Transgender At 10

People move to Portland for all sorts of reasons—a new job, the pace of life, the outdoors. Albert and Leigh came for an entirely different purpose.

Three months ago, they left the Everglades and their extended family because they have a 10-year-old daughter who was born a boy. And they were convinced that Portland was the best place to raise her.

Their child, whose name has been legally changed from Reed to Lynne, is a hyper kid with a wide grin and gangly limbs.

One minute Lynne dangles from her mother's neck, the next she sucks down tubes of fruit-flavored yogurt, swings from the ledge of the family's living room loft and chases their Jack Russell terrier, Storm. Then, laughing, she shoves a stuffed animal into the frozen jaws of a taxidermy alligator head her family brought with them when they moved from Florida.

Lynne collapses on the couch, exhausted, her gangly tanned legs and knobby knees stretched out on a makeshift coffee table. Her long brown locks hang in the classic unruly tangle of youth.

Albert looks at his daughter, slouched carefree on the couch watching cartoons after an afternoon swim in the Columbia River, and his eyes well up. He almost lost her in his determination to force his son to act like a boy.

"It got to the point where she didn't want anything to do with me," Albert says. "I had this expectation. I was going to make sure we would change this."

Seven years ago, few mainstream doctors could have told Albert and Leigh what was really going on when their toddler began showing a strong preference for dresses and dolls.

"There just hasn't been much focus on it before," says Caitlin Ryan, director of the Family Acceptance Project at San Francisco State University. "We've had 60 years of research on sex orientation. Maybe five years on gender identity research. On children, we've had even less."

But in the past few years, American medicine has transformed its attitudes about helping kids express their true gender even as research is still in its infancy.

And Portland is becoming a hub for families like Lynne's. 

Oregon is one of only a handful of places—including California, Washington, D.C., Colorado and Vermont—that bans private insurance companies from outright exclusions of transgender care. That stems from a 2007 state law banning discrimination against transgender people. 

This June, the Randall Children's Hospital at Legacy Emanuel launched the T-Clinic, where pediatric endocrinologist Karin Selva sees dozens of transgender adolescents. She's enlisted the help of psychologist Laura Edwards-Leeper, who developed the country's first protocol for assessing transgender youth.

Edwards-Leeper hired on at Pacific University in 2012 and hopes to develop a training program on transgender youth at the university's School of Professional Psychology.

"Most people don't get it. Dealing with school, telling their friends, parents, teachers, figuring out which bathroom to use," says Edwards-Leeper. "Portland is a great place for this."

Even in Portland, the practical difficulties for parents raising a transgender child are daunting—maybe the most challenging parenting imaginable. But first comes a tremendous leap of accepting something your own eyes tell you isn't true. It requires faith: a trust in the word of your child. 

Medicine has advanced at a rapid pace, but a father's feelings aren't so easy to change. 

Albert had to travel a lot further than 3,000 miles before he got in the car.

Albert and Leigh agreed to talk to WW as long as the newspaper didn't use their full names.

Albert grew up in Miami in a large Puerto Rican family. He joined the Coast Guard out of high school, then took a job as a dispatcher with the Florida Highway Patrol. During his free time, Albert—with thick arms and strong legs—and his buddies dressed in camouflage, hunted alligators, drove airboats and posed for photos with boa constrictors draped around their necks.

"He's a man's man," his sister-in-law Nicole explains.

He was also raised a conservative. It doesn't matter the candidate; he voted red.

He met Leigh when they both worked as dispatchers for the Florida Highway Patrol.

Albert and Leigh married at a small ceremony with Leigh's young son, Christopher, by their side. After two miscarriages and a high-risk pregnancy, they gave birth to Reed in June 2004. 

As soon as Reed could walk, he tottered into his mother's closet, pulling on T-shirts as if they were dresses and climbing into her high heels. 

He swapped out his blue pacifier for his cousin's pink one and developed a fascination for mermaids. During weekly trips to the Super Wal-Mart near their home, Reed would pull princess dresses from the racks. 

“We couldn’t keep his hands off anything that sparkled,” Albert says. 

Albert finally gave in and allowed the toddler to hold girl toys while he sat in the shopping cart. But at the checkout counter, Reed would scream and kick as Albert pried a Disney princess doll from his son's hands.

