Gender identity more than skin deep

When a girl or boy comes into the world, there is usually no question about his her sexual identity. Unless there is a physical difference in the baby, a girl has a vagina and a boy has a penis. Parents tend to dress him/her in gender specific clothes, buy gender specific toys and so on. But is it really that simple? According to Dr. Shuvo Ghosh, a developmental pediatrician at the Montreal Children’s Hospital of the MUHC, it is not.
“Working in Child Development,” says Dr. Ghosh, “means that part of my job consists of seeing families with children who have a conflict with their gender identity. For example, a young girl could feel she is really a boy trapped in a female body. This is not an easy thing for parents to accept or to understand There is a lot to discuss with these families to reach a point where the parents accept their child for who he/she is and consider the next steps for their child.”
According to Dr. Ghosh, gender identity is defined as a personal conception of oneself as male or female (or rarely, both or neither). For example, if a person considers himself a male and is most comfortable referring to his personal gender in masculine terms, then his gender identity is male.
Once a family comes to Dr. Ghosh with a gender identity conflict, a lot of one-on-one discussions with the child and parents are necessary to assess how to proceed. Some parents and children decide that the child will gradually progress through a series of steps that will begin an actual physical transition to the opposite sex. The option to undergo surgeries to change a penis to a vagina, for example, comes much later when the child is 17 or 18 and can make that decision for him/herself.
If the path of transitioning is chosen, there are reversible, partially reversible, and irreversible treatments available. But even the irreversible treatments are not always permanent if the child grows up to decide differently. Starting out is often the hardest part. “If we have a very young child—the youngest has been 5—with a lot of psychiatric difficulties stemming from his/her gender identity conflict, sometimes we have no choice but to begin treatment right away with some of the reversible steps,” says Dr. Ghosh. “However, treatment typically begins around puberty, when the child is 11 or 12, if the desire to transition is persistent.”
For younger children, the reversible steps include a name change, going to school in different clothing, or simply presenting themselves as the opposite sex. “We would never force the kids to go to school in one or another gender role—that is their choice— and the choice of the family,” says Dr. Ghosh. “I would also never recommend anything to a prepubescent child if there was no adult supervision and support and someone who is on his/her side through this process.”
If the child has support for the initial steps then the next step is to start talking about hormone blockers at the time of puberty. This offers the child the chance to not go through typical puberty right away, and to not have his/her body change in the direction they don’t want. It gives them the opportunity to consider, “Is this really how I prefer to go?” and to take some time before making further decisions.
The following step is to start taking hormones to induce the physical features of the opposite gender. The final step would be to have surgery, however many people with gender identity conflict do not choose surgery since it does not always produce the desired outcome. This can be difficult for families to understand.