The far majority of the population is cisgender, meaning they identify
with the gender they were assigned a birth,[1]
which is usually predicated by the esthetics of the infant’s genitalia.
Transgender is defined as a person who has a gender identity and/or gender
expression that is different than their assigned sex.[2]
First, there must be a solid understanding of the three components of
gender. People tend to use the word sex
and gender interchangeably and
incorrectly. Biological sex or sex is
referring to the biology, anatomy, and physiology of the human body. Many
people view sex as a binary concept with two concrete options: female or male.
Five reproductive functions quantify a person’s biological sex, which includes
chromosomes, gonads, sex hormones, internal reproductive anatomy, and
genitalia. Determining a person’s sex among these categories is not always as
easy or binary as society would have us believe. A third biological sex,
intersex, naturally exists in our human species. They do not fit into
traditional female and male binary categories. Depending on how intersex is
defined, roughly 1.7% of the world population intersex.[3]
The second component of gender is gender identity. Gender identity is a
person’s inner sense of being male, female, a blend of both, or neither. A
person’s gender identity may be in likeness or contrast to their assigned biological
sex. Different cultures have different gender identities and labels. Some
labels include: non-binary, gender queer, bigender, trigender, pangender,
agender, transgender, two spirit, or gender free. Prior to gender development
in adolescence, it is quite common for children to play and experiment in
cross-gender roles and performances. Some girls play with trucks and prefer boy
underwear, while some boys prefer dolls and dresses. Non-conforming gender
behavior is not necessarily and indicator that the child is transgender.
However, if a child is insistent, persistent, and consistent in their gender
identity for a significant amount of time, the child might be trying to
communicate they are simply not gender variant or non-conforming, but
transgender.[4] If
a three-year-old boy insists they are a girl and their responses don’t waiver
over the course of a year or two, the child is likely transgender. Although it
is important to note that gender, like biology, is not fixed or stagnant.
Gender variances can also be subject to change over the course of a lifetime.
This is called gender fluidity. Some gender specialists suggest that roughly 1
in 500 children is significantly gender variant or transgender.[5]
Children, as early as age two, begin to gender identify with a parent
of their same sex and through observation begin to mimic behavior and
activities of that gender.[6]
These children may also notice cross-gender humor and find there are societal
expectations on what is considered unacceptable and acceptable gender behavior.
Unfortunately, attitudes and perceptions about childhood and autonomy
can inhibit recognition of a child’s genuine and authentic desires that may
contrast with socially constructed ideas of normal gender identity, expressions,
and behaviors. Children can easily be dismissed as confused and are considered
unable to have the capacity to know what they really want. However, at what point is any person capable of
knowing what they really want? It’s
interesting to think that a transgender child who is able to recognize the
social taboo of acting in opposition to societal expectations and thus conforms
to those expectations, is also seen as incapable of knowing what they want. A
child’s ability to recognize social and communal repercussions and then to act
against their gender identity as a means of conforming to society is a rather
sophisticated thought pattern. Yet, these same children are often dismissed as
unable to know what they really want.
Who else is better qualified to determine their gender identity than the
individual? On the other hand, if a child does have an authentic gender
identity that is contradictory to their biological sex, what is the extent of
the child’s autonomy to alter their play, performance, appearance, style, or
even their body?
A recent study examined 32 transgender children between the ages of 5
to 12 years-old in which research methods included self-reports and implicit
measures of each child’s gender identity. “The results indicated that the
children thought of themselves in terms of their preferred gender identity, not
their biological sex. In addition, the pattern of responses of the transgender
children were similar to the pattern of responses from children who accepted
their biological sex as their gender identity.”[7]
In other words, the children were aware of the gender role expectations and
their biological sex, but their gender identity simply didn’t align with social
expectations. They were not confused;
they were very aware of the situation and still chose a contrasting gender
identity. It may seem surprising that preschool-aged children are aware that
they have a gender identity that is different than their biological sex, but
this also indicates the child is capable of understanding their decision.
Gender dysphoria is often associated with transgender children.
