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Treatment of Young MTF Transsexuals

(Part 2)

 


Angel (formerly Oliver) Wheadon began taking her Mum's HRT pills at 9, transitioned at 12 (shown left at 13), was prescribed oestrogen hormones at 14, had SRS at 17, and is shown right age 21. (UK)

The "Age 16 Passability Advantage"

Whilst the exact age can vary slightly, there does some to be huge divide in the ability of transgirls who began oestrogen treatment by age 16 to pass as female, compared to transwomen who started age 17 or later.  


Thalita Zampirolli began taking hormones age 15 and had SRS on her 18th birthday. Shown age 24. (Brazil) 

The following table compares the effects of beginning female hormone treatment before a male puberty starts (which is typically age 12), with beginning treatment after male puberty has completed (i.e. after about age 17).  Extensive experience with intersex but "XY" female individuals indicates that for the very best results, low-level oestrogen treatment should be started at age 9, and stepped up to "puberty" levels at 12.

Commencing treatment during puberty will produce mixed results between the two poles - e.g. the voice may have already deepened irreversibly but facial hair growth is prevented or greatly reduced. 

Desired Characteristic

Pre-Puberty Hormone Treatment

Post-Puberty Hormone Treatment (Note 1)

Prevent skeletal masculinisation, e.g. large hands & feet; square jaw

Some benefit
(e.g. growth may terminate earlier, less heavy bones)

No

Modest height, e.g. less than 70 inches, 180 cm

Yes (note 4)

No

Broad female type pelvis 

Probably some benefit

No

Soft clear skin

Yes.  Also little or no acne during puberty.

Substantial improvement

Prevent facial beard hair

Yes

Little effect

Thick female type scalp hair and forehead hairline

Yes

Hair loss ceases, slight reversal of balding 

Female pubic hair pattern.  Hairless trunk and limbs. 

Yes

Substantial improvement after prolonged treatment 

Feminine type voice 

Yes for most children
(Prevents the dropping of the larynx, also known as the breaking of the voice)

No

No "Adams Apple"

Yes - little to none

No, surgery required.

Slim neck
 

Possibly a slight benefit due to skeletal changes

No effect that's not ascribable to dieting or surgery.

Minimise muscular development 
(Note 2)

Yes

Some reduction

Female type subcutaneous fat deposits and body contours (Note 2)

Yes

Variable redistribution. Increased fat deposits most significant on hips, buttocks & thighs after prolonged treatment

Reduced weight  (Note 2) No

May actually increase unless supported by dieting and exercise.

Small waist

Some benefit

May actually increase unless supported by dieting and exercise.

Full and mature "Tanner V" breast development  
(Note 3)

Substantial benefit
Breast development 1 or 2 cup sizes less than mother / sisters

Variable from slight to substantial breast development, Tanner V very unlikely. 

Notes:
1.  Effects of hormone treatment vary considerably by individual and can take 2 to 5 years to fully achieve.  The longer after male puberty that female hormone therapy is started the less effective it will be - and the effects decline rapidly rather than on a linear scale.  E.g. results are considerably more dramatic with an 18 year old than a 28 year old, but not usually very different between a 38 year old and a 48 year old.  Other treatments can help feminise some characteristics in adult transsexuals.

2. Oestrogen hormones tend to deposit fat.  Sensible dieting and suitable exercising (e.g. aerobics, not power lifting!) will greatly assist and magnify the effects of hormones in developing a female type figure and body shape.  The objective should be a nicely rounded waist-hip ratio (WHR) of 0.7-0.8, a range which is a key visual "female indicator". 

3.  Breast development will vary considerably depending on the individual's genetic make-up and the time from puberty.  From hormones alone, a typical "natural" result in young transsexuals is one bra-cup size less than the girl's mother and sisters.

4.  Dr Stoker of the Boston Children's Hospital suggests that without hormone treatment one transgendered girl in the UK would have become 6ft 4in tall, rather than an acceptable 5ft 10in.  However excessive early oestrogen intake can also result in stunted growth and below average female height.

(Right, photos from The Teen and Transgender Comparative Study. This compares adult transsexual women with girls of puberty age (12-14) that have similar general characteristics.)

 


In June 2018, 17-year old reality television star Jazz Jennings celebrated her SRS by posting this photo with the caption "I have a vagina".  (USA)

Overall, the physical results of early hormonal treatment tend to be extremely successful, the girl developing a well feminised physique with full breasts (although rarely as large as the girl would like), no beard, plentiful scalp hair, and an unbroken female type voice.  It's less clear how much impact early treatment has on skeletal characteristics such as foot size and pelvic width.  For example pre-puberty, the  pelvis of boys and girls are indistinguishable, but post-puberty the female pelvis widens substantially.  This change is thought to be caused by estrogen, and studies of FTM  transboy's shows that hormone treatment suppressing estrogen and raising testosterone treatment can prevent this differentiation in transboys.  Oddly, there are no studies showing that conversely young transgirls taking estrogen, plus anti-androgens to suppress their testosterone levels, are likely to develop a wide, female-type pelvis.  Whilst this seems likely, the evidence is just anecdotal and medical studies are needed to prove significant skeletal changes rather than just fat redistribution. 


Wendy age 17, doctors would not prescribe her hormones despite her parent's full support for her transition. (UK)

Hormone Regimen's in Transsexual Girls
There seems to have been little published research with regard to the dosage for hormones in young transsexual patients, however research which relates primarily to Androgen Insensitivity Syndrome (AIS) patients is also probably applicable to transsexual girls.  Zachmann et al cite one AIS patient who had undergone orchiectomy in whom oestrogen administration was started at the earliest estimated pubertal age of 10.3 years in the form of Premarin 0.625 mg three times weekly.  It was found, however, that this stopped growth of the girl prematurely and the authors felt that it would have been better to have given the patient 0.005 - 0.01 mg ethinyloestradiol daily, instead.  From studies of patients with Turner syndrome it has been suggested that to ensure normal pubertal growth, physiologic oestrogen replacement should be started at the appropriate bone age of about 11 years and should not be delayed in the hope of achieving a greater mature height.  Batch et al suggest a regime of 5 micrograms of ethinyloestradiol daily for the first 6 months, increasing to 20 micrograms daily by the end of puberty.


