Transcripts For KQED Frontline 20240622

I had made to embrace this masculine part of myself so deeply. I dont want to focus on being trans forever. Id rather just go to college and move on, so ill be as complete as i want to be. Tonight on frontline, a journey inside this new world. Frontline is made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support for frontline is provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant and peaceful world. More information is available at macfound. Org. Additional support is provided by the Park Foundation dedicated to heightening Public Awareness of critical issues. The ford foundation, working with visionaries on the front lines of social change worldwide. At fordfoundation. Org. The wyncote foundati. And by the frontline journalism fund, with major support from jon and jo ann hagler. I am transgender. I was born male and identify as female. But i like to say that im a girl stuck in a boys body. I transitioned when i was six or seven to more of a girl and now im comp. Well, almost completely female. Second grade was the last year of liam, and this year i changed my name officially. So ive changed my name, my clothes, my room, and my pronouns. And thats really all you need except for the fifth one that i still need surgery and medicine to help me look like a girl. Narrator just a generation ago, it was adults, not children, who changed genders, usually late in life and often in the shadows. applause but today, as transgender adults gain wider acceptance, many children are transitioning too with new medical options and at younger and younger ages. This is a new generation growing up trans. Theres a big one naima, naima, do you like the bubbles . laughing lets count to ten, ready . One, two, three. Count, naima four. November 7, 2009. Shes four. Ready . Go there she goes. My given name was naima, and now my name is daniel. Ive been a boy for three years, and ive been. I was a girl for six. Come on, grab on to me or grab on to john. Come on i dont like to be called a she anymore, and i just. I really like it that they think of me as a boy. toy whirring i think its hard to get used to it because i was a girl for so long, and i havent been a boy for a very long time. As soon as daniel could start to express preferences in clothing, he was gravitating toward the boys section handmedowns from cousins wanting to wear just boy tshirts and boy shorts. From the very beginning, it seemed like to me, just didnt look as comfortable in a dress. Initially, a tomboy came to mind, right . Thats our standard goto for our society, is tomboy. And then the comments would start to come. I dont feel comfortable, i dont feel right, i just wish i were a boy. And i would say, i understand that you wish you were a boy but we cant do anything about that. You were born this way. And then starting second grade the tone of our conversation just took on a more serious depth, and naima felt like i have to tell you that im very unhappy, i dont like being in this body. I wish i had a penis, and just sort of laid it all out there. And so at that point it just sort of snowballed into a conversation about, well, you can live as a boy. I dont know what that means i dont know where to go really from here, but you can live as a boy, and you can change your name. And daniel, or naima at the time, immediately jumped on that idea. What . The lava keeps rising. The lava keeps rising, okay gotta stay above the lava. St i did feel a pressure from society, from our family members, what if daniel changes his mind . But we knew that we just had to listen to what we heard from our child. And it didnt. Nothing else mattered. Narrator although daniel transitioned two years ago recently he started to worry that his body is beginning to change. Ive been feeling a little weird, and its been feeling weird, so i stay up a lot of nights talking with my parents about it, and i dont get a lot of sleep. Yeah, and. Yeah. I just dont like feeling different. It starts making my tummy hurt a little, so. Sometimes it makes me cry when im very, very, very, very, very tired. To develop breasts would be horrifying for him. He doesnt want to be the kid that has to be different. And he has talked about suicide or killing himself before, which is why we immediately sought the help of professionals. I think he finds a great deal of reassurance knowing that there are things, there are steps we can take where he can look more like a boy and pass to be more like a boy. Bring it to the top, quick narrator its now possible for kids like daniel to never have to go through the puberty of their biological sex. But timing is crucial, so daniels parents are taking him to a clinic in chicago. The gender program at lurie Childrens Hospital is one of a growing number of clinics around the country providing treatment to gender nonconforming and transgender kids. Hi, how are you . Did you grow since last time i saw you . Um, yeah. And you just had a birthday right, on the 20th . Happy belated. Shoes off, if you dont mind. So these kids really are a new generation who are being cared for completely differently than children were in the past and that is. Its exciting for them to have opportunities that somebody wouldnt have had even ten years ago, but its also very challenging for the medical community to find the right way to do this. Step right here. R narrator one of the biggest developments in the treatment of transgender kids came in 2007 with the introduction of hormone blockers, drugs that suspend puberty and slow all physical development. The pubertal blockers are the medicines that pause puberty. So the idea is that we can just put the pause button on puberty and let children have a little more time to grow and develop and be more confident of their gender identity. Tight squeeze and ill be done, okay . Narrator but the treatment of transgender kids can be controversial. Its a field of medicine with very little research, and the few studies that do exist suggest that for most kids, the distress about gender will shift with time. The majority of children with gender dysphoria will not grow up to be transgender adolescents or adults. But i think the challenge is that were not able to definitively predict for whom gender dysphoria will continue and for those that it may not continue. All right, get your arm back. Our goal is to try to figure out which children are going to continue to identify as different than their natal sex. And we dont have any definitive test to do that right now, and thats very challenging. I wish there was a test to say oh yeah, of course, youre five and you think this now, and you will when youre 15, and you will when youre 30. I mean, we dont have it though, so its a real challenge. Hello, hello look whos here how are you, daniel . Narrator but there is growing consensus that the more intense gender dysphoria is in childhood, the more likely it is to persist, and that puberty itself can also be a telling predictor. And i just wanted to see if you were noticing any changes in your body recently that had you maybe feeling worried or sad . Well, this one over here, it started getting real tender. I think daniel had been really concerned about how quickly this was going to happen and just really feeling strongly about not developing breasts. And my husband and i want