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.
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.
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.
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.
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
Hormones and Attractiveness
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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.
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".
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".
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.
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?"
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.
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:
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:
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.]
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:
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.
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:
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
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:
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".
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.
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.
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:
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."
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.
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!
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,"
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.
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'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.
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.
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.
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.
Final Note: I would like to give a huge thanks to all the girls who have contributed to this page in some way.
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