GoKawiilBy the time the Children’s Hospital closed its doors to trans patients, Sage had already stopped taking testosterone. A nonbinary high school student, they originally received treatment for the rapid onset of puberty. The changes their body experienced felt frightening and sudden. They developed PMOS, a relatively common hormonal disorder that can lead to hair growth and irregular periods. The pandemic didn’t help. Too much time to focus on scrutinizing the person in the mirror while doomscrolling. Their doctor first prescribed puberty blockers to help with their PMOS symptoms — not explicitly for trans-related reasons — and eventually recommended they take testosterone to help with hormonal imbalances. Figuring out their gender came later. “Overall, my story was just I decided to attempt suicide and then that’s the only way that my parents took me seriously,” Sage says. “Which is sadly the case with a lot of trans people. They have to go to an extreme to be recognized.”
Kids are hardly supposed to be seen or heard in our society, especially trans ones. At a protest I attended last year, trans kids’ voices were centered in all their corny, beautiful, galaxy-brain words. In most spaces, however, it is the adults who get the last word. Why do we insist on hearing more from the parents and legislators than the actual children whose lives are at stake? Stories that aim to whip up panic about an alleged boom in trans kids gaining medical resources often only interview people with no firsthand knowledge of transness, infantilizing kids as naive or unreliable narrators. Sage’s story is just one in a chorus; many trans kids are struggling to have their voices heard. Few newspaper or magazine features have given space to the words and lived experiences of trans kids living under the Trump administration. “I had a lot of trans friends online or people that I used to know who were trans and did not make it,” Sage says. This troubled and difficult relationship to transition is often the kind of story people associate with coming out.
Now 17, Sage ended up getting care through the Children’s Hospital Los Angeles, which specialized in the relationship between gender, hormonal imbalances, and mental health. This care appealed to Sage as they sorted through their identity and their PMOS symptoms. Eventually, they decided to stop taking testosterone. Navigating care at the hospital was relatively easy. Their life opened up. They met a trans girl named Brooklyn in their high school marching band and the two started dating. Brooklyn’s coming out was less intense than Sage’s: She told her family she wanted to start taking estrogen after she began to experience dysphoria. Her parents understood, and Brooklyn got on hormones soon after.
“We’re teenagers, for God’s sake”
For many children in liberal cities, things were going relatively well. At least until last summer, when the Trump administration began to threaten the funding of hospitals that provided trans healthcare for kids. Around this time, Sage logged into a therapy session with a psychiatrist only to be told that the hospital would no longer be treating patients like them. There was no attempt to provide continuity of care and no suggestion of where else to turn. Kaiser Permanente, one of the largest providers of healthcare for trans people in California, paused providing surgical pediatric trans care. (In a statement, Kaiser Permanente spokesperson Hilary Costa said, “after significant deliberation and consultation with internal and external experts, we made the difficult decision to suspend surgical gender-affirming care for patients under the age of 19 in our hospitals and surgical centers.”) Since then, finding someone else who can navigate hormones and mental health has been a nightmare. Some parents, like Sage’s, are supportive. Others, less so. Without proper medical care, some kids have been forced to temporarily detransition — at least physically — until turning 18, 19, or 21, depending on the state’s current rules.
Sage couldn’t even continue seeing their doctor for PMOS-related care. Brooklyn also had to look elsewhere for care. Sage even knew a doctor who lost their job after the Children’s Hospital shuttered its pediatric trans care unit. (The Children’s Hospital did not respond to a request for comment.) The hospital cited potential funding issues, worried if it kept its gender clinic open it’d lose federal funding for its other services. Others may find hormone replacement therapy (HRT, as it is known, referring to testosterone and estrogen) through less official sources. Neither is a foolproof option.
Some kids like Sage and Brooklyn worry about the rapid rise of anti-trans sentiment. Not even in North Hollywood, where both members of the T4T couple reside, are they safe from teasing and victimization. “It just looks different than most people would describe,” Sage says. Some people even record themselves bullying trans teens and post it online. Others are harder on trans people who don’t pass than those who do. “I’ve had adult parents come up to me or my friends saying, ‘Oh, you’re trans, but you don’t look the part.’ Adults commenting on children’s bodies because they don’t look like the gender they’re trying to portray,” Sage groans.
As their own mental health frays, trans people may even end up bullying each other. Some trans kids use derogatory terms like trooning or pooning to refer to trans kids who don’t pass or meet strict beauty standards. It’s a symptom of self-loathing and internalized transphobia, Sage and Brooklyn tell me. This is a generation that’s had both more access to trans culture and more national scrutiny than ever before. That’s a lot to handle, something that Sage worries can create a hostile environment for all involved. “Sometimes it feels like everyone’s against each other,” they say. “I think a lot of it too is that transphobia is such a loud voice in discourse today that inevitably so many people are going to eventually hear it — even in the most accepting of places — and start to empathize with it,” Brooklyn adds.
Sage worries that few people are thinking about the effect HRT has on mental health. Not just as a way of keeping suicidal ideation at bay, but also in terms of balancing hormone levels during the volatile teen years. Going off HRT can be disastrous — even more so at such a vulnerable time. “We’re teenagers, for God’s sake,” Sage says exasperatedly. Adolescents shouldn’t have to stage die-ins or go on radio shows to demand their rights. Sage wants doctors to give trans people autonomy because they deserve it, not just out of pity.
Children can and do know the cost of their desires. It is adults who try to simplify the jagged contours of adolescence. “It is bitter for the young to see what awful innocence adults grow into, that terrible vulnerability that must be sheltered from the rodent mire of childhood,” the novelist Katherine Dunn once wrote. Kids understand the joys and risks of transition, perhaps as well as anyone. For children, the ability to get care has always been fickle. Not every parent is supportive. Some of the adults I talked to split custody with co-parents who weren’t as accepting.
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