Friday, May 26, 2017

Transgender Children: Autonomy and Personhood

(This is a copy of a required research paper for Philosophy of Childhood.)

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. bigenderpangender, 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.”