By Alex Vaughn

After his parents, Pauline Moreno and Debra Lobel, adopted Thomas at age 2, they observed that he was aloof.

Regardless of the fact he was physically male, Thomas has always maintained that he is a girl. At 3-years-old Thomas had learned sign language because he had verbal apraxia, a speech impediment that hindered his ability to talk. The toddler pointed to himself and signed, “I am a girl.”

“Oh look, he’s confused,” his parents said. Maybe he mixed up the signs for boy and girl.

So they signed back. “No, no. Thomas is a boy.”

But the toddler shook his head. “I am a girl,” he signed back emphatically. When teased at school about being quiet and liking dolls,

Thomas would repeat his simple response, “I am a girl.”

Thomas, now 11, goes by the name of Tammy, wears dresses to school and lives as a girl.
Transgender children experience a  disconnect between their sex, which is anatomy, and their gender, which includes behaviors, roles and activities. In Thomas’ case, he has a male body, but he prefers female things likes skirts and dolls, rather than pants and trucks.

“It’s important to acknowledge the signs of gender dysphoria, especially for children,” said Eli Coleman, who chaired a committee to update treatment guidelines for the World Professional Association for Transgender Health, an international medical group meeting this week in Atlanta, Georgia. “By not addressing it, it could be really more damaging for the child than not.

“It’s a very difficult area and there are a lot of children who have gender nonconformity. They will simply grow out of that. Many of them later on identify as gay or lesbian, rather than transgender.”

The American Psychological Assoc-iation warns that, “It is not helpful to force the child to act in a more gender-conforming way.”

When they’re forced to conform, some children spiral into depression, behavioral problems and even suicidal thoughts.

“He seemed so depressed and unhappy all the time,” Lobel said. “He didn’t enjoy playing. He sat there all the time, not interacting with anybody. He seemed really lonely.”

“His personality changed from a very sad kid who sat still … to a very happy little girl who was thrilled to be alive,” says Moreno.

After seeing therapists and psychiatrists, the mental health specialists confirmed what Thomas had been saying all along. At age 7, he had gender identity disorder.

The diagnosis was hard for Moreno and Lobel to accept. They have been accused of terrible parenting by friends, family and others, that “we’re pushing her to do this. I’m a lesbian. My partner is a lesbian. That suddenly falls into the fold: ‘Oh, you want her to be part of the lifestyle you guys live,’” Moreno said.

Moreno and Lobel allowed their child to pick his own clothes at age 8. Thomas chose girl’s clothing and also picked four bras. Then, Thomas wanted to change his name to Tammy and use a female pronoun. This is called social transitioning and can include new hairstyles, wardrobe. Aside from mental health therapy, this stage involves no medical interventions.

Every step of the way, her parents told Tammy, “If at any time you want to go back to your boy’s clothes, you can go back to Thomas. It’s OK.” Tammy has declined every time.

This summer, Tammy began the next phase of transition, taking hormone-blocking drugs. The hormone blockers are also reversible, because once a child stops taking the drugs, the natural puberty begins, said Dr. Stephen Rosenthal, pediatric endocrinologist at UC San Francisco.

But if the child wants to transition to the other gender, he or she can take testosterone or estrogen hormone treatment to go through the puberty of the opposite gender.

This transgender hormone therapy for children is relatively new in the United States after a gender clinic opened in Boston in 2007.

Programs for transgender children exist in cities including Los Angeles, Seattle and San Francisco. The kids are treated by pediatric endocrinologists after long evaluations by mental health professionals.

Dr. Kenneth Zucker, head of the Gender Identity Service in the Child, Youth, and Family Program and professor at the University of Toronto, conducted a study following 109 boys who had gender identity disorder between the ages of 3 and 12. Researchers followed up at the mean age of 20 and found 12% of these boys continued to want to change genders.

“The vast majority of children lose their desire to be of the other gender later,” he said. “So what that means is that one should be very cautious in assuming say that a 6-year-old who has strong desire to be of the other gender will feel that way 10 years later.”

All of this leads to unsettling answers for families trying to understand their children. No one knows whether a child’s gender dysphoria will continue forever or if it is temporary.