Girl of 13 can have sex change, Australian court decides

An Australian court has given the go-ahead for a 13-year-old girl to undergo sex-change treatment, in a landmark judgment that has ignited fierce public debate.

The child, known only as Alex, is to begin hormone treatment and will be allowed to have surgery when she turns 18. It is the first time that a child in Australia has been authorised to have a sex change on purely psychiatric, rather than biological, grounds.

The Family Court heard that Alex, who has been diagnosed with a condition called gender identity dysphoria, has always regarded herself as a boy. At school, she was so desperate to be regarded as male that she wore a nappy rather than using the female lavatories. The court was told that she was deeply distressed and contemplated suicide because she felt trapped in a female body.

Alex has no male chromosomes and has hormone levels typical of a teenage girl as well as female reproductive organs. She was rejected by her mother and brought up as a boy by her late father. She believed she was a boy until the age of five and wore male clothes. At primary school, she won arm-wrestling games against the boys and was the only girl on the boys' cricket team.

She has now enrolled at a new secondary school as a boy, with a new name and birth certificate. An interim order handed down earlier this year authorised her to take hormones to halt menstruation and arrest the development of physical feminine features.

When she is 16, she will take the male hormone testosterone, which will have irreversible effects, leading to a deepening of the voice, facial and body hair and muscle development.

The chief justice of the Family Court, Alistair Nicholson, said: "I am satisfied that Alex has the capacity and, indeed, does in fact know the side-effects that may arise and, further, that he wishes [to have] the proposed treatment with knowledge of such risks. The social implications of the proposed treatment are that Alex will face challenges in respect of peer relationships, possibly bullying and ostracism, but I'm satisfied that impressive steps have been taken to anticipate such risks."

The decision was condemned yesterday by a prominent Australian ethicist, Nicholas Tonti-Filipini, who said of the treatment: "To do it to a 13-year-old whose body is still forming, whose sense of identity is still forming, it's just irresponsible." But Louise Newman, chair of the adolescent psychiatry faculty of the Royal Australian and New Zealand College of Psychiatrists, welcomed the judgment. For some young people, she said, "the stress is so great that going through the hormonal and bodily changes of puberty would actually be too distressing for the child to tolerate."

The court action was initiated by a state government welfare department, which is Alex's legal guardian. She currently lives with an aunt, who treats her as a boy.