Early hormone treatment is not a miracle, but the benefits such as female hair pattern, no beard growth, no Adams Apple, no broken (deep) voice, breast development are immense.
Soule et al. suggest that the best course of action may be to perform a orchiectomy just before puberty (at 11 years in a case quoted) followed by oestrogen therapy (ethinyloestradiol 2 micrograms daily, gradually increasing to 20 micrograms over 2 years, in the case quoted) with regular bone density measurements. This policy, it is suggested, reduces any slight risk of malignant transformation of the gonads and ensures adequate oestrogen activity throughout the critical years of bone accretion. 


Emma Ellingsen (born Tobias in September 2001) realised that she was transgender age 8 and began puberty blockers age 10.  In 2014 she appeared in the Norwegian TV show «Født i feil kropp»
(Born in the Wrong Body. Pictured age 17, she had SRS age 18. (Norway)

However, oestrogen levels are higher in XX girls than in XY boys, even in childhood.  XX girls start producing oestrogen at 8 or 9 (i.e. a year or two before breast development) so several clinicians therefore recommend early oestrogen supplements in XY girls, irrespective of whether or not the gonads are in place.  Dr. Stanhope suggests 1 microgram ethinyloestradiol per day from age 8-9, with an increase at about 11-12 years.
 

Females Hormones and Attractiveness
A very awkward problem for psychologists advocating delayed hormonal treatment for young transgirls is that as result they will be physically less attractive as a woman to men.

There is a strong and direct correlation between a girl's oestrogen levels during puberty and how attractive and feminine she is perceived as a woman.  For example, the hormone has lasting effects on bone growth and tissue formation as well as the skin’s appearance during the average seven-year-long puberty.  Miriam Law Smith of the University of St Andrews states the hormone has a hormone has a crucial role in determining facial appearance, giving 13-year-olds doses of oestrogen will "certainly may make them more attractive [to men]" although she adds "who knows what other effects the hormone may have?" As regards the last comment, pubertal girls who have been prescribed oestrogen to prevent excessive height (over 6 feet) may according to one study subsequently suffer from lower fertility. 


A contemporary of Emma is Siri Lehland.  He was born in February 2001 and identified as transgender by age 10.
She must have started female hormones by age 16 in order to explain the breast development evident by age 17.
 Photos of her journey from age 8 to 17. (Norway).

 

A newspaper photo of sisters  Lauraine and Lenette beneath a cinema banner for a movie about Christine Jorgensen - who arguably had the first successful SRS. (USA)

Siblings

Since the 1960's the medical professional has been puzzled why one child may determinedly transgender, whilst his/her brothers and sisters are equally determinedly cis-gender.  If as some leading medical practitioners were suggesting (most notably Dr John Money) external factors during childhood played a critical role in determining gender, it seemed reasonable to predict that if one child is transgender, there was a good probability that their siblings were as well.

The theory got some support when in 1970 two American half-sisters - Lauraine and Lenette - were outed as having been born Cary and Burt.  They transitioned together and Lorraine had SRS age 26, the younger Lenette had to wait another six months as the clinic refused to perform her surgery until she was 21.  They not only appeared in newspaper stories at the time, but were mentioned in many medical textbooks published the 1970's.

Unfortunately for some members of the medical profession, few - if any - transgender siblings appeared (at least publicly) during the 1970's and 1980's. 


From left, father Maurice, Dominique, Alix (aka Yannick)  and mother M. (France)

In 1993 French newspapers briefly covered the story of supposedly transgender sisters Dominique and Alix, born brothers Patrick and Yannick.  Patrick had  shocked his parents by announcing on his 18th birthday that she was a girl and wanted to be called Dominique, and allegedly had SRS.  A few years later her younger brother Yannick made a similar announcement and asked to now be called Alix.  But the newspapers fed the story were unable to obtain a picture that showed Alix as anything other than a rather effeminate looking 18-19 year old teenage boy.  Also, Alix's claimed boyfriend turned out to be a divorced 41 year-old who had two sons of similar age to Alix.  It all seemed decidedly dubious and the newspapers soon gave up on the story.


(Top) Daniel and Jamie O'Herlihy in an undated picture posted on social media.  (Below) Chloe and Jamie in early 2019. (Ireland)

In 1996, two 20-something sisters Mi and Ana (right) featured on an American television talk show about exceptionally close sisters. The twist eventually revealed to the audience was that they had been born brothers, and were male-to-female transsexuals.  [I've tried to track down more details, but I've been unable to confirm anything.]

In the 21st century the transgender population has soared, and perhaps inevitably there has a emerged in to the public domain a few instances of two brothers becoming sisters.  For example, in February 2016, a 23 year-old barmaid working at The George pub in Cork - Jamie O’Herlihy - came out via a YouTube video as being transgender.  For several years she had worked as a drag queen at a gay bar but had transitioned to female and begun taking female hormones the previous November - retaining her androgynous first name.  The news attracted only mild interest until Closer magazine discovered that Jamie's younger 20-year old sister Chloe had been born Daniel. 

After a difficult final year at school as a boy, Chloe had quietly transitioned to female in the summer of 2015, before starting a college course to train as a hairdresser.  The story of the two transgender Irish sisters went viral, and they appeared in newspapers around the world, as well as on Irish television programmes such as This Morning and the Ray Darcy Show - often accompanied by their mother Sarah.  The money earned hopefully helped to pay for Jamie's facial feminisation surgery, and Chloe's SRS in 2019.


Madelyn (dark hair) and Margo (blond hair) Whitley regularly post photos of themselves on social media which
highlight the physical similarity of the twin sisters, born brothers.  Shown here ages 16 and 17. (USA)

Almost simultaneously, another story concerning two American transgender sisters was unfolding.  In 2016 14-year old Matthew Whitley transitioned and became Madelyn ("Maddie") Whitley.  Her twin brother followed just a few months later, transitioning as Margo in January 2017.  Both Madelyn and Margo have since been signed by model agencies and now work with great success as female models. 


