>> tonight ofrontline... >> i've been a boy for three years, and i was a girl for six. >> my name is ariel, and i identify as a girl. rr turning into a man is just probably the most ying thing ever. >> a story about change. >> cross hormones, i can get a deep voice, i can get a beard i caget a flat chest. >> family. >> i feel in a sense like something's been robbed. my daughter's gone. >> we just had to listen twhat we heard from our child. nothing else mattered.d >> at it really means to grow up trans. >> i started realizing at ound 16, 17 what a huge decision i had made to embrace this

masculine part of myself so deeply. >> i don't want to focus on being trans forever. i'd rather jusgo to college and move on, so i'll be as complete as i want to be. >> tonight ofrontline, a journey inside this new world. >> frontlinis made possible by contributions to your pbs station from viewers like you. thanyou. and by the corporation for public broadcasting. major support for frontliis provided by the john d. and catherine t. macarthur foundation, committed to building a more just, verdant and peacul world. more information is available at macfound.org. additional support is providedby he park foundation, dedicated to heightening public awareness of critical issues. the john and helen glessner family trust, supporting trustworthy journalism that informs and inspires.

and by the frontline journalismr fund, with mupport from jon and jo ann hagler. >> i am transgender. i was born male and identify as female. but i like to say at i'm a girl stuck in a boy's body.

i transitioned when i was six or seven to more of a girl, and now mp... well, almost completely female. second grade was the last year of liam, and this year i changed my name officially. so i've changed my name, my clothes, my room, and my pronouns. and that's really all you need, except for the fifth one that i still need: surgery and medicine to help me look like a girl.

on narrator: just a genera ago, it was adults, not children, who changed genders, usually late in life and often in the shadows (applause) but today, as transgender adults gain wider acceptance, many children are transitioning too, with new medical options and at younger and younger ages. this is a new generation "growing up trans." >> there's a big one!ai >>, naima, do you like the bubbles? >> (laughing)

>> let's count to ten, ready? e, two, three... >> count, naima! >> four... >> november 7, 2009. she's four. ready? go! there she goes. >> my given name was naima, and now my name is daniel. i've been a boy for three years, and i've been...or i was a girlix. come on, grab on to me! or grab on to john. come on! i don't like to be called a "she" anymore, a i just... i really like it tt they

think of me as a boy.rr (toy wg) i think it's hard to get used to it because i was a girl for so long, and i haven'teen a boy for a very long time. >> as soon as daniel could start to express preferences in clothing, he was gravitatingwa the boys' section, hand-me-downs from cousins, wanting to wear just boy t-shirts and boy shorts. >> from the very beginning, it seemed like to me, just didn't look as comfortable in a dress. initially, a tomboy came to mind, right? that's our standard go for our society, is tomboy. >> and then the comments would c start e. "i don't feel comfortable, i don't feel right, i just wish i were a boy." and i would say, "i understand that you wish u were a boy, but we can't do anything about that. you were born this way."en

and tarting second grade, onthe tone of our conversa just took on a more serious depth, andaima felt like, "i have to tell you that i'm very unhappy, i don't like being in this body. h i wish a penis," and just sort of laid it all out there. and so at that point, it just sort of snowballed into a conversation about, "well, you can live as a boy.ha i don't knowthat means, i don't know where to go reallym ere, but you can live as a boy, and you can change your name."or and daniel, naima at the time, immediately jumped on that idea. >> what? >> the lava keeps rising. >> the lava keeps rising, okay, gotta stay above the lava. >> i did feel a pressure from society, from our family members, "what if daniel

changes his mind?" but we knew that we just had to listen to what we heard from o child. and it didn't... nothing else mattered. >> narrator: although daniel transitioned two years ago, recently he started to worry that his body is beginning to change. >> ie been feeling a little weird, and it's been feeling weird, so i stay up a lot of nights talking with my parents about it, and i don't get a lot of sleep. yeah, and... yeah. i just don't like feg different. it starts making my mmy hurt a little, so... sometimes makes me cry when i'm very, very, very, very. very tir >> to develop breasts would be horrifying for him.

>> he doesn't want to be the kid that has to be different. and he has talked about suicide or killing himself before, which is why we immediately sought the help of professionals. i think he finds a great deal of reassurance knowing that there are things, there are steps we c take where he can look more like a boy and pass to be more like a boy. >> bring it to the top, quick! >> narrator: it's now possibleda for kids likel to never have to go through the puberty of tir biological sex. but timing is crucial, so daniel's parents are taking him to a clinic in chicago. the gender program at lurie children's hospital is one of a growing number of clinics around the country providing treatment dto gender nonconforming transgender kids.

l hi, how are you? did you grow sint time i saw you? >> um, yeah. >> and you just had a birthday,0 right, on the ? happy belated.f, shoes f you don't mind. >> so these kids really are a new generation who are being cared for completelyifferently than children were in the past, and that is... it's exciting for them to have opportunities that somebody wouldn't have had even ten years ago, but it's also very challenging for the medical community to find the right way to do this. step right here. >> narrator: one of the biggest developments in the trtment of transgender kids came in 2007 wine the introduction of hor blockers, drugs that suspend puberty and slow all physical development. >> the pubertal blockers are the medicines that pause puberty. t so the idea t we can just put the pause button on puberty and let children have a littlew more time and develop

and be more confident of their gender identity. >> tight squeeze and i'll be done, okay? >> narrator: but the treatment of transgender kids can be controversial. it's a field of medicih very little research, and the few studies that do exist suggest that for most kids, the distress about gender will shift with time. >> the majority of children with ownder dysphoria will not up to be transgender adolescents or adults. but i think the challenge isat e're not able to definitively predict for whom gender dysphoria will continue and for those that it may not continue. >> all right, get ur arm back. >> our goais to try to figure out which children are going to continue to identify as different than their natal sex. and we don't have any definitive

