Transgender Adults Start Out As Transgender Youth: The Science Behind the B. Jenner Story

Transgender adults start out as transgender youth. “Kids and parents often come to see me in tremendous distress,” says Johanna Olson, MD. “My job as a pediatrician is to help transgender kids move from ‘survive’ to ‘thrive’.”

Until quite recently, it was only possible to undergo a physical gender ‘transition’ as an adult. Medical intervention available for transgender individuals changed in 2006 when Dutch investigators published a paper that described a protocol for using hormone blockers to treat gender identity dysphoria in adolescents.

“We know that going through the ‘wrong’ puberty can be extremely damaging for many of these kids,” says Olson. “The risk of suicide is incredibly high. With hormone blockers – drugs that have safely been used in other contexts for a very long time – we can hit the ‘pause’ button on puberty.”

The Transition 

For younger children, hormone blockers, called GnRH agonists, are used to suspend the process of puberty – preventing the development of undesired secondary sex characteristics. This period of time provides the child or adolescent with an opportunity to acquire a better understanding of the benefits and risks of hormone therapy before committing to irreversible interventions. It also provides the parents time to navigate what can sometimes be a challenging journey for their family.

Older adolescents and teenagers are masculinized or feminized with cross-sex hormones that allow them to go through the ‘right’ puberty – consistent with their gender of identification.

The medical literature contains a lot of data on what happens when you treat adults with hormones, but now gender dysphoria is being treated at a younger age. Olson and her colleagues anticipate that early treatment will be more effective because people have more hormone receptors when they are younger. They expect that psychosocial measures including depression, suicidality, substance abuse and other high-risk behaviors will be diminished.

“Right now, we lack adequate safety and outcome data,” Olson says. “As a healthcare provider, I’m not comfortable with that.”

Olson and her team are working to collect that data. She points to a large file cabinet in the corner of her office. “That’s probably the only multiethnic transyouth data that exists in the world.” Olson has been following 101 individuals on cross-sex hormones for four years and has recently enrolled 15 kids in a hormone blocker study. She has also applied for an NIH grant to conduct a multicenter study with colleagues at Boston Children’s Hospital, the University of California, San Francisco, and Lurie Children’s Hospital of Chicago.

Turning to the Brain

In her continuing quest to understand gender nonconformity from childhood to early adulthood, Olson is already considering her next study – patterned after brain research now being published by gender centers in Europe. Recent studies have implied that there are structural differences in the brains of men and women. These regions, called sexually dimorphic, may develop after the organs of the reproductive tract.

The brain studies show that sexually dimorphic regions of the brain mirror the gender of identity, not the gender assigned at birth. For example, a person with XX chromosomes, assigned female at birth, who identifies himself as a transgender man, appears to have a brain that is structurally male.

While this preliminary data may indicate that gender identity is determined by in utero brain development, there is much more work that needs to be done.

“Science changes hearts and minds,” says Olson. “It helps people wrap their heads around the trans experience.”