Earlier this year, North Carolina passed HB2, the so-called "bathroom bill." The law bans anyone from using a public restroom that doesn't match up with his/her biological sex. HB2 put the state in the middle of a national fight about gender. But North Carolina is also home to one of the few gender clinics for kids in the South, at Duke University's Children's Hospital.
This week, we spend a day in that gender clinic, the only one in North Carolina. We wanted to know how a clinic like this one operates in this political climate. And we wanted to find out how these patients are coping.
Dr. Deanna Adkins, a pediatric endocrinologist, started the clinic a year ago. Over the course of our day, we met three of her very different patients. Drew Adams is a 15-year-old trans man who came with his mom, Erica, all the way from Jacksonville, Florida. On the drive up, Drew wore a T-shirt with "This is What Trans Looks Like" printed on it. He told us he decided to change out of it before he stopped for a bathroom break in North Carolina; he used the men's room. When Dr. Adkins told Drew that not only would he get a prescription for testosterone, but that he could give himself his first shot that very day, Drew stood up and cheered.
We also shadowed Dr. Adkins's appointment with Jaye, an 18-year-old African-American trans woman. Jaye's experience has been very different from Drew's; her family has had a harder time accepting her transition. She also worries a lot about her safety, especially in North Carolina, and she can tick off the names of a number of trans women of color who have been killed over the last few years. But, like Drew, Jaye was thrilled when Dr. Adkins handed her a prescription for estrogen. She planned to pick it up that day.
At the end of the day, we met Dr. Adkins's last patient, Martin, and his mom, Karen (we decided to use pseudonyms for them both). Martin was born a girl and came out as trans a year and a half ago, after a long struggle with depression and anxiety. At first, his mom worried that this was one more expression of Martin's unhappiness. But Martin's transition has completely changed his outlook. His mom said he used to be withdrawn; when his depression was at its lowest point, he started cutting himself and had to be hospitalized. Now, she says, "It's more like we've become friends again and we've reconnected. I think it's because he realizes that I accept him for who he is and I'm going to support him."
This fall, Martin plans to present as a boy when he returns to school in Raleigh. When we asked him which bathroom he’ll use, he told us it will depend how brave he’s feeling.
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Drew Adams: We've been in the car for eight hours now. And we are stuck in traffic.
Mary Harris: This is Drew Adams. He is 15 years old. He is riding shotgun in his mom’s SUV.
[Drew & Erica Adams singing]
They are on an all-day road trip, recording the drive on Drew's phone.
Erica Adams: Okay, so legit question. If we have to stop and use the restroom, which one are you planning to use?
MH: Drew’s mom Erica is asking her son which bathroom he’s going to use. Because Drew is trans. He was born a girl. And this road trip is heading right into the heart of this whole transgender controversy, North Carolina. Drew sort of dodges his mom's question, and says he''ll try not to stop at all.
DA: I'll figure it out when I get there. If I get there.
EA: Okay, alright.
MH: You have probably heard about HB2 - North Carolina’s “Bathroom Bill”. It bans people like Drew from using public restrooms that don’t match up with their biological sex. And it's made this state into a place a lot of people are trying to avoid. Ringo Starr and Bruce Springsteen have both canceled performances in North Carolina. PayPal and the NBA have pulled business deals out of the state. But Drew and his mom are driving eight hours from Jacksonville, Florida to get here because North Carolina is also home to one of the only clinics in the South that treats transgender kids.
EA: The drive up here every time we stopped for a bathroom break and Drew would go into a men's room, I held my breath because you just don't know. You don't know if he's going to walk out everything’s going to be fine, you don't know if he’s going to be in there awhile, you’re going to stand there and go I wonder if anybody else is in there. I wonder if they're giving him trouble I wonder if he's having to defend himself I don't know what's going on in there.
MH: I’m Mary Harris and this is Only Human. This week, we followed Drew and his mom to the child and adolescent gender clinic at Duke University. We spent a day here, following patients and specialists in exam rooms and waiting rooms and break rooms because, while the debate about transgender rights keeps raging on, more and more kids are showing up here.
