Chapter 7. Charles’s Case: Welding and Nail Polish

Client Name: Charles

Age: 15 years old

Gender: Male

Ethnicity: Biracial (White and African-American)

Occupation: Student

Current living situation: I live at home with my parents and sister, Amanda

Why are you seeking services at our clinic?

My doctor, Dr. Bird, wants me to see you before I start treatment for my condition and then I need to keep seeing you during the treatment. She says treatment is a long process, and I want to get this going before I start college. Dr. Bird also said it would help my family if we all talked to someone together about my condition. She’s concerned about me—how I’m going to adjust to everything.

Charles: [quietly at first but then becoming louder and more direct] Dr. Bird says I have to talk to you before I start my treatment regimen. She says we’ll need to work together to assess my progress before she will agree to do my surgery. I want to get this going. I know treatment can be a really long process, and I want this to MOVE. But… [pause] Dr. Bird says my family—my mom and dad-- also need to talk about the issues they have with my diagnosis. [Rolling eyes] So everyone is here.

Mom: We want to be supportive, don’t get us wrong, but I don’t understand why we have to rush into this, Charles. You can wait to start the treatment. You’re only 15.

Amanda: [almost interrupting--some hostility towards her mother evident in her voice] I, for one, want to be as helpful and supportive as I can.

Dad: [uncomfortable and frustrated] I really don’t understand why I have to be here. Why are we all required to be here when this is Charles’s personal issue?

Charles: I’ll start hormone treatment first; Dr. Bird says you’ll help her monitor my behavior as I go through the treatment changes…make sure I adjust ok to all the hormones, I guess?... I don’t really understand why I need to see you when she can just treat me. I will also make some behavioral changes before – or I guess during? – the treatment. I hope my family will help me with those, but [pauses, then softer] I know my mom and dad aren’t very comfortable with all this. Then in several years … such as long time to wait! ... when I’m ready, Dr. Bird will perform the surgery. [brighter and more hopeful] She’s known for this surgery. She’s world famous-- I feel really lucky to have her as my doctor.

Dad: [breaking in] This is really uncomfortable to talk about. Are you sure I need to be here?

Mom: We’re going to all try to be supportive, Lee. Even if I think it’s far too early for Charles to be taking these drastic steps.

Amanda: [to Charles] Even if mom and dad aren’t, I’m with you 100%. I’ve got your back!

Charles: [softly and with some hesitation] I… I actually prefer to be called Cheryl. And I honestly don’t remember when I first felt like this. I never felt like I was a guy. From the time I understood the difference between girls and boys, I just felt like I was a girl trapped in the wrong body.

Dad: I remember telling him to stop whining like a girl and be a man at age 2.

Amanda: I think when he was around 3, he wanted to play dress up with my clothes, put barrettes in his hair. We had a blast.

Mom: [nervously] We thought it was no big deal! He looked so cute in Amanda’s clothes. Just kids being kids, playing dress up.

Dad: [breaking in angrily] I knew it was a big deal. I used to tell him to take those girl clothes off. I told ALL of you not to encourage that behavior.

Amanda: Nobody was getting hurt. It was really fun for both of us! And then one day they freaked out because I painted his nails.

Mom: [quietly] That set off some warning bells for me. It was taking it too far.

Dad: That was also around 3, wasn’t it? And then there was the potty training! He wanted—no, insisted on —sitting down to pee like a girl. [Sadly] It took me a long time to figure out that Charles is never going to act the way men act. No matter what I said, how I tried to show him how to fit in… it just didn’t make a difference.

Dad: [aside] Cheryl. Such B.S. We named you Charles after my father - your grandfather.

Cheryl: Dad, I – [quiet, less comfortable] I started school when I was 4 or so, I think. My teacher, Mrs. Sabathia, was really nice. She saw that I was different from other boys, and she didn’t seem to care. I liked to be the mom when we played house, like pretending to clean and cook like my mom. I didn’t really like roughhousing or wrestling. I’d play hopscotch or jump rope with a group of girls, and no one seemed to mind – no one at school, that is.

Cheryl: [sadly] Things got really rough in first grade. We had separate boys and girls bathrooms for the first time, and I hated it! I don’t like to pee standing up, so I’d have to rush to be the first one in the bathroom so I could get a stall. I would complain about the other kids playing too rough with me or start crying – I mean, I really felt like I had emotions like a girl would, not a boy – and then I’d get called a “sissy.” The girls didn’t really accept me, even though I liked playing with them. It was like I didn’t fit in anywhere. And mom made me wear boy’s pants and overalls to school, so I felt really self-conscious and embarrassed.

Mom: [defensive] I made him wear boy’s clothes - as was appropriate … [sadly] but he hated it.

Amanda: As soon as Cheryl got home from school, she would change into my old clothes. She loved my pink and purple stuff! I’m only 2 years older, so lots of my stuff fit her. [To Cheryl] I remember that you always seemed more comfortable once you changed clothes, more like yourself…happier.

Dad: First grade was the first time someone outside the family expressed concern about Charles’s behavior. His first-grade teacher asked us to come in for a conference.

Mom: I remember she said how well he was doing in school! But—

Dad: [cutting her off] But she expressed concern about his social development. She told us that Charles’s behavior was – different – from that of the other boys. She said he wasn’t acting normal. She said that would get harder for him as he got older and she recommended that we go to see a psychologist.

Cheryl: [Brightening] Yeah, and she was great! We did some family therapy – I … I would say that wasn’t much help, but I got to do individual sessions, which were great. Dr. Edelman let me play out scenarios as a girl and we figured out how I could react when kids teased me. I saw her for about 3 years, I think. Super helpful!

Dad: [irritated] As Charles has explained, we already attended family sessions. We checked that box off. I don’t understand why Charles’s new doctor is making us go through this again.

