FRONTLINE

>> Tonight on Frontline... >> I've been a boy for three years, and I was a girl for six.

>> My name is Ariel, and I identify as a girl.

Me turning into a man is just probably the most horrifying thing ever.

>> A story about change.

>> Cross hormones, I can get a deep voice, I can get a beard, I can get a flat chest.

>> Family.

>> I feel in a sense like something's been robbed.

My daughter's gone.

>> We just had to listen to what we heard from our child.

Nothing else mattered.

>> And what it really means to grow up trans.

>> I started realizing at around 16, 17 what a huge decision I had made to embrace this masculine part of myself so deeply.

>> I don't want to focus on being trans forever.

I'd rather just go to college and move on, so I'll be as complete as I want to be.

>> Tonight on Frontline, a journey inside this new world.

>> I am transgender.

I was born male and identify as female.

But I like to say that I'm a girl stuck in a boy's body.

I transitioned when I was six or seven to more of a girl, and now I'm comp... well, almost completely female.

Second grade was the last year of Liam, and this year I changed my name officially.

So I've changed my name, my clothes, my room, and my pronouns.

And that's really all you need, except for the fifth one that I still need: surgery and medicine to help me look like a girl.

>> NARRATOR: Just a generation ago, it was adults, not children, who changed genders, usually late in life and often in the shadows.

(applause) But today, as transgender adults gain wider acceptance, many children are transitioning too, with new medical options and at younger and younger ages.

This is a new generation "Growing Up Trans."

>> There's a big one!

>> Naima, Naima, do you like the bubbles?

>> (laughing) >> Let's count to ten, ready?

One, two, three... >> Count, Naima!

>> Four... >> November 7, 2009.

She's four.

Ready?

There she goes.

>> My given name was Naima, and now my name is Daniel.

I've been a boy for three years, and I've been...

I was a girl for six.

Come on, grab on to me!

Or grab on to John.

Come on!

I don't like to be called a "she" anymore, and I just...

I really like it that they think of me as a boy.

(toy whirring) I think it's hard to get used to it because I was a girl for so long, and I haven't been a boy for a very long time.

>> As soon as Daniel could start to express preferences in clothing, he was gravitating toward the boys' section, hand-me-downs from cousins, wanting to wear just boy T-shirts and boy shorts.

>> From the very beginning, it seemed like to me, just didn't look as comfortable in a dress.

Initially, a tomboy came to mind, right?

That's our standard go-to for our society, is tomboy.

>> And then the comments would start to come.

"I don't feel comfortable, I don't feel right, I just wish I were a boy."

And I would say, "I understand that you wish you were a boy, but we can't do anything about that.

You were born this way."

And then starting second grade, the tone of our conversation just took on a more serious depth, and Naima felt like, "I have to tell you that I'm very unhappy, I don't like being in this body.

I wish I had a penis," and just sort of laid it all out there.

And so at that point, it just sort of snowballed into a conversation about, "Well, you can live as a boy.

I don't know what that means, I don't know where to go really from here, but you can live as a boy, and you can change your name."

And Daniel, or Naima at the time, immediately jumped on that idea.

>> What?

>> The lava keeps rising.

>> The lava keeps rising, okay, gotta stay above the lava.

>> I did feel a pressure from society, from our family members, "What if Daniel changes his mind?

But we knew that we just had to listen to what we heard from our child.

And it didn't... nothing else mattered.

>> NARRATOR: Although Daniel transitioned two years ago, recently he started to worry that his body is beginning to change.

>> I've been feeling a little weird, and it's been feeling weird, so I stay up a lot of nights talking with my parents about it, and I don't get a lot of sleep.

Yeah, and... yeah.

I just don't like feeling different.

It starts making my tummy hurt a little, so...

Sometimes it makes me cry when I'm very, very, very, very, very tired.

>> To develop breasts would be horrifying for him.

>> He doesn't want to be the kid that has to be different.

And he has talked about suicide or killing himself before, which is why we immediately sought the help of professionals.

I think he finds a great deal of reassurance knowing that there are things, there are steps we can take where he can look more like a boy and pass to be more like a boy.

>> Bring it to the top, quick!

>> NARRATOR: It's now possible for kids like Daniel to never have to go through the puberty of their biological sex.

But timing is crucial, so Daniel's parents are taking him to a clinic in Chicago.

The gender program at Lurie Children's Hospital is one of a growing number of clinics around the country providing treatment to gender nonconforming and transgender kids.

>> Hi, how are you?

Did you grow since last time I saw you?

>> Um, yeah.

>> And you just had a birthday, right, on the 20th?

Happy belated.

Shoes off, if you don't mind.

>> So these kids really are a new generation who are being cared for completely differently than children were in the past, and that is...

It's exciting for them to have opportunities that somebody wouldn't have had even ten years ago, but it's also very challenging for the medical community to find the right way to do this.

Step right here.

>> NARRATOR: One of the biggest developments in the treatment of transgender kids came in 2007 with the introduction of hormone blockers, drugs that suspend puberty and slow all physical development.

>> The pubertal blockers are the medicines that pause puberty.

So the idea is that we can just put the pause button on puberty and let children have a little more time to grow and develop and be more confident of their gender identity.

>> Tight squeeze and I'll be done, okay?

>> NARRATOR: But the treatment of transgender kids can be controversial.

It's a field of medicine with very little research, and the few studies that do exist suggest that for most kids, the distress about gender will shift with time.

>> The majority of children with gender dysphoria will not grow up to be transgender adolescents or adults.

But I think the challenge is that we're not able to definitively predict for whom gender dysphoria will continue and for those that it may not continue.

>> All right, get your arm back.

>> Our goal is to try to figure out which children are going to continue to identify as different than their natal sex.

And we don't have any definitive test to do that right now, and that's very challenging.

I wish there was a test to say, "Oh yeah, of course, you're five and you think this now, and you will when you're 15, and you will when you're 30."

I mean, we don't have it, though, so it's a real challenge.

>> Hello, hello!

Look who's here!

How are you, Daniel?

>> NARRATOR: But there is growing consensus that the more intense gender dysphoria is in childhood, the more likely it is to persist, and that puberty itself can also be a telling predictor.

