Understanding gender identity


In 2019, when Charlize Theron explained to the world that her eldest child, seven-year-old Jackson, is living as a girl, the response was divided. Some people were confused (Jackson had been introduced to the world as a boy when Charlize adopted him in 2012), while others were relieved that the South African-born Hollywood star was speaking so frankly about gender identity.

Yes, I thought she was a boy too, Charlize told the Daily Mail. Until she looked at me when she was three years old and said: I am not a boy! So there you go! I have two beautiful daughters who, just like any parent, I want to protect and I want to see thrive. The actress went on to point out: My job as a parent is to celebrate them and to love them and to make sure that they have everything they need in order to be what they want to be. And I will do everything in my power for my kids to have that right and to be protected within that.

You dont have to be living in California to be aware that we no longer live in a world where gender definitions are rigid, or binary; that is, 100% male or female. We live in a gender-fluid generation, where increasingly identity is expressed on a spectrum from 100% male to 100% female. Some people identify as non-binary (neither exclusively male nor female), others as gender-neutral (neither male nor female) and others as transgender, where they identify usually as 100% with the opposite sex to the one assigned at birth, but could also be anywhere on the spectrum.

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Constitutional right

My daughter attends a girls high school in Cape Towns southern suburbs where a group of students recently proposed that teachers no longer address the learners as girls because some of them no longer identify as female.

A suburb away, at my sons co-ed high school, there are two transgender learners currently transitioning. A few kilometres down the road, a learner who was born male but has been living as a girl since grade one has been offered a place at a girls high school. The decision by the school to accept her was received with mixed reactions from current parents. According to child and adolescent psychiatrist Dr Simon Pickstone-Taylor, there are transgender kids who have socially transitioned at more than 20 schools in the Cape Town area alone. And there are many more learners who identify as non-binary or gender-neutral. These learners, he says, are the lucky ones. They have parents and schools who accept them for who they are and support their journey. And, with the right professional support, these social transitions have invariably gone smoothly. It is not the same elsewhere in South Africa, where children experience bullying and abuse from teachers and learners.

What people dont realise, says Pickstone-Taylor, is that every single one of these transgender kids has spent years agonising over these issues. They dont wake up one day and decide to change sex. Who would do that? For years, they have detested their bodies because they dont align with the gender they feel in their heads, and have spent years feeling isolated and terrified of anyone knowing. Transgender children commonly experience social dysphoria, low self- esteem, emotional and behavioural problems, headaches, stomachaches, anxiety and depression. If not given the right support, 50% of transgender teenagers try to kill themselves before they turn 18, so its a very serious situation, he says.

But while some parents oppose non-binary and transgender learners in schools, others are accepting. There are currently no national or provincial guidelines on how to accommodate transgender or non-binary learners in schools, but constitutionally no-one is allowed to be discriminated against based on gender identity. The Western Cape Education Department is currently developing a policy for schools. Some schools have turned to local experts and international, evidence-based protocols to guide them on how to implement their own policy.

Understanding and empathy

The reality is that many people are bewildered about gender issues. Many parents admit to being confused and fearful. We dont understand the terminology or what it means to identify as transgender or non-binary, which is also referred to as genderqueer.

Pickstone-Taylor, who runs the Gender Identity Development Service at Red Cross War Memorial Childrens Hospital, says parents feelings are understandable. I understand the fear, he says, as parents are confronted with the fact that their child will have to take hormones for the rest of their life and have surgeries in order to feel comfortable with themself.

Most of us are cisgender, which means our gender identity corresponds with our birth sex. Weve never thought about our gender identity. The thought of having the body of one sex and feeling like the other sex is completely outside most peoples experience, says Pickstone-Taylor. Most people identify as 100% male or 100% female, but other people feel that they fall somewhere in the middle. Gender just isnt so simple. It isnt binary an either/or situation. For many people, its somewhere on the spectrum between male and female or 100% the opposite of the sex they were assigned at birth.
Its hard to imagine, but if a cisgender man tries to think how he would feel if he started to grow a full pair of breasts or a cisgender woman started to grow a hairy chest, we can just about begin to understand how a transgender teenager must feel.

Pickstone-Taylor, who gives talks to parents at schools, explains that being transgender is not something children have caught from the Internet or other children. Neither is it caused by parenting, which has been proven by medical research. There are biological reasons why people feel their anatomy doesnt match how they feel in their heads. While the medical reasons are not always visible,
it is likely that it is the relative mix of testosterone and oestrogen exposure in utero in the mothers uterus that causes the brain to be more male or female, says Pickstone-Taylor.