They thought it was a phase—at first. They had no daughters and no girl toys in the house, but Reed would find anything feminine, including Leigh's pink Nike running shoes. When he visited his girl cousins, he played with dolls and dressed in their princess costumes. 

Leigh wasn't concerned. 

"Maybe because it was a difficult pregnancy, and I knew I wanted him no matter what," she says. "Maybe that made it easier. I wasn't embarrassed. I wasn't ashamed. Even going to the store and buying the things he liked, that didn't bother me one bit."

Albert, however, was embarrassed and grew increasingly frustrated.

"I didn't want people to think I was encouraging that or causing that. I didn't want people to think it was because of us," Albert says. "I started to push back, you know? Enough’s enough.” 

By the time Reed turned 3, Albert had banned the color pink, dolls and dress-up. But Reed was already declaring to family and friends that he was a girl.

"I said OK. If he turns out to be gay, OK," Albert says. "But thinking he's a girl? How do you do that? Am I going to send my boy to school in a dress?"

About one in every 450 Americans identify as transgender, according to a 2011 study by the Williams Institute at the UCLA School of Law. 

Even today, "the medical community knows very little about transgenderism," says Dr. Jack Drescher, a distinguished fellow of the American Psychiatric Association. For many years, the Diagnostic and Statistical Manual of Mental Disorders included a condition called "gender identity disorder," classifying it as the discomfort a transgender person feels in his or her body.

Last year, a panel of experts at the APA considered removing the diagnosis from the DSM, as happened with homosexuality in 1974. Instead, they changed the name to "gender dysphoria" but left the diagnosis in place.

Drescher says that the name change was an attempt to destigmatize the condition. "For the DSM, 'do less harm' meant changing the language and keeping the diagnosis in so people still have access to care," he says. "If it's taken out of DSM, no one would pay for treatment. Without a diagnosis code you can't get hormones, you can't get surgery."

It might seem hard to believe that a preteen, let alone a 2-year-old, would know what gender is or how it is expressed. But the rapidly emerging scientific consensus is that they do.

For Halloween 2007, Reed, then 3, wanted to be a princess. His parents forced him into a Mr. Incredible costume. 

That night, the family gathered at Leigh's sister's house in Lake Worth. Reed followed his cousins upstairs. Later, he walked back down beaming, twirling and proudly parading in a Sleeping Beauty costume.

Everyone stared—not at Reed, but at Albert, whose heart was pounding. "I knew they were all looking at me," Albert says. "I didn't want to react."

Not long after, Leigh watched a taped episode of 20/20 featuring transgender kids, and finally realized her son's "condition" had a name.

“It was so identical to our story,” Leigh says. “We’re not alone, we’re not the only family going through this.” 

One of the people interviewed on the show was Dr. Marilyn Volker, a sexologist who worked with transgender youth and lived just 20 miles away, in Hollywood, Fla. Leigh made an appointment.

"I was scared," Albert says, after he had watched the show and agreed to see Volker. "I knew I needed to know more. I was blaming myself: Did I allow him to play too long with dolls?"

When Reed, his older half-brother, Christopher, and their parents arrived, Volker asked Albert and Leigh to stand aside in a low-lit corner of the office. 

On the other side of the room, a long couch was lined with dolls of all sorts. On one end slouched Chuck, wearing sunglasses and an Army hat. On the other end sat Star, a doll with long silver sparkly hair. Volker asked both children to choose a doll that they thought best represented them, a doll they could keep forever. 

Christopher chose Chuck. Reed beelined for Star.

"At that moment I realized Reed was hardwired," Albert says. "I realized this wasn't a phase. But I still didn't know what to do."

Volker suggested that they allow Reed some time to express himself. Back at the house, they sat down with Reed and explained the rules.

"We're going to give you two hours a day to dress however you want," Albert told his son, forgetting to mention that such self-expression needed to remain indoors. "You can play with whatever you want."

Reed, then 4, bolted from the room, changed into a dress and headed for the front door. He was halfway down the block before Albert could start after him.

Albert ran down the street, yelling, "No! No!" Then he realized he was drawing more attention to himself. A neighbor, working in her garden, walked over.

"I didn't know you had a little girl," she said.

One morning, Albert and Reed were engaged in what had become a routine battle: what shirt Reed would wear to school. He wanted to wear a girl shirt. Albert said no.

Reed fought has hard as he could. He kicked and bit and scratched his father.