Mom: I made sure we followed through together as a family, but Lee found the therapy sessions painful. The therapist knew about these sorts of things and had us bring in Amanda so that we could try to understand about Charles not wanting to be a boy.

Amanda: I was a little confused. Why were we going to a doctor that didn’t give us shots? [laughs a little, then more seriously] But it was helpful to have someone explain what was going on with Cheryl, because I was only 8 at the time, but I knew she was different. I felt like it was helpful, even if mom and dad didn’t.

Mom: [sharply] Amanda, being a child herself, has never understood what her father and I went through. We tried to understand. We went to—we paid for-- the sessions. It just never made sense to us to address this issue when Charles was still in elementary school. He was too young to know what he wanted or needed.

Dad: [grumbling under his breath] Ridiculous waste of time.

Cheryl: It was pretty good, I guess. Amanda and I had fun, and we got along with mom and dad—I mean, they loved us. We live in a really nice neighborhood. Our grandparents lived nearby, too, so we got really spoiled. My grandfathers didn’t get why I didn’t want to hunt and fish with them, but Grammy and Nana were totally cool about cooking with me, or taking me shopping. Mom and Dad sent me and Amanda to private schools, so I got a really good education.

Dad: I believe we gave Charles a good childhood, so I’m not sure why he continues to be so unhappy with who he is. [with pride] I’m an investment banker, so I can provide well for my family.

Mom: I teach high school English now. I started working again when Charles—I mean Cheryl-- entered junior high school. Lee and I met in college. He was quite a jock—played lacrosse, belonged to a fraternity. [Turning to her husband] That may be why it’s hard for you to understand what was going on with Charles.

Dad: [acknowledging his wife’s point] It was tough. It bothered me so much when he said he wanted to be a girl and wore his sister’s clothes and couldn’t enjoy sports the way I did as a boy. But it was even harder for our parents, especially our fathers. They thought Charles was a homosexual. They thought that was the only explanation for why he wanted to be a girl.

Amanda: I have to admit, at first it was a little confusing for me. I can basically understand where our grandparents were coming from. I always accepted Cheryl, but at first it was easier for me to think of her as gay. I have friends that are lesbians and gay guys, and I am completely cool with them – love whoever you want, right? But it took me a bit to understand what Cheryl meant when she said she wanted to be a girl instead of a boy. I think I get it now, though, and I really want you to be able to get this treatment, Cheryl.

Mom: I am trying to understand and accept this and love my child. I have helped him – her? – [to Charles] I don’t even know what to call you! –when kids bullied her at school. I love my children unconditionally and Lee and I have worked really hard to give them as happy a life as possible. But it’s so hard. I never learned about anything like this when I was growing up.

Cheryl: You know, it’s ok. I’m doing pretty well in high school--I have a B average. I’m excited to go to college in a couple of years and I’m looking for schools that have good support for transgender students. I know this treatment will be tough, and I probably won’t be able to get my surgery until after college, so I’m going to need an environment where I feel accepted. About a year ago, I started researching the sex reassignment surgery and hormone treatments. I read about how they don’t let you start till after puberty so your hormones don’t go all crazy. I like wearing my hair long, and because I’m skinny, I have this sort of androgynous look that I think my friends at school are into. There are definitely other kids who dress like me.

Dating has been really weird to figure out. I’ve realized that I have feelings for guys, not girls. [Looking at his parents.] I don’t think I’m gay, though – I want a guy to love me as his girlfriend. A lot of my friends have been girls, and Amanda is the best. Sometimes it’s hard, though, because my Dad doesn’t ever show me affection – you don’t, Dad – which sucks. It’s like me being me isn’t good enough. And Mom, sometimes I feel like I don’t know where you stand. It’s like you love me, but you could love me more if I were more like your idea of who I should be. And I need you to love me as ME.

Dad: You’re a good kid. I wish I could be even more supportive, son. I do love you. I just don’t understand this part of you and why you have to put us all through this.

Cheryl: [getting upset] It’s not something I’m putting you through! This is who I AM! I’m not doing it just to do it.

Mom: [a little emotional] I’m trying really hard. I just don’t know why you can’t wait until you are out of high school to make sure this is not just a phase.

Cheryl: It’s not a phase. It’s really not. It’s not going to go away, not matter how much you want it to. [louder] This is who I am.

Cheryl: I really like to dance. My mom encouraged me to take dance classes. I’m also good at art. I like ceramics, and I love metal sculpture and welding. I hope that when I go to college, I can major in art. I really can’t wait to get to college. I think things will be different for me there.

Dad: Welding is the most masculine thing he does. I guess he makes some great art – I wouldn’t really know how to judge it, but his teachers say good things.

Mom: And I love that he got into dancing – I think “Dancing with the Stars” made it more ok for boys and girls to dance again.

Amanda: I’m glad that you like to cook and I always get to be your taste-tester.

Cheryl: [excited] I’d like to get some clothes that are more “feminine.” I’m not sure if I’m ready to wear dresses yet, but maybe some leggings and brighter colors and patterns, and some cute shoes. I want to get a nice haircut and a mani-pedi. I think I might even paint my toenails but keep wearing closed-toed shoes. I’ve already started taking good care of my skin, but I don’t know if I’m ready to wear make-up yet. I’d like to start pushing the limits a little, [pauses, quieter] but I’m afraid of what the kids at school might say.

Mom: I told Cheryl we can go shopping right after this appointment if she wants. I’m going to try to be more supportive. I can do shopping.

Amanda: [excited] The three of us can go together! I loved painting your nails as a kid, Cheryl, and now we can do it together. This will be awesome – I’ve always wanted a sister to share this kind of stuff with.