Navigating Medical Care – Hormone Therapy

Getting medical care for transgender people can be a challenge. When our daughter’s journey began, her pediatrician was her primary care physician. Unfortunately he did not know anything about medical transitioning, nor did he know of a doctor who could help us. This is an issue in most areas of our country, but it is improving. Most large cities have good resources that are easy to find. In Philadelphia, there is the Mazzoni Center. In New York City there is the Callen-Lorde Community Health Center. Both were trailblazers in LGBTQ health care and support services. Now, many hospital healthcare systems are opening their own centers targeted to providing health care to the LGBTQ community, especially in larger cities.

The farther you live from large metropolitan areas, the harder it is to find care specific to gender transitions. We live about an hour and fifteen minutes from both Manhattan and Philadelphia. That’s a long way to drive for regular healthcare. Depending upon traffic, travel times can double. So we tried to find healthcare closer to home.

Any healthcare provider you choose should be familiar with the WPATH, World Professional Association for Transgender Health, guidelines¹. These are considered the standard of care for transgender and gender nonconforming patients. The first step is good therapy to help provide psychological and social support and to complete, or mostly complete, the social transition. Good mental health care for both the patient and their family are necessary to ensure a healthy transition. I can’t stress how important positive family support is to the mental well-being of your child. Some children and adolescents want to begin the medical transition as soon as possible. A well trained therapist can help you decide the appropriate timing for the various stages of the medical transition.

The first medical transition step is hormone therapy. Hormone therapy provides masculinization or feminization through the appropriate use of male or female hormones. Some general practitioners are trained to provide proper hormone therapy, previously called HRT, or Hormone Replacement Therapy. Other times it is better to go to an endocrinologist who is trained in hormone therapy. Hormone therapy is used to change secondary sex characteristics and is partially reversible. For male to female (MTF) transitions, estrogen causes feminization – breasts grow, muscle tone is feminized, body fat distribution changes and the sex drive is changed. For female to male (FTM) transitions, testosterone causes the growth of facial and body hair, deepening of the voice, changes in muscle tone and the sex drive.

Depending upon how young your child is, GnRH can be used to delay puberty by suppressing the natural hormones in the body. This is a totally reversible treatment to delay beginning the partially reversible and nonreversible treatments. Some statistics show that not all gender nonconforming children remain transgender through adolescence and into adulthood. For Anne, this was not an issue. Her gender dysphoria manifested during puberty and was persistent.

The WPATH Standards of Care for initiating any hormone therapies are as follows:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the Standards of Care outlined in section VI);
4. If significant medical or mental health concerns are present, they must be reasonably well- controlled.¹

Anne’s first physician was an adolescent pediatrician, Dr. R, who included treating transgender patients in her practice. She was the closest physician we could find who could treat Anne. Our therapist recommended her. We had asked the pediatric group and my family practice physicians if they knew of anyone who could provide hormone therapy. Neither practice had a physician trained to provide hormone therapy, nor did they know of other doctors in our community that did. So Dr. R is who we went to – a 30 minute drive from our home. Longer if there was traffic, or during rush hour.

Dr. R was fairly new at treating transgender teens. She worked hard to become knowledgeable about the mental and physical needs of her patients. For MTF patients, both estrogen and a testosterone suppressor (spironolactone) are required. When Anne’s testosterone levels didn’t drop, Dr. R researched options. We even tried a formulary medication that I had to learn to give Anne as an injection. When that didn’t work, she sent us to a pediatric endocrinologist who normally didn’t see patients of Anne’s age (19 at this point), but who would see Anne as a favor to Dr. R. As we were parking for the visit with the endocrinologist, it occurred to me that we should have just gone directly to an endocrinologist who treated adults. In the frustration of trying to find the right hormone treatment levels, and multiple doctor and therapy visits, I messed up. I had gotten into the habit of reacting to each problem as it came up – not being proactive. While we met with this doctor, I asked her if she knew of any adult endocrinologists who treated transgender patients. Guess what – no! More frustration.

