That was a fun title to write.
I wanted to add the word "autistic" in front of "nine year old", just for shock value, but that just makes me freak out even more.
Up to this point, I feel like I have been writing a lot about our journey with accepting our transgender middle child, Alex (age 6), and beginning to understand our genderfluid eldest child, Leah (now age 9). Most of this writing has chronicled events that have already happened.
Today, I am switching gears a bit, writing about an issue that we are dealing with presently. This is happening now, in real time. And honestly, I haven't given the whole thing enough thought, or research, which is not typical for me. I feel underprepared, uninformed, and this is not a reassuring place for a perfectionist that likes to be prepared and in control.
(You think I would have given up these ideas of perfectionism and any semblance of control by now, given my children. Apparently, I am a slow learner.)
This conversation, about hormone blockers for my autistic child, Leah, began several months ago. Well, actually, it began in June of last year.
No. Thinking back, it began in March of 2013. Only this was originally a conversation about Alex, not Leah.
Flashback: March 2013
I am sitting in the pediatric gender specialist's office, several hours away from our home, at a hospital clinic for transgender youth. I am with my husband and our four year old boy, Alex. We are in the waiting room, nervously awaiting our turn to go back to the exam room, not really knowing what to expect.
Alex is wearing light-up Star Wars sneakers (hand-me-downs from an older cousin), a sparkly skirt from his older sister, and a superhero t-shirt. He keeps dancing around the waiting room, enjoying watching the lights from his shoes dance along with him. His white blonde hair is beginning to grow out, and it hangs in his eyes. He wants to grow his hair long, like the Disney princesses that he so loves to watch on TV. He wants to be a princess. Alex wants to be a girl.
There is another family in the waiting room. They have a teenager- a tall, gangly adolescent with a boy body, dressed in a skirt and heels. I keep trying to sneak glances at the family, wondering what their story is, what the parents are like, and trying to imagine if my son will look like their child some day. I try not to stare, but we wait for a long time in this waiting room. The other family gets called back before we do- we have arrived too early.
Alex's name is eventually called by a nurse, and we make our way back to the exam room. My husband and I finally get to meet this wonderful doctor, who I will call Dr. Taylor, this amazing woman who has helped so many gender nonconforming, gender variant, and transgender children. An hour goes by, and we discuss all of Alex's history of female gender expression and eventual female identity. We move into the second hour of our appointment, and we discuss our options of how to handle Alex's gender nonconformity. And eventually, we find ourselves discussing a potential future timeline for Alex, if he (soon to be known as she) persists in identifying as transgender as he approaches puberty. And it is here, at this point in the visit, that we first learn about hormone blockers...and about blood work, endocrine science, and cross hormones. We realize we are learning a whole new language- transgender, cisgender, "T", blockers, stealth, preferred pronouns, social transition, and the list goes on. We have so much to learn.
May 2013
Fast forward several months. Alex has socially transitioned to female, at home, at school, at church, and with our families and friends. We are using the pronoun "she" at all times when we refer to Alex. Well, at least we are all trying to use the female pronoun. In the beginning we make mistakes. A lot of mistakes. At this point, I have read a lot more about transgender children, and I know the basics of hormone blockers and cross hormones, future surgery options, the educational laws in our state that protect my child at school, etc. I am eager to learn more, and so one weekend, I take the train several hours away to attend a workshop for health care providers and educators of trans*youth, which is being co-presented by Dr. Taylor, Alex's new doctor. This is definitely a technical workshop, and there is a lot of thorough, scientific, clinical discussion of the details of hormone blockers and cross-hormones, the unknowns, the potential risks, and the future implications.
Honestly, my mind wanders during this adolescent portion of the youth presentation- my transgender child is only five years old. I have time, years really, to think about this, I tell myself. Listening to the presenters' timelines, I figure I have at least five more years to think about puberty for Alex. Five years to research, read, ask questions, and learn more.
