>> toni..t ofrontlin >> 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. me turning into a man is just probably t most horrifying thing ever. >> a story about change. >> cross hormones, i can get a deep voice, i can get a beard, i can get a flat chest. >> family. >> i feel in a sense like something's been robbed. my daughr's gone. >> we just had to listen to what we heard from our child. nothing else mattered. >> and what it really means to grow up tra. >> i started realizing at around 16, 17 what a huge decision i had made to embrace thisma

uline part of myself so deeply. >> i don't want to focus on being trans forever. i'd rather just go 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 possibleon byibutions to your pbs station from viewers like you. thank you. and by the corporation for public broadcasting. major support for frontliis provided by the john d. and catherine t. macarthur foundation, committed tong buil more just, verdant and peaceful world. more information is available at macfound.org. tiditional support is provided by the park foun, dedicated to heightening public awareness of critical issues. the john and helen glessner family trust, supportingor trusy journalism that informs and inspires.

and by the frontline journalism fund, with major support from jon and jo ann hagler. >> im transgender. i was born male and identify as female. but i like to say that 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 i'm comp... 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,f exce the fifth one that i still need: surgery and medicine to help me look like a girl.

>> narrator: just generation 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 transioning too, with new medical options and at younger and younger ages. this is a new generation "growing up trans." >> there's a big one! >> naima, naima, do ke the bubbles? >> (laughing)

>> let's count to ten, ready? one, 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 yearse and een... i was a girl for six. o co grab on to me! or grab on to john. come on! i don't like to be called a "she" anymore, and i just... i really like it that they

think of me as a boy. (toy whirring)'s i think ard to get usedto t because i was a girl for so long, and i haven't been a boy for a very long time. >> as soon as daniel could start to express preferences in clothing, he was gravitating toward 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 staard go-to for our society, is tomboy. >> and then the comments would start to come. "i don't feel comfortable, i don't feel right, i just wish i were a boy." and i would say, "i undersnd that you wish you were a boy, but we can't do anything about that. you were born this way."

and then starting secode, the tone of our nversation just took on a more serious depth, and naima felt like, "i have to tell you that i'm very unhappy, i don't like being in this body. itwish i had a penis," and just sort of laill out there. and so at that point, it just sort of snowballed into a conversation about, "well, you can live as a boy. i dot know what that means, andon't know where to go really from here, but youive as a boy, and you can change your name." and daniel, or naima at the time, immediately jumped on that idea. >> what? >> the lava keeps rising. >> the lava keeps rising, okay, gotta stay abovehe 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 our child. and it didn't... nothing else mattered. >> narrator: although daniel transitioned two years ago, h recente started to worryod that hisy is beginning to chang >> i've been feeling aittle 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 like feeling different. it starts making my tummy hurt a little, so... sometimes it makes me cry when i'm very,ery, very, very, very tired. >> to develop breasts would be horrifying for him.

>> he doesn't want to be the kid that has to be dferent. and he has talked about suicide or killing himself before, whics hy we immediately sought the help of professionals. i think he finds a great deal of reassurance knowing that thereer are thingse are steps we can take where hean look more like a boy and pass to be more like a boy. >> bring it to the top, quick! >> narrator: it's now possible for kids like daniel to never have to go throu the puberty of their biological sex. but timing is crucial, daniel's parents are taking himc tonic in chicago. the gender program at lurie children's hospital is one of an grnumber of clinics around the country providing treatment to gender nonconrming and transgender kids.

>> hi, how are you? did you grow since last time i saw you? >> um, yeah. >> and you just had a birthday, right, on the 20th? happy belated. shoes off, if you don't mind. o >> sese kids really are a new generation who are being cared for completely differently than children were in the past, and that is... it exciting for them to ha opportunities that somebody wouldn't have had even teno, years ut it's also very allenging for the medica community to find the right way to do this. step right here. >> narrator: one of the biggest developments in the treatment of transgender kids came in 2007 with the introductioof hormone blockers, drugs that suspend puberty and slow all physical development. >> the pubertal blockers are the medicines that pause puberty. so t idea is that we can jus put the pause button on puberty and let children have a little more time to grow and develop

and be more confident of their gender identity. >> tight squeeze and i'll be done, okay? b >> narrator: the treatment of transgender kids can be controversial. it's a field omedicine with very little research, and the few studies that do exist suggest that for most kids, the distress about gender will shift th time. >> the majority of children with gender dysphoria wl not grow up to be transgender adolescentr dults. but i think the challenge is fat we're not able to definitively predi whom gender dysphoria wilcontinue and for those that it may not contue. >> all right, get your arm back. >> our goal is to try to fure out which children are goinge to continu identify asdi erent than their natal sex. and we don't have any definitive