>> And I just wanted to see if you were noticing any changes in your body recently that had you maybe feeling worried or sad?

>> Well, this one over here, it started getting real tender.

>> I think Daniel had been really concerned about how quickly this was going to happen and just really feeling strongly about not developing breasts.

And my husband and I want to do anything we need to to keep his emotional well-being in mind and how he feels about himself.

>> Okay.

>> Early intervention does make a huge difference.

Once physical changes, some physical changes of puberty have occurred-- you know, voice deepening in boy-bodied people, for instance-- they're irreversible.

So really starting puberty-blocking medications as early as possible is really important for some people who are really experiencing distress.

>> So there is a very, very faint amount of breast tissue under the right breast.

I mean, it's just a little tiny bit.

We typically want to see that a child has had a little bit of pubertal development, but that's the point at which we can start sort of talking about blocking puberty.

The medications that we use for puberty blockers all work, and for the most part have few side effects.

This is a sample of what the implant is.

>> Hmm, that small?

>> Yeah.

The medications are very expensive, and so they can be $15,000 to $25, 000 a year for some of these things, which is cost prohibitive for most people.

So we have worked on an option that we have, we can offer here now actually, which is called Vantas.

And its FDA approval is for men with prostate cancer, but this has been used successfully by pediatric endocrinologists taking care of kids like Daniel, and it seems to work just as well, and it is a lot less expensive.

And so, you know, Vantas is not... it's not approved for children, but none of these medications are actually approved for use in this situation.

>> For all?

>> For any of these.

>> For any of them, okay.

>> We have a lot of experience in pediatric endocrinology using pubertal blockers, and from all the evidence we have, they are generally a very safe medication.

But the concerns with this population are just different because we're using them at a little different age and for a different purpose.

So whether it is having any negative effect on their adult bone density or their neurologic development I think is... we don't know.

I much prefer to take care of conditions that have been well-researched and well-studied for 50 years, and that is not the case here.

We just really need good research that we don't have yet.

>> They're not easy decisions to make, and they shouldn't be made quickly, and I think the take-home message today is that nothing is going to happen quickly, okay?

Nothing.

>> This generation of kids are really...

They're the pioneers.

They are gonna be the ones to teach us.

>> My name is Ariel.

I am 13 years old, and I identify as a girl.

I haven't really experienced puberty at all.

I mean, the hormone blockers are like my life saver.

But me turning into a man is just probably the most horrifying thing ever, I could ever think of in the farthest reaches of my mind, is me not going on the hormone blockers anymore and me developing into a man.

That would just be horrible.

The hormone blockers, they give me a space where I can really feel completely just sure of myself, and I can just have that little breathing space before I enter puberty.

And you're just in this nice little world where you're still like a child, and it's just great, before you develop.

It's harder, teasing and bullying-wise, when you're a girlie boy, when you're in that in-between stage, than when you've fully transitioned.

It's much harder to be gender-nonconforming than to be transgender, because when you're gender-nonconforming, that is when really a lot of difficulties set in.

>> NARRATOR: Ariel did not transition until she was 11, when she started blockers, but there was a long period of time when she was living in secret as a girl.

>> That was a difficult time.

>> Very.

>> Just very confusing.

If we went into a restaurant and she was wearing something that was more feminine and she saw somebody from school, she would run into the bathroom and wouldn't want to come out.

>> It was kind of like a double life.

I think a lot of people are completely just comfortable and fluid, but for me, I was really scared.

My name before was Ian.

And then I guess when I was around nine years old, I started deliberating, like, "Maybe I should change my name to really show the world that I wanted to fully transition."

>> So she asked us to call her a different Disney princess name every day.

So every day... >> I forgot about that!

>> Every day, we had a different name.

And there was an order to it.

Cinderella, Belle, Ariel, Snow White, and they were in order, all the Disney princesses.

And on that day, I would have to call her that.

>> And I remember my grandmother, she cared so much about me, and she wrote on her calendar every day, like, what princess I was supposed to be.

>> So she would make sure she called you the right name.

>> (crying) It just made me think, like, she cares about me so much that she writes on her calendar who I am each day, which was really amazing and made me so happy.

>> NARRATOR: As Ariel's girl world intensified, her double life began to take a toll.

>> I believe that someday, I'm going to live in a castle and all the Disney princesses are going to visit me every single day.

I can play mermaids in the water.

Oh yeah, I'm going to have five courtyards, one main courtyard and one main garden, and the garden is going to be so pretty...

I feel like at that point in my life, I wanted to prove to everyone that I wasn't like any part of a boy in any way, shape or form.

What a perfectly, perfectly awful year!

>> Jeez!

This is from Cinderella III, right?

>> It was just, like, horrible and just confusing for me, and I tried to just...

I was trying to ground myself with all the dresses and the princesses, just trying to say to myself, you know, "I am a girl, " and prove to everyone else that I am a girl.

>> Which Disney princess do you think is the most beautiful?

>> Hmm... Ariel.

It was like I was putting on costumes, but now I'm putting on outfits and clothes, and it's not a Snow White dress or a princess dress anymore.

It's like it's actual girl clothes.

Now I'm actually me.

>> For me, the age that everything started to happen was around fifth grade.

I started really going through puberty.

That was... that is horrible.

I hate it.

I mean, for any transgender, male or female, it's probably the worst time in their life, because they're actually becoming what they don't want to become.

I was wearing three sports bras.

I was very self-conscious of my chest because guys obviously do not have a chest.

They are flat, completely.

And so before that, I was able to pass.

I was able to kind of be a guy.

But then once that started happening, I was like, "Oh, that is not going to help my appearance much, yikes."

In my mind, I saw this really strong, flat-chested guy that had an Adam's apple and a beard.

When I looked in the mirror, I saw this small girl who was not supposed to look like that.

I felt like I just needed to look the way I looked in my head, to be who I was and feel comfortable with who I am.

>> NARRATOR: This year, at the age of 13, Alex began to transition and formally changed his name in school, where everyone had known him as Karen.

>> Middle school can be kind of a scary time for lots of people.

Even after I started really transitioning, I would want to stay home because I know that everyone there knew me as a real girl.

I can feel them kind of, like, wondering why I couldn't just be a tomboy, why I couldn't just dress like a guy and I didn't have to become a guy.

