“It’s too late for the doctor to see you now. She has another meeting to go to. But we do feel bad that you came all this way.” The nurse said in her gentle tone carrying the slightest hint of accusation for being late. Or maybe I just imagined it. “We were going to discuss starting Testosterone for Mitchell. That is what you want isn’t it, Mitchell?”
“Yes!” He replied and lit up with the biggest smile possible.
“Your therapist made a very strong case for you and your level of maturity.” The nurse continued to explain that she scheduled a new date and time to meet with the doctor and immediately after she would go through the injection training with us. She gave us a pile of reading material with a consent form to study over the next three weeks.
Mitchell’s feet barely touched the ground in the parking garage on our way back to the car. I felt like I was trudging through molasses. I had a smile on my face, I said all the right encouraging words, but deep down inside I carried the weight of responsibility. I was about to consent to permanently altering my child’s body.
The Truth of our Children
Mitchell was assigned female at birth. The third of my four children. From the birth of all my children, I felt an overwhelming sense of responsibility for their happiness and wellbeing. I’m sure all mothers do as well. After turning ten, my third child’s happiness was difficult to achieve. Anxiety, social awkwardness, isolation, and depression loomed large for years. I did everything you could imagine to alleviate my child’s pain. I consulted every specialist and sat through hours of psychological testing yet nothing emerged. No diagnosis. No magic pill. My child was just deeply unhappy. As a mother, I felt like I failed.
And then Mitchell finally came forward with his truth.
When he told us he was transgender, and that becoming a boy on the outside to match his identity on the inside would make him happy, I booked another therapist appointment. Ashamedly, I didn’t want that to be the answer. Society at large was not nice to transgender people. There had been states trying to pass laws around what restrooms a transgender person could use. This was not a magic pill solution. This was not something I can kiss and make better.
Because he was insistent, consistent, and persistent, our whole family chose to be affirming. We changed his name and pronouns, his wardrobe, and his room from pink to blue. But his body dysmorphia remained. It was time to involve the medical professionals who started him on hormone blockers. The blockers helped immensely and gave us a few years with our happy sunny child. But for the last six months before starting testosterone, the clouds of body dysmorphia gathered over Mitchell while he watched all the other boys in his class have their voices drop and bodies change. He started to need much more frequent therapy sessions to cope with feelings of hopelessness which precipitated the decision to start cross hormones.
Responsibility and Agency
A friend of mine once told me that when she discussed our family with her brother, he said that I should be in jail for child abuse for allowing my son to transition. I had read similar comments on social media, but it bore an extra sting to hear it from the mouth of someone I knew. Until the nurse made the appointment to start testosterone, Mitchell’s whole transition was reversible. Once you stop hormone blockers, puberty resumes. I could paint his room pink again. We could buy a new dress. That was my out card. I wasn’t responsible for a permanent change, only responsible for making my child happy.
The plan to start testosterone filled me with fear because I felt like I would soon be responsible for altering my child. As if my husband, the doctor, the psychiatrist, the therapist, and most importantly, my son didn’t have a part to play in this decision.
To alleviate the unbearable weight of responsibility on my chest, I sat alone on my couch and played the what-if game. I asked myself, “What if he was born with a congenital birth defect? Would I agree to lifelong medication and surgery?” You bet I would! In a heartbeat. So how was this any different? He was born with the wrong endocrine glands secreting the wrong hormone for his brain. The doctors are giving him the right hormone. Just like a diabetic is given insulin. It’s not that radical when I think of it that way.
In the beginning, my problem was that I thought to be transgender had an element of choice. Not necessarily that my son was choosing to be a boy instead of a girl, but that we had a choice in terms of how fast or slow he transitioned and a choice to “just dress like a boy” vs. medical intervention. It took me living with him through his body dysmorphia to realize that this was not a choice I got to make for my son. We must ask ourselves, at what point does a child have ownership of their own body or life.
The whole experience of parenting is the struggle to choose when to let our children be independent. At what age do we let them cross the street without holding our hand? When do we let them take the bus on their own? When do we let them drive alone? Add to that self-governing in medical decisions. At what age are you comfortable with your child seeing their doctor without you in the room? It may feel like never, but there are rules about when they can legally ask you to leave.
When it came to my son having autonomy in the medical decision to start testosterone, I had to remind myself that he was making those decisions with a medical doctor—a doctor who is using guidelines provided by scientific studies and supported by the World Health Organization definitions and UCSF protocols. My friend’s brother may call it child abuse, but that is an opinion based on his beliefs and feelings, it is not based on science.
I can’t say that I have completely given up my own belief that I am responsible for my children’s happiness and wellbeing, but I am getting better at handing that responsibility over to them. Mitchell is quite clear who he is and what he needs. How many adults can make those claims? By his example, I am spending more time focusing my responsibility on being a good mother by championing for Mitchell and other trans youth and living free from judgments.