Here's The Thing They Won't Tell You About Giving Your Trans Kid Hormone Shots (2024)

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The first time I gave my son George a shot, right before I plunged the needle into his thigh, I looked him in the eye and said: “Don’t forget, you’re a chicken.”

I had forgotten that I was the one who needed to pretend he was a chicken. I thought it would be easier to stick him with a needle if I pictured his leg as a piece of poultry. The trick worked anyway — he was so confused that he didn’t notice when I jabbed him. Once in a while he still says to me: “Don’t forget, Mom, you’re a chicken.”

Here is the thing they don’t tell you when they teach you to give your kid shots: Muscle resists the needle. You have to create a small injury to finish the job. But the damage never sat right with me. I’m his mother — I was supposed to keep him in one piece. And I had, more or less.

There are people who would disagree, who would argue that my failure to keep him as one thing, and prevent him from becoming another, was like standing on the beach and watching him swim into a riptide. Parents are supposed to spot potential threats and steer our kids clear of them. But no one ever said we would agree on what they were. And why would we? What one parent might call a danger, another might call a life preserver.

George has always been terrified of needles. Annual vaccinations were an ordeal. The minute he saw the syringe, he would get a crazed look in his eyes and wrap himself up in his little arms, ready to fend off any sharp objects. It was George against the nurse, and part of me couldn’t help but cheer for his resistance; I found it reassuring that the protest in him could be stronger than an instinct to comply.

I didn’t know how much he would be needing this moxie down the line. But in the pediatrician’s office, I colluded with the enemy and played the clown long enough for the nurse to finish the job. Afterward, he would look at me like some kind of traitor, which I suppose I was. A traitor for a cause. Now George had his own cause.

George started hormone replacement therapy, a critical component of gender-affirming medical care for young people, when he was 16. Setting out on this trip, I made sure I was prepared to lead the charge. I did the homework, consulted the experts and asked all the questions. I had gained fluency in procedures, effects and outcomes. What I hadn’t known — what you don’t read about in any of the literature — was the scope and heft of the undertaking.

Advance warning wouldn’t have changed anything anyway. To be clear, none of this is to say I’m particularly heroic. I’m simply like most parents, operating within the implicit parental economy: Action taken on behalf of your child’s well-being increases the value of the effort and decreases any perception of labor.

“If any of them were to ask why I support George in his medical transition, I would tell them that I am doing what mothers do. You tend to your child’s wounds, and if their life needs saving, you save it.”

What most people don’t know is what a complex process it is to manage HRT for children. The shrewd marketers of laws banning gender-affirming care for kids would have you believe that in states without such bans, parents can put their child on hormones indiscriminately and without much effort. They couldn’t be more wrong. This obscuration of the gates parents have to pass through to access this care for their kids is just one of the many falsities endemic to the violent campaign to outlaw HRT for youth. What is true is that in many states, I could have bought an assault rifle in a fraction of the time it took to get George on testosterone.

I admit, I was naive at the outset. I assumed that finding a doctor for George would be like looking for any other specialized care in New York, and that the options would be plenty. I was wrong.

When George and I started this process in 2022, there were fewer than a handful of places offering gender-affirming care for transgender kids in our area. As a result, the demand for their help far outpaced their capacity. Even getting a consultation appointment with one of the doctors felt like a triumph. It became a test of how long I could sit on hold without yelling obscenities at my phone.

The hours of remixed classical music were worth it. We found a wonderful doctor at a community health clinic that has a special unit for LGBTQ+ youth. The clinic is a beloved anchor for the gay and trans communities, where people can find medical and mental health care regardless of their ability to pay for it. It’s crowded and chaotic, shuddering under the weight of so much need, but the doctors and nurses are good-natured and unflappable ― surprisingly so, considering their limited resources and unlimited patients. And they have a special waiting area for the kids where the walls are delightfully papered with the patients’ artwork and posters of queer teenagers urging safe sex in Spanish, English and Mandarin.

This place has an undeniable underdog charm that worked its magic on me. But more than that, it was where George could become himself.

It wasn’t just the doctors and nurses who needed goodwill and a sense of humor — we did too. Each step forward turned into more steps. There were more appointments for blood tests, records to gather, letters of support from therapists and psychiatrists to round up. George would need biweekly injections of testosterone by one of the nurses, which meant more appointments to schedule. Which meant more time waiting on hold. And more trips back and forth to the clinic. At a certain point, my calendar became less of a plan and more of an aspiration.

The day came when responsibility for the shots was handed off to me, and we were sent home with a paper bag of syringes and needles. George got his shot every Monday morning before he ran off to catch a bus to school. After I packed his lunch and cleaned the breakfast dishes, he would drop his pants and hop up on the counter. I would pull out his special kit, draw up 3.5 milliliters of testosterone, and give the needle a good flick as I had been taught to do.

Here is another thing they don’t tell you: A small puncture in the thigh can cause an unreasonable amount of bleeding if the needle lands in the wrong place. No matter what I did to calm or distract him, George would flinch the moment the needle found his thigh, and it would leave behind a small stream of blood that I chased with gauze like I was cleaning up a crime scene. Then we would both rush in with our apologies. Me, for not being someone he could count on to get it right. And George, for being the source of my sense of failure.