to do anything we need to to keep his Emotional Wellbeing in mind and how he feels about himself. Okay. Early intervention does make a huge difference. Once physical changes, some physical changes of puberty have occurred you know, voice deepening in boybodied people for instance theyre irreversible. So really starting pubertyblocking medications as early as possible is really important for some people who are really experiencing distress. So there is a very, very faint amount of breast tissue under the right breast. I mean, its just a little tiny bit. We typically want to see that a child has had a little bit of pubertal development, but thats the point at which we can start sort of talking about blocking puberty. The medications that we use for puberty blockers all work, and for the most part have few side effects. This is a sample of what the implant is. Hmm, that small . Yeah. The medications are very expensive, and so they can be 15,000 to 25,000 a year for some of these things, which is cost prohibitive for most people. So we have worked on an option that we have, we can offer here now actually which is called vantas. And its fda approval is for men with prostate cancer, but this has been used successfully by pediatric endocrinologists taking care of kids like daniel, and it seems to work just as well, and it is a lot less expensive. And so, you know, vantas is not. Its not approved for children, but none of these medications are actually approved for use in this situation. For all . For any of these. For any of them, okay. We have a lot of experience in pediatric endocrinology using pubertal blockers, and from all the evidence we have, they are generally a very safe medication. But the concerns with this population are just different because were using them at a little different age and for a different purpose. So whether it is having any negative effect on their adult bone density or their neurologic development i think is. We dont know. I much prefer to take care of conditions that have been wellresearched and wellstudied for 50 years, and that is not the case here. We just really need Good Research that we dont have yet. Theyre not easy decisions to make, and they shouldnt be made quickly, and i think the takehome message today is that nothing is going to happen quickly, okay . Nothing. This generation of kids are really. Theyre the pioneers. They are gonna be the ones to teach us. My name is ariel. I am 13 years old, and i identify as a girl. I havent really experienced puberty at all. I mean, the hormone blockers are like my life saver. But me turning into a man is just probably the most horrifying thing ever, i could ever think of in the farthest reaches of my mind, is me not going on the hormone blockers anymore and me developing into a man. That would just be horrible. The hormone blockers, they give me a space where i can really feel completely just sure of myself, and i can just have that little breathing space before i enter puberty. And youre just in this nice little world where youre still like a child, and its just great, before you develop. Its harr, teasing and bullyingwise, when youre a girlie boy, when youre in that inbetween stage, than when youve fully transitioned. Its much harder to be gendernonconforming than to be transgender, because when youre gendernonconforming, that is when really a lot of difficulties set in. Narrator ariel did not transition until she was 11, when she started blockers, but there was a long period of time when she was living in secret as a girl. That was a difficult time. Very. Just very confusing. If we went into a restaurant and she was wearing something that was more feminine and she saw somebody from school, she would run into the bathroom and wouldnt want to come out. It was kind of like a double life. I think a lot of people are completely just comfortable and fluid, but for me, i was really scared. My name before was ian. And then i guess when i was around nine years old, i started deliberating, like, maybe i should change my name to really show the world that i wanted to fully transition. So she asked us to call her a different Disney Princess name every day. So every day. I forgot about that every day, we had a different name. And there was an order to it. Cinderella, belle, ariel, snow white, and they were in order, all the Disney Princesses. And on that day, i would have to call her that. And i remember my grandmother, she cared so much about me, and she wrote on her calendar every day, like, what princess i was supposed to be. So she would make sure she called you the right name. crying it just made me think, like, she cares about me so much that she writes on her calendar who i am each day, which was really amazing and made me so happy. Narrator as ariels girl world intensified, her double life began to take a toll. I believe that someday, im going to live in a castle and all the Disney Princesses are going to visit me every single day. I can play mermaids in the water. Oh yeah, im going to have five courtyards, one main courtyard and one main garden, and the garden is going to be so pretty. I feel like at that point in my life, i wanted to prove to everyone that i wasnt like any part of a boy in any way shape or form. What a perfectly, perfectly awful year jeez this is from cinderella iii right . It was just, like, horrible and just confusing for me, and i tried to just. I was trying to ground myself with all the dresses and the princesses, just trying to say to myself, you know, i am a girl, and prove to everyone else that i am a girl. Which Disney Princess do you think is the most beautiful . Hmm. Ariel. It was like i was putting on costumes, but now im putting on outfits and clothes, and its not a snow white dress or a princess dress anymore. Its like its actual girl clothes. Now im actually me. For me, the age that everything started to happen was around fifth grade. I started really going through puberty. That was. That is horrible. I hate it. I mean, for any transgender, male or female, its probably the worst time in their life because theyre actually becoming what they dont want to become. I was wearing three sports bras. I was very selfconscious of my chest because guys obviously do not have a chest. They are flat, completely. And so before that, i was able to pass. I was able to kind of be a guy. But then once that started happening, i was like, oh that is not going to help my appearance much. Yikes. In my mind, i saw this really strong, flatchested guy that had an adams apple and a beard. When i looked in the mirror, i saw this small girl who was not supposed to look like that. I felt like i just needed to look the way i looked in my head, to be who i was and feel comfortable with who i am. Narrator this year, at the age of 13, alex began to transition and formally changed his name in school, where everyone had known him as karen. Middle school can be kind of a scary time for lots of people. Even after i started really transitioning, i would want to stay home because i know that everyone there knew me as a real girl. I can feel them kind of, like, wondering why i couldnt just be a tomboy, why i couldnt just dress like a guy and i didnt have to become a guy. So instead of calling me like hes and by the male pronouns, theyll call me it, because im kind of in the middle. I mean, i