March 2014
We meet with Dr. Taylor again, a check-up, to see how Alex is doing a year later. Fine, so much happier, we are all doing so much better, we tell the doctor. And it's true- we feel confident in our decision to support Alex's social transition to female, and her exuberance and joy is evident to everyone she meets. "This is going to be a welcome 'lull period' for your family," explains Dr. Taylor. "You have all socially transitioned, at home, school, church, etc.. Now, the next step is puberty, but that is a ways off."
A lull period? Hallelujah!! Celebrate! After all of the fall-out from our families, issues at preschool, etc., I was ready to enjoy this so-called lull period. We had definitely earned it.
Unfortunately for us, Leah didn't receive the memo about our much deserved "lull period".
May 2014
Two months later, Benjamin arrives. Leah, our eight year old girl with autism, informs us that she is actually a boy, and her name is Benjamin. By June, I am starting to be a little bit concerned. At some point, I make a point to mention something to our local pediatrician (who I'll call Dr. James), about Leah/Ben, and she tells me that we have time on our side, and not to worry just yet. "This just showed up, and we have at least a year to think about puberty and the onset of menarche." (I admit, I almost fall off my chair at the thought of my autistic child and menarche...oh, Lord, have mercy.) "This is different from Alex," Dr. James, our pediatrician continues. "Alex was consistent, insistent, and persistently identifying as female from a very young age. I think we just need to watch Leah, and be observant, and see where this takes us. Please keep me informed as this progresses."
It continues to progress. Leah begins to flip back and forth between identifying as male and female, at what feels like a dizzying pace. Friends call me, and ask: "Is it Ben or Leah today?" We have a meeting at school- which bathroom should Leah/Ben use, when she or he changes gender so frequently? Is this a phase, something to do with Leah's autism, another imaginative character for her to embody? Or is this truly another transgender child?
June 2014
Leah and I meet with a pediatric neurologist, to discuss an unrelated medical issue with one of her eyes. This doctor, who we have seen since Leah was diagnosed with Asperger's at age five, is a very brilliant man, with a lot of experience with children on the autism spectrum. He has treated and diagnosed hundreds of children with autism.
Leah is identifying as Ben, the boy, while we are at the neurologist's office. This, as always, is challenging for me to explain.
I ask the neurologist about his experience with autism and genderfluidity. "Have you ever seen this before?" I ask the doctor, as Ben plays with the toys in his office. "I have read about it," I continue, "this higher correlation of transgender identity among people with autism as opposed to neurotypical people. What is your experience?"
What a question.
I also briefly explain that we happen to have a six year old that is transgender.
My child's neurologist stares at me over the tops of his bifocals, processing what I have just asked him. He pauses, thinking for quite awhile, before answering me. "Well," he begins slowly, "I have only seen this once before, in one other patient, a young man. But, from what you are describing to me, it appears that you may have a genetic predisposition towards transgenderism in your family."
I'm not exactly sure what I was expecting the neurologist to say, but it definitely didn't include a genetic predisposition towards transgenderism. I take a deep breath, square my shoulders, and silently nod at the neurologist, letting his shocking observation hang in the space between us.
October 2014
Our family travels a few hours away to a support group for parents of gender nonconforming children and adolescents. We have been attending this group for a year and a half, since April of 2013. Alex's doctor, Dr. Taylor, the gender specialist, participates in this group. Several therapists, that have years of experience working with trans*youth, also attend to support the parents and kids.
I speak with a very experienced therapist after the group. She knows about Leah, who sometimes identifies as Ben, and the therapist asks how things are going. "I don't know," I reply. "I'm not really sure how to parent this kid. Pronouns are a mess, and she flips back and forth between a boy and a girl so frequently...frankly it's driving us all crazy. At least Alex was consistent- we knew that she was a girl. It was clear. This feels a lot more unknown, and I'm not sure how to handle everything. It's exhausting."
The therapist nods her head empathetically as she listens. She then mentions, almost nonchalantly, "Why not put her on hormone blockers? Allow him or her, and you and your husband, some time to sort everything out."
Honestly, my heart skips a beat when I hear her words. What about my five year plan? The five years that I have to meticulously research my options, ask questions, and form an opinion? I thought we had so much more time to think about all of this.
I want my five years. Haven't I earned that, at the very least?
