For Katie, a university researcher in southern Illinois and the mother to Seamus, her 16-year-old transgender son, the last few years have been harrowing.
"There was no gender dysphoria visible to us until about middle school," Katie told Yahoo News. "The progression was: very vocal lesbian feminist at age 13, a period of identification as nonbinary, and then coming out as trans at the end of freshman year.”
While Katie said that she and her husband, Jack, a college administrator, both describe themselves as liberal when it comes to questions of sexual identity and expression, the town where they raised Seamus was “a rough place to be a nonconforming kid.”
As a result, Seamus found a community waiting for him online.
“For me, it’s that a lot of young people understanding that they do not fit in a box, but then being told that if they don’t fit into that box, they’re in an opposite box,” Katie said.
In fact, during the course of Seamus’s journey, Katie said that she and her husband found themselves asking more questions about what was happening to their child and why. For the parents of transgender kids, navigating a child's newfound desire to transition from the sex of their birth presents a daunting series of choices and comes amid an ever-changing web of complex issues playing out against the backdrop of a larger national debate.
Last week, transgender rights again became an important political topic in Washington, D.C., when the Senate held a confirmation hearing for the first openly transgender nominee for a Senate-confirmed position and the House passed the Equality Act, a bill that would ban discrimination against people based on sexual orientation and gender identity.
Those two milestones were partly overshadowed, however, by two Republican lawmakers — Rep. Marjorie Taylor Greene of Georgia and Sen. Rand Paul of Kentucky — whose outspoken public comments angered the parents of transgender kids.
While some simply reject the notion that anyone is born into the “wrong” gender, others struggle to navigate decisions about whether to start their child on hormone blockers to suppress puberty or to begin hormone therapy with the eventual goal of gender reassignment surgery. Complicating matters, as the number of kids self-identifying as trans continues to rise, the medical establishment’s thinking on transgender care has also evolved at a rapid pace over the past decade.
“During the nonbinary stage, Seamus, who had started puberty, asked to wear a chest binder, and I was really taken aback by that," Katie said. "Binding for me is a misogynist practice that men have perpetrated on women, so I thought, ‘Why would you want to do that to yourself?’ So much about this journey has been figuring out why what is billed as ‘gender nonconformity’ bears so much resemblance to patriarchal misogyny and intense conformity. Sometimes I feel like I’m in a totally upside down world as far as that goes. It doesn’t make any sense to me.”
Seamus's parents were wary of tinkering with biology and have refused his requests to take hormone blockers and testosterone.
“Jack and I are in agreement that the science on the effects of those things, in terms of longitudinal studies, is totally not settled," Katie said. “For this generation, taking them this young, taking them for so long, taking them when your birth-sex hormones are trying to kick in — I mean there are so many unanswered questions on that, that we’re just like, ‘No, we’re going to watch and we’re going to wait and when you turn 18 and this is still what you want to do, that’s your choice.’”
Several health providers in the U.S. have policies that forbid sex reassignment surgery on minors. They can, however, begin administering hormone blockers at an early age that stall the onset of puberty, giving young people more time to decide whether they want to take testosterone or estrogen before moving on to surgery.
For Northern California resident Stacy, a stay-at-home mom, and her husband Rick, the CEO of a nonprofit, the decision to allow their 16-year-old transgender daughter, Maya, to begin taking estrogen came after years of anguish. At first, they bristled when Maya pushed them to start hormone blockers. She was just 14, after all, and had only announced she was trans a few months earlier.
“She kept pushing. Sometimes she would say that she wanted to get hormones and we said no, that it was too much and we weren’t ready for that yet,” Stacy said. “We took her to Kaiser [Permanente] and at the first meeting with the therapist, she privately told me that she thought it would be a good idea for Maya to take hormone blockers. I was surprised. It was my first time talking with a therapist about it and she had such a strong stance. I was totally frightened of doing anything biological.”
Maya's transgender identity has not been the most concerning chapter of her life, according to her parents. In the years leading up to her 7th grade proclamation, she began stealing money and using drugs and was eventually diagnosed with ADD. Along the way, she would often cut herself with knives so that the family had to lock away all the sharp objects in the house. Her mother suspects Maya is on the autism spectrum, which experts say is the case for a statistically significant percentage of transgender people.
“The basic thing for us, given that we were struggling with all these different kinds of things, is that we’re now on this path and we have people to help us along it and Maya buys into it, at least it feels like we’re not just crazily not understanding what the hell is going on,” Stacy said.
After several months of hormone blockers, Maya began receiving small doses of estrogen.
“Ever since we started the blockers and then made the transition to the estrogen, which felt like part of a trajectory, mood-wise she is much happier," Stacy said.
The endocrinologists at Kaiser’s Transgender Care unit start with with a low hormone dosage and take their time building it up. As they go, the patients receive regular therapy to assess their physical and mental state. Some kids find a comfortable hormone level along the way, and don't ever continue on to surgery. Stacy said she’s been happy with that approach, but she isn’t sure how it will continue to play out for her daughter.
