Most of the medical community -- including psychiatry, psychology and social work -- have joined the consensus in recognizing gender incongruence as a medical condition. Providers are now much more trans-positive towards transgender adults, and adolescent health care is growing rapidly following the path-breaking work of Dr. Norman Spack from Boston Children's Hospital. Dr. Spack introduced trans adolescent health care protocols involving puberty blockers, based on the European protocol. Major gender clinics specializing in adolescents have now sprung up in LA, Chicago and soon in Philadelphia.
The one group of trans persons over whom there is still oftentimes fierce debate in the medical community is composed of children. This is true for a number of reasons, including the fact that children can't give informed consent, their parents are often ignorant of their child's condition and/or resistant to being educated, and because blowback from religious extremists is often most vitriolic with respect to children. But there is another reason, which is deserving of study -- we simply don't have any evidence-based understanding of which gender non-conforming boys will turn out trans, which will be gay, and which straight -- gender conforming or not. Note that I'm focusing on those assigned male at birth; the care of "tomboys" is much less difficult, if only because more parents readily accept masculine behavior in their daughters.
This issue erupted in the media last week when it was announced that the Australian kids cartoon SheZow will debut in the United States on The Hub (formerly Discovery Kids). It features a 12-year-old boy who finds a magic ring that transforms him into a legendary crime-fighting superhero, SheZow, who happens to be a girl.
We should be clear that SheZow is not a trans character as we generally understand the concept. The cartoon is a metonym for the trans experience, as the protagonist transgresses gender in the process of becoming a superhero. The "super she" has her superpowers only while dressed as a girl; the character pretends to be a girl in order to do good. This then can seem more as a cross-dressing narrative, with the clothes making the supergirl, rather than a trans narrative in its more medical sense, where the boy becomes his authentic female self as a result of the transformation.
An earlier portrayal of the trans experience, for those of us living as closeted adolescent trans persons in the '60s, was Star Trek Classic's final episode, "Turnabout Intruder." Here Captain Kirk, as a result of a transporter accident (those damn transporters!) has his mind, including his male gender identity, swapped with that of a woman, who then thrives in Kirk's male body with her female gender identity. The end result is "a man trapped in a woman's body" but very unhappy about it (not the trans male experience), and a woman liberated into a man's body, and excited about it (a '60s feminist trope, and very un-trans as well). She is empowered; he is emasculated. A confusing gender-bending pas de deux, but the best we could get in the days of the Beatles' "Sweet Loretta Martin" of "Get Back" fame, a few years before Lou Reed took a "Walk on the Wild Side."
I dialogued about SheZow with the Gay Voices editor here at Huffington Post, Noah Michelson, who told me:
I personally find this show (or at least the sounds of it -- since I haven't seen it) really inspiring. I was one of those little boys who desperately wanted to have my life only filled with all things girlie (and -- shockingly -- my parents in small town Wisconsin in the '80s were cool and bought me things like the My Little Pony stable and Poochie dolls). One of my earliest memories was of my older brother telling my mom "Noah is pretending to be a girl again." I have never identified as trans or gender queer and I'm very happy as a man but I think supporting fluidity in gender expression for our kids is a really important thing and mainstream shows like this could go a long way in helping (if done right).
Noah strikes to the heart of this program, which is not about the trans experience, but more about the need to blur those lines in which our gender roles are constrained. A little fluidity is a good thing for society, and certainly for those who crave it as a part of their authentic selves. As SheZow and Star Trek make clear, gender biology, politics, social norms and the like can be very complicated. I mentioned earlier that the politics of gender non-conforming children is "the final frontier." Those of us who are trans adults clearly understand we were once trans children, and we want to support the trans children of today as best we can. We increasingly believe that even if a gender non-conforming child is misdiagnosed as trans and allowed to transition as a child, and then de-transitions, he will be far better off having had his sense of self respected by his family. As society becomes more accepting, that "phase" of transition in a person's life will be understood as just one step in the evolution of the person's sexuality. The other option -- prohibiting gender transition for a trans child out of fear that a potential de-transition would be emotionally scarring, still motivates many in the profession, such as Dr. Ken Zucker. I'm reminded of those who believed, not that long ago, that a boy growing up with a micropenis would be so scarred by being seen with a tiny penis that it was preferable to surgically reconstruct the boy and force him to grow up as a girl. We've learned that gender identity is innate and not malleable, as John Money and others believed in the '60s, and we no longer, for the most part, subject those children to surgery against their will. But it still happens -- here is a recent example from South Carolina.
The solution is research, so we can better distinguish those who will turn out to be gay men (like Noah) or straight men, from those who are truly trans and should be allowed, lovingly, to transition as children. Studies are finally beginning -- one site will be at the Children's National Medical Center in DC, which specializes in gender-variant children, as we are slowly becoming less afraid of grappling with these issues.