can deal with that. I dont really like it, but i have a minimum amount of friends. I want to keep the friends that i have. So i kind of just. Let it go. I definitely get depressed sometimes. I will listen and dance for hours. Whenever im feeling upset or something, its kind of a way to soothe me down and, like, get me happy again. I have my imaginary world, and thats one of my coping strategies. Like when im feeling down or depressed, ill kind of, like, go into my imaginary world. And in my imaginary world, i am a guy. I have a flat chest. Im strong. There are definitely girls and guys in this world, and they just help so much. And to me, theyre real. And like, if im feeling so down that i just cant talk, theyll sing or listen to music and dance with me. And that definitely helps. Its kind of like a telepathic thing. I can hear them in my head and then ill speak to them either through my head, or sometimes ill look really weird walking down the street and ill be, t like, hey, when i get home, do you want to, like, dance and sing with me . And theyll be, like, yeah, yeah, sure. And so ill have something to look forward to when i get home. I think at times, my mom can get a bit worried. I think shes sometimes worried that i dont know reality from imagination. I definitely know the boundary line, but like, ive brought them over so much that i think the line has definitely thinned and kind of become blurry. Alex does have an imaginary world that he has talked to me about, that hes talked to his therapists about. And they do feel that alex has his feet firmly planted in the ground, in reality, but that it has been a mechanism to deal with. His problems. Its very hard for him to have female hormones in his body, raging through his body. He wants those shut down. Narrator alexs parents are considering puberty blockers to stop his menstruation, but they have serious concerns about the medications. I think the real struggle is in the risks of the drugs. We know that the drugs have not been used for that long on children, and that there isnt really adequate data. And then there are potential side effects and possible longterm effects that are not known. And so we have been kind of wrestling with this decision talking to a lot of doctors, reading a lot of information. And not making a decision has implications also, because doing nothing is not really an option here. I mean, i would like to choose that option, but i dont know how a transgender person feels and based on our conversation with alex, doing nothing is not really an option. Narrator but the decision to take blockers can also lead to another complication. Two years ago, when ariel first transitioned, she and her mom decided to make a fresh start. They moved to a new town and enrolled in a new school where nobody had known her as ian. When she first went into school, she went into school with the teachers, the faculty knowing that she was transgender, but her classmates or any of the students in the school did not know. And i wanted that for her, not because we were even embarrasseded or we wanted to hide it, but i wanted everybody to just know ariel as ariel. I would rather you meet her as her, and then if you find that out about her, its just something about her. Its not who she is. Its just another part of her. We look like were in the next Percy Jackson movie. No, but we do look like demigods we can totally pass for that. Narrator although puberty blockers had allowed ariel to pass, three months into the new school year, while changing in the girls locker room, she was outed. At first, i sort of felt bad for her, because it must have been so hard, obviously. And it was just sort of like tension between us. Like, i didnt know how far i should go, like, if i should bring it up, or if i should just treat her normally, or just like nothing happened. Yeah, thats probably the reason that i felt uncomfortable, because. Not uncomfortable. The reason i was, like surprised. And, like, it was just a new idea to me too. I didnt even know what transgender was before that. And so because she was like. Shes such a girl that it really. It was so shocking. laughing its my duck face, okay . laughing well, it would have been different if i had met ariel as a boy first, but we still would be where we are now, i think. I. I know were really close, but i really. Like, i had an experience at my old school, and i really dont think it would be, like, as close as we are now. Like, it would never be like this if i came in as a boy. And it would have changed our relationship. I definitely know that. Youre right. It would have, actually. Wed still be friends, but it wouldnt. I guess it wouldnt really be where we are now. There is still some of that awkwardness, no matter how comfortable, you know . Say, like, all the girls in the class are having this giant slumber party, and theyre all just, like, throwing off their shirts and, like, just dancing around and, like, just changing and stuff. You know, its kind of hard. And im always sort of changing in the corner still even though how comfortable i could be. So i feel kind of left out. Its almost like theres a fine line between trying to include her and trying not to include her so much that it made her feel excluded from everything. I keep accidentally making her feel bad, and its just. It must be so hard for her. I cant even imagine it. I remember a couple years back, everyone was talking about, like, having babies and it really makes me upset. I mean, i dont want to tell them to stop talking about it,o but you know, its like. It kind of hurts my feelings and theyre always talking about that. Its like. Its so hard to explain. Its like, but im a girl, so its. But its like, could i have the pain of labor . Could i have to deal with that . And its kind of hard to have that happen, like, those conversations. crying and i feel like a lot of people, its hard for them to understand, but i dont want to, like, burden them with that. I kind of just either walk away or i just kind of deal with it. I try to sometimes get into the conversation, but you know its hard. Do you ever feel like youre, like. You can get so close to being a girl, but you just cant get to that exact point . Is that what upsets you . Yeah, thats exactly how i feel. The thing with having a baby its like i can never be fully there. Thats just, like, a natural thing that happens. I buy a bra, but its not to hold in my boobs. Its for an illusion. It felt sort of like an act. So i kind of feel lost sometimes. For me, i always, like, see these really cool guys, and im always like, i want to be like them and morgan and ben were those, like, cool guys that i wanted to be like. Once i really realized that they were perfectly fine with me being transgender, it was like a whole new world for me. Good job i kind of think that it really shocked people, like, knowing that were hanging out with this. Like, because i know that people were thinking that, like, alex is weird and stuff, like, thinking that hes, like, really different from everyone else. In all reality, hes just. Hes the same as us. Wait, are we moving the quarter pipes together . I sometimes mistake alex, like, if im talking to morgan ill be like, she, but then i might like correct myself and be like, he did this. But i think ive gotten a lot better about that, definitely. I