The therapist leads me over to our 6 year old's doctor, the gender specialist. She quickly explains our current situation with Leah to Dr. Taylor. The doctor nods her head as the therapist speaks, listening attentively. "Yes," the doctor responds once the therapist has finished speaking, "Just put him on blockers. Why not? It will allow you the time you need to figure out what is going on with Ben, or Leah. It's totally reversible."
What about cost? I think to myself. "What insurance do you have?" asks the doctor. I reply with the name of our insurance company. "Oh sure, no problem," she continues. "It should be totally covered."
What?? That's it? I don't even have the prohibitive cost to stop this from happening? It all seems so obvious, such a simple solution from these two trans*youth experts, and yet....and yet. How on earth did I get to this point in my parenting, where I'm considering hormone blockers for my autistic nine year old??
What should I do next? What are my next steps? I ask the doctor. "Call my office, set up an appointment. We can do some bloodwork, find out Ben's levels, and discuss your options," the doctor tells me over her shoulder, and then she walks away to speak with another family. She is in high demand.
I stand there stunned for a minute. This is not how I pictured things to go with my eldest daughter, now maybe my son. The autism, the genderfluidity, it's all so very much. I take a deep breath, square my shoulders, and walk toward my husband.
We have a lot to discuss.
December 2014
I call our local pediatrician, and set up an appointment for Leah's 9 year well child visit.
"I have some news for you," I inform our pediatrician, Dr. James. "We met with Dr. Taylor at our last support group. She is recommending that we put Ben on hormone blockers."
I wait.
And I think, Here will be the voice of reason. Surely Dr. James won't want to put Leah on hormone blockers. It's way too early, and we haven't been at this long enough. I remember- Dr. James wants more time to observe Leah.
"I agree," says Dr. James. "I think it's time we start talking about hormone blockers."
Oh no...
"I've been reading a lot about this since we met six months ago," our pediatrician explains. "It seems to me that Leah has been identifying much more consistently as Ben, and that there are still a lot of unanswered questions as to how she or he identifies. I think this might allow us to have some more time to figure out who Leah is, and for Leah to have some more time as well. And, puberty is rapidly approaching- her body is already beginning to change."
Oh good grief. How am I going to explain this one to my husband? I swear, sometimes I think he thinks that I make this sh*t up.
I swallow, pausing for a moment to think. "So...do you think I should call and make an appointment with Dr. Taylor?" I adore Dr. Taylor, but- please say no!
Dr. James nods her head. "Yes. Let's see what she has to say about Leah. Or Ben."
That evening, my husband and I decide that we will call Dr. Taylor, and see what she has to say. We schedule the appointment with the hospital clinic. It will be in January.
So, instead of five years, I have maybe a matter of weeks. It's Ben's birthday- he is turning 9 years old. He wants a superhero party, a Pokemon party, a costume party. Leah wants a princess party, tiaras, nail painting. I offer an animal party, something gender neutral. Ben refuses, Leah pouts. I'm going crazy. I can't do this.
But of course, we do. We decide on a rainbow party instead, a generic "Happy Birthday!" party. Rainbow cupcakes, rainbow balloons, rainbow tablecloths. One of my friends goodnaturedly teases me that my house looks like its very own Pride parade...but really- how does one throw a genderfluid birthday party? This wasn't in any of my baby books. There's no manual for this!
I don't know how to do this.
Here's what I do know, seemingly the only thing that I know these days. I love my kid. I love Ben. And I love Leah. I love his or her creativity, spontaneity, and authenticity. I love how he marches to his own drum. I love that she is such an out-of-the-box thinker- even, apparently, when it comes to gender. It drives me crazy, it pushes me to the very edge of my anxiety in so many ways, and yet- I admire this child so very much. Leah, or Ben, it seems, has no choice, societal norms and taboos be damned- she or he must, must be herself or himself. Authenticity in its purest form. Every single day. Always.
And, so we wait. I have a few more weeks to research the hormone blockers. I have a few more weeks to remain undecided, and to focus on the holidays, and loving my kid, all of my wild and beautiful kids. My family.