So instead of calling me like "he's" and by the male pronouns, they'll call me "it," because I'm kind of in the middle.

I mean, I can deal with that.

I don't really like it, but I have a minimum amount of friends.

I want to keep the friends that I have.

So I kind of just... let it go.

I definitely get depressed sometimes.

I will listen and dance for hours.

Whenever I'm feeling upset or something, it's kind of a way to soothe me down and, like, get me happy again.

I have my imaginary world, and that's one of my coping strategies.

Like when I'm feeling down or depressed, I'll kind of, like, go into my imaginary world.

And in my imaginary world, I am a guy.

I have a flat chest.

I'm strong.

There are definitely girls and guys in this world, and they just help so much.

And to me, they're real.

And like, if I'm feeling so down that I just can't talk, they'll sing or listen to music and dance with me.

And that definitely helps.

It's kind of like a telepathic thing.

I can hear them in my head and then I'll speak to them either through my head, or sometimes I'll look really weird walking down the street and I'll be, like, "Hey, when I get home, do you want to, like, dance and sing with me?"

And they'll be, like, "Yeah, yeah, sure."

And so I'll have something to look forward to when I get home.

I think at times, my mom can get a bit worried.

I think she's sometimes worried that I don't know reality from imagination.

I definitely know the boundary line, but like, I've brought them over so much that I think the line has definitely thinned and kind of become blurry.

>> Alex does have an imaginary world that he has talked to me about, that he's talked to his therapists about.

And they do feel that Alex has his feet firmly planted in the ground, in reality, but that it has been a mechanism to deal with... ...his problems.

It's very hard for him to have female hormones in his body, raging through his body.

He wants those shut down.

>> NARRATOR: Alex's parents are considering puberty blockers to stop his menstruation, but they have serious concerns about the medications.

>> I think the real struggle is in the risks of the drugs.

We know that the drugs have not been used for that long on children, and that there isn't really adequate data.

And then there are potential side effects and possible long-term effects that are not known.

>> And so we have been kind of wrestling with this decision, talking to a lot of doctors, reading a lot of information.

And not making a decision has implications also, because doing nothing is not really an option here.

I mean, I would like to choose that option, but I don't know how a transgender person feels, and based on our conversation with Alex, doing nothing is not really an option.

>> NARRATOR: But the decision to take blockers can also lead to another complication.

Two years ago, when Ariel first transitioned, she and her mom decided to make a fresh start.

They moved to a new town and enrolled in a new school where nobody had known her as Ian.

>> When she first went into school, she went into school with the teachers, the faculty knowing that she was transgender, but her classmates or any of the students in the school did not know.

And I wanted that for her, not because we were even embarrassed or we wanted to hide it, but I wanted everybody to just know Ariel as Ariel.

I would rather you meet her as her, and then if you find that out about her, it's just something about her.

It's not who she is.

It's just another part of her.

>> We look like we're in the next Percy Jackson movie.

>> No, but we do look like demigods!

We can totally pass for that.

>> NARRATOR: Although puberty blockers had allowed Ariel to pass, three months into the new school year, while changing in the girls' locker room, she was outed.

>> At first, I sort of felt bad for her, because it must have been so hard, obviously.

And it was just sort of like tension between us.

Like, I didn't know how far I should go, like, if I should bring it up, or if I should just treat her normally, or just like nothing happened.

>> Yeah, that's probably the reason that I felt uncomfortable, because... not uncomfortable.

The reason I was, like, surprised.

And, like, it was just a new idea to me too.

I didn't even know what transgender was before that.

And so because she was like... She's such a girl that it really... it was so shocking.

>> (laughing) It's my duck face, okay?

(laughing) >> Well, it would have been different if I had met Ariel as a boy first, but we still would be where we are now, I think.

>> I...

I know we're really close, but I really... Like, I had an experience at my old school, and I really don't think it would be, like, as close as we are now.

Like, it would never be like this if I came in as a boy.

And it would have changed our relationship.

I definitely know that.

>> You're right.

It would have, actually.

We'd still be friends, but it wouldn't...

I guess it wouldn't really be where we are now.

>> There is still some of that awkwardness, no matter how comfortable, you know?

Say, like, all the girls in the class are having this giant slumber party, and they're all just, like, throwing off their shirts and, like, just dancing around and, like, just changing and stuff.

You know, it's kind of hard.

And I'm always sort of changing in the corner still, even though how comfortable I could be.

So I feel kind of left out.

>> It's almost like there's a fine line between trying to include her and trying not to include her so much that it made her feel excluded from everything.

I keep accidentally making her feel bad, and it's just... it must be so hard for her.

I can't even imagine it.

>> I remember a couple years back, everyone was talking about, like, having babies, and it really makes me upset.

I mean, I don't want to tell them to stop talking about it, but you know, it's like... it kind of hurts my feelings, and they're always talking about that.

It's like...

It's so hard to explain.

It's like, "But I'm a girl," so it's...

But it's like, "Could I have the pain of labor?

Could I have to deal with that?"

And it's kind of hard to have that happen, like, those conversations.

(crying) And I feel like a lot of people, it's hard for them to understand, but I don't want to, like, burden them with that.

I kind of just either walk away or I just kind of deal with it.

I try to sometimes get into the conversation, but you know, it's hard.

>> Do you ever feel like you're, like... you can get so close to being a girl, but you just can't get to that exact point?

Is that what upsets you?

>> Yeah, that's exactly how I feel.

The thing with having a baby, it's like I can never be fully there.

That's just, like, a natural thing that happens.

I buy a bra, but it's not to hold in my boobs.

It's for an illusion.

It felt sort of like an act.

So I kind of feel lost sometimes.

>> For me, I always, like, see these really cool guys, and I'm always like, "I want to be like them!"

And Morgan and Ben were those, like, cool guys that I wanted to be like.

Once I really realized that they were perfectly fine with me being transgender, it was like a whole new world for me.

>> Good job!

>> I kind of think that it really shocked people, like, knowing that we're hanging out with this... Like, because I know that people were thinking that, like, Alex is weird and stuff, like, thinking that he's, like, really different from everyone else.

In all reality, he's just... he's the same as us.

