QUESTION: I am a 39 year old single mother of a 14 year old child living in India. My son had both his testicles removed due to testicular cancer 4 years ago. Since cancer at his age is extremely rare nobody suspected it until it was very late. By the time surgery was performed the cancer had spread to both his testicles and unfortunately a complete orchiectomy was the only option to save his life.
Due to the surgery my son has shown no signs of male puberty like thickening of his voice or facial hair, infact sue to his slim build and unbroken voice he easily passes as a girl. Recently he is showing a greater inclination in wearing girls clothes and behaving in public like a girl. I have tolerated it and allowed him to dress and behave more femininely like growing his hair long and painting his toenails. Recently I even changed his wardrobe to include more feminine clothing. When he goes out with me he usually wears a dress and I refer to him by his girl's name which he himself has picked.
One thing I have noticed about him is that he frequently gets depressed when I talk about the future with him as a boy. He has confessed many times at wanting to grow up as a girl. He is terrified at returning to his old school where he is frequently at the receiving end of vicious and malicious comments by bullies about his girly nature and appearance. So recently after quite a lot of searching I have found a convent school where they will accept him as a girl student without an official sex change. In India a person needs to be atleast 18 before he has sex change surgery. My question is do you think it is still possible that a therapist may change his mind on becoming a woman or should I just go along with his wishes and raise him as a girl?
Thank you for contacting me and I'm sorry I didn't get back to you sooner as I wanted a little time to think this over. Also as you refer to your son with male pronouns that is what I will do here as well. I think what you are doing and allowing your son to do is extremely brave. Forgive me if I don't know the rules and customs of India's society. I understand the Hindu religion is very prevalent there, and that can be a very good thing as there are elements of the Hindu religion that favor a very diverse point of view. However I also understand it can be a very male dominated society and women are not always given an equal voice in all matters. So a male transitioning to female, can be seen as very week by some. Thus it's a brave but possibly dangerous thing to do. I understand why your son would be bullied. Similar things have happened here in the United States. Again I applaud your sons and your courage to take the steps you have.
I would advise you to sit down with your son and have a very long discussion on what he wants in the future as well as about his past. He needs to understand the ramifications of living as a female and you will need to understand the ramifications of living as a transgender. This conversation will have to be very open between the two of you but also very private. Therefore you should not divulge anything he tells you unless he gives you permission to do so. One of the things transgender people are most afraid of is being "outed" by someone they trust. Even a well meaning parent doing what they feel is the best for the child can unknowingly do something very upsetting. This is why so many transgender people hide. When you speak to him ask him how long he has wanted to live as a girl. If he is truly trans than it would predate the loss of his testicles. Most transgender people I've met have claimed they knew they were different as early as 4 to 7 years of age. However if he claims it was not until after the operation than there may be other issues that a psychologist would have to discover. He may be using the female persona as a defense mechanism. As you said he was bullied and looks more like a girl than a boy. In public a boy looking girlish can be a target for ridicule. However a girl looking boyish can be seen as assertive and sometimes 'clever and cute'.
Considering his unique medical situation as he does not have testicles he is unable to produce the testosterone he needs to enter a male puberty. Without this he will grow up and develop as a eunuch. However I would not be surprised if the doctors want to give him artificial hormones of some type. Now that he is living as a girl and if he wishes to continue to do so he will need to take some form of estrogen. This would be the decision of the therapist if the therapist has the ability to prescribe them. I don't know what the laws are in India, but in the U.S. it is legal for a transgender teen to be given medical hormone replacement but the final sex-change surgery can not take place until they are 18. Giving him estrogen now would allow him to enter a female puberty. Considering his body is male, he would not have the same development of a genetic female but due to his young age and lack of testosterone I doubt anyone would be able to tell he is not a typical girl. The secondary female characteristics would develop as his body fat would settle into a more female pattern giving him a larger butt and softer appearance. Also due to his young age his bones are still growing, this may work to his advantage thus causing his hips to widen a bit giving him a narrow waist. His face would keep a soft and feminine appearance giving him a more female look. A huge concern many transgender people have is breast development. He will develop breast but in most male to female transgenders breast growth is about a cup size less than the average females in the family. Therefore most will seek out breast enhancement at some point in the future. Now I know this sounds scary to you as a mother to put your son through this but the good news is just about all it is reversible. If he decides at some point in the future to live as a male, then he will need to start taking testosterone. This would reverse most of what the estrogen will do to him. If there is any breast development that does not go away, it can be removed via a mastectomy.
