Nature’s Anomalies
Dr. Norman Spack’s office is located in a sleek building with an atrium and wide windows, as open and relaxed as Spack himself. A balding man in his sixties, Spack began his career as a pediatric endocrinologist and helped run an endocrine clinic in the 1970s and ’80s. Because of this work, he had seen a variety of children and adults with disorders of sex development. But it was his volunteer work at the time with a nonprofit group called Bridge Over Troubled Waters that drew him to what would become his life’s work.
Bridge Over Troubled Waters still serves homeless youth in the Boston area. In the 1970s, Spack and another doctor, usually another pediatrician, would take the agency’s van out once a month and make stops all around Boston Common, down by what was called the Combat Zone, and in the Bay Village area of Boston, where they were most likely to see homeless kids. Most of them were runaways, kids fifteen to seventeen years old, and mostly white. Usually they’d walk up to the van in a haze of marijuana smoke. One night, Spack’s co-worker turned to him and asked him a question.
“You’ve been coming out for three or four months now. Don’t you wonder why you see the same kids?”
Spack hadn’t thought about it, but yes, it was true, they did keep seeing the same kids, even after the police tried to take some of them back to their parents. The ones who said they were gay or the ones who were boys but dressed like girls, or girls dressed like boys—those were the kids they’d see again and again.
“They’re not runaways,” the other doctor said. “They’re throwaways.”
Spack had never been particularly judgmental about the people he saw. He was a physician, after all, and he was treating medical conditions. The idea of kids being transgender wasn’t something foreign or uncomfortable. In fact, Spack was unusually familiar with nature’s anomalies. As a student at Williams College in western Massachusetts, Spack majored in history, even though he dreamed of becoming a doctor. He loaded up on pre-med courses in his junior and senior years, and in one of them the professor asked him if he wanted to continue the research project of a student who was about to graduate. That seemed easy enough, Spack thought. The research involved newts and their life span from larvae to adults, showing how an amphibian metamorphosis takes place as they begin life in the water, like tadpoles, then come ashore, then return to the water to lay eggs. The experiment Spack took over was meant to show how the administration of hormones alone could initiate this metamorphosis in the newts.
As early as college, then, Spack began to understand that who we are—creatures of land or sea, male or female—is malleable. The transgender teens he met during his volunteer work or the intersex individuals he met in his endocrinology practice were as much a part of nature as the lowly newt, and therefore not aberrations or mistakes. But it took his first transgender patient to drive that home for Spack. The patient was a student at Harvard, someone assigned female at birth but living and dressing as a man. His college roommates knew and accepted him, even the Harvard registrar listed him under a male name, but he’d been rejected by his upper-class family in the Midwest. The Harvard undergraduate wanted Spack to give him testosterone, but Spack was a pediatric endocrinologist, used to dealing with children. He’d have to step outside his comfort zone if he took on this patient. Spack agreed, on one condition: “I’ll treat you if you teach me.”
Lesson number one: “Sexual orientation is who you go to bed with,” he told Spack. “Gender identity is who you go to bed as.”
Spack was surprised to find support among his colleagues for treating the transgender college student. They were all beginning to see children with gender issues, and, by treating an adult, Spack could gain valuable knowledge for his pediatric practice—and theirs.
His colleagues were right. Soon Spack was traveling overseas, especially to the Netherlands, where medical treatment for transgender people, including children, was years ahead of the United States. Leading the pack was Louis Gooren, a Dutch endocrinologist known worldwide for his work with transgender people. He was also one of the first to treat transgender youth. Gooren opened Spack’s eyes to the possibility of treating transgender kids before they go through puberty, thus sparing them both the trauma and, later in life, the challenges, of sex reassignment surgery. Gooren had found a safe, effective way to suppress puberty long enough for transgender kids to undergo intense psychological testing to find out how deep-seated their gender dysphoria was. Then, by giving them the appropriate hormones, they could develop in the direction of the gender their brains were telling them.
When Spack got the go-ahead, and the money, to open his gender clinic in Boston at Children’s Hospital, his first patient was a prepubescent British boy who identified as a girl. Jackie Green had tried to kill herself four times and was destined, if she went through male puberty, to be about six feet four inches tall. Spack gave her puberty-suppressing drugs, then estrogen to close her growth plates and develop natural breasts. Great Britain didn’t allow sex reassignment surgery if you were under eighteen years old and there were few people willing to do it at that age in the United States, so Jackie completed sex reassignment surgery in Thailand when she was sixteen. Two years later she was competing in the Miss England beauty pageant, a strikingly beautiful five-foot-eleven-inch-tall woman. Her only complaint, she half-joked to Spack, was that she was going to be a model and would have preferred a couple of extra inches in height.
In 2006, while under the care of psychologist Virginia Holmes, nine-year-old Wyatt Maines became one of Spack’s first American transgender pediatric patients. The entire family showed up for the initial appointment, all a bit tongue-tied. Spack put them at ease by making one thing perfectly clear: Gender identity is in the brain, not the anatomy, and there are many, many things that can happen to a developing brain to change or alter how a child will develop, including a child’s gender identity. But he also told them that just because some children prefer to act and dress like the opposite gender doesn’t mean they all are truly transgender. Only about a quarter of those who express themselves as the opposite gender early in life still feel that way as they approach puberty. But for that 25 percent who remain convinced they were born into the wrong body, the idea of going through puberty in that wrong body is anathema to them.