Studies using brain scans of the sizes of different parts of male and female brains have established that there are statistically significant differences in size in certain parts of the brain, he says. When one scans a group of transwomens brains, their brains will follow the typical female brain trend and a group of transmens brains will follow the typical male brain trend. According to the Intersex Society of North America, approximately one in every 1 500 to 2 000 babies is born with noticeably atypical genitalia that require the attention of a doctor specialising in sex differentiation. But, the society states, a lot more people than that are born with subtler forms of sex-anatomy variations, some of which wont show up until later in life. Some never show up.

If people know that someone has parts of the male and female body, then they can more easily relate to the situation, says Pickstone-Taylor. Generally, people feel sorry for an intersex person and say they should be able to have hormones or surgeries to make them more male or female.
But, he says, because transgender people look like their birth-assigned sex, people tend to assume they are psychologically unwell in feeling they are the opposite sex, as they cannot see their brains being those of the opposite sex.

It comes as a surprise to many to discover that more sex-reassignment surgeries are carried out in Iran than any other country in the world except Thailand. The state, which subsidises surgery, accepts that a persons gender identity may not align with their anatomy. After surgery, a person legally becomes the new sex and all identity documents are changed. In 1986, Ayatollah Khomeini stated that sex-change operations and hormone replacement therapy are compatible with Islam.

My child was suicidal

When people saw Charlizes child, Jackson, living as a girl, many felt the child was too young to make a decision about gender. It became a dinner-party debate. What would you do if your child told you he or she did not identify with the gender they were born with? Would you listen? Laugh it off? Think your daughter was a tomboy; your son simply in touch with his female side?

Mom Jean*, whose male-born child is transitioning to a girl, says it was only after years of suicidal unhappiness that she and her husband began to take their childs protestations seriously. People cannot imagine the journey we have been through to get to the stage we are at now. Who would put their child through this if they did not believe it to be a real biological condition? We have had to dig deep, ignore lots of well-intentioned but ultimately hurtful comments from family and friends, and allow our child to be the person she is. You can imagine my stress levels the day she went to school dressed as a girl for the first time, but she was received well and her mental health improved overnight.

Pickstone-Taylor says children as young as two and three really do know their gender identity. Most transgender kids are far more aware of gender identity from a young age because they think about it every day thanks to being misgendered by the world around them on a daily basis.
Of course, lots of young boys like to dress up in princess outfits and young girls wear boys clothes. This does not mean they are transgender, nor will it make them so, insists Pickstone-Taylor. You cannot make someone transgender. So, what sorts of things might a transgender child say? Basically, its as simple as a child telling her parents, I am a boy or a boy saying, Im a girl and I want to cut off my penis. That sort of language can be pretty disturbing to parents if they do not understand. Some kids express these thoughts at a very young age, says Pickstone-Taylor.

While transitioning in the early grades of school may seem radical, Pickstone- Taylor says these protocols are based on best scientific-based evidence guidelines from the World Professional Association for Transgender Health (WPATH). Whats more, when a child is supported and allowed to transition socially there is an immediate improvement in mental health, he says. The problem is removed and kids are allowed to grow and thrive in a healthy way.

At first, a child is allowed to socially transition name and pronoun change, clothes/uniform and, perhaps, toilets and sport. At any time, a child can revert to their birth-assigned sex. In high school, blockers, which are reversible, may be given to halt puberty. Later, opposite-sex hormones can be given. No surgery is usually given before the age of 18. However, top or breast-reduction surgery is recommended in the guidelines for some transboys before 18. Not every child wants all these changes, says Pickstone-Taylor, but when given early enough, the outcomes, emotionally and behaviourally, are much better, he says. It is also a reality that young people who are able to transition at the right time during puberty are able to pass as the opposite sex easily.

There are increasing numbers of gender-diverse people coming out all over the world because, he says, we live in a more accepting society, and because the Internet, movies and television have allowed young people to put a name to how they feel. Their prognosis is much better if they are allowed to socially transition and get the physical changes they need during puberty. What Pickstone-Taylor hopes is that as people become more aware, informed and open to people who identify as gender diverse, it will become much less of a big thing.

* Name has been changed

Image: Rifrazione/iStock


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