A 13-year-old girl is to begin undergoing sex-change treatment following an unprecedented ruling by the Australian Family Court.

Chief Justice Alistair Nicholson declared it was in the best interests of the child, who has been diagnosed as having gender identity dysphoria, to authorise the use of hormone therapy to begin the gender reassignment process.

The child, who has been identified only as Alex, is biologically female but has been allowed to change his birth certificate and be enrolled at high school as a boy. He is on a contraceptive pill to stop menstruation and has been given permission to start other hormone treatment at age 16 to begin the process of masculinisation. The court ruled that Alex have no surgery until he is at least 18 years old.

The case was launched by the undisclosed state welfare department which is Alex’s current guardian, and was supported by family, doctors and psychiatric specialists.

The court heard Alex was born overseas and virtually raised as a boy by his father, who died when Alex was six. The death was clearly devastating to Alex, who had spent almost all of his waking and sleeping time with his dad. Alex said they slept in the same bed and would shower together; however, none of the evidence suggests there were any sexual advances by the father towards him.

Alex said his father taught him karate and how to punch and kick and to be self-protective. He described their relationship as like best friends. He told me if he was sad and I told him how I felt.

His mother remarried and the family moved to Australia in 2000. When Alex became unhappy at home and estranged from his mother he lived with an aunt, until she began to worry Alex was so depressed he would harm himself.

We had to put him in a placement because he was actually threatening to kill himself and saying he would rather be dead and didn’t want to live this way, that he wasn’t a girl and didn’t want to be a girl, said his aunt. I felt very seriously that he actually meant that.

Alex’s primary school principal recounted how the child refused to use the girls’ toilets and would wear nappies to avoid having to do so.

One of the psychiatrists revealed to the court Alex had told him he was distressed about being trapped in a girl’s body, and had been sad and miserable for a long time and wanted to die. He said menstruation is extremely distressing to him because it reminds him he’s not a boy, and that Alex is frightened of continued breast development because it will make it impossible to present himself as a boy.

[He] has repeatedly stated his desire to be a boy and has behaved as such, going to boys’ toilets, dressing in boys’ clothes, boys’ hairstyles and boys’ games and activities, the psychiatrist said.

Justice Nicholson said Alex had a clear understanding of the hormone therapy process.

Katherine Cummings of the Gender Centre said the ruling is a tremendous step forward for transgendered people in Australia. But it has to be recognised it’s not a decision that gives people permission to change their sex at 13, Cummings said. What it gives them is the right to have puberty held back until they are of a legal age to make their own decision.

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