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<br>Q&A Doctors on Puberty-Delaying Treatments<br><br>A small group of doctors around the world have introduced a controversial approach to the treatment of preteens and teenagers who believe they are the opposite sex. <br><br>Right before puberty begins, they prescribe children hormone-blocking medication. This allows the child to continue growing without developing physical characteristics such as breasts, facial hair or Adam's apples. Later, the child can elect to resume their natural puberty development or can begin a gender transition by taking the sex hormones of the opposite sex. <br><br>Researchers in the Netherlands pioneered this treatment. Its prevalence in the United States is unclear, because most physicians using this approach keep it secretive. NPR talked with two doctors about the treatment's benefits and risks: one who practices it in the United States and another from the United Kingdom, where the treatment is not practiced by the National Health Service. <br><br>Spack is an endocrinologist at Children's Hospital in Boston. He has worked with transgender adults for over 20 years and was one of the first doctors in the country to offer hormone-blocking treatments to teens. <br><br>About 10 people are now on the treatment, but we hear from one or two new people a week for some kind of service. <br><br>How confident are you that you can identify a kid who will become a transgender person as an adult? <br><br>It's a very good question. My confidence comes partly because I've yet to see one change their mind and partly because we're using the psychological testing methods the Dutch have perfected, and they've yet to see one person change their mind. And they've run 100 kids through the treatment. <br><br>Ultimately, in a girl it blocks her ability to make estrogen. That means her breasts will not grow. The uterus lining will not get built up enough to ever flow, and because growth plates stay open, it allows a girl to grow for four more years. So genetic females have potential to get height [closer to a male height]. <br><br>For boys, it prevents body hair, facial hair, Adam's apple. And remember, hair, along with aspects of the skeleton, can never be reversed. If a person goes all the way through puberty and develops facial hair, [he or she] will spend, on average, $120,000 in their lifetime on electrolysis. <br><br>How long do you use the hormone blockers to suppress puberty? <br><br>Until around 16. Then you use the cross hormones to bring on the characteristics of the opposite sex. And remember, if you just stop the hormone blockers at 16, the person will go right back to genetic puberty within months. So the beauty of the suppressant is not as a treatment but for prolonging the evaluation phase ... 'til a young person has greater ability for abstract reasoning. It buys you time without a tremendous fear of their body getting out of control. <br><br>And the treatment can really enable them to look like a person of the opposite sex? <br><br>In the cases of people we see, they are horrified. It's a very risky time; many attempt self harm. human hair extensions  The development of the first period in someone who thinks they're a boy — you can only imagine. <br><br>There's been very little criticism. If anything, it's been totally opposite to what I expected. Transgender people have written in saying, 'Thank God for you. Now another generation won't have to suffer.' <br><br>[Transgender people are] a group of people who historically have been among the most unhappy in the world — and in some cases the most poorly accepted. Now I think we can make them happy, and the Dutch have shown that they can fit in — in the way they want to. And I think we owe it to them. <br><br>Carmichael is a psychologist at the Portman Clinic in London, where national guidelines say hormonal treatment of transgender teenagers should take place only after puberty. Carmichael has worked with dozens of kids with gender identity issues. In 2000, the Portman Clinic, which specializes in gender issues, published a study of all the children treated at the clinic who had been diagnosed with gender identity disorders. There were 124 children in all. <br><br>I understand that you have done a study of all 124 children who have gone through your clinic, and that 80 percent of those under 12 chose not to pursue sexual reassignment as adults. The kids who didn't continue — what were their reasons? <br><br>It's very tempting to be looking for similarities that might predict it, but there's a very wide range. I can think of one [boy] who came first at 6 or 7 and we saw on a regular basis. And over that time, he felt more comfortable being the sort of boy he was: having female friends, being very theatrical. At first, he really wanted to wear pink — and the mother was torn between wanting her child to choose his own clothes and the teasing. That changed, and at a later stage he said he just felt OK as he was — that he still sometimes had those feelings, but he felt happy being a boy. And that's how he wanted to continue. <br><br>I wouldn't say it's impossible to identify individuals [who] will go ahead with sex reassignment. Clearly, the Dutch have an assessment battery that they feel is quite accurate at identifying them at an earlier stage. But I think there's a lot of flexibility. <br><br>Do you have reservations about identifying kids under 12 as transgender? <br><br>I think some of the children under 12, as well as over, would fulfill diagnostic criteria for transgenderism. But I would say, in general, my experience is that in younger age groups there is greater flexibility, and the figures support that. <br><br>How do you feel about giving hormone treatments to young transgender individuals? <br><br>There are debates to be had around the impact of giving hormone blockers at an early stage. One of the debates is, indeed, does one's own sex hormones have an impact on identity development in adolescence? So if one intervenes, is that affecting the final outcome? I think that's just one part of the debate, but important to debate. <br><br>What we're doing now is new, so it's appropriate to be exploring and discussing. And it's a plausible question — is one of the effects a change in final outcome? <br><br>I don't know where you'd get that evidence from, really. It's relatively new treatment, so in general individuals have been exposed to their own sex hormones — and some will go on to be transgender, some not. It's more important to have a debate. <br><br>Have you been around transgender children going through puberty? <br><br>I have been around them, kids up to 16 to 18. It's exceedingly distressing for many of them. If you have a strong conviction that you are in the wrong body, then to feel your body developing in an alien way is extremely distressing. Often, what individuals seek to do is avoid any contact or thought of their sexual characteristics. For instance, girls bind their breasts in part because they're