“I’m sorry, ma’am, but we can’t see that patient today,” the receptionist said.
“What do you mean?” I asked, trying not to panic. I pulled Max and his little sister, Lulu, out of school that afternoon in order to drive an hour to their asthma doctor. Both kids had a cough, and their asthma inhalers were running low. We needed this appointment.
“Well, we only have one referral and it’s for Lulu,” the woman at the desk said. “The other referral is under Max’s old name.”
Max’s dad and I had helped him change his name and gender marker on his birth certificate just a few months earlier in the year—a process that is neither cheap nor easy, especially for transgender kids like him—but one that we felt would better protect him against discrimination as he gets older and begins applying for jobs and housing, because his legal documents would match his gender identity.
“But this is the same patient,” I demanded. “I already called the insurance company to let them know about this change, too. You’ve been seeing him for years. You can hear him coughing. Why can’t he be seen today?”
“I’m sorry, ma’am, but insurance won’t process this under the other name,” she responded. “You have to call his pediatrician to get another referral, so we can see him. That process usually takes 3-5 days. Can I help you book something for Max next week? His cough sounds pretty bad.”
This moment perfectly encapsulates what it’s like navigating health care with a trans child. If Max can’t even get an inhaler refill at the same doctor he’s been seeing for years, how easy will it be for him to get access to affirming care as he gets older?
Max is coming of age during a unique moment in history in which trans identities are being publicly debated and scrutinized like never before. Although families of transgender children can and do develop their own support networks of loving friends and community members, there remains a dearth of qualified professional services to help guide parents through all the ambiguities that come with having a gender expansive child. Too often, the comprehensive care needed to understand the options, with their risks and benefits, is simply unavailable, inaccessible, or not covered by private insurance.
The recognition of these struggles was largely missing from a recently published cover story in The Atlantic. Author Jesse Singal explores what happens when people begin to transition, only to reverse course after after well-meaning (but underqualified) professionals encourage them to try treatments like hormone therapy or surgery. The people in his essay are understandably frustrated that they struggled so long with their gender identities just to end up nearly back where they started from just a few years later.
Singal misses the mark entirely by focusing the majority of his article on a group of people dubbed “detransitioners,” a small population of people who decide transitioning isn’t for them. In doing so, he risks (either intentionally or unintentionally) frightening people away from seeking professional help at all.
Singal could have used the same thesis (“medical professionals need more training in transgender healthcare”) to focus instead on well-adjusted, confident, charming kids like Max. These are kids who are fortunate enough to have 100 percent supportive parents, an affirming school environment, badass friends, and—just as importantly—access to the resources and medical professionals that they’ll need in order to navigate puberty and beyond, even despite the struggles of getting care at all.
Framing the essay this way would have been more reflective of what happens when children are actually supported in their gender identities, not only by their friends and family members, but by their doctors and counselors, too.
In fact, the 2011 National Transgender Discrimination Survey reports that 78 percent of trans people experience better mental health when they are able to receive gender-affirming treatment. As a result, suicidality among transgender individuals drops significantly, and their quality of life and overall health improves as well.
Yet 19 percent of those surveyed reported being denied care entirely because of their transgender status, and more than 50 percent reported that they were actually the ones who educated their medical providers on transgender care—either because the professional training is inadequate or scarce, or because of the bias that so many people still (knowingly or otherwise) still have towards transgender people.
When we were still using female pronouns and Max’s birth name, we made an appointment with his pediatrician to ask this question specifically: We think maybe our child might be transgender—what do we do? Where do we go for support? What happens next? As compassionate as he was, he quite simply didn’t know. We live in Texas, and he suggested going to San Francisco to find the care our child needed. That was neither practical nor encouraging, and we left feeling disappointed that even our own pediatrician had no idea what to do when we were pleading for guidance.
No wonder so many parents and gender expansive youth feel frustrated and confused about where to turn for help. Though gender-affirming care is crucial for young trans people, it remains extremely difficult for many families to access, even when you’re specifically looking for it.
My husband, son, his little sister, and I live in the Dallas-Fort Worth metroplex in north Texas, which means by the luck of geography we just happen to be within easy driving distance to GENECIS, a comprehensive transgender pediatric clinic. It’s unfortunately the only one of its kind in the southwest. GENECIS employs a team of social workers, counselors, nurses, and endocrinologists, who work collaboratively to bring transitional care to transgender youth.
The screening process is exhausting and thorough, and the waitlist—as you can imagine—is excruciatingly long. But once a child is finally accepted to the program, the care they receive can be truly lifesaving. Because of the comprehensive model of care in programs and clinics like GENECIS, the providers are able to better anticipate if a patient is a good candidate for hormone therapy.
Yet once this medicine is prescribed, advocating your way through the loopholes and policies of your insurance company can be exhausting and often lands you in a dead end. When your child with diabetes needs a shot of insulin, that prescription is often approved fairly quickly. When your child with gender dysphoria needs a shot of Lupron to give them a temporary break from the effects of puberty, good luck. A single injection can cost upwards of $3,000 and only lasts a few months, a financial burden that can be difficult to meet for families juggling medical care with putting food on the table.
Through luck, tenacity, research, and prayer, my family has been able to find the care and support that Max—and indeed, all of us—need. It’s taken a few phone calls and face to face meetings to get on board, but his school is supportive, using the correct name, pronouns, and bathroom. That’s huge for anyone, let alone a kid in a Texas public school. Our church embraced us when we went public as a trans-inclusive family. Max lost zero friends when he came out. My family is stronger than ever before. And GENECIS is right down the road.
When I look at Max today, as the thriving, articulate, courageous, goofball of a boy that he is, I feel incredibly grateful. It is such a blessing to know that at his tender young age, he already has many of the resources he needs to thrive—loyal friends, a loving home, and just as importantly, properly trained professionals practically outside our front door.
To be perfectly honest, I never expected to find so much support right here in Texas—but I suppose I didn’t really expect to have a transgender child either, so there you go.
In the end, all Max and I want is for people to see him as his true, authentic self: a 10-year-old boy who loves cats, ukuleles, taekwondo, and tacos. Like you or me, he’s so much more than his gender identity: and yet, Max wouldn’t be as articulate, courageous, and well-grounded as he is if my husband and I hadn’t turned over every stone and pounded on every door to find him (and indeed our entire family) the resources we needed to ensure he was well cared for. Had Singal’s piece been published earlier, I wonder if we would have been as headstrong as we were when seeking out this type of care, and I’m glad we followed our parental instincts instead of the cautionary tale of an author who has never met my family or studied what makes us unique.
My hope is that more parents will follow their instincts too, seek out and demand the resources that they know their children need, keep asking for answers, and challenging a medical establishment that can and must do so much more—because our kids’ lives and futures are counting on it.