test to do that right now, and that's very challenging. i wish there was 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 yore 30." i mean, we don't have it, though, so it's a real challenge.o!>> hello, hell look who's here! how are you, daniel?ut >> narrator: bhere is growing consensus that the more intense gender dysphoria is in thildhood, the more likely it is to persist, an puberty itself can also be a telling predictor. >> and i just wanted to see if you were noticing any changes in your body recently that had you maybe feeling worried or sad? >> wel this one over here, it started getting rnder. >> i thinkaniel had been really concerned about how quickly this was going 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 mine and how he about himself. >> okay.ly >> entervention does make a huge difference. omonce physical changes, se physical changes of puberty have occurred-- you ow, voice deepening in boy-bodied people, for instance-- they're irreversible. so really startingrt publocking medications as early as possible is really important for some people who arreally experiencing distress. >> so there is a very, very fainamount of breast tissue under the right breast. i mean, it's just a little tiny bit. typically want to see that a child has had a little bit of pubertal development, but that's the point at which we can startort of talking about blocking puberty.

the medications that we use for puberty blockers all work, and for the most part have few side effects. thiss a sample of what the implant is. >> hmm, that small? >> yh. the medications are very expensive, and so they can be $15,000 to $25,000 a year for some of these things, which is cost prohibitive for most people. so we have worked on an option that we have, we can offer here now actual, which is called vantas. and its fda approval is for men with prostate cancer, but this has been used successfully by pediatric endocrinologists taking care of kids like daniel, and it seems to work just as ll, and it is a lot less expensive. and so, you know, vantas is not... it's not approved foril en, but none of these medications are actually approved for use in this situation. >> for all? >> for any of these. >> for anyf them, okay.

>> we have a lot of experience in pediatric endocrinology using pubertal blockers, and from all the evidence we have, they a generally a very safe medication. dit the concerns with this population are juserent because we're using them at a little different age and for apu different rpose. so whether it is 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 the take-home message today is that nothing isoing to happen quickly, okay? nothing. >> this generation of kids

are really... they're the pioneers. they are gonna be the ones to teach us. l. >> my name is ar i am 13 years old, and i identify as a girl. i haven't really experienced puberty at all. i mean, the hormone blocrs are like my life saver. but me turning into a man is just probably the most horrifying thingver, i could ever think of in the farthest reaches of my mind, is me not going on the hormone blockers anymore and me developing intoa n. that would just be horrible. the hormone blockers, they give

me a space where i can really feel completely just sure ofd myself, ancan just have that little breathing space before i enter puberty. and you're just in this nice little world where you're still tlike a child, and it's j 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 bend -nonconforming than to be transgender, because when you're gender-nonconforming, that is when really a lot of i difficulties s >> narrator: ariel did notan tion until she was 11,

when she started blockers, but there was a long period of time whenhe was living in secret as a girl. >> that was a difficult time. >> very. >> just very confusing. nt if we nto 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 come out. >> it was kind of like a double life. i think a lot of people are completelyust 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 startee deliberating, "maybe i should change my name to really show the world that i wanted to fully transition." >> so she asked us to call her a different disney princess name every day. so every day... >> i forgot about that! >> every day, we had a different name. and there was an order to it. cinderella, bee, ariel, snow

white, and they were in order, all the disney princesses. and on that day, i would have 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 she would make surshe called you the right name. in (crying) it just made me like, she cares about me so much that she writes on her caldar who i am each day, which was really amazing and made me so happy.

>> narrator: as ariel's girlie kerld intensifd, her double life began to ta a toll. >> i believe that someday, i'm going to live in a castle and all the disney princessesto are go visit me every single day. i can play mermaids in the water. oh yeah, i'm gng 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 life, i wanted to prto everyone that i wasn't like any part of a boy in any way, shape or form. what a perfectly, perfectly awful year! this is from cinderella iii, keght? >> it was just, li, horrible and just confusing for me, and i tried to just...s i ying to ground myself with all the 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. it was like i was putting on costumes, but now i'm putting on outfits andlothes, and it's not a snow white dress or a princess dress ymore. 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 through puberty. that was... thatlhorr i hate it.r i mean, y transgender, male or female, it's probably

the worst time in their life, because they're actually becoming what they don't want to become. i was wearing three sports 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 that started happening, i was like, "oh, that is not going to help my appearance much. yikes." in my mind, i saw thiseally strong, flat-chested guy that had an am's apple and a beard. when i looked in the mirror, ssaw this small girl who not supposed to look like that. okfelt like i just needed to look the way i in my head, to be who i was and feel comftable with who i am.

