Sex-Change Operations: Mistakes in God's Factory

Even as children, transsexuals have the feeling of living in the wrong body. When should they be allowed to switch genders? Two years ago, a twelve-year-old German boy became the world's youngest person to start hormone treatments for a sex change.

Tanja Pfeil, a 49-year-old transsexual from northern Germany. "Michael dissolved and became Tanja," she says. "She is stronger than he was."
Stephan Elleringmann

Tanja Pfeil, a 49-year-old transsexual from northern Germany. "Michael dissolved and became Tanja," she says. "She is stronger than he was."

Kim P. is 14 years old. She wears light eyeshadow, a navel-baring top and embroidered jeans. She plays with strands of her long hair as she describes her dream of going to Paris one day to be a fashion designer. Her attic bedroom in her parents' house is a girl's paradise in pink, with the requisite fashion magazines, a makeup table, a sewing machine and even a clothes mannequin near the window.

She's had enough of psychiatrists who ask weird questions. She's had enough of doctors who reject her case because this fashion-conscious girl -- previously called "Tim" in her patient file -- unsettles them.

She was born as a boy. Her body, chromosomes and hormones were all undoubtedly masculine. But she felt otherwise. For Kim it was clear from the beginning that, as she says, "I wound up in the wrong body."

At the age of two, Tim tried on his older sister's clothes, played with Barbies and said, "I'm a girl." Her parents thought it was a phase, but at the age of four Tim was still bawling after every haircut. At last he ran into his room with a pair of scissors and hollered that he wanted to "cut off my thing!" -- and it was clear to his parents that the problem was serious. From then on, at home, Tim went by "Kim."

His parents found stories on the Internet about men and women who felt so unhappy in their own bodies as children that they came out as transsexuals and underwent sex-change operations as adults. They weren't all freaks -- there were engineers and lawyers, artists, programmers and teachers -- and it wasn't easy. A switched gender had to be maintained with a lifelong regime of hormones. Germany alone has 6,000 transsexuals under permanent medical treatment.

The P. family wanted a less complicated future for their Tim, but they've also found reasons for optimism. They've learned that transsexuality has nothing to do with homosexuality. It's not about feather boas and red-light districts so much as identity. Transsexuals aren't "queer birds" -- they want the perfectly normal life of the opposite sex. And some will submit to radical methods, from hormones to surgery, to conform their bodies to the "right" gender.

Well-adjusted in the wrong body

Maybe Kim's family could have tried to change her mind about feeling like a girl if they'd sent her to a psychiatrist early on. But would that have helped? By age eight there was nothing boyish about her hair; she wore it parted in the middle. She played typical girl games with other girls, went to their birthday parties and even dressed up for the ballet. In school she always wore trousers and never braids. Her teachers praised her exemplary social skills, and when she was teased in the schoolyard and called names like "tranny" or "queer," she simply walked away.

"We always saw Kim as a girl, but not as a problem," says the father. "In fact, our life was surprisingly normal."

Normal until Kim was twelve, and experienced the first signs of puberty. She was overcome by panic when her voice began to drop. She had no interest in becoming one of those brawny creatures with gigantic hands and deep voices who dressed like women but looked unfeminine. Only hormones could prevent Kim from turning into Tim again, and time was of the essence.

The family was at a loss when it came to seeking medical advice. "If your child has a heart defect you send him to a specialist," says Kim's mother, "but when your child is transsexual everyone seems to have an opinion."

"Hormone treatment! Gender adjustment! How could you possibly do this to the child?" the family's pediatrician barked at the father -- in Kim's presence. Then came the sessions at the state psychiatric hospital, where Kim would sit in green rooms with high ceilings, playing with experimental blocks, while her parents answered endless questionaires.

Sitting in the waiting room, Kim thought to herself: Does this mean I belong in an insane asylum?

The family's whole life up that point was suddenly in question. "Are boys unwelcome in your family?" they asked the mother. "Have you ever considered, instead of manipulating the child, sending him to be cared for by others for a while? Putting him in a closed children's psychiatric institution, for example?"

"What's wrong with being a real guy?" a doctor in a white coat would ask Kim. "Have you ever tried it? What do you think about your mother? Were you ever in love? With a boy or a girl? Do you like your penis?"

Kim answered their questions to best of her ability, but the whole thing felt humiliating. "All of a sudden I had the feeling that it was my fault, that there was something dirty going on."

Second-guessing nature

Kim's is a classic case, according to Bernd Meyenburg. "Transsexual development is extremely rare, and very few youth psychiatrists have any experience with it. The families wander from one psychiatrist to the next" -- until they wind up in his office, or in the office one of his colleagues at the university hospitals in Hamburg and the southern city of Ulm. Germany has only a few experts on child transsexual development, and Meyenburg heads the Psychiatric Special Outpatient Clinic for Children and Adolescents with Identity Disorders at the University of Frankfurt Hospital.

Gender identity disorders are not rare among children, and they often appear as soon as a child starts to speak. The problem goes away in about a quarter of these children. Most of the remaining three-quarters become homosexual. In about two to 10 percent of the cases, though, early gender identity disorders lead to transsexualism.

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