Gender Care

We’re really lucky to live near one of the longest-running, most prestigious gender programs in the country.  When Lee first came out as trans, I called them right away.  Sadly, I wasn’t impressed with what they had to offer.  At that point, Lee was still young.  Too young for any medical intervention, but as a parent, I still felt I needed a medical professional to guide us through this process.  They gave me a referral to a counselor and told me to call back when he started puberty. I felt totally dismissed.  

I called that counselor, and wasn’t impressed with her, either.  She was condescending and rude and seemed to fundamentally doubt most of what I said. Also, she didn’t take our insurance. So I kept looking.  

We finally found a therapist who ‘got it.’  She is a trans person herself, and also a minister.  We love our therapist.  She pointed us toward a lot of great resources, and helped us work through a lot of our questions and concerns.  But truth be told, she was also still pretty new at this.  She hadn’t worked with a child as young as Lee before.  Even so, she helped us find support groups and an endocrinologist nearby who was beginning to expand her practice to include transgender children.  

So we made an appointment with this endocrinologist.  And it was okay.  The first time we went, I had a whisper conversation with the receptionist telling her to make sure they used the right name.  They did.  The doctor was timid, but professional.  I was feeling overwhelmed but I didn’t want my child to see that, so I held back my tears. The doctor noticed and asked me if I was okay.  I forced a smile and told her I was fine.  I wished I had had a moment in private to express all of my concerns.  

Any time we had a question, she assured us that she had read a lot of literature and attended a lot of conferences, and if she didn’t know the answer, she found out for us quickly. From then on, their office (mostly) got the name right, although the same could not be said when we had to go down the hallway for blood work or a bone scan.  

We had one battle over insurance.  They billed the procedure incorrectly, and it took me weeks to get it changed and covered. We also had a billing problem with the pharmacy, because they ordered his medication as a prescription instead of part of a procedure.  It took months to get that corrected. But the really upsetting conflict had to do with getting his name changed.  

We did all the work of going through the courts, petitioning for a legal change.  It was granted.  Then we had to change it with Social Security.  Then with the insurance company.  And finally, we could change it with the hospital.  I was told that I just needed to bring in the new insurance card with the correct name on it.  So I did. This worked everywhere else; at our pediatrician and our dentist and our therapist and our psychologist.  But here, at the GENDER clinic, I presented the card and requested the change, and I was told that I needed to bring in all of the supporting documents.  The old birth certificate.  The court order.  The old insurance card.  

And after months of fighting with these people over stupid things, I wanted to curl up and cry.  Why was it so hard to get this right?  They called a supervisor, who repeated the request for documentation.  They told me I needed to come back with all the paperwork.  When I expressed my frustration, I was treated as if I were overreacting.  When I explained that I had been told that I just needed the insurance card, they insisted that no one in their office would have told me that.    

At that same appointment, the doctor proposed that we begin administering testosterone in the near future. She mentioned exploring the options for preserving fertility.  According to my research, there were no fertility options for us, because Lee had never progressed through a natal puberty.  If we wanted to preserve fertility, we would have to stop our current treatment and allow him to enter a female puberty, which feels akin to abuse, knowing what we know now.  I asked a few questions in this vein, and the doctor’s lack of knowledge was appalling. It had only taken me a few Google searches to learn more than she seemed to know about the issue. 

I pushed, and I asked a lot of questions.  Eventually, I learned that this particular doctor had never taken a child from puberty-blocking medication to gender-affirming hormones.  I returned home, feeling frustrated and defeated.  A few hours later, I got a message from the doctor saying that Lee’s name had been changed in their system and that they didn’t need all of the documentation after all.  I wanted to scream.  I felt as if my child were being used as a guinea pig, and I began again to search for knowledgeable, experienced care.  

I called that first place back. After all, they were the experts.  It took nearly a week for them to return my call, and while the director was helpful and informative on the phone, the next available appointment was nearly six months away.  

So, on a friend’s recommendation, I made another call.  I contacted a lesser-known gender clinic.  They’ve only been officially running for a little over a year now, but they’ve been doing transgender care for much longer than that.  They could get us in right away.  So we made the appointment, and yesterday was the big day. 

We parked in a garage nearby, and had to walk about two blocks to get to the hospital where the clinic was.  I’ve never been particularly nervous to walk down a city street in broad daylight. But this time, I had my three kids with me, and the erratic behavior around me had me wishing that I had three arms to hold their hands and usher them safely along the sidewalks.  There was shouting and swearing and lewd gestures.  People were confrontational, not just around us but toward us. 

I later found out that the area has a huge drug problem and a local methadone clinic.  That explained the erratic, unpredictable behavior. 

But we powered through. We made it into the hospital and up the elevator and into a space that was relatively quiet and friendly, if a little run-down.  

I sat with the three kids in that hospital waiting room, and already, I was thinking, “I don’t think this is going to work.”  I was making a mental list of the things I didn’t like, starting with the neighborhood and ending with the cracked drywall and the sad-looking pamphlets in the waiting room.  I thought, “It’s too far to drive,” and “Our current care isn’t THAT bad,” and “Maybe we CAN wait the six months to get into that other program.”  

The nurse stepped into the waiting room.  She wore hospital scrubs over a Run DMC tee shirt and she called our last namewith a smile on her face.   What a simple way to avoid misgendering or using the wrong name!  I handed over some books and snacks to the other two kids and told them where I’d be in case they needed me.  They assured me that they would be fine, and Lee and I walked through a set of double doors into a wide hallway.  The nurse asked if it was our first time to the clinic and made small talk with Lee as she checked his height and weight.  We were ushered into a small exam room, and told that the doctor would be with us shortly.  