Once again, it was Anne’s therapist who helped. There was an endocrinologist in Princeton – about 45 minutes away – who could help Anne. So away we went. After a few months of tweaking Anne’s dosages, the new endocrinologist was able to get Anne’s hormones under control. Finally, Anne had a hormone therapy protocol that worked for her. Initially, Anne was having her hormone levels checked and tweaked every 3 months or so. It took about 3 years and 3 physicians to get her hormone levels figured out, but once stabilized, her checks are just twice a year.

Anne will tell you that as soon as she started hormone therapy, she felt better mentally. She could tell the difference. I’m not sure what the feeling is – only a transgender person could describe it. But this is a revelation from many people who undergo hormone therapy. I noticed another uptick in her affect and mood – she was happier, more comfortable with herself. Each step in our journey just revealed more of our true daughter and confirmed the rightness of her steps to becoming the young woman she is today.

Our therapist was invaluable in helping us find medical care for Anne. Other resources you could use would be area medical facilities with LGBTQ specialities or even affirming policies. If they don’t have an appropriate physician on staff, they may know of one in your region. As you look for health care providers for your child, be prepared to travel and use multiple doctors. For a while, we used our regular pediatrician for Anne’s regular check-ups and urgent care. They are a welcoming practice who were sympathetic to the needs of a transgender adolescent, even if they couldn’t provide the hormone therapy she needed. In addition to the pediatrician, Anne went to Dr. R for hormone therapy, ultimately ending up with an endocrinologist. She now uses the same family practice group that I go to for check-ups and urgent care and the endocrinologist in Princeton for hormone therapy. Just make sure that all of your physicians are open to treating LGBTQ patients with respect and consideration for their needs. Not all physicians are comfortable treating LGBTQ people and can actually cause harm. You may have to really search, but there are caring doctors who have made it a point to specifically help transgender patients.

¹Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version, 2011, The World Professional Association for Transgender Health, www.wpath.org

Making it Official

Once your child/teen/young adult has chosen his/her/their new name, it’s time to use it. Every transgender person’s transition is unique, just as they are. But there are common steps in each journey. Choosing a name, deciding whether to transition only in private or go all in, deciding whether to use gender affirming hormones, and if surgical options are for them.

Our daughter’s transition began privately. She only presented in her true gender at home in the beginning. She was more comfortable waiting until after high school graduation to transition “publicly.” This included changing her name legally so she could live as her true self without having to deal with harassment due to her birth name. For this, the name must be legally changed before official identification documents, such as birth certificates and driver’s licenses, can be update. State issued ID’s are needed to open bank accounts, rent a home, buy a car, and get a job, among many other things.

The process of changing your name legally varies from state to state, but it involves court systems and judges. In NJ, the petitioner is required to submit a petition to the court, pay a fee, and publish a notice of intent in a court designated newspaper. After the change is approved, the judgement must be posted in the newspaper. The whole process takes several weeks, but was rather painless. I recommend purchasing extra copies of the legal certification – you will need them. In NJ, a court date is set, but the petitioner doesn’t usually need to appear; it’s all done by mail. The newspaper posting is required to make sure the petitioner is not trying to avoid debts or hide illegal activities.

Figuring out the name, and gender, change process in your state may take a little sleuthing. The best place to start is the NCTE (National Center for Transgender Equality): https://transequality.org/documents. NCTE keeps up-to-date information about the legal requirements for name and gender changes for each state. On their site, there is a nifty map. Click on your state and a summary of the required steps are shown along with links to the appropriate state and county agencies.

Changing your name can be pricey. The TLDF (Transgender Legal Defense Fund) Name Change Project provides free legal help in a few areas of the US. Their website is https://transgenderlegal.org/our-work/name-change-project/.

Once the official name change certifications are in hand, it’s time to get updated birth certificate, driver’s license, social security card and passport.