Born twin brothers, Mayla Rezende and Sofia Albuquerck transitioned and began taking female hormones age 19.  (Brazil)
In 2020, headlines were made when identical twins Mayla Rezende and Sofia Albuquerck (right) both had SRS/GRS.  Although they grew up as boys in the small town of Tapira in southwestern Brazil, they’ve always known they were girls.  Malya says “I would blow dandelion seeds into the air and wish for God to turn me into a girl, I always loved my body but I didn’t like my genitalia.”

On  11 and 12 February 2020 the 23 year old sisters received surgeries to affirm their gender identity. Dr. Jose Carlos Martins of the Transgender Center Brazil performed five-hour surgeries on the sisters one day apart. “This is the only reported case in the world of twins who were presumed to be male at birth undergoing female gender confirmation surgery together” the doctor claimed.

The global transgender community now numbers in the millions - compared to hundreds in the 1950's, thousands in the 1960's, and tens of thousands in the 1970's.   If the theories of Dr John Money et al are correct then there should now be a very large population of transgender siblings.  But there aren't, so their theories are incorrect.  Unfortunately this doesn't help us understand a situation where in the UK the ratio of children with gender identity disorders has in just two decades changed from 1 in 10,000's, to 1 in 100.

 


Kelly van de Veer  had SRS at age 19. (Netherlands)

Passing and Sexual Orientation
There seem to have been no formal clinical studies, but it seems certain that young male-to-female women are far more likely to complete their transition and settle well into their new lives than those who transition at a later age. 

About 95% of natal "XX" women consider themselves as being heterosexual.  In comparison, studies of the sexual orientation of post-SRS transsexual women indicate that only half are heterosexual and exclusively select males as sexual partners; nearly one-fifth are lesbian and sexually attracted only to females; and about one-third are bisexual.  However these studies cover all age groups (with an average age in the 30's or even 40's), and are almost certainly not representative of the relatively few young transsexuals who transition before the completion their male puberty.  It is very likely that when compared to older transwomen, a far higher percentage of young transsexual women identify themselves as heterosexual and attracted to men.  Indeed, for under 21's, I would suggest that there are very few girls who do not consider themselves to be heterosexual, and have or would like to have, a boyfriend.


14 year old Jamie (left) and 15 year old Danique are unambiguously girls after their transition. (Netherlands)


Roberta Close (shown age 17) had numerous liaisons with male 'A list' celebrities after her SRS.
 (Brazil)

Unlike older transsexual women, young transsexual girls rarely have had any sexual activity before they transition, and if they do it's likely to be of a homosexual nature, generally playing a female role during intercourse.  Mentally they are often only erotically stimulated by men, although overall their sexual urges may be very low because of puberty suppressants.  When released from such drugs and placed on hormone therapy, they become just as interested in boys and men and sex as other girls of their age - if not more so.  "G", a nearly 16-year old transgirl undergoing an intense female puberty thanks to being on hormones illicitly obtained by her parents, may be quite typical when she writes:  "I can't stop thinking about my [neo-vagina] ... I want to be ['screwed'] by any guy in sight.  I was even thinking about my teachers and my best friend's dad."  But this girl does not expect to undergo SRS for years yet.


Veronique on holiday with her second male fiancée, age just 19. 
(Netherlands)

Hopefully G will be able to emulate Veronique Renard, who has happily led a very active love life as a woman since her teens.  She may have the youngest patient in Europe when she had SRS in 1984, but the resulting advantage was immense:

"I always felt part of a group called Females, my female penis [was] a birth defect ... I was only 17 when I started hormones. I had the big operation at 18. I never got to know what I would have been like as an adult male. As I was so young, I could experience life like my girlfriends. I got my first boyfriend at age 18 as a girl. I [have] experienced my entire adult life as a female."


Alina - in red - was born the brother of her cis-sister.  (Russia).

Unlike older transsexual women - young transsexual girls rarely have any problems passing easily and naturally as female, readily assimilate themselves as women.  For example, in one survey (Sex Reassignment of Adolescent Transsexuals: A Follow-up Study, Cohen, 1997) of young transsexuals, all the male-to-females were satisfied with their appearance after hormone therapy, and it was the interviewer's observation that it was difficult to discern any signs of their [genetic] sex.  Most of the girls had been approached in a flirtatious manner, and not one had been approached by strangers as if they were still of the male sex, 60% expressed satisfaction with their vaginoplasty, and had experienced sexual intercourse without problems.  The author of the study suggested that part of the adolescents' success was due to the fact that they more easily pass in the desired gender role because of their convincing appearance.  With one exception the voices of the girls were not male sounding, and early anti-androgen treatment apparently had acted in a timely way to block facial hair growth and the lowering of the voice.


A young trans-girl with a cis-girl.

Somewhat disputably, the study also stated: "Another aspect of this relatively positive outcome may be attributable to the criteria for treatment eligibility. ... [The] patients selected for early treatment not only are among the best-functioning applicants, but probably they also belong to the subtype of so-called "homosexual transsexuals" (that is, individuals who are, before SRS, sexually attracted to same-sex partners) .... They are also referred to as "primary" or "early-onset" transsexuals."

Nevertheless, success in passing may well be an important factor in young trans-girls being far more likely to have a heterosexual sexual orientation than transsexuals who transition as adults.  It's clear that trans-women who transition at a young age are almost always physically able to go stealth, they typically do as soon as possible, and often quickly begin to have boyfriends and eventually a husband.  The desire for a normal relationship with a man tends to pull the stealth transwoman away from any open acknowledgement of her transsexuality and male past, she believes (unfortunately often correctly) that the relationship may not survive this becoming known to him.   In the balance between personal happiness and revealing "the whole truth and nothing but the truth", most people choose happiness.  Based on anecdotal experience, when a young transwoman out's herself, most (but not all) soon regret.


These young transsexual women featured in the July 2002 edition of the UK magazine Marie Claire. 
Nina (second from left) was 22, Jamie (back, fourth from left) was 16, and Zoe (first from right) was 21.


 
These four post-operative transsexual women (ages 23-27) from Thailand appeared in some
editions of
Maria Claire in 2006, making an interesting contrast to the picture above.


