Learn more about the Transgender Youth Program at the University of Vermont Medical Center. 

Set of gender symbols with stylized silhouettes: male, female and unisex or transgender. Isolated vector illustration.

Donna Purl is a Vermont resident.

Donna Purl is a Vermont resident.

“Hi, I’m Donna, and my younger son is transgender female-to-male.”

This is how I introduce myself at the transgender parent support group – a small group of parents who get together to talk about the changes in our lives. The parents come in a variety of flavors – disapproving, bewildered, confused, gung-ho and matter-of-fact — but we are all afraid. Our children are on a path we haven’t experienced. How do we get them the care they need? Re-enforce their self-identities to let them grow into the persons they decide to be? Know what is a transgender issue, a mental health issue, or a teenager issue? Keep them safe long enough to grow up? Teach them to identify potential dangers, so that they can learn to protect themselves? Hide our fears? Not scare them, so they can just be kids? Show them how proud we are?

A Mother’s Reaction

My fifteen year old son, Nick, came out as transgender female to male eight months ago. I cried for three days. Apparently, it’s not an uncommon reaction, according to the Internet. However, my reasons for crying were different from the accounts that I read. I was not mourning the loss of a daughter — I had never had a daughter — nor, the loss of dreams of a huge wedding, which I had dreaded. Nor, the loss of the possibility of grandchildren; modern medicine had solved that issue. No, I cried in terror. By making that announcement, my baby had become an object of hatred. He could choose either to live in hiding, or to live with a target on his back. My eyes had seen too much hate not to know what his future may hold. True, society is becoming more accepting; however, that acceptance takes a long time and a lot of injuries. So, I cried. I was terrified and worse, I felt powerless and ignorant. I knew that I would not be able to protect him from the dangers that would come. He, blissfully surrounded by the blanket of teenage invincibility, told me that he’d be fine.

Finding Health Care

My next reaction was to research. I spent most of the next week gathering any information I could find from the Internet and talking to people with relevant experience. I ended up confused. Most of the information I found on the Internet pertained to female-to-male transitions. The rest seemed out-of-date or anecdotal. Also, scary. I wanted facts and figures. I ended up getting the most help from my son’s pediatrician. We learned what procedures were necessary for treatment. Within two weeks, we had appointments with a pediatric endocrinologist, a reproductive specialist, and a transgender therapist. The recommended treatment for Nick is ongoing talk therapy, puberty blockers until he reaches an age when treatments can be done, fertility preservation, testosterone injections, breast reduction surgery, a hysterectomy with ovary removal, and, eventually, a penile construction.

Telling Family

Then, we told friends and our families – very large families. My parents are religious zealots. My husband’s parents are traditional Catholic. I was understandably nervous about their reactions. Nick’s friends were unfazed. The grandparents were very supportive and unsurprised. My dad said that he had expected the announcement sooner. My brother had had a bet riding on the timing of the announcement – he lost, having put the announcement a year later. My mom was immediately concerned about Nick’s safety and suggested martial arts lessons. My worrying was for nothing. At least, the acceptance worries…

The Costs of Transgender Care

As it happens, having a transgender child is expensive – medical bills, new clothes, new activities, bedroom redecoration, etc. Having become male, Nick rejected anything that was remotely feminine from his possessions. That was an expensive month. However, the cost of medical care dwarfs the cost of the lifestyle changes. The estimated cost for a female-to-male transition, as near as I could calculate based on the extensive research I did, is about $250,000. In Vermont, medical insurance covers transgender-related medical expenses. However, my husband is employed by a company based in Maine. His employer’s medical insurance specifically excludes transgender care. Puberty blockers cost $10,000 per dose. Nick needs a dose each quarter until he may begin transition. We had to apply for Medicaid disability benefits for Nick to be able to get him any transgender care. It was humiliating. Also, applying was a confusing and long process. The approval took more than four months. And, we are still unsure as to what Medicaid will pay for. The money worries and insurance hassles have been the worst, so far.

The Easiest Change

Oddly enough, the change that might seem to be the most difficult – the mental change of having a son versus having a daughter – was the easiest. This change seems huge, but I simply changed pronouns. I had some difficulty saying “younger son” instead of daughter. There is no difference in my child. He is the same – same likes, dislikes, and behavior patterns. Eventually, he will look different. I will be there during the transition. But, for now, he is the same. And so, the change is small because, as I mentioned earlier, I never had a daughter, in anything but words.

