When G. was seven, I bought her a book on puberty. I’d been a few years older when my mom presented me with a copy of Our Bodies, Ourselves, and, having grown up with all the books smarts on my body and sex that Planned Parenthood could provide, I wanted to make sure my daughter had the same accurate information, and for her to have a resource if she ever felt there were questions she didn’t want to ask us. I decided to start slow, with a book written for elementary school girls. She read it eagerly. Then she asked for the boys’ version--she felt it was important to be informed “about both sides”.
It became clear fairly early that she wasn’t excited about puberty. She often said that she wished she was still a baby. A few times, I casually asked if she was looking forward to getting breasts; her response was a sharp and unequivocal No. Her perspective didn’t change with time. In fact, when she began to get tiny breast buds at age 10, it became more emphatic. The idea of having a girl’s puberty terrified her.
We broached the subject with her therapist, who shared a lot of information about hormone blockers, which had originally been developed for kids who had precocious puberty but had been used for a decade or so now to “pause” puberty for gender-questioning kids. The idea was that stopping puberty at the outset would give them more time to explore their gender identity, and to decide if it was best for them to grow into the gender of their birth body, or to begin to transition to their affirmed identity. G., who was now becoming very eager to live as Muir, was immediately sold. His relief at the possibility of avoiding a girl’s puberty was so complete and genuine that whatever doubt I might have had about G. being Muir was completely dissolved.
Of course, there were pros and cons.
Pros: Muir’s happiness and mental health. More time for all of us to think through and adjust to a future we had never anticipated. No periods. No breasts, which to me seemed terribly important: If G. did indeed decide to grow into Muir, he wouldn’t feel he was living in the wrong body or had to hide his breasts, and by being a man instead of trying make his body “pass” as male, he’d be safer as he walked through the world. It would also eliminate the need for “top surgery” in the future; given that he might choose to have “bottom surgery” in his 20s, one less surgical procedure had to be a good thing.
Cons: Lack of data. While puberty blockers had been used to treat kids with precocious puberty for decades, they’ve been used to support kids with “gender dysphoria” for a much shorter time. Those who’ve used blockers for this purpose haven’t yet reached adulthood, so few studies are available on possible long term impacts. There are questions about their effects on bone development and height. Since blocking hormones in adolescents appears to also block the rise of “typical teenage” behaviors such as risk-taking, moodiness and rebelliousness, it might also be possible that they pause cognitive development (though there is no data to support this).
We were increidbly fortunate to have Muir’s therapist, Dr. Diane Ehrensaft, who is one of the most accomplished and respected clinical psychologists specializing in youth gender in the world. She’s also on the team at the Child & Adolescent Gender Center at the University of California at San Francisco, which includes Dr. Stephen Rosenthal, a renowned pediatric endocrinologist, as well as nurse practitioners, a social worker and a director of education and training. When Diane assessed Muir at length and recommended that pausing puberty would be important to his mental health, we decided to move forward with a consultation with Dr. Rosenthal. He determined that Muir was at the ideal stage to begin puberty blockers, and we all left the appointment believing that using a hormone-blocking implant for a few years was almost certainly the right choice.
Muir was overjoyed. He was eager for his small breast buds to recede and to be rid of the anxiety about his body betraying him. Bryn and I were nervous. At this point, we were more than confident that Muir would continue to live as his affirmed gender. It wasn’t so much a question of making a “forever decision” at such a young age (because the whole purpose of the blockers was to buy insurance against the extremely unlikely event of him choosing to have a female puberty), but the fear of doing physical harm. The bone density scan Muir took to assess his bone health prior to starting blockers already showed that he was on the borderline-low side. What if pausing puberty did irreparable damage to his growing bones, or impacted his cognitive development? What if the long term effects of using histreline turned out to be cancer?
There was nothing to suggest that this would be the case. Whatever bone density or height kids might lose while on blockers had proven to be temporary, regained once that blockers were stopped and puberty resumed. But we had an uneasiness that we couldn’t quite name; something to do with getting on Mother Nature’s shit list for attempting to derail her plans for our child. It was superstitious, silly perhaps, but it was a feeling that was hard to shake.
But then, if we were bringing Mother Nature into it, what exactly were her plans for Muir? She’d given him a female body, but she’d also given him a male identity. Maybe her plan had always been to leave it all up to him. Maybe she wasn’t going to punish us for using science to cheat her designs; maybe she didn’t actually have any designs in the first place.
We continued trying to wrap our heads around our options. We tried to slow the decision-making down somewhat, a process that was helped along by the fact that we couldn’t get an appointment to insert the histreline implant for another three months. But we were acutely aware that the clock was ticking, that every day we waited was another day closer to Muir starting a female puberty, and another day that he spent grappling with anxiety about his body. I’m still not sure how Bryn finally accepted that we should move forward, but for me, it came down to Muir’s mental health: If forced to experience a girl’s puberty, he’d unquestionably face traumatic psychological harm (and there was plenty of powerful evidence that showed this could swiftly lead to self-harm); I just couldn’t compromise his emotional well-being in an attempt to avoid physical damage that might never even happen.
So, we took deep breaths and forged ahead. To address concerns about harm to bone development, Dr. Rosenthal prescribed weekly injections of a small amount of testosterone along with the hormone blocker, an experiment he’d never tried with female-to-male patients, but one that seemed promising, and that somewhat eased our concerns. Muir would also have an annual bone density scan, and monthly blood tests, and would be monitored closely to catch and address any negative side effects as quickly as possible. It was the best we could hope for.
One afternoon, a little giggly from the small dose of Ativan the nurse practitioner had given him, Muir had a very thin, inch-long rod inserted inside his upper arm. For the next year at least, it would do something magical, something previous generations of trans people hadn’t even imagined possible: Make Muir’s body match his gender identity.
He was visibly happy. His body, which had been on the very cusp of lurching into the next phase of development, simply took a breather. The puffiness on his chest receded. He settled comfortably back into a child’s body. Bryn and I still have our private worries (mine lead me to pump Muir full of calcium-rich foods and supplements at every opportunity and to obsess over his blood test results). We’ve had scary challenges as we adjust and adapt, but we’re working through them. We’re confident that, in doing the best thing for our child, we also did the right thing.
When I watch Muir in front of the mirror, tying his bow ties and working pomade into his hair, looking so confident in his own skin, it's hard to believe that I was ever wracked with doubts. Now, I just feel grateful, not only that science has given us this chance, but that the three of us have been brave enough to take it.