The clinic is only open a couple of days a month. It's part of Duke's children's hospital, a sunny, modern addition to the main hospital next door. There’s a giant fish tank when you walk in, and everything - the armchairs, the art - is crayola-colored and bright. At 9 am, Drew and Erica check in at reception.
Receptionist: Drew, when’s your date of birth?
MH: A sign on the desk reads “We value diversity: tell us your pronouns!” They’re all over the hospital, actually, asking kids to tell doctors whether they go by “him,” “her,” or “they.”
R: Who’s your primary care doctor?
DA: Dr. Tarbox.
DA: Drew looks pretty androgynous. Drew has blond hair cut short, with a sweep of bangs across his forehead. He has a ring through the center of his nose, and as the medical assistant gets his height and weight, Drew squints at her through his wide, wire-frame glasses.
Medical Assistant: I’m going to get your blood pressure.
MH: This is Drew’s second time here. He has been living as a boy for about a year: asking friends and teachers to call him “he”. Now he's looking to start his physical transition. He's hoping the doctor will prescribe testosterone, a once a month injection.
MA: Alright did you guys have any other questions or concerns about anything? No.
MH: While they’re waiting for the doctor, my producer Jillian asks Drew about the shirt he's wearing.
Jillian Weinberger: Can you tell me what your t-shirt says?
DA: Yeah, it says this is what trans looks like and the word trans is in trans flag colors.
JW: Where did you get that T-shirt?
DA: Mom made it.
MH: A few months back, Drew's mom posted a “re birth announcement” on Facebook -- coming out as a mom of a trans kid. Today she's wearing this little button that says "I'll go with you." It means she'll go to the bathroom with anyone who feels unsafe going on their own.
Erica's learned to embrace Drew's new identity because when he was living as a girl, she says he was really anxious and depressed.
EA: Then after he came out as trans it was like flipping a light switch. Suddenly he has not had an issue with anxiety or depression pretty much since that day. He's been so confident, he's been so positive, he's so bright -- that's kind of his mood all the time now.
MH: She doesn’t like talking about what Drew’s life was like before he started transitioning. But when I asked her how she knew living as a boy was the right choice for Drew, she was blunt. She said: “I’d rather have a living son than a dead daughter.”
Dr. Deanna Adkins: Hey! How are you?
DA: I’m great.
Dr. A: Excellent.
MH: Dr. Deanna Adkins started this clinic. She’s an endocrinologist - a hormone doctor.
Dr. A: Anything new since I saw you last? Medically.
Dr. A: You’ve been healthy? Excellent.
MH: Drew is almost giddy to see her. When she walks in, his only question is when can I start testosterone.
Dr. A: Today. Sound good!? Yeah! All right.
MH: Drew will start out on a fraction of the dose an adult would get. But there are still a lot of unknowns about what these hormones will do, long-term. When Dr. Adkins leaves to write up a prescription, the clinic’s social worker comes in. She’s got this packet of paper that lists every potential side effect of this treatment, and she starts reading off these statements for Drew to agree with.
Kristen: I understand that the medical effects and the safety of testosterone are not completely known. There may be some long term risks that are not yet known.
MH: Drew is required to affirm that he’s heard all of them, and it’s a long list. The hormones might give him headaches, high blood pressure, an inflamed liver…
K: Emotional changes -- for example more aggression. I know that the effects of testosterone on fertility are unknown. I have been told that I may or may not be able to get pregnant even if I stop taking testosterone.
MH: Going through these side effects takes nearly 20 minutes.
K: I know that using testosterone to appear more masculine is an off-label use. I know this means that is not approved by the government.
MH: Drew signs one final form. And Dr. Adkins comes back with the prescription.
Dr. A: Alrighty. Guess what I have in my hand?
DA: Happy drugs.
Dr. A: Yay! Yay!