However, dysphoria is not confusion. Gender dysphoria is also not dysmorphia.
According to the American Psychiatric Association, gender dysphoria is the
inner conflict between a person’s physical or assigned gender and that
individual’s gender identity.[8]
Some people describe gender dysphoria as feeling like they were born into the
wrong body. Gender dysphoria may often be accompanied by distress, anxiety, and
depression, but when transgender persons also experience discrimination,
victimization, or rejections from family, friends, and peers this puts them at
a higher risk for suicide than the general population.[9]
The third component of gender is gender expression. Gender expression
is usually the external appearance of one’s chosen gender identity. This is
expressed through various mannerisms, behaviors, apparel, style, voice pitch,
speech, and even the way a person stands. Gender expression is mostly
predicated on socially constructed ideals of what constitutes as masculine and
feminine. Many people express some sort of androgyny containing both masculine
and feminine qualities. Gender performance is highly subjective and varies
across cultures, geography, time, and belief systems.
To be clear, some gender expressions come with more risk than others.
Some expressions are easily adopted and rejected, fluid, and changing. A
transgender girl may enjoy wearing make-up and dresses, even though she does
not indicate any desire to have her body altered through gender conformation
surgery. While make-up can be washed off at the end of the day, hormonal
therapies and surgical alterations should not be treated as lightly. A child
may insist they are transgender, but to have the child undergo gender
conformation surgery prior to the age of consent, which is highly disputable,
would likely be a disservice to the child. There in the problem lies, paternalism
is in contradiction to autonomy and agency. One could argue that paternalism overrides
a child’s desire to physically alter their body and may, in fact, be a way to
maximize future autonomy. This is a gamble. The minor may or may not change
their mind in the future about what they really
want, yet the same could also be said concerning adults. There
are no easy answers. This is also not to say that hormonal therapies and surgical
alterations should not happen for anyone under the age of eighteen either, just
that paternalism and child autonomy is a delicate balance between protection
and oppression.
For example, Ruby Rose came out
as a lesbian at age 12 and identifies as gender fluid. At an early age she
started saving money for gender conformation surgery for when she turned 18,
but eventually decided against it. Rose explained in an interview, “When I got
to 15 was when I kind of decided to get more into my body, and I shaved my
head, and my mom was just like, ‘I don’t know what’s going on right now, but if
you are happy, then do it.’ I decided to change the way that I dressed and
talked and realized that I didn’t want to transition, I just wanted to be more
comfortable in my own skin.” Now that Rose is a 30-year-old woman she’s stated,
“I’m a woman … I want to have babies one day, so I’m glad I didn’t make changes
earlier in my life.”[10]
Some children may be adamant
about bodily changes while others aren’t. Some children may change their minds
while others don’t. Sometimes respecting autonomy means being willing to
listen, observe, and respect a child’s desires to help guide them for long-term
options, which may or may not include hormonal or surgical interventions.
Critics tend to conflict gender dysphoria with dysmorphia, or body
dysmorphic disorder, despite them being two different concepts. Conflation is
usually a tactic used to justify discrimination and marginalization of the
transgender community. According to the Mayo Clinic, body dysmorphic disorder
is considered a mental disorder in which a perceived defect or flaw in one’s
body that is either minor or not observable to anyone else.[11]
This definition is actually quite interesting, because millions of cisgender
people who have undergone cosmetic, plastic, or reconstructive surgery could be
considered to have body dysmorphic disorder, but for some reason it is the
transgender population that gets incorrectly identified with body dysmorphic
disorder.
An example of body dysmorphic disorder can offer additional insight
into this topic. A 22-year-old man, Joe, believes that his perfectly normal
right leg is grotesque and deformed to the point that he desires amputation.
