"Shane Smith:" "This week on Vice:" "The controversial medical decisions faced by transgender youth." " Your dose is 25 milligrams." " Very proud." "There's no words to describe how hard, you know... and it's not really connecting mentally with what you see physically." " Are we doing it?" " We're doing it!" "Max, why is it so important that you get the hormone blockers?" "So I don't go through girls' puberty." "I don't want that to happen." "What we're trying to do is provide the treatment, the care for young people who have a very high likelihood of taking their lives." "Toboni:" "Go!" "Go!" "Go!" "Refugee:" "We are not animals!" "I've never seen a shiny puzzle like this." "Yeah, 'cause it's a three..." " 'Cause they're 3-D puzzles." " No way!" "You've never solved a 3-D puzzle before?" "Never seen a 3-D puzzle." "Kai, how old are you again?" "Five and a half." "What grade are you going into?" "I'm going into kindergarten." "Uh-oh." "Look!" "Oh!" "A piece of Ariel!" "Well, that's it." " This one goes here." " Nice!" "Good job." "Do you want to show us some of your other favorite toys?" "Like maybe your five favorite toys?" "My most favorite ones?" "Well, my most favorite five ones is... my light-up Rarity." "Well, this one, and my bird is my other one." "Her name's Princess, um, Polly." "I even have a book, um, of "My Boy Princess."" "Why do you like that book?" "Well... because it's about a boy who likes to be a princess." "Does this story remind you of your story at all?" "Well, um..." "When Mom thought I was a boy, and dressed me like a boy," "I did not like it, so I... and I already thought she, um, knew I was a girl, but she didn't know, so I had to tell her when I was old enough to say it." "What did you say?" "I said, um... well, I told her, "Mom." ""I'm not a boy, I'm a girl."" "That's pretty brave." "Toboni:" "What were the first signs that you noticed that Kai was transgender?" "Transgender, in the beginning, wasn't a word that I knew." "It wasn't in the media." "Uh, Caitlyn Jenner hadn't happened." "Bathroom laws hadn't started." "So, I just thought that Kai was extremely feminine." "Between the ages of two and four," "Kai started playing with girls, and thought boys were yucky." "It's at that age when Kai wanted a tutu and not a truck." "Kai:" "These are just my dress-up dresses." "This one is Rapunzel." "Rapunzel?" "Oh, that's beautiful." "Which one is your favorite?" " Whoa!" " This dress is." "Were you hiding this one from us?" "No." "It was there the whole ti... it... always in there." "Oh, wow, look how much it poofs up!" "Kimberly:" "By the age of three," "Kai came to me and told me," ""You know I'm a girl."" ""I am a girl."" "And it just didn't stop." "How did you react to her telling you that?" "I'm embarrassed to say that I would scream at her." "I would yell at her, I would punish her, and I would tell her, "You're a boy."" ""You're a boy."" "There were days when I would have to tell myself that I could not spank her again that day." "I was horrible to her." "I thought that I was doing everything that any other parent would do to make their kid not be this way." "Three, two, one, go!" "Boing in the desert!" "It hops and hops, with..." " and it carries..." " Kangaroo!" " Yes!" " Yes!" "The social transition happened a little after the fourth birthday." "Oh!" "Oh, this is easy." "Not a sheep." "Another type of sheep." " Your time's running out." " Lamb?" "Goat?" " Yes!" " Nice." "Toboni:" "How did your family and friends respond to Kai transitioning?" "I had come from a really large, Southern, you know, Republican, Christian family." "All of my friends... uh, were in ministry." "Strong, devout Christians." "Straight-ticket Republicans like I was." "So, we immediately started losing nearly every friend, and every close and meaningful relationship that we had." "How does it feel to lose 90 percent of your family because your child is transgender?" "It feels lonely." "You feel like... you're in the fight of your life... to save your child." "And the people that have been in your life... they leave you on the battlefield alone." "How do you do that to Kai?" "There are a lot of people in the world that hate my child simply because she exists." "Toboni:" "Around 1.7 percent of American youth identify as transgender, and those estimates are conservative, since the population is likely under-reporting." "Today, these trans students find themselves at the center of a national debate over bathroom laws." "Breaking