DA: I have one question. Yes. So you said you know you can give me a shot right now. No. What if I went to the hospital pharmacy, picked this up, and gave me the shot in the hotel. Can I do that?
Dr. A: Yes, you can do that.
DA: YAY! I can do that! I can get my shot today. Cause I told all my friends I was going to get it today.
MH: And Drew does give himself the shot that day -- in a conference room at the hospital. He sets up his iPhone to record it...
DA [recording]: This is a big moment for me, yes. So I want to blog it...purple needle...okay testosterone...put the needle in the thingy...I did it! I'm on testosterone. I did it!
MH: How do you feel?
MH: OK so how many friends have you texted already?
DA: I posted about it on Instagram so that’s about 550 right there. And then my best friend Ana.
MH: Drew has created a whole online identity as a trans kid. He has a youtube channel, and he sells pride tattoos on etsy.
[Cheering crowd on Ellen]
MH: Drew came out as transgender after watching an episode of “Ellen” featuring a trans man named Aydian Dowling. Aydian’s online video chronicling his transition has more than half a million views.
Aydian Dowling: And I started Googling ‘girl that becomes a boy’ and ‘how to grow up to be a man’ and for the next 48 hours it was videos and links and articles and everything was just totally involved.
Ellen: I think I have to say at this point -- I think people’s fear of like, oh my god, if it’s just floating out there, then my child is going to just look on the internet and become a different gender. I don’t think it works that way.
AD: No, it was more like this was the missing puzzle piece.
MH: But Aydian started his transition at 21. Drew is fifteen.
MH: Do you ever worry you're making this big decision. Like what if I change my mind.
DA: Absolutely not. This is the happiest I’ve been all my life. Like today getting that prescription -- that's probably the happiest I've been.
MH: Even just a few years ago, hormones might not have been an option for a kid like Drew. This clinic is brand new. Dr. Adkins opened it only a year ago.
MH: When did you see your first patient who was trans?
Dr. A: Oh wow. I have to think about that. I want to say 2012. 2012.
MH: So just four years ago.
Dr. A: Yeah.
MH: When she was in medical school, Dr. Adkins trained to treat kids with diabetes or growth hormone deficiencies. But in 2012, she got a call from a physician in New York City. He had a transgender patient who needed a local doctor.
Dr. A: I said wow I don't know what to do. I've never studied that, I hadn't been trained to do that and he said That's OK I wrote the articles, I'll send them to you [laughs] and so he sent me all his articles.
MH: Deciding to treat that first patient wasn’t easy for Dr. Adkins. She spent about a month going back and forth about it. She knows that in North Carolina, patients like hers are targets. And that means she is too.
Dr. A: It was a big decision for me. I mean we're at risk too, just like our patients and there are some not so nice people that would push us around or say ugly things about us because we're doing this work.
MH: So safety is a big concern for her, but it’s the patients she really worries about. Patients like Jaye.
Assistant: This is Jaye.
MH: Hi nice to meet you.
JW: Nice to meet you.
MH: I’m Mary.
JW: I’m Jillian.
MH: We walk into Jaye’s appointment just after lunch. Jaye is an 18 year old African-American trans woman who lives just outside Raleigh. She’s here to get a prescription for estrogen -- Dr. Adkins is ticking off the side effects.
Dr. A: Sometimes the risk increases for diabetes. Any in the family? (Yes). Your mom?
J: My mom, grandfather, brother.
MH: Jaye’s dad was supposed to be here, but in the end, she is here alone.
Dr. A: Alright I'm going to give you a little bit of a once over. Just the usual. Let me wash my hands…
MH: Jaye is incredibly thin and perfectly styled. She has long fake eyelashes and lots of pink eyeshadow. The only real sign that she wasn’t born a girl is the distinct shadow of hair on her neck. She’s hoping that’s about to change. She says she's going to pick up her prescription as soon as she leaves the doctor.
J: I'm going to go marching in there, I'm probably going to twerk to the counter (laughs). This is a really good feeling for me. I’m not able to scream like I would at home. But I would be screaming right now.