Medically speaking, there is nothing wrong with his leg that anyone else can
observe other than his disdain for it. Psychiatric interventions fail to
convince Joe his leg is normal. At face value, it may seem there isn’t a legal
or ethical dilemma until Joe seeks out an orthopedic surgeon to amputate his
leg. The man’s personhood is more than right leg, even if removed Joe would
still be Joe, perhaps an even happier or more peaceful Joe. His identity does
not reside in his right leg, nor does it reside at all. Identity is a process
of existing that is composed of values and desires that cannot be limited to a
singular body part, whether that is a leg or a penis. However, does Joe’s
desires for amputation justify it? In this case, whoever Joe is, perhaps he would simply be better off without his leg. If
Joe is an autonomous individual he can also give valid consent to have his leg
removed of his own will and volition. However, even if Joe is not autonomous,
perhaps it’s in his best interest to remove his leg anyway.[12]
Whose best interests are at stake anyway, if not the mental health and
well-being of the individual? Does Joe know what’s best for Joe, even if it doesn’t conform to what
others deem as best for Joe? Even if dysmorphia is comparable to gender
dysphoria, does this necessarily indicate surgical intervention is wrong?
Perhaps not. There are millions of people across the globe altering their
bodies due to dysmorphic and dysphoric fixations to achieve specific esthetic
standards, yet the far majority are not being diagnosed with body dysmorphic
disorder. However, at what age can a child give meaningful consent to such a
physically altering change, especially one that cannot be reversed? Children
are prone to change their minds, but aren’t adult too? Perhaps there are less
risky ways of having the child continue to express and experiment with their
gender identity without risky and expensive physical changes. After all,
children are developing and changing, biologically and cognitively speaking, faster
than adults.
In their early years, young children usually experiment in gender
cross-play, while still conforming to gender expectations. Social learning
theory suggests children learn these behaviors from parents, peers, and media,
mainly by environmental factors from a punishment and rewards social system.
Parents may reward children from appropriate gender behavior and even punish
children for what is considered by some as inappropriate gender behavior, like
telling a boy, “Stop crying like a girl.” Other examples include research that
suggests parents underestimate the physical capabilities of their daughter.[13]
Everyday interactions can create strong and powerful messages about how a child
is allowed to express themselves with a socialized gender construct. According
to cognitive theorists, children between the ages of two and five form strict
gender stereotypes base of observation.[14]
A transgender child may feel the need to repress, hide, or reject their gender
identity for fear of punishment. Conformity is not necessarily a sign of
resolution, but likely a sign of emotional intelligence that identifies gender
cross-expression as a taboo or bad behavior.
During school years, children, especially boys, tend to be treated harshly
and are rejected by peers for not conforming to social standards of normal
gender expressions.[15]
“The classroom itself can also strongly reinforce gender stereotypes. Even
though teachers believe they show equal attention to both boys and girls, research
shows that teachers spend more time with boys, give them more attention, both
praise and criticize boys more, direct more follow-up questions to boys, and
tolerate more bad behavior from boys than girls.”[16]
Teachers may also unintentionally stereotype boys and girls by tasks they are
asked to perform, such as asking boys to help move desks and girls to tidy up
the class room or clear the white board.
Gender socialization, intentional and unintentional, in early child
development can cause a great deal of distress to transgender children who
struggle to find a balance between an authentic gender expression and social
isolation from their peers, teachers and parents. Violation of gender stereotypes
can result in harm, violence, or even death. In fact, in 2008 a 15-year-old boy
was shot to death at school by a peer who was uncomfortable with this boy’s
gender identity and expression which included wearing women’s accessories, high
heels, makeup, and clothing.[17]
Bathroom using is another area of distress on controversy. In February
2017, the Trump administration withdrew federal protections for transgender
students. Last year, the Department of Education and Justice, under the Obama
administration, issued guidance that schools receiving federal funding could
not discriminate students on account of sex, including gender identity. Thus,
students could use the bathroom that corresponded with their gender identity.[18]
While civil rights groups praised federal involvement, questions have been
raised about federal involvement now that the Trump administration has lifted
the ban against gender discrimination.
Schools across the nation have adopted more inclusive bathroom policies.