Keep in mind there is no known cure for being transgender. Very few people ever claim they have been "cured" those that do are usually subject to some extreme social or religious pressure from their families. The only known treatment at this point is acceptance and to act on the feelings. Thus for those of us who are cross-dressers we have to cross-dress, just as a painter needs to paint or a musician has to play their instrument. A transsexual person has to transition. Hiding and denying this fact leads to years of emotional turmoil.
I know you may be feeling the loss of your son, but if he is truly transgender than you never really had a son, you had a daughter who was born in the wrong body. Yes there is emotional struggles all sides. Likely there are going to be friends and family members who will not accept him as a girl. Thus they will do and say the wrong things. These are struggles we have all had to deal with. As long as he has a support group in place overtime it will only make him stronger and better person.
As I stated I've known hundreds of trans people and they are the kindest and most generous people I know. I'm happy to be considered a member of this unique group. Because of the dual nature of our personalities we tend to be able to see issues from multiple sides. We are great negotiators and mediators. We are extremely intelligent. I don't want to sound like I'm boasting, but the average I.Q. scores for transgender people are in the 110 to 130 range. I've known doctors, lawyers, psychologist, pilots, musicians, police officers, firefighters, college professors, entrepreneurs, etc. who all identified as transgender. One of the key elements in their life was the ability to not only be successful but excel in their chosen profession after they came to terms with their chosen lifestyle. Myself included.
I have to admit I have never been to India and I'm only familiar with what I've seen on television and from those who I've spoken to who have been there. Going back to what I said about the Hindu religion being prevalent reminds me of a situation that happened to a good fried of mine who is also a cross-dresser. He was traveling here in the U.S. with his wife and he was in his feminine attire at the time. They stopped for coffee at a local doughnut shop and it just so happened the owners of the restaurant were from India and were worshipers of a deity who was known for being both male and female. (Ardhanarishvara I think was the name of the deity.) They considered the visitation of my friend to be a blessing on their business and therefore could not charge them for their meal and would not accept any type of compensation. They gave them everything they asked for and more. The reason I mention this is there may be groups in India where you can go to meet others in a similar situation for support and guidance. I would strongly recommend you seek them out if you haven't already. The two of you should not have to face everything alone. Having someone there who has been through it can be a huge help for you and him to face the everyday issues. Plus he may find some good friends and it never hurts to have friends when your 14.
So to answer your final question.
"do you think it is still possible that a therapist may change his mind on becoming a woman or should I just go along with his wishes and raise him as a girl?"
The truth is I don't know? Is that what you want, or is that what he wants? As a parent your job is to raise a child to be a competent and productive member of society to the best of your ability. Our children will echo our behaviors and values. If it's the parents desire to teach hate than the child will learn hate. If it's the parents desire to teach love and forgiveness, than the child will do the same. If the parents show acceptance and understanding and not judge others than the child will reflect that back. Therefore a legacy will be passed on long after the parents are gone. This is what I try to teach to my sons.
I would like to continue this discussion if you wish. Let me know how things go and I will keep this 100% confidential. You can e-mail me directly at email@example.com
I hope this helps
---------- FOLLOW-UP ----------
QUESTION: Thank you for your detailed and quick response. I have already had long chats with my son about his sex change and the role he will have to play as a woman in society. I have also talked with him about sex and the fact that if he does choose to become a woman he will not have biological children of his own. He is fine with that and says that having children is a long way off and he doesn't want to think about it. He still firmly believes that his future is as a woman.