tonight:" "A firestorm of criticism continues to build 24 hours after the White House drops a late-night memo changing the rules at every school in America when it comes to the issue of transgender students." "Toboni:" "In May of last year, the White House issued a directive to public schools to allow students to use the bathroom matching their gender identity, or risk losing federal funding." "In response, Texas led a dozen states in suing the federal government over the guidance." "Ten more states followed." "If this prevails, this'll be the end of public schools as we know it." "Kimberly:" "Most of the leadership in Texas, have come out and made strong stands against the transgender community." "The school district has an ultraconservative school board, and an ultraconservative superintendent." "We are probably in the worst school district, in the worst state right now at this time, starting kindergarten." "Toboni:" "With kindergarten less than two weeks away," "Kimberly is heading to her local school board meeting to fight for Kai to be able to use the girls' bathroom." "All:" "One nation, under God, indivisible, with liberty and justice for all." "Woman:" "Next on the agenda, we have Miss Shappley?" "Dear Board Members, my name is Kimberly Shappley, and I am the parent of a transgender student here in PISD." "Toboni:" "As soon as Kimberly started speaking, the superintendent and several audience members left the room." "Kimberly:" "The suicide rate for a transgender youth is 41 percent." "That is why we are fighting so adamantly for these children." "I propose that transgender students be allowed to use the restroom which corresponds to their gender identity, and allow students whose parents do not want them to use the same restroom as a trans student, use the alternate facility that's supplied." "That way, my child won't remember anything about discrimination from her first year of public school, and 30 years from now, students whose parents chose to segregate them will remember which side of civil rights history their family was on." "What I would like to say now is, I am a mom of a little girl that I would like to see live." "I am a mom of a little girl who has a 41 percent suicide rate." "That is a very real thing." "Please understand, I'm not fighting about bathrooms." "I'm fighting about her life." "Toboni:" "The day before school started, a Texas judge temporarily blocked the White House directive." "Meaning Kai isn't able to use the girls' bathroom." "I pledge to every citizen of our land that I will be president for all Americans." "Toboni:" "The election of Donald Trump sent a shock wave through the trans community, and one month into office, he withdrew the Obama administration's federal bathroom guidance." "Former Attorney General Loretta Lynch has been a leading advocate for the trans community." "Why should this be viewed as a civil rights issue?" "Because this issue of how we treat transgender people in our community, in particular, how we treat transgender students in our schools relates to how our government is gonna interact with people whom we perceive to be different." "We've made such great progress in so many areas of civil rights... uh, accepting people for who they are, and when you see that attempt to roll back that change, through the use of the law," "that's exactly when the Department of Justice has to step in." "One of the main opposing arguments is that... predators could go into, let's say, a girls' bathroom, making parents feel that their children's safety is at risk." "What is your response to that?" "Of course we want to protect our children from people who are gonna prey on them, in a bathroom, in a school." "But that's not the basis for the violence that we see directed against children." "It's not coming from the transgender community." "The reality is, it's a sad reality, that transgender individuals in this country are much more likely to be the victims of violence than the perpetrators of violence." "Is this more than about bathrooms?" "I think that it's more than bathrooms because it is about innate dignity." "Adolescence is hard for any child." "And you couple that with the issues of making sure that you're comfortable and secure with your gender identity, it adds an extra weight to it." "This literally is a matter of life and death for so many young people who are dealing with these issues of identity." "Toboni:" "It's life or death, because the rate of suicide attempts