Critics Slam Decision to Approve 'Sex-Change' Treatment for 13-Year-Old

By Patrick Goodenough | July 7, 2008 | 8:05 PM EDT

Pacific Rim Bureau ( - An Australian court has given the go-ahead for a 13-year-old girl who wants to be a boy to begin a "sex change" process, prompting strong criticism and calls for government intervention.

A psychiatrist who works in the field expressed concern that gullible youngsters were being misinformed about exactly what could be achieved by medical intervention, while ethicists argued that the child's condition was mental, not biological.

The girl, known only as "Alex," will be allowed to begin taking hormones - initially estrogen and progestogen to suppress menstruation and the feminization of her young body and, at the age of around 16, testosterone to begin the masculinization process.

The testosterone will "have certain irreversible effects such as the deepening of Alex's voice, the promotion of facial and body hair, muscular development and enlargement of the clitoris," according to the summary ruling of Family Court judge Alastair Nicholson.

Once she turns 18 she will be able to have surgery to make changes to her sexual and reproductive organs.

Nicholson, who referred to the girl in his judgment as "he," heard testimony that painted a picture of a girl who regarded herself as a boy from a young age, preferring activities usually enjoyed by boys.

Alex lives with an aunt, and a government welfare department is her guardian, which brought the case on her behalf.

The court heard that her father, with whom she was very close and who treated her as if she was a boy, died when she was five. The court was unable to contact her estranged mother, whose whereabouts are unknown.

With onset of puberty, Alex began to develop suicidal tendencies, which the judge said was "due to his body not matching his male gender identity."

Nicholson said he was satisfied Alex was aware of the physical consequences of the treatment and possible side effects.

"The social implications of the proposed treatment are that Alex will face challenges in his chosen identity in respect of peer relationships, possible bullying and ostracism, but I am satisfied that impressive steps have been taken to anticipate such risks."

Nicholson said if the treatment was not allowed, there was concern that Alex would "revert to unhappiness, behavioral difficulties at home and self-harming behavior."

He also ruled that Alex could change her name on her birth certificate to a boy's name now, and would not have to wait until having surgery to do so - a requirement in some Australian states.

The court ruling has caused a stir.

While transgender campaign groups and some medical bodies approved, leading Australian ethicist Nicholas Tonti-Filippini called the decision "irresponsible" and said medical treatment was being used to treat a mental condition.

He called on the attorney general to review the case and take it to a higher court.

Christian ethical action group Salt Shakers called for a federal government inquiry into "gender reassignment" procedures.

The group argued that there was no way to turn a woman into a man or vice versa successfully.

"Alex will never have a fully functioning penis, never produce sperm or be able to father a child, and if Alex changes her mind again they will never be able to turn her back into the woman she really is," it said.

"She would have to have breast implants and be given an 'artificial' vagina. She will never be able to produce a child or feel a complete woman."

Second thoughts

Last year, an Australian named Alan Finch was the subject of a television documentary that drew widespread attention.

Finch underwent what is known as gender reassignment surgery (GRS) to "become" a woman, but was unhappy with the results and nine years later reverted to living as a man, taking male hormones and considering surgery to restore his male organs.

Finch's story called into question the assessments carried out before GRS: He described how he had failed a psychiatric assessment as his answers were too "masculine." He was allowed a second attempt and, having learned to fake the responses, passed and was approved for surgery.

He also recalled having second thoughts in the operating theater, but being reassured by a surgeon who said he was just having "pre-operation nerves."

Finch, who now runs a group called the Gender Identity Awareness Association, said he believed Alex was "much, much too young" to be making the decision.

He questioned whether the girl had been given adequate psychotherapy to explore the issues of her family background that may contribute to her "gender confusion."

Finch also mulled the potential problems the judge's ruling could lead to, for instance when Alex becomes romantically involved with another girl at school.

"Initially, her girlfriend would have no idea that she is anything other than a young boy. She will be presenting as a boy. Her teachers and parents will say that she is a boy. The girlfriend's parents would also have no idea that their daughter is becoming romantically involved with another girl. Is such a situation morally and ethically acceptable?"

When the girlfriend eventually finds out that her "boyfriend" is actually another girl, this could have implications for her own social-sexual development, he argued.

"Simply changing the sex recorded on the girl's birth certificate and enrolling her into school as a boy cannot begin to address the major issues facing this 13-year-old and those with whom she becomes involved."

'Changing sex, gender not possible'

An Australian psychiatrist who works with patients who struggle with gender identity agreed that the government should investigate the GRS issue.

Speaking on condition of anonymity, he said Thursday the case raised serious issues.

"At the age of 13 a child's very much half-formed. There has to be the greatest concern about 13-year-olds determining that much of their destiny," the psychiatrist said.

"If someone believed they were only meant to have one arm, there's no way you'd sanction the surgical removal of the other," he added.

The psychiatrist argued that authentic sex changes were not possible, and accused many clinics involved in the practice of "coercion, promotion and persuasion."

"People are being injured by misinformation," he said.

Some of his patients said they had been told by staff at clinics "that they can actually be made male or female, that they'll have normal sexual functioning" after GRS.

"No one ever becomes the opposite sex. You might become a facsimile of that, and it might be cosmetically relieving and more convenient for swimming and so on, but that's a very different thing from being a biological male or female."

He recalled that one patient who had male-to-female surgery observed that any sexual pleasure he experienced afterwards was "a highly male pleasure."

"Any sexual pleasure experienced after such an operation is a painful reminder that the operation didn't do anything [to authentically change a person's sex]," the psychiatrist said.

"People do become somewhat feminized by hormone treatment, but not completely. You don't become a woman. You don't have those kind of emotions," he said.

Not only does GRS not offer a true sex change, neither does it fully alter gender, he said. (He differentiated between the two by saying sex is physical and biological, while gender has to do with a social role and has a psychological component).

There may be a biological proclivity towards the other sex, as seen in "tomboys and effeminate males," but gender is something that's "entirely learnt."

One of his patients is a 15-year-old girl who was heading down "the perilous path" towards gender reassignment to male.

The girl's mother bought her a kitten, and "suddenly all the tenderness and love and mothering qualities came to the fore." The mother's "stroke of genius" had effectively cured her daughter, he said.

"You can have a tendency towards pursuits or activities which are more male...but nobody actually becomes the opposite sex."

The psychiatrist also said that a girl's hopes that she would be fully accepted as a male were unlikely to be realized.

"At best, she could end up being a tenth rate male, looked at sideways by all other males...what a terrible life she'd choose for herself."

He said not enough honest investigation had been done into these issues, because most research that had been carried out was done by proponents of GRS, or by transsexuals themselves.

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Patrick Goodenough
Patrick Goodenough
Spencer Journalism Fellow