Bioethics Blogs

It’s More Than Just Bathrooms – Ethical Considerations for Prepubescent Transgender Children

By Andrew Hawkins

Social media and television have brought newfound visibility to the distinctive issues faced by transgender youth. The TLC show “I Am Jazz” documents the life of Jazz Jennings, a transgender teenage girl living in South Florida, who was diagnosed with gender dysphoria at the age of four—the youngest publically disclosed case of gender identity dysphoria (GID).[i] Her parents have supported her gender transition by addressing her with female pronouns and changing her name, dressing her in female clothing and enrolling her in activities that supported her gender identity. Jazz has received medical services that have enabled the development of alternative physical characteristics that include the use of pubertal endocrine blockers and cross-sex hormones. Her story is a foray into the ethical considerations associated with treatment and gender reassignment of prepubescent transgender children.

Professional opinion in regard to hormonal treatments and gender reassignment surgery has changed drastically since the publication of the Standards of Care (SOC) for transsexual people in 1980 by the World Professional Association for Transgender Health (WPATH).[ii]In particular, gender reassignment surgery for adults has been widely accepted and as of May 30, 2014 is an included service for Medicare recipients.[iii] According to Jack Drescher and Jack Pula, this is largely due to the relative persistence of GID in adults once a diagnosis has been made. [iv] However, children who present with GID are not necessarily fixed in their gender identity. As noted in the latest Standards of Care, only 6 to 23 percent of boys and 12 to 27 percent of girls display persistence of GID into adulthood.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.