Social security cards and passports are federal documents. To update the passport gender marker, a medical certification of treatment is required. This does NOT mean surgery. It means almost any type of transition related treatment such as psychotherapy or hormone therapy. The letter of certification does not need to include treatment details. You can update both the gender marker and the name at the same time. Instructions for updating the gender can be found here: https://travel.state.gov/content/travel/en/passports/need-passport/change-of-sex-marker.html. Passport name change information can be found here: https://travel.state.gov/content/travel/en/passports/have-passport/change-correct.html

Updating the social security system is similar to the passport changes. You need a gender transition certification and a name change certification. If you have an updated passport, it can be used as gender certification for social security. A medical certification from a physician (same format as the passport letter) can also be used for the gender change.

If you have multiple name change certifications, you can do the passport, social security and birth certificate changes simultaneously. The federal changes are simpler. The state ID change requirements for birth certificates vary widely from self-certification to a surgical requirement. Two states don’t allow gender marker changes on birth certificates (Ohio and Tennessee). Different requirements are used for driver’s licenses. It’s generally a mess.

Anne had to go thru the updated birth certificate process twice. The first time for her new name. At the time, she couldn’t change her gender marker because NJ required sex reassignment surgery in order to change the gender marker. This law was changed a couple of years later. As soon as the law changed, Anne submitted the paperwork to update her gender.

Some experts recommend parents of transgender children carry a file of identity paperwork to ensure their child is treated properly. If completing a name change, a copy of the certification should be part of this file. This is especially important in states that are more hostile to the transgender community.

I wish you well as you go through these processes.

Becoming Anne

There are many steps in transitioning, and each transition is as unique as its person. One of the most important steps is claiming a name. Names have immense importance in defining who we are. Our names become us; we become our names. They have so many meanings.

Like parents everywhere, my husband and I took great care in choosing our children’s names. Do we use names of beloved relatives? Do we use a name from a favorite literary character? We made sure the initials didn’t spell a “difficult” word to live with. We both worked in corporate jobs, so we were cognizant of using names that wouldn’t be difficult for adults in a business setting. It’s hard to take someone named Bunny seriously.

So, when our second child was born, we chose a name we both liked. Unfortunately, we didn’t consider that perhaps we had the gender all wrong. We didn’t know anything about gender at the time. Our society has a rigid understanding of gender. It’s easier that way.

When Anne was ready, my husband and I agreed she should be able to choose her new name. Our reasoning was that since Anne had no control over her body, she could have control over her name. As with everything, Anne put a lot of thought into the name she wanted. We also had some fun with it, offering ideas of silly names.

She chose Anne. A strong, feminine, simple name. Nothing flowery – which Anne isn’t. It’s the perfect name for her.

When it came to her middle name, she was having difficulty. So we offered suggestions, and she settled on Elizabeth. I was especially happy with this. Elizabeth was the middle name of my maternal grandmother. Our older daughter, Catie, was named after her too. So Catherine Elizabeth, a woman I admired, a woman who was strong and overcame diversity, lives on in both my daughters.

Trump Administration and Coronovirus Care

It’s been quite a while since my last post. The main reason is that I did not want this blog to become purely political, which is something I was having trouble avoiding for the past 3 years. The current Republican administration has consistently attacked transgender Americans, eroding their rights, and putting them in danger. Now, during the coronavirus pandemic, I can no longer remain silent.

The Trump administration is moving to make health care rule changes that will have adverse, and potentially life-threatening effects to the transgender community. From the NCTE website, they are “moving quickly to pass a rule change that would dangerously and falsely tell hospitals and health care workers it’s okay to discriminate against patients based on their gender or sexual orientation.” They have chosen to proceed with the rule change this month – despite the pandemic.

This means that health care providers can refuse to treat transgender people for any health issue, including covid-19, just because a person is transgender.

This is just wrong! I urge you to help the transgender community by sending a letter to the administration and to the Department of Health and Human Services. It’s easy to do – just click here and follow the instructions.

The National Center for Transgender Equality (NCTE) has more information about this rule change. You can find it on their website post FAQ: Trump Administration Plan to Roll Back Health Care Nondiscrimination Regulation.

https://transequality.org/blog/faq-trump-administration-plan-to-roll-back-health-care-nondiscrimination-regulation

Thank you, and God bless!