Jenny Hiloudaki was born Yiannis in 1981.  He began secretly taking female hormones when just 13, and had Sex Reassignment Surgery age 20.  She was 'outed' at age 29, but two years later was voted 'Greek Woman of the Year'.

 

 
deborah.jpg (7472 bytes)
In the early 1990's
Deborah Davis had sex reassignment surgery at age 17.  Twenty years later it is still very rare for teenager's to be able to have such surgery.

Sex Re-assignment Surgery
After hormones and transition, the next and final step is sex-reassignment surgery.  Extra-ordinarily, only about 1% of SRS operations performed by western surgeons are on girls under age 20 (almost all of whom are 18 or 19).  The reasons seem to be a combination of the Standards of Care guidelines, the need for a two year real life test when a hormone supported transition can only begin no earlier than age 16, money, the requirement for parental permissions in some countries, the reluctance of surgeons to operate on very young transsexuals, and the extreme rarity of under-20 (or indeed under 25) surgery candidates compared with older candidates - the median average age of European transwomen at the time of their SRS is mid-to-late 30's, with a mean average age of around 40. 


Angel Paris-Jordan (formally Oliver Whedan) had SRS and breast implants when just age 17. (UK) 

By interesting contrast, one study of 195 Thai male-to-female transsexuals found that "many participants had transitioned very early in life, beginning to feel different to other males, and identifying as non-male by middle childhood. By adolescence many were living a transgendered life. Many took hormones, beginning to do so by a mean age of 16.3 years, and several from as early as 10 years. Many underwent surgeries of various kinds, on average in the twenties, with one undergoing SRS as early as 15 years".


Claire Farley.  The film Red Without Blue documents her transformation from Alex and her evolving relationship with her twin brother.  (USA)

Clair (formerly Alex) Farley told her parents that she was gay in when 13.  After a suicide attempt age 15 she told a councillor "I feel that I should be a girl".  She finally transitioned at age 18 and began hormones, over the next year: "My hips widened, my thighs thickened and tiny breasts started to appear".  She finally had her SRS at age 23, "a few days later I pulled out a hand mirror and got a first glimpse of my new vagina ... it was badly bruised but I couldn't have been more excited, I was all woman".


Lucille age 21 on a magazine cover, and a photo six years later. (Austria)

Another extraordinary tale of determination is Lucille.  Born in 1986 as Lucien, he knew even at pre-school that he was a girl, not a boy.  By secondary school his long hair and wearing of girl’s cloths led to teasing and worst.  He sought medical help but faced three year waiting lists.  After leaving school he obtained a job as a female hair dresser but lost it after being out'ed.  In desperation he persuaded a private medical clinic that he was from a noble family and had well-to-do parents.  In June 2006 - age 20 – the clinic performed sex reassignment surgery and breast augmentation on her.  Unfortunately Lucille couldn’t pay the clinic's  €18,000 bill and the subsequent court case made headlines in Austria and Germany.  Although sentenced to six months in jail, she had no regrets, saying “My suffering was enormous… I had finally become a woman because I am a woman.  I am a real woman.  I have a vagina, can experience orgasm.  [My breasts are also very important and] now I have 345 millilitres of silicone per breast.”  Happily the sentence was suspended and she eventually paid the bill.  Lucille married soon after her SRS and is now a successful artist.


Céline Van Den Bossche

Finally, whilst at primary school, Van Den Bossche knew that she was different from the other boys.  She began wearing make-up and dressing as a girl. When age 15 she transitioned with the name Celine and began a long process of change, involving psychologist appointments and hormone pills. Age just 18, she underwent a sex change operation and was legally a woman.  Four years later, whilst working as a hair dresser she entered and won a local beauty contest. As a result she qualified for the Miss Belgium contest.  As a favourite, she was interviewed by a reporter from Laatste Nieuw who had done some research, she said "Yes, I'm transgender, so what?"

Problems
If a transgirl has been determined in her identification as female from a very young age, then (as described above) there are many advantages in the prescription of puberty blockers and even female hormones by age 12.  One advantage would seem to be that the penis remains tiny (maybe an inch in length) and the testicles do not drop.  But this suppression of developing a male body actually creates a serious problem as most SRS procedures use scrotal and penile skin to create the neo-vagina, and there maybe simply not enough skin to do this. 


Another photo of Jazz Jennings age 18, note the scars from her surgeries.  She has exceptionally good breast development from only female hormone treatment.

A high profile example of this is the experience of American TV reality star Jazz Jennings, who grew up as a girl from age 5.  Going into her SRS age 17, her doctors were worried there wouldn't be enough tissue to reconstruct her genitalia because she had a puberty blocker inserted in her arm before puberty. As feared the procedure did not go well and she had serious complications (basically her shallow neo-vagina split open) which required another procedure a week later, with further surgery required.  She said in a video posted on her YouTube channel:

"I didn't have growth in that region and because there was a lack of tissue, they didn't have enough material to construct the vagina. So they're using a special procedure where they extract my peritoneum lining through my belly button and they use that and they harvest it and they use it to create a vaginal canal."


A photo of Maxim Magnus in  June 2017 after her SRS, age 19. (Belgium/UK)

This surgery went quite well, but yet another corrective procedure was required to improve the external appearance of her clitoris and vulva area.

Maxim Magnus had very similar problems to those experienced by Jazz.  She began female hormones at age 14 and had SRS in 2016 when age 18, but soon encountered major complications:

"One night, I was in the middle of dilating when I felt the most excruciating pain, and I began screaming and crying. By the next morning, I was back in for another surgery. The wound had basically ripped itself open"

She had recently been discovered as a model and was being hailed by the likes of Vogue as "Fashions next big star".  Instead she was forced to retire from modelling for a year.  In 2019 she posted "I’m about to have my fifth surgery in two and a half years to correct more issues related to my SRS [but] in spite of everything, I’m glad that I had SRS"

[Note: Articles and interviews about Maxim give her confusingly different ages, but the concensus seems to be that she was born on 15 April 1998.]