in the trans community is 40 percent." "As families try to support their children and lessen the potential for self-harm, they're now forced to weigh the options of early medical intervention." "Now kids, like eight-year-old Max O'Brien, can delay the onset of puberty using drugs called "hormone blockers."" "Max, when did you first realize that you were a boy?" "I just thought I was a boy my whole life." "How many times did you ask your parents to get your hair cut before you actually did?" "Like, I think like... 245." "So, I got really excited, and I went to Hounds, which is an only men's barbershop, and... cut my hair." "How did things change once you got your hair cut?" "My life changed, 'cause I felt good in my skin." "What are you gonna do tomorrow?" "I'm going to the doctor's to see if I need hormone blockers." "Max, why is it so important that you get the hormone blockers?" "So I don't go through girls' puberty." "I don't want that to happen." "Toboni:" "Has Max started to talk about puberty at all?" "He knows about puberty, about female puberty." "He started to have some breast growth last year, um, and he, actually, was using Band-Aids to try to cover himself up." "He's eight, you know." "And, in general, how do you feel about hormone blockers?" "Nervous about it a little bit, just because I always... like to know a little bit more about medical intervention, you know, and anytime we're introducing chemicals into bodies that, you know, weren't there naturally." "I'm just, kind of, a little bit worried about it." "So, that's on my mind." "Toboni:" "Max goes to Boston Children's Hospital which opened the first clinic for transgender youth in the US." " Woman:" "Max O'Brien?" " Toboni:" "Since 2007, they've treated hundreds of children and teens." "In the past couple years, our volume has just about doubled." "Toboni:" "Dr. Jeremi Carswell is the director of the gender program here." "What are hormone blockers?" "It's a hormone that will block the progression of puberty." "We can give it in a couple different forms." "It's an implantable device, or it's an injection and it's reversible." "Max, I'm gonna have you hop on up here." "Okay, just look at me." "Toboni:" "What are the downsides, or what are the adverse effects of getting hormone blockers, when you're, you know, say Max's age?" "Carswell:" "We have concerns, about primarily, bone health, because the sex steroids, estrogen and testosterone, really do help build those bones to be nice and strong." "Another one is, really, kind of the psychosocial development." "Our brains are supposed to be ex... you know, exposed to estrogen and testosterone." "You know, if you're not getting your sex steroids, do you still go through that?" "And how important is that in gender identification?" "We don't know." "That's it!" "You're done!" "I do think that puberty has actually started." "Um, the labs do show..." " really early puberty." " I'm sorry, I'm sorry." "I..." "I think we can move forward." " Okay." " Do you want to see what it looks like?" "See this little thing?" "Okay?" "This is the Histrelin implant." "Are you gonna put it in my skin as a shot?" "It actually goes right about here." "This is what it feels like when it's inside." "Okay." " Yeah." " Ew!" " So you will be..." " Well, this isn't real skin, right?" "Right." "You won't be clammy like this." "But do you feel how you can feel it in there?" "Yeah, I can worry about you." "Kimberly:" "So, while he's on the blockers, he's not going to get a lot taller, right?" "You will have catch-down growth, okay?" ""Catch-down," which means that he will grow probably at a slower rate, because we're taking away..." "Kimberly:" "The puberty that's making growth happen." "Exactly." "If Max changes his mind at any point, um, we can release the blockade, and we know from lots of papers, lots of experience, that he will go into puberty on his own." " On his..." " A female puberty." "I always ask, every time," " "How are things feeling," you know." " Yeah." "It's important to keep the space open, right?" " Keep the door open." "Yeah." " And we do." "Yeah." "And he gets really annoyed with it." " 'Cause we keep on saying to him..." " Right!" ""You know, if you want to change your mind,"" " and he's like, "I'm not."" " Right." "But we keep saying it to him, so he knows that it doesn't matter to us." "Toboni:" "A month later," "Max went to Boston Children's Hospital at Waltham to have the blocker placed." "So, we'll get our