For decades endocrinologists have been treating transgender adults with cross-gender hormones: testosterone if you're female-to-male, and estrogen if you're male-to-female. This is nothing new. But for kids like Spack's patient Justine (names have been changed to protect the identities of the children and their families), who, from the moment she could speak, "told us she either wanted to be a girl or she was a girl," as her dad describes it — kids who can articulate their gender identity, without a shred of doubt, from the time they are toddlers — waiting until after puberty means years of psychological agony; girls develop thick muscles and deep voices, and boys grow breasts and hips and get their period. The risk for self-harm during this time is enormous; among Spack's patients, one in five has engaged in cutting or other self-mutilation, and almost 10 percent have attempted suicide. Waiting to intervene until after puberty also means playing catch-up physically, with more medical interventions and more extensive surgeries required to "pass" in the right gender as teenagers and young adults.

Unlike the cross-gender hormones that kids may start later as teenagers, the effects of the puberty suppressors are entirely reversible: adolescents who stop taking them will immediately begin to experience puberty in their birth sex. The idea is to buy them some time. Time to grow up, time to develop what Spack calls "clarity and certainty" without the stress of their unwanted puberty bearing down with increasing intensity every passing day.

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  Topics: Lifestyle Features , KIDS, parents, hormones
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