test to do that right now, and that's very challenging.re i wish tas a test to say, "oh yeah, of course, you're five and you think this now, and you will when you're 15, and you will when you're 30." remean, we don't have it, though, so it's challenge.>> hello, hello! look who's here! how are you, daniel? >> narrator: but there is growing consensus that the more intense gender dysphoria is in childhood, the more likely it is to persist, and that puberty itself can also be a telling predtor. >> and i just wanted to see if you were noticing any changes in your body recently that had you maybe feeling worried or sad? >> well, this one over here, it started getting real tender. >> i think daniel had been really concerned about how quickly this was goi to happen and just really feeling strongly about not developing breasts. and my husband and i want to do

anything we need to to keep his emotional well-being in mind and how he feels about himself. >> okay. >> early intervention does make a huge difference. once physical changes, some physical changes of puberty hae occurred-- you know, vo deepening in boy-bodied people, for instan-- they're irreversible. so really starting puberty-blocking medications as early as possible is reallypo ant for some people who are really experiencing distss. >> so there is a very, very faint amount of breast tissueun r the right breast. i mean, it's just a little tiny bit. we typically want to see that a child has had a little bit of pubertal development, but that's the point at which we can start sort ofng about blocking puberty.

the medications that we use for puberty blockers all work, anfor the most part havesi fe effects. this is a sample of what the implant is. >> hmm, that small? >> yeah. the medications are very expensive, and so theybe ca15,000 to $25,000 a year for some of these things, which is cost prohibitive for mo people. so we have worked on an option that we have, we can off here now actually, which is called vantas. and its fda approval is for men with prostate cancer, but this has been used successful by pediatric endocrinologists taking care of kids like daniel, and it seems to work just as well, and it is a lot less expensive. and so, you know, vantas is not... it's not approved for alildren, but none of these medications are ac approved for use in this situation. >> for all? >> for any of these. >> for any of them, okay.

>> we have a lot of experience in pediatric endocrilogy using pubertal blockers, and from all the eviden we have, they are generally a very safe medication. t the concerns with this population are just different because we're using tha little different age and for a different purpose. so whether iis having any negative effect on their adult bone density or their neurologic development i think is... we don't know. i much prefer to take care of conditions that have been well-researched and well-studied for 50 years, and that is not the case here. we just really need good research that we don't have yet. >> they're not easy decisions to make, and they shouldn't be made quickly, and i think theag take-home metoday is that nothing is going to happen quickly, okay? nothing. >> this generation of kids

are really... they're the pioneers. they are gonna be the ones to teach us. >> my name is ariel. i am 13 years old, and i identify as a girl. i haven't really experienced puberty at all. i mean, the hormone blockers are like my life saver. ist me turning into a man th just probably most horrifying thing ever, i could ever think of in the farthesty reaches ofnd, is me not going on the hormone blockers anymore and me developing into a man. that would just be horrible. the hormone blockers, they gives

mece where i can really feel completely just sure of myself, and i can just have that little breathing space before i enter puberty. and you're just in this nice little world where you're still like a child, and it's just great, before you develop. it's harder, teasing and bullying-wise, when you're a girlie boy, when you're in that in-between stage, than when you've fully transitioned. it's much harder to be gender-nonconforming than to be transgender, because when you're gender-nonconforming, that is when really a lot of fficulties set in. >> narrator: ariel did not transition until she was 11,

when she started blockers, but p there was a loiod of time when she was living in secret as a girl. >> that was a difficult time. >> very. >> just very confusing. if we went into a restaurant and she was wearing something that was more feminine and she saw somebody from school, she would run into the bathroom and wouldn't want to ce out. >> it was kind of like a double life.th k a lot of people are completely just comfortable and fluid, but for me, i was really scared. my name before was ian. and then i guess when i was around nine years old, i started liberating, like, "maybe i should change my name to really show the world that i wanted to fully transition." >> so she asked to call her a different disneyrincess name every day. so every day... >> i forgot about that! >> every daywe had a different name. and there was an order to it.

cinderella, belle, ariow white, and they were in order, all the disney princesses. and on that day, i would have to call her that. >> and i remember my grandmother, she cared so much about me, and she wrote on her calendar every day, like, what princess i was supposed to be. >> so e would make sure she called you the right name. >> (crying o just made me think, like, she cares about mech that she writes on her calendar who i am each day, which was really amazing and made me so happy.

>> narrator: as ariel's girl world intensified, her doubleli fe began to take a toll. >> i believe that someday, i'm going to live in a castle and all the disney princesses are going to visit me every sing day. i can play mermaids in the water. oh yeah, i'm going to have five courtyards, one main courtyard and one main garden, and the garden is going to be so pretty.. i feel like at that point in my lifei wanted to prove to everyone that i wa't like any part of a boy in any way, shape or form. what a perfectly, perfectly awful year! >> jeez! this is from cinderella iii, right?>> it was just, like, horrible and just confusing for me, and i tried to just... i was trying to ground myself t with a dresses and the princesses, just trying to say

to myself, you know, "i am a girl," and prove to everyone else that i am a girl. >> which disney princess do you think is the most beautiful? >> hmm... ariel.wa it was like i putting on costumes, but now i'm putting on outfits and clothes it's not a snow white dress or a princess dress anymore. it's like it's actual girl clothes. now i'm actually me. >> for me, the age that everything started to happen was around fifth grade. i started really going throu puberty. that was... that horrible. i hate it. i mean, for any transgender, male or female, it's probably

the worst time in their life, because they're actuly becoming what they don't want to become. i was wearing three spor bras. i was very self-conscious of my chest because guys obviously do not have a chest. they are flat, completely. and so before that, i was able to pass. i was able to kind of be a guy. but then once thattarted happening, i was like, "oh, that is not going to help myar apce much. yikes." in mmind, i saw this really strong, flat-chested guy that had an adam's apple and a beard. when i looked in the mirror, s i saw thll girl who was not supposed to look like that.t i ike i just needed to look the way i looked in myi head, to be whs and feel

comfortable with who i am. >> narrator: this year, at thebe age of 13, alen to transition and formally changed his name in school, where everyone had known him as karen. >> middle school can be kind of a scary time for lots of people. even after i started really transitioning, i would want to stayome because i know that everyone there knew me as a real girl. i can feel them kind of, like, wondering why i couldn't just be a tomboy, why i couldn't just dress li a guy and i didn't have to become a guy. so instead of calling me like "he's" and by the male pronouns, they'll call me "it," because i'm nd of in the middle. i mean, i can deal with that. i don't really like it, but i have a minimum amount f friends. i want to keep tends that i have. so i kind of just... let it go.

