Monday, May 18, 2009

'I'm a boy-girl,' says 8-year-old

How about this one now? A truly transgender case? I don't see the whole picture. What can I say?

Published Saturday May 16, 2009


Now that Ben has had his final day at a west Omaha Catholic school, he gets to give away the last of his boy clothes — his school uniform — and live full time as the person inside: Katie.

This decision seems like a no-brainer for parents who at first presumed their prancing, pink-loving son who squirreled away cousins' girl toys was gay. That was before he told them he had a girl heart, a girl soul and was, in fact, a girl.

A defining moment came when it was time for First Communion. Eight-year-old Ben declared he wouldn't go if he had to wear a suit, and he pined for the white dress that girls wear. But neither his family nor church leaders thought it would be a good idea to introduce Ben as Katie in the Communion line. The church doesn't want Ben to be Katie at the school at all.

So, after behavioral testing, therapy and a lot of research, the parents have decided to switch their child to a public school and to let their son live as a girl. They asked not to be named out of concern for their child's safety outside the circle of those who know the family.

They know the path Katie faces is long, difficult and fraught with controversy. Some scientists say the approach they are taking amounts to child abuse. Other scientists say any other response would be abuse.

What might seem like a drastic, life-altering decision for their child is in fact the culmination of years of words and deeds that convinced Katie's parents, extended family members and therapists of this: She is a girl born into a boy's body.

* * *

As young as age 2, Ben would use anything he could find to create long hair.

At Grandma Mary's, it was old scarves. At home, he wore armchair covers and sweatpants around his head to mimic ponytails. He did this so often that his father caught himself hollering for Ben to "throw your hair down the steps" so he could get a full load in the washer.

At 3, Ben was a princess for Halloween, wearing a tiara.

When he turned 4, he told his mother, "I can't wait to be a mommy and have babies."

At age 5, Ben was taking girl toys to show-and-tell in kindergarten despite the razzing he got from some classmates.

He felt as deep a passion against boy things, including his penis. He asked when God was going to make it go away so he could get his girl parts. He began to urinate sitting down.

Ben's mother raised the issue with the pediatrician, who told her Ben was going through a common stage. Kids often experiment and mimic the opposite gender. Ben's mother persisted: This was no stage.

The pediatrician referred Ben to specialists. After a series of verbal and behavioral tests, the Boys Town specialists said Ben met all the criteria for gender identity disorder.

But they held off on a diagnosis. He was 5. And the disorder is rare.

The American Psychological Association says it is difficult to accurately estimate the prevalence of transgender people in Western countries. Current estimates of the prevalence of transsexualism are about 1 in 10,000 for biological males and 1 in 30,000 for biological females, the association says. The number of people in other transgender categories is unknown.

Transgender is a broad term and generally applies to people who see themselves as the opposite gender. Transsexual is a more specific term and generally refers to people who live as a different gender, including some who have sought or had sex-change surgery.

Author and gender specialist Stephanie Brill said as many as one in 500 children could be gender-variant or transgender. A small portion of youths with gender-variant behavior end up transgender.

The advice to the parents?

Let Ben drive the bus.

His mother asked if letting Ben do girl things was reinforcing the behavior somehow.

She was told no.

And so she and Ben's father went home and decided not to make gender identity a major issue for any of their three boys.

They didn't push pink. His mom, in fact, talked Ben out of pink paint and into teal when it was time to redecorate his room.

They set some boundaries. The hand-me-down dressy clothes from his cousins were OK inside the house and in the backyard but not at school.

And Ben still got his regular buzz haircut. Maybe if he looked like a boy, his mother said, it would help with socialization.

She also routinely took what she called "temperature checks." She'd ask: "What do you like about being a boy?"

Ben's consistent response: "Nothing."

* * *

Gender Identity Disorder is the formal classification found in medical and psychiatric manuals.

There is no medical test, and Ben has yet to have a formal diagnosis.

Ben would have to meet certain criteria. He would have to show persistent and intense distress about being a boy and a desire to be a girl. He'd have to show a preoccupation with stereotypical female activities or a rejection of stereotypical male toys and activities.

He'd also have to show a persistent repudiation of his male anatomy.