The American School Counselor Association, the National Association of
Elementary School Principals, the National Association of School Psychologists,
and the National Association of Secondary School Principals all support a
positive school culture where the safety of all students is valued while
implementing gender inclusive policies.[19]
Children having a support system at school that allows them to use the bathroom
consistent with their gender identity has become an important way schools are
combating recent alarming statistics about transgender persons. Most recent
statistics state that 75.1% of transgender students feel unsafe at school
because of their gender expression, 63.4% of transgender students reported
avoiding bathrooms, and 41% of transgender or gender non-conforming people have
attempted suicide.[20]
These startling statistics may be enough to motivate some people toward change,
but not everyone. Questions remain.
What is the role of government? Is this simply a matter of policy? Is
the issue at hand really about bathrooms and locker rooms, or is it about
discrimination of personhood? Perhaps the real question at hand is do these
children have the right to autonomy and not just autonomy over their body, but
over their minds and identity? Does a child have the right to choose their
gender identity? Does a child have the right to personhood? If so, to what
extent do transgender children have rights over their minds and bodies?
Some may cite studies showing that gender roles and behaviors are
innate and predicated upon biological sex, but even so, they are not universal.
As discussed previously, determining a person’s biological sex if far more
complicated than simply glancing at an infant’s genitalia. Even if gender roles
are innate and predicated of biological sex factors, does that mean deviation
from these gender roles is any less innate? If the biology of a human being
determines a person’s gender, shouldn’t the same argument apply to transgender
persons? Is their biology also not the product of being transgender?
There is also the dilemma of how to address the autonomy of children in
self-disclosure, we also can’t ignore the very real harm and dangers that can
inhibit a transgender child from a more authentic gender expression. According
to the American Psychiatric Association, being Transgender is not a
psychological disorder,[21]
yet dogmas and stereotypes persist. This can make it difficult for trans
children to recognize or come out to themselves.[22]
Coming out as transgender can be an extremely difficult experience for a child.
Children are often told by well-meaning adults “just be yourself” without recognizing
the seriousness of the risks involved. Oddly, many transgender children
comprehend the risks involved and that is exactly why they are experiencing
depression or anxiety. It is because they are aware that these feelings
persist. This issue of self-disclosure and peer-disclosure can be quite
complicated for a child and can be even more complicated for a child whose
parents practice heavy paternalism. If a child prefers privacy, but the parent
does not, the child may be even less likely to disclose their identity to their
parent. If the child does not have control over whom to disclose, the safest
solution then is to remain private about their gender identity. This also
requires a quite sophisticated line of thought that indicates a child is not confused,
but aware. Conversely, if privacy is emphasized by the parent, the child may
develop feelings that their identity is something to be ashamed of.[23]
Children must be in control over whom and when they disclose private
information about their mind and bodies or else there will be little chance in
developing an authentic relationship with the child.
In closing, transgender children
don’t solely need protections, but they also need trust, autonomy, and
responsibility. As the transition process progresses, transgender children need
to be in an environment where their agency is respected and autonomy honored.
Transitions for transgender children can be taken thoughtfully and slowly; not
simply as a product of paternalism, but as a means of maximizing potential
options for the future. However, paternalism should also not become an
oppressive tool to which a child loses a sense of control over their identity.
Children are capable of communicating their authentic desires when others are
willing to observe and listen.
*Note to my transgender or non-binary readers: My perceptions and opinions are based upon academic research and my own subjective experience. If you think I have inaccurately represented the queer community, feel free to contact me. I’m happy to learn more about your unique experiences.
Notes and Citations
[1]
Wikipedia, The Free Encyclopedia, s.v. “Cisgender,” accessed April 15, 2017, https://en.wikipedia.org/wiki/Cisgender.
“Cisgender (often abbreviated to simply cis) is a term for people
whose gender identity matches the sex that they
were assigned at birth. Cisgender may also be defined
as those who have a gender identity or perform a gender role society considers
appropriate for one's sex. It is the opposite of the term transgender.”
[2]
Wikipedia, The Free Encyclopedia, s.v. “Transgender,” accessed April 15, 2017, https://en.wikipedia.org/wiki/Cisgender.
