Meet Ava, an exuberant, happy nine-year-old. Perhaps it's a bit mind-bending to learn that she was born, by all appearances, a boy. Ava's mother said, "Even before she could talk, she gravitated towards all the girly toys, and colors, and when she could talk she would say, like, 'I wish I was a girl.'"

Her parents admit it was hard to process: Their then-son begging, in tears, to wear a dress. Ava's father said, "I feel like I'm an open-minded person. But when it's, like, your son, you know, asking to do this, you know? And I think I wasn't thinking about her feelings at the time. I was just thinking about, how are people gonna react to it?"

"You were afraid, a little bit afraid for her?" Ava's mother asked.

"Yeah, I was. And I still am afraid for her."

But the North Carolina family (who asked that we not use their name) has learned to embrace a change they never saw coming.

According to Ava's mother, "If we continued to say, 'No, you have to live as a boy,' she would continue, you know? She's young. I'm sure she would have done it. But, like, we didn't want to be her first bully; we wanted to support her."

And so, Ava became Ava in the second grade. Her mom recalled, "She had to walk into her classroom and identify that, you know, she had a new name and pronouns. And she was so excited. It was like Christmas."

Spencer asked Ava how it was to introduce herself in the second grade. "It went well," she replied. "They didn't treat me any different."

"So now, are you who you think you should be?"

"Yeah. 100%."

Her mother said, "It was just very clear the difference in her once she was allowed to present as a girl. She went from being shy and anxious to, everyone remarked, she was so much more confident, she just seemed happier."

Dr. Meredithe McNamara, an assistant professor of pediatrics at Yale University, sees transgender teens in her medical practice. She told Spencer, "About 10% of youth these days, we think, are identifying as gender diverse. They don't quite feel like the gender they were assigned at birth."

Transgender, McNamara said, is defined as an identity that's different from one's sex assigned at birth. Six-tenths of a percent of all Americans identify as transgender – including about 300,000 teenagers, according to the Williams Institute, UCLA School of Law.

At least 121,000 trans kids have been diagnosed with "gender dysphoria": severe distress – even suicidal thoughts – related to their gender identity.

McNamara said, "It is painful to live with gender dysphoria, and it really does need medical treatment."

The Endocrine Society's guidelines covering adolescents and adults diagnosed with gender dysphoria deal both with when to give puberty-blocking drugs (which stave off development, and buy time), and when to prescribe sex hormones (which cause permanent changes in line with gender).

According to McNamara, "This is the most careful and thoughtful type of medicine I have ever practiced."

But Americans are split on whether minors ever should be offered any treatment. A 2022 Pew Research poll found 46% favored making it illegal, period.

Since 2021, 20 states have enacted full or partial bans.

• Utah becomes first state to ban gender-affirming care for trans youth in 2023
• Fla. Gov. DeSantis signs flurry of anti-trans bills, including ban on gender-affirming care for minors
• Texas legislature bans gender-affirming care for minors
• Missouri lawmakers pass bill to ban gender-affirming care for transgender kids
• North Dakota governor signs veto-proof law restricting transgender health care

Terry Schilling, president of the American Principles Project, a conservative advocacy group that promotes bans on care for minors, told Spencer, "We wanna see all of America protecting children from all gender-affirming care.

"I think that adults transitioning is a totally different thing than children transitioning," Schilling said. "Children don't know what they're going to be when they get older."

Spencer asked, "Explain to me why that is a decision that should be made by the state?"

"The state makes all types of decisions around our children," Schilling replied. "You have to be 21 years old to smoke cigarettes; you have to be 21 years old to drink; you have to be 18 years old to get a tattoo. But we're gonna let children get cross-sex hormones?"

Spencer asked Dr. McNamara, "What do you say to people who say, 'You know, what's the downside of just waiting at least until a child is 18?'"

"If parents don't want to consent to this treatment, then they shouldn't," McNamara replied. "So, the problem with waiting, if that young person is in serious distress, is that that distress is only gonna get worse. And we do know that young people who qualify for gender-affirming care, desire it, and don't receive it, have high rates of depression, anxiety, suicide attempts, and even completed suicide."

Anne Geddes knows firsthand what it's like to watch a trans child in a mental health crisis. Her son was born, as she puts it, biologically a girl back in 1988. She said, "When he was 13, he became profoundly depressed. There was a suicide attempt. And he became a severe self-injurer. We tried to find new therapists, we tried new psychiatric drugs, and he never really seemed to get better."

Geddes knew hormone treatment was an option, but said, "Prior to his turning 18, I would not, we would not approve it."

Why not? "Because we had it backwards," Geddes replied. "We were just absolutely of the belief that we couldn't take any permanent measures until he had his mental health problems sorted out."

Her son – who declined to be interviewed, but supported his mother in speaking to "Sunday Morning" – started hormone therapy on his own at 19. And, Geddes said, the change was dramatic: "Literally from the time he started taking testosterone, the self-injuries stopped. The depression started to alleviate. He was able to go back to school. He got his four-year degree in computer science. He's married, and he's happy."

Spencer said, "Your whole expression changed when you started telling me what he's like today."

"Yeah!"

"Have you ever talked to him about the decision you made back then?"

"Yeah. He's very forgiving."

"But he's acknowledging that there is something to forgive?"

"Yeah. Yeah. That we, by not taking more drastic measures, we prolonged his suffering. And we could have lost him."

Spencer asked Terry Schilling, "The parents of some of these children would look at you and say, 'If you wanna protect kids, leave us alone.'"

"We are leaving your kids alone," Schilling said. "We are the ones that are protecting them from getting sex change procedures and puberty-blocking and cross-sex hormones –"

"And they would say, 'We know better than you do.'"

"And I would tell them, they don't," Schilling replied.

"Who are you to say that?"

"I am an American citizen that gets to vote, and organize people in politics," Schilling replied. "When we both disagree, then we go to the American people and make our cases to them, and we see who can pass the most laws. And right now, we're starting to win."

But families like Ava's back in North Carolina don't see this as a matter of winning or losing. For them, it's a matter of surviving.

Ava's mother said, "We are afraid that more restrictions are on their way, like we are seeing in other states. Because, you know, here in North Carolina, lawmakers are kind of seeing what will stick, and what can be passed. And so, it seems like we're gonna have to live in fear for a little while."

       
For more info:

• Dr. Meredithe McNamara, Yale Institute for Global Health
• American Principles Project
• PFLAG
• Human Rights Campaign
• Maryland Coalition of Families

      
Story produced by Amiel Weisfogel. Editor: Lauren Barnello. 

In:
• Transgender

Susan Spencer

Correspondent, "48 Hours"