>> narrator: this year, at the age of3, alex began to transition and formally changed s 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 itarted really transitioning, i would want to stay home 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 like a guy and i didt have to become a guy. so instead of calling me like"h s" and by the male pronouns, they'll call me "it," because i'm kind of in the mide. i mean, i can deal with that. i don't really like it, but i ve a minimum amount of friends. i want to keep the friends that i have.of so i kinust... let it go.

i definitely get depressed sometime i will listen and dance for hours. whenever i'm feeling upset or something, it's kind of a way to soothe me down and, like, get me happy again. i have my imaginary world, and that's one of my coping strategies. like when i'm feeling down or depressed, i'll kind of, like, go into my imaginary world. and in my imaginary world, i am a guy. i have a flat chest. i'm strong. there are definitely and guys in this 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 withe. 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 either

through my head, or sometimes i'll look really weird walking down the street d i'll be, like, "hey, when i get home, doo u want to, like, dance and sing with me?" and they'll be, like, "yeah, yeah, sure." and so i'll have something to loom forward to when i get he. 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 thinkth line has definitely thinned and kind of become blurry. >> alex does he an imaginary world that he has talked to me about, that he's talked to his therapists about. and they do feel that alex has his feet firmly planted in the anound, in reality, but that it has been a mem to deal with... ...his problems.

it's very hard for him to have female hormones in his bod raging through h body. he wants those shut down. y narrator: alex's parents are considering pubeockers to stop his menstruation, but they have serious concerns about the medications. >> i think the real struggle is in the risks of the ugs. we know that the drugs have not been used for that long on children, and that there isn't really adequate data. and then there are potential side effects a possible long-term effects that are not known. o >> and have been kind of wrestling with this decision, talking to a lot of doctors, i reading a lot ormation. and not making a decision has implations also, because doi 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 alex, doing nothing is not really an option. >> narrator: but the decision to take ockers can also lead to another complication. twtyears ago, when ariel fi transitioned, she and her momd decide 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 first went into school, she went into school with the teachers, the faculty knowing that she was transgender, but her classmates e any of the students in school did not know. and i wanted that r her, not because we were even embarrasse or wnted to hide it, but i nowanted everybody to just ariel as ariel. i would rather you meet her asnd

her,hen 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 jackson >>vie. o, but we do look like demigods! we can totally pass for that. >> narrator: although puberty blockers had allowed ariel to pass, three months inte new school year, while cnging in the girls' locker room, she was outed. >> at first, i sort of felt bad for her, because it must have been so hard, obviously. and it was just so 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 feltun mfortable, because... not uncomfortable. the reason i was, like, surprised. and, like, it was just a new idea to me too. i didn'tven know what transgender was before that. and so because she was like...

she's such a girl that it really... it was so shocking. o (laughing) it's my duck facy? (laughing) >> well, it would have been different if i had met ariel as a boy first, but we still w would be wheare now, i think. >> i...re i know weally close, but i really... like, i had an expernce at my old school, and i really don't think it would be, like, as close as we are now. like, it would never be like th if i came in 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 ldwouldn't... i guess it wt really be where we are now. >> there is still some of thato awkwardness,tter how comfortable, you know? say, like, all the girls in thei class are this giant slumber party, and they're all just, like, throwing off their

shirts and, like, just dancing around and, like, just changing and stuff. you know, it's kind of hard. and i'm always sort of changing in the corner still, even though how comfortable i could be. so i feel kind of left out. e'>> it's almost like thera fine line between trying to include her and trying not to include her so much that it made her feel excluded from everytng. i keep accidentally making her feel bad, and it's just... it must be so hard for her. i can't even imagine it. >> i remember a couple years back, everyone was talkingou t, like, having babies,an d it really makes me upset. i mean, i don't want ttell them to stop talking about it, but you know, it's like... it kd of hurts my feelings,

and they're alwaysalking about that. ex's like... it's so hard to ain. it's like, "but i'm a girl," so it's... but it's like, "could i have 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 people, it's hard for them to understand, but i don't wa to, like, burden them with that. i kind of just either walk away or i just kind of deal with it. i try to sometimes get into the conversation, but you know, 's hard. >> do you ever feel like you're, like... you can get so closeir

to being a gl, but you just can't get to that exact point? is that what upsets you? >> yeah, that's exactly how i feel. the thing with having a baby, it's like i can never be fully there. .hat's just, like, a natural thing that happe i buy a bra, but it's not to hold in my boobs. it's for an illusion. it felt sort of like an ac i ind of feel lost sometimes. >> for me, i always, like, see these really cool guys, and i'ms alike, "i want to be like them!" and morgan and ben were those, like, ol guys that i wanted to be like. once i really realized that they were perfectly fine with me being transgender, it was like a whole new rld for me.>>

