In her career as a licensed professional counselor in Colorado Springs, Dara Hoffman has worked with transgender adults, teenagers to retirees. The hundreds of stories she's heard are diverse, but consistent about one thing: Gender -- and transgender -- awareness comes at a very young age.
"Today, I met a new client who is (female) transitioning to male. He said, 'ever since I was a little kid, I felt like a little boy.' That's almost word-for-word the same thing I always hear," Hoffman said. "There's just this innate sense of gender, even before they know that boys do this stuff or girls do this stuff."
The story of 6-year-old Coy Mathis has garnered national attention and fueled discussion about the issue of transgender awareness among pre-adolescent children.
Coy was born with male genitals, but as soon as she was able to express herself at around 18 months it became clear to her parents that she thought of herself as a girl. Mathis' parents, Kathryn and Jeremy, through New York-based Transgender Legal Defense & Education Fund, filed a complaint with the Colorado Civil Rights Division after Coy was denied access to the girls' bathroom at Eagleside Elementary School in Fountain-Fort Carson School District 8. A news conference Wednesday in Denver about the discrimination complaint became an educational session about the logistics and science of being a transgender child.
"People are asking, how can a kid really know? But it's not impossible whatsoever (for an adult) to be able to remember back that long ago, and say that's when I really started to feel different," Hoffman said. "We don't start off knowing for sure what our unique expression of gender is."
Matt Kailey, an author and teacher who transitioned from female to male in 1997, knew at age 10 that he wasn't comfortable living the role defined by his birth gender.
"I think that age three is pretty typical, though. People say this is a phase, you need to let (the child) grow out of it, but that's just not accurate," said Kailey, who teaches transgender studies at Metropolitan State University in Denver and authored the book "Just Add Hormones: An Insider's Guide to the Transgender Experience." "There's a big difference between 'My kid wants to play with dolls,' and 'My kid says he's a girl.'"
The stirrings of gender identity and awareness occur early, alongside a child's evolving sense of self, said Kevin Everhart, PhD, a clinical psychologist and early childhood specialist.
"This is something that is with us from the very beginning," said Everhart, associate clinical teaching professor of psychology at the University of Colorado in Denver. "With transgender children, they appear to be born with an unshakable conviction and a knowledge that they are the sex they believe they are."
A 2011 study of population-based surveys by UCLA's William's School of Law estimated that about 0.3 percent of the U.S. population, or 700,000 people, are transgender.
An often-cited study of about 500 children by Toronto-based psychologist Kenneth Zucker, however, found that only a fraction of children who are uncomfortable with their birth gender go on to consider changing their sex, a process that can begin in the pre-teen years with medications that block the onset of puberty.
"(Zucker) found that only 20 percent of the children will ultimately end up in the transgender category and want the full physical switch of gender," said Dr. Norman Spack, an associate in endocrinology and co-founder of the Gender Management Service Clinic at Boston Children's Hospital. "All we know is that is determined at the very onset of puberty, ages 10-12. If at that point a child absolutely affirms the opposite gender, it is the real deal."
Many children experiment with non-gender-conforming behaviors prior to puberty, "but it doesn't mean they're going to become transgender adolescents or adults," said Dr. Johanna Olson, medical director of the Center for Transyouth Health and Development at Children's Hospital Los Angeles. "That's what makes it so difficult in childhood because we don't know which ones like to do things the other gender does and which ones actually are transgender."
But is there harm to a child who is socially transitioned to the opposite gender, and who then goes on to not be transgender? Olson knows of no studies showing such negative connections.
"What families tell us about these children is that when they are allowed their gender identity preference they do a lot better in life," Olson said.
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