One thing that I am concerned about is the fact that he never showed any inclination of dressing as a girl or behaving as a member of the opposite sex before his castration. Even though we are close I feel very awkward at asking him if he is sexually attracted to girls or boys. Perhaps it is too early. One thing I have tried to do is that I have watched bollywood movies with him and surreptitiously asked him if he liked the hero or whether he would love to have a handsome hunk like someone in the movie romancing him in real life. His answers have always been positive. I think he imagines himself in the place of the girl rather than the boy when he watches a romantic scene in a movie or a song and dance sequence which are commonly found in bollywood movies.
The reason I asked you whether a therapist would change his mind about being a girl is that I wanted to know for sure that he is firm on becoming a girl or if this is just a passing phase. I would infact be happy if he chose to be a girl. I always wanted a daughter whom I could dress and play with and share secrets with. But I think the psychological consequences of choosing one sex and then later going back on that decision is immense. Also in our society the roles of girls and boys are more distinct than in western societies. It's fine for him to wear short skirts and make up and behave like a girl but when he grows older he won't be able to do any of those things and will have to conform to the rigid roles that women have to follow in Indian society. For example most women wear saris and many are housewives who stay at home to take care of their children. It's hard for me to picture my son in such a role. So I think it will be difficult for him to reverse his sex change if he does go through with it.
The deity that you mentioned Ardhanarishvara is indeed found in Hinduism. It is a unification of the Hindu god 'Shiva' and his wife 'Parvati' to denote a unification of the masculine and the feminine forces. It is depicted as half male and half female split down the middle. Most hijras which is the name of the eunuch community found in India worship it as their deity. But I think it is not so well known throughout India.
I have also spoken to a doctor about starting him on hormone therapy. Since my son is not functionally male he has agreed to start it without a clearance from a psychologist which is usually mandatory for someone who has the full functional body of one sex. I would like to know from you about how much work female hormones can do. Is it possible for him to have the complete external appearance of a girl? He already has slightly wider hips than the average boy, so will hormones help give him a more natural appearance?
The only thing that remains I think is my own fears about taking this final step. My son doesn't seem so perturbed at all about the enormity of the decision he is about to take and is eagerly looking forward to the day he can be completely female.
If your son is not concerned and seems happy than allow him to stay that way. As a parent we want to protect our kids and I feel the same way. There comes a time when we have to allow them to explore the world on their own and that can be scary. Even more so when the child adopts a non-traditional role. Often when a transgender person is forced into complying with society the stress is immense and many will attempt suicide. I know you don't want to see that happen. Don't worry about the future, he will find his way and he will find someone. If it's with a man or with a woman or another transgender person, it's going to be his life. Allow him to live it as he feels is right.
As you said the role of women in India is more limited than it is in the west. However India is in a way unique as it's one of the few cultures that accepts transgender people as a subset the population, the hijar. I don't know if your son would consider himself as a hijar and may wish to be seen as fully female. As far as children he will not be able to have children of his own, but he may be able to adopt. Then he can be a wife and mother, taking on the traditional roles. If he doesn't wish to conform to the traditional female roles in India, there is always the possibility he may decide to move to a more westernized country, (i.e. the U.K. or the U.S.) Where opportunities for women are much more available and clothing styles are more diverse.
As far as exactly what the hormones will do to him at this point in time is unknown but I will say they will give him the outward appearance of a woman and he should be able to pass without any issues. If you go to Youtube and search for male to female transformation there are a number of videos by transgender people showing various stages of their transformation. Many are quite convincing and pass easily. So I wouldn't worry about your son not looking female. Here is one of my favorites, and yes it's the same person in every picture.
Here are a few things you will begin to see.