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

a guy, and saying like, "you've got to start working out more.bu you've gotild up that upper body muscle." >> "try and talk in a deeper voice. even if it's not normal, get used to it. burp. if you have to burp, just let it fly. don't try and hold it in. lsrls do that all the time." >> in terms of gir and dating, i'd just say, like, "try not to really show any otion towards it. just, like, treat her like you don't even like her. just treat her like that." so i'm like... i'm not trying to make thatny sound bad oring, 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 i'll slip up a bit, but their tips are amazing, and i'll go with them.

>> you have to keep your foot straight with the board. t >> i'd still sayt he's still in the process of, like, really learning how to be a guy. but i say he's comg close to finishing that for sure, so... >> i've been struggling with depreson 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 hurting myself, cutting myself, killing mylf, even. i got very close, very close, twice. i was just thinking, "i can't do it anymore. i can't live like this. i can'live in this 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 younger, he was always like, "no, you have to wear a dress. you're a girl. you can't. not allowed. no, can't do it."so hat probably made me , rrified.

i finally told hich was not that long ago. my dad was really worried about the effects of the medicines, snd what if i later in life decided that this the path that i wanted to go down. >> i had some concerns, and there were some things about me, or about it, that nd of bothered me a little bit. we have these educated doctors offering kids who are at a young age some optns that i'm not really sure should have been available to them.al i was kind of surprised and put off by it, quite honest. >> because i was only 13, he didn't want me to make a life decision like that at this age.t as still hard. i couldn't really see why. it was horrible. i felt like my parent, my dad, he didn't love me.

i felt like he didn't want m to be this way. >> i didn't want her to... (clears throat) ...think that she could make n me changes to her outward appearance and tddenly, everything would be fine and she would just move on from there fe would be great. i think there are a lot of other implications to this tn just the few that you're fosing in on right now. >> narrator: but kyle is still ,ping to start testostero and although his father remains concerned, he'agreed to go to lurie's gender clinic for the first time to arn more about hormone treatments. >> heels all t way against the wall. >> narrator: cross-sex hormones, estrogen and testosterone, used to be given only to adults.t treatment guidelines established in 2009 now include childrenthough they do not

recommend starting before the age of 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 hormones at 15 or 14. and with the changes in the age of onset come some challges to care that i think teams need to be very savvy about. how are you? >> how are you?>> 'm dr. garofalo. >> do you remember me? dr. chen, good to see you again. >> iean, i think the big decision that families have to make when they embark on cross-sex hormones is that nowu' re not hitting a pause button, right? so when you move on to cross-sex hormones, you're now initiating medil therapy where some of the changes that are going to take place are permanent. d that's a whole other, like, ball of wax, i think, for some of these families, and that can be really ha. so when we think about medications, if we're going to with the route of medications, there's two kinds.n one are medicathat sort ofbl

k progression through puberty.ne the other medithat you could use would be right to going to sort of what we call cross-sex hormones, or in this case it would be sort of testosterone. there are plenty of drugs that get approved by the fda, and everybody goes on their merry way and thinks things are great, and then two years later, people are dropping dead from e 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. so testosterone as a medication has been around obviously for a long time. ore way we would consider using it here, sort ofin a cross-sex sort of way, there aren't, like, a tremendous amount of studies that have beeo to document, like, all the potential side effects and theri s and benefits. but i think 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 the things that ki of freak people out. gst when you think of thin

like, you know, hair loss on the temples, you know, facial hair grth, deepening of the voice,ha all things tt go along with sort of a le sort of hormone. you're gonna have increased muscle development. so some of it's going to be things that he'll want, but some of the things you want to look out for are things like acne, mood changes, and then all the risk factors that go along with a typical male predisposition.hi sos like heart disease, stroke, you know, those kind of things. males are more likely to have heart disease than females. we're asking families to take some leaps of faith bad 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, like, vague language and, like, "may, could..."