i definitely get depressed sometimes. i will listen and dance for hours. whenever i'm feelingpset or something, it's kind of a way to soothe me down and, like, get me happy again. i have my imaginarworld, and that's one of my coping strategies. like when i'm feeling down or depressed, i'll kind of, like, go into my imanary world. and in my imaginary world, i am a guy. i have a flat chest. i'm strong. there are definitely girls and guys in th world, and they just help so much. and to me, they're real. and like, if i'm feeling so down that i just can't talk, they'll sing or listen to music and dance with me. and that definitely helps. it's kind of like a telepathic thing. i can hear them in my head and

then i'll speak to them ther through my head, or sometimes i'll look really weird walking down the street and i' like, "hey, when iet home, do you want to, like, dance and sing with me?" and they'll be, like, "yeah, yeah, sure." and so i'll have something to t look forwardo when i get home. i think at times, my mom can get a bit worried. i think she's sometimes worried that i don't know reality from imagination. i definitely know the boundary line, but like, i've brought them over so much that i think the line has definitely thinned and kindcome blurry. >> alex does have an imaginary world that he has talked to me about, that he's talked to h therapists about. and they do feel that alex has his feet firmly planted in the ground, in reality, but thatit as been a mechanism to deal with... .his problems.

it's very hard for him to have female hormones in his body, raging through his body. he wants those shut down. >> narrator: alex's parents areo idering puberty blockers to stop his menstruation, but theys have seroncerns about the medications. >> i think the real struggles in the risks of the drugs. wetnow that the drugs have been used for that long on children, and that there isn't really adequate data. and then there are potential side effects and possi long-term effects that are not known. >> and so we have been kind of wresing with this decision, talking to a lot of doctors, reading a lot of information. t and king a decision has implications also, because doing nothing is not really an option here. i mean, i would like to choose

that option, but i don't know how a transgender person feels, and based on our conversation with ax, doing nothing is not really an option. >> narrator: but the decision to take blockers can also lead to ather complication. two years ago, when ariel first transitioned, she and her mom decided to make a fresh start. they moved to a new town and enrolled in a new school where nobody had known her as ian. >> when she firswent into school, she went into school with the teachers, the faculty knowing that she was transgender, but her cssmates or any of the students in the school did not know. and i wanted that for her, not because we were even embarrassed or we wanted to hide it, but i wanted everybody to just know eeiel as ariel. i would rather youher as

her, and then if you find that out about her, it's just something about her. it's not who she is. it's just another part of her. >> we look like we're in the next percy jason movie. >> no, but we do look like demigods! we can totally pass for that. >>yarrator: although pubert blockers had allowed ariel toth pass, e months into the new school year, while changing in the girls' locker roomshe was outed. >> at first, i sort of felt bad slr her, because it must have been so hard, obvi and it was just sort of like tension between us. like, i didn't know how far i should go, like, if i should bring it up, or if i should just treat her normally, or just like nothing happened. >> yeah, that's probably the reason that i lt uncomfortable, because... not uncomfortable. the reason i was, like, surprised. and, like, it was just a new idea to me too. i didn't even know what transgender was befo that. and so because she was like...

she's such a girl that it really... it was so shocking. >> (laughing)it my duck face, okay? g) (laugh >> well, it would have been different if i had met ariel as a boy first, but we still would be where we are now, i think. >> i... i know we're really close, but i really... like, i had an experience at my old school, and i really don't think it woulde, like, as close as we are now. like, it would never be likeme this if i n as a boy. and it would have changed our relationship. i definitely know that. >> you're right. it would have, actually. we'd still be friends, but it wouldn't... i guess it wouldn't really be where we are now. >> there is still some of that awkwardness, no matter how comfortable, you know? say, like, all the girls in the class are having this giant slumber party, and they're all just, like, throwing off their

shirts and, like, just dancing around and, like, just changing and stf. you know, it's kind of hard. and i'm always sort of changingn the corner still, even though how comfortable i could be.nd so i feel f left out. mo >> it's alst like there's a fine line between trying to include her and trying not to include her so much that it made her feel excluded from everything. i keep accidentally making her feel bad, and it's just... it must be so hard for her. i can't even imagine it. >> iemember a couple years back, everyone was talking about, like, having babies, and it really makes me upset. i me, i don't want to tell them to stop talking about it, but you know, it's like. it kind of hurts my feelings,

d they're always talking about that. it's like...it so hard to explain. it's like, "but i'm a girl," so it's... but it's like, "could i ha the pain of labor? could i have to deal with that?" and it's kind of hard to have that happen, like, those conversations. (crying) and i feel like a lot of peopleh itd for them to understand, but i don't want to, like, burden them with that. i kind of justither walk away or i just kind of dealith it. i try to sometimes get into the conversation, but you know, it's hard. >> do you ever feel like you're, like... you can get so close

to being a girl, but you just can't get to that exact point? is that what upsets you? >> yeah, that's exactly w i feel. the thing with having a baby, it's like i can never be fully there. that's just, like, a naturalth ing that happens. i buy a br but it's not to hold in my boobs. it's for an illusion. it felt rt of like an act. so i kind of feel lost sometimes. >> for me, i always, like, see these really cool guys, and i'm always like, "i want to be like them!" and morgan and ben were those,th like, cool guy i wanted to be like. once i really realized that thef were perfecte with me being transgender, it was like

