While the transition for a preadolescent transgender child is social, often entailing a pronoun, wardrobe, and/or name change, and sometimes legal, entailing a gender marker and/or name change on government documents, adolescence can include a medical transition. The outwardly gender-neutral body of childhood may begin to betray who a transgender teen knows themselves to be in heart and mind. For these kids – for my kid – there is help.
When a child enters the Tanner 2 stage of puberty, diagnosed with a hand x-ray and blood test, they can receive a puberty blocker, which can be delivered in a monthly injection or a 3-year implant. This puberty blocker is known as “the pause button,” because just as the name implies, it pauses puberty, buying the pre-teen a few more precious years to grow into knowing themselves and their right path, with no permanent effects. I am so grateful this intervention exists (and for the privilege we enjoy in having insurance that 100% covers transgender medical care and a physician who fully supports our trans youth community), though my mama heart worries about the short-term side effects of reduced bone density and delayed brain development, along with unknown long-term side effects. After 3 years, or whenever the teen is ready, they either remove the implant and go through their natal puberty or receive cross-sex hormones and go through the puberty of their affirmed gender. Once the hormone surge of puberty takes hold, the brain should catch up in development and the bone density should strengthen.
Today, at 12 years old, we prepare to step into medical transition with the puberty blocker Histrelin. Thankfully, my hard stage of grief has passed, and I am now comfortably in acceptance and hope, moving happily forward down this path with the transgender label in hand. “The grief will pass,” they said, “allow it,” they urged, “the light will return,” they reassured. It did.
“I’m nervous,” Sky says as she collapses onto our bed for some family bedtime read aloud.
“What thoughts are beneath that nervous feeling?” I asked.
“It’s going to hurt,” she quickly responded.
“Ah, so you are feeling nervous about the discomfort of the implantation procedure itself. That is understandable. Do you want me to remind you of the conversation we had with the doctor when he went over what is going to happen or do you just want me to hug you tightly while we read?” I offered.
“No, I remember. I’m just still nervous,” she said as she settled in closely.
“Are you nervous about the choice to get the puberty blocker or just the potential discomfort?” I already knew the answer but felt it important to check in. I wanted to gently remind her of her power around these choices and of the potential relief that awaited on the other side of the short-term pain.
“No, I’m grateful to be able to pause male puberty but I’m not excited about being stabbed and sliced and having something jammed into my arm.”
“So, it’s like the lesser of two evils,” I joked.
We made the hour drive into downtown Seattle the next morning and I engaged in my routine 30 minutes of going the wrong way and cursing the lack of parking. Also routinely, I called my husband and had him leave work to jump in the driver’s seat and drop us off while he parked the car. I give up. I have an excellent sense of direction but my brain just does not speak urban. Thankfully, I have the self-confidence and sense of humor to laugh at my short-comings and my family has the empathy and patience to accept them. Sky and I spent 15 more minutes getting lost in the elevators of the historic building. “Why is this elevator missing buttons for floors 5-10?” Sky couldn’t stop giggling as she insisted floor after floor was not right. Eventually, we stumbled upon the right office . . . at almost the same time as my husband who had found and paid for parking over a block away. Why do I even try?
The visit began with a thick layer of awkward, nervous joking from my husband and numbing cream being applied under her arm where the implant would be inserted. Then the cream was wiped away, dots were drawn to map out his path, and the doctor injected the first numbing shot horizontally under the skin. This was rough. My poor baby was in a lot of pain but she is tough and breathed through it. He did the same thing again to span the rest of the distance before repeating the process with a second numbing solution that included adrenaline to slow bleeding. Once this was finished, the worst of the pain was over.
Now, I need to digress for a minute and offer some background. I am the family nurse, if you will. By that I mean, I am the one who is typically treating the bleeding wounds and painful injuries, of which there are a healthy amount with 3 unschooling wildlings. Just a few months ago, I was in urgent care helping the doctor irrigate a big gash in the top of Sky’s head, incurred while moon walking down the hallway. In these moments, I am always completely calm and focused. It’s a strength of mine, for sure. I’m good in a crisis and I can hold other people’s pain while moving everyone forward.
But when the doctor took the scalpel and cut into my beautiful child’s perfect arm, stretched the hole, and then inserted the puberty blocker, my stomach flipped, I went pale and sweaty, I collapsed into a nearby chair, and I nearly passed out. I was still holding Sky’s hand and I insisted that I was fine and that everyone should focus on Sky. Within minutes she was being bandaged up and was perfectly fine and I was back up and by her side, but I felt awful. I apologized to her profusely and she lovingly insisted that it was completely okay. But I’m going to spend a long while beating myself up. I’ll need to clear the space in my calendar for guilt.
It was a quick visit and we emerged into the maze of Seattle’s historic meets tech/modern architecture to a symphony of bustling, hippie city life and a magical air of gently falling snow. The 3 of us strolled past endless bicycles and flannelled dog owners to a nearby restaurant and enjoyed a special lunch together before I drove back home and Sky went to work with her daddy to finish out the day.
We were told to expect bruising and possibly a headache followed in 2 weeks by a potential week of emotional cruminess as her testosterone levels crash. So far, our sweet Sky is bruised but has had no pain at all. She’s so happy and relieved to have the time she needs to mature into being ready to make some big, permanent decisions. For today, she is simply free to play with her brothers.