“Transgender people are people who have a gender
identity or gender expression that differs from their assigned sex.
Transgender people are sometimes called transsexual if
they desire medical assistance to transition from one sex to
another. Transgender is also an umbrella term:
in addition to including people whose gender identity is
the opposite of their assigned sex (trans men and trans women),
it may include people who are not exclusively masculine or feminine (people who
are genderqueer,
e.g. bigender, pangender,
genderfluid, or agender). Other definitions of transgender also
include people who belong to a third gender,
or conceptualize transgender people as a third gender. Infrequently, the
term transgender is defined very broadly to include cross-dressers,
regardless of their gender identity.”
[3] Intersex
Society of North America, “How common is Intersex?” ISNA, accessed February 12,
2017, http://www.isna.org/faq/frequency. “Anne
Fausto-Sterling s suggestion that the prevalence of intersex might be as high
as 1.7% has attracted wide attention in both the scholarly press and the
popular media. Many reviewers are not aware that this figure includes
conditions which most clinicians do not recognize as intersex, such as Klinefelter
syndrome, Turner syndrome, and late-onset adrenal hyperplasia. If the term
intersex is to retain any meaning, the term should be restricted to those
conditions in which chromosomal sex is inconsistent with phenotypic sex, or in
which the phenotype is not classifiable as either male or female. Applying this
more precise definition, the true prevalence of intersex is seen to be about
0.018%, almost 100 times lower than Fausto-Sterling’s estimate of 1.7%.”
[4]
Human Rights Campaign, “Transgender Children & Youth: Understanding the
Basics,” accessed
April 16, 2017, http://www.hrc.org/resources/transgender-children-and-youth-understanding-the-basics.
[5] Stephanie
Brill and Rachel Pepper, “The Transgender Child: A Handbook for Families and
Professionals,” (San Francisco: Cleis Press Inc., 2008), 2. “No one knows how
common transgender children are. Some gender specialists say that one in 500
children is significantly gender-variant or transgender. This may be a
reasonable statistic, though the rate may actually be higher. Older studies,
based only on statistics of postoperative transsexual men, say that the number
is closer to 1 in 20,000. This figure is disputed by adult transgender
activists today and seems to bear little relevance to the transgender and
gender variant children currently coming forward.” Perhaps that as society
evolves to be more accepting of the transgender population, those that are gender
variant or transgender will be more likely to self disclose, not that
transgenderism is necessarily more common.
[6] Janell L. Carroll, “Sexuality Now: Embracing Diversity,” 4th
Edition (Belmont: Wadsworth, 2013), 100.
[7] Sarah
Grison, Todd F. Heatherton, and Michael S. Gazzaniga, “Psychology in Your Life”
2nd Edition (New York, W.W. Norton & Company, Inc., 2015), 359.
[8]
American Psychiatric Association, “What is Gender Dysphoria?” accessed April
16, 2017, https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria.
“Gender
dysphoria involves a conflict between a person's physical or assigned
gender and the gender with which he/she/they identify. People with gender
dysphoria may be very uncomfortable with the gender they were assigned,
sometimes described as being uncomfortable with their body (particularly
developments during puberty) or being uncomfortable with the expected roles of
their assigned gender. People with gender dysphoria may often experience
significant distress and/or problems functioning associated with this conflict
between the way they feel and think of themselves (referred to as experienced
or expressed gender) and their physical or assigned gender. The gender conflict
affects people in different ways. It can change the way a person wants to
express their gender and can influence behavior, dress and self-image. Some
people may cross-dress, some may want to socially transition, others may want
to medically transition with sex-change surgery and/or hormone treatment.
Socially transitioning primarily involves transitioning into the affirmed
gender’s pronouns and bathrooms.”
[9]
Sarah Grison, Todd F. Heatherton, and Michael S. Gazzaniga, “Psychology in Your
Life” 2nd Edition (New York, W.W. Norton & Company, Inc., 2015),
360.