"When I finally got the shirt over his head, I forced it over his head, the fight just left him," Albert remembers, blinking back tears. "He seemed defeated. His body went limp, and he looked up at me."

"I hate you," Reed said.

"What I was doing, it was a form of abuse," Albert says. "I felt helpless. I was really lost."

That fall, Albert told Reed that, for Halloween, he could dress as whatever he wanted.

Reed wanted to be Mulan, the Chinese princess who disguises herself as a male soldier to save her father's life. Reed picked out a costume complete with gown and black wig. Leigh powdered his face and drew on red lips. 

"It was really awesome," Lynne now says through a grin. "I got to be who I wanted for once. I didn't have to be Mr. Incredible."

That night, Reed's parents watched him race down the sidewalks, visible in the dark only by the blinking pink LED lights of his plastic princess sandals.

“He was so happy, it was like exploding rainbows of happiness,” Albert says. 

When Reed turned 6, the family moved to a new town so Reed could start first grade as a girl, at a school where no one knew she had been a boy. 

Their daughter suggested names that made Leigh and Albert cringe: Star. Sparkles. Rainbow Girl. They were relieved when she settled on Lynne.

Lynne says she felt better when people began calling her by her new name. The old one "makes me think of something weird,” she says. 

That summer, Lynne's parents petitioned the court to legally change her name. 

"I knew it was the right thing to do, but I had these expectations," Albert says. "I felt like I had lost a son."

Leigh nudged Albert out of mourning. Albert had never taken Lynne out in public as a girl, so Leigh suggested a father-daughter day at the beach. His fear was swept away by his little girl's delight. She splashed in the waves and ran in the sand.

"It was the first time she was happy with me," Albert says.

Albert finally accepted that his son should have been born a girl. But they hadn't yet considered the logistics of their daughter's transition.

Once Albert and Leigh had begun the steps to support their daughter, they realized there was so much they didn't know about the law, about medicine, even proper terminology. 

So, in May 2013, Leigh and Albert attended the Philadelphia Trans-Health Conference. That's where they met Jenn Burleton.

In 1994, Burleton relocated to Portland with her partner, and in 2010 used $6,000 to launch TransActive from the basement office in a strip mall on 122nd Avenue in Southeast Portland. 

Today, she's one of 12 volunteers (they have one paid staffer) who work with families across the country, including 350 in the Portland area, on a budget of less than $100,000 a year.

Children and parents nationwide reach out to TransActive confused, angry or excited. The staff help children come out to their parents, help parents understand their children, and intervene with schools, employers, police and the courts.

Burleton was in Philadelphia last year speaking about insurance coverage and transgender health when Albert and Leigh sat in on her session.

Leigh and Albert realized during the Philadelphia conference they had some choices to make and they had to make them soon. Lynne would need pubertal suppressants within a couple of years.

Without them, Lynne's voice would dip lower once puberty began. Her facial hair would grow and an Adam's apple form. Her shoulders would broaden, and her hands and feet grow larger.

The effects of the suppressants are reversible—all Lynne would have to do is stop taking them.

Around age 16, Lynne might move forward with hormone therapy—an irreversible treatment that would protect her bones and allow her to go through female puberty.

Pubertal suppressants would cost about $1,000 a month. Hormone therapy would be cheaper, anywhere from $50 to $300 a month. And genital reconstruction surgery—if Lynne chose to have it—could cost $15,000 to $25,000.

They couldn't afford to pay for treatment on their own. That's why Oregon started to look so attractive to Albert and Leigh.

Advocates here have won a patchwork of policy battles since 2007, when the Legislature passed an anti-discrimination law that included protections for transgender people.

In 2012, the Oregon Insurance Division banned insurers from discriminating against transgender patients. A few months later, the Public Employees' Benefit Board agreed to provide an inclusive policy.

The Oregon Health Plan will begin in October to pay for costly puberty-suppressing drugs, but still doesn't cover other transgender-related medical procedures. That's expected to change as early as next week, when the Health Evidence Review Commission meets to consider updates to its coverage. The state estimates the annual cost to cover these therapies at less than $300,000 out of a total two-year budget of $9.7 billion.

Those legal and insurance protections led Albert and Leigh to decide that Oregon would be their new home.

At the time, Albert was working for a large company with offices around the globe, including one in Portland. He hadn't told anyone at work about his daughter, so he was nervous as he sat down with his boss to explain that he was seeking to relocate. 