presenting as male outside, but also because they just don't want to see themselves. And for adolescent boys, they wouldn't want to look at their penis, they would find that incredibly distressing and would wee sitting down or would always shower wearing underpants. <br><br>When you see that, does it seem cruel to not allow children to have hormonal therapy? <br><br>It's a really hard question. Obviously, in working with families, one is trying to ameliorate distress. It's important to remember these are very complex cases; gender disorder is part of a complex presentation. <br><br>Why haven't Netherlands researchers had any kids who decided transitioning was a mistake? <br><br>Because I think they've selected that group. They identify individuals through a battery, a group who they feel would go on and seek sex reassignment. So it's very positive. But they're a selected group. One of the Dutch criteria is a stable biological background, and certainly many of the children we see wouldn't fulfill that criterion in that they're not psychologically stable. <br><br>My personal view is no, I don't think it's immoral, but my personal view isn't relevant, really. The arguments are complex, and what's not helpful is to have a very polarized debate, because that's not the issue. It creates a lot of distress among gender identity-disordered individuals who feel strongly that they want treatment. But it's important to have a proper debate. brazilian hair  <br><br>The tragedy is we all want the same thing: We want to do our very best to support individuals to do what's right for them in the long term and short term. The problem is, managing anxiety in the short term is very difficult. remy hair  Suddenly something comes along and offers a solution, and I know families have gone to America to seek treatment. It's horrible to be cast as withholding something that's the solution to everything. But we have to keep the bigger picture in mind, think long term, and develop an approach based on evidence. <br>
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<br>Dachshunds<br><br>Dachshunds, often referred to as "weiner dogs," are most commonly depicted as pets. The "cute" factor in Dachshund puppies can be somewhat deceptive  brazilian hair about the "big dog" lurking underneath. The Dachshund is available as a standard and miniature size in smooth, wire and long haired  human hair weave varieties. <br><br>Said to date back to North Africa during the time of the Pharaohs but generally credited with being developed in Germany, the Dachshund has long been beloved by celebrity and ordinary people alike. They are the smallest of the hunting breeds, developed to follow badger "to ground", with the ability to dig out prey as well as go down inside the burrows. A vicious animal when cornered, the badger needed an equally courageous dog to successfully unearth them. Dachshunds have also taken on fox and otter.  weave hair <br><br>The dog originally cast in the Wizard Of Oz actually was a miniature Dachshund - post-war hostility towards their home country meant that Toto was fired and depicted as a Norwich terrier. The role of the miniature Dachshund in the classic has long been buried. Famous fanciers of the breed include Marlon Brando, Clark Gable, John Wayne, Errol Flynn, Joan Crawford and others.  A Dachshund once made an appearance on "Hogan's Heroes". Gary Berghoff, who played "Radar" on the MASH series, is said to have kept one wirehaired, two smooths and two long-haired Dachshunds. <br><br>William Shakespeare is said to have kept a pack of Dachshunds. William Faulkner and Danielle Steele also kept the breed. From the 14th to the 16th centuries Dachshunds were kept by Catholic popes as "altar-dogs" in Catholic ceremonies. George S. Patton, Dwight D. Eisenhower, Napoleon Bonapart were a few of the higher ranking people who kept the breed. Queen Victoria kept a royal kennel and arranged a bronze statue of one of her dogs at Windsor castle. <br><br>The Dachshund name means, literally, "badger dog". They are a fierce hunting breed, very people orientated and love to cuddle but absolutely retain the instincts of a hunting dog. Originally the dogs worked in packs, leading to the development of a highly social hound that generally gets along with other dogs. <br><br>Competing in shows, obedience, agility, field trials and "earth dog" competitions are just some of what the Dachshund can do besides being a beloved pet. For reasons of being a true scenthound, they should not be allowed off leash loose - the scent of something interesting can mean crossing traffic or other hazards that can be fatal. <br><br>In the 1930s they were called officially called "badger dogs" to give a verbal distance from their home country of Germany. Here in the US they rose in popularity to be one of the top ten breeds. Often recognized in the popular black and tan or red colors, they can also be several other colors, including chocolate and tan, blue and tan, fawn and tan, chocolate, dappled, fawn, cream, 'wild boar,' wheaten and blue or black and cream. <br><br>According to the Dachshund Club of America some have also been trained as drug sniffing dogs, a modern day use for that sensitive nose. By their definition the standard is 16-32 pounds while the miniature is 11 pounds and under. Of course, as pet dogs or for working and performance, slightly over or under this is of no real importance. There are of course many who fall between - too big for miniature status and not quite big enough for standard status. What to do with the 14 pound Dachshund - love him! <br><br>This makes them ideal size for small yards and apartments but one must also keep in mind their original purpose - as hunting hounds! This can mean for some in    idual hairs - this retains the texture of the coat, removing the dead hairs. This is, from a show standpoint, the highest maintenance coat. <br><br>The long-hair variety pet dog should have the hair between the pads clipped and thinning the "feathers" - the longer hair that makes this variety so pretty. Show dogs have a flat iron used in addition to trimming. The coat of show dogs takes special care to condition it and keep it from breaking or drying out. Keeping a long-haired show dog takes effort. Of course pets do not need to be maintained as do their showable kin. <br><br>As with other hounds, the ears should be checked and kept clean of excess water and debris to reduce irritation. <br><br>Being a smaller dog, with proper care living to 12-14 years of age isn't uncommon, with many dogs still remarkably active. Good care helps any dog, but the Dachshund is a breed that can easily reach the teenage years. <br><br>The Dachshund is a wonderful small dog for the right home. Older children and adults who pay attention to their needs, strengths and weaknesses - and who have the patience to get through the early training - will have a loving dog that is small in stature but large in heart and personality. <br>
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