consents." "We'll get him right in." "Max, just so you know, this is gonna be very quick." " Are we doing it?" " Rachel:" "We're doing it!" " Green light." " Are you ready to go for a ride?" "This is all you have to do." "You can give him a smooch." "I'll see you in a couple minutes, bud." "Diamond:" "So, what we're gonna do is put a Supprelin implant in Max's left arm." "Typically, these implants are functional for between 14 and 18 months." "Uh, given his age, he's likely to need... the implant replaced at some point." "Okay, so we put the implant into this introducer, and, uh, we just slip it right in." "That was so quick." "The whole thing took 10, maybe 15 minutes." "Toboni:" "Now that Max has the hormone blocker, his parents are weighing the consequences of the next step:" "Cross-sex hormone therapy." "Does it make you nervous to consider cross hormone therapy for your child?" "Rachel:" "To me, blockers is, again, it's not a permanent thing." " Right." " It just puts a pause for a while." "But the cross hormones," "I'm glad we have a ways to go, before we have to start going down that road because that brings on a whole other slew of questions about fertility and about all these different things that," "I think, are really impossible to decide when you're 11 or 12 or 13." "At some point," " you'll have to make that decision." " Rachel:" "At some point." " And he'll still be a child." " Yep." " How will you make that decision?" " I have no idea." "I don't know." "I don't know." "Toboni:" "It's a difficult decision because the changes that come with cross-sex hormones can be irreversible." "And while clinical guidelines recommend them for teens 16 and older, many doctors are starting even earlier." "At 15 years old, Steviee is getting ready to start on testosterone." "First year in high school, so that's a little weird." "Then getting used to everything, trying not to get lost." "It's not like the movies." "You don't get shoved in lockers or anything." "It's pretty, you know, if you fade in the background a little bit, nobody really notices you, so it's like easier to get through your day." "So, let me guess, this is Steviee's side?" "Toboni:" "Steviee and his twin sister, Hailey, have lived with their grandfather, Rich, since their mother passed away." "Did your mom know what you were going through?" "Um, yeah." "She was the one who helped a lot, and, you know, when I was younger," " it really helped me." " Hailey:" "She was very supportive." "She was the one who bought, you know, guy clothes, and my whole family was like," ""No, they're twins." "We're gonna dress them the same." ""They're two little girls," but my mom, like, knew." "Toboni:" "Tomorrow, Steviee is going in for his first shot of testosterone." "You're about to take a step tomorrow, starting on cross-hormone therapy, um, that will cause you to experience irreversible changes." " Mm-hmm." " How do you feel about that?" "Um, I know there's a lot of people who are like," ""You're a 15-year-old, making adult choices."" "Like, "This is something that's gonna effect you for the rest of your life."" "After a certain point, my voice is forever, you know, changed." "There's a possibility that I could not, you know, bear children or have a child of my own." "And, you know, those are big things to think about, but at the same time, you know, you have to think about," ""Okay." "What's the first step in liking the way you look, and like, liking yourself?"" "Hailey:" "There you go, you can have your own cooking show, Steviee." "How are you guys all feeling about tomorrow?" "Steviee:" "I'm probably gonna wake up tomorrow, and like..." "Hailey:" "Freak... freak out, yeah." " Sounds like Steviee." " Yeah." "This is what he's been wanting for years, so... it's what we're gonna do." "What changes are you most looking forward to?" "You know, like the more stronger, sharper features." "Like broad... broader shoulders, and more, like, narrow hips, gain muscle mass really quick." "So, yeah, there's a lot of perks." "Woman:" "All right, come with me." "You can have a seat up there, so I can grab your blood pressure, okay?" "A little nervous?" " Hey, how you doin'?" " Steviee:" "Hey, good." "Good to see you again." "I'm gonna go over all the stuff about the medication." "Hormones start several months just at a really low dose." "You know, you want it to be kind of slow and steady, so you can adjust, transitioning is a big deal." "But if at any point, you feel like... this wasn't