 


Britney Kade transitioned age 14, began hormones age 15, and is pictured age 16 after having breast augmentation. Her mother strongly support her journey. (UK)

Parental Support - Changing the Rules
A positive reaction from their parents when a child comes out as out as trans is a huge support and the impact can’t be underestimated.  A supportive family can make huge difference to a  transperson’s mental well-being in the long-term, and their relationship with the rest of the family will be much more positive, in particular with the parents.  One supportive mother of a young transgirl said:

“When your kid presents to you exactly how they are, there’s no changing it, you just need to follow their lead on it.  And it doesn’t necessarily mean having of all the medical intervention that people are now so scared of with their kids for some reason – I think it’s just about letting your kid experiment and play around with who they are, and if they change their mind that’s fine but they just need to know that you love and support them.”

The active  support of their parents is also essential for transgirls when trying to find help at school or from the health system.  Considering all the advantages of the early treatment of the young transgender children, it's unsurprising that this is now increasingly demanded by  knowledgeable parents increasingly informed via the Internet.


The stories of young transsexuals are often very news worth.  Melanie McPryce (formerlyTom McGlone) transitioned at 16, started hormones at 17 and spent €22,000 to have sex-reassignment and breast augmentation surgery in Thailand the day after her 18th birthday. The 
News of the World newspaper gave her story a centre page spread and hopefully suitably recompensed Mel and her mum.

Parents are undoubtedly influencing a 'system' and medical profession that was in the 1990's retreating rapidly from early treatment and accommodation of young transsexuals.  After a decade long reaction to the tragic David Reimer affair, it has become recognised that it is necessary to separate and differentiate between the voluntary and non-voluntary gender reassignment of children.  While numbers are still small, there is nevertheless an increasingly willingness by doctors and the "system" to support and aid the early reassignment of children.  The revised guidelines in the current version 6 of the "Standards of Care" issued in 2001 makes it slightly easier for young transsexuals to officially obtain treatment - including puberty-delaying drugs but not female hormone therapy for those reaching their teens. 

But doctors still face circumstances where a failure to support young transsexuals in order to comply with guidelines can seem at best totally unreasonable.  For example, in 2006 a 5-year boy was allowed to enrol in kindergarten as a girl with a "gender-neutral name" in Florida, USA, having been diagnosed with gender identity dysphoria (GID) two years ago earlier.  The parents said the child refused to wear boy's clothing and repeatedly said she hated having a penis - often trying to hide it between her legs.  Officials said that were already a number of trans-students in the school system but none as young as kindergarten age, they expected that the youngster would go unnoticed as a girl.  Can she be denied female hormones at age 11-12?

Meanwhile, in Japan a 7 year old boy with GID, Ryoko Kanda, has been allowed to enrol as a girl at a school is in the prefecture of Hyogo, about 270 miles west of Tokyo after being diagnosed with gender identity disorder at age 6.  The school has not told other parents about the switch, and a spokesman for the local school board said there had not been any complaints from other students or from the boy's parents since his enrolment.  He stated that the boy's name is listed with girl students, she uses the girls' bathroom, attends a girls' gym class and wears a girl's swimsuit at the school pool.  The official also said "At this point, we are relieved that the child was accepted into [second] grade and is being raised in a healthy manner", he added that the school district would watch his case closely and reassess the decision as the boy reaches puberty.  Katsuki Harima, a psychiatrist specializing in gender identity disorder at Tokyo Musashino Hospital, said the decision to allow the boy to enrol as a girl seemed appropriate, but would get complicated as he grew older. Harima said the boy is not old enough to determine whether he really has the disorder. A boy who behaves like a girl does not necessarily have gender identity disorder and he could discover as he grows older that he wants to be male.

Although identified at birth as boy, Norwegian Siri Lehland always wanted to wear girls cloths and by age 10 she was adamant that she was female.  Her mother, Katja says:

"As parents we soon realized that this was not a phase that would pass. This is why we have always said that Siri was not born as a boy, but in a male body. As a mother I was always worried about how Siri would be treated as she grew up. We have had good people with us all the way. They have shown us respect"


Siri and her mother, Kayja Lehland (Norway)


A staged but effective p
icture of a young and petite transwoman in a locker room

With the strong support of her mother, Siri transitioned by age 12 and began to aspire to be a model.  Four years later she appeared on the front cover of the Norwegian edition of Elle magazine in 2018, still just 17, much to the delight of her proud mum! 

Progress since 2001
This article was first written in 2001, revisiting it a decade later there has been some progress in the treatment of young transsexuals.  There can be almost no doubt that a series of highly publicised transgender success stories - basically young boy-to-girls who thanks very substantially to early medical treatment look and sound like teenage girls - have helped this immensely. Another generally very positive development has been the appearance on social media such as YouTube, Facebook, Instagram and Twitter of openly transgender girls who then act as an inspiration and source of information for other girls


Openly transgender teenagers on social media include:-
Above from the left: Cadence, Emma, Nikkie, Devon and Jackie
Below:  Gemma, Gabriella, Georgie, Maya, Britney, Sydney and Michelle

Little by little an increasing number of clinics are now willing to help young transsexuals with medication and even surgery at an early age.  Two examples:


In 2017 the advocacy group Transilient selected this image of Carmen for "17 Photos Reveal The Realities Of The American Transgender Experience".  Although born in Mexico, she was
studying in Arkansas to become a Water Engineer.

USA: In 2007 the pediatric endocrinologist at the Children's Hospital Boston, Dr. Norman Spack, set up a clinic for pre-adolescent transgender children. Dr Spack uses drugs to delay the first stirrings of a youngsters' puberty, typically age 12 to 14 for a boy. The effects of these puberty-blocking drugs are reversible but is not the case with hormones. Dr Spack is flexible about the age he prescribes estrogen - i.e. he's not rigid that the child has to be age 16+, but will only do so after months of consultation with the patient and her parents.  He says "When kids take this step, they are rewriting their own future: The hormones have a powerful, pervasive effect, changing their height, breast development, and the pitch of their voices ... You have to explain to the patients that if they go ahead, they may not be able to have children. When you're talking to a 12-year-old, that's a heavy-duty conversation".