didnt know she changed her name to alex, like, since this year, like before i knew her. I always thought her name was karen, i said, hi, karen in the hallways and stuff. I cant imagine, like, what the change is between that stuff like, being a girl to a guy. I dont even know what being a girl is like, so. Remember to apply enough pressure to the tail as you pop. Just in general, ive been showing him the ropes of being a guy, and saying like, youve got to start working out more. Youve got to build up that upper body muscle. Try and talk in a deeper voice. Even if its not normal, get used to it. Burp. If you have to burp, just let it fly. Dont try and hold it in. Girls do that all the time. In terms of girls and dating, id just say, like try not to really show any emotion towards it. Just, like, treat her like you dont even like her. Just treat her like that. So im like. Im not trying to make that sound bad or anything, but i mean, im just saying. Well, the, like, tactics and all the information that theyre giving me, i definitely use it. Sometimes, i know that ill slip up a bit, but their tips are amazing, and ill go with them. You have to keep your foot straight with the board. Id still say that hes still in the process of, like, really learning how to be a guy. But i say hes coming close to finishing that for sure, so. Ive been struggling with depression for about four years. Its more anxiety and sadness, the kind of depression i have. I have medicines to, like, boost my happiness, but those dont always work. I had thoughts of hurting myself, cutting myself killing myself, even. I got very close, very close twice. I was just thinking, i cant do it anymore. I cant live like this. I cant live in this body. Its not going to work. My moms just been super supportive. Shes been great the entire time. I was terrified of telling my dad, because when i was younger,d, he was always like, no, you have to wear a dress. Youre a girl. You cant. Not allowed. No, cant do it. So that probably made me terrified. I finally told him, which was not that long ago. My dad was really woied about the effects of the medicines and what if i later in life decided that this wasnt the path that i wanted to go down. I had some concerns, and there were some things about me, or about it, that kind of bothered me a little bit. We have these educated doctors offering kids who are at a young age some options that im not really sure should have been available to them. I was really kind of surprised and put off by it, quite honestly. Because i was only 13, he didnt want me to make a life decision like that at this age. It was still hard. I couldnt really see why. It was horrible. I felt like my parent, my dad, he didnt love me. I felt like he didnt want me to be this way. I didnt want her to. clears throat . Think that she could make some changes to her outward appearance and then suddenly everything would be fine and she would just move on from there and life would be great. I think there are a lot of other implications to this than just the few that youre focusing in on right now. Narrator but kyle is still hoping to start testosterone and although his father remains concerned, hes agreed to go to luries gender clinic for the first time to learn more aboutbo hormone treatments. Heels all the way against the wall. Narrator crosssex hormones, estrogen and testosterone, used to be given only to adults. But treatment guidelines established in 2009 now include children, though they do not recommend starting before the age of 16. All right, have a seat in the chair for me. The age limits which used to say 18 now are 16. Now youre seeing people starting crosssex hormones at 15 or 14. And with the changes in the age of onset come some challenges to care that i think teams need to be very savvy about. How are you . How are you . Im dr. Garofalo. Do you remember me . Dr. Chen, good to see you again. I mean, i think the big decision that families have to make when they embark on crosssex hormones is that now youre not hitting a pause button, right . So when you move on to crosssex hormones, youre now initiating medical therapy where some of the changes that are going to take place are permanent. And thats a whole other, like ball of wax, i think, for some of these families, and that can be really hard. So when we think about medications, if were going to go with the route of medications, theres two kinds. One are medications that sort of block progression through puberty. The other medicines that you could use would be right to going to sort of what we call crosssex hormones, or in this case it would be sort of testosterone. There are plenty of drugs that get approved by the fda and everybody goes on their merry way and thinks things are great, and then two years later, people are dropping dead from one thing or another. And this is really important, so im actually going to pull up a stool so i can sit and face you. So testosterone as a medication has been around obviously for a long time. The way we would consider using it here, sort of for, in a crosssex sort of way, there arent, like, a tremendous amount of studies that have been done to document, like, all the potential side effects and the risks and benefits. But i think in general, its fairly well tolerated. Some of the changes, again are permanent, and some sort of arent, and i think those are the things that kind of freak people out. But when you think of things like, you know, hair loss on the temples, you know facial hair growth deepening of the voice all things that go along with sort of a male sort of hormone. Youre gonna have increased muscle development. So some of its going to be things that hell want but some of the things you want to look out for are things like acne, mood changes, and then all the risk factors that go along with a typical male predisposition. So things like Heart Disease stroke, you know, those kind of things. Males are more likely to have Heart Disease than females. Were asking families to take some leaps of faith based upon the child that they have in front of them, and really what we dont know with regard to some of the longterm consequences of these medications. If you look at our consent forms, theyre fraught with, like, vague language and, like may, could. We know very little about things that are really important to families, like fertility, like cancer potential or oncologic potential of these agents, cardiac risk. I mean, things that, like, families want to know when theyre making decisions about their children. And there definitely is the potential for the testosterone or the crosssex hormones to prevent sort of normal, or what we call normal, fertility to sort of occur. Have you ever thought about having kids yourself . Were sort of asking you to be really grown up really quickly when you make these decisions, and thats whats tough. But i want you to really think through some of the stuff were talking about here. Does that make sense . Well, you know, i would like to have kids, maybe someday, but. If youre saying, you know, i might want to have my own kid one day, then i think its probably a good thing for you and your parents to sort of at least get some information and find out whether sort of preserving your fertility might be something that youre interested in. Up till now, its been things that