One day at a time.
I wanted to add the word "autistic" in front of "nine year old", just for shock value, but that just makes me freak out even more.
Up to this point, I feel like I have been writing a lot about our journey with accepting our transgender middle child, Alex (age 6), and beginning to understand our genderfluid eldest child, Leah (now age 9). Most of this writing has chronicled events that have already happened.
Today, I am switching gears a bit, writing about an issue that we are dealing with presently. This is happening now, in real time. And honestly, I haven't given the whole thing enough thought, or research, which is not typical for me. I feel underprepared, uninformed, and this is not a reassuring place for a perfectionist that likes to be prepared and in control.
(You think I would have given up these ideas of perfectionism and any semblance of control by now, given my children. Apparently, I am a slow learner.)
This conversation, about hormone blockers for my autistic child, Leah, began several months ago. Well, actually, it began in June of last year.
No. Thinking back, it began in March of 2013. Only this was originally a conversation about Alex, not Leah.
Flashback: March 2013
I am sitting in the pediatric gender specialist's office, several hours away from our home, at a hospital clinic for transgender youth. I am with my husband and our four year old boy, Alex. We are in the waiting room, nervously awaiting our turn to go back to the exam room, not really knowing what to expect.
Alex is wearing light-up Star Wars sneakers (hand-me-downs from an older cousin), a sparkly skirt from his older sister, and a superhero t-shirt. He keeps dancing around the waiting room, enjoying watching the lights from his shoes dance along with him. His white blonde hair is beginning to grow out, and it hangs in his eyes. He wants to grow his hair long, like the Disney princesses that he so loves to watch on TV. He wants to be a princess. Alex wants to be a girl.
There is another family in the waiting room. They have a teenager- a tall, gangly adolescent with a boy body, dressed in a skirt and heels. I keep trying to sneak glances at the family, wondering what their story is, what the parents are like, and trying to imagine if my son will look like their child some day. I try not to stare, but we wait for a long time in this waiting room. The other family gets called back before we do- we have arrived too early.
Alex's name is eventually called by a nurse, and we make our way back to the exam room. My husband and I finally get to meet this wonderful doctor, who I will call Dr. Taylor, this amazing woman who has helped so many gender nonconforming, gender variant, and transgender children. An hour goes by, and we discuss all of Alex's history of female gender expression and eventual female identity. We move into the second hour of our appointment, and we discuss our options of how to handle Alex's gender nonconformity. And eventually, we find ourselves discussing a potential future timeline for Alex, if he (soon to be known as she) persists in identifying as transgender as he approaches puberty. And it is here, at this point in the visit, that we first learn about hormone blockers...and about blood work, endocrine science, and cross hormones. We realize we are learning a whole new language- transgender, cisgender, "T", blockers, stealth, preferred pronouns, social transition, and the list goes on. We have so much to learn.
May 2013
Fast forward several months. Alex has socially transitioned to female, at home, at school, at church, and with our families and friends. We are using the pronoun "she" at all times when we refer to Alex. Well, at least we are all trying to use the female pronoun. In the beginning we make mistakes. A lot of mistakes. At this point, I have read a lot more about transgender children, and I know the basics of hormone blockers and cross hormones, future surgery options, the educational laws in our state that protect my child at school, etc. I am eager to learn more, and so one weekend, I take the train several hours away to attend a workshop for health care providers and educators of trans*youth, which is being co-presented by Dr. Taylor, Alex's new doctor. This is definitely a technical workshop, and there is a lot of thorough, scientific, clinical discussion of the details of hormone blockers and cross-hormones, the unknowns, the potential risks, and the future implications.
Honestly, my mind wanders during this adolescent portion of the youth presentation- my transgender child is only five years old. I have time, years really, to think about this, I tell myself. Listening to the presenters' timelines, I figure I have at least five more years to think about puberty for Alex. Five years to research, read, ask questions, and learn more.
