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With specialized medical treatment, my transgender teen is thriving. Don’t criminalize it.

With specialized medical treatment, my transgender teen is thriving. Don’t criminalize it.

Picture of Jeff Gottlieb
Multi-Specialty Transitions Department for Kaiser Permanente in Oakland.
(Ted Eytan via Flickr/Creative Commons)

A few weeks ago, we had friends over for a socially distanced dinner in our backyard, sitting around our fire table to take the chill out of the evening. The next day I was driving with our 13-year-old transgender daughter, and she scolded me for referring to her that night as “he.” 

After 11 years of using masculine pronouns when talking about my child, it was not easy to call her by her new name or use the correct pronouns since she came out. Sometimes I’d slip, and she’d explode. Now that my brain has been rewired, I seldom make a mistake. Still, she gets angry even when I tell her, “C’mon man,” an expression I might use with my wife or almost anyone else.

I explained to her that the night before I had been referring to the time when she was a small child, before she had transitioned.

“Daddy,” she said, “I never was a boy.”

I know how lucky my daughter is to live in California and not in a state like Arkansas, where the legislature recently overrode the governor and passed a bill outlawing medical treatment to help transgender youth transition to their preferred gender. Sixteen other states have introduced similar legislation this year, according to the ACLU, in what has become a Republican campaign to demonize transgender youth. For example, bills moving through the Texas legislature would outlaw the established treatment for transgender youth. Parents who violate the law could face prison and their children could be sent to foster care. Medical professionals could lose their licenses.

Five states have passed laws prohibiting transgender girls from competing in sports against their cisgender peers, and 34 states are considering similar bans.

If we lived in Arkansas, the treatments my daughter receives would have become illegal. Legislators have ignored the recommendations of the American Academy of Pediatrics and the American Medical Association that young people who identify as transgender should have access to gender-affirming care in a safe, inclusive environment

Will children like my daughter be forced to travel out of state? Will they and their parents be turned into criminals, sneaking into underground clinics for treatment, sometimes by dangerously unqualified practitioners, like women who had to resort to back-alley abortions before Roe v. Wade? Friends in Texas who have a transgender daughter are terrified that the bills there will become law. They’re considering moving or arranging for treatment out of state.

I’ve heard the searing pain in transgender kids' voices as they describe friends and relatives who don’t accept them. I’ve heard the anguish in parents’ voices as they struggle to understand their transgender children, whether young or grown up. My daughter wakes up every morning wondering why she has been subjected to this cosmic joke that put her in the wrong body. She just wants to be known as a girl. Not a transgender girl, but a girl.

Since our daughter came out to us, our biggest concern has never changed: for her to live a happy and productive life. We had heard the frightening statistics about the suicide risks among transgender kids. According to large survey of adolescents, published in Pediatrics, more than half of transgender males, about 30% of transgender females and nearly 42% of non-binary youth reported they had attempted suicide.

We searched the internet for reliable information about gender dysphoria. We talked to parents of transgender kids. We consulted a therapist and then scheduled an appointment with a doctor at Children’s Hospital in Los Angeles who specializes in transgender treatment. When we arrived at the fourth-floor clinic, we were greeted by a security guard, a reminder of the hostility that can be directed at the transgender community, even in California.

Will children like my daughter be forced to travel out of state? Will they and their parents be turned into criminals, sneaking into underground clinics for treatment, sometimes by dangerously unqualified practitioners?

My daughter, the doctor said after examining her, was about to enter puberty. He told us about puberty blockers, which had been developed for children who begin puberty early, and are now being used on transgender children of both genders. The blocker uses the drug histrelin to stop the production of sex hormones and pause puberty, providing breathing time to figure out what comes next. Once the drug is stopped, puberty resumes.

My daughter was impatient. She wondered why she couldn’t skip the blocker and go straight to “girl hormones.”

A couple months later, a surgeon inserted the blocker into her left arm and closed the incision with a couple of stitches. Our medical insurance wouldn’t cover the procedure, which cost us more than $3,500.

About six months after that, we visited the doctor and he said that soon my daughter could take estrogen. This meant no turning back. My wife later told me she thought she was going to faint. 