were reversible. Change your name, we can refer to you as he and him and sure, fine. But at 13, i dont think shell change her mind, but you have to think a little bit more about that. I mean, those are. And those are things that your parents should be there for, to help you be as certain as you can about a decision that later in life could have a huge impact. So theres a lot to think about. You feel better now . I do. Good. I dont envy these parents. I mean, i think theyre making decisions in a very difficult environment. I mean, i know that we do informed consent, but really, i mean how realistic is it to believe that a 14 or 15yearold or 16yearold has really the capacity to make that kind of decision for him or herself . But at the same time, to deny them, thats tough. I an theres a. This is a. This is tough stuff. Hi, okay. So i guess around 11 00, uh, i injected testosterone into my body. And so todays my first day, like, being born, i guess. I watch lots of Youtube Videos of like skylar eleven and stuff. So like having him like kind of explain everything through his videos has helped me a lot. So this is kind of like me pretestosterone, but some is like floating around through my bloodstream right now. Um, and i feel really good. I looked at other videos. I realized that they were exactly like skylar eleven, that they had the same thoughts and the same, like, views of things. These are my muscles pret. Theyre not that bad for a biological female, i think. And these are my abs, so this is all like pretestosterone. Cross hormones, i cant wait for. Its going to mean that im going to start being able to gain muscle easier, the way guys should be able to. My voice is going to drop. Im going to get an adams apple. Woohoo i can get a deep voice, i can get a beard, i can get a flat chest. Did someone look at my christmas list . To inject testosterone, you have to use specific needles and a specific syringe depending on your dosage. I always pull out more than i need, because then i just push the rest of it back up into it. One, two, three, just like that. Ready. Today was my first t shot. It was actually about half an hour ago. Hey guys, today is july 16 2010. Hello, people. Hey guys. Hey guys. Hey guys. Today is my nine months on t. Hey guys. So today, actually it was yesterday, it was my 11 months on t. lowered voice hey guys, so this is my voice 12 months on t. Im a lot hairier. As for my happy trail, which is the hairiest part of my body its like a happy super highway. Today is my first day on t. Um, i feel like a new man. Basically i was pretty much born today. Today is my one year on testosterone. It is my official t birthday. I am now one years old, and it feels freakin awesome. Its the best thing in the world, you know. Crossgender hormones and top surgery are going to be the two major things that im, like, looking forward to in my future of being able to transition all the way. I myself, i got top surgery. I take testosterone. I got top surgery about twoandahalf months ago, and this is what it looks like. Theres several different procedures. This is a double incision procedure. I can finally show off my wonderful abs. Like theyre really there. But they kind of are. Thats about it, yeah. So this is my chest. Online is a great place for trans people. The internet is the best place you can go to, if youre like scared about talking to anyone. The internet, like tumblr. Oh my god, tumblr. And, um. Just youtube, too. Youtube is like one of the. Thats how i found out i was trans. It was from a Youtube Video that i found a long time ago. Narrator kyle met his friend john in a support group for transgender teens. The online world has helped them learn to pass as guys even without testosterone. When i officially came out as trans, yeah, it took my parents a long time. And my dad, my dad is still having his issues with it. It seems super hard for dads, though. It seems a lot diff. Because its like, oh, daddys girl, that thing. Did that ever happen to you . I dont feel like thats what was up with my dad. I dont think it was a daddys girl kind of thing. I thinit was. I think its just hard for him to imagine like, being able to be born one way and identify as another. I think hes just. Guys arent really allowed to play with their gender at all. Oh yeah. So i think that was more about what its hard for him to wrap his head around. My birth name was gianna. For as long as i can remember, i always felt male. I did come out to my parents as a lesbian sometime around seventh, maybe. You know, i thought, oh, well i seem to wear boys clothes all the time, i feel masculine, and i realize that i like girls, so i was like, okay, i must be a lesbian. That was tough. My dad, he just. He just wouldnt have any part of it. I think he said something to me, he was like, he said, this is not a world that youre going to be a part of. Then when i got to my freshman year, i identified as trans, so i came out to them again as a trans male. At that point i was using pronouns she and her and he said, mom, you know, when you say that, when you say she, it feels like im actually naked and i feel horrible, and i just want to disappear. So i started to say gi. And now he would like to be called john. So i just go between both names still. Still getting used to the process of the name. So its still gi to me, certainly not the gianna from, you know, childhood, but its still gi. And i guess i havent switched over to the john. A little harder for me. I feel, in a sense, like somethings been robbed, right . Like, you know, so my daughters gone, it seems, and is morphing into this other person, but i feel like this may be where it ends up. I dont know. I hope not, but i think theres another way. Theres a whole spiritual side to this, to me. So i pray a lot. You know, and the whole spiritual piece of this is, you know, i just dont believe that this is the right way to go. This is a personal place that im at. I want gi happy. I want, you know, the best life for her, you know, want that life based in how do i put this on the path that god has planned for her, i dont know that this is it. This route, to me, can be an eternal death. She may not see that, but theres a hope that if i can just stay there, you know, show the love, see what happens, and we have to take it day by day. With the upbringing that we had, you know, we were taught that, you know, man and a woman, and a man and a man is bad, and you know, theyre damned, and thats how we grew up. Thats what we grew up thinking. But in time i realized, with regard to my child, this is the way hes felt on the inside for so long. Merry christmas, gi gi. I mean, he could hardly speak when he was pulling on his tights saying, you know, this is not what i want, and this is not who i am. I dont understand how you could be born that way and have that happen, and yet, you know its something that you could be damned for. It doesnt make sense to me. Wave hi, everybody. Say hi. Say hi. I always had a hard time making friends. I think part of it was that i was a very strange kid. I would just feel bad because every day i went to school, i just felt like everybody wanted me to go. Nobody wanted me there. One time, this girl, we were in the girls locker room because we have to change for gym. She just went off on me. She was, like, man, youre an ugly dyke. Youre