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LGBT Fri Feb 27 2015

Transgender Teens Face New Struggles, Options

By Laura Bartusiak, James Wendt & Maddie Mathie

Naperville North junior Adam Beaty sat in the back of a classroom with a group of friends giving him a pep talk. A teacher who knew Beaty before he transitioned to male stood at the front of the room.

"I was terrified. My heart was racing and I was like, 'This is going to go horribly,'" Beaty said. "I went up and I was like, 'So, about the name and everything.'"

But before he could finish his sentence, the teacher asked Beaty his preferred name, to which he responded, "Adam." Today, Beaty identifies as male, but he was born female.

When he was a sophomore, Beaty asked his parents to rename him in accordance with his male gender identity. Since coming out as transgender, Beaty has taken steps to correct his perceived biological disconnect, including legally changing his name.

The Gay and Lesbian Alliance Against Defamation (GLAAD) defines transgender as an umbrella term for those whose gender identity differs from his or her assigned birth sex. For many transgender people like Beaty, the teen years are especially transformative.

Advocates for Youth, an adolescent sexual health advocacy group, reported that it's difficult to identify exactly what percentage of the transgender population are teens because existing data is rarely broken down by age. However, the Williams Institute at UCLA School of Law estimated that there were 700,000 transgender individuals in the U.S. in 2011.

Dr. Diane Chen, a pediatric psychologist at Lurie Children's Hospital's Gender and Sex Development Program, said that puberty can be an especially distressing time for many transgender people.

"We often see either worsening gender dysphoria or patients initially presenting for care around the onset of puberty, which is when male and female bodies really differentiate," Chen said.

Chen explained that a symptom of gender dysphoria is being distressed by the development of pubertal changes consistent with one's assigned birth sex — examples include developing facial hair or breasts. Another manifestation is strongly desiring the pubertal changes of the opposite gender, she said. Some teens experiencing gender dysphoria choose to have medical interventions, but not everybody does.

"It's important to recognize that not every transgender youth or adult is interested in medications or surgeries," said Dr. Lisa Simons, a pediatrician at Lurie Children's Gender and Sex Development Program. "Everything really needs to be led by the individual."

It's a common misconception that all transgender people have some sort of surgery, but Time magazine's 2014 article "The Transgender Tipping Point" reported that only about one-third of transgender people seek surgery. Beaty said he's encountered curious peers throughout his journey.

"I've had people who, even if I don't know them, come up to me and (say), 'So, what do you have?'" Beaty said.

According to Simons, cross-sex hormones are a possible treatment for older adolescents who have shown consistent, persistent and insistent gender identity. The National Transgender Discrimination Survey found that 62 percent of transgender participants reported having hormone therapy.

Cross-sex hormones induce pubertal changes of the patient's opposite biological sex. Transgender women might see breast development and differences in skin and body shape. Transgender men might experience voice deepening or facial and body hair growth.

Patients on cross-sex hormones generally start seeing changes in their bodies after three to six months, but some changes take years to develop, Simons explained. Many effects of cross-sex hormones are permanent, like a deepened voice or developed breasts.

Despite concern that teens aren't mature enough to make decisions about gender, Simons said that older adolescents are capable of making informed health decisions with a team of experts around them. Decisions about gender, however, are another matter.

"It's important to note that adolescents don't make decisions about gender. They are who they are," Simons said. "Adolescents can be and are harmed by not getting the treatment they need."

Making decisions about medical intervention isn't the same as getting a tattoo that a teen might regret later in life. Chen said that Lurie follows recommendations that a patient must receive a mental health evaluation before transitioning.

Chen evaluates patients to confirm that they meet the diagnostic criteria for gender dysphoria and that they identify as transgender. Chen also gauges patient safety and mental health. The evaluation also ensures the patient and his or her family understand the positive and negative effects of any medical intervention and have reasonable expectations for the process.

"When you're working with adolescents, you're always working with the family," Chen said. "Having the parents on board who are there to support the child through that transition is really important to having a successful transition."

While cross-sex hormones and surgery have more permanent effects, puberty-blocking medication is a treatment option for youth who are still exploring their gender identity or who are too young to make permanent health decisions. According to Simons, puberty blockers pause adolescent development by suppressing pubertal hormones. They have the benefit of being reversible while blocking irreversible pubertal developments.

Simons said that she's honored to work with transgender youth because they experience so much in order to be their authentic selves. Fortunately, that journey may be getting easier for members of the lesbian, gay, bisexual and transgender community.

According to the Pew Research Center, 92 percent of surveyed LGBT adults said society is more accepting of them now than it was 10 years ago. Laws reflect these changes too — 18 states and the District of Columbia prohibit employment discrimination based on gender identity.

"We're in this time where the writing is on the wall. The reality is that trans people are here and we have protection," said Owen Daniel-McCarter, policy and advocacy director of the Illinois Safe Schools Alliance, a group that promotes LGBT youth safety in Illinois schools. "In the simplest terms, we're demanding our rights."

Still, many transgender students experience discrimination at school. The 2011 National Transgender Discrimination Survey asked transgender participants about their personal experiences. Those who expressed a transgender identity in grades K-12 reported several different forms of harassment. Thirty-five percent said they were physically assaulted, 12 percent reported sexual violence and one-sixth said they had to leave a school due to severe harassment.

Some schools factor in these safety concerns — in addition to privacy concerns — as cause for prohibiting transgender students from using their affirmed gender's locker rooms and bathrooms.

The locker room and bathroom debate is a major concern in the transgender community. Daniel-McCarter encouraged school systems, like Chicago Public Schools, to address the causes of violence and discomfort instead of denying transgender students access to locker rooms and bathrooms.

Jennifer Leininger, the program coordinator at Lurie Children's Gender and Sex Development Program, said that schools shouldn't make policies based on some students' biases.

"Let's say someone was racist and didn't feel comfortable sharing a bathroom with someone of another race. You can't make policy based on that discomfort," Leininger said.

John Knight, director of the LGBT and AIDS Project of the American Civil Liberties Union of Illinois (ACLU), said the ACLU interprets Illinois' anti-discrimination law as requiring schools to make certain accommodations for transgender students.

Those accommodations include allowing transgender students to use whatever private or public facilities (locker rooms, bathrooms, etc.) they feel comfortable using, calling them by their preferred names and pronouns, adjusting records accordingly and holding them to the dress code of their affirmed gender.

Given the considerable challenges transgender students face, having a supportive community is crucial.

Daniel-McCarter said the three key things people can do to support the transgender community are: Get educated about the culture, be sensitive to the trauma that transgender students may face and create safe spaces.

"It's all about learning how to be allies to each other," he said.

This article, was written by Laura Bartusiak of Woodlands Academy, James Wendt of Naperville North High School and Maddie Mathie of Barrington High School, and was originally published at on Feb 26, 2015. It is featured here as part of our new content exchange program with TheMash, the Chicago Tribune's teen edition.

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