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Diane Ehrensaft, Ph.D.

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When Talking About Children's Gender, Words Matter

Posted: 03/ 1/2012 4:04 pm

Over the last year, there is no question that transgender and gender-nonconforming children have become more visible in our media and culture than ever before. Most recently, a Colorado Girl Scout troop ignited a national controversy by stepping up to include a transgender child as a member of their troop. And a very unconventional young boy, Roscoe Kaan, who wears girls' clothing and wants to play Sandy in his school's production of Grease, is a featured character on the popular Showtime series House of Lies.

Transgender and gender-nonconforming children and their families, like the ones I work with every say, constitute one of the least visible or understood parts of the LGBT community. They are just beginning to come into focus. As we see the media's and the public's growing interest in these families, I can't underscore enough the responsibility of journalists who cover them and the issues related to these children and young people to get the terminology right, as they are often the general public's main portal on these issues. All of us need to get educated; it is far too easy in the binary-gendered world in which we live to confuse and misinform people who are only just becoming aware of the children who live outside these gender boxes.

Take a recent, well-intentioned example of how terminology can lead readers astray. The Associated Press' Lindsey Tanner and her article "Sex-Changing Treatment for Kids: It's on the Rise," published last week, confused sex-change with delaying puberty, right from the headline and lead sentence: "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."

First of all, "teens and even younger children" are conflated into one group, even though the treatments used for transgender and gender-nonconforming children are completely different depending on age and maturity. Secondly, she lumps all medical treatment for these children into the category of "sex-changing treatments," a wording often associated with surgery or irreversible hormonal treatments to change genitals and other gender characteristics. This is completely inaccurate; no "sex-changing treatment" is or should be prescribed to young children. As Tanner herself notes, an increasingly common treatment for younger children (and by that we are referring to pre-teens entering puberty) is the use of pubertal suppression treatment, which merely delays the onset of puberty. Far from changing a child's sex, this is a completely reversible treatment that simply buys time for a child struggling with gender identity to decide his or her own true gender. It can only happen when a youth has reached Tanner Stage 2 of puberty. Finally, Tanner credulously includes a claim by one doctor, Margaret Moon, that "some [children] may be gay and are coerced into treatment by parents more comfortable with a sex change than having a homosexual child." But a Pediatrics study conducted by the Gender Management Service clinic in Boston, just released in February 2012, found no such coercion. Overwhelmingly, it is the children, not the parents, who want to get the treatment that will allow them to live in their true gender, which may not be the gender listed on their birth certificate. And no irreversible treatment is provided to children "too early"; such treatment is provided only to older youth, and only after a long and extensive period of complex preparation and review, which may include using pubertal suppression to allow time to make the decision to move on to cross-sex hormones.

As I said above, Tanner's good intentions are evident in her piece. Regretfully, the same cannot be said about a piece produced by Fox News last October about a transgender girl, 11-year-old Tammy. While their report included two gender-affirming quotations from two professionals (Joel Baum and I), the bulk of the professionals quoted cast aspersions on Tammy's family and made evidence-free, scientifically erroneous arguments that her pubertal suppression treatment could harm her, such as increasing her risks of cancer, creating the impression that this child had fallen victim to a dangerous and unsafe treatment regime. Said one: "This is child abuse. It's like performing liposuction on an anorexic child." Another professional, who was given the last word, suggested that Tammy's parents, a lesbian couple, might have coerced her into becoming a girl -- regardless of the fact that extensive, thorough psychological and medical review was conducted before Tammy began pubertal suppression, and that Tammy has a brother who is not transgender and who is much-loved by both parents, as a boy. Not one of these experts stopped to consider that it might be Tammy's decision, based on her own authentic psychological needs -- and one that was far from rashly made, which I can only conclude meant that they had never themselves talked to a transgender or gender-nonconforming child, or, if they had, they had failed to listen to the child and instead imposed their own ideology.

Fortunately, not all media coverage of transgender children has these weaknesses. In November I appeared alongside Tammy and her family on an episode of Anderson Cooper's talk show, Anderson. This broadcast sensitively, accurately portrayed the mothers' decision to put Tammy on puberty-delaying treatment (and similar decisions by two other sets of parents) as one made with respect and responsibility, and one that was necessary for her health. Careful distinctions were made between pubertal suppression and actual "sex-changing treatment" -- that is, hormone treatment and surgical interventions, which we might more correctly call "sex-affirming," not "sex-changing," treatment. What came through was the message that this treatment was the right one for these children, that the harm would come from not giving the children the hormone blockers, and that we now have the means to allow children to live happy and healthy lives in the gender they know themselves to be.

This April, In the Life Media, which produces the nationally syndicated program In the Life, will air an in-depth piece about transgender children, one I expect will provide a comprehensive and nuanced look at the lives of these children. This is just the beginning of visibility for these children and their families -- their "Stonewall," if you will, and it is vital that the larger community support and embrace these courageous families who are stepping into the public eye to tell their stories. And it is equally important that the media get it right from the beginning, helping all of us understand gender, gender identity, and gender expression.

My best teachers are the brave and creative children I have met who transgress and transcend the social gender constraints we have all been ingrained with and can show us the path to true acceptance, beyond a binary world of pink and blue and boys and girls. If we truly want to educate ourselves and get the words right, just listen to the children. We will discover that they are our best teachers, not just about themselves but about our own selves, as well.