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Children typically have a stable idea of their own gender identity by an age that varies between two and four years. By this time, most children identify as the gender that matches their biological sex: children with male bodies regard themselves as boys, children with female bodies regard themselves as girls. However, some children identify as other genders than the one they’re assigned at birth.
When this happens in early childhood it’s a social problem: the child wants to use different bathrooms, clothing and social institutions than those mandated by its biological sex. That’s now becoming more possible as awareness of transgender issues spreads. But it’s made easier by the fact that there are few obvious physical differences between a 7-year-old male body and a 7-year-old female body. Come puberty, with its broad hips and shoulders, facial hair, menstruation, breaking voices, and breasts, trans children can have their first major encounters with truly crushing gender dysphoria — much as a cisgender person would feel if they were slowly turning into the opposite gender in their teens.
In transgender adults treatment takes three forms: psychotherapy, hormone treatment to establish an endocrine environment appropriate to the target gender and gender confirmation surgery — vaginoplasty or phalloplasty to create genitals appropriate to the target gender. In transgender teens, one option is to use puberty blockers, or anti-androgens. These prevent the biologically present sex organs from beginning puberty.
It’s a good idea at this point to talk about what puberty actually is. Aside from its social aspects it’s a biological process controlled by the pituitary gland. It comes in five stages, referred to as Tanner stages 1 through 5. Tanner 1 is basically birth through to the onset of puberty, while Tanner 2 is the beginning of puberty. As early as 8 or 9 in some people and as late as 16 in others, the pituitary gland triggers the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH). These affect the testes in male bodies and the ovaries in female bodies, causing them to grow in size and then to release their characteristic hormones.
The majority of the changes we associate with the differences between children and adults are a result of sex hormones released during puberty rather than with chromosomes: men’s larger heads and hands, women’s breasts and other characteristic curves, as well as men’s deeper voices and facial hair, are a result of sex hormone exposure. A body that isn’t exposed to sex hormones won’t enter physical puberty.
One is that hormone therapy for transitional puberty isn’t recommended before age 16. Most doctors agree with this and it’s the international consensus — one reason puberty blockers are used is to allow trans kids the time to grow sufficiently mature to be able to make a decision about physical transition, and even 16 is very young for such a choice. However, it’s worth remembering that some trans kids have been waiting for physical transition their entire lives and 16 feels like very old to them!