Trans kids come out in stages, to relatives, friends, the neighborhood. “It takes a couple of years for a person to transition from one gender to another,” says Angello, “and that’s if everything goes right.”
Doctors often require trans patients to live in their new gender identity, under a psychologist’s care, for a year prior to surgery. Two therapists must write letters affirming that the patient is truly transgender and psychologically stable enough to deal with the stress of transitioning. “It’s a lot to manage,” says Patrice.
Let’s start with drugs.
Trans children can take drugs that delay puberty’s onset or suppress it, preventing facial hair or breasts from developing. There are also hormone treatments—estrogen for the male-to-female transsexual, testosterone for the opposite.
The drugs cause a cascade effect. Estrogen triggers breast development; testosterone produces facial hair and a deeper voice. The outward changes render “coming out” an imperative, forcing kids and parents to deal with a whole host of social and family issues. Families are advised to draft a list of whom to tell and in what order, perhaps even preplanning some sensitive bits of the conversation. “It becomes all-consuming,” says Patrice. “For a while, everything revolves around this. I used to think: Why couldn’t my child just be gay? It would be so much easier!”
The surgeries can be tough and costly. Male-to-female surgery, including testicle removal, a vaginoplasty and breast augmentation, runs about $30,000. Only five to 10 percent of such surgery is covered by insurance.
Finally, no matter how much better someone might feel, the rest of the world is still there. In the year she spent living as a girl in the run-up to surgery, Jill got harassed by a couple of boys when she wore skinny jeans to class. But a couple of girls ate lunch with her and talked, well, just like girls. School administrators supported her, but Jill faced the same controversy every trans kid does: Which bathroom should I use?
“It seems ridiculous,” says Angello, “but that’s the big thing everyone gets worked up about: the bathroom. They are afraid someone is going to get hurt. But I tell them: ‘If you have bathrooms in which kids aren’t safe, you have a bigger problem than a trans student on your hands.’”
In the end, Jill’s school settled on the bathroom in the nurse’s office. “I don’t mind,” says Jill. “I think everyone’s been great.”
Some people face harsher roads.
Ashley, who found out her son was her daughter via the texted photograph, is afraid to see her family’s name published. Her child, whom we’ll call Sarah, is now moving toward surgery, taking hormones and living as a girl. Sarah has the support of her father, but her grandfather won’t acknowledge her. She ducks old friends from high school entirely and has spent most of the past year hiding out in her parent’s house. “We’re not out to everyone yet,” says Ashley. “Friends or family.”
Being supportive is only a parent’s first step. The rest of the journey runs mostly uphill, through doctors’ offices and past countless cultural and personal dragons. Jeff and Julie, whose child cried out about God’s mistake, still worry: Will their son find someone to love and accept him? But as for their kid being transgender, “We’re past it,” Jeff says. “Hale is just my son, and we’re a family. The fact that he was born with the wrong anatomy is just part of our history.”
“I’m going to call it,” the nursing assistant declares.
“Go ahead,” Sherman Leis replies.
The assistant reads off the name of the patient: “Jill Baringer.” Then the name of the procedure: “Gender reassignment surgery.”
By this time, Jill, now 18, has been living as a girl for a year. The surgery will align her body with that fact. She lies on a heavy surgical table, anesthetized into unconsciousness, her legs in stirrups. Just minutes ago, Leis performed a “feminizing” procedure, opening Jill’s throat to shave away four millimeters of the milky white cartilage that protects her voice box.
“This was sort of a warm-up,” Leis tells me, backing away from the table. “Next up is the main event.”
McGinn calls her practice “The Papillon Center”—papillon being the French word for butterfly, suggesting that trans men and women lie cocooned inside their own bodies before surgery’s big reveal. As metaphors go, the butterfly is sentimental and apt. But this imagery also misses something—about the desire, so great that the transgender ask for this; about the clarity they have, to look past our judgment. To see what they could and should be.
(A note: The descriptions of this surgery are graphic.) Leis makes his first incision, drawing blood from the skin just beneath Jill’s testes. Deploying a Bovie, which both cuts and cauterizes, he works in a slow, careful circle till he can peel away the entire skin of the scrotum, raw and gleaming, in one single sheet. This is the start of the four-hour procedure, during which Leis, 71 and thin as a wire doll, takes just one brief break.
