Two weeks ago I was having a talk with a local provider who treats transgender patients. She was telling me about some of her more challenging cases, including a young patient who had been unable to get a letter approving him for hormones from his therapist, in part due to his age. She asked me what I thought, and my response was “Well, I haven’t had to make any judgment calls like that yet. All of my patients have been older and firmly established in their gender identity. Most of them have already been on hormones at some point in their lives.” As an old housemate of mine likes to say: If you want to hear God laugh, make a plan. Less than a week later, I received a phone call from a barely-over-the-age-of-consent young adult who’s looking for someone to start them on hormones. The patient sounds like they have it together, but also sounds very young. They have already seen an endocrinologist in this state, who declined to start hormones (it sounds like it was due to age, but I’m not sure if there’s more to the story).
I’m not opposed to people starting a gender transition in adolescence, if it’s a thoughtful decision made with professional support. I’m not opposed to people wanting to modify their bodies to fit their gender identity, even if they don’t fit into the gender binary mold. Generally speaking, I’m pretty fucking progressive on this topic. But part of me instinctively thinks “Gosh, adolescence. That’s pretty young to make decisions about permanently altering your body.” I guess the answer is: it is, and it isn’t. I know people who have transitioned later in life, and would have been fully capable (and happier) to make that decision earlier. I know that for someone who has spent years, or even a lifetime, feeling that their body doesn’t match their mind, no time is soon enough to start changing. And I know a few people who transitioned in their early 20’s, and then later decided that they really wanted to live as their original gender and transitioned back (un-transitioned?). I guess what makes me nervous is the patient’s youthful excitement and exuberance. Yes, it is exciting. Yes, I understand that often patients are dying to get the transition process underway as quickly as possible. But even if it’s exactly what the patient wants, it’s still a big deal. Sometimes a really big deal.
Some readers are probably wondering if I have a plan for this patient. The answer is yes. I want to know more about their gender identity, and the history of their identity. I want to talk to their therapist. I want to talk to the patient and find out what they think is going to happen when they start hormones. I want to find out if they’ve come out as trans to their family, friends or school. I’d like to know what kind of support they have. And I don’t plan to give them hormones on the first visit. Maybe the second, or the third, but I’d really like to do a good assessment first. We’ll see how it goes.