And he had to have shown these behaviors for at least six months.

Ben's mother, a lawyer, dived into research. She documented Ben's words — even scribbling notes in the Wal-Mart parking lot — and saved his artwork.

On one piece, he drew himself with pigtails and blue bows. On another, he drew himself twice: once with long hair and labeled "the rile me is Katie." For an assignment about household tasks, he wrote about folding his princess blankie.

When Brill's "The Transgender Child: A Handbook for Families and Professionals" was published in 2008, Ben's mother bought copies by the dozen to pass out.

Ben's father, a manager at a manufacturing plant, did not mourn losing someone to toss a baseball with. He saw how happy and peaceful Ben was with girl toys and clothes.

At three years older than Ben, the family's oldest child has coped remarkably well, but expressed frustration at Ben having to switch identities between home and school.

The change for now involves clothes, pronouns and a name.

But in a few years, Katie could join the first generation of U.S. children receiving hormone therapy to first forestall puberty and then make the body outwardly conform to the female identity. Genital reconstruction surgery could be the final step after she turns 18.

To Katie's parents, the course to take was obvious. Yes, they knew their son's life would not be easy.

So they strive to make it less hard and to avoid at least this pitfall: instilling a sense of shame. He did nothing wrong; they believe he was born this way.

"This really isn't our journey," his mother said. "We're kind of observers on this path."

* * *

The correct path is not so clear to everyone.

The term Gender Identity Disorder itself is controversial, with advocates for transgender people arguing it's natural diversity, not a disorder.

The advocates also say not all therapists making diagnoses are versed on nuances, including the distinction experts make between homosexuality and identifying with the opposite gender.

Science has not yet ruled about the degree to which biology influences gender identity.

Few medical specialists oversee hormone therapy in children with Gender Identity Disorder.

"We have not been able to find a pediatric endocrinologist who feels comfortable dealing with this issue," Dr. Jennifer Larsen of the University of Nebraska Medical Center wrote in an e-mail. "Some of us do care for individuals who are transgender as adults. But the issues are quite controversial as kids."

Furthermore, professionals who do treat children with the disorder are deeply divided.

Psychiatrist Paul McHugh, who closed the nation's first sex-change clinic at Johns Hopkins University, called the medical treatment of transgender children child abuse.

And Canadian psychologist Kenneth Zucker says he has helped hundreds of youths return to the gender of their birth through behavior modification. Parents must remove clothes, toys and other items used to identify as the opposite gender.

Zucker says the children who continue to exhibit Gender Identity Disorder after this are in that small minority of transgender people.

Other psychologists balk at the idea a transgender person can or should be cured. Diane Ehrensaft is a California psychologist and author who says Zucker's approach doesn't work.

Children who end up accepting their birth gender were never transgender, she said. They might be gay or be more fluid in their definition of gender, but they do not hold the deep belief that they were born into the wrong bodies.

Such children, she said, when forced to conform to the gender of their anatomy, may hide the behavior. That can lead to anxiety, depression, acting out and, for some, substance abuse and suicide.

Ehrensaft wrote a book, "Spoiling Childhood: How Well-Meaning Parents Are Giving Children Too Much — But Not What They Need." But she said there is no comparison between a child pushing for a later bedtime and a child insisting he is really a girl. ?

* * *

Last spring, toward the end of first grade, Ben pestered his mom and dad for a new name.

He hated that china plate on display in the dining room curio that listed his birth date and name, Benjamin James.

Together, they came up with a new name: Mary Kathryn. Katie for short.

Katie at home, Ben at school.

Katie was Katie all summer, and his mother began buying girl clothes.

She also realized she and her husband needed help.

They rejected Zucker's approach. "This does not go away, this is not a phase," said Katie's mom.

Instead, they enlisted Megan Smith, an Omaha therapist who works with transgender people. A licensed therapist with a master's degree in counseling who initially was a social worker, Smith has counseled women in prostitution. A number were transgender — men passing as women.

Smith declined to comment on Katie's situation, saying she would not discuss a client.

In general, she said she has heard a lot of sad stories from transgender adults. Many were rejected by families and kicked out of their homes. Bullied at school, they dropped out. They turned to prostitution to survive and drugs to cope.

