Dear Dr. Eva,

There is a child I am really concerned about. I thought you might be able to shed some light on this situation. This child (we’ll use the name Marion) is in the same 2nd grade class as my daughter. Marion is a little girl whose parents allow (force?) her to come to school dressed as a boy. This situation is an open secret in the school. All of the teachers and many of the parents are aware of it, and I’m sure many of the children are too.

I did call Marion’s parents. They were very pleasant. They explained that their child had always thought of herself as male and they were letting her follow her feelings.

I cannot help but feel that this is a form of child abuse. I am on board with the idea of adults choosing to change gender. But is it responsible to let an 8 year old make such a life changing decision?

Concerned Adult

Dear Concerned,

I understand your   concern. This reaction is common the first time an adult encounters a child   in transition. However, what Marion’s parents are doing could be called child   affirmation, and it is the opposite of child abuse.  Here are a few   points I would like you to consider:

· Early   childhood onset of cross-gender identification is one of the most reliable   factors in diagnosing transsexuality.

· Transsexual   children are happier and relate better with their peers when they are allowed   to live in the gender they identify with.

· No parent   wants or plans for their child to be transsexual. I have never heard of a   case in which it is the parent’s idea to have their child dress as the   opposite gender. Cross-dressing is always the child’s idea and only occurs   after the child makes repeated and insistent requests.

· This child is   undergoing social transition. This means that no hormones have been given and   no surgery is planned. Social transition is 100% reversible. Very few   children choose to reverse it, but it can be easily done, with the most   disruptive part being a possible change of schools.

· Cross-gender   hormones will most likely be considered at the start of puberty. By that   time, having lived as a boy for several years, the child will be much better   prepared to participate in decisions about hormones and later about surgery

Dr. Eva

Hi Dr. Eva!

I have a transgender   hormone question. My female-to-male son is 14 and just started on   testosterone 6 months ago. He is doing well on testosterone, but he is   wondering if he could go up on the dose. He's pleased with all the physical   changes but continues to have fat mainly in female distribution around hip   and thighs.  He is currently taking 40 mg every 5 days. His last   testosterone level was 524, which is at the low end of the normal range for   that lab. Would you recommend increasing the testosterone dose even though he   is currently in the normal range?

Concerned Mom

Dear Mom,

I’m happy to know you   are allowing your transmale son to transition from female to male by starting   testosterone in adolescence, which is a good time to do so. Once the   diagnosis of transsexuality is established in a child, it is usually best for   the child to start cross-gender hormones at the first signs of puberty,   usually age 10-12 in genetic females and 12-14 in genetic males. If puberty   has already begun, hormones should be started as soon as possible.

To respond to your   question: No, I wouldn't increase your son’s testosterone dose at this time.   Based on the Endocrine Society guidelines for transsexual hormone therapy,   changes in any individual transman's (or transboy’s) testosterone dose should   be determined by that individual's testosterone level, and your son’s level   is currently in the normal range. Please let your son know that his testosterone-induced   body changes will take three years, at least, to be complete. If his   testosterone level falls on future tests, it would be appropriate to increase   the dose.

To look into his   "female fat pattern", the first step is to know his BMI (Body Mass Index).   All you need to calculate BMI are his current weight, his height, and   internet access. Go to the internet and search for Teen BMI Calculator (or   use this link: http://bmifit.com/bmichildteen.php)   and enter his birthdate, gender (use male), weight and height. If his BMI is   over 25, weight loss is the most effective thing he can to decrease the fat   in his hips and thighs.  If his BMI is between 18 and 25, his weight is   normal. In that case, he may have a gynecoid-shaped pelvis, a permanent configuration   of the pelvic bones that results in wide hips. If that's the case, there's no   way to avoid having wide hips. (It might be better for his morale if you   don’t bring this possibility up to him.) Finally, there are plenty of men   with wide hips, just as there are women with narrow hips. If the rest of his   appearance is typically male, no one will notice the width of his hips.

Dr. Eva