Puberty Suppression 101

A great canopy of glass over us, a towering wall of glass beside us, my 14-year-old son, Noah, and I ride a series of escalators upward into the Washington State Convention Center. We are attending the Gender Odyssey (GO) International Conference for transgender people, their families, and health care professionals.

It’s late August, just before ninth grade starts. For ten months, one of my daughters has been my son. He identifies as a boy at home and in school, while his body remains female. Now he wants a hormone blocker to stop menstruating. The blocker would offer Noah psychological relief while my husband and I decide whether to allow him to take testosterone to develop male characteristics. I want my son to be happy and yet I am terrified of making a grave mistake. I’ve come to the conference to learn more about puberty suppression and cross-hormones, and to give Noah my decision about whether or not he can have the blocker.

Bracing myself against experiencing even more loss and change, I’ve been stalling. I somehow adapted to one of my identical twin girls becoming a boy. Now I even prefer Noah’s buzz cut to the long hair that used to hang in his eyes. But the idea of a child changing his biology seems drastic to me. I fear that Noah is too young to make decisions that will affect the rest of his life.

Meanwhile, my husband, who is a medical researcher, and our family’s multiple therapists all seem to think that Noah’s mindset is permanent. After initial doubt and reticence, my husband has already taken Noah to Dr. Roger Stedman, a Seattle endocrinologist, and approved the plan for the blocker. I’d been too upset to go to the appointment. But I’ll meet the doctor now, anyway: he’s speaking at this conference.

The escalator I’m standing on moves terrifyingly onward.

Noah and I step into the foyer. Before us stands a striking individual dressed in a strapless purple evening gown with a sparkly corset, layered skirt, and green, iridescent wings—fairy wings. “Welcome!” she calls. She is quite tall, has a masculine-looking face, and long brown hair. She smiles warmly. Intrigued, I linger.

“Come on, Mom. The conference has already started,” Noah says, practicing a deeper boy voice. Costumes don’t impress him. In fact, he doesn’t want to stand out, or be thought of as different or “transgender”—he just wants to be a boy.

After we check in at the registration table, we find the room assigned to the trans teens and Noah takes a seat within the circle. He’s with his wolf pack. On my own now, I shut the door behind me.

* * * * * *

During the day’s presentations, listening to hours of technical data unfamiliar to me, I feel as emotionally stale as the bare, windowless conference room. Leading medical experts explain the basics of puberty “blockers.” When the child receives an implant in the arm, medicines block testosterone from being released from the testes or estrogen from being released from the ovaries. Consequently, this pauses normal sexual development. For children who feel “gender dysphoria”—wrong-body psychological distress—researchers find that stalling puberty results in children who are happier and function better in the world.

Eventually cross-hormones are given, and the doses are incrementally increased. When the youth reaches 18, the doctor removes the blocker. By then the hormone doses have reached an adult level, so the blocker is no longer needed.

My breathing becomes shallow when I hear that if Noah goes on a blocker, he’ll have hot flashes and go through early menopause. Eventually, if given large enough doses of testosterone, he’ll have enlarged sex organs, voice and facial changes, increased acne, hairiness, and, of course, infertility. The infertility bothers me the most of all. Noah might want to become a biological parent someday. And perhaps he will blame me for having allowed him the hormones.

In one session, a doctor from Los Angeles presents slides of gender-nonconforming teens. I look at the wall of faces: light-skinned, dark-skinned, skinny, chubby, braces or no braces. She divides the screen with a horizontal line. “The teens below the line committed suicide,” she says. I hold my breath. Murmurs rise in the audience when the doctor relates that 40 percent of trans teens report they have contemplated or attempted suicide.

My stomach does a summersault. I remember Noah’s severe depression almost a year earlier and dread the day it might return. As the presentations continue, my mind freezes to the point that I can hardly talk. Every so often, I touch base with Noah in the teen room. All smiles, he’s sensing the possibilities of a new life. It is this spark in him that prevents me from leaving the conference when all I want to do is go home, get into bed, and cry.

