Out of Control?

By Hara Estroff Marano, published October 11, 2019 - last reviewed on November 5, 2019

I work as a nurse at a therapeutic boarding school for boys ages 10–17. We have a boy who identifies as a girl and, soon after admission, we were instructed to refer to him as she. The student was then permitted to dress as a girl. All the students bunk together. She is 12 years old and disruptive, physically and verbally, fighting with staff and the boys. I am asked to administer hormone blockers. I feel to admit a girl to a boys boarding school is inappropriate. And I am not comfortable with administering hormone blockers to someone who is so out of control.

HARA ESTROFF MARANO
HARA ESTROFF MARANO

Your discomfort is well-placed. There are many important issues embedded in this situation. The most basic is whether a sole girl—and a troubled and young one at that—should be in residence at a school for adolescent boys. That would seem to pose basic safety issues for the gender-transitioning student, who already has a contentious relationship with the other students. The gender issue singles the student out and could make her an easy target of harassment. It would be wise for you as a nurse, a guardian of health, to convene a meeting with the child’s parents, the school head, and the child to have a frank discussion of the many basic safety concerns. Some quiet fact-finding before such a meeting could reveal whether any incidents have already occurred or been threatened.

Second, and at least as important, is your recognition of a young person who has many problems in addition to the presumed gender dysphoria. The student is not at the school because of wanting to be a girl but because lots of things appear to have been going wrong—at the very least an inability to discuss feelings. It seems wildly premature to pinpoint gender as the root of the distress, as if the other problems will somehow resolve after gender transition.

Social transitioning is one thing—however difficult it may be in an all-boys environment. Biological transitioning, including puberty delay, is another thing entirely. I am not sure it is the role of a school to carry out the gender transition of a minor through invasive procedures such as hormone injections that prevent normal development. Nor do I know what the legalities are. As I understand the guidelines of the American Academy of Pediatrics, such a course of treatment at the very least requires specific, supportive psychotherapy.  

Nevertheless, you are in a unique position to do what no one else may have even attempted—have an ongoing series of conversations with a troubled child to clarify the acting out by talking through what is going on. The aim is not to challenge the child but to open her up—to know more about her to discover the best ways to help.

You may be the person with the most leverage in this young person’s life. You can undertake a sincere conversation that takes the student’s point of view seriously and engages with her honestly.

The student has  been labeled “trouble”—how does she see herself? How does she feel about that? What does she think has gone wrong, and why? What interests her? What does she envision as her future? What things bother her? What will be better as a female? What will she be able to do or express then?

I asked adolescent psychologist Carl Pickhardt, author most recently of Who Stole My Child?, what advice he would add. “The child is not ‘out of control,’” says the Austin, Texas, clinician, “but struggling to gain some control in a very threatening situation. The counseling role is to help the child do so in ways that work for, and not against, the child. Credit the feeling of life being out of control, and then encourage facing the adversity by claiming agency.” There is no easy way through a truly hard time.

Even in a therapeutic boarding school, where many students may be given psychoactive medications to moderate behavior and manage emotions, Pickhardt  notes, “giving hormone blockers to a young adolescent who is struggling with sexual identity seems like an unwarranted reach.”