It was something Wyatt certainly feared deeply, and it was incredibly reassuring when Spack told him that by taking puberty-blocking drugs he would never have a visible Adam’s apple, no deepened voice, no accelerated height, thicker bones, or facial hair. But first, Wyatt would have to undergo psychological tests. If he passed them, then he would officially begin what was sometimes called the “12-16-18” program. At age twelve, or earlier if need be, Wyatt would take puberty suppressants: injections to stop him from becoming an adult male. Then at about sixteen, Wyatt could begin taking female hormones, and breasts would soon develop. All the while, his identical twin, Jonas, would be going through his own puberty naturally, growing taller, his voice deepening, a faint mustache appearing on his upper lip—exactly what Wyatt would have looked like and become, were he not to take puberty suppressants. By the age of sixteen, Jonas would be several inches taller than his brother and his face would be squarer than Wyatt’s. Finally, at about age eighteen, Wyatt could have sex reassignment surgery.
“I can make you as tall as you want to be and give you whatever kind of voice you want to have,” Spack kidded with Wyatt during that first visit.
“Why can’t I just start the hormones now?” he asked.
“If you do, it will stunt your growth, and we can’t have that, but as soon as it looks like Jonas is beginning puberty, that’s when we’ll begin.”
Jonas, in other words, would be the guinea pig. The timing of puberty varies greatly from one person to the next and is highly hereditary. Because Jonas and Wyatt were adopted and their biological mother, Sarah, knew little to nothing about their father, no one could predict when the twins would begin puberty. So while Wyatt was taking puberty-suppres
sing drugs, it was all-important to watch Jonas. Jonas didn’t mind. In fact, he felt good to be able to contribute somehow.
For Wayne, once again it was about hearing from someone outside his family, an expert, that this was the right thing to do that helped push him that much further down the road to realizing Wyatt’s transition was going to happen with or without him, and if he wasn’t entirely convinced yet that Wyatt was transgender, he was not holding Kelly back from moving ahead. The sense of relief that enveloped Kelly, especially after meeting Dr. Spack, seemed almost miraculous. Years of tension, of worry, of having to figure things out on her own—suddenly it all melted away. Finally, here was someone who could make it all better. Someone who understood. Someone to whom she could entrust her child.
CHAPTER 17
Being Different
Within a few months Wyatt and his parents would have to face another watershed moment: the fifth grade. Asa Adams had so far been a positive experience for both children, mainly because the overwhelming majority of students appeared to be accepting of Wyatt. But in a town like Orono, things could change quickly. While it was a college town, it was also a very old town with families that had lived there for generations and whose views on life tended toward circumscribed and conservative. Parents of one student might be mill workers while the parents of the kid sitting next to him might be professors at the university. The other problem with moving into the fifth grade was that the classroom was in a different part of Asa Adams than the third and fourth grades had been. In this other section of the school, the girls’ and boys’ bathrooms were multi-stall. That minor architectural alteration represented a psychosocial leap of enormous proportions for Wyatt.
The use of public bathrooms is fraught with controversy and anxiety when it comes to transgender people who prefer to use the restroom of the gender with which they identify. It hadn’t ever been a concern for Wyatt, or anyone else for that matter, because all the bathrooms up to that point had been unisex and single stall. Kelly worried what the change would mean not so much for Wyatt, but for other kids or, more particularly, the parents of other kids. She’d learned that children were far more accepting of differences, including gender-fluid behavior. When it came to their parents, however, Kelly was never sure who might voice an objection.
On January 7, 2007, Lisa Erhardt, in her capacity as school counselor, submitted a Section 504 form to the Special Services Office of the board of education in Orono: “Parental Notice of Initial Referral to Pupil Evaluation Team.” The 504 is put in place to prevent discrimination against any student with a disability, which is defined as anyone who:
has a mental or physical impairment which substantially limits one or more major life activities;
has a record of such impairment; or
is regarded as having an impairment that affects activities such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning and working.
Kelly had been talking to Erhardt about how to make sure Wyatt would be protected going into the fifth grade, and the 504, which usually pertains to kids with physical disabilities, learning disorders or mental or behavioral issues, was Erhardt’s idea. At first Kelly didn’t think it would work, or that it was even appropriate. There was nothing wrong with Wyatt. But it was also true that he had been diagnosed with a disorder that manifested itself when other people misperceived or mistreated him. Erhardt convinced Kelly a 504 would protect Wyatt. And besides, his gender dysphoria diagnosis qualified him for it. Bottom line: Kelly and Wayne would be allowed to take part in meetings with teachers and school staff when it came to evaluating Wyatt’s needs.
