A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.
It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones.
An eight-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.
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.
Pediatricians need to know these kids exist and deserve treatment, said Dr Norman Spack, author of one of three reports published on Monday and director of one of the nation's first gender identity medical clinics, at Children's Hospital Boston.
Gender-reassignment surgery, which may include removing or creating penises, is only done by a handful of US doctors, on patients at least 18 years old, Dr 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.