>> Wait, are we moving the quarter pipes together?

>> I sometimes mistake Alex, like, if I'm talking to Morgan, I'll be like, "She," but then I might like correct myself and be like, "He did this."

But I think I've gotten a lot better about that, definitely.

I didn't know she changed her name to Alex, like, since this year, like before I knew her.

I always thought her name was Karen, I said, "Hi, Karen" in the hallways and stuff.

I can't imagine, like, what the change is between that stuff, like, being a girl to a guy.

I don't even know what being a girl is like, so... >> Remember to apply enough pressure to the tail as you pop.

Just in general, I've been showing him the ropes of being a guy, and saying like, "You've got to start working out more.

You've got to build up that upper body muscle."

>> "Try and talk in a deeper voice.

Even if it's not normal, get used to it.

Burp.

If you have to burp, just let it fly.

Don't try and hold it in.

Girls do that all the time."

>> In terms of girls and dating, I'd just say, like, "Try not to really show any emotion towards it.

Just, like, treat her like you don't even like her.

Just treat her like that."

So I'm like...

I'm not trying to make that sound bad or anything, but I mean, I'm just saying.

>> Well, the, like, tactics and all the information that they're giving me, I definitely use it.

Sometimes, I know that I'll slip up a bit, but their tips are amazing, and I'll go with them.

>> You have to keep your foot straight with the board.

>> I'd still say that he's still in the process of, like, really learning how to be a guy.

But I say he's coming close to finishing that for sure, so... >> I've been struggling with depression for about four years.

It's more anxiety and sadness, the kind of depression I have.

I have medicines to, like, boost my happiness, but those don't always work.

I had thoughts of hurting myself, cutting myself, killing myself, even.

I got very close, very close, twice.

I was just thinking, "I can't do it anymore.

I can't live like this.

I can't live in this body.

It's not going to work."

My mom's just been super supportive.

She's been great the entire time.

I was terrified of telling my dad, because when I was younger, he was always like, "No, you have to wear a dress.

You're a girl, you can't, not allowed.

No, can't do it."

So that probably made me terrified.

I finally told him, which was not that long ago.

My dad was really worried about the effects of the medicines, and what if I later in life decided that this wasn't the path that I wanted to go down.

>> I had some concerns, and there were some things about me, or about it, that kind of bothered me a little bit.

We have these educated doctors offering kids who are at a young age some options that I'm not really sure should have been available to them.

I was really kind of surprised and put off by it, quite honestly.

>> Because I was only 13, he didn't want me to make a life decision like that at this age.

It was still hard.

I couldn't really see why.

It was horrible.

I felt like my parent, my dad, he didn't love me.

I felt like he didn't want me to be this way.

>> I didn't want her to... (clears throat) ...think that she could make some changes to her outward appearance and then suddenly, everything would be fine and she would just move on from there and life would be great.

I think there are a lot of other implications to this than just the few that you're focusing in on right now.

>> NARRATOR: But Kyle is still hoping to start testosterone, and although his father remains concerned, he's agreed to go to Lurie's gender clinic for the first time to learn more about hormone treatments.

>> Heels all the way against the wall.

>> NARRATOR: Cross-sex hormones, estrogen and testosterone, used to be given only to adults.

But treatment guidelines established in 2009 now include children, though they do not recommend starting before the age of 16.

>> All right, have a seat in the chair for me.

>> The age limits which used to say 18 now are 16.

Now you're seeing people starting cross-sex hormones at 15 or 14.

And with the changes in the age of onset come some challenges to care that I think teams need to be very savvy about.

How are you?

>> How are you?

>> I'm Dr. Garofalo.

>> Do you remember me?

Dr. Chen, good to see you again.

>> I mean, I think the big decision that families have to make when they embark on cross-sex hormones is that now you're not hitting a pause button, right?

So when you move on to cross-sex hormones, you're now initiating medical therapy where some of the changes that are going to take place are permanent.

And that's a whole other, like, ball of wax, I think, for some of these families, and that can be really hard.

So when we think about medications, if we're going to go with the route of medications, there's two kinds.

One are medications that sort of block progression through puberty.

The other medicines that you could use would be right to going to sort of what we call cross-sex hormones, or in this case it would be sort of testosterone.

>> There are plenty of drugs that get approved by the FDA, and everybody goes on their merry way and thinks things are great, and then two years later, people are dropping dead from one thing or another.

>> And this is really important, so I'm actually going to pull up a stool so I can sit and face you.

So testosterone as a medication has been around obviously for a long time.

The way we would consider using it here, sort of for, in a cross-sex sort of way, there aren't, like, a tremendous amount of studies that have been done to document, like, all the potential side effects and the risks and benefits.

But I think in general, it's fairly well tolerated.

Some of the changes, again, are permanent, and some sort of aren't, and I think those are the things that kind of freak people out.

But when you think of things like, you know, hair loss on the temples, you know, facial hair growth, deepening of the voice, all things that go along with sort of a male sort of hormone.

You're gonna have increased muscle development.

So some of it's going to be things that he'll want, but some of the things you want to look out for are things like acne, mood changes, and then all the risk factors that go along with a typical male predisposition.

So things like heart disease, stroke, you know, those kind of things.

Males are more likely to have heart disease than females.

We're asking families to take some leaps of faith based upon the child that they have in front of them, and really what we don't know with regard to some of the long-term consequences of these medications.

If you look at our consent forms, they're fraught with, like, vague language and, like, "May, could..." We know very little about things that are really important to families, like fertility, like cancer potential or oncologic potential of these agents, cardiac risk.

I mean, things that, like, families want to know when they're making decisions about their children.

And there definitely is the potential for the testosterone or the cross-sex hormones to prevent sort of normal, or what we call "normal," fertility to sort of occur.

Have you ever thought about having kids yourself?

We're sort of asking you to be really grown up really quickly when you make these decisions, and that's what's tough.

But I want you to really think through some of the stuff we're talking about here.

Does that make sense?

>> Well, you know, I would like to have kids, maybe someday, but... >> If you're saying, you know, "I might want to have my own kid one day," then I think it's probably a good thing for you and your parents to sort of at least get some information and find out whether sort of preserving your fertility might be something that you're interested in.