On March 28, 2007, Kelly, Erhardt, Wyatt’s future fifth-grade teacher, the principal of the middle school who was filling in at Asa Adams while its regular principal was on sick leave, and the head of special services all met to discuss a range of issues related to upcoming changes in Wyatt’s life, including the likelihood of a legal name change. Wyatt’s friends at Asa Adams already treated him as a girl; they talked about clothes and makeup together, they giggled, and they poked fun at the boys. Wyatt was comfortable and he was popular, but in the fifth grade he’d have a new teacher and a few new peers, and both the family and the school wanted to make sure there were “safe” people Wyatt could turn to if he needed them. Wayne was still not fully committed to believing his son was transgender, but he was certainly committed to seeing that he was safe and his needs at school were met.
Wyatt’s hair was long, and he wore nail polish and girls’ blouses, but beneath all the surface accessories, he knew his body was a boy’s. He still had a penis, and one of his greatest fears was that other students would see it and know it, too. That may have been why he was having trouble concentrating at school. He was more fidgety, nervous, and even argumentative with his friends if he did not get his own way. Under the most recent “Behavioral Difficulties” section of the 504 form, Lisa Erhardt had filled in: “Does not complete assignments,” “easily frustrated,” “cries easily,” and “anxious.” The most important result of the meeting between Kelly and the school was that they all agreed Wyatt should use the girls’ bathroom.
Sometimes there were unforeseen consequences of the accommodations made for Wyatt. Both he and Jonas participated in sports, but as he got older, Wyatt’s pleasure in them was more about the social rituals than the athletic ones. At age nine, the twins began to play on single-sex teams. When it came to Little League, there was no question Wyatt wanted to play softball with the other girls, not baseball. Wayne supported Wyatt’s decision, but once again left it to Kelly to make it happen. She contacted the Maine Principals Association, which included a number of standing committees that regulate team sports. Then she called around to different school systems in Maine. Virtually all of them had nondiscrimination policies, but none that specifically addressed gender identity.
It was another frontier, and Kelly did what she always did: She forged ahead, first by writing to officials at the local softball organization, educating them on the issues, and introducing them to Wyatt. They replied that they would review the rule that “regular season, special games and tournaments teams in all divisions of softball must be composed of either all females or all males.” Kelly wasn’t going to wait, though. She consulted with an EqualityMaine attorney, then wrote to Orono-Veazie Little League to say that she and Wayne were willing to answer any questions they might have about “this unique situation.” Attached to the email was a letter from the EqualityMaine lawyer explaining that Wyatt’s rights to participate in girls’ softball were protected by the state of Maine. Again, Kelly didn’t wait for a response, and sent off another email, this time, just to be sure, to the regional Little League office in Bristol, Connecticut. It was the first time Kelly referred to Wyatt using feminine nouns and pronouns in any kind of official correspondence:
Our daughter will be joining her team, with her welcoming friends, when the season begins. It is our sincere hope that we can count on you and your organization to support her right to be there, and her right to privacy.
Two weeks and a flurry of letters later, the regional office approved a waiver request from the Orono-Veazie Little League softball team on which Wyatt wished to play. He was officially eligible. But being part of the team meant he had to abide by regulations regarding the wearing of certain equipment. Wyatt shared his concern with his therapist after several games had been played. When Dr. Holmes asked him why he seemed so anxious and upset, he explained he felt bad about his softball uniform.
“Why?” Holmes asked.
Wyatt wanted to play softball with his girlfriends because that was more natural to him than playing baseball with boys. But no matter how female he felt, under his uniform he had to wear what no other girl did: a cup and an athletic supporter.
“Because it’s different than the others. Because I’m different,” Wyatt said.
“Different in what way?”
“I really am a boy, not
a girl.”
“Yes, you are different.”
Wyatt did a double take. Usually Dr. Holmes went along with him, agreeing he was a girl if that’s what he said he was. But now she was confirming something he never had really talked about with anyone—deep down he knew he still looked like a boy under his clothes. There was no disputing he had a penis and testicles. And he hated it.
After the session, Holmes wrote in her notes: “Then I talked about how much I appreciate the way in which he is different: how special it is that he knows who he is in spite of all the evidence. I don’t think he took that in, but we will work more on that. Really dealing with the true pain: not harassment, REALITY. Great.”
Holmes had escorted Wyatt out to the parking lot after the session. Wyatt had almost gotten to Kelly, waiting in the car, when he told his mother “Just a minute.” He ran back to Holmes and gave her a big hug.
CHAPTER 18
Becoming Nicole
Kelly had guided Wyatt through so many transitions, always trying to balance his desires with her sense of caution. They’d navigated clothes, sports, and what pronouns to use at school, and it hadn’t been easy. For so long it had made Kelly heartsick in stores when she passed by the racks of girls’ dresses looking for things for Wyatt to wear that were more gender neutral: She knew she was denying her child the thing he most coveted. Kelly and Wayne had made him live with compromises until, one by one, each had fallen by the wayside. With the start of the fifth grade, and the boys’ and girls’ bathrooms no longer single stall, they decided Wyatt should be allowed to wear all the feminine clothes he wanted—within reason. The problem was, everyone still called him Wyatt. The idea of a name change had been hanging over the family for quite some time. If they were going to let Wyatt look like a girl and dress like a girl, then surely he deserved a girl’s name.
Becoming Nicole Page 11
