Sydney,
Australia — The case of 13-year-old "Alex" has
reignited controversy over a little-understood area of
medicine. Family Court <http://www.familycourt.gov.au/>
Chief Justice Alistair Nicholson this week ruled that a
13-year-old Australian girl could begin treatment to
become a boy <http://www.austlii.edu.au/au/cases/cth/family_ct/2004/297.html>.
"Alex" will immediately begin a course of hormones, of
the same type as the contraceptive pill, to suppress
menstruation. At 16, "he", as the Chief Justice referred
to Alex, can begin a course of testosterone. This will
deepen her voice and promote the growth of facial hair,
muscular development and an enlarged clitoris.
The judge agreed with
psychiatric assessments that Alex has dysphoria, a
medical condition that results in a mismatch between the
gender a person believes themselves to be and the
physical sex of their body.
Court orders prevent much
being written about Alex, but The Age can write
that she was born overseas and that she adored her
father, who treated her as a boy. He taught his daughter
karate and self-defence.
When her father died,
when Alex was five or six, she was devastated. The family
migrated to Australia. Her mother has no contact with
Alex or her family, including Alex's aunt, with whom she
lives.
Child protection workers
were first alerted to Alex's situation nine months after
the family arrived in Australia in 2000. She is under the
guardianship of a government department, who brought the
case to court with the support of her aunt and school
after Alex started to develop suicidal and self-harming
tendencies when she entered puberty.
When Alex was enrolled in
a faith-based primary school (she is now at high school),
her principal and teacher described how she refused to
stand in either the boys' line or girls' line at school
assembly. She played cricket and arm-wrestled boys on
school camp.
While puberty is indeed a
troubling time, Lauren Christopher, convener of
TransGender Victoria, says questions about gender
identity can start at any age: "You just know, most
people say they have always known, they may not have
given it a name, but they knew.
The one Australian clinic
that deals exclusively with questions about gender
identity, the Gender Dysphoria Clinic, is based at Monash
Medical Centre and only treats adults. In the past 29
years, it has performed about 600 gender reassignment
operations. Some Australians travel overseas to Thailand
and Canada for surgery. Generally, dysphoria specialists
use the Harry Benjamin International Gender Dysphoria
Association <http://www.hbigda.org/>
standards of care, which state that a person must live in
their preferred gender full-time for one year and seek
the counsel of two psychiatrists and an endocrinologist
before transition can begin.
At the Gender Dysphoria
Clinic, patients must have a doctor's referral. They must
also write a letter explaining their feelings and
describing the impact of their condition on their lives.
If the clinic agrees to
see them, they regularly meet with two psychiatrists and
possibly a psychologist as well. They must live full-time
in their nominated gender for 18 months before surgery.
If the two psychiatrists agree, hormone therapy may start
while patients are living in their nominated
sex.
Dr Louise Newman, the
chair of the Faculty of Child and Adolescent Psychiatry
of the Royal Australian and New Zealand College of
Psychiatrists <http://www.ranzcp.org/>,
says regulations are needed to help professionals decide
when and how best to deal with gender identity and
dysphoria.
"If we are going to have
these sorts of treatments available, then ethically and
clinically we need a model where there are centres of
excellence," Dr Newman says.
Katherine Cumming,
resource and development worker for support service the
Gender Centre <http://www.gendercentre.org.au/>,
says some people also take dangerous risks by
self-medicating to speed up the process.
"I am also quite sure
there are a number of doctors that do things off the
record. We know that lots of doctors want to relieve
people of their great suffering by helping with hormone
therapy," Cumming says.
Awareness about teenage
dysphoria is growing. Five years ago, there were four
support groups in Melbourne for gay, lesbian, bisexual
and transgender people - there are now 34 across the
state.
The growth in services
followed a 1999 La Trobe University study which found
that young homosexuals were four times more likely to
consider suicide than heterosexuals.
A Joy FM radio show
Transmission Time co-host, Sally Goldner, says some
progress in raising awareness about transgender issues
has been made. She hopes to develop a transgender
mentoring program.
"I think young people are
becoming more aware of it, and the internet has made a
massive difference. They can ask questions safely and get
some answers," Goldner says.
Meanwhile, Lauren
Christopher says Alex's future is now brighter than
before.
"It is going to be hard
when he goes to the beach and all the guys are in their
shorts when it's 39 degrees at Bondi. Sure he is going to
have issues, but he has the freedom to live his life now
and he has a choice."
