“Mommy, Mommy, come quick!” my daughter shrieked at the top of her lungs while taking her nightly shower, her voice piercing so loudly I suspected the worst.

“What’s wrong?” I instinctively screamed back, simultaneously closing my computer, jumping up from the couch, and running towards the kids’ bathroom, just barely catching myself after tripping over a rogue backpack left lying in the middle of the hallway and half stumbling through the door.

“Are you okay, love?” I asked, slightly out of breath and looking through the shower steam for anything awry.

“Are YOU okay?” Gabby asked from inside the shower, loofah in hand, suds all over her body, a slight smile forming as the water splashed down around her.

“I’m fine, but you scared me. What’s the matter?”

“Oh, sorry, nothing’s the matter,” she began. “I was washing myself, and the loofah hurt my boobs. Do you think they’re growing?”

I laughed. “They might be, G. They really might be.”

“Yay!” she squealed. And then, “you can go now.”

Accustomed to being “summarily dismissed” by my 13-year-old twins, I chuckled to myself and headed back to the living room, hoping my daughter’s boobs were indeed growing.

Unlike my daughter, I’d been an early bloomer when it came to “developing,” as my mom called it. I distinctly remember my boobs beginning to poke through my favorite pink Izod shirt in the spring of 5th grade and my math teacher literally saying to me, “wow, Katie, June is busting out all over” one day after class (in mid-June) and giggling. While that language wouldn’t fly in today’s education environment, my teacher’s observation was accurate- my breast buds were beginning to form.

Several months later, my mom took me for my first bra fitting. Several years later, when it became abundantly clear that my boobs were, well, abundant, I become a regular at the bra and swimsuit specialty store two towns away. I quickly learned that a slender build, small back, and big breasts meant I would not be an “off-the-rack” bra or bikini buyer. Decades later, when I gave birth to twin boys, I assumed my children wouldn’t be any type of bra or bikini buyers. I was wrong.

Gabriella socially transitioned from Gideon when she was 8 years old and realized she was transgender. Candidly, I’d suspected G was trans since he was about two. It wasn’t simply his affinity for shoes- we’d walk down the street and he’d point to passersby excitedly squealing, “heels, flats, heels, flats.” Or that he was just as obsessed with princesses, dresses, and my bras as his twin bro was with baseball cards, trucks, and the Yankees. But somehow, I just knew.

While emotionally draining (ummm, the understatement of the century) for me and our whole family, Gabby’s first few years living as her “authentic self” were, in retrospect, somewhat easy. After all, socially transitioning “only” meant calling herself by a different name, using female pronouns, growing her hair, and shopping for (and wearing) girls clothes. No medical procedures were involved; nothing was irrevocable.

Hitting puberty two years later, though, brought bigger decisions- economically, physically, and emotionally. G already hated her penis and didn’t want it to grow any bigger. (What she really wanted was to get rid of it altogether, something she and we knew wouldn’t be possible for another 8 years or so.) She also feared getting a deeper voice, an Adam’s apple, or facial hair.

Enter puberty blockers.

Historically, puberty blockers were used to treat a condition known as precocious puberty, the abnormally early onset of puberty. Why would anyone care if a kid hits puberty early? For a couple of reasons. The first are social and emotional; young girls and boys who begin puberty well before their peers can become very self-conscious about their bodies, often leading to depression or substance abuse. Second, precocious puberty can lead to short height. Kids with precocious puberty may grow faster at first and be taller than children their age, but they often stop growing before their peers [1].

The stakes for trans kids who don’t take puberty blockers can be much higher. So much so that guidelines from the Endocrine Society, the American Academy of Pediatrics, and the World Professional Association for Transgender Health recommend that transgender adolescents be offered blockers to suppress puberty. In 2020 a first of its kind study found a link between puberty blockers and lower odds of suicidal thoughts. Researchers from Massachusetts General Hospital, Boston Children’s Hospital, and the Fenway Institute analyzed the data from more than 20 thousand transgender adults, ages 18–36, and found “approximately 9 out of 10 transgender adults who had wanted but were denied pubertal suppression reported having suicidal ideation during their lifetime.”[2]

This doesn’t mean puberty blockers are a panacea. They can’t guarantee a transgender person won’t feel depressed, nor can they prevent puberty from beginning. They can, however, “pause” puberty once it begins. Perhaps equally as important? Puberty blockers help “buy time” for kids like Gabriella, allowing them to solidify their gender identity (a.k.a. ensure it’s not just a phase) without developing secondary sexual characteristics. This way, if Gabriella later decides not to transition, she could simply stop taking the puberty blocking meds, and her body would go through traditional male puberty.

With the help of a gender therapist and an endocrinologist — both of whom Gabby had been seeing for several years to monitor her emotional and physical development, our daughter was prescribed puberty blockers as soon as the first signs of puberty presented themselves.