* * * * *

The next morning, Noah sits beside me as Dr. Stedman takes the stage with a panel of doctors and psychologists. He is quite tall, has graying hair, seems about 50, and has a bit of a smile playing on his lips. He wears a casual suit without a tie. If not for the knowledge that Dr. Stedman would be the one to insert the hormone blocker into Noah’s arm, I might like the man.

Dr. Stedman comments sparingly and with thoughtfulness. I’m hearing repeated information from the previous day, though it still hits me hard. Among the three medical doctors on the panel they’ve treated more than a thousand trans teens, all of whom remain firm in their resolution to become the opposite gender.

The panel discussion over, Noah rises to his feet. I follow him to the stage where we wait in line to talk to Dr. Stedman. Many parents here know this doctor, I notice. The teens seem to view him as a rock star.

Noah says, by way of introduction, “I came to see you a month ago, about getting a blocker. My mother is still deciding whether she’s going to allow it or not.”

Dr. Stedman’s eyes meet mine. Then he looks to Noah. “Your parents must be on board. You know that.”

“Yes,” Noah says.

“Please contact me with any questions,” Dr. Stedman says.

I nod. We step aside so he can greet other people.

There’s kindness in the doctor’s face, and I feel his goodwill toward Noah. He seems relaxed, sure of himself and his vocation. But I still have a nagging doubt that my 14-year-old may someday regret his choice to alter his body.

A few hours later, trans teens and their parents fill one double-wide conference room for the panel in which the teens themselves will be the speakers. I look about the room, wondering where Noah has gone. Several mothers greet me by name. They must be facing the same dilemmas as I am, I realize. I’m grateful for the community of parents, and touched to see how our children have bonded.

A group of ten teens line up behind a table with microphones. Then I see Noah hop onto the stage. Our eyes meet. He looks delighted.

Other than Noah’s experiences in a band, I’ve not known him to go up in front of people. I discover that, despite the angst of the day, I’m occasionally enjoying myself.

The moderator asks general questions, such as “When did you realize you were trans? When did you come out to your parents?” Then he lets the teens speak one by one. “I spent my whole life trying to be something I’m not,” Noah tells the audience. “I got depressed. Things got a lot better when I decided to come out as trans. I started thinking, ‘I have a right to be myself.'” He turns toward me. “I know it hasn’t been easy on my mom. She’s been great!”

I wipe away a tear. After the presentation, Noah hugs me. “I’m so proud of you,” I say.

* * * * *

The next day, the final day of the conference, there’s just one more session I want to go to, a panel in which five transgender adults talk to the parents of transgender children. One speaker, whom I dub “The Buddha,” is bald and has big ears. She identifies as female, though I find it impossible to tell her gender. She’s around 60, a bit heavyset, and wears a shapeless black dress. “I’m here as a living example of what you are afraid of,” she says in a deep voice. She’s right.

She grew up in South America, an attractive girl who was constantly harassed by men. She didn’t feel safe. Then, in San Francisco, she took testosterone, became a man, received constant advances from gay men and still did not feel safe. In recent years, she has reverted to a woman again, though her voice, hair, and other body changes can never be restored. “Being a woman was not who I was. Being a man was not who I was, either. I decided to go back.”

I grip my bag. Suddenly I’m feeling weak, frightened again, and confused. For two days, I’ve listened to doctors say trans people do not change their minds. This one did.

And yet, I come to feel soothed by the woman’s sure voice and her calm demeanor. The Buddha smiles as she answers questions. “I have no regrets,” she says, more than once. “It has taken me many years, and now I am content with who I am.” 

As she continues to talk, I think how courageous she is to speak to us parents. I sense her inner stillness. How many people are so wise, so content, at any age, of either gender? If Noah should turn out like her, someone who transitions, then de-transitions, would it be so terrible, if he gained wisdom and compassion?

I feel my heart open up and then the next thought comes: I will not stop Noah from receiving the blocker. Noah’s journey, whatever it turns out to be, belongs to him alone.