we know very little about things that are really important to families, like enfertility, like cancer pal or oncologic potential of these agents, cardiac risk. i mean, things that, like, families want to know when they're making decisions about their children. and there definitely is the htential for the testosterone or the cross-sexormones to prevent sort of normal, or what call "normal," fertility to sort of occur. have you ever thought about having kids yourself? we're sort of asking you to be really grown up really quickly when you make these decisions, and that's what's tough. but i want you to really think through somef the stuff we're talking about here. does that make sense? >> well, you know, i would like to have kids, ybe someday, but... >> if you're saying, you know, "i might want to have my own kid one day," then i think it's yoprobably a good thing fo 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. u till now, it's been things that were reversible. change your name, we can refer to you as "he" and "him" andne sure, but at 13, i don't think she'll change her mind, but you have to think a little bit more about that. i mean, those are... and those are things that yourre s should be there for, to help you be as certain as you can about a decisionli that later i could have a huge impact. so there's a lot to think about. you feel better now? >> i do. >> goo >> i don't envy these parents. i mean, i think they're makingsi des in a very difficult environment.ha i mean, i knowwe 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? but at the same time, to deny them, that's tough.an i here's a... this is a... this is tough stuff. >> hi, okay. so i guess around 11:00, uh, i injected testosterone into mybo . and so today's my first day, like, being born, i guess. >> watch lots of youtube videos of like skylar eleven and stuff. so like having him like nd of explain everything through his videos has helped me a l. >> so this is kind of like me pre-testosrone, but some is like floating around through my bloodstream right now. um, and i fe really good. >> i looked at other videos. i realized that they were exactly like skylar eleven, that they h same thoughts and the same, like, views of things>

hese are my muscles pre-t. they're not that bad for a biological female, i think. >> and these are my s, so this is all like pre-testosterone. >> cross hormones, i can't wait for. it's going to mean that i'm going to start being able to in 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!de i can get voice, i can get a beard, i can get a flat chest. did someone look at my christmas list? y to inject testosterone,ou epve to use specific needles and a specific syringeding on your dosage. >> i always pull out more than i 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 wasye erday, it was my 11 months on t. (lowered voice): hey guys, so tht. is my voice 12 months o >> i'm a lot hairier. as for my happy trail, which is y e hairiest part of my body, it's like a happsuper highway. >> today is my first day on t. um, i feel like a new man. basically i was prty much born today. today is my one year on bistosterone. it is my official hday. i am now one years old, and it feels freakin' awesome. it's the best thing in the world, you kno >> cross-gender hormones and top surgery are going to be the two major things tt 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 like. there's several different procedures.le this is a do incision procedure. >> i can finally show off my wonderful abs. like they're really there. but they kind of are. that's about it, yeah. so this is my chest. >> online is a great por trans people. the internet is the best place tu can go to, if you're like scared about talkianyone. the internet, like tumblr. oh my god, tumblr. and, um... just youtube, too. youtube is like one of the... that's how i found out i was trans. 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 evenwi out 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 lotiff... because it's like, "oh, daddy's girl," that thing. did that ever happen to you? >> i don't feel like tt's what was up with my dad. i don't think it was a "daddy's girl" kind of thg. i think it was... i think it'sar justfor him to imagine, like, being able to be born onea and identify as another. i think he's just... guysren't really allowed to play with their gender at all. >> oh yeah. >> so i think that was more about what it's hard for him to wrap his head around. >> my birth name giann for as long as i can remember, i always felt male. i did come out to my parentss a lesbian sometime around

seventh, maybe. you know, i thought, "oh, well, i seem to wear boys' clothes all 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 wodn'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 hem said, you know, when you say that, when you say 'she,' it feels like'm actually naked and i feel horrible, and i just want to disappear." so i started to say "gi." and now would like to be called john. so i just go between both names

still. still getting used to the process of the name. >> so it's still gi to me, certainly not the gianna from, you know, childhood,t's still gi. d guess i haven't switched over to the john. a little harder for me. i feel, in a sense, like y mething's been robbed, right? like, you know, soughter's gone, it seems, and is morphingi intoother person, but i m feel like thisay be where it ends up.kn i don'. i hope not, but i think there's another way. there's a whole spiritual side to this, to me. so i pray a lot. you know, and the wh

spiritual piece of this is, you 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 her, you know, wan life based in-- how do i put this-- on the path that god has planned for her, i don't know that this is it. this rou, to me, can be an eternal death. she may not see at, but there's a hope that if i can just stay there, you know, show the love, see what happens, an we have to take it day by day. >> with the upbringing that we had, you kw, 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 how we grew up. that's what we grew up thinkingt

but e 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 speak when he was pulling 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 to me. >> wave hi, everybody. say hi. say hi. >> i always haa hard time making friends. i iink part of it was that was a very strange kid. i would just feel bad because every day i went to school, i just felt like everybody wanted me to go. nobody wanted me there.