>> Up till now, it's been things that were reversible.

Change your name, we can refer to you as "he" and "him" and sure, fine.

But at 13, I don't think she'll change her mind, but you have to think a little bit more about that.

I mean, those are... And those are things that your parents should be there for, to help you be as certain as you can about a decision that later in life could have a huge impact.

So there's a lot to think about.

You feel better now?

>> I do.

>> Good.

>> I don't envy these parents.

I mean, I think they're making decisions in a very difficult environment.

I mean, I know that we do informed consent, but really, I mean how realistic is it to believe that a 14- or 15-year-old or 16-year-old has really the capacity to make that kind of decision for him or herself?

But at the same time, to deny them, that's tough.

I mean there's a... this is a... this is tough stuff.

>> Hi, okay.

So I guess around 11: 00, uh, I injected testosterone into my body.

And so today's my first day, like, being born, I guess.

>> I watch lots of YouTube videos of like Skylar Eleven and stuff.

So like having him like kind of explain everything through his videos has helped me a lot.

>> So this is kind of like me pre-testosterone, but some is like floating around through my bloodstream right now.

Um, and I feel really good.

>> I looked at other videos.

I realized that they were exactly like Skylar Eleven, that they had the same thoughts and the same, like, views of things.

>> These are my muscles pre-T.

They're not that bad for a biological female, I think.

>> And these are my abs, so this is all like pre-testosterone.

>> Cross hormones, I can't wait for.

It's going to mean that I'm going to start being able to gain muscle easier, the way guys should be able to.

My voice is going to drop.

I'm going to get an Adam's apple.

Woo-hoo!

I can get a deep voice, I can get a beard, I can get a flat chest.

Did someone look at my Christmas list?

>> To inject testosterone, you have to use specific needles and a specific syringe depending on your dosage.

>> I always pull out more than I need, because then I just push the rest of it back up into it.

>> One, two, three, just like that.

>> Ready.

>> Today was my first T Shot.

It was actually about half an hour ago.

Hey guys, today is July 16, 2010.

Hello, people.

Hey guys.

Hey guys.

Hey guys.

Today is my nine months on T. Hey guys.

So today, actually it was yesterday, it was my 11 months on T. (lowered voice): Hey guys, so this is my voice 12 months on T. >> I'm a lot hairier.

As for my happy trail, which is the hairiest part of my body, it's like a happy super highway.

>> Today is my first day on T. Um, I feel like a new man.

Basically I was pretty much born today.

Today is my one year on testosterone.

It is my official T birthday.

I am now one years old, and it feels freakin' awesome.

It's the best thing in the world, you know.

>> Cross-gender hormones and top surgery are going to be the two major things that I'm, like, looking forward to in my future of being able to transition all the way.

>> I myself, I got top surgery.

I take testosterone.

I got top surgery about two-and-a-half months ago, and this is what it looks like.

There's several different procedures.

This is a double incision procedure.

>> I can finally show off my wonderful abs.

Like they're really there.

But they kind of are.

That's about it, yeah.

So this is my chest.

>> Online is a great place for trans people.

The Internet is the best place you can go to, if you're like scared about talking to anyone.

The Internet, like Tumblr.

Oh my God, Tumblr.

And, um... just YouTube, too.

YouTube is like one of the... That's how I found out I was trans.

It was from a YouTube video that I found a long time ago.

>> NARRATOR: Kyle met his friend John in a support group for transgender teens.

The online world has helped them learn to pass as guys even without testosterone.

>> When I officially came out as trans, yeah, it took my parents a long time.

And my dad, my dad is still having his issues with it.

>> It seems super hard for dads, though.

It seems a lot diff... because it's like, "Oh, daddy's girl," that thing.

Did that ever happen to you?

>> I don't feel like that's what was up with my dad.

I don't think it was a "daddy's girl" kind of thing.

I think it was...

I think it's just hard for him to imagine, like, being able to be born one way and identify as another.

I think he's just... Guys aren't really allowed to play with their gender at all.

>> Oh yeah.

>> So I think that was more about what it's hard for him to wrap his head around.

>> My birth name was Gianna.

For as long as I can remember, I always felt male.

I did come out to my parents as a lesbian sometime around seventh, maybe.

You know, I thought, "Oh, well, I seem to wear boys' clothes all the time, I feel masculine, and I realize that I like girls, so I was like, okay, I must be a lesbian."

That was tough.

My dad, he just... he just wouldn't have any part of it.

I think he said something to me, he was like, he said, "This is not a world that you're going to be a part of."

Then when I got to my freshman year, I identified as trans, so I came out to them again as a trans male.

>> At that point I was using pronouns "she" and "her" and he said, "Mom, you know, when you say that, when you say 'she,' it feels like I'm actually naked and I feel horrible, and I just want to disappear."

So I started to say "Gi."

And now he would like to be called John.

So I just go between both names still.

Still getting used to the process of the name.

>> So it's still Gi to me, certainly not the Gianna from, you know, childhood, but it's still Gi.

And I guess I haven't switched over to the John.

A little harder for me.

I feel, in a sense, like something's been robbed, right?

Like, you know, so my daughter's gone, it seems, and is morphing into this other person, but I feel like this may be where it ends up.

I don't know.

I hope not, but I think there's another way.

There's a whole spiritual side to this, to me.

So I pray a lot.

You know, and the whole spiritual piece of this is, you know, I just don't believe that this is the right way to go.

This is a personal place that I'm at.

I want Gi happy.

I want, you know, the best life for her, you know, want that life based in-- how do I put this-- on the path that God has planned for her, I don't know that this is it.

This route, to me, can be an eternal death.

She may not see that, but there's a hope that if I can just stay there, you know, show the love, see what happens, and we have to take it day by day.

>> With the upbringing that we had, you know, we were taught that, you know, man and a woman, and a man and a man is bad, and you know, they're damned, and that's how we grew up.

That's what we grew up thinking.

But in time I realized, with regard to my child, this is the way he's felt on the inside for so long.

>> Merry Christmas, Gi Gi.

>> I mean, he could hardly speak when he was pulling on his tights saying, you know, "This is not what I want, and this is not who I am."

I don't understand how you could be born that way and have that happen, and yet, you know, it's something that you could be damned for.