a lesbian. It just kind of went from shaky, to unstable to almost impossible, is what it felt like. By the end, i was just trying to hang on. I started getting some anger issues in my sophomore year. When i was very stressed out well, sometimes i would break and i would punch a hole in the wall, or kick a hole in the wall, or things like that. I. I would just get so mad. Eventually, i could keep it from all spilling out, but it would instead, it would spill in. I was just drifting off into this very violent. Very violent experience into my head. Sometimes i would think about harming my family. The images would pop up in my head. It got. It got so bad. And thats when i really decided, i feel like a threat to my family. I feel like a threat to myself. I just cant control myself. So very late at night, i went down to my mom. I was just crying. And i said, hey, i want you to take me to a hospital and i want to get locked up. Thats what really motivated me, to know that he was in so much pain, and that i could be causing it. That was too much for me. I just have to support him, and i kind of just have to figure out whatevers going to happen is going to happen, but today he needs me, and thats what im going to do, whatever he needs me to do. You know, i guess im holding out on hope that, you know could this reverse . Theres a possibility. Is this going to move fully forward, and this is where gis going to go . Thats a possibility, too. I just cant make that switch just in. For me, myself. I dont talk about anybody else. Its because its a personal issue, and where youre at. The choice for me is, i just like, i cant go there. Do you want to go to the barnes noble down here . Yeah, yeah, down here. Im on the verge of cross hormones right now. Im excited just to become a woman, to have breasts, to have a beautiful figure, to just be a woman. And i think now with the technology and the hormones, you can actually transform into who you actually envision yourself as. And thats what i think is really amazing. We signed the legal papers on friday, so its all set with the cross hormones, and im really excited. Its really big news and im also just aware of. I feel like youve been waiting for quite a long time. Yeah, a very long time. chuckles and you know, i mean, its interesting. Some people think, how come someone your age knows so well and so clearly, you know, who you are and who youre going to be . And youve known who you are you know, as a girl for so long already that, you know, from my perspective, sort of asking you to wait longer feels more harmful than, you know, than not. The guidelines have always said that cross hormones should start when an adolescent is 16 years old. And thats something that weve been working on with our therapist. He really feels that ariel is ready. Hes asked. Weve gone through, you know, many sessions of therapy. Weve gone through questionnaires. We have to. The endocrinologist has to talk to us, the pediatrician, and were now were at the point that ariel is going to be able to get cross hormones earlier than the guidelines of 16. So, taking this next step of taking cross hormones means something in terms of your ability to have biological children. You know, some transgender adolescents decide to actually postpone, you know, even taking cross hormones until they can store their genetic material. I wouldnt really want to produce sperm. I really wouldnt. Like, i dont want to have a child that way. And it just wouldnt make me feel good. Like, if i had, like, sperm, i wouldnt be happy, like, yay, now i can have like a baby or something. I would just be, like, horrified. You know, its interesting, you said, i wouldnt even want to produce sperm and have a child that way. And i wondered what you meant by that. Like if you meant it would remind you that youre having a child from your boys body . Yeah, yeah. Thats partially. And its also that i couldnt have a child, like, in a girls body. Got it. But you want children . Yeah, i want. Well, of course im going to have children, but im just not going to have them that way. Okay. Mmhmm. Its not like im not going to have a child. That would be like the worst thg ever. But thats a bit painful . Yeah, its very painful. And this. I think about it constantly. Cry about it sometimes. chuckles of course. Its okay. Really sad. Yeah. But my excitement to start the cross hormones completely overrules my, like, despair to just not have a child of my own. Like, that just completely overrides it. Okay. Any other thoughts or questions about that . No. Okay, good. Oh, thats a very nice house. Uhoh. laughing you can build it again. When alex was young, like i would say three or four years old, one of the favorite activities, at least for me, used to be on saturday morning where i would make pigtails in the sunroom, and we would like capture some information on video, and just i was. I was trying to, you know, have a chronology of different parts, moments of alexs life. Youre the best. Thank you, my baby. Every once in a while i still called him karen. Theres like a karen phase in my mind, and then theres the alex phase. So if i was to, lets say, look at a picture of fouryearold, it will be karen. And then if im looking at a picture now, it will be alex. And accidentally, sometimes i call him karen. knocks hi, alex. Im going to wash my hands. Narrator alex and his mom come to the clinic every six weeks for an injection of lupron, the puberty blocker. But today, they are also here to sign a consent form for testosterone. You want to squeeze anything, are you good . Im going to do one, two, three, okay . Okay. It is very, very hard to make the decision to allow your child to take a medication that has unknown side effects. But it becomes a lot easier when youve come to the conclusion that the benefits outweigh the risks. And when you see your child suffer the way i have and struggle, the way we have seen alex struggle, we dont have a choice. I dont feel as though we have a choice. So some of the changes of testosterone are permanent meaning, these changes wont reverse. Okay . Once your voice deepens, theres no going back. So hair loss at the temples and crown. Other thing is facial hair growth and body hair growth, so those are things where, again, if you decided to stop at one point in your life, that hair growth may slow down, but it may not stop. So once your estrogen goes down, theres actually changes in that area, usually thinning and sometimes you can get a little discomfort with that, with the walls of the vagina. Okay . That can increase the risk of sexually transmitted infections. You know there are some transgender men who use that area to have sex, to use the vagina for sex, and some people dont. But, you know, when we talk about increased risk for infections and things like that, thats really related to, you know, if youre using that area for vaginal sex. Okay . So i know, a little bit hard to think about and perhaps not comfortable. Especially at 13. Especially at 13. I hear this, i know. We have to go over this now, and youre like, why do you have to bring that up with anyone . Its not known whether this increases the risk of ovarian cancer, breast cancer, or uterine cancer. So pelvic exams and regular cervical screenings are strongly recommended unless theres been a removal of those organs the ovaries, the