It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.

An 8-year-old second-grader in Los Angeles is a typical patient. Born a girl, the child announced at 18 months, "I a boy" and has stuck with that belief. The family was shocked but now refers to the child as a boy and is watching for the first signs of puberty to begin treatment, his mother told The Associated Press.

Pediatricians need to know these kids exist and deserve treatment, said Dr. Norman Spack, author of one of three reports published Monday and director of one of the nation's first gender identity medical clinics, at Children's Hospital Boston.

"If you open the doors, these are the kids who come. They're out there. They're in your practices," Spack said in an interview.

Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different. They feel certain they were born with the wrong bodies.

Some are labeled with "gender identity disorder," a psychiatric diagnosis. But Spack is among doctors who think that's a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.

Spack said by some estimates, 1 in 10,000 children have the condition.

Offering sex-changing treatment to kids younger than 18 raises ethical concerns, and their parents' motives need to be closely examined, said Dr. Margaret Moon, a member of the American Academy of Pediatrics' bioethics committee. She was not involved in any of the reports.

Some kids may get a psychiatric diagnosis when they are just hugely uncomfortable with narrowly defined gender roles; or some may be gay and are coerced into treatment by parents more comfortable with a sex change than having a homosexual child, said Moon, who teaches at the Johns Hopkins Berman Institute of Bioethics.

It's harmful "to have an irreversible treatment too early," Moon said.

Doctors who provide the treatment say withholding it would be more harmful.

These children sometimes resort to self-mutilation to try to change their anatomy; the other two journal reports note that some face verbal and physical abuse and are prone to stress, depression and suicide attempts. Spack said those problems typically disappear in kids who've had treatment and are allowed to live as the opposite sex.

Guidelines from the Endocrine Society endorse transgender hormone treatment but say it should not be given before puberty begins. At that point, the guidelines recommend puberty-blocking drugs until age 16, then lifelong sex-changing hormones with monitoring for potential health risks. Mental health professionals should be involved in the process, the guidelines say. The group's members are doctors who treat hormonal conditions.

Those guidelines, along with YouTube videos by sex-changing teens and other media attention, have helped raise awareness about treatment and led more families to seek help, Spack said.

His report details a fourfold increase in patients at the Boston hospital. His Gender Management Service clinic, which opened at the hospital in 2007, averages about 19 patients each year, compared with about four per year treated for gender issues at the hospital in the late 1990s.

The report details 97 girls and boys treated between 1998 and 2010; the youngest was 4 years old. Kids that young and their families get psychological counseling and are monitored until the first signs of puberty emerge, usually around age 11 or 12. Then children are given puberty-blocking drugs, in monthly $1,000 injections or implants imbedded in the arm.

In another Pediatrics report, a Texas doctor says he's also provided sex-changing treatment to an increasing number of children; so has a clinic at Children's Hospital Los Angeles where the 8-year-old is a patient.

The drugs used by the clinics are approved for delaying puberty in kids who start maturing too soon. The drugs' effects are reversible, and Spack said they've caused no complications in his patients. The idea is to give these children time to mature emotionally and make sure they want to proceed with a permanent sex change. Only 1 of the 97 opted out of permanent treatment, Spack said.

Kids will more easily pass as the opposite gender, and require less drastic treatment later, if drug treatment starts early, Spack said. For example, boys switching to girls will develop breasts and girls transitioning to boys will be flat-chested if puberty is blocked and sex-hormones started soon enough, Spack said.

Sex hormones, especially in high doses when used long-term, can have serious side effects, including blood clots and cancer. Spack said he uses low, safer doses but that patients should be monitored.

Gender-reassignment surgery, which may include removing or creating penises, is only done by a handful of U.S. doctors, on patients at least 18 years old, Spack said. His clinic has worked with local surgeons who've done breast removal surgery on girls at age 16, but that surgery can be relatively minor, or avoided, if puberty is halted in time, he said.

The mother of the Los Angeles 8-year-old says he's eager to begin treatment.

When the child was told he could get shots to block breast development, "he was so excited," the mother said.

He also knows he'll eventually be taking testosterone shots for life but surgery right now is uncertain.

The child attends a public school where classmates don't know he is biologically a girl. For that reason, his mother requested anonymity.

She said she explained about having a girl's anatomy but he rejected that, refused to wear dresses, and has insisted on using a boy's name since preschool.

The mother first thought it was a phase, then that her child might be a lesbian, and sought a therapist's help to confirm her suspicion. That's when she first heard the term "gender identity disorder" and learned it's often not something kids outgrow.

Accepting his identity has been difficult for both parents, the woman said. Private schools refused to enroll him as a boy, and the family's pediatrician refused to go along with their request to treat him like a boy. They found a physician who would, Dr. Jo Olson, medical director of a transgender clinic at Children's Hospital Los Angeles.

Olson said the journal reports should help persuade more doctors to offer these kids sex-changing treatment or refer them to specialists who will.

"It would be so nice to move this out of the world of mental health, and into the medical world," Olson said.