It doesn't make sense to me.

>> Wave hi, everybody.

Say hi.

Say hi.

>> I always had a hard time making friends.

I think part of it was that I was a very strange kid.

I would just feel bad because every day I went to school, I just felt like everybody wanted me to go.

Nobody wanted me there.

One time, this girl, we were in the girls' locker room because we have to change for gym.

She just went off on me.

She was, like, "Man, you're an ugly dyke.

You're a lesbian."

It just kind of went from shaky, to unstable to almost impossible, is what it felt like.

By the end, I was just trying to hang on.

I started getting some anger issues in my sophomore year.

When I was very stressed out, well, sometimes I would break and I would punch a hole in the wall, or kick a hole in the wall, or things like that.

I...

I would just get so mad.

Eventually, I could keep it from all spilling out, but it would instead, it would spill in.

I was just drifting off into this very violent... very violent experience into my head.

Sometimes I would think about harming my family.

The images would pop up in my head.

It got... it got so bad.

And that's when I really decided, I feel like a threat to my family.

I feel like a threat to myself.

I just can't control myself.

So very late at night, I went down to my mom.

I was just crying.

And I said, "Hey, I want you to take me to a hospital and I want to get locked up ."

>> That's what really motivated me, to know that he was in so much pain, and that I could be causing it.

That was too much for me.

I just have to support him, and I kind of just have to figure out whatever's going to happen is going to happen, but today he needs me, and that's what I'm going to do, whatever he needs me to do.

>> You know, I guess I'm holding out on hope that, you know, "Could this reverse?"

There's a possibility.

Is this going to move fully forward, and this is where Gi's going to go?

That's a possibility, too.

I just can't make that switch just in... for me, myself.

I don't talk about anybody else.

It's because it's a personal issue, and where you're at.

The choice for me is, I just like, I can't go there.

>> Do you want to go to the Barnes & Noble down here?

>> Yeah, yeah, down here.

I'm on the verge of cross hormones right now.

I'm excited just to become a woman, to have breasts, to have a beautiful figure, to just be a woman.

And I think now with the technology and the hormones, you can actually transform into who you actually envision yourself as.

And that's what I think is really amazing.

We signed the legal papers on Friday, so it's all set with the cross hormones, and I'm really excited.

>> It's really big news and I'm also just aware of...

I feel like you've been waiting for quite a long time.

>> Yeah, a very long time.

(chuckles) >> And you know, I mean, it's interesting.

Some people think, how come someone your age knows so well and so clearly, you know, who you are and who you're going to be?

And you've known who you are, you know, as a girl for so long already that, you know, from my perspective, sort of asking you to wait longer feels more harmful than, you know, than not.

>> The guidelines have always said that cross hormones should start when an adolescent is 16 years old.

And that's something that we've been working on with our therapist.

He really feels that Ariel is ready.

He's asked... we've gone through, you know, many sessions of therapy.

We've gone through questionnaires.

We have to... the endocrinologist has to talk to us, the pediatrician, and we're now we're at the point that Ariel is going to be able to get cross hormones earlier than the guidelines of 16.

>> So, taking this next step of taking cross hormones means something in terms of your ability to have biological children.

You know, some transgender adolescents decide to actually postpone, you know, even taking cross hormones until they can store their genetic material.

>> I wouldn't really want to produce sperm.

I really wouldn't.

Like, I don't want to have a child that way.

And it just wouldn't make me feel good.

Like, if I had, like, sperm, I wouldn't be happy, like, "Yay, now I can have like a baby or something."

I would just be, like, horrified.

>> You know, it's interesting, you said, "I wouldn't even want to produce sperm and have a child that way."

And I wondered what you meant by that.

Like if you meant it would remind you that you're having a child from your boy's body?

>> Yeah, yeah.

That's partially.

And it's also that I couldn't have a child, like, in a girl's body.

>> Got it.

But you want children?

>> Yeah, I want... well, of course I'm going to have children, but I'm just not going to have them that way.

>> Okay.

>> Mm-hmm.

It's not like I'm not going to have a child.

That would be like the worst thing ever.

>> But that's a bit painful?

>> Yeah, it's very painful.

>> And this... >> I think about it constantly.

Cry about it sometimes.

(chuckles) >> Of course.

It's okay.

>> Really sad.

>> Yeah.

>> But my excitement to start the cross hormones completely overrules my, like, despair to just not have a child of my own.

Like, that just completely overrides it.

>> Okay.

Any other thoughts or questions about that?

>> No.

>> Okay, good.

>> Oh, that's a very nice house.

Uh-oh.

(laughing) You can build it again.

>> When Alex was young, like I would say three or four years old, one of the favorite activities, at least for me, used to be on Saturday morning where I would make pigtails in the sunroom, and we would like capture some information on video, and just I was...

I was trying to, you know, have a chronology of different parts, moments of Alex's life.

>> You're the best.

>> Thank you, my baby.

>> Every once in a while I still called him Karen.

There's like a Karen phase in my mind, and then there's the Alex phase.

So if I was to, let's say, look at a picture of four-year-old, it will be Karen.

And then if I'm looking at a picture now, it will be Alex.

And accidentally, sometimes I call him Karen.

(knocks) >> Hi, Alex.

I'm going to wash my hands.

>> NARRATOR: Alex and his mom come to the clinic every six weeks for an injection of Lupron, the puberty blocker.

But today, they are also here to sign a consent form for testosterone.

>> You want to squeeze anything, are you good?

I'm going to do one, two, three, okay?

>> Okay.

>> It is very, very hard to make the decision to allow your child to take a medication that has unknown side effects.

But it becomes a lot easier when you've come to the conclusion that the benefits outweigh the risks.

And when you see your child suffer the way I have and struggle, the way we have seen Alex struggle, we don't have a choice.

I don't feel as though we have a choice.

>> So some of the changes of testosterone are permanent, meaning, these changes won't reverse.

Okay?

Once your voice deepens, there's no going back.

So hair loss at the temples and crown.

Other thing is facial hair growth and body hair growth, so those are things where, again, if you decided to stop at one point in your life, that hair growth may slow down, but it may not stop.