March 2014
We meet with Dr. Taylor again, a check-up, to see how Alex is doing a year later. Fine, so much happier, we are all doing so much better, we tell the doctor. And it's true- we feel confident in our decision to support Alex's social transition to female, and her exuberance and joy is evident to everyone she meets. "This is going to be a welcome 'lull period' for your family," explains Dr. Taylor. "You have all socially transitioned, at home, school, church, etc.. Now, the next step is puberty, but that is a ways off."
A lull period? Hallelujah!! Celebrate! After all of the fall-out from our families, issues at preschool, etc., I was ready to enjoy this so-called lull period. We had definitely earned it.
Unfortunately for us, Leah didn't receive the memo about our much deserved "lull period".
May 2014
Two months later, Benjamin arrives. Leah, our eight year old girl with autism, informs us that she is actually a boy, and her name is Benjamin. By June, I am starting to be a little bit concerned. At some point, I make a point to mention something to our local pediatrician (who I'll call Dr. James), about Leah/Ben, and she tells me that we have time on our side, and not to worry just yet. "This just showed up, and we have at least a year to think about puberty and the onset of menarche." (I admit, I almost fall off my chair at the thought of my autistic child and menarche...oh, Lord, have mercy.) "This is different from Alex," Dr. James, our pediatrician continues. "Alex was consistent, insistent, and persistently identifying as female from a very young age. I think we just need to watch Leah, and be observant, and see where this takes us. Please keep me informed as this progresses."
It continues to progress. Leah begins to flip back and forth between identifying as male and female, at what feels like a dizzying pace. Friends call me, and ask: "Is it Ben or Leah today?" We have a meeting at school- which bathroom should Leah/Ben use, when she or he changes gender so frequently? Is this a phase, something to do with Leah's autism, another imaginative character for her to embody? Or is this truly another transgender child?
June 2014
Leah and I meet with a pediatric neurologist, to discuss an unrelated medical issue with one of her eyes. This doctor, who we have seen since Leah was diagnosed with Asperger's at age five, is a very brilliant man, with a lot of experience with children on the autism spectrum. He has treated and diagnosed hundreds of children with autism.
Leah is identifying as Ben, the boy, while we are at the neurologist's office. This, as always, is challenging for me to explain.
I ask the neurologist about his experience with autism and genderfluidity. "Have you ever seen this before?" I ask the doctor, as Ben plays with the toys in his office. "I have read about it," I continue, "this higher correlation of transgender identity among people with autism as opposed to neurotypical people. What is your experience?"
What a question.
I also briefly explain that we happen to have a six year old that is transgender.
My child's neurologist stares at me over the tops of his bifocals, processing what I have just asked him. He pauses, thinking for quite awhile, before answering me. "Well," he begins slowly, "I have only seen this once before, in one other patient, a young man. But, from what you are describing to me, it appears that you may have a genetic predisposition towards transgenderism in your family."
I'm not exactly sure what I was expecting the neurologist to say, but it definitely didn't include a genetic predisposition towards transgenderism. I take a deep breath, square my shoulders, and silently nod at the neurologist, letting his shocking observation hang in the space between us.
October 2014
Our family travels a few hours away to a support group for parents of gender nonconforming children and adolescents. We have been attending this group for a year and a half, since April of 2013. Alex's doctor, Dr. Taylor, the gender specialist, participates in this group. Several therapists, that have years of experience working with trans*youth, also attend to support the parents and kids.
I speak with a very experienced therapist after the group. She knows about Leah, who sometimes identifies as Ben, and the therapist asks how things are going. "I don't know," I reply. "I'm not really sure how to parent this kid. Pronouns are a mess, and she flips back and forth between a boy and a girl so frequently...frankly it's driving us all crazy. At least Alex was consistent- we knew that she was a girl. It was clear. This feels a lot more unknown, and I'm not sure how to handle everything. It's exhausting."
The therapist nods her head empathetically as she listens. She then mentions, almost nonchalantly, "Why not put her on hormone blockers? Allow him or her, and you and your husband, some time to sort everything out."
Honestly, my heart skips a beat when I hear her words. What about my five year plan? The five years that I have to meticulously research my options, ask questions, and form an opinion? I thought we had so much more time to think about all of this.
I want my five years. Haven't I earned that, at the very least?