Matti, age 15 (UK)

UK: The Portman and Tavistock Clinic was established in North London to provide treatment to transgender children under the age of 16.  It was initially deemed controversial due to the patients' ages - with critics arguing that the youngsters lacked the ability to consent to the therapies.  However in the two years 2011 and 2012 the clinic received 142 referrals of children in the age group 11 to 15 from parents and carers.  Dr Polly Carmichael, director of the service, said it was "better for children not to have gone through puberty before transitioning". But she added: "You are asking someone aged as young as 11 to make big decisions about their adult life and identity. We have to be very careful to keep options open".

Perhaps the most important recent development is that the famous/notorious "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People" (which very few medical professionals will dare not to conform to) has now advanced a tiny bit as regards young transsexuals in its seventh edition, published in 2011.  It now allows the use of puberty-suppressing hormones - but only when puberty has already begun!  It also says that "Adolescents may be eligible to begin feminizing/masculinizing hormone therapy", essentially from age 16

Huge progress has undoubtedly been made in recent years in the treatment of transgender children.  Further the increasingly positive image presented about gender dysphasia in social media, in television programmes such as I am Jazz, Transparent and films's such as the Danish Girl has resulted in young children identifying themselves as being transgender in unprecedented numbers.  For example the number of under-18 children being referred to the Portman and Tavistock Clinic as having gender identity problems has been nearly doubling annually - in 2009/10 there were 97 referrals, by 2015/16 this had reached 1398.  Interestingly, the clinic now had twice as many girl-to-boy than boy-to-girl referrals.

 


Young transgender children in a screen shot from a television documentary by National Geographic.  They also featured in associated magazine articles.

Transgirls in the Media

Perhaps a sign of the progress that has been made in recent years in the United Kingdom are the stories of Campbell Kenneford and Maxine Heron.

Maxine Heron was born a born 1996, but she “always knew that I was a girl".  She came out age six to her mum when she refused to have her hair cut.  "I think it came as no surprise because as soon as I could start to express myself I would always do so in a way that was really female ...  I just was always kind of her daughter".  Her parents accepted her choice and with their support she had the courage to transition full time when she went to a College of Higher Education, age 16. 


Maxine, ages 12 to 22 (UK)

After she left college she had a variety of jobs, from receptionist to booking agent.  After having SRS (perhaps age 19) she began to work as model.  She was completely passable with a very feminine voice, an acceptable height of 171cm / 5´7" and slight weight 63 kg / 138 lbs, but in late 2018 she "decided to come out on social media and tell everybody about my history".  The response was very positive, e.g. one photographer who had booked her a few months earlier posted:

"As a straight, cis-male man, I am not often called to question my gender or sexuality. ... It was a privilege for me to be able to learn more about Maxine's experiences and share a brief creative moment with her.  Our conversation [made] me think about identity generally, and the secrets each of us keep: we all carry the burden of things unsaid."

Shortly afterwards the BBC booked Maxine for the reality TV series Heartbreak Holiday, where "Ten 20-somethings travel around Europe, attempt to get over their heartbreak and  get pretty loose and wild along the way".  The tagline for Maxine was that "After a string of bad, short-term relationships since she and her serious boyfriend broke up on New Year’s Eve in 2017, Maxine is looking to have her faith restored in men and her heart healed."


Evie MacDonald in the short film
First Day (Australia)
The series was shown in August 2019, in episode four Maxine unexpectedly stood up during a meal and revealed that she is transgender to her apparently genuinely shocked table mates.


Evie's appearance changed considerably between the first and second series of First Day.
Another significant development in 2020 was Children's BBC (widely available around the world) showing the Australian made short film First Day.  This was made in 2017 and follows the traumatic first day at High School of 12-year old Hannah Bradford, a boy who had transitioned to a girl.  Importantly, it starred 11/12-year old transgirl Evie MacDonald, born Ethan Macdonald on 24 April 2005.  The film received so much critical aclaim that a four-episode TV series was commissioned in 2019 (shown 2020) that followed Hannah through the rest of her first year.  Evie again starred, although her two-to-three years of physical development since the original short film is obvious.  However her co-stars had also aged, so the problem wasn't too evident.  A second series of another four episodes was commissioned, shown 2022.  

Ethan was calling himself a girl by age three, and transitioned age nine.  She began taking puberty blockers age 10 and estrogen hormones age 13.  Evie regulatly posts on social media.


The progression of 9 year-old Ethan Macdonald (left) to 16-year old Evangeline ("Evie") Macdonald  (right). The final photo is just before her 17th birthday. (Australia)

A Warning

In 2018 the British media reported that one school had 19 children (2% of its roll) listed as transgender.  Subsequent reports claimed that about 1% of all school children were now identifying themselves as transgender.  These percentages were plausible given that about 40 times more children were being treated by the NHS for gender identity disorder (GID) than a decade earlier, the  Portman and Tavistock Clinic (mentioned above) had 2,590 children referred to it in 2018, compared with just 77 in 2008.

It seems that for good or bad a critical point has been reached where children (particularly in their early teens) are beginning to consciously choose their gender.  It is attention gaining and potentially even trendy for a 12-14 year old to proclaim that they are androgynous, transgender, non-binary, etc., with children encouraging each other to transition and request medical treatment such as puberty blockers (available on NHS from age 11 since 2011) and hormones (available from age 16, but increasingly prescribed at 15). 

In 2013 a controversial Dutch study was published, it followed 127 adolescents (79 boys, 48 girls) who were identified as having GID in childhood (<12 years of age). The researchers found that 80 (63%) of the children no longer considered themselves transgender by the ages of 15 and 16 - significantly higher percentage than other studies. However critics of the study note the researchers lost contact with 28 children and assumed that they were in the "no" column, an alternative possibility was that they had transitioned and gone stealth, which would nearly reverse the percentage!  


Young transgender actress Josie Talah posted on social media many photos of her 20th birthday with prominent LGBTQ+ friends.  This one shows her (right) with Harley Wittmer (left) and Landrey Bender (center).

