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Caitlyn Jenner. Getty Images Pediatrician Dr. Johanna Olson-Kennedy uses a stethoscope and otoscope, of course. But active a dispensary for transgender boyhood agency her pediatric medical aliment additionally accommodate a alternative of silicone penises and chest-flattening binders.

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Thanks to the artlessness of Caitlyn Jenner and others, accessible acquaintance of transgenderism — and address for trans-specific medical affliction like counseling, hormone treatments, and animal anaplasty — is exploding, alike for the youngest of patients. At the 30-plus clinics for transgender boyhood above the US, doctors like Olson-Kennedy can about accumulate up with the demand.

Chicago’s Lurie Children’s Hospital, for example, opened its auto dispensary aloof four years ago but already has 500 patients — and a four-month cat-and-mouse list. Seattle Children’s Hospital opened its dispensary in October and anon got array of calls. Olson-Kennedy’s clinic, the Center for Transyouth Bloom and Development at Children’s Hospital Los Angeles, is the country’s largest, alleviative 725 auto boyhood from above the western US. Five hundred of those patients are Olson-Kennedy’s.

Her youngest accommodating is 3.

What her patients allotment is the strong, about certain, accepting that they acquire been built-in into the amiss body. Their accuracy acquaint them they are one gender, their bodies another. Too often, Olson-Kennedy said, these kids acquire no one to advice adviser them or affluence their affliction or alike action accepted medical affliction afterwards calumniating them. “You sit in this allowance with these adolescent bodies and see their ache so clearly,” said Olson, a 47-year-old California native. “It’s not OK to do nothing.”

So Olson-Kennedy battles. She fights with allowance companies, tangles with pediatric colleagues who anticipate accouchement are too adolescent to transition, and persuades afraid parents to advice their afflicted kids. She’s alike taken on the authors of “What to Expect Back You’re Expecting” for not including a area on transgender children. And now, aloof as her apprentice acreage is alpha to accretion medical and boilerplate acceptance, she’s got a new adversary: President-elect Donald Trump, who abounding abhorrence will abrade the contempo assets of the transgender association and cut admission to the bloom affliction they charge to transition.

“It’s my cardinal one affair appropriate now,” Olson-Kennedy said. “I’m actual worried.”


But there are additionally signs of hope. Olson-Kennedy is allowance advance the aboriginal National Institutes of Bloom admission for analysis on transgender youth, now in its additional year. And she and others achievement that abstracts will advice win out over discrimination.

Penelope Patterson does a one-handed advance up at his home in Brooklyn, New York, U.S. December 13, 2016. Reuters/Brendan McDermid

Olson-Kennedy’s dispensary sits on the fourth attic of a coffer architecture on a active amplitude of Sunset Boulevard. In her appointment with a appearance of the iconic Hollywood sign, she counsels patients and their parents — a acceptable abounding of whom acquire apprenticed or aureate from away states to see her. She can absorb hours accepting to apperceive a accommodating afore alpha any medical treatment.

The youngest patients acquire no medical interventions, aloof counseling. Olson-Kennedy describes one 18-month-old, built-in a girl, who accepted her gender afore her grammar. “I a boy,” she afresh told her parents. Abounding adolescent accouchement who agreement with gender roles end up reverting to their bearing gender.

But back the gender ache persists into adolescence, said Olson-Kennedy, it’s usually there to stay. And puberty, back accessory sex characteristics develop, can be a alarming trigger.


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“I’ve had mothers alarm me who say their adolescent tries to annihilate themselves every time they acquire their period,” Olson-Kennedy said. “Parents appear in saying, ‘My kid approved to cut off his penis with dental floss.'”

Olson-Kennedy’s aboriginal band of analysis for adolescents is endlessly boyhood so accouchement and their parents can buy time to array out what they appetence to do. Boyhood blockers, GnRh agonists like the injectable Lupron or the implant Supprelin, abolish boyhood by modifying hormone release. Such drugs acquire been acclimated off-label cautiously for added than 30 years to stop aboriginal puberty.

Auto doctors say it’s analytical to stop boyhood afore the anatomy morphs in means that are difficult to change — the adorning of amateur for men, for example, or the angled achievement of women. “Even 14 or 15 is too late,” said Dr. Norman Spack, an endocrinologist who founded the country’s aboriginal transgender boyhood dispensary at Boston Children’s Hospital.

Once accouchement are accessible to accomplish a abiding change, they can stop boyhood blockers and use masculinizing or feminizing hormones. Some auto boyhood go on to acquire anaplasty to abolish breast tissue or add breast contours or adapt their genitals. Others abandon anaplasty and use anchor and packers to adapt their anatomy shape.

While some religious groups argue the action of transitioning — and radio host Laura Ingraham, in the active to be Donald Trump’s columnist secretary, told her admirers to abrasion developed diapers rather than use accessible bathrooms with bodies who are auto — Olson-Kennedy and her colleagues mostly abstain the flack. They say the affliction they are accouterment is not alone abbreviation affecting ache but extenuative lives. Afterwards abutment and treatment, Olson-Kennedy said, auto kids are a accident for about everything: depression, cocky harm, actuality abuse, homelessness, HIV and suicide.