“Maya would do surgery tomorrow if we would allow her. I just feel like that’s so heavy for me to take on,” Stacy said, adding, “I would say it’s likely it’s going to happen.”
For Republican politicians like Paul, doctors and parents simply shouldn't allow kids to begin taking hormones.
“American culture is now normalizing the idea that minors can be be given hormones to prevent their biological development of their secondary sexual characteristics,” Paul said Thursday during the confirmation hearing of Dr. Rachel Levine, President Biden's nominee for assistant secretary of health. Paul then cited a controversial report by the American College of Pediatricians that found that 80-95 percent of pre-pubescent children would simply outgrow gender dysphoria if no medical intervention or “social affirmation” was introduced.
“It’s just so offensive to me that these so-called libertarians think that government should come in and make these decisions for families on these very excruciatingly difficult, personal matters,” Nevada journalist Jon Ralston, the father of a 25-year-old transgender son, told Yahoo News. “What might be right for one family and one kid might not be right for another.”
Likening gender reassignment surgery to genital mutilation, Paul also bemoaned any steps that parents or children might take regarding the interruption of puberty.
“Dr. Levine, do you believe that minors are capable of making such a life-changing decision as changing one’s sex?” Paul asked.
Levine, who transitioned in 2011, did not directly answer him. “Well, senator, thank you for your interest in this question. Transgender medicine is a very complex and nuanced field with robust research and standards of care that have been developed,” she said. “And if I am fortunate enough to be confirmed as the assistant secretary of health, I will look forward to working with you and your office and coming to your office and discussing the particulars of standards of care for transgender medicine.”
For Ralston, that exchange epitomized a black-and-white mind set prevalent among many politicians. In 2016, he detailed his experiences raising his child, who, from an early age, seemed to want nothing to do with being a girl.
“As she grew up, Maddy eschewed the traditional girly girl stuff. ‘If you get me a doll for Christmas, I’ll cut its head off,’ she once admonished me,” Ralston wrote in a moving essay on his blog.
After turning 18, Maddy transitioned and legally changed his name to Jake. For Ralston, the experience taught him about the myriad complex issues faced by transgender people and their families, which he said are not something that can be "understood by people unless they’ve had to go through it.”
"You hope parents are going to make the right decisions, but to use terms like ‘genital mutilation’ to try to get people to your side is just not the real world. It’s just an attempt to divide people,” Ralston said.
“Calling it 'genital mutilation,' I can’t stand that. It just makes me so pissed off.” Stacy said. “It just feels like the old guard. I mean, come on, the world’s passing you by.” (All of their family names in this piece except for those of Ralston and his son have been changed to protect the privacy of the minor children.)
A second tense exchange took place last Wednesday in Washington, in the lead up to the House vote on the Equality Act.
In a speech on the House floor in support of the bill, Rep. Marie Newman of Illinois noted that it would provide protections for transgender people like her daughter.
“The right time to pass this act was decades ago. The second best time is right now,” Newman said. “I’m voting yes on the Equality Act for Evie Newman, my daughter and the strongest, bravest person I know.”
Rep. Taylor Greene, who unsuccessfully sought to block a vote on the legislation, went after Newman on Twitter.
“As mothers, we all love and support our children. But your biological son does NOT belong in my daughters’ bathrooms, locker rooms and sports teams,” Taylor Greene wrote.
In response, Newman posted a video of herself installing a transgender flag in the hallway that separates the offices of the two congresswomen. Not to be outdone, Taylor Greene shot a video of her putting up a sign in the hallway that reads, "There are TWO genders MALE & FEMALE. ‘Trust the science!’”
“It’s very difficult for politicians trying to make laws when there isn’t a one-size-fits-all solution,” Ralston said. “The first thing I’d say to all parents is just love your kid, however that manifests itself. The real problem here, of course, is that this divides families. The rate of transgender suicide is so much higher than most cohorts and so many parents reject this or just won’t accept that their little boy is really a girl or that their little boy is really a girl. It can be very devastating for families and especially for the child.”
Some skeptics of transgenderism point to religion when making their case. Christian Broadcasting Network host David Brody took aim this weekend at the controversy over Hasbro's inclusion of a gender-neutral version of the famous Mr. Potato Head and Mrs. Potato Head toys.
“I think it’s hard for these people to think that there really is a social construct of gender as opposed to it being 100 percent biological,” Stacy said. “I feel like I’ve become more conscious that that is really true.”
A large body of research backs her up.
“The idea that a person’s sex is determined by their anatomy at birth is not true, and we’ve known that it’s not true for decades,” Dr. Joshua D. Safer, an endocrinologist and executive director of the Center for Transgender Medicine and Surgery at Mount Sinai Health System in New York, told the New York Times.
Katie and her husband, on the other hand, have sometimes clashed with doctors who practice what has become known as a "gender-affirmative care model," which prioritizes the self-reporting of young patients to help guide a course of treatment.
“In a fight that I had with a doctor, he said, ‘Well, I’m just concerned about my patient and I don’t want my patient to commit suicide.’ I was like, ‘Listen, I’m the one who has to shepherd this person through whatever choices they make, and you’re gambling with this person’s fertility and you cannot tell me that you can even definitively say what’s happening,’” Katie said.