Phew. No further penis growth. No manly abs. No deep voice. But also, no boobs. Not a problem for Gabby when she was only 10. A growing concern, however, when her friends began growing boobs and curves a couple years later, and her chest remained flat, her hips straight.

“Mommy, I want boobies, too,” she told me more than once. “Not like yours, though, no offense. Yours are sort of droopy.”

“No offense taken,” I laughed. “Though to be fair, they were a lot prettier before I gave birth to you and your brother,” I assured her.

Gabby laughed. But her laughs quickly turned to longing as more of her friends began wearing bras and filling out their bathing suits. It was bad enough, Gabby said, that she had to wear shorts over her bikini bottoms to hide her penis. Not having anything to show for herself “up top” was like adding insult to injury.

“Mom, I want to look like a real girl,” she began saying with greater frequency. “I’m never gonna be a real girl.”

“You do look like a real girl. You are a real girl,” I fully believed and wanted desperately to say. But I knew those words wouldn’t help. So instead, I validated her feelings and empathized the best I could. “It must be really tough to feel that way, my love,” I told her. “And even though I see things differently, I know this makes you sad. I’m so sorry, Gabby.”

“I just want to be like everyone else,” she’d cry. “I don’t want to be trans. It’s not fair.”

Gabby was right. It wasn’t fair. She didn’t choose to be trans. I don’t think anyone would choose to be trans. It’s simply who she is. Period. And while gender affirming surgery (a.k.a. sexual reassignment surgery) can ultimately give her a vagina, it still won’t change the fact that she’s transgender. But again, surgery- should she choose to have it (“having a vagina doesn’t make someone a girl” I’d explained to her repeatedly), wouldn’t happen for years. Breasts, however, were a more immediate option.

“Once she starts taking female hormones, Gabby’s body will start to develop like a young woman’s” our endocrinologist explained. Medically speaking, feminizing hormones use anti-androgens to block male hormones. Taking estrogen and progestin helps girls like Gabby develop breasts, softer skin, and rounder hips- giving them a more feminine appearance.

“So, I’ll get boobs?” Gabby had asked excitedly towards the end of 6th grade when she was almost 12 and a half. “If I take the pills now, will I get them before camp?”

Sleepaway camp was a month away. Our doc explained it could take 3–6 months to notice any changes. And even before she could begin taking hormones, Gabby would need to undergo blood tests, take a bone density exam, and sign a waiver saying she understood the risks of taking the meds. Things like an increased chance of blood clots, stroke, or even a heart attack.

“So, if I take them, I can get a heart attack?” our tween daughter wanted to know.

“Studies show there may be a small, increased risk,” the doc told us. “But we’ll be monitoring you to make sure you stay healthy.”

Turns out taking the hormones would also speed the closure of Gabby’s growth plates, potentially causing her to be shorter than she would otherwise. This news prompted our daughter to put hormones on pause for a few more months, in the hopes she could eek out a little more height. The irony, I thought. Our daughter had gone from worrying she’d grow to be 6 feet tall (my husband and I are both well above average height-wise; our respective fathers are 6 foot 3 and 6 foot 5) to worrying she’d be the runt of the family.

If I’m being honest, part of me hoped my daughter would start taking the hormones sooner than later. I figured doing so would help her fit in better with the other girls. “Why wait?” I wondered, “when the benefits of beginning hormones are so big.” But I didn’t push her in any direction. Gabby already had to make so many decisions other kids her age did not (whether to tell people she was trans, whether to go to mainstream camp or trans camp, whether to save sperm for the future, the list goes on), and I didn’t want to add any more pressure to the pot.

Another part of me wanted to postpone hormones. Up until now, everything we’d done to help our daughter transition was reversible. If she realized she was, in fact, a boy she could cut her hair, stop taking puberty blockers and begin developing like her twin brother, no harm no foul. Hormones, though, were different. The results were lasting. We were standing on the precipice of forever altering the physical and physiological trajectory of our child. Not something my husband and I… nor Gabby, took lightly.

Six months after returning from sleepaway camp and a couple weeks after her 13th birthday, our daughter decided she was ready to begin taking the hormones. One small pill in the morning. One small pill at night. Less for the promise of big boobs, more for the hope that Gabby’s outsides would grow to match her insides.

The loofah sponge, the tender breasts, and the shower shriek heard around the apartment were just the beginning. I’m pretty sure the pubescent mood swings have kicked in, and I could swear my daughter looked a little curvier when she put on her tennis shorts and tank top before heading to lessons the other day.

“Mommy, how does this bra look with this shirt?” she asked this morning while getting dressed.

“Fabulous, baby girl,” I told her. And I was telling the truth.

“Not sure I really need it yet,” she admitted. “But my chest is definitely growing. I can feel it. And soon I’ll have real boobs,” she said. “But not like yours,” she added with a smile.

“No, definitely not like mine,” I agreed and went to make breakfast for her and her brother.

[1] https://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/syc-20351811

[2] https://pediatrics.aappublications.org/content/145/2/e20191725