a whole new world fo >> good job! >> i kind of think that it really shocked peoe, like, knowing that we're hanging out with this... hate, because i know people were thinking that, like, alex is weird and stuff, like, thinking that he's, like, really different from everyone else. in all reality, he's just... he's the same as us. er wait, are we moving the quarter pipes toge >> i sometimes mistake alex, like, if i'm talking to morgan, i'll be like, "she," but then i might like correct myself and be like, "he did this." but i think i've gotten a lot better about that, definitely. i didn't know she changed her name to alex, like, since this year, like before i knew her. always thought her name was karen, i said, "hi, karen" in the hallways and stuff.ag i can't e, like, what the change is between that stuff, like, being a girl to a guy. i don't even know what being a girl is like, so... >> remember to apply enough pressure to the tail as you pop. just in general, i've been owing him the ropes of being

a guy, and saying like, "you've got to start working out more. you've got to build up that per body muscle." >> "try and talk in a deeper voice. even if it's n normal, get used to it. burp. if you have to burp, just let it fly. don't try and hold it in. girls do that all the time." i >>terms of girls and dating, i'd just say, like, "try not to really show any emotion towards it. just, like, treat her li you don't even like her. just treat her like that." so i'm like... i'm not trying to make that sound bad or anything, but i mean, i'm just saying. >> well, the, like, tactics and all the information that they're giving me, i definitely use it. sometimes, i know that il slip up a bit, but their tips are amazing, and i'll go with them.

>> you have to keep yo foot straight with the board. >> 'd still say that he's still in the process of, like, really learning how to be a guy. tot i say he's coming clos finishing that for sure, so... >> i've been struggling with depression for about four years. it's more anxiety and sadness,

the kind of depression i have. i have medicines to, like, boost my happiness, but those don't always work. i had thoughts of hurtingmy lf, cutting myself, killing myself, even. i got very close, very cse, twice. i was just thinking, "i can'do it anymore. i can't live like this.th i can't live i body. it's not going to work." my mom's just been super supportive. she's been great the entire time. i was terrified of telling my dad, because when i was youngerw he wass like, "no, you have to wear a dress. you're a girl. you can't. not allowed. no, can't do it." so that probably made me

terrified.i nally told him, which was not that long ago. my dad was really worried about the effects of the medicines, and what if i later in lifeci d that this wasn't the dpath that i wanted to goown. >> i had some concerns, and there we some things about me, or about it, that kind of bothered me a little bit. we have these educat doctors offering kids who are at a young age some options thanot really sure should have been available to them. i was really kind of surprised and put off by it, quite honestly. >> because i was only 13, he didn't want me to make a life decision like that at this age. it was still hard. i couldn't really see why. it was horrible. i felt like myarent, my dad, he didn't love me.

i felt likhe didn't want me to be this way. >> i didn't want her to... (clears throat) ...think that she could make some changes to her outward appearance and then suddenly, everything would be fine and she would just move on from there and life would be great. i think there are a lot of other implations to this than just the w that you're focusing i on right now. >> narrator: but kyle is still hoping to start testosterone, and though his father remain concerned, he's agreed to go toc lurie's gendnic for the first time to learn more about hormone treatments. >> heels all the way a the wall. >> narrator: cross-sex hormones, estrogen a testosterone, used to be given only to adults. but treatment guidelines estaeished in 2009 now includ children, though they do not

recommend starting before the agof 16. >> all right, have a seat in the chair for me. >> the age limits which used to say 18 now are 16. now you're seeing people starting cross-sex hormonesor at 14. and with the changes in the age of ons come some challenges to care that i think teams need to be very savvy about.ho are you? >> how are you? >> i'm dr. garofalo. >> do you rememb me? dr. chen, good to see you again. >> i mean, i think the big decision that families he to make when they embark on cross-sex hormones is that now you're not hitting a pause button, right? so when you move on to cross-sex hormones, you're now initiating medical therere some of the changes that are going to take place are permanent. and that's a whole other, like, ball of wax, i think, for some of these families, and that can be really hard. so when we think about medications, if we're going to go with the route of medications, there's tds. one are medications that sort of

block progression through puberty. e other medicines that you could use would be right to going to sort of what call cross-sex hormones, or in this case it would be sort testosterone. >> there are plenty of drugs that get approved by the fda, and everybody es on their merry way and thinks things are great, and then two years later, people are dropping de from one thing or another. >> and this is really important, so i'm actually going to pull up a stool so i can sit and face you. t tosterone as a medication has been around obviously for a long time. the way we would consider usingt ere, sort of for, in a cross-sex sort of way, there aren't, like, a tremendous amount of studies that have been done to document, like, all the potential side effects and the risks and benefits. but i ink in general, it's fairly well tolerated. some of the changes, again, are permanent, and some sort of aren't, and i think those are thkthings that kind of frea people out. y but when think of things

like, you know, hair loss on the temples, you know, facial hair growth, deepening of the voice, all things that go along with sort of a male sort of hormone. you're gonna have increased muscle development. so some of it's gointo be things that he'll want, but some of the things you want to look out for e things fake acne, mood changes, and then all the risors that go along with a typical male predisposition. so things like heart disease, stroke, you know, those kind of things. males are more likely to have heart disease than femal. we're asking families to take someeaps of faith based upon the child that they have in front of them, and really what we don't know with regard to some of the long-term consequences of these medications. if you look at our consent forms, they're fraught with,li , vague language and, like, "may, could..."

