Finding out we were parents of a transgender child was like landing in a foreign country after being blindfolded--we had no idea where we were and we didn't speak the language. We struggled with how to parent during what we thought might be a teenage, hormone-fueled crisis. The consequences of not believing her, or of blocking her from pursuing her true identity were dire. If we were wrong (spoiler alert...we were) the likelihood that she could die by suicide hit us square in the face. We quickly realized that it was time for us to listen and follow her for a change. She didn't need parents to guide her. She needed us to get the hell out of the way so she could pursue her one true life.
As parents new to learning about the transgender experience, we consumed all the information we could about transgender children, gender identity and gender dysphoria. We poured through so many books, articles, documentaries, etc., and yet nothing resembled our experience.
Allison wasn't saying she was a girl as a toddler. In fact, it was the opposite. She wore red cowboy boots, was a rough and tumble little kid. She got dirty. She played with cars and trucks. She tackled her brothers with gusto. Needless to say, when she told us at 14 that she felt like a girl, it blindsided us.
After a lot of conversations, therapy and education from medical professionals, we came to realize that every trans person's experience is different. Yes, some children begin expressing their gender identity when they are small children. They beg to wear clothes that match their identity and not their sex assigned at birth, while others come to this knowing much later in life.
As private people living a very public life (we grew up in a small town--iykyk) we've been asked so many questions.
"Did she have surgery?"
"Is she going to have surgery?"
When is she having surgery?
Surgery, surgery, surgery (so many people think I'll just willingly talk about our child's private parts)
"Was she telling you this when she was young?"
"Did she used to wear dresses as a kid? Did she play with dolls?"
"So that means she likes boys?"
"Is she gay?"
The question of transitioning is one of the most intriguing and yet misunderstood aspects of being transgender and having a trans kid. For parents (and loved ones interested in learning more), I thought I'd share our transition experience to dispel the bad info circulating in state houses, social media, bars, school board meetings, and now in Washington D.C.
What Transition Looked Like for Us
Allison began sharing her gender identity at 14. We started meeting with doctors and therapists more than a year later. By 16 when her dysphoria was life-threatening, we agreed to approve the use of a reversible testosterone blocker in order to limit hair growth. The thickening hair growing on her arms, legs and face induced self-harm and made it so that she couldn't stand to look at herself as evidenced by the sheet covering her bathroom mirror.
The decision to begin medical transition was life-saving treatment. Yes, it was reversible, something so many are hung up on for trans kids. The medication she needed--spironolactone--is actually a diuretic and blood pressure drug. Fortunately for us, this drug would also benefit her kidneys (Allison also lives with polycystic kidney disease.) It's a safe drug that has been used to address a number of issues for many years including acne for women and congestive heart failure. It is an anti-androgen which means it also stops male hormones, like testosterone, from working. What's important to know here is that our clinic doctors didn't quickly prescribe spironolactone and send us on our way like legislators would have you believe. It was thoughtful, well researched, done in consultation with her medical team in nephrology, and, most importantly, only possible with our consent.
It took another year before we started talking with her doctors about hormone therapy. There were a number of stringent requirements and international standards of care, including mental health therapy. She was anxious to start. We were more comfortable taking the slow route. We have a scary breast cancer history in my husband's family (my mother-in-law was BRCA+) so we consulted with geneticists too--all available through Cincinnati Children's Transgender Health Clinic. After months of appointments, consultations, and careful, prayerful consideration, we talked as a family about any possible increased breast cancer risk (there is no research on breast cancer risk and transgender hormone therapy so we couldn't base this decision on science or data). Allison, as always, put this in perspective. "I'd rather live one day as a woman knowing I might get cancer, than never live as my true self." She was 18 by this point, so it really was her decision. She started a micro-dose of estrogen. There was a lot of blood work. More consultation with her medical team. Slowly increasing estrogen. Another year later with regular monitoring and blood work, she began progesterone.
During the last four years she's been researching and contemplating surgical options. We still aren't there yet. She understands the permanence, the risks, and the costs. She's taking her time to make sure surgery is what she wants and not what is expected. If you watch television and see all the nasty election ads, you would think trans kids are cutting off body parts. It's just not happening. These surgeries don't happen to children--they are performed on consenting adults by physicians who treat adults. These are big decisions, taken with immense care, time and medical consideration. Many trans people never have surgery either because of the reasons previously mentioned, or because they simply don't want to surgically transition.
The thought of surgery used to weigh heavily on me. It is such a big step. However, I'm now completely at peace with whatever decision she makes. She still battles dysphoria, and I want her to experience life in the body that matches her identity. To be honest, I don't know how much I'll share if she does choose to pursue surgical transition. What I do share will only be with her permission.
The Types of Transition
It's important to know that because each trans and non-binary person's experience is different, every transition is different as well. There are generally four types of transition and they aren't necessarily sequential. For example, some people start with social transition, while others may begin medical transition before coming out socially. Some never medically or surgically transition. And many cannot legally transition because the laws related to doing so are different in every state.
Social transition--This phase is the most common. Name and pronoun changes. Wardrobe changes. New hairstyles. New undergarments that hold in or camouflage the body parts that cause the most dysphoria. Chest binders that fit tightly around the breasts in order to conceal them. Tight underwear or tucking panties hold in or tuck the penis.
Legal transition--This looks different depending on the state/country in which a trans person was born or where they reside. Name changes and gender marker changes on birth certificates must be done by petitioning probate court. Gender markers may be changed on a driver's license or state identification without petitioning the court in some instances with the proper documentation. Social security cards can be reissued in one's new legal name by filing paperwork with the Social Security Administration. Passports can also be issued with new legal name and gender marker documentation. All of this comes with one GIANT caveat...across this country courthouses, judges, county clerks and state personnel are making decisions about how easy or difficult legal transition will be--especially for minors. I highly recommend reaching out to other parents in your county and state who have walked this road. Attorneys aren't required for any step in legal transition, however, it may be necessary if you run into roadblocks.
Medical transition--In this phase, medical refers to supporting transition through medical means such as gender affirming hormone therapy--puberty pausers, testosterone blockers, estrogen and progesterone therapy. These therapies are safe and largely reversible. There are a number of requirements that must be met for minors. Parental consent being #1. Other requirements are time (you can't walk into a gender affirming clinic and get meds because you ask for them), months or years in therapy, and constant medical supervision.
Surgical transition--For the very few, gender affirmation surgery is a life-saving method to address extreme gender dysphoria. There are a number of gender affirming surgeries that some transgender and non-binary adults seek to treat dysphoria and gain peace and agency over their bodies. Some examples of surgical transition include facial reconstructive surgery--to make facial features appear more masculine or feminine; top surgery--removal or augmentation of breasts and breast tissue; and bottom surgery--transformation of genitalia.
For new trans parents--this is a lot of information to absorb. Just know this...you don't have to be the experts. Check our Resources page. Rely on your therapist and physicians. Connect with other trans families. My best advice is to take it one day, one step at a time. When the decisions come down to life-saving treatment, it's quite simple. We wanted our daughter to live. If she had cancer, we would go to the ends of the earth to save her life. That's exactly what we did with her gender dysphoria diagnosis. If you looked at Allison's bio on our "About" page, you may have watched her story on the local news. In Allison's words, it all came down to this..."I didn't want to live. And now I do. Cincinnati Children's saved my life."