Fat redistribution: His body fat will take on a more female pattern. This means his body fat (if he has any) will begin to deposit more evenly over his frame instead of just around the belly as it does in men. This has the results of giving a softer looking face, thinner waist, fuller hips and butt.
Softer skin, his pores will become smaller, like a girls and the skin will become softer.
Female hair pattern: The hair follicles on his head should become more dense resulting in a fuller head of hair and less chance of male pattern baldness when he's older. Body hair, if any, will be minimal and grow in in a typical female pattern including pubic hair. Most transgenders will have to undergo some kind of beard removal. As he has not begun male puberty this may not happen and he will be very lucky. However keep an eye on the face. If there are any dormant hair follicles present he may begin to grow a thin beard. Shaving would be a short term solution, but electrolysis and laser are the 2 most common permanent fixes for hair removal.
Genital atrophy: A male to female transgender person will experience atrophy of the genitals. A person that has completed puberty will notice their penis and testicles will shrink, and in some cases the testicles will rise back up into the body cavity. However you said your son had a complete orchiectomy. I don't know by complete if only the testicles were removed or if the penis was as well. If he still has his penis, the hormones will attempt to shrink it to the size of a clitoris. However the hormones will not be able to get it this small and he will end up with the penis the size of a young boy prior to puberty. He may be at this stage already so it may not be a concern.
Breast Development: He will begin to develop breast within 2 months. The amount of growth depends on several factors. Most transgenders will develop one cup size smaller than the average women in the family as they do not have the fully developed mammary ducts required to make milk. This results in most transgender people being unsatisfied with their breast growth and will seek breast enhancement when they have reached their full development after about 3 years of hormones.
Muscle atrophy: Women are not as strong as men. They don't need to be as they are not the hunter/gathers. Therefore he will lose some of his upper body strength and his muscles will be smaller.
I would recommend you take some photos of him every week in order to compare the development and changes that are taking place. There will be times when the changes are major and times when they are more subtle. Having a visual record to go back on will help him during the times when he feels discouraged. Also I'm sure the doctors would like to see what has already happened to him.
There is something you said that made me pause. There is a condition known as Klinefelter's syndrome and it's very rare but slightly more common in the trans community. It only effects biological males. One of the external conditions is to be tall and thin plus a slightly wider set of hips. A normal male has a set of XY chromosomes and a female has a set of XX chromosomes. However in Klinefelters the male has an extra X chromosome resulting in XXY. You may want to read more about it at this Wikipedia page.
The only way to test for the condition is a DNA test and there is no treatment as it's purely genetic. If he test positive that might explain many things including why he got testicular cancer at such a young age.
There is a case of a transgender woman named Caroline Cossey who as a young boy was diagnosed with a even more rare form of the condition where he had 3 X chromosomes and a singe Y. (XXXY) Outwardly he/she appeared to be a tall thin boy however she never really started puberty. When she decided to transition and received female hormones the changes to her body was quick and amazing. She became an internationally famous model appearing in many magazines in the 1970's. She was the first transgender woman to appear in a James Bond film and the first transwoman to be in Playboy. However at the time she did not make public she was transgender. She was outed by a gossip magazine and has since taken a more conservative profile but she is still a very outspoken and an advocate for transgender rights. You can read more about her at the links below.
So with that being said... Allow your son to be your daughter. At this point just about everything is reversible. As he grows and learns to understand the life he has chosen he can make better decisions. After the age of 18 he will be able to make the final decision and if the reassignment surgery is what he wants, he should be well enough informed to make that decision. If he decides to live as a male again, the effects of the female hormones can be mostly reversed with testosterone. If there is substantial breast development he may need to have that surgically removed. So for now if he is more comfortable presenting as a girl, than there is nothing wrong with that as long as those closest to him understand what he is going through and treat him with respect and that includes using the correct pronouns.
If you have any more questions let me know and I'll do my best to answer them.