So once your estrogen goes down, there's actually changes in that area, usually thinning and sometimes you can get a little discomfort with that, with the walls of the vagina, okay?

That can increase the risk of sexually transmitted infections.

You know there are some transgender men who use that area to have sex, to use the vagina for sex, and some people don't.

But, you know, when we talk about increased risk for infections and things like that, that's really related to, you know, if you're using that area for vaginal sex.

Okay?

So I know, a little bit hard to think about and perhaps not comfortable.

>> Especially at 13.

>> Especially at 13.

I hear this, I know.

We have to go over this now, and you're like, "Why do you have to bring that up with anyone?"

It's not known whether this increases the risk of ovarian cancer, breast cancer, or uterine cancer.

So pelvic exams and regular cervical screenings are strongly recommended unless there's been a removal of those organs-- the ovaries, the uterus, and the cervix.

>> It is very difficult to have a 13-year-old in the driver's seat and playing such a big role in this decision.

I think that we would both prefer to see Alex transition naturally, to live his life as a man without medical intervention, but... and without the need for puberty blockers or cross hormones.

But we feel that, you know, we are not experiencing what he is experiencing.

So from my perspective, I do feel that testosterone is the right course for Alex.

>> NARRATOR: John's father remains opposed to testosterone, but John was hoping he might agree to a smaller step: a legal name change.

>> Dad had just come home from a business trip and I said to him, "Yeah, I'm hoping to get my name changed.

I was hoping that you could sign."

And he told me, you know, "I'm just not ready.

I'm not ready for that yet."

I...

I did start getting angry, but I tried to... tried to explain to him why I need this.

He still said that he wasn't going to sign.

Then I got really mad and... Well, I threw a cup at him, a cup of water, and I said to him that he's not my father.

I didn't mean that.

>> I know, I know.

It pains me that you have to go through that process.

I'm not unempathetic about that.

The bigger piece for me is, I don't know that I am going to be comfortable with this life and the way it's going for you.

And it's just my fatherly concern.

Everything else aside, I'm still at, I don't know that this is the right way because I'm basing this on love.

And I just, in love, for the way I'm thinking, the way I'm feeling, I couldn't sign.

>> I said, you know, "You say you love him, but it just doesn't feel like love, and if I were John, it wouldn't feel like love.

So I'm just telling you what it looks like from the outside."

So, whether he can see it or agree with it, I sort of just laid it out that I'm going forward with giving John his name and trying to do everything we can to get that to happen with or without his okay.

>> I don't know what that holds.

I don't know.

I don't know what that means.

I don't know if we split, I don't know if we...

I don't know.

I don't know what that means.

I care, though.

I mean, I would love to keep us together, but I don't know what that's going to do.

I mean, I think people have to, Lisa's going to have to make up her mind.

Gi will have to make up her mind.

If I choose this route, this very well could be it.

While I hate that stance, there's...

I just cannot get off this point.

I can't...

I can't.

>> I guess... knowing that I'll leave out maybe a year or so... it's kind of a...

I hope the tensions don't last, you know, because it would be nice to leave out with less conflict, have the family be a little bit more happy, a little more put together.

>> The life we live.

>> Okay, so let's start group now and just a couple of guidelines.

Highlight, lowlight.

Preferred name and pronoun.

And we'll go this way.

>> I'm Lia, female pronouns.

I'm leaving tomorrow to go to Arizona for surgery.

So, that's cool.

(applause) Yeah, I had like a really good, like, week and month.

I graduated from high school.

I was prom queen.

>> Really, oh my God!

That's wonderful.

>> Yeah.

My friend AJ, who is gender non-conforming, was prom king, so like it was cool.

>> Oh, I know AJ.

>> AJ Jonathan?

>> Oh my God, I know AJ.

>> Yeah, so we're prom king and queen, which was awesome.

I graduated from high school, having surgery, pretty good.

>> NARRATOR: Lia Hodson, who just turned 18, is among the first wave of kids in the United States to medically transition with puberty blockers, hormones and now surgery.

Walking through a crowd, the village is aglow >> I'm about to go in for surgery.

It's a SRS bottom surgery.

So I'll be getting a nice little vagina.

(laughs) SRS means sexual reassignment surgery, or GRS, gender reassignment surgery.

I think that's what they call it.

It drives you crazy, but you know you wouldn't change Anything, anything... They just kind of put it all inside and invert and sew it all up, and I got new parts.

(laughs) I think, soon as I realized who I was, I was, like, "Oh, yeah, I'd like to have the correct anatomy."

In my mind, I felt it would...

I wanted it to match.

It was never really like a question of if I would.

I just kind of felt like I would, and it was a matter of time.

I don't think that surgery's going to magically change anything in my life.

I mean, it'll just make me feel more comfortable with my body and myself.

I don't want to focus on being trans forever.

It's kind of just the little hassle I have to deal with.

I'd rather just go to college and move on, so be as complete as I want to be, and just start my next chapter of my life, I guess.

I don't want to make it my life.

I don't want to...

I don't really identify as being trans.

I'm just a girl, I'm just myself.

And I don't...

I don't really like making it a big deal.

I feel like a woman.

I don't feel trans.

I just feel like myself, I feel comfortable, and I feel like a woman.

>> NARRATOR: Isaac also fully transitioned, with blockers, hormones and top surgery.

Now 19 and a sophomore in college, his perspective has been gradually shifting.

>> I mean, in a way, I very much fit the very typical trans narrative.

I decided to transition, I legally changed my name, you know, I started taking testosterone, I got top surgery.

But I started realizing at around 16, 17 what a huge, huge decision I had made to embrace this masculine part of myself so deeply.

Going through an artificial puberty, you know, I didn't really experience this sort of formative time.

And I kind of mourn that in a way because, you know, as much as we all know puberty is that sort of, you know, gross, slimy molding of everybody into a person, and the way that I went through that was, you know, meticulously tested and controlled and dosed, and it's been good, but I wonder what that experience... or what role that experience has in a person's conception of his or her gender.

And I can never know that for me.

You know, none of this is to say that I made any sort of wrong decision or regret transitioning, because it was really painful to be presenting as male and not be on testosterone and not have top surgery.

And my mind was really cleared of that sort of pain after that in a way that allowed me to come to this openness, I guess, about my gender.