we know very little about things that are really important to families, like fertility, like cancer potential or oncologic potential of these agents, cardiac risk. i mean, things that, like, families want to know when they're making decisions about thr children. and there definitely is the potential for the testosteroneor he cross-sex hormones to prevent sort of normal, or what we call "normal," fertility toort of occur. have you ever thought about having kids yourself? we're sort of asking y to be really grown up really quickly when you make these decisions, red that's what's tough. but i want you tly think through some of the stuff we're talking about here. does that make sense? >> well, you know, i would like to have kids, maybe so but... >> if you're saying, you know, "i might want to have my own kid one day," then i think it'sa probabood thing for you

and your parents to sort of at least get some information and find out whether sort of preserving your fertility might be something that you're interested in. >> up till now, it's been things that were reversible. change yr name, we can refer to you as "he" and "him" and sure, fine. t at 13, i don't think she'll change her mind, but y have to think a little bit more about that. i mean, those are... and those are things that ur parents should be there for, to help you be as certain as you can about a decision that later in life could have a huge impact. so there's a lot to think abt. you feel better now? >> i do. >> good. >> i don't envy these parent i mean, i think they're making decisions in a very difficult environment. mean, i know that we do informed consent, but really, i mean how realistic is it to believe that a 14- or 15-year-old or 16-year-old has really the capacity to make that

kind of decision for him or herself? t but at same time, to deny them, that's tough. i mean there's a... this is a... this is tough stuf >> hi, okay. so i guess arod 11:00, uh, i injected testosterone into my body. and so today's my first day, like, being borni guess. >> i watch lots of youtube videos of like skylar eleven and stuff. so like havi him like kind of explain everything through his videosas helped me a lot. t so this is kind of like me pre-testosterone, me is like floating around through my bloodstream right now. um, and i feel reall. >> i looked at other videos. i realized that they were exactly like skylar eleven, that they had the same thoughts and, the sake, views of things.

>> these are my muscles pre-t. they're not that bad for a biological female, i think. and these are my abs, s is all like pre-testosterone. >> cross hmones, i can't wait for. it's going to mean that i'm going to start being able to gain muscle easier, the way guys should be able to. my voice is going to drop. i'm going to get an adam's apple. woo-hoo! i can get a deep voice, i can get a beard, i can get a flat chest. did someone lo at my christmas list? >> to inject testosterone, you haveo use specific needles a a specific syringe depending on your dosage. >> i always pull out more than need, because then i just push the rest of it back up into it. >> one, two, three, just like that. >> ready. >> today was my first t shot. it was actually about half an hour ago. hey guys, today is july 16,

2010. hello, people. hey guys. hey guys. hey guys. today is my nine months on t. hey guys. so today, actually it was yesterday, it was my 11 months on t. (lowered voice): hey guys, so this is my voice 12 months on t. >> i'm a lot hairier. as for my happy trail, which is the hairiest part of mbody,it 's like a happy super highway. >> today is my first day on t. um, i feel like a new man. basically i was pretty much born today.da is my one year on testosterone. it is my official t birthday. i am now one years old, and it feels freakin' awesome. it's the best thing in the world, you know. >> crossender hormones and top surgery are going to be the two major things that i'm, like, looking forward to in my future of being able to transition all the way. >> i myself, i got top surgery. i take testosterone.

i got top surgery about two-and-a-half months ago, and this is what it looks li. there's several different procedures. this is a double incision procedure. >> i can finally show off my wonderful abs. like they're really there. but they kind of are. that's aut it, yeah. so this is my chest.nl >> oe is a great place for trans peop. the internet is the best place you can go to, if you're like scared about talking to anyone.i the internet tumblr. oh my god, tumblr. and, um... just youtube, too. youtube is like one of the... that's how i found out i wass. tr it was from a youtube video that i found a long time ago. >> narrator: kyle met his friend john in a support group for transgender teens. the online world has helped them learn to pass as guys even without testosterone. >> when i officially came out as

trans, yeah, it took my parents a long time. and my dad, my dad is still having his issues with it. >> it seems super hard for dads, though. it seems a lot diff...se it's like, "oh, daddy's girl," that thing. did that ever happen to u? >> i don't feel like that's what was up with my dad. i don't think it was a "daddy's girl" kind of thing. i think it was... i think it's just hard for him to imagine, like, being able to be born one way and identify as another. i think he's just...al guys aren't allowed to play with their gender at all. >> oh yeah. >> so i think that was more about what it's hard for him tor his head around. >> my birth name was gianna. for as long as i can remember, i always felt male. i did come o to my parents as a lesbian sometime around

seventh, maybe. you know, i thought, "oh, well, i seem to wear boys' clothes a the time, i feel masculine, and i realize that i like girls," so i was like, "okay, i must be a lesbian. that was tough. my dad, he just... he just wouldn't have any part of it. i think he said something to me, he was like, he said, "this is not a world that you're going to be a part of." then when i got to my freshman year, i identified as trans, so i came out to them again as a trans male. >> at that point i was using pronouns "she" and "her" and he said, "mom, you know, when youy at, when you say 'she,' it feels like i'm actually naked and i feel horrible, and i just want to disappear." ik i started to say "gi." and now he wouldto be called john. so i just go betwe both names

still. still getting used to the process of the name. ll >> so it's si to me, certainly not the gianna from, you know, childhood, but it's still gi. and i guess i haven't switched over to the john. a little hardefor me. i feel, in a sense, like something's been robbeht? like, you know, so my daughter's gone, it seems, and is morphing into this other person, but i feel like this may be where it ends up. i don't know. i hope not, but i think there's other way. there's a whole spiritual sides, to to me. so i pray a lot. you know, and the whole

spiritual piece of this isyou know, i just don't believe that this is the right way to go. this is a personal place that i'm at i want gi happy. i want, you know, the best life, for ou know, want that life based in-- how do i put this-- on the path that god ha planned for her, i don't know that this is it. this route, to me, can be an eternal death. she may not see that, bu there's a hope that if i can just stay there, you know, show the love, sewhat happens, and we have to take it day by day. >> with the upbringing that we had, you know, we were taught that, you know, man and a woman, and a man and a man is bad, and you know, they're damned, and that's how we grew up. that's what we grew up thinking.

