can change, puberty blocking medication can be stopped and the puberty that aligns with the anatomy can begin.

Once cross-gender hormones are started, the ability to procreate stops. For a child who wants to align their body with their identity, this might not seem like a big consequence. But, as a parent, the impact is clearer.  There is the possibility of allowing puberty to progress to the point where sperm or eggs could be harvested. But there is also concern about denying cross-gender hormones and seeing your child suffer. And, I’m not just talking about a few sad days. I’m talking about the extremely high risk of depression and suicide that is disproportionately experienced by these kids. There’s rarely an easy answer.

So how did our appointment with the endocrinologist go? Well, frankly, it was kind of a shit show. I was tense and babbled inappropriately or sat rigidly in my chair and tried to sound like the medical professional that my degree proclaims me to be. Conner was stressed and slept poorly the night before which triggered her cyclic vomiting syndrome. She spent most of the appointment nauseous and moaning until, of course, the actual physical exam, when she began to violently throw up in the sink (she missed puking on the endocrinologist, thankfully). And poor Mike just sat there trying to take in all the information while supporting his mess of a wife (we were both shocked when I burst into tears) and his (literal) mess of a daughter.

It could have gone better.

That’s why I was surprised when I got a phone call from the clinic asking if I would speak on a parent panel for an endocrinology conference that was being held a month later. I’m not sure how that happened. Maybe it was my quick thinking when my daughter was about to hurl on the doctor. I suspect it’s because it was clear that I understood the complexities of these issues and would be unlikely to downplay the very real concerns that parents face when raising a transgender or gender non-conforming child.

Post appointment, there has been a sense of relief that Conner is still months, likely even a year or two away, from needing puberty blockers. I forgot to ask if we have to make the decision to allow puberty to progress to the point of being able to harvest sperm once puberty begins in a year or two, or if we start blockers right away and make that decision later. I guess we should also consider it a positive that we have time to navigate yet still more adult conversations with our ten-year old. She would love to have her own children someday and would be open to having a conversation about allowing enough puberty to make that happen. But, we don’t know what kind of changes her body will go through to get her to that point and that’s a big scary unknown. Right now, she is happy and healthy and my first priority is to keep her that way. I don’t want to take away her ability to have her own children, but I don’t want to see her anxious and suicidal as her body changes irreversibly due to the wrong puberty.

I find myself both relieved and frustrated that it’s not my decision alone that will dictate this course for her life. In fact, I suspect that my role will be to help her navigate possible consequences and help her tease out the complexities of her own thoughts on this. I’m sure that I’ll voice my opinion, but in the end defer to her decisions once I see that she has considered her options.

I chose to share this part of our lives because too often people assume that parents, kids, and medical professionals are blithely making decisions that have sweeping consequences without considering the the long term effects. Nothing could be further from the truth. Our lives are constantly weighing decisions.

I don’t know any accepting parent of a gender awesome kid who doesn’t find themselves struggling to balance support for their child with naked fear of the future. The authors of the study mentioned in the Slate article called us pioneers. They would know. We sat with them just a few months ago as we took part in their study. I’m so appreciative that researchers see the need to conduct well-designed studies like this. If you are the parent of a child like mine, then I encourage you to get in contact with the TransYouth Project. It was a few hours of our time, to be repeated if we are willing, so that the development and mental health of our kids can be studied long term.

As someone who teaches evidence-based practice, I see the need for studies like this to help future children. While many adults rigidly conform to expected gender norms, our children do not. Adults raise a ruckus when Jaden Smith  wears a skirt for Louis Vitton or  when Miley Cyrus refuses to conform to a specific gender. But do you know what our kids do? Nothing. Because they don’t care unless you tell them to care. We need strong evidence to help us determine which kids will need continuous love and support to express themselves authentically and which kids need that AND hormone therapy.

If you are looking for a great resource to help you understand the complexities of transgender and gender-nonconforming identity, I encourage you to start with the book Trans Bodies, Trans Selves. It will help you understand the rich layers of identity and why you can’t assume that one person’s transgender expression is the same for someone else.

The longer I advocate for my daughter, the more my understanding grows, and the more I realize how ignorant I am about this subject. I will never be able to step into her shoes, I will never be as eloquent as others in illustrating the needs of this community, but I will always try to be open to having my assumptions and beliefs challenged.