Friday, October 12, 2012

Goodbye Katie, hello Ben

Should we have known? With hindsight there were plenty of clues. Katie had always been something of a tomboy – never a "girly" girl and most definitely not a Barbie girl – and we had begun to suspect that there was a possibility that, as adolescence progressed, she might turn out to be attracted to women rather than men. After all, my side of the family had previous form in this respect, so it crossed our minds and we did joke about it.

About two or three weeks before the bombshell dropped, an overheated dinner-table discussion (nothing unusual about that) erupted between Katie and Cass, my wife, about transgendered people and sexuality. It started with Katie talking about the film "Boys Don't Cry", which she had seen recently. Katie seemed unusually animated by the issues and engaged in a discussion about the difference between gender identity and sexual orientation.

She exclaimed that she was astounded that her mother didn't know the difference; she did, but 15-year-olds in the heat of an argument are difficult to convince at the best of times. As the argument came to a head, Cass glared across the table and demanded of Katie whether there was something she needed to tell us. There was a slight pause, then a defiant "no" and we finished the meal in glum silence.

It must have been a few days later that Katie confided in Josh, her 14-year-old brother, that she no longer wished to be a girl and intended to start the transition towards becoming a boy. Two weeks later she plucked up the courage to tell her mother.

Gender dysphoria (also known as transgenderism, gender identity disorder or gender incongruence) is the medical term for the feeling that one's biology and gender identity are mismatched. Although still classified as a mental-health problem, increasingly the professional's view is that the root causes are likely to be organic, prompted by genetic predisposition or overexposure to particular hormones in the womb or both. For the person with the condition, it feels as if they are trapped in a body of the wrong sex.

One can only imagine the anxiety and discomfort this can produce, and the fear that the person is, somehow, not quite right. The NHS estimates that about one in 4,000 people seeks help with gender dysphoria but suggests there may be many more who do not.

On average, men are diagnosed with gender dysphoria five times more than women. Treatment may involve help to come to terms with the condition by means of dress and lifestyle, or result in hormone therapy and surgical intervention. It is often the case that pre-pubescent children who feel such dysphoria find it resolves itself before puberty. For those who enter adulthood with these feelings, the most common outcome is hormone treatment and surgery to alter their biological sex.