Source: ABC News

A transsexual woman and an openly gay man took seats in Poland's newly elected parliament Tuesday, historic firsts that reflect profound social change in this traditionally Roman Catholic country.

Anna Grodzka, who was born a man but underwent a sex change operation, entered the assembly hall wearing a burgundy skirt and jacket. Several men and women shook her hand, while one male lawmaker kissed her on the cheek.

Grodzka then took a seat next to Robert Biedron, a leading gay rights activist who is the first openly gay person to be elected to parliament. Both belong to Palikot's Movement, a new progressive party that became the third-largest party in parliament in Oct. 9 elections.

Grodzka said she felt overwhelmed by emotion, particularly when the session opened with the playing of the national anthem and when she later took her oath of office.

"It is a symbolic moment, but we owe this symbolism not to me but to the people of Poland because they made their choice in the elections," Grodzka told The Associated Press.

"They wanted a modern Poland, a Poland open to variety, a Poland where all people would feel good regardless of their differences. I cannot fail them in their expectations."

Palikot's Movement, led by outspoken entrepreneur-turned-politician Janusz Palikot, has vowed to push for liberal causes. It opposes the power of the church in society, promotes gay rights, and wants to challenge the country's near-total ban on abortion.

The first session of the new parliament was opened by a former speaker, Jozef Zych, who invoked words spoken by the late Polish pope, John Paul II, and acknowledged the presence of archbishops and other church leaders who observed the ceremonial opening from a balcony.

Zych also remembered the late President Lech Kaczynski and lawmakers who died with him in a plane crash last year — words spoken as Jaroslaw Kaczynski, the late leader's twin brother, sat with other conservative lawmakers.

Kaczynski heads the country's largest opposition party, the nationalist Law and Justice party, which is riven by deep divisions and internal turmoil after expelling three key leaders on Friday who had called for a more democratic leadership style from Kaczynski.

The 460 lawmakers to the lower house, or Sejm, gathered for the first time since the elections last month gave the center-right prime minister, Donald Tusk, a mandate for a second term. The 100-seat Senate will meet for the first time later in the day.

The elections marked the first time since Poland threw off communism 22 years ago that a government won a second consecutive term, another historic first that reflects growing stability following political turmoil and revolving-door governments in the early years of democracy.

Lech Walesa, the hero of Poland's anti-communist revolution and a former president, also watched the ceremony from a balcony in the assembly hall.

Tusk has remained popular thanks to an image he has cultivated of moderation and because the economy has grown impressively since Poland joined the European Union in 2004. It was the only EU country to avoid recession during the global crisis of 2008-09.

President Bronislaw Komorowski addressed the newly elected lawmakers, urging them to work together to maintain Poland's strong economic performance as Europe faces a new financial crisis.

He called on them to show the courage to make changes that would bolster the nation's development, including trimming bureaucracy, reforming the judiciary and the health system and tackling state debt.

"We know that the state exists for the citizens, and not the other way around," Komorowski said.

Lawmakers then rose, one by one, to take their vows.

Tusk formally resigned with his outgoing government, and later in the day will be ceremoniously tasked by the president with forming a new Cabinet. The new government will then face a confidence vote in parliament in coming weeks. No date has been set yet for that vote.

Tusk plans to keep governing with his junior partner of the past four years, the conservative agrarian Polish People's Party. He also plans to keep many of his key ministers in their jobs, including Foreign Minister Radek Sikorski and Finance Minister Jacek Rostowski.

Source: AP

Source: BBC News

The child has been diagnosed with gender dysphoria, a condition where a person feels they are trapped in the wrong body.

The mother said her child was called a freak before the decision was taken but said school staff had been helpful.

The child said she was scared about returning but also excited.

Her mother said her child is not too young to have taken the decision over the summer to return to school dressed as a girl.

"She has been our daughter from the age of two-and-a-half really," she said.

She said she had played with girl's toys since she was young.

"It was utterly natural.

"She just grew up the years and we just knew that this was the way she was.

"She has been our daughter from the age of two-and-a-half really.

"She chose the stereotypical girl's toys so if you put a truck in front of her she would not want to play with that she would want to play with a Barbie."

The child said: "Mum was buying me boys clothes but whenever I went over to my friend's house, I always used to dress up in her clothes and get her make up on.

"It was nice."

The child's mother said she hoped people would stop calling her child a freak but felt people did not understand.

"She was called a freak long before she went back to school as a girl," she added.

"They will never understand, I don't expect them too... I just don't want them to call my daughter a freak

"This is a child and you live with it and you accept your child no matter what."

Worcestershire County Council said: "Our school operates an inclusive policy and works hard to ensure all our pupils have the support they need.

"As part of this, we feel it is important to encourage discussion and promote understanding.

"As a school, we strive to make sure that all our children get the most possible out of their time here and a key part of this is helping pupils understand that all their peers are unique.

"We have very low incidents of bullying and this is in part thanks to our policy of equality and diversity."