Nick’s Story

My background is in Elementary Special Education, and I was raised in the San Francisco Bay area. I had definite ideas about how my children would be  raised. My primary goal was to allow my sons to choose the person they would grow to be with as little interference from stereotypes as possible. Also, I tried to teach my sons from the outset that people come in a variety of shapes, sizes, gender, orientations, colors and abilities; with everyone being of equal importance.

One of the things I did to work toward these goals was to keep “gender roles” and “body image” out of their lives as much as I could. The kids had dolls, trucks, art supplies, building toys, make-up, princess costumes and super hero costumes. I didn’t tell them how to play with the toys in an effort to limit the transfer of gender role stereotypes. I discouraged Barbie, Bratz, and WWE toys because I think that those types of toys teach a distorted view of the body. I monitored their TV watching and video games. I even asked relatives to watch how they spoke to the children. No one told Nick to sit still like a “polite young lady” or called him a “little princess.” I informed a few family members that pudgy bellies on a child are fat storage used for later growth, not obesity. Maybe I over-parented a bit. Anyway, some of my ideas panned out and some didn’t.

Nick was a normal baby, healthy and doing everything at the average time. He wore cute baby outfits with hair bows on what little hair he had. I let his hair grow, hoping for long waves to put into pony tails. When he was eighteen months old, he cut his hair completely off. Thereafter, anytime his hair was long enough to touch his neck, he picked up the scissors. When he started to dress himself, he chose his brother’s hand-me-downs rather than his traditional feminine clothes. Nick would dress up like Superman. He then dressed the dog up like a princess, so that he would have someone to rescue. There were no tea parties while Nick was growing up, there were Nerf gun wars with forts made from sheets and yarn. His room was decorated with Buzz Lightyear and dinosaur decals. He and his brother used the play kitchen for a pizza delivery service or mission control. Nick’s baby dolls went on Amazon explorations and missions to the Moon.

Problems started when Nick started to preschool. It became apparent that Nick had severe ADHD. Also, the kids had segregated into boys and girls. Nick was not welcome in the boys group. Nick didn’t fit in with the girls. He got into a few fights with the boys before the boys decided to play with Nick. Nick told everyone that he was a boy. Halfway through the school year, the preschool teacher called me at work complaining that Nick would not stop going into the girl’s bathroom. I had to explain to the teacher that Nick was technically a girl.

During the spring of the second year of preschool, Nick announced that he had decided to be a girl in Kindergarten because people weren’t nice. So, he grew his hair. That being the main difference between a boy and girl. This long hair/feminine phase lasted less than six months.

From first to fourth grades, he continued to have social problems, and his mental health issues developed. He started to identify himself, in public, as a girl who preferred short hair and sports. In first grade, the girls physically threw him out of the bathroom. Once, when a girl told him that he was wearing a boy shirt, he replied, “No, it’s a Superman shirt.” He wasn’t invited to many birthday parties. There were countless slights and insults because he was different. He had to prove himself to the boys repeatedly to be allowed to be part of the group. He wasn’t allowed to join Cub Scouts. He tried Brownies, but refused to go back because “there are girls there, Mom.” He had to be on girls’ teams for sports, but he played too rough and too competitive. He developed a terrible stutter and anxiety disorder. He saw a child psychiatrist twice a week in third grade. He was bullied horribly. He became an outcast at school.

In fourth grade, he started a new school in a new city, and he made another attempt to be female. This one lasted four years. He grew his hair to halfway down his back. He wore traditional feminine clothes to school, except for Superman and dinosaur shirts. He got his ears pierced and wore earrings. And, he started to befriend girls. He became part of a circle of girlfriends – a hanger-on, not a central member. However, he had friends for sleepovers and going to the mall. He played on the school basketball team. And, he mentally unraveled. He began seeing a talk therapist in fourth grade. We added a family therapist in seventh grade. As his mental health deteriorated, children started to pick on him again. In eighth grade, he came out as bi-sexual. I didn’t think it was noteworthy, most people are bi-sexual. However, some school kids bullied him. Some of the member circle of girlfriends avoided him. He started to self-harm and have violent outbursts. He went to stay in a group home for intensive therapy. When he came home, we decided to homeschool him for the rest of the school year. Away from school, the pressure of grades, and his school friends, he was healthier.

After Nick came out as transgender, life didn’t dramatically change. He has a few more happy days. His friend group gradually changed to be mainly other LGBTQQA kids and/or other kids with mental health issues. However, his overall mental health has not improved. He is still homeschooled. He is no more eager to chores or schoolwork. He is the same teenager with the same drama –tantrums, tragedies and triumphs.

Learn more about the Transgender Youth Program at the University of Vermont Medical Center. 

Donna Purl is a Vermont resident.

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