#WontBeErased

The events of the last week have been quite disturbing – a white man targeting African Americans at a grocery store, pipe bombs sent to top Democratic political figures, and the murder of 11 Jewish people as they were participating in a worship service.

In the midst of these horrific events, a letter circulating the White House was released which would significantly harm gender nonconforming and intersex Americans (trans*). The administration would like to define gender narrowly – as male or female – based on the gender assigned at birth. You can read the New York Times article here: ‘Transgender’ Could Be Defined Out of Existence Under Trump Administration.

This is just the most recent attack on one of the most vulnerable populations in our country. The National Center for Transgender Equality has a running list of the attacks on the rights and liberties of our trans* friends and family members: Trump’s record of action against transgender people.

The basis behind these actions is fear, ignorance, and lack of compassion. Contrary to Western cultural beliefs, gender is not a simple binary – it is neither simple nor a binary. It’s a hard topic to understand – it takes time and effort to learn about it and then to try to understand this learning. I get it; it’s not easy, especially for those of us in our middle to late years of life. But, because something is hard, doesn’t mean we should not try to learn. Our political leaders (ALL of them), should lead by example – learning, trying to understand, and then sharing their learnings.

The climate for transgender, non-binary, and intersex people is becoming more dangerous. This latest attack would essentially make it legal to discriminate against them. Our federal government will not stand behind them and protect them. They are a vulnerable population that is subject to far higher incidences of violence than the population at large (something I’ll cover in another post). By making gender male or female only, the Trump Administration is saying they don’t care.

As a mother, this makes me very afraid for my child and others in their community. As the deadly events of the last week show, hateful rhetoric can persuade some people to acts of violence, and I fear if this change is made, some will take it as a call to be judge, jury and executioner to those they believe are trans*.

What can we do to prevent this? There are a few things. Contact your senators and congressional representatives and let them know you do not support this change and want them to fight it. The trans* community is small and needs the help and support of everyone.

Let your representatives know you support the Equality Act (PFLAG Equality Act Information). This act would strengthen anti-discrimination for everyone (LGBTQI, people of color, women). The link provided gives a short explanation of the Act and also has a link to the actual bill so you can read it in its entirety.

And finally, vote for representatives who support equal rights and legal protections for trans* citizens. This is more important than any political philosophy or platform topic – it is a very real matter of health, safety, and life or death for members of our community.

I will do everything I can to ensure that my child is not erased.

#WontBeErased

Book Resources

Upon finding out I have a transgender child, one of my first instincts was to learn as information as I could. While transgender humans have probably been around as long as there have been people, recognition of them had very little exposure in the Western worldview until recently. This makes finding information difficult.

After exhausting as many websites as I could find for parenting, I started purchasing books and building a small library about the subject. My first books were those I hoped would educate me about phenomenon and help me know what to do as a parent. But, there wasn’t a lot of written information for parents whose child comes out as a teenager, which I thought was different than for parents whose child came out at a young age. I now know that it is not unusual for gender dysphoria to burst forth in the teenage years. All gender variant teens have to face the same challenges whether they came out as a young child or during their teen years.

The first book I found is Helping Your Transgender Teen, A Guide for Parents, by Irwin Krieger, copyright 2011, published by Genderwise Press, New Haven (ISBN: 069201229X. A second edition of this book was published this year. I have not read the new edition, but based on the preface, and the updated list of resources, this still seems to be a good starting point.

This book was very helpful in learning the basics, the terminology, beginning to learn the complexity of gender, and the steps a transgender teen may want to take if they choose to transition. It’s a short book, simple and straightforward. I recommend it for anyone who’s child comes out as a teenager and who has no experience or knowledge of gender identity. The author is a clinical social worker with decades of experience with the LGBT community, and 15 years experience with transgender youth and families.

A few months ago, a friend gave me The Transgender Teen, by Stephanie Brill and Lisa Kennedy, copyright 2016, published by Cleo’s Press (ISBN: 978-1-62778-174-9). Both women are leaders at Gender Spectrum, https://www.genderspectrum.org/, an organization supporting families with gender variant children. This book is denser, and more detailed than Krueger’s book. It definitely helped to have a prior understanding of the basics before reading this The Transgender Teen.