Kai Shappley is a transgender adolescent about to access kindergarten.John L. Mone/AP Photo

Athena Fenstermacher was built-in male, but articular as a babe from her ancient days. “As anon as she could aces colors. As anon as she could talk,” said her mother, Jill. “There are pictures of me with a buzzcut and artificial heels and a Barbie,” Fenstermacher said. “I aloof knew I wasn’t built-in into the appropriate body.”


Now 18, Fenstermacher is a baby and appealing blonde, demure, adroit and complete above her years. Living in adjacent Continued Beach, she begin Olson-Kennedy at 15, afterwards years of abashing and chief she charge be a gay male. “I didn’t alike apperceive transitioning existed until I was 14,” she said. “Everyone told me, ‘We don’t apperceive what to do.'” Her analysis was added delayed by attorneys who told her she had to abide months of analysis afore they would accord her a barometer to Olson-Kennedy. (While Olson-Kennedy said analysis is important, she said it should not be acclimated as a roadblock to seeing a physician.)

Fenstermacher’s alteration was excruciating. She attempted suicide, she said, afterwards connected continued blowing through aerial academy and ambidextrous with issues like aggravating to acquisition a bath she could use comfortably. A 2015 abstraction by the National Center for Transgender Equality begin a majority of transgender Americans abstain application accessible bathrooms, alike activity so far as to absolute their aliment and baptize assimilation back away from home. For 8 percent of bodies surveyed, this led to urinary amplitude or branch infections.

It all took a toll: Fenstermacher went from an ceremoniousness apprentice with a arch GPA to about passing. She concluded up earning her amount at home. Now, she fights connected bareness and a faculty she’s consistently actuality stared at and appraised. She hasn’t been pond in seven years and says her hardly added amateur accomplish her feel like a linebacker. She’s contemplative back she describes watching her adolescent sister advance into the anatomy she wishes she could acquire had. And she’s affronted at her own analysis and a apple that won’t acquire her.

Charlie Lowthian-Rickert, 10, who is transgender, and her ancestor Chris acknowledge afterward a account appointment announcement that Canada will acquaint legislation to assure transgender bodies from bigotry and abhorrence crimes, on Parliament Hill in Ottawa, Canada, May 17, 2016. Reuters/Chris Wattie

Fenstermacher is accommodating to altercate her acquaintance and affliction because she’s so beholden of Olson-Kennedy and because she wants bodies to acquire the acute affliction that comes with disturbing with your bearing gender. But she flinches every time her physician says the chat “trans.” That word, Fenstermacher said, sets bodies to gawking, authoritative judgements, and scrutinizing.

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“I don’t feel like a auto woman.” Fenstermacher said. “I feel like a woman.” The chat trans, she said, conjures up extremes: the baroque models of “Strut” or affluent auto women like Caitlyn Jenner who adjustment up any medical or corrective analysis they want. “The action is a little altered back you can aloof airing out the aperture and get facial feminization surgery,” said Fenstermacher, who dresses artlessly in jeans and T-shirts and, with her mother, has struggled to pay for therapy, treatment, hormones, and the anaplasty she afresh underwent at a clandestine dispensary in San Francisco.

Athena’s mother actually accurate the transition. “When you see their pain, you do what you acquire to do,” she said. Divorced and a waitress, Jill Fenstermacher actually had to scrape and borrow to get the money for Athena’s care, which was alone partially covered by insurance. The costs of accepting a accustomed name change, alteration Athena’s driver’s license, it all adds up. “I told her, ‘I don’t affliction if I acquire to beddy-bye in my car, I’m allowance you do this.'” She’s battled so much: academy districts, allowance companies, therapists, doctors. “I’m like the advanced band for her,” Jill Fenstermacher said. “I try to assure her, but there’s so abundant discrimination.”

Gender aloof bathroomElaine Thompson/AP Photo

Not all doctors accede with the access of Olson-Kennedy and her colleagues. Some anticipate adolescent patients will abound out of their gender dysphoria, or that accouchement should delay until they are 18 to accomplish analytical gender decisions. Abounding would artlessly like to see abstracts on whether dabbling boyhood and acceptance accouchement to alteration at adolescent ages is safe and advantageous for them in the continued run.

Olson-Kennedy is acquisitive to oblige. In 2015, she and three added arch auto boyhood doctors accustomed the aboriginal NIH admission accustomed to abstraction transgender youth. The $5.7 million, five-year abstraction will attending at about 300 youth, some who accustomed puberty-blocking hormones and others who took masculinizing or feminizing hormones afterwards puberty. Teams at children’s hospitals in L.A., San Francisco, Boston, and Chicago acquire recruited patients and are now accession abstracts to appraise the aftereffect of analysis on brainy bloom and actuate how safe the treatments are.


The doctors anticipate the abstraction will prove that aboriginal analysis and puberty-blocking advance to far bigger abiding outcomes, authoritative it easier for doctors and parents to acquire that approach.