MH: What are you most looking forward to?
J: To be honest I'm ready for my boobies. [[laughs]] I’m been already been a long time for you know to be able to develop breasts.
MH: How long have you known that you’re trans?
J: Well, at first, when I was younger, I would first get into nail polish and eyeliner and my mom would notice and asked me if I wanted to be a girl.
MH: When she was younger Jaye didn’t think she did want to be a girl. She came out as gay, and her mom was pretty supportive of that. But when Jaye told her mom she was trans…
J: She was angry at me, she thought I was lying to her, I was living a lie. And it just just took me by surprise that she you know wouldn’t accept me the way I thought she would.
MH: Because she'd been asking you: Do you want to be a girl, do you want to be a girl?
J: And I would say no, no I'm not.
MH: And then you were like hold it, maybe I am.
J: And that kind of confused her, threw her off. My dad had a really hard time with it -- it became an unspoken thing. But my mom she got most of the flack from it you know from my family they were asked why I was like that. And eventually they started to understand that I couldn't help the way I was and they started understanding that this is a real thing, I’m not acting, this isn’t a phase. They don't use my pronouns.
MH: So your family still calls you he?
MH: Your mom and dad, too?
J: My mom -- she’s saying she. My dad calls me he still.
MH: So part of the reason we’re here is because North Carolina's been in the news so much because of this bathroom law. You got a look on your face when I said that.
J: Since I've lived here in North Carolina I know how it is, and people I know from out of state say it’s not that bad and I'm like yes it is. I know a lot of discrimination, know places not to go I could be hurt. And I just knew for a long time it would end up coming to light and it would be nasty.
MH: She can recite the names of trans women of color who have been killed over the last couple of years. She’s scared that if she does something kind of normal - like make the first move with a guy - she’ll get hurt. Physically.
MH: How do you keep yourself safe in the outside world?
J: I stay home. It shouldn't be that way but, otherwise, you know I like to travel in groups; I don't like to go anywhere late at night. I don't like to-- I don't seek out men. A lot of places don’t feel safe. Work doesn’t feel safe sometimes. Home doesn’t feel safe sometimes. I'm safe when I’m by myself.
Dr. A: Alright, here is the discharge information. It has your vitals from today, your medications that I sent to your pharmacy, and I put the side effects, once again, for the medications here and a reminder to put the estrogen under your tongue.
J: Awesome. Thank you.
MH: After seeing Jaye, Dr. Adkins goes into this little workroom to go over patient records and catch her breath.
Dr. A: I'm getting a little worried. I mean not that I wasn't worried already but I was just told by the third patient that they're moving out of state. Because they don't feel safe.
MH: Dr. Adkins tells patients about support groups, and makes sure they visit with a social worker. But she worries that it’s not enough.
Dr. A: The thing that I fear is also something that I know will eventually happen. I hope not, but I feel from talking to other people who care for transgender kids that it's likely, highly likely, that one of my patients will kill themselves one day and that's that the day I don't I don't look forward to.
MH: Oh God. That’s just heartbreaking.
Dr. A: But all of, all of the providers who've done this work for any length of time all have patients who have either taken their own life or someone's killed them.
MH: After the break: Dr. Adkins says the work she does is an art, more than a science. And for parents, that means there aren't a lot of easy answers.
Karen: Well, sometimes I feel hopeful, I'm thinking well maybe it'll change, maybe he'll wake up one day and say no this is not for me, this was a mistake. The likelihood of that happening is probably really low, so I try not to get excited about it, hoping that something would happen.
**** MIDROLL ****
MH: Hey everybody, thanks for listening. We've got a quick favor to ask of you. We're working on an episode about how learning a bit about your genes can totally shift your perspective, and we're looking for your stories. So, have you ever taken a DNA test to figure out your ancestry? And did the results surprise you? Maybe you were inspired to learn a bit about a remote place you never knew you were connected to. Write to us. Send us an email at email@example.com or @onlyhuman on twitter and Only Human podcast on Facebook. We want to hear from you, and you might get to be part of an upcoming show.