The authors really dig into gender, gender identity consolidation in the teen years, and congruence which they define as “when a person has accepted their gender identity and feels satisfied with how they are physically and socially expressing their gender.” The goal of the book is to aid parents to help their child achieve both physical and social gender congruence.

The book provides a guide for how to support a healthy emotional and psychological development as gender variant teens travel through adolescence and into adulthood. There are explanations of concrete actions parents can take to support their children. The authors do not address the details of name changes, document changes, and medical interventions, which would complicate the book.

Another plus is the authors delve into non-binary genders, something that is becoming more recognized in recent years. The variations are breathtaking. The explosion of terminology is hard to keep up with.

The authors do a good job of explaining the multiple psychological effects that transgender teens may be experiencing. Things a lay person would not be aware is happening in a person’s psyche such as internalized stigma, internalized transphobia, and minority stress. There is a section about co-occurring psychological concerns (PTSD, eating disorders, etc.) and co-occurring Autism Spectrum Conditions.

The book does get a bit repetitive, but the information I learned was worth working through this. I wish this book had been available 4 or 5 years ago when we were starting our journey.

I hope this is helpful to others supporting transgender teens, and those in their early 20’s. I especially recommend The Transgender Teen to anyone (not just parents) wanting to really understand what psychological stressess are at play for gender variant people.

Reflections on Secrecy – Part 2

Most of the secrecy is over, but the residue is still here. Secrecy doesn’t affect just the trans person – it affects the ones who love them the most and who try to protect them. I’ve been affected by having to keep this secret, and it’s given me some understanding of what my child has gone through.

I’ve thought a lot about what keeping secrets can do to one’s psyche. Months and now years, of thinking about it. Sometimes, keeping secrets is a good thing. Sometimes it’s not. When it causes me to lie to people I care about, it’s bad. I feel guilty. Sometimes, it’s smart – for safety. Other times, it causes confusion. It can make having a normal conversation difficult. Having to stifle my feelings and not discuss them with family and close friends was difficult. When I was worried, scared, or mad about A being transgender, I didn’t have anyone to talk to about it. Keeping these feelings in, burying them wasn’t healthy. I didn’t want to burden my sister, who for a while was the only one who knew, by always going to her for emotional support. She has her own life and issues. She was very supportive, but I didn’t want to over do it.

The months and months of keeping the secret had many negative results. I developed a lack of motivation. Probably due to depression, which is probably due to keeping secrets, among other things.

Communication was difficult. I couldn’t remember what I had told people, what they told me. Sometimes I thought I’d discussed something with A (or others), only to have her tell me I never said anything about that topic to her. And vice versa!

It made me feel disconnected from the world around me. Like I had one foot in the present, but the other was in the realm of being careful of what I said – and thought.

Then, as A started to live more and more as A at home, talking about her became an exercise in being deliberate. Did I use the right name and pronoun for the situation?

And memory – did I mention that? I couldn’t remember things I should have. There were holes in my thoughts. A saying she told me something – and I didn’t remember at all. Searching for words, names of things and people I should know. My memory used to be fantastic. After months of keeping A’s secret, I began to worry about things I had forgotten and was not even aware of them being forgotten. How would I know? This does a number on one’s self-confidence. Like now. I know there were some other good conclusions I had about the effects of secrecy on people, but I can’t remember all of them!

Keeping secrets affected the quality of my sleep. It affected my health. I found I withdrew from friends because it was easier than being constantly vigilant of what I said. I also found conversations difficult if people brought up LGBT issues.

Before coming out to our family, A was nearing high school graduation. She decided a gap year was for her. In fact, A wasn’t even sure if college was for her. This was not something many in our family could understand. My mother wouldn’t accept my explanation, which was partial at best. She kept questioning the decision and offering suggestions about pushing A to go to college. That added more pressure to the situation.