Despite the diverse results of studies, its VERY important to note that many children who test their gender identify at a young age (3 - 10) will actually revert to their physical sex by puberty - VERY great care thus needs to be exercised by both parents and medical professionals to avoid irreversible decisions and medical actions at too young an age.  Although the incidence of GID referrals in young children below age 12  is exploding in number, the percentage that eventually have sex-reassignment surgery is actually declining - down to just 10% in the UK in 2015.  After therapy, transition and perhaps hormones, many decide that they have made a mistake, whilst others decide that whilst they wish to live as a woman, they don't want surgery.

Conversely, children who begin questioning their gender at an older age seem far less likely to change their mind.  As puberty begins. it seems that almost every child who age 12+ begins blockers or hormones will eventually have surgery, and nearly zero later regrets.  For example, Jack Green started to show signs of GID as young as 3.  By age 9 his mother Susie was letting him dress as Jackie but by age 13 she was veryoncerned about both the resulting bulling and the onset of male puberty.  Puberty blockers were obtained from an American clinic and Jackie also referred to the Tavistock Clinic. 

When it became clear that Jackie was unlikely to have surgery via the NHS for many years due to the long waiting list, Jackie's parents for arranged for her gender confirmation surgery to be performed in Thailand on her 16th birthday.  Her mother later saying: "Medical intervention is very important, especially for teenagers who are already in puberty.  It's absolutely vital. [Particularly] if you’ve got a child who's suicidal and self-harming because their body is changing against their will,"

From left to right: Jackie Green (born Jack) shown age 3; age 9; immediately after her SRS age 16; participating in the Miss England beauty contest age 18; a social media post age 20; and finally 25 year old Jackie with her mother Susie.

Susie's high-profile campaigning for the medical treatment of children suffering from GID extraordinarily led in 2019 to a journalist reporting her to the police for having "castrated her child".  No legal proceedings resulted.

In the UK transchildren over 16 are legally able to have gender confirmation surgery with their parents consent.  However the process by which young, trans people access such medical interventions is subject to additional safeguards and it's unofficially estimated that in 2018 just 35 such procedures were performed privately or via the NHS - a tiny proportion of the children being identified as having GID.  However, there have been an increasing number of complaints that it has becone to easy for a transgender child to receive irresverable gender conformatiom surhery. 

As a result, UK guidelines have been revised and in practrice it has become impossible to have SRS in the UK if under 18.  The small number of operations (35) previously performed will now happen outside the UK, predominantly in Thailand - were a far larger number already go.


Three young transgender children who appeared in television documentaries and magazine articles in the early 2010's.  Names were changed to protect their identity and privacy.


Son, we need to talk ...

The NHS’s statistics show that the rate of regret around gender affirmation surgeries is very low but apparently a small number of young patients do subsequently de-transitioned as an adult, and they then bitterly regretted having had irreversible 'bottom surgery' as a child.  [I have been unable to find even one quotable example of this]  As a result, in April 2020 the UK government announced plans to ban all gender confirmation surgery on under 18's.  Dr Jane Hamlin, President of the Beaumont Society, a transgender support group, generally supported the decision, stating:

“It is important that those young people who identify as trans should have puberty blockers available to them if they are able to make an informed decision, have the appropriate medical support and there are no underlying health issues that would make this intervention unwise.  This would mean that decisions about irreversible surgery would not need to be considered until the individual has reached adulthood.”


In season 6 of the long running TV series Pretty Little Liars it's revealed that a major character, Charlotte DiLaurentis 
(alias CeCe Drake) was born a boy - Charles - who had been struggling with her gender identity since age 6.  She
transitioned in her early teens but was still pre-SRS.  Athough fictional and played by a female actress
(Vanessa Ray), transwomen will relate to aspects of the story.

Conclusion

It's difficult to over-exaggerate just how great the advantages of early medical treatment are for the pubescent transgender girl whose body will otherwise rapidly turn in to that of a man, and how much of a disaster each month of delay is.  The end of puberty is a fundamental and irreversible physical marker, from which the plausible effects of feminizing hormonal treatments on the body of a transgirl/woman decline with depressingly rapid speed.  For any transsexual woman starting treatment when already physically mature (and this merely means age 20 onwards), a muscular and robust stature; a deep and masculine sounding voice; obvious facial beard growth; and a receding hairline, are just four of the immediate challenges that may seriously threaten her ability to pass convincingly as a woman.  She also faces the high cost of electrolysis, breast augmentation, facial feminisation, and other risky procedures such as voice feminisation surgery that could have been avoided

There is no longer any debate that for the best possible final outcome, the medical treatment of a male-to-female boy/girl with GID should be started as early as possible - ideally before puberty.  Decades of slowly accumulated empirical evidence seems to indicate that age 12 or 13 (depending on the individual) is the optimum age for a successfully transitioned transgirl to commence high dose hormonal treatment. 


Elaine at her college graduation (USA)

Puberty blockers are a poor second choice, but still far better than nothing.  When compared with the experiences of older transsexuals, the results of early hormonal treatment are dramatically positive.  It is however important that the girl has already successfully transitioned - this is a key point at which some young boys realise that are making a terrible mistake. 

Gender Clinics are reporting a near 100% success rate for children who transition, begin hormones and have SRS surgery in the age 16-18 window. Almost all successfully these teenage transgirls identify totally with their female gender and appearance, passing well both psychologically, socially and physically; they are far happier as a female and have no regrets.  They still face long term problems as being infertile as a woman, and how to tell this to a fiancée ... but these are a totally different set of problems from that which delaying medical treatment would have imposed upon her - such as an inability to pass due her beard, deep voice, and bald patch. 

The Cohen study mentioned above concluded: "Even adolescent applicants who are functioning well will need a lot of guidance through the process of sex reassignment. However, provided they manage to pass SRS without problems, they have a lot to gain.  They can catch up with their peers and devote their attention to friendships, partnership, and career."

It is unfortunate that the medical profession is advancing so very slowly, partially due to a lack of facilities and specialists.  In the UK only one NHS Gender Identity Clinic, the Portman and Tavistock Clinic in London, is able to offer specialist psychiatric and endocrinology services for transsexual children - and this for a population of over 60 million people!  

There is a valid argument that if medical treatment was not provided to transgirls, some would successfully revert to a male gender.  But it equally seems that many would resort to extreme measures, even suicide.