MH: I’m Mary Harris, this is Only Human. Today we’re visiting the only gender clinic for kids in the state of North Carolina. It's really busy.
Dr. A: The next new patient appointment is in November now.
MH: And this is the beginning of June.
Dr. A: Yeah.
MH: Dr. Deanna Adkins opened this place about a year ago. And a few months after that, the state passed their “bathroom bill,” also known as HB2. It's changed how Dr. Adkins sees her work and herself. She says it's made her “mama bear” come out. And she's become an expert witness in the case against that bathroom bill.
Following Dr. Adkins around, though - I noticed something else. A lot of her teenage patients had severe depression and anxiety. Their parents were coming to Dr. Adkins for answers. But she didn't have a quick fix.
Dr. A: The big question that I get is what's the test. Are they transgender or not. We're here to find that out. And I'm like ooooh. There's no test. [laughs] You know it's takes a lot of understanding, a lot of conversation, a lot of things to really figure that out. I think they just really want me to tell them no and they can move on with their life.
MH: They want you to say like no I'm the doctor you can't have the medicine.
Dr. A: Yeah, yeah. And you know. Sometimes that's where we end up, that's not the usual case. You know we got to sort through it we got to figure out really where you are really where you want to go. Is that transgender, is it not transgender, is it -- where is it?
MH: The day we visited, Dr. Adkins saw ten patients. The last one came in at around 4:30, and I caught up with him in the waiting room first.
MH: What’s your like biggest question from this appointment.
Martin: Um. Why am I so tired all the time, I guess.
MH: We’re calling this patient Martin -- but we’re using pseudonyms for him and his mom, Karen.
M: I thought that when I started the hormones I would get more energy, and I was looking forward to that, actually.
MH: Martin is slouched in the waiting room chair. He's sixteen, and he’s really thin, in baggy clothes. He has short brown hair with blond highlights. And it’s kind of hard to tell his gender just by looking at him.
He says he first remembers feeling like his body wasn’t quite right when he was 7. He was at summer camp, and he didn’t want to use the girls’ changing room. A year and a half ago, he came out as transgender.
MH: Tell me about when you first told your mom about being trans.
M: It was one of the last days of the year. I couldn't sleep and one night I went to my mom's room and I was like I need to talk to you about something right now. I can't stop thinking about it.
MH: Martin’s mom, Karen, didn’t really believe what he was saying.
M: She was like it could be that you're just you know curious. It could be that you’re just not like most girls.
MH: Before Martin’s appointment, I pulled Martin's mom aside to talk to her one-on one. Because it was clear - she’s still struggling.
Karen: The whole thing was just very shocking. I mean I gave birth to this child, this is my daughter, and I just it was just hard out of habit. Just knowing her.
MH: Gender isn’t the only thing Martin is having a hard time with. When Martin hit puberty, he got depressed. He refused to go to school. After he started cutting himself, his mom had him hospitalized. She worries now that coming out as trans is one more expression of how unhappy Martin is. And that’s made accepting his new identity even more difficult.
K: I felt almost like I was lying by calling her he felt like I was lying to myself to everybody and I just it just didn't seem natural to me at all.
MH: Was there a point when that stopped or does it still kind of feel like that?
K: It's gotten much better. I've been working really hard at trying to do that and I do I do slip every now and then still. I've talked to other parents who have transgender children and they still make mistakes every now and then in fact on the way here I made a mistake and he corrected me. But it's it's really odd. I feel like I'm talking about somebody else sometimes when I talk about this is my son.
MH: Most of the time we were talking, Karen was literally shaking, she was so nervous. She desperately wants her kid to be OK. And transitioning has made a huge difference for her him. She says the changes were --
K: Almost like immediate -- yeah. I saw immediate changes.