For a long time, I felt like I was floundering. But now, the secrecy with family and friends is over – replaced with a new one. A is living as her true self.

We now live with the more benign secret that A is transgender. And that really isn’t anyone’s business. It’s interesting how this secret is not a problem. It’s not a negative. We don’t have to hide anything from those closest to us, those we love. We don’t have to hide who our daughter truly is. This new secret is just a fact; a fact that isn’t anyone’s business unless A wants them to know.

So, there’s secrets … And then there’s “secrets!”

Reflections on Secrecy – Part 1

Being transgender can involve secrecy – lots of secrecy. Cisgender people dominate the world – and the conversation about gender. Trans children learn early what is acceptable and what isn’t. Children also learn when it is safe to trust, and when it isn’t. Sometimes, adults just don’t pay attention. Sometimes we don’t take children seriously. When our children were young and had questions about their bodies and gender, I answered with what I thought were the right responses – boys have penises and girls have vaginas. Hmm. Turns out that wasn’t a good answer for our family!

What does keeping a really big secret do to a child. My child is transgender. She’s always known she feels like a girl, but her body is wrong for her. I can’t imagine her confusion, the effect on her feelings of worth, who she is, how she fits into the world around her. At some point, she discovered the word transgender, the phrase “gender dysphoria.” It must have been a miracle to her to realize she wasn’t alone. There are others like her.

But it’s a difficult discovery too. Transgender people aren’t well accepted in our society. So now there are other issues for a young child/early teen to deal with. Things they really aren’t equipped to handle mentally. Can they risk telling their parents and siblings? Or will they be rejected and possibly kicked out of their home. What a horrible fear to have to face. The fear of being rejected by one’s family – the people who are supposed to protect their children, to love them, and support them. Children are basically powerless in our world. How much more powerless are transgender children?

And if Mom and Day are ok with them – still love them – what about the rest of the family? Siblings, grandparents, aunts, uncles and cousins are unknowns. Then, the child has to navigate their friends. Facing rejection is so difficult for children. So the child, and often their parents, keep this vital fact a secret. A secret that affects how they interact with others, coloring their relationships with the people in their world. The people that should be the closest to them, those they should be able to confide in, those a person can be open and vulnerable with must be kept at arms length. This is a terrible burden for a child to take on.

If the transgender child comes out in school, the bullying can be horrific. The bullying may be both emotional and physical abuse. And fellow students are not the only bullies, teachers, administrators and parents are just as likely to be bullies. The lack of understanding and kindness in our society forces many transgender children and teens to keep their secret. To hide who they truly are.

Conversely, some go to school in their true self, hiding the physical body that could betray their secret.

Keeping these secrets involves lying. We teach that lying is wrong, but then force transgender children to choose – do they lie about who they are and risk harm? For many, the answer is yes. Does this make lying about other things easier for them? Are we teaching them that honesty is a sham? Our child “borrowed” their sibling’s clothing. Clothes disappeared, and A claimed to not have seen them anywhere. Yet, all along, they were hidden away in her room. So lying about her true self led to stealing someone else’s clothing and more lying. It must have bothered her on some level. She probably felt trapped and scared of being found out. It isn’t healthy mentally to have to live that way.

I wonder if she ever felt that Mom and Dad knew when she was lying, so why haven’t they figured this out? Up to a certain age, young children believe Mom and Dad know everything, even what they are thinking. Did A think we disapproved and that’s why we didn’t talk about it? Or did A think we didn’t love her enough to care that she felt uncomfortable in her own body? Or maybe we were just stupid.

Letting go of the secret has been healing for A. The emotional change has been amazing – happiness, laughter, and a lightness in A’s personality has appeared. It seems like A is becoming comfortable with who she is. My wish, and prayer, is that every transgender child may find peace and safety with being honest about who they truly are.

What are they thinking?

Parents have all sorts of fears for their children and their children’s safety. When your child comes out as transgender, those fears multiply and increase in magnitude. Some fears result from not being able to control the environment our child is in. Early in A’s transition I found myself on the lookout for other people who may be looking at A in an odd way. Did they know my child is transgender? Would they say something hurtful? Would they draw attention to A?

