A small but growing number of teenagers and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.
It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.
An 8-year-old second-grader in Los Angeles is a typical patient. Born a girl, the child announced at 18 months, "I a boy," and has stuck with that belief. The family was shocked but now refers to the child as a boy and is watching for the first signs of puberty to begin treatment, his mother told the Associated Press.
Pediatricians need to know these kids exist and deserve treatment, said Dr. Norman P. Spack, author of one of three reports published today and director of one of the nation's first gender-identity medical clinics, at Children's Hospital Boston.
"If you open the doors, these are the kids who come. They're out there. They're in your practices," Spack said in an interview.
Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different; they feel certain that they were born with the wrong bodies.
Some are labeled with "gender identity disorder," a psychiatric diagnosis. But Spack is among doctors who think that's a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.
Spack said that by some estimates, 1 in 10,000 children have the condition.
Offering sex-changing treatment to kids younger than 18 raises ethical concerns, and their parents' motives need to be closely examined, said Dr. Margaret R. Moon, a member of the American Academy of Pediatrics' bioethics committee. She was not involved in any of the reports.
Some kids may get a psychiatric diagnosis when they are just hugely uncomfortable with narrowly defined gender roles; or some may be gay and are coerced into treatment by parents more comfortable with a sex change than having a homosexual child, said Moon, who teaches at the Johns Hopkins Berman Institute of Bioethics.
It's harmful "to have an irreversible treatment too early," Moon said.
Doctors who provide the treatment say withholding it would be more harmful.
These children sometimes resort to self-mutilation to try to change their anatomy; the other two journal reports note that some face verbal and physical abuse and are prone to stress, depression and suicide attempts. Spack said those problems typically disappear in kids who've had treatment and are allowed to live as the opposite sex.
Spack's report details a fourfold increase in patients at the Boston hospital who are dealing with this issue. His Gender Management Service clinic, which opened at the hospital in 2007, averages about 19 patients each year, compared with about four per year treated for gender issues at the hospital in the late 1990s.
The report details 97 girls and boys treated between 1998 and 2010; the youngest was 4. Children that young and their families get psychological counseling and are monitored until the first signs of puberty emerge, usually around age 11 or 12. Then children are given puberty-blocking drugs, in monthly $1,000 injections or implants imbedded in the arm.
In another Pediatrics report, a Texas doctor says he's also provided sex-changing treatment to an increasing number of children; so has a clinic at Children's Hospital Los Angeles, where the 8-year-old is a patient.