MH: When he was living as a girl, Martin was withdrawn. But now, after a couple of months on testosterone --
K: He's really opened up to me he confides in me he will sit down and have dinner with me have a conversation with me. You know it's more like we've become friends again and we've reconnected. I think it's because he realizes that I accept him for who he is and I'm going to support him.
MH: But Martin’s become really sluggish. He’s been sleeping all day when he can, sometimes for stretches of 11 hours at a time. When they get into the exam room, Dr. Adkins wants to figure out why.
Dr. A: Alrighty, I just want to give you a once-over, if you’ll hop up there...
MH: She asks a few questions and does a quick physical exam. When Martin rolls up his sleeves, I can see his arms are covered in delicate white scar tissue from cutting.
Dr. A: Blood sugar was good. Kidney, liver function was all normal. Testosterone was 294, which is a good number. Have you seen any change in facial hair, acne, oiliness?
M: Acne and oiliness. Definitely a lot more. Also on my back a lot.
MH: Dr. Adkins eventually convinces Martin to take a little less testosterone to see if that helps him feel less tired.
Dr. A: Yeah I'm a little worried about the fatigue that --you too?
Dr. A: OK.
MH: Martin is not thrilled with this decision. He’s been so much happier since he began transitioning. But Dr. Adkins is insistent. And she asks him to get one more round of blood work before he goes.
DA: She’s going to come grab you for the labs in a minute and then you can check out. For right now I put in for a 4-month follow-up, so you can make that out front.
MH: When I started reporting this story, the one question I kept coming back to was “how do these kids know what they want when they are so young?” So before Martin left, I asked him to explain to me how he knew.
M: I could never see myself being the woman in a relationship and it was the most uncomfortable idea to me.
MH: To be the woman. (Yeah) Why?
M: It's something that I really can't put into words exactly like it's sort of has to do with like traditional roles in a relationship that a woman has like you know the man would ask the woman out kind of thing but also something that you can't really explain you just have to feel it.
MH: Martin told me he doesn’t think he’ll ever change his mind about his transition. But when I listen back to him trying to explain exactly what trans feels like to him, I can hear him struggling to do it. His mom hears it, too.
K: Even his therapist said, you know, this may not be forever, we don't know for sure, nothing is one hundred percent guaranteed. He could change his mind two months from now. Six months. Ten years. We don't know. But right now this is where he's at.
MH: How do you feel about that?
K: Well I know it's sometimes I feel hopeful I'm thinking well maybe it'll change, maybe he'll wake up one day and say no this is this is not for me, this is not this was a mistake. But the likelihood of that happening is probably really low, so I try not to get you know excited about it, hoping that something would happen.
MH: And she does worry that Martin can’t know how he’ll feel, down the line. Remember all those side effects?
K: His ovaries may become destroyed. But he said that he's fine with that because he never really planned on having children, but he's only sixteen so, you know, I hope that he doesn't change his mind down the road and regret -- have any regrets.
MH: By the time Martin leaves, this clinic has been seeing patients for almost 12 hours straight. Back in the clinic workroom, Dr. Adkins goes over paperwork with the clinic’s social worker.
Dr. A: We made it. End of the day. Yay.
Kristen: We made it before 6:30.
Dr. A: Yeah. It’s been 7 before.
MH: How do you feel at the end of a day like this.
Dr. A: Exhausted and rewarding definitely feel like I've done good but it takes a lot of me.
In about a month, Martin will head back to school, in Raleigh. And, for the first time, he’ll walk through those doors as a boy. I asked him what bathroom he’ll use. He said, it will depend how brave he’s feeling.
Only Human is a production of WNYC Studios. This episode was produced by Jillian Weinberger. Our team includes Amanda Aronczyk, Elaine Chen, Paige Cowett, Julia Longoria, Kenny Malone, Fred Mogul, and Lisa Rapaport. Our technical director is Cayce Means. Our executive producer is Leital Molad. Thanks this week to Ben Adair, along with Danielle Fox and Stephanie Daniel.
Jim Schachter is the Vice President of news at WNYC. I’m Mary Harris, talk to you next week.