Once you’ve read this story, make sure to check out the essay by the twins’ father as he discusses what it’s like to raise a transgender child.
Although born identical twins with matching DNA, Tom* and Ryan were two immensely different children. As toddlers, Tom entertained himself with toy trucks while Ryan fawned over his girl cousin’s Barbies and Little Mermaid dolls. Photo after photo of them at that age show Ryan with a t-shirt wrapped around his head, mimicking long, flowing hair. At age 4, he asked his mom, Cecelia, a heartbreaking question: When do I get to be a girl? A few months later, while assisting his dad, Dennis, with a plumbing job, he told him that he hated his own penis. Dennis choked up. “I cried and he cried, and then his brother came in and we all hugged and cried,” he says.
When he was 6, his parents sought professional advice. A local psychiatrist diagnosed Ryan with gender identity disorder (GID) or transgenderism, a rare condition in which a biological male or female feels a strong identification with the opposite sex and is extremely uncomfortable with his or her own gender. Like Ryan, many transgender youth express disgust with their genitals from a young age, and some even believe they’ll grow up to become the opposite sex. These feelings can cause significant psychological distress, and, not surprisingly, depression, anxiety and the desire to self-harm when they become teens. Statistics on the number of transgender children are hard to estimate. In adults, where the prevalence is approximately one in 500 to one in 1,000—an elusive figure due to lack of national registries—diagnoses of GID have tripled since the 1960s. This increase is likely due to more people coming out as transgender because of growing cultural acceptance, not an increase in prevalence.
|Tom, who says he always felt like his twin was a girl, isn’t surprised by the twists their lives have taken so far. “I do wonder what it would be like to have a brother,” he says, smiling at Sylvia mischievously, “But I guess a sister cuts it.”|
Ryan is now 12 and goes by the name Sylvia. In skinny jeans and metallic ballet flats, painted nails and pigtails, she comes off as an energetic tween girl. She’s the more gregarious of the twins, but her bubbly disposition also serves as a protective facade: Since that first therapy visit at age 6, Sylvia has been in counseling to help her cope with anxiety and depression. In a world where everything is divvied up according to gender, there’s little room for a kid who falls somewhere in the middle.
It was easy to fit in when she was younger, but elementary school brought new challenges. She grew her hair long and asked to wear dresses and skirts. When her parents tried to discourage her, Sylvia rebelled by acting out in school and at home. One day she told a teacher she wanted to die. “It was terribly hard on her, to be told repeatedly that everything she thought and felt was wrong,” says Cecelia. “We finally decided to just let her be whoever she wanted to be.”
In fifth grade, after the long summer, Ryan came back to school as Sylvia. Although she was nervous on her first day with her new name, Sylvia found the majority of her classmates warm and welcoming. “Some of my friends asked me why I had waited so long,” she says. That year, Sylvia excelled academically and was voted class vice-president. At the same time, she was being seen by Norman Spack, MD, an endocrinologist at Children’s Hospital Boston and a leading expert in GID in children and adolescents, and evaluating psychologist Laura Edwards-Leeper, PhD. Spack, along with urologist David Diamond, MD, had helped launch the interdisciplinary Gender Management Service (GeMS) Clinic at Children’s—the first pediatric academic program in the Western Hemisphere to evaluate and medically treat young transgender people.
Sylvia’s parents immersed themselves in transgender research before coming to Children’s. “We were learning everything we could,” says Cecelia. Their biggest concern was what would happen when Sylvia hit puberty. She was petrified of developing “whiskers,” and was increasingly embarrassed about her body. Some afternoons, she stared at herself in the mirror in bewilderment. “I’d look at myself from the neck up, and I’d be okay with it, but then I’d look from the neck down and I’d feel like I was one of those mismatch puzzles,” she says.
Her parents knew if Sylvia went through puberty and into adulthood as a male, she was likely destined for a life of expensive surgeries to attempt to reverse the masculine attributes and transition into a female body. But their hopes rose when they heard of another option that could help Sylvia avoid some of the irreversible physical changes, like a deepened voice, facial bone structure, a beard and broad shoulders, which would forever define her as a genetic male.
Puberty is embarrassing and awkward enough, but for transgender kids, it’s the body’s ultimate betrayal. “This is the only big change in the body that they remember, and they feel it’s all going terribly wrong,” says Spack, adding that transgender youth have one of the highest suicide rates among teens in the country.