uterus, and the cervix. It is very difficult to have a 13yearold in the drivers seat and playing such a big role in this decision. I think that we would both prefer to see alex transition naturally, to live his life as a man without medical intervention, but. And without the need for puberty blockers or cross hormones. But we feel that, you know, we are not experiencing what he is experiencing. So from my perspective, i do feel that testosterone is the right course for alex. Narrator johns father remains opposed to testosterone, but john was hoping he might agree to a smaller step a legal name change. Dad had just come home from a business trip and i said to him, yeah, im hoping to get my name changed. I was hoping that you could sign. And he told me, you know, im just not ready. Im not ready for that yet. I. I did start getting angry but i tried to. Tried to explain to him why i need this. He still said that he wasnt going to sign. Then i got really mad and. Well, i threw a cup at him, a cup of water, and i said to him that hes not my father. I didnt mean that. I know, i know. It pains me that you have to go through that process. Im not unempathetic about that. The bigger piece for me is, i dont know that i am going to be comfortable with this life and the way its going for you. And its just my fatherly concern. Erything else aside, im still at, i dont know that this is the right way because im basing this on love. And i just, in love, for the way im thinking, the way im feeling, i couldnt sign. I said, you know, you say you love him, but it just doesnt feel like love, and if i were john, it wouldnt feel like love. So im just telling you what it looks like from the outside. So, whether he can see it or agree with it, i sort of just laid it out that im Going Forward with giving john his name and trying to do everything we can to get that to happen with or without his okay. I dont know what that holds. I dont know. I dont know what that means. I dont know if we split, i dont know if we. I dont know. I dont know what that means. I care, though. I mean, i would love to keep us together, but i dont know what thats going to do. I mean, i think people have to lisas going to have to make up her mind. Gi will have to make up her mind. If i choose this route, this very well could be it. While i hate that stance theres. I just cannot get off this point. I cant. I cant. I guess. Knowing that ill leave out maybe a year or so. Its kind of a. I hope the tensions dont last you know, because it would be nice to leave out with less conflict, have the family be a little bit more happy, a little more put together. The life we live. Okay, so lets start group now and just a couple of guidelines. Highlight, lowlight. Preferred name and pronoun. And well go this way. Im lia, female pronouns. Im leaving tomorrow to go to arizona for surgery. So, thats cool. applause yeah, i had like a really good like, week and month. I graduated from high school. I was prom queen. Really, oh my god thats wonderful. Yeah. My friend aj, who is gender nonconforming, was prom king, so like it was cool. Oh, i know aj. Aj jonathan . Oh my god, i know aj. Yeah, so were prom king and queen, which was awesome. I graduated from high school having surgery, pretty good. Narrator lia hodson, who just turned 18, is among the first wave of kids in the United States to medically transition with puberty blockers, hormones and now surgery. Walking through a crowd the village is aglow im about to go in for surgery. Its a srs bottom surgery. So ill be getting a nice little vagina. laughs srs means sexual reassignment surgery, or grs, gender reassignment surgery. I think thats what they call it. It drives you crazy but you know you wouldnt change anything, anything. They just kind of put it all inside and invert and sew it all up, and i got new parts. laughs i think, soon as i realized who i was, i was, like, oh, yeah, id like to have the correct anatomy. In my mind, i felt it would. I wanted it to match. It was never really like a question of if i would. I just kind of felt like i would, and it was a matter of time. I dont think that surgerys going to magically change anything in my life. I mean, itll just make me feel more comfortable with my body and myself. I dont want to focus on being trans forever. Its kind of just the little hassle i have to deal with. Id rather just go to college and move on, so be as complete as i want to be, and just start my next chapter of my life, i guess. I dont want to make it my life. I dont want to. I dont really identify as being trans. Im just a girl. Im just myself. And i dont. I dont really like making it a big deal. I feel like a woman. I dont feel trans. I just feel like myself, i feel comfortable, and i feel like a woman. Narrator isaac also fully transitioned, with blockers, hormones and top surgery. Now 19 and a sophomore in college, his perspective has been gradually shifting. I mean, in a way, i very much fit the very typical trans narrative. I decided to transition, i legally changed my name, you know, i started taking testosterone, i got top surgery. But i started realizing at around 16, 17 what a huge, hug decision i had made to embrace this masculine part of myself so deeply. Going through an artificial puberty, you know, i didnt really experience this sort of formative time. And i kind of mourn that in a way because, you know, as much as we all know puberty is that sort of, you know, gross, slimy molding of everybody into a person, and the way that i went through that was, you know meticulously tested and controlled and dosed, and its been good, but i wonder what that experience. Or what role that experience has in a persons conception of his or her gender. And i can never know that for me. You know, none of this is to say that i made any sort of wrong decision or regret transitioning, because it was really painful to be presenting as male and not be on testosterone and not have top surgery. And my mind was real cleared of that sort of pain after that in a way that allowed me to come to this openness, i guess, about my gender. But i think, you know, its become really clear in recent years that any sort of big problems that i thought i would fix by transitioning werent really fixed. I really dont like to use the term regret, although its kind of hard to speak about how i feel about my gender without there being some element of regret, or at least of fear, i think, a little bit of what the implications of the choices that i made are. Im putting a chemical into my body once a week. A im like. And there are very very, very clear effects of that. And im assuming that there are also unclear effects to that. I mean, it is super easy as a kid to hear, you know, these things are irreversible and be like, okay. I dont care. You know, just i want it. Because time doesnt, you know you dont think of time in the same way when youve only experienced a tiny little sliver of it. But i think in the past few years, at least for me, i would at some point like to take a break, at least, from testosterone, because i dont like to imagine that, you know the entirety of the time that i spend on this earth will be spent sort of separate from what my body actually is. Like, i dont really know what it means to be a man in this body, or a man in the body that i was born in, because ive