If the growing awareness of transgenderism and its early manifestation has meant that some families now support their children through the first steps of a transition, it has also made those steps more frightening, as parents realize sooner where the path is headed. The so-called social transition that allowed Mark to become Molly at 7 is just the beginning. The most widely used protocols for transgender health care suggest that “cross-hormones”—testosterone for female-to-male transboys (FTMs); estrogen and progesterone for male-to-female transgirls (MTFs)—should be started at 16. This step is sometimes called the medical transition, beginning the process of reshaping the body chemically. Surgical transition, which creates the most obvious outward signs of the “target” gender by removing or creating breasts and genitals, is generally withheld until a child is 18, or otherwise of legal age to provide informed consent. (Many transgender people opt not to have such surgery at all, or to have certain procedures but not others.) Of course, by 18 or even 16, most transgender kids are already well along in adolescence, developing all the characteristics of the gender to which they are sure they do not belong. The medical and surgical interventions are in that sense too late, offering only a clumsy eraser against the powerful markings of maturity.
But within the last decade, endocrinologists have quietly been promoting another possibility. Since puberty itself is a torturous crisis for many transgender kids, why not use synthetic hormones called puberty blockers to prevent the problem altogether? When started at the right moment, these blockers freeze the child’s development before the arrival of noticeable secondary sex characteristics. For several years, perhaps as many as seven, they keep the child in a kind of preadolescent holding pattern, physically and even emotionally. Then, at 16, if a decision is made to proceed with cross-hormone therapy, the child will belatedly undergo adolescence—but in the desired gender instead of the dreaded one. MTFs will start to develop round hips and bigger breasts; FTMs, square shoulders and more prominent Adam’s apples. Later, if surgery ensues, there is much less of the wrong adulthood to undo.
These puberty blockers, more formally called gonadotropin-releasing hormone analogs, are most effective if started when a child is entering Stage 2 of growth as indicated in the Tanner scale of physical development. At the beginning of Stage 2, there is almost no breast development in girls, or genital enlargement in boys, and only the faintest shadow of pubic hair in either sex. As Hanna Rosin reported in The Atlantic in 2008, girls reach Stage 2 at a mean age of about 11, boys at about 13. But those are means, and the age of puberty continues to drop. These days, Tanner Stage 2 may begin as young as 9 in both sexes.
Which suggests that if the Benders don’t want Molly’s male biology to assert itself any further, they may soon have to play God again, this time not just with swirly dresses but with the administration of years of hormones. That’s a lot of God to play.
The Benders are not alone in facing this decision, though statistics on transgender kids are hard to come by. Trans Youth Family Allies, or TYFA, a national support organization for parents, offers an anecdotal figure based on its counselors’ visits to schools: one or two out of 500 students. (Scaled up, that would suggest 150,000 to 300,000 nationally.) It’s unclear whether the phenomenon is on the increase, but it is definitely changing. Wylie C. Hembree, an endocrinologist affiliated with New York Presbyterian and a leader in the field, notes that MTFs, like Molly, used to be as much as ten times more prevalent than FTMs. Now the ratio is almost one to one.
Online, FTMs seem to be in the majority. YouTube is crawling with jerky homemade videos of transboys talking about transition. Their posts often include stark visuals of such rites of passage as the first injection of testosterone, the burning of uncomfortable chest binders, first sightings of facial scruff or biceps bumps, and, of course, the big reveal: the results of “top surgery,” or breast removal. By and large, the boys in these videos come off as thoughtful, funny, and unusually articulate. (A boy named Jacob reports the emergence of “a solar system” of acne and “gross, nasty” “bacne” after four months on “ ’stosterone”: “I gotta deal with it; it’s puberty, right?”) But in a few cases it’s hard to tell whether these FTMs are expressing relief and pride in a new, more congruent body or indulging in a kind of macho posturing that seems as conventional and false as the femininity they meant to escape.