Transgendered people are those whose psychological self (“gender identity”) differs from the social expectations for the biological sex (genitals, chromosomes, etc.) that they were born with. The persistent discomfort they suffer is called gender dysphoria, causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Current “standards of care” define stages of treatment, beginning with extensive exploration of psychological, family, and social issues, and then moving to physical interventions, which occur in stages from reversible to irreversible. Depending on specific state laws, reconstructive surgery is required before allowing name and gender changes on legal documents and health insurance cards.
A significant ethical question in transgender care involves interventions for children: should transgendered children complete puberty before being offered the same therapy used for adults? National or international protocols still do not exist. One side argues that physical intervention should be delayed until after puberty, as teens may change their minds about their gender identity. The other side, as Dr. Norman Spack proposes in the TED talk, argues for the importance of early endocrinological intervention to prevent severe depression that accompanies the onset of unwanted puberty and to avoid physical, psychological procedures to reverse puberty’s progress.
Norman Spack is a pediatric endocrinologist at Boston’s Children Hospital and the co-founder of the hospital’s Gender Management Service clinic. The clinic remains one of the few worldwide that treats minors with hormone replacement therapy.
For more information on Lesbian, Gay, Bisexual, and Transgender Health.