The therapist leads me over to our 6 year old's doctor, the gender specialist. She quickly explains our current situation with Leah to Dr. Taylor. The doctor nods her head as the therapist speaks, listening attentively. "Yes," the doctor responds once the therapist has finished speaking, "Just put him on blockers. Why not? It will allow you the time you need to figure out what is going on with Ben, or Leah. It's totally reversible."
What about cost? I think to myself. "What insurance do you have?" asks the doctor. I reply with the name of our insurance company. "Oh sure, no problem," she continues. "It should be totally covered."
What?? That's it? I don't even have the prohibitive cost to stop this from happening? It all seems so obvious, such a simple solution from these two trans*youth experts, and yet....and yet. How on earth did I get to this point in my parenting, where I'm considering hormone blockers for my autistic nine year old??
What should I do next? What are my next steps? I ask the doctor. "Call my office, set up an appointment. We can do some bloodwork, find out Ben's levels, and discuss your options," the doctor tells me over her shoulder, and then she walks away to speak with another family. She is in high demand.
I stand there stunned for a minute. This is not how I pictured things to go with my eldest daughter, now maybe my son. The autism, the genderfluidity, it's all so very much. I take a deep breath, square my shoulders, and walk toward my husband.
We have a lot to discuss.
December 2014
I call our local pediatrician, and set up an appointment for Leah's 9 year well child visit.
"I have some news for you," I inform our pediatrician, Dr. James. "We met with Dr. Taylor at our last support group. She is recommending that we put Ben on hormone blockers."
I wait.
And I think, Here will be the voice of reason. Surely Dr. James won't want to put Leah on hormone blockers. It's way too early, and we haven't been at this long enough. I remember- Dr. James wants more time to observe Leah.
"I agree," says Dr. James. "I think it's time we start talking about hormone blockers."
Oh no...
"I've been reading a lot about this since we met six months ago," our pediatrician explains. "It seems to me that Leah has been identifying much more consistently as Ben, and that there are still a lot of unanswered questions as to how she or he identifies. I think this might allow us to have some more time to figure out who Leah is, and for Leah to have some more time as well. And, puberty is rapidly approaching- her body is already beginning to change."
Oh good grief. How am I going to explain this one to my husband? I swear, sometimes I think he thinks that I make this sh*t up.
I swallow, pausing for a moment to think. "So...do you think I should call and make an appointment with Dr. Taylor?" I adore Dr. Taylor, but- please say no!
Dr. James nods her head. "Yes. Let's see what she has to say about Leah. Or Ben."
That evening, my husband and I decide that we will call Dr. Taylor, and see what she has to say. We schedule the appointment with the hospital clinic. It will be in January.
So, instead of five years, I have maybe a matter of weeks. It's Ben's birthday- he is turning 9 years old. He wants a superhero party, a Pokemon party, a costume party. Leah wants a princess party, tiaras, nail painting. I offer an animal party, something gender neutral. Ben refuses, Leah pouts. I'm going crazy. I can't do this.
But of course, we do. We decide on a rainbow party instead, a generic "Happy Birthday!" party. Rainbow cupcakes, rainbow balloons, rainbow tablecloths. One of my friends goodnaturedly teases me that my house looks like its very own Pride parade...but really- how does one throw a genderfluid birthday party? This wasn't in any of my baby books. There's no manual for this!
I don't know how to do this.
Here's what I do know, seemingly the only thing that I know these days. I love my kid. I love Ben. And I love Leah. I love his or her creativity, spontaneity, and authenticity. I love how he marches to his own drum. I love that she is such an out-of-the-box thinker- even, apparently, when it comes to gender. It drives me crazy, it pushes me to the very edge of my anxiety in so many ways, and yet- I admire this child so very much. Leah, or Ben, it seems, has no choice, societal norms and taboos be damned- she or he must, must be herself or himself. Authenticity in its purest form. Every single day. Always.
And, so we wait. I have a few more weeks to research the hormone blockers. I have a few more weeks to remain undecided, and to focus on the holidays, and loving my kid, all of my wild and beautiful kids. My family.
One day at a time.
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