But I think, you know, it's become really clear in recent years that any sort of big problems that I thought I would fix by transitioning weren't really fixed.

I really don't like to use the term "regret," although it's kind of hard to speak about how I feel about my gender without there being some element of regret, or at least of fear, I think, a little bit of what the implications of the choices that I made are.

I'm putting a chemical into my body once a week.

I'm like... and there are very, very, very clear effects of that, And I'm assuming that there are also unclear effects to that.

I mean, it is super easy as a kid to hear, you know, these things are irreversible and be like, "Okay.

I don't care, you know, just I want it."

Because time doesn't, you know, you don't think of time in the same way when you've only experienced a tiny little sliver of it.

But I think in the past few years, at least for me, I would at some point like to take a break, at least, from testosterone, because I don't like to imagine that, you know, the entirety of the time that I spend on this earth will be spent sort of separate from what my body actually is.

Like, I don't really know what it means to be a man in this body, or a man in the body that I was born in, because I've only really been a man in the constructed body.

Which I enjoy, and it's comfortable, but also it's just not really my body.

(birds chirping) (humming) >> I do not want any of my boy puberty.

I don't want, like, the big hairy legs, or like... the like the body they get, like with all the muscles.

I mean, I want to be a muscly lady, but not a muscly man that's like, "Ooh, strong man."

Like, eh.

I want to be as close to a girl as I can.

>> NARRATOR: At the age of nine, Lia has not yet entered puberty, but Daniel has, and he will start blockers in the next few months.

>> We don't have a lot of choices.

It's a drug that they say is, you know, reversible that, you know, they don't think will do a lot of harm, and so we're forced to pick the lesser of two evils in some ways, just because of what we don't know for one of them.

But it's our son's happiness, and that's the bottom line.

We want him to be happy.

>> All right, so, let me show you your medicine.

So this is testosterone, right?

>> Mm-hmm.

>> Okay, so always get in the habit of reading your vial.

>> I wish we can fast-forward to, you know, 100 years from now, and then go get the data which is going to be available and being generated, and there would be a better understanding about this gender dysphoria.

But we don't have that information.

So what we are trying to do is, make the best decision possible with the known facts.

>> One, two, three.

Aw, you did good.

>> NARRATOR: Soon after meeting with the doctors at the clinic, Kyle's father agreed to let him start testosterone.

>> It was the happiest day of my life.

Just seeing my dad finally accept me for who I am, it was the best day ever.

>> I need testosterone to be comfortable with myself.

And my dad, he keeps saying, "I'm just not there yet."

>> Can I see it down the road?

You're asking me today, no.

I'm just being honest, you know, so we'll need to sort through that and talk about that as a family and what that means, but today I don't see it.

It's hard for me.

>> NARRATOR: Not long after this interview, John was suspended from school for punching a classmate who had just started testosterone.

Three weeks later, his father relented and signed the consent forms.

>> Right when she found out she was going to get it, she sent me a text in like... this long, in, like, all capitals, like, "Save the date!

I'm getting the hormones!"

In like all caps with like a million exclamation marks.

>> And it was... actually, it was, like, kind of exciting for us when she finally said that she was going to get them.

>> Well, I remember the first day, like, I got the hormones.

So I walked around my room and touched every article, like every fiber of my carpet and every, like, piece of thing on my bookshelf, and I said, "I'm... these are the last things I'm touching while I'm a child."

And I was, like, walking around and, like, touching the entire things.

And it was so funny and I, like, finished touching the last snow globe and I'm, like, "Now I'm a woman," and I was just so happy.

I already feel like I've gone so far and I'm only 13, so.

Before I just wanted to be a girl, like just a girl, girl, girl.

But now that I've gotten on my feet a little bit, I want to show people, like, I'm a trans girl.

I mean, if you're sure of yourself, then why do you need to hide it?

>> There's definitely times where I thought like, "Okay, well, now that this town knows, maybe I could move, so I could just start a whole new life and just be the guy that I am."

But some part of my mind sees that as kind of lying to myself.

I mean, I'm never going to be a cisgender guy.

I'm never going to have been born an actual male.

I'm always going to have, like, that sense in me.

And if you lie to yourself, then you're kind of lying to the world.

And it puts a lot of weight on your shoulders, a lot of pressure for you.

And I think that if I can just clear that pressure off, I'm Alex the transgender guy.

>> These are not families that are living in the shadows anymore.

You know, the world is changing.

I mean, this is a movement that is happening.

It's not going to not happen, it's going to happen.

But the stakes are super high, and we don't have all the answers.

There hasn't been a lot of research in this area.

Hopefully there's going to be more research and some of those unanswered questions, hopefully, will begin to be answered and then we can give families, like, legitimate options in terms of what we're doing now, which is really, I think, approaching families with a lot of unknowns.

>> We are all kind of navigating this new world.

I hope that what we will have done is to give them a chance to have what for many of us is natural for us, to appear and live as the gender in which we identify.

I also hope that these individuals will be able to give us feedback, both... both just to tell us and that they will be involved in studies that we can learn what things we did right and what things we didn't, and that it will be even better for the next generation.

I really hope that what we're doing is the right thing.

>> Go to pbs.org/frontline for more about transitioning at an early age.

>> Just put the pause button on puberty.

>> And check out our special Facebook First series of original stories about growing up trans.

>> When I was younger I didn't really know what transgender was, so I kind of just like, I guess I'm a guy who's just really feminine.

>> Now that I have friends that actually, like, accept me, that are guys, I'm more myself, yeah.

>> Then tell us what you think at pbs.org/frontline.

>> Next time on Frontline... >> We're in the post-antibiotic era.

>> Untreatable infections.

>> They had asked me to sign the papers to let her go, and I did.

>> Drug-resistant super bugs.

>> He had some bugs that they had never seen before.

>> Frontline investigates.

>> We are seeing the emergence globally of bacteria that are untreatable.

>> "Hunting the Nightmare Bacteria."

>> For more on this and other Frontline programs, visit our website at pbs.org/frontline.

Frontline's "Growing Up Trans" is available on DVD.

To order, visit shopPBS.org or call 1-800-PLAY-PBS.

Frontline is also available for download on iTunes.