He hands the scrotal skin to an assistant, who performs electrolysis on it and trims away fatty tissue before wrapping it around a stent—a phallus-shaped tube of medical-grade plastic maybe 10 inches long. Leis will use this skin later. He pulls Jill’s testes taut on the cords that carry sperm, maybe six inches from the body, and cuts them free. He proceeds to “deglove” the penis: He makes a new incision just below the head, then slowly fillets the shaft, all the way down to the base. The effect is like seeing the facade of a building torn away to reveal the steel beams and wire guts. The urethra and the pair of corpus cavernosa, which fill with blood to produce an erection, retain a phallic shape, but loom now as supporting pillars in a structure being methodically torn down.
The work is delicate, careful, bloody and mind-blowing. The hours pass in a speedy haze of activity. Leis turns the shaft of Jill’s penis and the scrotum inside out and sutures them around the tube-shaped stent, to be used, later, as a vagina. He inserts a catheter. And he destroys three pillars—trimming the urethra and removing the corpus cavernosa. At each stage he switches the Bovie to cauterizing mode, sending up small puffs of smoke as he sears Jill’s tissue with electricity to stop the bleeding.
By now, almost the entire groin is torn open—a bloody mass of fascia, muscle and fat. All that is left of the penis is the head, attached to the body by a thin strip of tissue, as if the final pillar of the building has been winnowed, but for its top, and knocked over. Carefully, Leis’s long, narrow fingers feel their way, and he carves a pea-shaped section from the head of Jill’s penis to create what is called the “neoclitoris.” Folding the tissue gently to preserve all the nerve endings, he places this new clitoris carefully. Pink and undamaged, it suggests an end to the brutal facts of surgery. Leis then takes a small section of the urethra and places it on Jill’s groin, directly under the glans, to comprise the minor labia. He sutures each into place.
Finally, it’s time to create the vagina.
Leis cuts an incision between Jill’s anus and the patch of raw tissue that once held her scrotum and inserts the tube of skin created from her genital tissue. Then, using his fingers before switching to the hard metal of a speculum, he slowly deepens and widens this new canal, by force. And something about this entire operation seems to speak to everything that came before.
As a culture, even a secular one, we are still influenced by the Christian notion of the Refiner’s Fire—the idea that we are made into something more perfect and pristine when great heat has burnt away the extraneous us. We lean on this image in tough times—trust and hope that the death of a loved one, the loss of a treasured job, will, when the pain passes, reveal in us some harder, stronger form. In this sense, Jill’s hard times came prior to surgery—in the years she spent struggling with the knowledge she’d been born into the wrong body, locked in a life of secrets and alienation from her own shape, shunted into what her own mother dismissed as weirdly dramatic shyness.
All was burnt away, so that when her mother finally asked if she felt trapped, she could respond, without hesitation, yes. And at the end, after Leis reshaped her so that her outside could match what was inside, he sewed her back together. He brought her legs down in the stirrups of the surgical table so her skin bunched around the new physical facts of her. Jill finally looked just like the girl she always knew herself to be.
One day this summer, in Michele Angello’s monthly support group for parents of transgender kids, a mom starts crying almost from the moment she opens her mouth. “I am just afraid that no one will ever love my son,” she says. “I mean, who will ever be able to accept him, and love him, and be intimate with him and be there for the rest of his life?”
Her fear resonates with every parent in the room. “It’s true,” Angello says finally. “The dating pool for your children will be much smaller. Your children will have to be patient, resilient and careful. But there are some other things you may not be considering.”
She admits that men or women who choose a transgender partner will need to push beyond the person’s past to see who he or she is now. They will need to be strong enough to withstand the looks and questions they might draw from others. But that means trans children won’t wind up with any ordinary partner. Such children will—because they must—find someone special.
By the time Angello finishes, everyone in the room is crying. “It’s always like that in group,” she says afterward. “There is always some new, tearful epiphany.”
Five days after her surgery, Jill Baringer reclines in bed, her shoulders in the thin straps of a tank top, her body covered by blankets.
Prior to surgery, Jill was so difficult to engage in conversation that just being around her could be awkward. But today, she is relaxed and smiling constantly.
She will skip her senior year of high school, secure a GED, get a job, and start community college. Because this, she says, is a time of new beginnings.
She feels normal now. Comfortable in her own skin. And when she looks down at the result of Sherman Leis’s surgery, she feels “happiness. It never should have been there in the first place. I’m glad it’s gone.”
“Do you think,” I ask her, “that the surgery may make you less shy?”
Jill Baringer throws her arms up over her head, as if she’s throwing open a window. “Oh,” she says, her voice rising an octave, “I think I already am.”