PORTLAND, Maine (NEWS CENTER) -- “Gender identity is who one identifies them self as that can be different from their sexual orientation, it could be different from how they express their gender,” explains Dr. Jerry Olshan, Pediatric Endocrinologist at the Barbara Bush Children’s Hospital at Maine Medical Center in Portland.
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Olshan opened The Gender Clinic in 2010 after working with several young patients who appeared to improve greatly from the positive re-enforcement the clinic provided them.
“I had about four patients myself, about 10 years ago and we have over 160 children that we’re following now.”
Olshan says if doctors use gender-affirming approaches, as they have been doing in Europe for years, the outcome for a trans child greatly improves.
“Say, for example, that a child appears to have gender questioning in childhood around 8 or 9 years of age, is affirmed by the family, by the school that their gender identity is different than their natal sex, that no one’s pushing them one way or another but you try to be neutral, you accept that.”
Olshan’s team consists of doctors, child psychiatrists and social workers. They all meet with the whole new group of pediatric patients who call themselves, among other titles, transgender, questioning gender, non-binary, gender fluid, gender queer.
According to the dictionary, gender is not sex. Gender is how someone identifies, someone who doesn’t feel comfortable with the sex they were born and chooses to identify as the other is known as transgender.
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Olshan calls his work “absolutely a new frontier.” His patients, children and young adolescents he says “probably had this imagination, this thought, this hope that when they developed they’re gonna develop as the gender that they see themselves and then all the sudden they develop in the wrong gender, which is often traumatic.”
Patients often refer to this as feeling trapped in the wrong body, in a box they can’t get escape. The trauma often leads to gender dysphoria, a condition of feeling one’s emotional and psychological identity as male or female to be opposite to one’s biological sex.
For example, Olshan uses the case of some of his young male patients.
“They’re acting like a girl, they want to dance, they’re doing princess things their friends are girls. They start having male pubertal changes, they freak out, it’s horrible, they don’t believe it, they won’t talk about anything below their waist.”
Olshan says there are many models in both medicine and in human biology where doctors view this as likely being a biological process. The explanation of ‘how’ and ‘when’ a person becomes trans is complicated. Dr. Olshan and other gender experts believe it begins ‘in utero’, as the baby is growing inside its mother’s womb.
Olshan goes to the white board in a patient room, picks up a red pen and explains through a series of drawings. “This baby is XY so it has the Y chromosome which we typically think would lead to a male infant, and let’s say that there’s some abnormality that happens during pregnancy.”
There are many, Olshan included, who believe the physical markings for trans also appear in the brain. Olshan says there’s “some good evidence in biology that clearly there’s something about the brain that has some male tendencies and female tendencies.”
He explains, ““In fact, if you look at adult brains and, there are studies in the last five years where they show how the connections between front and back and across are different on average in men and women. Men tend to have more connections front back, women tend to have more connections across, which may argue to different types of intuition and all the different stereotypes you might want to associate with being male or being female.”
In essence, he says one can rationalize sex by the anatomy of the brain, and so too male and female preferences.
In the January 2016 issue of Scientific American, they reported trans people have brains that “are different from males and females, a unique kind of brain.” S.A. reported that studies, using an MRI to examine the brains from test groups of male to female and female to male trans patients before and after treatment with cross sex hormones. According to the published article, results showed “that even before treatment the brain structures of the trans people were more similar in some respects to the brains of their experienced gender than those of their natal gender”.
“The most common age is before five years of age for all those patients that they identify that they were quote gender dysphoric or transgender as children.”
By five, often certainly as early as two or three, trans children begin expressing their “other” selves. They wear clothing associated with the opposite sex, and proclaim out loud they are not a ‘he’ but a ‘she’, or not a ‘she’ but a ‘he’.
“I would say, understand, rarely are these choices that people are making anymore than someone chooses to have diabetes or chooses to be hypo-thyroid someone chooses to be gay or transgender. These are not choices that most people would choose to make since rarely do they make life easier,” Dr. Olshan insists.
In fact, the path for a person to make a transition from one sex to another can be a difficult physical journey, beginning for children just as their bodies naturally begin to change: puberty blocking drugs and then at 16, cross sex steroids, estrogen and testosterone to help them develop the gender they identify as.
At 18, a transgender patient can decide whether to have expensive gender re-assignment surgery. The projected cost for it ranges wildly from one $7,000 estimate to another that puts the cost at over $100,000.
Dr. Olshan says there are difficult ethical and medical issues associated with transgender. He says medical professionals like himself are trying to do the right thing.
Olshan says he has heard criticism and questions like, “is this just a fad?” “If God wanted him to be a girl, God would have made him a girl.” “Why are we allowing children to make this decision? Won’t they outgrow it?”
“We know if you do nothing in these children,...their incidence of fatal outcomes from suicide, suicidality, homicide, etcetera is markedly increased over the general population, so to say to do nothing is risk free, is absolutely not true.”
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Olshan says he understands why people would ask questions and why there is controversy and push back.
“I can’t disagree whole heartedly with the concerns by some that anytime there’s an evolution in how we as a society are accepting of something or not accepting I think there’s extremes.”
Olshan says the key is education. He hopes communities will begin to better understand where trans people are coming from through education.
“And more often than not I think it’s ignorance rather than the desire to be nasty, or mean or whatever. I think there’s a lot of ignorance; part of it being the fact that many people think this is a choice that people make. “
Olshan stops talking, looks down and up again saying emphatically, “This isn’t a choice that people can make.”
Before he leaves the small pediatric patient room in which we’ve conducted our interview, Dr. Olshan shares that what he does is difficult, but the most important work he could hope to do.
“I’m saving lives. It is amazing to see some of the times you can go from this incredibly life threatening situation to happiness and joy.”