one time, this girl, w in the girls' locker room because we have to change for gym. she just went off on me. she was, like, "man,ou're an ugly dyke. you're a lesbian." it just kind of went from shakys to uble to almost impossible, is what it felt like. by the end, i was just trying to hang on. i started getting some anger issu in my sophomore year. when i was very stressed out, well, sometimes i would break and i would punch a hole in the wall, or kick a holee wall, or things like that. i... i would just get so mad. eventually, i could keep it from all spilling out, but it would

instead,t would spill in. i was just drifting off into this vy violent... very violent experience into my head. sometimes i would think about harming my family. the images would pop up in my head. it g... it got so bad. and that's when i really decided, i feel like a threat tl myy. i lfel like a threat to myse i just can control myself. so very 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 much pain, and that i could be causing it. that was too much for me. h i jue 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, "could this reverse?" there's a possibility. is this going to move fully forward, and this is where 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 elsee it's bect's a personal issue, and where you're at. the choice for me is, i just, lican't go there. u

>> do 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.ha and that'si think is really amazing. we signed the legal papers on friday, so it's all set with the cross hormones, ani'm really excited. >> it's really big news and i'm also just aware of... i feel like you've been waiting for quite a long time. >> yeah, a very long time.

(chuckles) >> and you kw, i mean, it's interesting. some people think, how come someone your age knows so well and so clearly, you know, whowh you are anyou'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 perspective, sort of asking you to wait nger feels more haful than, you know, than not. rm the guidelines have always said that cross es should start when an adolescent is 16ol year and that's something that we've been working on with our erapist. he really feels that ariel is ready. he's asked... we've gone through, you know, many sessiont rapy. we've gone through questionnaires. we have to... the endocrinologist has to talk to us, the pediatrician, and we're now we're at the point that

giel is going to be able cross hormones earlier than the guidelines of 16. >> so, taking this next step of taki cross hormones means something in terms of your ability to have biological children. you know, some transgender adolescents decide to actually postpone, you know, even taking cross hormones until they can store their genetic 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, now 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 haveat a child ay." 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's also that i coun't have a child, like, in a girl's body. re got it. but you want chi >> yeah, i want... well, of course i'm going to have children, but i'm ju not going to have them that way. >> okay. >> mm-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.s. >> and t >> i think about it constantly. cry about it sometes. (chuckles) >> of course. it'skay. >> really sad. >> yeah. >> but my excitement to starte oss hormones completely overrules my, like, despair to just not have a child my own. like, that just completely ovrides it.

>> okay. any other thoughts or questions about that? >> no. >> okay, good. ve >> oh, that's a nice house. uh-oh. (laughing) you can build it again. >> when alex was young, like i would say three or four years old, one of the favorite, activiti least for me, used to be on saturday morning where i would make pigtails in the sunroom, and we would like capture some information on video, and just i was... i was trying to, you know, have aro chlogy of different parts, moments of alex's life. >>ou're the best. >> thank you, my baby. >> every once in a while i still called him karen. there's like a karen phase in my mind, d 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 a picture now, it will be alex. and accidentally, sotimes i call him karen. (knocks) >> hi, alex. i'm going to wash my hands. >> narrator: alex and his mom come to the inic every six weeks for an injection of lupron, the puberty blocker. but today, they are also here to sign a consent form for testosterone. >> you want to squeeze athing, are you good? i'm going do one, two, three, okay? >> okay. >> it is very, very hard to make the decision to allow your child to take a medication that has unknown side effects. but it becomes a lot easier when you've come to the conclusion that the benefits outweigh the risks. d when you see your chil

suffer the way i have and struggle, the way we have seen vealex struggle, we don't choice. i don't feel as thoughe have a choice. >> so some of the changes of testosterone are permanent meaning, these changes won't reverse. ok? once your voice deepens, there's no going back. so hair loss at the temples and crown. other thing is facial hair a grow body hair growth, so those are things where, toagain, if you decided toat one point in your life, that hair growth may slow down, but it may not stop. so once your estrogen goes dow ngere's actually changes in that area, usually thinnd sometimes you can get a littleth discomfort wit, with the walls of the vagina. okay? that can increase the ri of sxually transmitted infections. you know there ae transgender men who use that area to have sexto use the