[10]
Julie Mazziotta, “Ruby Rose Is ‘Glad’ She Didn’t Get Gender Reassignment
Surgery: ‘I Want to Have Babies One Day.’” People, January 20, 2017, accessed
April 17, 2017, http://people.com/bodies/ruby-rose-glad-didnt-get-gender-reassignment-surgery/.
[11]
Mayo Clinic, “Body Dysmorphic Disorder” accessed April 2017, http://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/home/ovc-20200935.
[12]
Charles Foster & Jonathan Herring, “Identity, Personhood and the Law”
(Switzerland: Springer Nature, 2017), 61.
[13]
Janell L. Carroll, “Sexuality Now: Embracing Diversity,”
4th Edition (Belmont: Wadsworth, 2013), 92.
[14] Ibid, 93.
[15] Ibid, 100-101. “Overall, boys are treated more harshly than girls
when the adopt cross-gender characteristics. […] During the school years,
gender roles become the measure by which children are judged by their peers.
Children who violate sex-typed play are usually rejected (and not kindly) by
their peers. This is especially true of boy, who experience rejection from
their peers when they violate gender stereotypes than girl do.”
[16] Ibid, 101.
[17]
Wikipedia, The Free Encyclopedia, s.v. “Murder of Larry King,” accessed April
16, 2017, https://en.wikipedia.org/wiki/Murder_of_Larry_King.
[18]
Ariane de Vogue, Mary Kay Mallonne, and Emanuella Grinberg, “Trump
Administration Withdraws Federal Protections for Transgender Students,” CNN,
February 23, 2017, accessed April 15, 2017,
http://www.cnn.com/2017/02/22/politics/doj-withdraws-federal-protections-on-transgender-bathrooms-in-schools/.
[19]
Gender Spectrum, “Transgender Students and School Bathrooms: Frequently Asked
Questions,” accessed April 15, 2017, https://www.genderspectrum.org/bathroomfaq/.
“This resource is endorsed and supported by the American School Counselor
Association, the National Association of Elementary School Principals, the
National Association of School Psychologists, and the National Association of
Secondary School Principals. While this may be new to some educators, parents,
and students, this document builds on the successful experiences of educators
throughout the country who have skillfully implemented gender inclusive
policies, including those related to bathrooms. Enacting these policies allows
school leaders to support the needs of all students.”
[20]
Gender Spectrum, “Transgender Students and School Bathrooms: Frequently Asked
Questions,” accessed April 15, 2017, https://www.genderspectrum.org/bathroomfaq/.
[21]
Sarah Grison, Todd F. Heatherton, and Michael S. Gazzaniga, “Psychology in Your
Life” 2nd Edition (New York, W.W. Norton & Company, Inc., 2015),
160. “According to the American Psychiatric Association, being transgender is
not a psychological disorder. Instead, psychologists are increasingly viewing
people who are transgender as experiencing normal variations in gender identity.”
[22]
Nicolas M. Teich, “Transgender 101: A Simple Guide to a Complex Issue,” (New
York, Columbia University Press, 2012), 30. “Realization that one is trans can
take anywhere from a few moments to several decades. Usually transpeople have
an inkling early on in their lives that their assigned gender feels out of
whack with their bodies. The self-realization process is extremely complicated.
The human mind does its best to help us survive, which can translate into
triggering intense denial.”
[23]
Nicolas M. Teich, “Transgender 101: A Simple Guide to a Complex Issue,” (New
York, Columbia University Press, 2012), 138. “Revealing this level of personal
information is something that needs to be navigated. Transgender children from
a very early age learn to read safety in a situation and use this information
to decide how much to reveal, and how much to keep private. Privacy can develop
into shame if the need for privacy is driven by the parents—the communication
to the child is that there is a secret to keep. Secrets breed shame. However if
the desire for privacy comes from the child, and the parents encourage the
child to test the waters of self-disclosure when it feels right, because there
is nothing to be ashamed of, the child is much less likely to choose privacy due
to internalized shame.”