right, just say so." "Anything else you want to talk about before we go any further?" " I'm just nervous as hell." " Okay, understandable." "I'm just worried about what it's gonna be like" " 10, 20 years down the road." " Uh-huh." "So, I can tell you that from my trainings and from advocates in the community, a lot of people wish they could have started at a young age, when the body wasn't a full adult body." "I mean, if it wasn't for the fact that I've seen" " all of his life that..." " Right." "He wants the boys toys, and the boys clothes and all that stuff." " He's told me numerous times." " Right." " "Pappy, I'm a boy."" " Uh-huh, yeah." "I said, "You're sure?"" " "I'm sure, I'm a boy."" " Okay." "So one thing we sort of talked about in the beginning," " was fertility issues." " Mm-hmm." "You know, it's not the best thing, but, you know, I never really... it just wouldn't be natural for me to have, you know, carry a kid of my own, so." "Probably the best option, do this rather than wait" " until I have kids or something." " Okay, okay." "Toboni:" "Steviee's sister and all of his grandparents came in to support him as he got his first shot of testosterone." "Your dose is .125, you're at 25 milligrams." "It says that on here." "You're gonna be self-administering." "The thighs are the easiest part, but if, today, you want me to," "I can do it in the back of your arm, or I can do it in your thigh, wherever you would like." " My arms." " Back of your arm?" "Okay." "All right, little pinch." "We're done." "I'm very proud of you." " How do you feel?" " Pretty good, I've waited a while, so, this is weird." "Grandfather Rich:" "Paps gettin' emotional." "Oh, and Grandma's gettin' emotional too." "I've just always prayed that they would find happiness." " Well, like you always said..." " And I think this is it." "We know there was something, but we didn't know what." "If you weren't able to get access to cross-hormone therapy, how would that make you feel?" "It'd be very, like, very difficult." "Like I couldn't... there's no words to describe how hard, you know, it is waking up, and not really connecting mentally with what you see physically." "And I feel, like, to prolong... prolong the treatment and the process for that would be, like dreadful." "Toboni:" "Many trans youth can't transition until well into adulthood, because they don't have the support of their families." "Estimates show that about 40 percent of homeless youth identify as LGBT." "Long-term residency programs, like the Waltham House, provide a place for these teens to go." "The kids that we see come in here, they're just in fragile states." "Toboni:" "Program director, Rebecca Reed, has worked here for over a decade." "You know, kids feeling..." "feeling suicidal, um, kids making some significant self-harm attempts, and it's heartbreaking to think that... somebody so young and so full of life can feel like there's nothing to, kind of, live for." "Can I have my estrogen, please?" "Toboni:" "Charlotte came to the Waltham House at age 16." "After a lengthy legal battle with her family, she is now able to take estrogen." "What was your childhood like?" "I was very lonely." "I remember my father yelling at me one time." "I came downstairs in my sister's black tutu, and he screamed at me to get it off, that I wasn't a fag, and that his son wasn't gay." "At fourteen years old," "I told my mother that I wanted to be a woman." "And she looked at me, and she goes," ""I'm gonna tell you this once..." ""I will kill you." ""I brought you into this world, and I can take you out."" "How did you feel when your mom said that to you?" "Like I really had no place in this world." "I thought a lot about how I was gonna kill myself." "I only stopped thinking about that because I got hormone treatment." "Toboni:" "After years of fighting for her transition, tomorrow, Charlotte is going in for the next major step:" "Breast augmentation." "Toboni:" "Are you nervous?" "Charlotte:" "A little nervous 'cause it's my first surgery, but it's gonna make me feel a lot more confident and secure in my body." "Woman:" "So, what do you like to be called?" " Charlotte." " Charlotte, okay." "But tell me, though, your first and last government name." "My legal name is Charlotte Jane Michaels." "Okay." "Reed:" "Charlotte and I have had many conversations about her identity." "If somebody mis-genders her, she constantly thinks," ""Well, it's 'cause I don't pass."" "And so, going into surgery, she thinks