Published April 6, 2023
By TERESA FRAHM
From the moment she knew what gender meant, Kay Gardner’s daughter knew she was different.
“She told me when she was 2 or 3, when she first learned the words girl and boy, she told me from the very beginning she was a girl,” says Gardner, mother of a young transgender woman in Santa Cruz. “It was me that didn’t understand.”
Caught between political battles and personal identity, transgender and gender diverse minors and their families seek understanding as they navigate the complex process of securing the hormonal and surgical treatments that can offer them legal and psychological security and affirmation in their gender identity.
For many parents of transgender, or trans, children, Gardner’s experience is a familiar one. Navigating gender is a complicated issue for families of trans people, those who don’t identify with the gender associated with their biological sex. Complications can come not only from the conversation of identity and its implications, but from dangers in an occasionally hostile outside world.
“You’re always on your guard,” says Lisa, mother of Ash, a local transgender middle schooler. “It’s a constant conversation whenever we enter a new environment: What is that going to look like, and how are they going to be safe?”
Due to these risks, several sources have asked to be identified by their first names or by assumed names to protect their identities. Others, including Gardner’s daughter, remain unnamed.
While a person can come out, or reveal their gender identity, at any point in their life, many trans people become aware of the dissonance between their assigned sex and their gender identity early in childhood.
“My entire life, I’ve known I didn’t fit into the gender I was assigned at birth,” Ash says.
Those who realize that they are gender diverse face significant challenges through adolescence. According to Luana Calvano, a licensed family therapist in Salinas, puberty and the resulting development of body parts that more distinctly code them as feminine or masculine can be an especially difficult period in a transgender person’s life. Gender dysphoria, which the American Psychiatric Association describes as the feeling of dissonance between a trans person’s physical body and gender identity, can become increasingly severe during this time. Without treatment this can have serious effects on mental health.
According to Planned Parenthood, a national sexual health educator and provider, one of the most common methods of treatment for gender dysphoria is known as hormone therapy, wherein estrogen for trans women or testosterone for trans men are introduced to change the body to better match their gender. Over years of use, these hormones redistribute body fat, trigger the growth of body hair or muscle and affect many other factors associated with adolescent development. In the same way naturally occurring hormones dictate maturation and growth, administered hormones adjust the body’s chemistry.
“It’s like going through second puberty,” Archie, a trans student at Cabrillo College, says. “But it’s different because it’s the puberty you want.”
Planned Parenthood describes hormone blockers as the first step in transition for many younger teens. Instead of making changes to the body, blockers prevent further pubescent development, functionally halting progress until the person is ready to either move forward with their transition or return to the gender assigned at birth. While some trans people choose to only ever use puberty blockers, which are reversible, most later transition to hormone therapy.
Archie describes administered hormones as a semi-permanent solution. Taking testosterone as a transmasculine person or estrogen as a transfeminine person can be very effective as a relatively non-invasive way to change certain parts of the body to better fit the person’s gender, creating many of the same changes that they would in a body where they naturally occur. Hormones must be used steadily for the entirety of the person’s life, taken either as a topical gel or through frequent injections.
“Both estrogen and testosterone will change your body to be more like what you want,” says Archie. “That can take years. All the things that hormones do to your body, it will do to you.”
People taking hormones, regardless of their age, receive regular care from a medical team ensuring their hormone levels and body chemistry stay within normal and safe parameters.
“It sounds like this horrible thing that will turn you into a monster, and yes, it’s scary that you’re putting things into your body, but there’s checkups,” Archie says. “It’s very monitored. It’s not like surgery, where you can’t really go backwards.”
For some people, this treatment is a critical stepping-stone to gender-reassignment surgery, a more permanent treatment, while others choose not to take that further step.
“Sometimes those medications will do a lot of the work already for us, so we don’t do more than we have to,” says Dr. Wendy Wong, owner and surgeon at Gallery Plastic Surgery in Monterey. “Everything in surgery is trauma, and we don’t want extra trauma.
Most commonly reserved for adults, surgery is the most permanent form of trans-affirmative treatment. It allows a trans person to embody the physical characteristics of their gender as closely as possible. The two categories which fall under the label of trans-affirmative operations are known as top surgery, which focuses on either reduction or addition of breast tissue, and bottom surgery, which focuses on reproductive organs.
While Mayo Clinic, a nonprofit medical center, categorizes many of the effects of hormone therapy as reversible in the statistically unlikely event that a person should come to regret their decision, one of the largest concerns held by objectors to trans-affirmative care is the irreversibility of surgery. The potential for re-transitioning, defined by a study conducted by Dr. Kristen R. Olson and others as a person changing their gender back to the identity assigned to them at birth, is a common reservation cited by those with concerns about the transition process.
Olson’s study found that 7.3% of transgender youth re-transitioned at least one time. Within that group, 2.5% of those people transitioned back to cisgender, the term used for a person who identifies with the gender associated with their biological sex. This most commonly occurred before the age of 10 and often to children whose initial transition began before the age of 6, typically before the age when hormone treatment begins. While these numbers are significant, they also demonstrate how frequently transitions are successful, even for children who transition early in life.
In acknowledgement of these risks, before any level of treatment can take place, those looking for hormone therapy or surgeries are required to go through a rigorous process. Due to insurance requirements and individual business policy, several doctors’ recommendations and a substantial amount of time with the previous treatment phase is typically required, among other things.
“Based on what their insurance tells us, we usually require a note from a therapist or psychologist,” Wong says. “We also require that they have been on their hormonal medications for at least a year.”
In most cases consent from a legal guardian is required for a minor to receive treatment, and while it is not required by California law, many surgeons decline trans-affirmative surgery to patients under 18.
Others, however, argue that treatment is more important for minors than for any other age group.
“Puberty is dangerous for trans kids when they don’t have care,” Gardner says. “That’s why a lot of them commit suicide.”
According to the Trevor Project, a non-profit crisis-prevention organization for LGBTQ youth, a 2022 nationwide survey demonstrated that 53% of trans youth seriously considered suicide in the past year. Students who experienced an unaccepting home or school environment were significantly more at risk than those who felt accepted in those environments.
“The suicide rates, the self-harm rates, are so much higher in this populations than other populations,” says Calvano. “[They] are dealing with family members who may not understand and a culture at school that sometimes doesn’t give the support that’s needed. It’s really difficult to be different, and to be marginalized is really hard on our mental health.”
In recent years, trans issues have expanded from purely family conversations to take a starring role at the forefront of American politics.
“It’s really not political,” Gardner says. “It’s extremely one-on-one, personal.”
Forty-three states, including California, face proposed legislation perceived to be anti-trans, and many trans individuals feel the effects of an increasingly polarized political climate. These bills range from restricting trans students’ access to restrooms and sports teams to compelling teachers and school staff to ignore preferred names or pronouns and inform family members if a student uses a different pronoun in class to limiting access to gender-affirmative health care.
“What a lot of people don’t understand is that there are some places in America that aren’t safe for trans kids,” Lisa says.
According to the Trevor Project’s 2022 survey, 93% of transgender and nonbinary youth were worried about their future access to gender-affirming medical care due to recent legislative proceedings.
“You’re not going to stop people from being trans by legislating against the care they need,” Gardner says. “That doesn’t stop anything. All it does is make things harder, and more kids will die.”