Another photo posted by the Whitley sisters, age 18.

Finally, we appear to be heading to a world where a substantial proportion of the population will live most of their life in a gender that does not align to their genetic sex.  In the UK less than 1 in 10,000 children under age 18 were identified as transgender in 2000, twenty year later we seem to be in the situation where about 1 in a 100 children consider themselves as being transgender, increasing to 3 in 100 if we include those who identify as asexual, pansexual or gender fluid.

This has huge implications in terms of reproduction, and the normalisation families where one or both of the parents is transgender.  In 2019 nearly 10% of British babies are born using the IVF procedures pioneered over 40 years ago in 1978.  In another 40 years it possible to envisage that a similar proportion of children will have a transgender mother or father, and have been gestated and born using the various medical procedures that are now just being realised.

 

Personal Examples
(Please contact me if you wish your details to be added)

Warning:  Some of the hormone regimes stated below seem to be excessively high, overdosing on hormones will not have any additional physical feminisation effects but does have very serious and dangerous health risks.  Hormones should only be prescribed and taken under qualified professional supervision.

Belinda Darlington
http://www.facebook.com/
profile.php?id=528701532

Born: ?
Hormone Regime: Began hormones age 14
Surgery: 
SRS (May 2001) Facial feminisation (2010)

 

Rachel Saunders
http://www.geocities.com/
  lightandbeauty/

Born: April 1982
Transitioned: Age 17
Hormone Regime: Began hormones Sept 2000.  Daily regime: 1.25 mg Premarin.
Surgery: None.

 

Anonymised Entry

Born: October 1982
Hormone regime: Began hormones age 18, initially 0.625 mg of Premarin per day & 5 mg of Proscar per day.  Premarin dose later increased to 2.5 mg daily. 
Surgery: Age 18  Orchiectomy (August 2001).

 

Kie
[Website off-line]

Born:  January 1975
Hormone regime: From age 16, Diane 35 & Progynon Depot/Proluton Depot hormone injections
Surgery: Age 18,  rhinoplasty; age 25, SRS, tracheal shave, breast augmentation (textured 280cc silicone gel implants, submusc., transaxillary incision)

Natta Klomklao
http://www.srs-thailand.com/
  nklomklao/

 
Born: July 1970
Hormone Regime: From age 11, Diane 35, from age 16, Premarin and 10mg estradiol valerate + 250mg hydroxyprogesterone-Caproate injections
Surgery: Age 16, SRS; age 17, rhinoplasty; age 18, tracheal shave; age 25, breast augmentation (280cc).

Anonymised Entry

Born: January 1977
Hormone Regime: From age 18, 2.5mg of Premarin and 50mg of Novo- Cyproterone per day
Surgery:  Age 24.

 

Jhenna Kelly Taylor
[Website off-line]
 
Born:
17 August 1981
Transitioned:
Age 16
Height:
169 cm; Weight 52kg
Hormone Regime:
From age 17, 100mg Androcur & Estradam
daily.
Surgery:
Age 21, SRS (November 2002).

Barbie
[Website off-line]

Born: 1983
Transitioned: Age 16
Hormone Regime: Began hormones at 17.  Current regime is twice monthly injections of 40 mg Estradiol Valerate and 150 mg Depo-Provera. 
Surgery: Plans to have SRS in 2003.

Anonymised Entry

Born:
October 1981
Transitioned: Age 15
Hormone Regime:
Began Premarin age 14.  Current regimen is 10mg Depo-Estradiol (estradiol cypionate)  biweekly intramuscularly.
Surgery: SRS planned mid-2005

Kelly van der Veer
http://www.bigkelly.com

Born: 6 May 1980
Transitioned: Age 16
Height: 186 cm
Hormone Regime:
Began hormones at age 17
Surgery: Age 19, SRS (February 2000)

Nun Umdomsak
http://srs-thailand.com/nudomsak/

Born:  11 June 1980
Hormone regime:
From age 13, Diane 35 tablet & 1.25mg Premarin daily; age 15 10mg Progynon Depot & 250mg Prolution Depot combined injection.
Surgery: Age 18, rhinoplasty, thyroid cartilage reduction, silicone injections to chin and cheeks, chin implant; age 19, breast augmentation; age 20 SRS (Oct. 2000)

Jordana
http://www.vh1.com/artists/az/
   1_8_7/bio.jhtml

Born: 1977
Height: 173 cm; Weight 54kg
Hormone Regime:
Began hormones age 15, 2.5 mg Premarin & 100mg Spironolactone daily.  Later Estrace, Androcur daily and Estinyl injections monthly.
Surgery: Age 21, SRS

Anonymised Entry

Born:
19 January 1987
Height: 173 cm; Weight 61kg
Hormone Regime:
  Began hormones age 17 - 3.75 mg Premarin and 200 mg Spironolactone daily
Surgery: Age 18, SRS and tracheal shave

Anonymised Entry

Born:
1986
Height: 168 cm; Weight 55kg
Hormone Regime:
  8 mg Estrofem, 0.5 mg Dutasteride 200 mg and Spirolacatone 200 mg daily. Microgest first 10 days of the month
Surgery: Age 21, breast augmentation
Vanessa Lopez
http://es-es.facebook.com/people/Vanessa-Lopez/772304486

Born: 6 December 1982
Height: 175 cm; Weight: 59 kg
Hormone Regime:
  Testosterone blockers age 17.  Began hormones age 18 - Premarin.  Currently 1 mg Androcur every second day.
Surgery: Age 20, SRS

Jamie Sullivan
[Her social media links are no longer working]

Born: 1988
Transitioned: Age 21
Height:  178 cm; Weight: 64 kg
Hormone Regime: Began hormones age 19 - 300 mg Spironolactone and 6 mg estrodiol daily, 5mg medroxyprogesterone on a monthly cycle
Surgery: Age 22, facial feminization

Final Note: I would like to give a huge thanks to all the girls who have contributed to this page in some way. 

More contributions and information are very welcome, and your identity will remain confidential unless you consent otherwise. 
  

 

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Last updated: 29 November, 2020