but in time i realized, with regard to my child, this is the way he's felt on the inside for so long. >> merry christmas, gi gi. >> i mean, he could hardly spea when he walling on his tights saying, you know, "this is not what i want, and this is not who i am." i don't understand how you could be born that way and have that happen, and yet, you know, it's something that you could be damned for. it doesn't make sense toe. >> wave hi, evybody. say hi. say hi. >> i always had a hard making friends. o i think partf it was that i was a very strange kid. i would just feel babecause every day i went to school, i just felt like everybody wanted me to nobody wanted me there. me

one this girl, we were in the girls' locker room because we have to change for gym. she just went off on me. shwas, like, "man, you're ugly dyke. you're a lesbian." it just kind of went from shaky, to unstable to almost impossible, is what it felt like. by the end, i was just trying to hang on. i started getting some angerop issues in mymore year. when i was very stressed out, well, sometimes i would break and i would punch a hole in the wall, or kick a hole in the wall, or this like that. i... i would just get so mad. eventually, i could keep it from

all spilling out, but it would instead, it would spill in. i was just drifting off intot. this very viol very violent experience into my head. sometimes i would think about harming my family. the images would pop up in my head. s it got... it go bad. and that's when i really decided, i feel like a threat to re family. i feel like a th to myself. i just can't control myself.so ery late at night, i went down to my mom. i was just crying. and i said, "hey, i want you to take me to a hospital and i want to get locked up."

>> that's what really motivated me, to know that he was in so muchain, and that i could be causing it. that was too much for me. i just have to support him, and i kind of just have to figure out whatever's going to happen is going to happen, but today he needs me, and that's what i'm going to do, whatever he needs me to do. >> you know, i guess i'm holding out on hope that, you know,re "could thirse?" there's a possibility. is this going to move fully forward, and this is gi's going to go? that's a possibility, too. i just can't make that switch just in... for me, myself. i don't talk about anybody else. it's because it's a personal issue, and where you're at. the choice for me is, i just like, i can't go there.

>> do you want to go to the barnes & noble down here >> yeah, yeah, down here. i'm on the verge of cross hormones right now. i'm excited just to become a woman, to have breasts, to have a beautiful figure, to just be a woman. and i think now with the technology and the hormones, you can actually transform into who you actually envision yourself as. and that's what i think is really amazing. we signed the legal papers on friday, so it's all set with the cross hormones, and i'm really excited. >> it's really big news and i'm also just aware of..i feel like you've been waiting fore qulong time. >> yeah, a very long time.

(chuckles) >> and you know, i mt's interesting. some people think, how come someone your age knows so wellly and so cleyou know, who you are and who you're going to be? and you've known who you are, you know, as a girl for so long already that, you know, from my lsrspective, sort of asking you to wait longer fore, harmful thu know, than not. >> the guidelines have always said that cross hormones should sten an adolescent is 16 years old. and that'something that we've been working on with our therapist. he really feels that ariel is ready. he's asked... we've gone through, you know, many sessions of therapy. we've gone through questionnaires. we have to... the endocrinologist has to talk to us, the pediatrician, and we'ree noe at the point that

ariel is going to be able to gee cross hormonlier than the guidelines of 16. >> so, taking this next step ofr taking crossnes means something inerms of your ability to have biological children. you know, some transgender adolescents decide to actually postpone, you know, even taking cross hormones until they canr store thnetic material. >> i wouldn't really want to produce sperm. i really wouldn't. like, i don't want to have a child that way. and it just wouldn't make me feel good. like, if i had, like, sperm, i wouldn't be happy, like, "yay,no i can have like a baby or something." i would just be, like, horrified. >> you know, it's interesting, you said, "i wouldn't even want to produce sperm and have a child that way." and i wondered what you meant

by that. like if you meant it would remind you that you're having a child from your boy's body? >> yeah, yeah. that's partially. and it also that i couldn't have a child, like, in a girl's body. >> got it. but you want children? >> yeah, i want... well, o course i'm going to have children, but i'm just not going to have them that way. >> okay. >>m-hmm. it's not like i'm not going to have a child. that would be like the worst thing ever. >> but that's a bit painful? >> yeah, it's very painful. >> and this... >> i tnk about it constantly. cry about it sometimes. (chuckles) >> of course. it's okay. >> really sad. >> yeah. >> but my excitement to start the cross hormones completely overrules my, like, despair to justot have a child of my ow like, that just completely.

overrides >> okay. any otr thoughts or questions about that? >> no. >> okay, good. >> h, that's a very nice house. uh-oh. (laughing)bu you can d it again. >> when alex was young, like i would say three or four yearsol one of the favorite activities, at least for me, used to be on saturday morning where i would ma pigtails in the sunroom, and we would likee captme information on video, and just i was... i wasyi to, you know, have a chronology of different parts, moments of ax's life. >> you're the best. >> thank you, my baby. >> every once in a whi i still called him karen. there's like a karen phase in my mind, and then there's the alex phase.

so if i was to, let's say, look at a picture of four-year-old, it will be karen. and then if i'm looking at picture now, it will be alex. and accidentally, sometimes i call him karen. (knocks) >> hi, alex. i'm going to wash my hands. >> narrator: alex and his mom scome to the clinic everyix weeks for an injection oflu pron, the puberty blocker. but today, they are also here to sign a consent form for testosterone. >> you want to squeeze anything, te you good? i'm going to do wo, three, okay? >> okay. >> it is very, very hard to make the decision to allow your child to take a medication that has unknown side effts. but it becomes a lot easier when you've come to the conclusion that the benefits outweigh the risks.ou and whenee your child

suffer the way i have ande struggle, y we have seen alex struggle, we don't have a choice. i don't feel as though we have a choice.o >>me of the changes of testosterone are permanent, meaning, these changes won't reverse. okay? once your voice deepens, there's no going back. so hair loss at the temples and crown. other thing is facial hair growth and body hair growth, so those are things where,f again,u decided to stop at one point in your life, that hair growth may slow down, butay itot stop. so once your estrogen goes downr s actually changes in that area, usually thinning and sometimes you can get a little discomfort with that, with the walls of the vagina. okay? that c increase the risk of sexually transmitted infections know there are some transgender men who use that hearea to have sex, to use

vagina for sex, and some people don't. but, you know, when we talk about increased risk for infections and things like that, that's really related to, you know, if y're using that area for vaginal sex. okay? so i know, a little bit hard to think about d perhaps not comfortable. >> especially at 13. >> especially at 13. i hear this, i know. we have to go over this now, and nyu're like, "why do you have to bring that up withe?" it's not known whether this increases the risk oovarian cancer, breast cancer, or uterine cancer.c so pelams and regular cervical screenings are strongly recommended unless there's been a removal of those organs-- the ovaries, the uterus, and the cervix >> it is very difficult have a 13-year-old in the driver's seat and playing sucg role in this decision.