Lee could tell by my expression that I was still unsure. I was beginning to think that maybe my standards were just too high. After all, this kid whom I was trying to protect often felt that I was overreacting.  I had never shouted or lost my temper with the staff at our doctor’s office, but I was frequently frustrated, and I let it be known.  He would often say things like, “Mom.  It’s not that big of a deal,” or “I’m fine, mom.  It’s okay.  It was just a mistake.”  Maybe my efforts to protect him were unnecessary.  Was I embarrassing him?  Doing more harm than good?  

And then the doctor walked in.  She was accompanied by a social worker, and they both introduced themselves with their names AND their pronouns, and Lee lit up.  That small gesture let him know right away that they GOT IT, and that they were on his side.  The two of them sat with us, and addressed Lee as much as they addressed me.  They asked so many questions.  They asked if we had enough food and if Lee felt safe at home. They asked all the typical questions about medications and prior treatment and family history.  And then they kept going.   They asked what Lee liked to do for fun, and when he mentioned all of his pets, they didn’t just jot it down and keep going.  They asked what kind of pets he had and what type of environments they lived in.  They asked what else he liked to do, and when he said he likes to ride his bike with his guinea pig, the doctor followed up the typical, “Do you wear a helmet?” with an additional, “Does the guinea pig wear a helmet?”  Her lightness and her humor won us both over in that moment.  

They asked thoughtful questions; questions I hadn’t even thought to ask.  They asked about bullying and bathroom use and whether he stands or sits to pee.  They asked him about his body and what parts he’s comfortable with and what parts he’s not comfortable with.  They asked him about his legal documents and his name change and his gender marker.  They asked, “Who is your biggest supporter?” and “Do you have a best friend?” They asked him about his goals and when we finally got to talking about testosterone, I already knew that they were going to be able to help us.  

When I asked a question about fertility, the answer was accurate and comprehensive and corresponded to what I had already read.  The doctor did, in fact, share that we don’t have a lot of options.  But then she talked about current research and some potential future advances and she was knowledgeable and honest and she was able to speak from actual experience with actual patients.  

She asked questions about our current care; talked with us about the bone scans we had been receiving and really explained their purpose.  She asked Lee how often he had been taking his calcium and vitamin D, and when he timdily responded, “Not EVERY day,” she pressed him further. “So, how often do you think you’re actually taking it?”  He responded, “Like, once or twice a week?”  

I think Lee and I both braced ourselves for the lecture on the importance of taking these vitamins. Instead, she looked at him wide-eyed, tilted her head just a bit, and proclaimed, “That’s LAME, dude.”  It was perfect.  She made her point.  She connected with him and also let him know that he needed to step it up.  She didn’t blame or lecture.  And then she told us about a concentrated pill that he could take once a week.  Within minutes, she had placed the order with our pharmacy at home. Problem solved.   

As we talked, the doctor and the social worker both curled their feet up under their bodies and leaned in, as if we were chatting in my living room.  They never rushed us, and they took the time to wait for our answers. When Lee wasn’t sure how to respond to a question, they gave him options.  They were patient, and kind, and obviously aware of the myriad emotions that we were facing.  

Lee expressed concern about his height, and about how his pets might react to the body changes that testosterone would produce.  Instead of glossing over his concerns, the team probed further, showed him graphs and charts and made reasonable predictions about his future stature. Then they listened as he shared his own research about animal’s reactions to testosterone.  When the doctor thoughtfully replied, “You probably know more about this than I do,” Lee beamed and I felt the relief that accompanies the belief that a person is willing to admit what they don’t know. 

At one point, they proposed talking to just Lee, and asked if he wanted me to step out for a minute. He looked at me and smiled. “I don’t think that’s necessary,” Lee responded.  They asked the same of me. It was powerful to have medical professionals acknowledge that I, as a parent, might have emotions and concerns and fears that I did not want to express in front of my child.  What I would have given to have that chance three years ago! 

And initially, I said, “Sure.  If Lee wants to go sit in the waiting room with his siblings, we can just finish up.” I thought I was giving him a pass; a chance to leave a few minutes early.  He wasn’t going to argue with me; he started to gather his coat.  But I saw a flicker of concern in his eyes- What did I want to say to them that I couldn’t say in front of him?  And so I stopped him.  I looked into his eyes, and I said, “You don’t have to leave.  No secrets.  I don’t have anything to say that you can’t hear.  Would you rather stay?”  Relief flooded his face and he nodded and sat back down.  

We talked through the next steps and options.  I asked logistical questions and insurance questions and expressed my thanks.  Lee did the same.  His whole demeanor was different here, in this context where he felt supported and understood.

Over dinner that night, we talked as a family. And we decided that we’re ready to make a switch. Lee is eager to begin his medical transition, and we’ve finally found the support we need to support him through it. 

When we told Lee that we were going to change providers and that he was going to start on testosterone, I swear he stopped breathing for a moment.  His face lit up and his eyes filled with tears and he choked out a joyful, “Thank you.”  Until that moment, I hadn’t realized how much we both needed this.  

This kid still sometimes lets me tuck him in at night.  In the darkness, we have some of our most powerful conversations.  And that night, he said something strange.  “Mom, you’re like a hipporoceros.”  At first, it sounded like a jab at my weight, but I know my kid, so I asked more.  “What do you mean?”

“Well, obviously, it’s like a cross between a hippo and a rhinoceros.  It’s the fiercest animal.  And it protects its young.”  I fought back tears as he continued.  “Mom, I know I sometimes tell you to stop, but I’m glad you protect me fiercely.  If it wasn’t for you, we wouldn’t have found these great new doctors.  Thanks. You’re aggressive like a hipporoceros. And that’s a good thing.”  

And for the first time in ages, he let me rub his back until he fell asleep.