Ralston said that while he understands the hesitance to simply cede health care decisions to adolescents in the midst of a tumultuous period of life, he was initially in denial about his son being transgender and had to change his own thinking on the subject.
“No parent should answer ‘always trust your kid.’ They’re not going to be very good parents if they answer that. Of course you shouldn’t ‘always trust your kid,'" Ralston said. "But the point here is very simple: Every single family, every single one of these situations, is different and these are very difficult decisions to make.”
At the heart of the debate, Katie said, is the question of whether children are equipped to make such long-lasting decisions and if doctors should encourage them to do so. Senator Paul made that point during his grilling of Levine, citing what he said were “dozens and dozens” of people who have regretted undergoing gender-affirming surgery.
In a Friday op-ed in Stat, Sai Shanthanand Rajagopal, a researcher at Boston Children's Hospital's Center for Gender Surgery and Henna Hundal, a researcher at the Max Bell School of Public Policy, took issue with Paul's characterization.
“In a 2015 national survey of nearly 28,000 transgender people in the U.S., only 8% of patients detransitioned — and of that 8%, two-thirds detransitioned temporarily,” the authors wrote. “Most important, only 0.4 percent of the those surveyed said they detransitioned because gender transition was not right for them. Instead, the few who permanently detransitioned most often cited parental and spousal pressure as the reason for doing it. Gender transition regret, as Paul decries, is statistically scarce.”
While a record-high 5.6 percent of U.S. adults now identify as LGBTQ, just 11.6 percent of that total consider themselves transgender, according to a Gallup survey released last week. For Generation Z, or those born between 1997 and 2002, just 1.8 percent say they are transgender, the highest of any age demographic in the survey.
“Over three generations, trans identity has gone from 0.2 percent to 1.8 percent, a staggering 800 percent increase," author and longtime gay rights activist Andrew Sullivan wrote in response to the poll's findings. “That may be because anti-trans attitudes are shifting for the better and more people are able to express themselves; it may also be because of a shift among lesbians to the trans category, as butch dykes increasingly become men; and some of it is probably due to the sheer trendiness of being trans among the young."
Stacy and Rick recounted what a friend's daughter who had recently come out as trans first told them: “Why can’t she just be a butch lesbian?”
Katie made a similar point about acceptance and changing attitudes.
“Right now, I can tell you, it’s way cooler and you’ll get way more attention coming out as trans than you do as being a lesbian. If you come out as trans you are brave, you’re courageous, you get a huge amount of praise,” she said.
Stephen Rosenthal, medical director at the Adolescent Gender Center at UCSF, which treats children for a range of gender-related issues, said back in 2018 that the rise in self-reporting for transgender kids was, in part, explained by changing societal attitudes.
“The question I’m most often asked is whether the transgender population is actually growing or whether more people are coming out,” Rosenthal told the Washington Post. “I’m convinced it’s the latter. It seems there’s almost a critical mass that’s emerged because of increased public awareness and increasing acceptance of diversity.”
Ralston, who still has a close relationship with his son Jake five years after from his gender reassignment surgery, believes that we still haven’t reached critical mass for the percentage of kids who self-identify as transgender.
“It’s going to keep going up. People who just had no idea what this was or is now are going to know somebody very soon, either in their family or friend or friend’s family who is trans,” Ralston said.
Katie attributes some of the rise in trans self-reporting to the fact that today’s kids can hop online and come away with a script of sorts on how to become transgender.
“I think the internet plays a huge role. There’s no nuance to the conversations there. The most extreme voices are the loudest,” she said. “So many of those transitioning are on the autism spectrum or they have ADHD or they’re high-sensitivity kids or they have anxiety issues. On top of that, a huge number of them are same-sex attracted, so when they transition, it turns out that they were lesbian or they were gay. And we’re not dealing with that. We’re not dealing with the true ability to be gender non-conforming and it really bugs me.”
While the three parents of transgender kids who spoke to Yahoo News each had a different understanding about transgender identity and its implications, they all agreed that what they heard from Paul and Greene last week was not helpful.
“I feel like at this point I’m willing to say to people, I don’t feel like the trans thing is a terrible tragedy that is happening to our families,” Stacy said. “I don’t think it’s completely abnormal even though I don’t understand it. It’s really new for all of us.”
In response to the debate in Washington, Ralston reposted his 2016 story about his son last week. “The reason I wrote that piece was not to ask for more tolerance for transgenderism, it was to say to parents, ‘just love your kid no matter what,’” he said. “The fact is that there’s so much ignorance about what transgenderism is and what people actually go through that breeds this kind of intolerance, or, worse, hatred. That has continued to distress me.”
While Katie struggles with her decision to keep Seamus from taking hormones and blockers until he's 18, she has made sure he understands her motivation. “Anything that hurts Seamus, hurts me. I am bound to this being and my whole life has been centered on helping him thrive,” Katie said. “I take this pretty seriously and I don’t assume that I know everything.”
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