Conservatives are ramping up a campaign to end transgender care for minors in Tennessee. They’ve implied — without evidence — that young children are having their bodies “mutilated” on a whim. But the journey of one Nashville teenager in the midst of a gender transition shows just how painstaking the process already is.
It was only a few years ago that Matt, who was born female, disclosed to his mother all that was going on inside.
For their safety and privacy, WPLN News has granted them anonymity. Matt and Emily are pseudonyms.
In true 21st century teenager fashion, Matt’s message was relayed by text: “I think I’m a boy.”
“That honestly struck a little fear in me,” Emily says. “As if his life hasn’t been hard enough, and as if being a teenager isn’t hard enough.”
But the low-key revelation explained a lot. Matt, now 14, had already suffered several mental health challenges. Some were related to the death of his father in an accidental overdose a couple of years ago. There had been depression, dysmorphia — when someone obsesses over what they see as flaws in their body — and dissociation.
It’s been rough.
“If I could choose not to be trans, I probably would,” Matt says. “If I could choose to be a cisgender girl, I probably would.”
When the body does what it was wired to do — like grow breasts and begin a monthly menstruation cycle — it can be a constant source of anxiety.
“I want to ease that for him,” Emily says. “To a parent who’s terrified and is wanting to shut these clinics down, I would say it’s scary. But in the end, it’s going to save your kid. I mean, the suicide rate is off the charts for trans kids.”
The latest study shows trans teens are five times more likely to consider suicide than their peers.
It took a year to get into Vanderbilt’s pediatric clinic for transgender care, which is currently under assault from conservative lawmakers following a misleading segment by far right activist and Daily Wire host Matt Walsh. Using clips of doctors speaking during academic presentations, Walsh made it seem like the clinic regularly performs genital surgeries on minors, though Vanderbilt has said it follows professional standards that recommend waiting for adulthood. By those same clinical standards, hormones don’t start until a therapist signs off.
“Even if it was the process to just say, ‘Yep, sign me up,’ I can’t imagine any parent would just jump into it headfirst, no matter how open they may be,” Emily says.
More: For trans teens in Tennessee, state law has a limited say in guiding their care — for now
Hormones like testosterone are powerful, especially in teenagers. The therapy is akin to going through puberty all over again, says Dr. Maddie Deutsch at the University of California San Francisco. Some of the effects are not entirely reversible, such as facial hair or a deeper voice. Fertility also suffers.
The decision-making process about surgery is even more complicated. The professional standards discourage removal of breasts before 16. Genitalia surgery often waits until at least 18 — if it’s ever desired.
For Matt, mom is pulling the reins a bit. They’re waiting on a therapist to give the go-ahead on hormones. But surgery is a bit further off.
“God forbid he has his surgery, and all of a sudden, he’s like, ‘Maybe, I’m not really a boy after all.’ I mean, I don’t know. I know he says that’s not going to happen. And the research shows that’s very unlikely. But surgeries are so permanent. I just, I don’t feel good about it yet.”
Emily’s parental concerns about making life-altering decisions so young echo those of some conservative lawmakers. But she says having options to consider — even as a minor — is critically important, because it gives some hope to desperate families. She’s watching psychological damage occur in real time whenever her son looks in a mirror.
“He wears a binder, and when he takes the binder off … the body dysmorphia kind of takes over, and that’s really hard. And so part of my motivation for wanting to do the top surgery eventually, and the testosterone, is to keep him from feeling that way.”
She says she wants her son to feel like he fits in his own body. It’s just a matter of timing.
Matt, as teenagers tend to be, is pretty impatient with it all. He says he even knows the teenage brain can be unreliable when it comes to long-term consequences. But he’s certain who he is.
“Everyone’s just like, ‘Well, why don’t you just be a girl again?’ I went through that phase before,” he says. “It was the worst year of life.”
Emily’s face falls as Matt reveals more of how he has suffered largely in silence. “Oh, baby,” she says with a sigh.
She’s genuinely concerned about the health and safety of teens like hers if those gender-affirming options are no longer available until they’re adults.