Born in the wrong body

By DAVID SCHARFENBERG  |  October 26, 2012

But there is little evidence, as advocates of the new approach point out, that the sort of "corrective" therapy practiced by Zucker does much to change a child's gender identity. And asking a child to stick with his or her assigned gender can lead to its own, very real pain.

Incidents of substance abuse, depression, and suicide among those with gender identity disorder and the stress it spawns — "gender dysphoria" — are staggering.

Indeed, advocates for the transgendered want the influential Diagnostic and Statistical Manual of Mental Disorders, to drop its classification of gender identity disorder as a mental illness and shift to a focus on the impact of the condition.

The American Psychiatric Association's choice of Zucker to review the GID diagnosis for the next edition has sparked widespread protest.

Dr. Forcier, for her part, takes a relatively liberal approach to diagnosing and treating kids. She does not, for instance, require a formal evaluation by a psychologist before beginning treatment. That "gatekeeper mentality," she argues, is out of date: "You don't have to prove to me you're transgender, just like you don't have to prove you have asthma."

Dr. Forcier says her own exhaustive evaluation of each patient's medical history, family history, and gender goals is more than sufficient. And sussing out a kid's gender identity, she suggests, is not nearly as difficult as it sounds.

Here, she turns to her four-year-old daughter, who has tagged along for the lecture. "Are you a boy or a girl?" she asks.

"A girl."

"Yeah," Dr. Forcier says.

It's not quite that simple, of course. Dr. Forcier has extensive training in child and gender development, which she regularly puts to use. But "most of my gender nonconforming kids are pretty clear," she says. "I'm not sitting there going, 'are they psychotic,' or 'are they hallucinating right now?' "

Of course, research suggests that less than one-quarter of pre-pubertal children with "gender dysphoria" maintain the condition through adulthood. But for parents of the truly persistent — kids adamant that they were born in the wrong body — something like certainty can descend.

And puberty blockers can buy time — for the certain and less certain — until adolescence, when preliminary research suggests virtually all who are still gender dysphoric will remain so into adulthood.


TWO REVOLUTIONS

The Rinis are moving pretty quickly.

Hannah just got her first puberty blockers a couple of weeks ago. And she might begin taking cross-hormones, which are only semi-reversible, as soon as six months from now. The idea is to launch her female puberty at the same time as her peers.

I ask Michelle if there's any part of her that worries if she's doing the right thing. She says she's pretty certain that Hannah's female gender identity is here to stay. But the prospect of beginning cross-hormones, she allows, is "a little scary."

The potential for infertility, she says, is the biggest concern. "But when you weigh the pros and cons," she adds, "I think the pros far outweigh the cons."

Transition has presented some early difficulties. Michelle's parents, if generally supportive, resist using Hannah's new name. And Mom is confronting all kinds of novel problems; she frets, for instance, about setting guidelines for birthday parties. Should she insist that family and friends address cards to "Hannah?"

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