The Gender Creative Child: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes

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In 1985, WHEN I ran an adolescent medicine practice, a colleague asked me to provide testosterone treatment for a recent college graduate, my first transgender patient. Although the patient had been born anatomically female and had reached full female puberty, he went through college as a male with the support of his three male non-trans roommates, who kept his secret.

Treatment was simplistic and insufficient then, especially for patients transitioning from male to female. We only treated adolescents over the age of sixteen (post-puberty) who had been referred by highly experienced therapists, of whom there were few who worked closely with gender-nonconforming young people. No psychological tests were performed, no blockers given to suppress the hormones from the ovaries or testes.

The cross-sex hormonal protocols used for those patients transitioning from female to male were identical to those used for genetic males born without testes or with low levels of testosterone. Even patients who had undergone full puberty could cease menstruating with normal male replacement doses of testosterone. The patients emerged much the way they do now: bearded, with a male build, although often short for a male, and in need of mastectomy to flatten the chest. They looked so virilized that, when clothed, only someone with knowledge of their history would guess their anatomic birth sex.

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