But what if you could halt puberty and stop the permanent changes from occurring? While it remains controversial, puberty suppression has been the standard treatment for transgender kids in the Netherlands since the 1990s. Since 2007, Children’s has been one of a handful of hospitals in North America to offer this treatment. Before any medical intervention takes place, psychologist Edwards-Leeper administers a rigorous series of psychological tests, forming a complete history of the child’s gender identity development. “The testing protocol we use is modeled after the Dutch clinic, which has been successfully treating and researching transgender youth for many years,” she says. Those who meet the stringent criteria for treatment are given monthly injections or a temporarily implanted drug to block their sex hormones. It’s fully reversible at any point; if they want to go through puberty as their biological sex, they can stop taking the drugs.
So far, the GeMS clinic has treated 17 patients with pubertal suppressors. “For the appropriate patients, we’ve found that the use of this therapy not only prevents severe psychological distress, but allows these young adolescents a chance to begin to blossom into their true selves,” says Edwards-Leeper. Spack scoffs at critics who accuse the clinic of fooling with nature. “I don’t think of transgender people as ‘changing genders,’” he says. “Almost every one of our patients felt that they were born with the wrong body. They’re not changing genders, they are affirming the gender they always felt they had.”
Puberty-suppressing therapy should be seen as a method that gives families and medical teams more time to think about what to do, according to Spack. “We no longer have to rush to beat the patient’s biological clock,” he says. It was the perfect choice for Sylvia. At age 11, at the first signs of puberty, she started taking the pubertal suppressors.
On a recent afternoon, Sylvia and Tom ride their bikes in circles in front of their house, soaking up the summer heat. When they stand side by side, they’re no longer identical. After a year on the puberty-suppressing medication, Sylvia only needs to look at her brother to see the path she avoided. She’s willowy, he’s stocky. He has wispy new facial hair, while her face is clear.
Tom, who says he always felt like his twin was a girl, isn’t surprised by the twists their lives have taken so far. “I do wonder what it would be like to have a brother,” he says, smiling at Sylvia mischievously, “But I guess a sister cuts it.”
Sylvia can’t delay puberty indefinitely, and in a few years, she’ll need to make a decision. She may choose to stop the pubertal suppressors and go through puberty as her biological sex. But it is hard to imagine. It’s more probable that, at age 16, after undergoing additional rigorous medical evaluation, she will decide to physically transition to the female she has always felt she was. If so, she can start taking hormone therapy under Spack’s supervision, and will develop breasts and hips. When she’s 18, she can have feminizing genitoplastic surgery at an adult hospital if she desires. If she does go through with the full transition to a female gender, Sylvia—with a narrow frame, womanly curves and feminine voice—will be indistinguishable from a genetic female. But for now, the family is taking it one day at a time, encouraging Sylvia to enjoy her life as a kid while she can.
Of course, there have been some bumps in the road. After Sylvia faced painful bullying from a particular student in sixth grade, the family uprooted and made a fresh start in a new town. “We’re a normal family raising kids; Sylvia just happens to have this medical condition and not cancer or heart disease,” says Cecelia. “Why everyone gets so upset about it, I can’t understand.”
But the family is more cautious now. At her new school, Sylvia easily passes as a genetic female, and none of her classmates know she is transgender. Hiding her true identity isn’t ideal, but at least while she’s in middle school, it’s the route she’s decided to take. “It makes me feel like I’m not being completely honest, but my honesty got me in a lot of trouble a few years ago,” she says. Seventh grade isn’t easy: when the other girls aren’t fixating on the minute differences that set them apart—whose nose is bigger, who’s taller, who has freckles—they’re gossiping about boys. “Boys, boys, boys, it’s all these girls think about,” says Sylvia. “It’s a little hard to find someone to talk to right now.”
While her parents are nervous about the coming years, especially high school, they’re upbeat about Sylvia’s opportunity to live an adult life unrestrained by her appearance. “She will get past this and become a productive member of society,” says Cecelia. “We’re giving her the resources to become whoever she is.” Though it took Sylvia’s dad, Dennis, some time to adjust, he’s now one of her biggest advocates and works to educate other parents about transgender youth. “The key is, you have to be courageous enough to do this while these kids are young,” he says. “It’s so much harder later on. You’ve got to be brave so you can give them a chance.”
*All names have been changed for confidentiality.
Now, read a personal essay by the twins’ father, as he explains how his transgender tween has changed his outlook on manhood, acceptance and the concept of family.