Each time we made a decision about our daughter’s treatment, it felt like the most important one we would ever make. Were we making the right decisions? We wanted a second opinion, so we scheduled an appointment at UCLA’s Gender Health Program. The doctor brought along a psychologist and a social worker. The doctor asked my daughter when she realized she was transgender. “I’ve kind of known all my life,” she answered, “but earlier I tried to push those feelings away, but a year and a half year ago they came back.”

Our daughter’s next appointment was to discuss taking female hormones. When I drove her to the school bus, she said this could be the best day of her life. 

Every night now, the last thing she does before she goes to bed is to slip an estrogen pill under her tongue and let it dissolve.

Recently, I took our daughter to the hospital for a bone density scan to make sure that her hormone treatment was not causing osteoporosis, one of the potential side effects. She lay on a table for about 10 minutes while the DXA scanner traveled back and forth over her body.

As parents, we need the wisdom and expertise of doctors and therapists who specialize in the care of transgender children. We come to them with our fears and worries, our questions and concerns. My wife and I expect and receive expert care for our daughter, the same as if she suffered from cancer, a heart problem or a broken leg. Imagine if a doctor weren't allowed to treat those conditions. What would we do without their help?

With her curly brown hair and blond highlights flowing past her shoulders, and her dresses and necklaces, you would think my kid was a girl. I have just one thing to say to those lawmakers in Arkansas, Texas and elsewhere: She is.



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Thanks for sharing your experience Jeff - I hope it has an impact on those with no idea who are trying to create a hostile and non inclusive environment through legislation and politics.

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She is!

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How powerful! All our children have a right to be happy. What a powerful well written article. And how tough for the parents and child, when it shouldn't be political or controversial.

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Hi Jeff,
Seems a long time ago since we worked in the MV bureau! Someone sent me your article and I was so moved by it I wanted to let you know. I sent it on to other bureau-ites. Puberty is challenging enough (for child and parents) but this challenge I can't even imagine. You and your wife are terrific parents. Shame on those states banning the therapies....but of course the Republicans have no shame.
Best wishes to you and your family, Carole (and Mike!)

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Hi, Jeff: Thank you for sharing this with me. It is beautifully, warmly, lovingly written. It needs to be 'out there' for others to see and try to understand. I am happy for your daughter that she is receiving the proper care and the support of her parents and medical community.

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Jeff, I am sending this on to several friends with transgender children. You have articulated so well the difficulty of navigating this journey. And you have reminded us all that the most important, underlying goal should be the health and happiness of our children. Excellent story. All the best to you and your family. Megan
PS: And Childrens Hospital is the brother, in the 60s, had to live there for a month at a time to get growth hormone treatment, which was experimental then.

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Hi Jeff,
Your former Merc colleague here, and I just wanted to say what a wonderful piece you have written. I'm now with Planned Parenthood Mar Monte in Silicon Valley, and we have posted it on all our social media channels. Your daughter is lucky to have you for a dad! Best, Sue

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Lawmakers should learn more about how endocrinologists treat their patients' problems. I had to take male hormones for a brief period, because the doctor was trying to determine why I had failed to have regular periods, even though I was in high school.

Later, when I got my first job, after college, I was working at a lab down the hall from the offices of that same doctor. One of the department's patients was a young man who had chosen to become a girl.

20 years ago, one of the men in my office became a woman. I talk with another co-worker, an African-American, who had spoken with our new female worker. I could tell that she had been careful about her comments. She understood what it meant to be different.

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I am a parent of a non-binary 22-year-old. Two years ago, their best friend in college came out as a trans woman, but could not begin hormone replacement therapy or consider gender reassignment surgery because she was experiencing a recurrence of bone cancer and needed to resume chemo. She died on April 19 at age 22, her gender identity never supported by her father, who misgendered her in her obituary and during her funeral. (Her mother died 9 years prior.) The loss of a young adult to cancer is tragic enough; the lack of support from her father in the final years of her life is truly incomprehensible. Thank you for supporting your daughter. It can be challenging to understand, but we can still support.


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