I felt this acutely the first time we went shopping with A in their true gender. Were the other shoppers looking at my child and thinking something was wrong? Was the nice young sales clerk watching A because she thought A looked strange, or was she just keeping track of customers who may need help? It’s overwhelming, exhausting, and just plain scary. Would someone say something nasty or cruel to A? How would I react? I didn’t want to get defensive and be nasty back to protect my child. That would be counterproductive and would just embarrass A.

“A” and I are both artists. A few months ago, we went to a live figure drawing session at the local art museum. When we arrived, there were 4 other artists, the museum coordinator, and the model in the studio. That evening, the model was posing nude. I had some worry that this would bother A because of the dysphoria that transgender people feel. Many are simply repulsed by their bodies. We started about 6:45, and all seemed to be going well. We began with several 2 minute poses, then proceeded to a few 5 minute poses. These go fast, so I was concentrating on my drawing, and not the other artists in the room. The model took a break, and then we did a 20 minute pose. After this, at about 8 pm, A abruptly decided to leave, even though the session lasted another hour and a half. I asked if anything was wrong, and A said no.

The next day, I asked A again about leaving the drawing session early. I thought maybe the nude model may have been disturbing. It turned out that A already felt upset when we arrived at the session. While walking in town earlier that day, A felt that a couple people were looking at A “funny.” Then one of the other artists was looking “funny” at A at the figure drawing session. I was so concentrated on my drawing, I didn’t really pay attention to anyone else and didn’t notice if there was any extra attention being paid to A. This fear is one the transgender person and their families feel. We are sensitive to what other people may be thinking.

Just a couple of weeks ago, we were in the grocery store and another person in the produce section kept staring at A. I found myself becoming protective and more alert. Was this person looking at A with a positive or a negative attitude? I couldn’t tell from their facial expression or body language.

Some may say that it really doesn’t matter what other people think or say. In some situations, that’s true. But the statistics show that the transgender people are both subject to and more vulnerable to violence than the general population. Transgender women, especially transgender women of color, are particularly vulnerable. Tracking crimes of violence specifically against transgender people is relatively new. Even so, in 2017 there has been a marked increase in the number of murders of transgender people. This year to date, at least 24 transgender people have been murdered in the US; this is the same number for all of 2016. Many were targeted just for being transgender.

The current political climate has signaled it is ok to discriminate against transgender people, and the Trump administration has rolled back legal protections. With the change of administrations in January, there has been an increase in hate crimes of all types in our country. Our legislative branch is not stepping in to correct this issue. In fact, the far right is working very hard to perpetuate legal discrimination toward transgender, and LGBQI people. Several judges with a history of antagonistic and hateful treatment of LGBTQI Americans have been nominated for federal judgeships. These are lifetime appointments and will affect the judicial climate for decades. One has even said that transgender children are proof that “Satan’s plan is working.” It is abhorrent that a person who is willing to attack young children – not protect them – is being considered for a federal judgeship. There is a vacuum of moral political leadership in this country.

So right now, it does matter what other people think. It matters what they say. Transgender people don’t have the luxury of just being themselves in public – something cis-gender people take for granted. Those of us with transgender loved ones also walk in fear. It’s hard to know if A was right about the other artist or what the person at the grocery store was thinking. Maybe someone did notice A is transgender and stared. Maybe we were being overly sensitive. Even if others notice A is transgender, it doesn’t mean that they intend to cause harm. Many people are supportive of our transgender family and friends. We’ll never know. We do know that we need to figure out how to handle these situations, worries, and feelings in the future. We have to figure out the balance between healthy caution and awareness of our environment and being overly fearful to the point it affects our well being.

Support – Websites and Groups

There are several established groups that provide resources, educational materials and support for parents and families of transgender youth.  There seem to be more groups for parents with young transgender children, which is a good thing.  Unfortunately, their resources don’t always help if you have a child who comes out in high school or college.  While I was searching for information in the early days of our family’s transition, I often wondered if my child was going through a phase or being influenced by friends or popular culture. I found lots of information about young children being adamant about their gender at an early age, but almost nothing about kids coming out as teenagers and young adults. This fed my worry and misunderstanding of my child’s gender dysphoria.