"If the child is truly transgender," Smith said, "it's not going to go away."

* * *

At most schools, the emphasis on gender is reflected in the same-sex lines of children walking down the hallway and the gender-specific restrooms, locker rooms and sports teams.

Schools often are not equipped to deal with gender identity issues. The Omaha Public Schools try to discuss concerns, like restrooms, while honoring the family's choice of gender for the child. Millard said it was a private family matter. Westside said it hadn't dealt with any cases.

Teachers at St. Wenceslaus Catholic School appeared to take Ben in stride. They allowed him to use the nurse's restroom. When his letter to his Kimball, Neb., pen pal said "I'm a boy-girl," his first-grade teacher told him that was a little personal for the first letter and saved it for his parents.

Last fall in gym class, a classmate told Ben he was a boy. Ben responded by spitting on the classmate.

Ben's parents decided they had to move faster to transition Ben to Katie.

The church leaders, however, said Ben was welcome as Ben but not as Katie. This came just as Ben was telling his parents he would refuse to go to First Communion if he had to wear what he called a "tuxedo."

His mother didn't want to force Ben into a suit; nor did she want to spring "Katie" on Ben's classmates at Mass.

She found the option of First Communion at Sacred Heart parish in north Omaha, where her family had worshipped with Katie as Katie.

But when the mother took the case of Ben's transition to Katie in third grade to the chancellor for the Archdiocese of Omaha, the Rev. Joseph Taphorn, he said no.

In a recent interview, he explained the decision. From the church's perspective, Taphorn said, one is either male or female and can't change.

He added: "It's not fair to other children or families to introduce this question and this issue that is obviously a very real and serious one."

Educated in Omaha's Catholic schools, Katie's mom was hurt and upset. She asked friends by e-mail to show their support by putting empty envelopes in the collection plate.

Later, she said she didn't want to hurt the school, but wanted to spark discussion.

Katie's mom decided to end the school year a week early. "Katie's waited long enough to be Katie," she said. The child will enter third grade at a public school in fall.

On Mother's Day, Katie was oblivious to all the grown-up turmoil. She showed up at her grandmother's suburban home wearing a turquoise tank top with a sparkly star, and jeans that had the cuffs dotted with faux jewels.

She played in the basement with her 5-year-old brother. She sat on her mom's lap to nuzzle.

Her thick, sandy brown hair now is past her chin. Blue clips pin back the short parts.

Dancing into the kitchen to color a picture, her voice and manner were so girl, it would be difficult to tell she was a boy.

* * *

Puberty, of course, could change that.

Unless Katie decides to be Ben before age 11 or 12, her parents will try to get her on puberty blockers.

The blockers, the first stage of medical intervention, delay puberty. A boy on blockers won't get his Adam's apple. A girl won't get her period. If the blockers are stopped, the child proceeds with puberty.

If not, the child proceeds to take cross-hormones. Boys develop female characteristics, including breasts. Girls gain deeper voices and facial hair.

Most of the transgender patients Dr. Carol Milazzo treats in the Sacramento, Calif., area show more than physical change.

"When I first see them," the former Omaha pediatrician said, "they are very introverted, very insecure, and then they come out of their shell. They just blossom tremendously in social skills and, generally, happiness."

Milazzo's clinic has treated about 150 transgender patients, some as young as 10. The youngest prescribed cross-hormones was 15. They come from as far as 500 miles away.

* * *

The Omaha parents constantly ask themselves: Are we doing the right thing?

Then they think about how their middle child loved to play with Polly Pocket dolls, still is a Hannah Montana fan and often strikes a pose with hand on hip.

And how Katie is unequivocal when choosing girl clothes.

For Katie right now, there is no uncertainty.

Several days ago, a present arrived in the mail.

Her grandmother had ordered a replacement plate for the curio. Overjoyed, Katie took the old Benjamin James plate and wrapped it in three plastic sacks.

She threw it with all her might, shattering it to pieces.

In its place, on display in the dining room, a new china plate reads: Mary Kathryn.



From Omaha World-Herald; see the source article here.

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