only really been a man in the constructed body. Which i enjoy, and its comfortable, but also its just not really my body. birds chirping humming i do not want any of my boy puberty. I dont want, like, the big hairy legs, or like. The like the body they get, like with all the muscles. I mean, i want to be a muscly lady, but not a muscly man thats like, ooh, strong man. Like, eh. I want to be as close to a girl as i can. Narrator at the age of nine, lia has not yet entered puberty, but daniel has, and he will start blockers in the next few months. We dont have a lot of choices. Its a drug that they say is you know, reversible that, you know, they dont think will do a lot of harm, and so were forced to pick the lesser of two evils in some ways, just because of what we dont know for one of them. But its our sons happiness and thats the bottom line. We want him to be happy. All right, so, let me show you your medicine. So this is testosterone, right . Mmhmm. Okay, so always get in the habit of reading your vial. I wish we can fastforward to, you know, 100 years from now, and then go get the data which is going to be available and being generated, and there would be a better understanding about this gender dysphoria. But we dont have that information. So what we are trying to do is make the best decision possible with the known facts. One, two, three. Aw, you did good. Narrator soon after meeting with the doctors at the clinic kyles father agreed to let him start testosterone. It was the happiest day of my life. Just seeing my dad finally accept me for who i am, it was the best day ever. I need testosterone to be comfortable with myself. And my dad, he keeps saying, im just not there yet. Can i see it down the road . Youre asking me today, no. Im just being honest, you know, so well need to sort through that and talk about that as a family and what that means, but today i dont see it. Its hard for me. Narrator not long after this interview, john was suspended from school for punching a classmate who had just started testosterone. Three weeks later, his father relented and signed the consent forms. Right when she found out she was going to get it, she sent me a text in like. This long, in, like, all capitals, like, save the date im getting the hormones in like all caps with like a million exclamation marks. And it was. Actually, it was, like, kind of exciting for us when she finally said that she was going to get them. Well, i remember the first day, like, i got the hormones. So i walked around my room and touched every article, like every fiber of my carpet and ever like, piece of thing on my bookshelf, and i said im. These are the last things im touching while im a child. And i was, like, Walking Around and, like, touching the entire things. And it was so funny and i, like, finished touching the last snow globe and im, like, now im a woman, and i was just so happy. I already feel like ive gone so far and im only 13, so. Before i just wanted to be a girl, like just a girl, girl girl. But now that ive gotten on my feet a little bit, i want to show people, like, im a trans girl. I mean, if youre sure of yourself, then why do you need to hide it . Theres definitely times where i thought like, okay, well, now that this town knows maybe i could move, so i could just start a whole new life and just be the guy that i am. But some part of my mind sees that as kind of lying to myself. I mean, im never going to be a cisgender guy. Im never going to have been born an actual male. Im always going to have, like that sense in me. And if you lie to yourself, then youre kind of lying to the world. And it puts a lot of weight on your shoulders, a lot of pressure for you. And i think that if i can just clear that pressure off, im alex the transgender guy. These are not families that are living in the shadows anymore. You know, the world is changing. I mean, this is a movement that is happening. Its not going to not happen its going to happen. But the stakes are super high, and we dont have all the answers. There hasnt been a lot of research in this area. Hopefully theres going to be more research and some of those unanswered questions, hopefully, will begin to be answered and then we can give families, like, legitimate options in terms of what were doing now, which is really, i think, approaching families with a lot of unknowns. We are all kind of navigating this new world. I hope that what we will have done is to give them a chance to have what for many of us is natural for us, to appear and live as the gender in which we identify. I also hope that these individuals will be able to give us feedback, both. Both just to tell us and that they will be involved in studies that we can learn what things we did right and what things we didnt, and that it will be even better for the next generation. I really hope that what were doing is the right thing. Go to pbs. Org frontline for more about transitioning at an early age. Just put the pause button on puberty. And check out our special Facebook First series of original stories about growing up trans. When i was younger i didnt really know what transgender was, so i kind of just like, i guess im a guy whos just really feminine. Now that i have friends that actually, like, accept me that are guys, im more myself, yeah. Then tell us what you think at pbs. Org frontline. Next time on frontline. Were in the postantibiotic era. Untreatable infections. They had asked me to sign the papers to let her go, and i did. Drugresistant super bugs. He had some bugs that they had never seen before. Frontline investigates. We are seeing the emergence globally of bacteria that are untreatable. Hunting the nightmare bacteria. Frontline is made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support for frontline is provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant and peaceful world. More information is available at macfound. Org. Additional support is provided by the Park Foundation dedicated to heightening Public Awareness of critical issues. The ford foundation, working with visionaries on the front lines of social change worldwide. At fordfoundation. Org. The wyncote foundation. And by the frontline journalism fund, with major support from jon and jo ann hagler. For more on this and other frontline programs, visit our website at pbs. Org frontline. Frontlines growing up trans is available on dvd. To order, visit shoppbs. Org or call 1800playpbs. Frontline is also available for download on itunes. Mother what are you doing . Possibilities, your day is filled with them. Dance instructor reach up, energy in the finger tips. Collapse. Woman t. V. , play downton abbey. And pbs helps everyone discover theirs. Anytime, anywhere. Father up in the sky, you might see it. Pbs, were with you, for life. Edgar after a 14andahalf hour flight from new york to tokyo, it feels like youve stepped out of a space capsule and emerged on a futuristic planet. At first, the sleek modernity of the city feels familiar. But before you can say konichiwa, you start to notice that many things in japan are not always what they seem on the surface. Its a city of clean lines and striking, modernistic architecture, impossibly polite pedestrians that actually wait for the light to change before crossing the street, and hightech trains that are quiet, fast, and always on time