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 u know, if you're using that area for vaginal sex. okay? l so i know, atle bit hard to think about and perhaps not comfortable. >> especially at 13. >> especially at 13. i hear this, i know. we have to go over this now, and you're like, "why do you have to bring that up with anyone?" it's not known whether this increases the risk of ovarian cancer, breast cancer, or uterine cancer. so pelvic exams and regularce ical screenings are strongly recommended unless there's been a removal of those organs-- the ovaries, the uterus, and the cervix. >> it is very difficult to have a 13-year-old in the driver's seat and playing such a big role in thision.

i think that we would both prefer to see alex transitiontu lly, to live his life as an t.out medical intervention, bu.. and without the need for puberty blockers or cross hormones. but we feel that, you know, we are not experiencing what he ise encing. so from my perspective, i do feel that testosterone is the ght course for alex. >> narrator: john's ther 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 chged. i was hoping that you could sign." and he told me, you know, "i'm just not ready. i'm not ready for that yet." i... i did start getting angry, but i tried to... tried to plain to him why i need this. he still said that 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.no >> i know, i kw. it pains me at you have to go through that process. i'm not unempathetic about that. the bigger pie for me is, i don't know that i am going to be coortable with this life a the way it's going for you. and it's just my fatherlync

n. everything else aside, i'm still at, i don't know that this is the right way because i'm basing this on love. and i ju, in love, for the way i'm thinking, the way i'm feeling, i couldn't sign.>> said, you know, "you say you love him, but it just doesn'feel like love, and if i were john, it wouldn't feel like love. g you what itell 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.we i don't know iplit, i don't know if we... i don't know. i don't know what at means. i care, though. i mean, i would love to keep us together, but i don't know what that's going to do. e i mean, i think people h, lisa's going to have to make up

her mind. gi will have to ma 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. i can't. >> i guess... i knowing thl leave out maybe a year or so... . it's kind of a i hope the tensions dot last, you know, because it wld be nice to leave out with less

conflict, have the 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 guidelin. highlight, lowlight. preferred name and pronoun. and we'll go this way. >> i'm lia, female pronouns. i'm leaving tomorrow to go to arizona for surgery. , 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. >> yea my friend aj, who is gender non-conforming, was prom king, so like it was cool. >> oh, i know aj. >> aj jonathan? >> oh my god, i know aj.

>> yeah, so we're prg and queen, which was awesome. i graduated from high school, having surgery, pretty good. mo narrator: lia hodson, who just turned 18, is the first wave of kids in the united states to medicalltransition with puberty blockers, hormonesg and now y. ♪ w alking through a crowd, the village is agl♪ >> i'm about to go in for surgery. it's a srs bottom surgery. so i'll be getting a nice little vagina. (laughs) srs means sexual reassignment suery, or grs, gender reassignment surgery. i think that's what they call it. ♪ it drives y crazy, but you know you wouldn't change ♪ anything, anything... us theykind of put it all inside and invert and sew it all

up, and i got new parts. (laughs) i think, soon as i realized who i was, 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. n itever really like a question of if i would. i just kind of felt like i would, and it was a matter of time. i don't think that surgery's going toagically change anything in my life. i mean, it'll just make me feel more comfortable with my body and myself. i don't want to focus on being trans forever. it's kind of just the littleha ssle 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. i doe.t want to make it my lif i don't want to... i don't really identify as being tns.l. i'm just a gir

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 tra. i just feel like myself, i feel comfortable, and ieel like a woman. >> narrator: isaac also fully transitioned, with blockers, rmones and top surgery. now 19 and a sophomore 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 my name, 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 embraceli this mas part of myself so deeply. going through an artificialou puberty,now, i didn't really experience this sort of formative time.f and i kindurn that in a way because, you know, as much as we all know puberty is that sort of, y know, gross, slimy molding of everybody into a person, and the way that i went through that was, you know, meticulously tested and controlled and dosed, and it's been good, but i wonder what that experience... or at role 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 o decisiregret transitioning, becau it was 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 kno it's become really clear in recent igyears that any sort of b problems that i thought i would fix by transitioning weren't really fixed. i really don't like to use the term "regret," altho's

kind of hard to speak about how i feel about my gendhout there being some element of regret, or at least of fear, i think, a little bit of what thes implicatf the choices that i made are.a i'm puttinemical into my body once a week. ecm like... and there are very, very, very clear e of that. and i'm suming that there are also unclear effects to that. i mean, it isuper easy as a kid to hear, you know, these things are irreversible and be like, "okay. i don't care. you know, just i want it." because time doesn't, you know, you don't think of time in the same way when you've only experienced a tiny little sliver of it. but i think in the past few years, at least for me, i would

at some point like to take a break, at least, from testosterone, because i don't like to imagine that, you know,o the entirethe 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 only really been a man in the constructed body. 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 all the muscles. 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 to a girl as i can. >> narrator: at the age of nine lia has t entered puberty, but daniel has, and he will start blockers 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 r lot of and so we're forced to pick the lesser of two evils in some ways, just because of what we don't know for one of em. 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.ys >> okay, so alet 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 data 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 what we are tryinto do is, make the best decision possible with the known facts. >> one, two, three.