Those who wish to do away with HRT for trans youth would say that I, with the help of his doctor, was the one who put George in harm’s way. They would say the damage I may have done is far greater than the puncture of a needle. That I recklessly endangered his well-being, exposing him to speculative medical and psychological harm. They argue that what we do is child abuse, and they now have a trail of state laws to back that up. But if any of them were to ask why I support George in his medical transition, I would tell them that I am doing what mothers do. You tend to your child’s wounds, you pull them out of moving traffic, you see the value in them when they’ve lost sight of it. And if their life needs saving, you save it.

George was an enchanting little girl. I know it’s true because everyone told me so. He had smooth olive skin, giant eyes and endless lashes. Now he is a rather short guy with hairy limbs and stubborn acne. He still has the lashes, but they are eclipsed by an unruly thicket of eyebrows. And since no one taught him to shave (I was all George had on the parenting front, and I knew nothing about beards), he usually has little islands of stubble. The beautiful girl is gone and he’s not quite yet a handsome man. That will come with time.

But it’s neither here nor there. I am loveblind. I take him on his own terms, which erases as many worries as it adds back in. So long as George can be in the body he wants, he has no impulse to hold it up to scrutiny. To George, we are all just bodies in motion. What freedom that is. And yet, the first time I watched him walk off to use a public men’s room, my throat tightened. I worry about things — people — that I’m afraid he doesn’t know to be scared of.

It’s a strange transmogrify — the slow-motion dissolution of one form in favor of another, a mutability that undermines conviction in the fixedness of either. When a female body is exposed to an abundance of testosterone, it sets off on a second puberty, only this time in a different direction. You start to sweat more and your body gives off new odors. Acne erupts and spreads out like a wildfire. Coarse hair sprouts up all over your body. Traces of a beard and mustache begin to appear, and will grow thicker over time. Weight in the body begins to shift. Fat collected around the hips disappears, and muscle in your arms and shoulders becomes more pronounced. Your face squares off, becoming more angular. Your vocal cords get thicker, your voice cracks and then deepens. Menstruation fades and the libido ratchets up. A boy emerges behind the girl, overtaking her.

But the truth is more complicated than any before-and-after story. Testosterone didn’t suddenly turn George from girl to boy. As a young child, he was different in ways that were undefinable but palpable enough to make him an outcast. Invitations to sleepovers and birthday parties were rare. Kids thought he was strange; he thought they were incomprehensible and cruel.

George was bookish, had odd interests and was utterly ignorant of the things that captivated the girls around him. He stood outside the worlds of either girls or boys in a state of loneliness I can still hardly bear to recall. And then puberty came along and took his suffering to new levels. It was like being buried alive in a body not his own, a body suggesting roles he could in no way fathom.

“One more thing they don’t tell you: When your daughter becomes your son, it is he who births himself.”

Not too long ago, a note popped up on a professional messaging service I use. Someone was looking for a therapist to help a man whose teenage son had just died by suicide. His transgender son. I wrote a reply with my contact information, which is still sitting with all the other messages I’ve written and never sent. The truth was that this father’s loss was a wire I couldn’t touch.

It sent me back to an incident at the airport before George began his transition. We were making our way through security at JFK, trying to catch a flight to Peru. While I was still pushing our bags down the conveyor belt, George was stopped by a TSA agent who wouldn’t let him pass through the scanner. She was barking the same question at him over and over, getting increasingly pissed off.

“What do you have under there?”

George just stood there, mute, not understanding what she was asking. All the passengers held up in the line were waiting for George to answer. She pointed at his chest.

“UNDER YOUR SHIRT! WHAT DO YOU HAVE UNDER YOUR SHIRT??”

The agent had noticed the swell of his breasts, which he tried to keep locked away under tight sports bras. George wasn’t trying to pass as a boy back then; he was just living as best he could in the body he had been given. He couldn’t help but confuse people. And that confusion sometimes angered people like this TSA agent, as if their embarrassment at getting his gender wrong was his fault.

The moment still haunts me. When you are just 15, standing in front of a crowd, how do you answer a question like “What are you?”

“Breasts. I have breasts.”

One more thing they don’t tell you: When your daughter becomes your son, it is he who births himself. It didn’t matter which one of us injected the hormones; the boy they uncovered was of his own making. And this new person began where the one I gave birth to left off. A piece of my motherhood dissolved along with her.

When I tried to explain this to my well-intentioned friends, they pointed to the breadth of action on my part that George’s transition required. But they were getting it all wrong. The fact that I captained the ship on his behalf doesn’t make it any less true that my son was someone he, himself, chose to bring into the world. I don’t take credit for that.

When George was ready to head off to college, I arranged for the school nurse to give his injections, but he went to the clinic on his own to learn how to do the injections himself. He returned puffed up and proud of his accomplishment. George was ready to remove me as the middleman between himself and himself.

It’s OK. When George comes home, he still asks me to give him the shots.

Stephanie Manes (LCSW + JD) has been in private practice for over a decade, working with adults, teenagers and couples. She teaches couples therapy at Columbia University and works extensively with the LGBTQ+ community. Her work is always informed by anti-racism and anti-oppression of any form.