i think that we would both prefer to see alex transition naturally, to live his life as a man without medical intervention, but... and without the need for puberty blockers or cross hormones. but we feel that, you know, we are not experiencing what he is experiencing. p so from spective, i do feel that testosterone is th right course for alex. >> narrator: john's father remains opposed to testosterone, but john was hoping he might agree to a smaller step: a legal name change. >> dad had just come home from a business trip and i said to him,

"yeah, i'm hoping to get my name changed. i was hoping that you could sign." and he told me, you know, "i'm just not ready. i'm not readfor that yet." i... i did start getting angry,u i tried to... tried to explain to him why i need this. he still said th he wasn't going to sign. then i got really mad and... well, i threw a cup at him, a cup of water, and i said to him that he's not my father. i didn't mean that. >> i know, i know. it pains me that you he to go through that process. i'm not empathetic about that. the bigger piece for me is, i don't know that i going to be comfortable with this life and the way it's going for you and it's just my fatherly

concern. everything else aside, i'm still at, i don't know that is is the right way because i'm basing e,is on love. and i just, in lov for the way i'm thinking, the way i'm feeling, i couldn't sign. >> i said, you know, "you say you love him, but it just doesn't feel like love, and if i were john, it wouldn't feel like love. atso i'm just telling you t looks like from the outside." so, whether he can see it or agree with it, i sort of just laid it out that i'm going forward with giving john his name and trying to do everything we can to get that to happen with or without his okay. >> i don't know what that holds. i don't know. i don't know what that means. don't know if we split, i don't know if we... i don't know. .don't know what that mea i care, though. i mean, i would love to keep us together, but i don't know wha that's going to do. i mean, i think people have to,

psa's going to have to ma her mind. gi will have to make up her mind. if i choose this route, this very well could be it. while i hate that stance, there's... i just cannot get off this point. i can't.ca t. >> i guess... knowing that i'll leave outa maybe ar or so... 's kind of a... i ho, the tensions don't last you ow, because it would be nice to leave out with less

conflict, have t family be a little bit more happy, a little more put together. >> the life we live. >> okay, so let's start group now and just a couple of guidelines. highlight, lowlight. preferred name and pronoun. and we'll go ts way. >> i'm lia, female pronouns. i'm leaving tomorrow to go to arizona for surgery. so, that's cool. (applause) yeah, i had like a really good, like, week and month. i graduated from high school. i was prom queen. >> really, oh my god! that's wonderful. >> yeah. my friend aj, who is gender non-conforming, was prom king, so like it was cool. >> oh, i know aj.j >>nathan? >> oh my god, i know aj.

>> yeah, so we're prom king and queen, which was awesome. i graduated from high school, having sgery, pretty good. >> narrator: lia hodson, who n st turned 18, is among the first wave of kidse united states to medically transition mowith puberty blockers, hs and now surgery. ♪ ♪ walking through a crowd, the village is aglow ♪ >> i'm about to go in for surgery. it's a srs bottom surgery. so i'll be getting a nice little vagina. (laugh srs means sexual reassignmentgr surgery, o gender reassignment surgery. i think that's what they call it. ♪ it drives you crazy but you know you wouldn't change ♪ anything, anything... they just kind of put it all inside and invert and sew it all

up, and i got new parts. (laughs) i think, soon as i realized whoa i was, like, "oh, yeah, i'd like to have the correct anatomy." in my mind, i felt it would... i wanted it to match. it was never really like a question of if i would. i just kind of felt like i would, and it waa matter of time. i don't think that surgery's going to magically change i mean, it'll just make me feel moreomfortable with my body and myself. i don't want to focus on beingve tranr. it's kind of justhe little hassle i have to deal with. i'd rather just go to college and move on, so be as complete as i want to be, and just start my next chapter of my life, i guess. o i don't want tmake it my life.nt i don't wao... i don't really ideify as being trans. i'm just a girl.

i'm just myself. and i don't... i don't really like making it a big deal. i feel like a woman. i don't feel trans. i just feel like myself, i feel amfortable, and i feel li woman. >> narrator: isaac also fully transitioned, with blockers, hormones and top surgery. now 19 and a sopmore in college, his perspective has been gradually shifting. >> i mean, in a way, i very much fit the very typical trans narrative. i decided to transition, i legally changed myame, you know, i started taking testosterone, i got top surgery. but i started realizing at around 16, 17 what a huge, huge

decision i had made to embce this masculine part of myself so deeply. going through an artificial puberty, you know, i didn't really experience this sort of formative me. and i kind of mourn that in a way because, you know, as much ro we all know puberty is that sort of, you know,, slimy molding of everybody into a person, and the way that i went through th was, you know,es meticulouslyd and itcontrolled and dosed, an been good, but i wonder what thatxperience... or what rol that experience has in a person's conception of his or

her gender. and i can never know that for me. you know, none of this is to say that i made any sort of wrong decision or regret trsitioning, because it wa really painful to be presenting as male and not be on testosterone and not have top surgery. and my mind was really cleared of that sort of pain after that in a way that allowed me to come to this openness, i guess, about my gender. but i think, you know, it'sll become rclear in recent years that any sort of big problems that i thought i wouldi fix by transit weren't really fixed. i really don't like to use the term "regret," although it's

kind of hard to speak about how i feel about my gender without there being some element of regret, or at least of fear, i think, a little bit of what the implications of the choices that i made are. i'm putting a chemical into my body once a week. i'm like... and there are very, very, very clear effects of that. and i'm assuming that there are also unclear effects to that. i mean, it is super s a kid to hear, you know, these things are irreversible anbe like, "okay. i don't care. you knowjust i want it." because time doesn't, you know, you don't think of time in the me way when you've only experienced a tiny little sliver of it. but i think in the past few years, at least for , i would

at some point like to take a break, at least, from testosterone, because i don't like to imagine that, you know, the entirety of the time that i spend on this earth will be spent sort of separate from what my body actually is. like, i don't really know what it means to be a man in this body, or a man in the body that i was born in, because i've onle really ba man in the constructed dy. which i enjoy, and it's comfortable, but also it's just not really my body. (birds chirping)