“It’s an amiss acreage with commendations to decisions we are allurement these families to make,” accustomed Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is additionally alive on the transgender boyhood study. Garofalo hopes the aggregation will be able to abstraction patients far above the accepted five-year appellation to abode a host of questions that currently acquire no answers. Does hormone use in auto boyhood access breast blight risk? How able-bodied do adults who acquire transitioned as boyhood attack with their accident of fertility? “These are things that are actually unknown,” Garofalo said.

And the advisers are hopeful that added abstracts will advice to action misconceptions, both about and aural the medical profession itself.

Olson-Kennedy credibility to the belief she hears of pediatricians who say they don’t accept in accouterment auto care. “You don’t acquire bodies opting out of diabetes affliction because they don’t accept in alleviative diabetes,” she said.

Allowance companies additionally prove a roadblock for abounding of her patients. But with California law authoritative it actionable to abjure affliction for gender anguish and with her advantageous appetence for a fight, Olson-Kennedy usually gets her way. “I acquire arrangement belletrist for 100 altered denials,” she said. “I aloof fax in a 100-page address and acquaint them if they abjure me, I’m activity to fax in 200 pages.” This Tuesday Aug. 25, 2015 book photo shows Gavin Grimm on his advanced balustrade during an account at his home in Gloucester, Va. Associated Press/Steve Helber

The best counterintuitive end ambition of such specialized transgender boyhood clinics may be to eventually not alike charge them.

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“My ambition is to accomplish this actually mainstream,” said Dr. Cora Breuner, an orthopedist and pediatrician at Seattle Children’s Hospital who chairs the American Association of Pediatrics board on adolescence. “People should not acquire to drive 17 hours for this care.” She thinks added kids would get the affliction they charge if pediatricians — usually the aboriginal doctor parents seek out — were added adequate with auto patients. Sensing urgency, the AAP is currently fast-tracking a account on affliction for transgender kids, Breuner said.

Abounding physicians acquire a continued way to go. The Twitter hashtag #transhealthfails chronicles a account of arresting experiences, from auto women actuality affected to booty abundance tests afore X-rays admitting their not accepting uterus, to a doctor adage he couldn’t put a casting on a burst arm because he wasn’t abreast in auto bloom care.

Sixteen-year-old Shay Sullivan, a Montana resident, had a alternation of arresting medical adventures afore the ancestors begin Olson-Kennedy four years ago. For years, the Sullivan ancestors had approved to acquisition affliction afterpiece to home and dealt with a clearly afflictive bounded pediatrician. All the while, Shay was acceptable more anxious. The alarm was active as boyhood approached.

Afterwards the family’s aboriginal affair with Olson-Kennedy, Sullivan’s mom, Shelley, said, “We aloof looked at anniversary other. We were so relieved. We assuredly begin addition who was activity to advice us acquisition our way.”

The family’s allowance covered all but $200 of the amount of Shay’s $17,000 hormone blocking implant and helped awning the gender acceptance anaplasty she had at 16. (Most doctors delay until patients are over 18 for such surgery, but Shay was advised awfully mature, her mother said.) The ancestors paid for the biking to see Olson-Kennedy and for blockage in Arizona for about two weeks for the surgery. “We’re fortunate,” said Shelley, a concrete therapist. “We both acquire acceptable jobs and are able to acquiesce it.”

In this Aug. 23, 2007 book photo, a assurance marks the access to a gender aloof bathroom at the University of Vermont in Burlington, Vt. AP Photo/Toby Talbot, Book

Today, Shay is a apprenticed aerial academy junior, earning an International Baccalaureate amount in aerial academy as able-bodied as acquirements several languages and is planning to abstraction away during college. She doesn’t biking as abundant to the Los Angeles dispensary now because her pediatrician has agreed to assignment with Olson-Kennedy to accommodate her care. Shay volunteers to advice added auto boyhood in Missoula and is accepting a “pretty acceptable year socially,” she said. One low point: Since entering aerial school, she’s not accustomed to comedy on girls’ sports teams.


Doctors on the advanced curve of transgender boyhood affliction say they are heartened that accouchement are advancing in at adolescent ages and that transgender boyhood clinics are aperture in burghal areas. But they’ve additionally nervously got their eyes on what Trump may do.

“I don’t apperceive if it will be any worse, but I don’t anticipate things will get better,” said Boston Children’s Spack, 73. “I’m old abundant to bethink back homosexuality was advised a disease. Those account die hard.”

Garofalo, a self-described optimist, said he hopes medical affliction for auto kids won’t ache abundantly beneath the new administration. But he said, “I’d be aboveboard not to be worried.” He said he is absolutely “poised to fight,” if needed, to assure his patients and families.

Olson-Kennedy already has her sleeves formed up. She’s afraid about action changes, like a dismantling of the Affordable Affliction Act, that ability abolish the allowance advantage auto boyhood need. But she’s additionally afraid about an arising appearance that may acquiesce accessible bigotry and abandon adjoin transgender boyhood and adults.

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“We’ve fabricated such absurd strides,” she said. “We don’t appetence to see bodies activity underground again.”

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