A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.
It is an issue that raises ethical questions, and some specialists urge caution in treating children with puberty-blocking drugs and hormones.
Pediatricians need to know these children exist and deserve treatment, said Dr. Norman Spack, author of one of three reports published today and director of one of the nation’s first gender identity medical clinics at Children’s Hospital Boston.
“They’re out there. They’re in your practices,’’ Spack said in an interview.
Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these children feel certain they were born with the wrong bodies.
Some are labeled with “gender identity disorder,’’ a psychiatric diagnosis. But emerging research suggests they may have brain differences more similar to the opposite sex. Spack said by some estimates, 1 in 10,000 children have the condition.
Offering sex-changing treatment to children younger than 18 raises ethical concerns, and their parents’ motives need to be closely examined, said Dr. Margaret Moon, a member of the American Academy of Pediatrics’s bioethics committee. She was not involved in the reports.
Some children may get a psychiatric diagnosis when they are just uncomfortable with narrowly defined gender roles; or some may be gay and are coerced into treatment by parents more comfortable with a sex change than having a homosexual child, said Moon, who teaches at the Johns Hopkins Berman Institute of Bioethics.
Children sometimes resort to self-mutilation to try to change their anatomy; others face verbal and physical abuse and are prone to stress, depression, and suicide attempts. Spack said those problems typically disappear in patients who have had treatment and are allowed to live as the opposite sex.
Guidelines from the Endocrine Society endorse transgender hormone treatment, but say it should not be given before puberty begins.