(humming) >> i do not want any of my boy puberty. i don't want, like, the big hairy legs, or like... the like the body they get, like with alc the s. i mean, i want to be a muscly lady, but not a muscly man that's like, "ooh, strong man." like, eh. i want to be as close girl as i can. >> narrator: at the age of nine, lia has not yet entered puberty, but daniel has, and he will start blocke in the next few months. >> we don't have a lot of choices. it's a drug that they say is, you know, reversible that, you

know, they don't think will do a lot of harm, and so we're forcee to pick ther of two evils in some ways, just because of what we don't know for one of them. but it's our son's happiness, and that's the bottom line. we want him to be happy. >> all right, so, let me show you your medicine. so this is testosterone, right? >> mm-hmm. okay, so always get in the habit of reading your vial. >> i wish we can fast-forward to, you know, 100 years from now, and then go get the dat which is going to be available and being generated, and there would be a better understanding about this gender dysphoria. but we don't have that information. so,hat we are trying to do make the best decisiossible with the known facts. >> one, two, three.

aw, you digood. >> narrator: soon after meeting with the doctors at the clinic, kyle's father agreed to let him start testosterone. >> it was the happiest day of my life. just seeing my dad finally accept me for who i am, it was the best day ever. el i need testosterone to be comfortable with m and my dad, he keeps saying, t'm just not there yet." >> can i see it do road? you're asking me today, no. i'm just being honest, you know, so we'll need to sort through that and talk about that as a

family and what that means, but today i don't see it. it's hard for me. ar >>tor: not long after this interview, john was suspended from school for punching a classmate who had just startedos terone. three weeks later, his father relented and signed the consent forms. >> right when she found out she was gog to get it, she sent me a text in like... this long, in, like, all capitals, like, "save the date! i'm getting the hormones!" w in like all cah like a million exclamation marks. a it was... actually, it was, like, kind of exciting for us when she finally said thate s going to get them. >> well, i remember the first day, like, i got the hormones. so i walked around my room and touched every article, like ery fiber of my carpet and

every, like, piece of thing on b kshelf, and i said, "i'm... these are the last things i'm touching while i'm a child." w and i was, likking around and, like, touching the entire things. and it was so funny and i, like, finished touching the last snow globe and i'm, like, "now i'm a woman," and i was just so happy. i already feel like i've gone so far and i'm only 13, so. before i just wanted to be a girl, like just a girl, girl, girl. but now that i've gotten on my feet a little bit, i want to show people, like, i'm a trans girl. i mean, if you're sure of yourself, then why do you need to hide it? >> there's definitely times wheri thought like, "okay, well, now that this town knows, maybe i could move, so i could st start a whole new life and

just be the guy that i am." but some part of my mind sees that as kind of lying to myself. i mean, i'm never going to be a cisgder guy. i'm never going to have been born an actual male.m ways going to have, like, that sense in me. and ifou lie to yourself, then you're kind of lying to the world. and it puts a lot of weigh on your shoulders, a lot of pressure forou. and i think that if i can just clear that pressure off, i'm alex the transgender guy. se >> tre not families that are living in the shadows anymore. you know, the world is changings i mean, s a movement that is happening. it's not going to not happen, it's going to happenst but akes are super high, and we don't have all the

answer there hasn't been a lot of research in this area. g to bely there's go more research and some of those unanswered questions, hopefully, willegin to be answered and then we can give families, like, legitimate options in terms of what we're doing now, which is really, i think, approaching families with a lot of unknowns. >> we are all kind of navigating this new wld. i hope that what we will have done is to give them a chance to have what for many of us is natural for us, to appear and live as the gender in which we identify. i also hope that these individuals will be able to give us feedback, both... both just to tell us and that they will be involved in studies that we cant learn whngs we did right and what things we didn't, and that it will be even better for the next generation. at

i really hope hat we're doing is the right thing. >> go to pbs.org/frontline for more about transitioning at an early age. >> just put the pause button on puberty. and check out our special facebook first series of original stories about growing up trans. >> when i was younger i didn't really know what transgender was, so i kind of just like, i guess i'm a guy who's just really feminine. >> now that i have f that actually, like, accept me, that are guys, i'm more myself,eah. >> then tell us what you think at pbs.org/frontline. >> critics have called frontline's "the choice" ofust see tv for every voter," "a striking examplow to avoid false equivalency," he indisputable facts," "richly detailed," and "unlike the media circus."

"frontline is once again demonstrating how indispensable it is."mi ss "the choice 2016." monday, november 7th at 10:00/9:00 centr on most pbs stations. >> frontlinis made possible by contributions to your pbs station from viewers like you. thank you. and by the corporation for public broadcasting. major support fo frontliis provided by the john d. and catherine t. macarthur foundationcommitted to building a more just, verdant and peaceful world. more informaon is available at macfound.org. additional support is provided by the park foundation,d dedica heightening public awareness of critical issues. hn the nd helen glessner family trust, supporting trustworthy journalism that informs and inspires. and by the frontline journalism fund, with major support from a

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fox: many communities around the world see disease and mental illness not as somhing to be treated, but as something to be feared. as a result, many suffering from curable conditions are stigmatized within their communities, butnd through education organizing, some people are challenging these stigmas and addressing previously taboo health issues. in our first segment, we learn how the ebola utbreak spread quickly through western africa and caused widespread social turmoil. for many, the disease became a mark