that this will be just one more defining moment, to kind of, help her get to that Charlotte she ultimately wants to become." "Toboni:" "This generation of trans youth are some of the first to transition medically before reaching adulthood." "Because of that, doctors are concerned about the potentially unknown long-term effects of treatment." "Dr. Elizabeth Miller co-founded the gender program at the Children's Hospital of Pittsburgh." "Do you ever worry that kids will grow up to regret their decision?" "I think that is absolutely... the largest concern that we have about doing anything that's potentially irreversible." "Someone in your position is criticized from both ends at times, right?" " Mm-hmm." " You're not giving care fast enough." "Or you're giving care that people don't agree with, that's very controversial." "It's part of the bargain, I think, that we have committed to, recognizing that things are not black and white." "What we're trying to do is provide the treatment, the care, um, for young people, who, in the absence of that care have a very high likelihood of taking their lives." "So, my sense is... cross-sex hormones, pubertal blockers, are absolutely medically necessary." "Toboni:" "For Charlotte, taking estrogen has helped her to feel more comfortable in her own skin." "We caught up with her two months after her breast surgery." "Charlotte:" "I still look like a trans woman, but... people have been treating me a lot different now." "People have been using female pronouns predominately." "If I had access to hormone treatment when I was younger, blockers," "I think it would have made such a difference." "I probably wouldn't have been this tall." "I probably wouldn't have been mannish at all." "I would have looked a lot like a female." "Toboni:" "For Max's father, Tom, starting on blockers isn't the only important step to take in embracing his son's transition." "Tom:" "Here is this tattoo that I figured I would get because it was never changing, and... now I have Max's old name on my leg." "So, it... it dawned on me at some point, that that was something that I needed to change." "Rachel:" "I think he's coming." "Oh my gosh!" "Oh my gosh!" "Rachel:" "How did he do that?" "You would never even know it said Amelia on it." " Tom:" "What do you think, Max?" " It's awesome." "Yeah." "Max:" "I can't even remember what it looked like before." "What have been some of the challenges or struggles that you've had through Max's transition?" "The thing that's been hardest for me has been the grief." "I totally, a lot of times, feel like..." "I lost a daughter." "There was one day that we were at the bus stop, and..." "Max had on really tight jeans, and um, uh, a big puffy coat where the hood was up over his face, and I couldn't see his hair, and it looked like Amelia, and I just started crying like," ""I don't get to see you anymore, you know, you're right there."" "Just stay, like stay for a little bit." "I just want to see you for a little bit before you go away." "I feel like it sounds really selfish, because I do still have my kid." "The suicide rate in the trans community is something like 40 percent." "When you factor in an accepting family, it drops." "I love you." "Sleep good, okay?" "I'll see you in the morning." "Tom:" "When people talk about us being such brave and courageous parents and stuff, I just..." "I didn't see any other option." "Sleep good." "Like, to me, he..." "I don't think he would have made it." "I mean, the stuff that he's said and felt, and so, I want a live kid." "I want my kid, I don't care." "I'll take him as a boy, it doesn't matter to me." "Toboni:" "What do you hope for Steviee's future?" "He's happy, that's all." "I kind of hurt inside, because I know he's gonna have a rough life." "'Cause too many people look down on... trans people as... like society's misfits, say... and they don't seem to get the respect they deserve." "Toboni:" "Kai's only five, but when you think ahead to her going through puberty, does it worry you, the decisions that you'll have to make?" "You know, I..." "I never thought I'd be in a position to have to need to know about hormone blockers, or hormone therapy, or when do you have to start estrogen, or do... are we gonna have to get breast implants or..." "There's so many things coming down the line." "The medical decisions coming up, they're very important, but they won't be as challenging, emotionally, because I'm supporting my child and what's best for her."