"I'll back you up," his boss said to Albert's surprise. "Put in for a medical transfer."

They set out for Oregon in May with barely enough cash to make the trip and are now settled in to a North Portland rental home in high spirits.

"We're in a good place," Albert says.

Albert and Leigh are looking into summer camp and school sports, things they've avoided until now. They had wanted to shield Lynne from difficult conversations or unwinnable fights.

Lynne will begin fifth grade in the fall, and even with Oregon's laws that protect transgender youth from discrimination and polices that ban bullying, her parents worry whether teachers will be accepting and aware.

Leigh and Albert know they can't protect their daughter forever. Even if no one else can tell her apart from other girls her age, Lynne feels different. And some day, as in every child's life, she'll get hurt.

Portland may seem like a liberal mecca, but psychologist Laura Edwards-Leeper says the majority of area adolescents she sees have experienced depression, anxiety, bullying and harassment. Transgender kids still get bullied in Portland-area schools, studies show.

Lynne doesn't talk much about feelings, even to her parents. Instead she does it with her body language. She looks down, changes the subject, shrugs. She likes to make new friends, but as she grows closer to other kids, she pulls away, afraid they will find out and reject her.

"There's still a yearning to be considered who she is," Leigh says. "She doesn't have sleepovers. She doesn't walk into a bathroom without being concerned. We haven't entered her in sports. So her desire is probably to be able to exist without that fear of someone rejecting her when they learn the truth."

Albert thinks about those times he forced her to act like a boy, when she fought him with fists, feet, nails and teeth.

"She's a fighter, and not all kids are like that," he says. "She yelled and yelled and didn't lose hope. She didn’t buckle under the pressure.” 

Medicine Transformed

Dr. Karin Selva has treated a lot of kids with diabetes as an endocrinologist at Randall Children's Hospital in Portland. But in 2011, she met one young man whose health was failing in spite of treatment. 

“When he came in, everyone was worried about him,” Selva says.  

His hair hung over his face. He wouldn't look up. Then he disclosed that he felt like he was born in the wrong body.  

"We had started hearing rumblings about transgender youth," Selva says. She connected the youth with a mental health professional and eventually placed the teen on hormone therapy.

“Every time we saw her, she was brighter, more interactive, laughing,” she says. “She got her GED and was making friends.” 

Word quickly got out that Selva treated transgender kids. 

Medical intervention for transgender youth is so new that until 2007 there wasn't a single children's hospital in the country that formally addressed the need.  

Since then, medical advances have been swift. 

The nation's professional association of endocrinologists established best practices in 2009 that included prescribing puberty-suppressing drugs to preteens followed by hormone therapy beginning at about age 16. 

The American Academy of Child and Adolescent Psychiatry echoed these recommendations in 2012. And while experts disagree exactly when teens should begin hormone therapy, which can cause irreversible changes, they do agree that prescribing suppressants when puberty hits is a safe, reversible therapy to buy kids time. 

Last year, at the request of a panel of endocrinologists, U.S. News and World Report, for the first time in its hospital rankings, assigned additional points to hospitals that have programs designed to meet the needs of transgender youth. 

Boston endocrinologist Norman Spack opened the nation's first clinic to treat transgender children at Boston Children's Hospital in 2007. 

"By putting puberty on hold, this buys them four to five years so they can work it out, live without feeling their bodies are running away with them," Spack said during a 2013 TED Talk on the topic. "With hormones they looked beautiful. Normal. You would never pick them out of a crowd.” 

Last fall, Selva approached Sevket Yigit, medical director of pediatric endocrinology at Randall Children's Hospital. She wanted to start a clinic especially for transgender kids.  

Yigit was aware of studies that showed soaring rates of depression, drug abuse and suicide among transgender youth. The San Francisco Unified School District, for example, surveyed middle-school children in 2011 and discovered that 50 percent of transgender kids had attempted suicide, compared to 6 percent of straight youth. 

A more hopeful study suggests that number can change: 92 percent of gay and transgender teens who had very accepting families said they believed they could mature into happy adults.  

Yigit helped Selva secure $25,000 in seed money from the Randall Children's Hospital Foundation.  

"If we treat them early, then when they're adults, no one needs to know," Selva says. "I don't want them to be known as the man in the dress, where they have to shave and wear a wig. I want them to live normal, happy, fulfilled lives." KATE WILLSON.

WWeek 2015