Part 2
Legal battles
When fifth grade started, Wyatt was gone. Nicole showed up for school, sometimes wearing a dress and sporting shoulder-length hair. She began using the girls? bathroom. Nikki?s friends didn?t have a problem with the transformation; there were playdates and sleepovers.
?They said, ?It was about time!? ?? Nicole says. She was elected vice president of her class and excelled academically.
But one day a boy called her a ?faggot,?? objected to her using the girls? bathroom, and reported the matter to his grandfather, who is his legal guardian. The grandfather complained to the Orono School Committee, with the Christian Civic League of Maine backing him. The superintendent of schools then decided Nicole should use a staff bathroom.
?It was like a switch had been turned on, saying it is now OK to question Nicole?s choice to be transgender and it was OK to pursue behavior that was not OK before,?? Wayne says. ?Every day she was reminded that she was different, and the other kids picked up on it.??
According to a 2009 study by the Gay, Lesbian and Straight Education Network, 90 percent of transgender youth report being verbally harassed and more than half physically harassed. Two-thirds of them said they felt unsafe in school.
To protect her from bullying at school, Nicole was assigned an adult to watch her at all times between classes, following her to the cafeteria, to the bathroom. She found it intrusive and stressful. It made her feel like even more of an outsider.
?Separate but equal does not work,?? she says.
It was a burden that Jonas shouldered as well. The same boy who in fifth grade objected to her using the girls bathroom made the mistake of saying to Jonas in sixth grade that ?freaking gay people?? shouldn?t be allowed in the school. Jonas jumped on him and a scuffle ensued.
?He?s taken on a lot,?? Wayne says. ?Middle school boys and sexuality, you know . . . boys can get picked on.??
Nicole and her parents filed a complaint with the Maine Humans Right Commission over her right to use the girls bathroom. The commission found that she had been discriminated against and, along with the Maines family, filed a lawsuit against the Orono School District. The suit is pending in Penobscot County Superior Court, and the Maines family is represented by lawyers from the Gay & Lesbian Advocates & Defenders (GLAD) in Boston and by Jodi Nofsinger, who serves on the Maine ACLU board.
?What Nicole and Jonas both went through in school was unconscionable,?? says Jennifer Levi, one of the GLAD lawyers on the case. ?Their one huge stroke of luck was having Kelly and Wayne as parents.??
A huge relief
Since that first visit to Spack when Nicole was 9, her parents discussed putting her into the GeMS Clinic when the right time came. They were glad there was time to adjust to the idea. ?Baby steps,?? Kelly calls their path toward treatment.
?I wasn?t always on board,?? Wayne says. ?Kelly and I were not on the same page. My question was, what is this doctor doing? It scared me. I was grieving. I was losing my son.??
But the more he watched his child struggle, the better he felt about going to Spack. And once he got there, he says, it was a huge relief. ?Not only does he know what he?s doing, he?s extremely comforting. He?s got to deal with a ton of dads who are just freaking out, and he made me feel good.??
Spack?s experience runs deep; before the clinic was established, he had long worked with transgender youth, as well as with adults. ?The most striking thing about these kids was the fact that they were just normal young people who had this incredibly unusual and problematic situation,?? says Spack, 68.
He believes it is crucial to intervene with such children before adolescent changes begin in earnest.
?Most of us look pretty similar until we hit puberty,?? he says. ?I bet I could go to any fourth or fifth-grade class, cut the hair of the boys, put earrings on various kids, change their clothing, and we could send all those kids off to the opposite-gender bathrooms and nobody would say boo.??
He adds: ?We can do wonders if we can get them early.??
Second-guessing
Not everyone agrees that they should, of course, and Spack has heard the arguments: Man should not interfere with what God has wrought. Early adolescents are too young for such huge decisions, much less life-altering treatment.
Though GeMS treatment is now considered the standard of care by mainstream medical groups, some have their doubts. Dr. Kenneth Zucker, a psychologist and head of the gender-identity service at the Center for Addiction and Mental Health in Toronto, says he worries about putting youngsters on puberty blockers, drugs that suppress the release of testosterone in boys and estrogen in girls.
?One controversy is, how low does one go in starting blockers??? Zucker says. ?Should you start at 11? At 10? What if someone starts their period at 9??? Nicole started on the blockers at age 11.
He also questions the role the parents have played; have they simply followed the child?s lead? ?Say a 5-year-old says repeatedly that he wants to be a girl,?? Zucker says. ?The parents deduce this must mean the child is transgender, so they socially transition him to living in the other gender.??
Spack and others, however, say the issue is a medical one and that early intervention makes sense. ?We?re talking about a population that has the highest rate of suicide attempts in the world, and it?s strongly linked to nontreatment, especially if they are rejected within their family for being who they think they are,?? says Spack, who adds that nearly a quarter of his patients admitted to ?serious self-harm?? before coming to him.
As for the criticisms about ?playing God,?? Spack quotes from the Old Testament: ?Leviticus says, ?If thy neighbor is bleeding by the side of the road, you shall not stand idly by the blood of thy neighbor.? It?s a mandate. I think these kids have been bleeding.??
The next step
The clinic, which includes geneticists, social workers, psychiatrists, psychologists, and nurses, has so far treated 95 patients for disorders that range from babies born with ambiguous genitalia to cases where normal sexual development does not occur.
About a third of the patients have undergone puberty suppression.
Each patient must have been in therapy with someone familiar with transgender issues and who writes a letter recommending the treatment. The child?s family also must undergo extensive psychological testing before and during treatment. And the patient must be in the early stage of puberty, before bodily changes are noticeable.
Nicole and Jonas are the first set of identical twins the program has seen, and they have provided critical comparative data, Spack says.
The effects of the blockers ? an injection given monthly to prevent the gonads from releasing the unwanted hormones ? are reversible; patients can stop taking them and go through puberty as their biological sex. This is critical, Spack says, because a ?very significant number of children who exhibit cross-gender behavior?? before puberty ?do not end up being transgender.??
Since the 1970s, the blockers have been used for the rare condition of precocious puberty, when children as young as 3 can hit puberty. They are kept on the blockers until they are of appropriate age. ?The drugs have a great track record; we already know that these kids do fine,?? says Spack. ?There are no ill consequences.??
It is the next big step ? taking sex hormones of the opposite gender ? that creates permanent changes, such as breasts and broadened hips, that cannot be hormonally reversed.
?In puberty,??? Spack says, ?when your body starts making a statement, you either have to accept it or reject it.??
There is no definitive answer to the question of what causes gender identity disorder, though studies suggest a genetic contribution. ?It?s still a very open question,?? Zucker says. And how could it affect just one of two identical twins? ?There can be genetic changes during fetal development that maybe hit one twin but not the other.??
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