It’s ok to wonder about this – none of us wants to feel like we are the only ones going through this. We want to know that other people are experiencing the same thing – it’s how we know it’s something to be expected. Funny thing is – this is how young people with gender dysphoria feel. All around them, society tells them what it is to be female and male. No one looks, acts or feels like them. It’s given me a tiny inkling of what my child felt. Questioning if they are truly transgender because they didn’t follow the “normal” path of coming out as a young child.

The first site I would recommend that parents and families visit is PFLAG, Parents, Friends, and Families of Lesbians and Gays at https://www.pflag.org/.  PFLAG has local chapters all over the country run by local parents and and relatives of members of the LGBTQI community.  One of the chapters in my region has a separate group just for families with transgender loved ones.  PFLAG has several helpful publications, some of which are free to download, others may be purchased for a nominal fee. In the beginning of our journey, Our Trans Loved Ones and Guide to Being a Trans Ally were very helpful publications, and a source of comfort to me.  Full disclosure – I am not an active member of my local group.  Because of other commitments in the evenings, it is difficult for me to make the meetings.  The information on their website has been extremely helpful to me and I encourage anyone with questions to wander through their site.

If your child is younger, a good resource is Gender Spectrum at https://www.genderspectrum.org.  By the time A began transitioning, this group didn’t really apply to us. “A” went stealth her last two years of high school.  But if your child is out and transitioning, then their resources regarding school are very helpful.

Once you’ve begun to accept the new complexion of your family, you’ll, probably want more information about transitioning.  Your teen will be well ahead of you at this point, and will probably want to jump right into their transition.  Patience – for both you and your loved one – is the key.  Transitioning takes time – a lot of time.  There is the social transition, medical transition, and legal transition.  It can be confusing wading through it all.

The standards for medical care for are set by WPATH, the World Professional Association for Transgender Health. Any mental or physical health provider you choose should follow the protocols set forth by WPATH. The website is geared for medical professionals and also provides some resources geared for patients and their families. The information relevant to patients includes the accepted standards of care, links to providers of care (of all specialties), research information and links to other key websites.

The Center of Excellence for Transgender Health is run by the University of California, San Francisco and has vetted information on their site http://transhealth.ucsf.edu/trans?page=guidelines-legal. They cover all aspects of transitioning with links to care providers around the country.

The National Center for Trans Equality is a good resource for name change guidelines at http://www.transequality.org. The organization is an advocate in Washington DC providing a voice for transgender equal rights. Their ID document section is an extremely useful resource for the process of legally changing both names and gender markers. They keep up to date with the laws in each state and at the national level. Simply click on the ID Documents tab then choose your state of residence. There will be links and explanations of what is needed to make the changes on all of your loved ones documents – birth certificate, drivers licenses, passports, social security cards, etc. There is not a national standard at this time for what changes are legally allowed and how to go about obtaining them.

Another good resource for name change help is the TLDEF or Transgender Legal Defense and Eucation Fund. Their Name Change Project provides free legal assistance to transgender people with limited financial resources obtain the documents they need – at this time they are able to help residents of Chicago, Milwaukee, NYC, Philadelphia, and Pittsburgh and their respective surrounding counties.

There are several other websites with support resources and information. Wading through it all gets confusing, so I only offer this short list now – these are the sites I keep returning to for information and guidance for transitioning. I’ll include links for these and other sites on a separate page with the intention of periodically updating the list for accuracy.

My best wishes to all who are helping a loved one transition. We’ve completed the legal name change and the social transition and have embarked on the medical transition. This is more complicated – adjusting A’s hormone levels has been difficult. Even after 2 years, they aren’t responding to treatment as well as our doctor would like. We’ve also begun investigating further medical interventions. Like many processes that are long and slow, I wish we were already at the end with a healthy, content child (young adult actually!).