aw, you did good. >> narrator: soon after meeting with the docto 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. >> i need testosterone to be comfortable with myself. and my dad, he kee saying, "i'm just not there t." >> can i s it down the 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

mily and what that means, but today i don't see it. it's hard for me. >> narrator: not long after this interview, john was spended from school for punching a classmate who had just started testosterone. three weeks later, his fatherle ed and signed the consent forms. sh right when she found ou was going 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!" in likall caps with like a uallion exclamation marks. >> and it was... ay, it was, like, kind of exciting for t when she finally said that she was going to gm. >> well, i remember the first day, like, i got the hormones. so i walked around my room and touched every article, every fiber of my carpet and

every, like, piece of on my bookshelf, and i said, "i'm... these are the last things i'm touching while i'm a child." and i s, like, walking around and, like, touching the entire things. and it was so funny and i, likei shed 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 ake girl, li just a girl, girl, girl. but now that i've gotten on myit feet ae bit, i want to show people, like, i'm a trans girl. i mean, if you're sure of w yourself, th do you need to hide it? >> there's definitely times where i thought like, kay, well, now that this town knows, maybe i could move, so i could just start a whole new life and

just be the guthat i am." st some part of my mind s that as kind of lying to myself. i mean, i'm never going to be a cisgender guy. i'm never going to have been harn an actual male. i'm always going t, like, that sense in me. and if you lie to yourse, then you're kind of lying to the world. and it puts a lot of weight onde your srs, a lot of pressure for you. and i think that if i can just clear that pressure off, i'm alex the transgender guy. >> these are not families that are living ithe shadows anymore. you know, the world is changing. hamean, this is a movement is happening. it's not going to not happen, it's going to happen. hbut the stakes are superigh, and we don't have all the

answers. there hasn't been a lot of research in this area. hopefully there's going to bees morerch and some of those unanswered questions, hopefully, will begin to be answered and then we can give families, like, legitimate options in terms of what we'reoing now, which is really, i think, approaching families with a lot of unknowns. >> we are all kindf navigating this new world. 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 individus will be able to give us feedback, both... both just to tell us and that they will be involved in studies that we can htarn what things we did r and what things we didn't, and that it will be even better for the next generation.

i really hope that what we're doing is the right thing. t >> gopbs.org/frontline for more about transitioningat n early age. >> just put the pause button ec puberty. >> and 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 friends that actually, like, accept me, at are guys, i'm more myself, yeah. >> then tell us what you think at pbs.org/frontline. e >> critics havcalled frontline's "the choe" "must see tv for every voter," "a striking example of how to avoid false equilency," "the indisputable facts," "richly detailed," and "unlike thmedia circus."

"frontline is once again demonstrating how indispensable it is." don't miss "the choice016." th monday, novembert 10:00/9:00 central on most pbs stations. >> frontlinis made possible by contributions to your pbs station from viewers like you. thank you. d by the corporation for public broadcasting. major support for frontliis provided by the john d. ander cae t. macarthur foundation, committed to building a more just, verdantld and peaceful w more information is available at macfound.org. additional support is provided by the park foundation, ubdedicated to heighteningc awareness of critical issues. the john and helen gle family trust, supporting trustworthy journalism thatrm inand inspires. and by the frontline journa fund, with major support from

jon and jo ann hagler. >> for more onhis and other frontline programs, visit our website at pbs.org/frontline. frontline's "growing up trans" is available on dvd. to order, visit shoppbs.org or call 1-800-play-pbs. frontline is also availabler wnload on itunes.

the faces you know the news you rely on, anytime you want anywhere you are. i ma really value pbs's news coverage because i think it's rigorous journalism woman: clear and concise reporting man: both thoughtful and thought provoking woman: mind blowingly honest and open woman: information that will help me make a good decision with so much at stake, this election year one plnee has the news yo to decide pbs

fox: many communities around the world see disease and mental illness not as something to be treated, but as something to be feared. as a result, many suffering from curable within their communities, but through ecation and organizing, some people are challenging these stigmas and aing previously taboo health issues. in our first segment, we learn how the ebolaq outbreak spreckly through western africa and caused widespread social turmoil. for many, the disease became a mark