Life
Without Puberty

Many transgender people have just one regret: not transitioning sooner. That may soon be a thing of the past as a growing number of trans kids turn to puberty-blocking hormones.

The Food and Drug Administration has long approved hormone blockers for nontransgender children experiencing early puberty. But a growing number of U.S. physicians are legally prescribing these blockers to trans youth at the onset of puberty--an investigational off-label use. Doctors argue that medical intervention at that point is safer than letting trans children endure the wrong kind of puberty or take medications without supervision.

Some transgender minors delay puberty until adulthood; others begin cross-sex hormones soon after starting hormone blockers while minors. Though the treatment is reversible, prescribing minors hormone blockers is clearly an incendiary issue. Psychologist Kenneth Zucker believes that forcing transsexualism is dangerous for children who simply don't fit normative gender roles. Other practitioners advocate a different kind of intervention: forcing normative gender roles on gender-nonconforming children, e.g., making a little girl, even if she identifies as a boy, wear dresses and play house.

Can an 11-year-old be sure he or she is in the wrong body? Some studies seem to indicate gender identification occurs long before puberty. According to psychologist Marsha Weinraub, children typically become aware of adult sex role differences by the time they're 3, and gender identity follows closely behind. Other results are less clear--as in cases of infants whose sex is reassigned due to cloacal exstrophy, a rare birth defect. In a Johns Hopkins study of 16 genetic males affected by cloacal exstrophy, eight of the 14 who had been reassigned the female sex neonatally later declared themselves male.

Betsy*, a Kentucky mom, didn't wait for her doctors to arrive at a consensus. She knew her son Tucker was born into the wrong body and that menstruation and breast development would traumatize him. By the time Tucker was 11 he had starting taking hormone blockers, and Betsy was driving him 300 miles to the nearest doctor who would treat him.

"It's financially devastating," Betsy says, certain she's doing the right thing. "Insurance covered the pills, but they're not working. His hormone levels are still rising, so we plan to switch to injections."

*Surname omitted by request. Disclosure: Author is affiliated with TransYouth Family Advocates, a nonprofit that supports medical intervention for trans minors.