Leo, a South Broward 14-year-old, recalls how “very uncomfortable” he became when his first-grade teacher referred to him with female pronouns.
“I hated my body. I did not feel comfortable who I was presenting as. I knew it was not who I truly was,” said Leo, who back then told his mother how he felt, but that “she didn’t understand and she kind of dismissed it.”
Six years later, Leo scrawled on his bedroom mirror, “I’m not your daughter anymore.” Mom’s response: “I think I would know if you weren’t my daughter.”
A month before school began in 2017, Leo said he wanted a short haircut. “She kept telling me no. I kept bringing it up and at some point I blurted it out that I’m trans. She dismissed it. She didn’t want to talk about anything.”
Leo says that shortly after, “I had a mental breakdown on my couch. She was out grocery shopping and she came home to find me on the couch sleeping and crying.”
His mom asked why he was upset. “I said, ‘I don’t want to be here.’”
“We went into her room and she asked if this was about being a boy and I nodded my head yes. I can’t remember much, but I do remember her saying she would try to understand and talk to our stylist to make an appointment to cut my hair. After talking with her, I felt better, but I still had thoughts about not wanting to be alive and wishing things were different. And that I’m trans.”
Leo (a nickname given by friends) began seeing a therapist. “A big part of my transition was having to deal with my depression. My therapist wanted to get me to a stable point where I wasn’t living on the edge of life and death.”
The therapist also referred Leo to Dr. Lisa Kenigsberg Fechter, a pediatric endocrinologist at Broward Health Coral Springs who specializes in treating transgender patients.
“There are not many doctors in the area doing what I’m doing, and patients are having to travel really far to get the healthcare that they need. Our goal is to make this care more accessible for our patients,” said Kenigsberg Fechter, whose new Broward Health clinic is treating about 10 teens.
“We’re in the process of building a multidisciplinary clinic which will include a mental health professional who has extensive experience treating transgender youth,” she said. “We’re also helping to build a list of resources. For example, pediatric surgeon, gynecologist and other specialists who are familiar with transgender care.”
There are “two categories of treatment” for transgender youths, according to Kenigsberg Fechter, who graduated from the University of Florida School of Medicine in 2009 and later trained at New York University medical school and Montefiore Medical Center in the Bronx.
The first category: reversable puberty blockers to stop development of male or female sexual characteristics.
“As soon as a [trans] child begins puberty, puberty blockers are recommended,” Kenigsberg Fechter said. “The puberty blockers are the same medications we use for children who are undergoing puberty too early. It just stops their bodies from being able to produce hormones, either estrogen or testosterone. However, when we remove the medications, the hormones begin producing again.”
Another reason to use puberty blockers on younger patients, she said: “In some cases, you can avoid surgeries in the future. Such as if you’re a transgender boy and you haven’t developed breast tissue, you won’t need to have breast surgery later.”
The second treatment category, for older youths: cross-gender hormones such as estrogen for girls and testosterone for boys. “Those are partially irreversible treatments, Kenigsberg Fechter said. “The purpose of these medications is to help a person go through changes that would match their gender identity.”
Patients usually need to take hormone treatments the rest of their lives. “If a transgender male stops taking testosterone and hasn’t had [bottom] surgery, they could start having their periods again,” she said. “Until there is surgery, the body keeps manufacturing hormones consistent with the birth sex.”
Leo said Kenigsberg Fechter fully briefed him and his family about the treatments, which are covered by their health insurance.
“She talked to me about the changes testosterone has on the body,” Leo said. “Everything she was going over were things I researched myself, but was news to my mother who was in the room.”
Lauren Foster of Miami Beach, a South African-born fashion model and actress, transitioned at 17 before she appeared in Vogue.
Four decades ago, “I really didn’t have any trans role models,” Foster said. Instead, there were celebrities such as David Bowie, Grace Jones and Annie Lennox, whose “gender was ambiguous.”
“Nowadays, society is far more accepting,” said Foster, who appeared in 2012 and 2013 on Bravo’s “The Real Housewives of Miami.”
Foster has worked nearly five years as director of LGBTQ concierge services for UHealth/University of Miami Health System.
“These trans boys come in here all the time, [ages] 15, 16, 17, 18,” Foster said. “They’re always hunched over and wearing huge hoodies and stuff like that. I always wondered why that happened until I went into consultation with one of them:
“They’re asked to put on a gown. They take off their hoodie or their jacket. Underneath that is normally ACE bandages or a binder. When we remove the binder to examine them for their top surgeries, they’re usually black and blue under. That’s how badly these kids don’t want to have breasts.
“They have their top surgery – it’s basically a double mastectomy but teens don’t want to refer to it as that. The mastectomy implies that it’s feminine.
“After they have their top surgery, I normally see them for post op. They come in again kind of hunched over, still in their old attire — no binder because they’ve had everything removed. When they leave, we remove the stitches, we clean the wound — and when they leave the consultation, their posture changes. They walk out of there with straight posture and a smile on their face because now they can go out and play soccer in the sun, just like any other straight young guy.”
Gynecologist Dr. Lydia Fein, who directs UHealth’s Gender Affirmation Program, said 30 percent of her transgender patients are teens.
“I’m seeing a shift to younger patients,” Fein said. “In general, with transgender and gender nonconforming people being more visible in society and the media, younger people are identifying this within themselves and parents are more aware. It’s more accepted.”
Prepubescent children can be treated nonmedically, by allowing them to dress and socialize as their identified gender. Fein said that just before the onset of puberty, a preteen with gender dysphoria (“the distress that can come from being in the wrong gender”) should be seen by a pediatric endocrinologist.
UHealth’s LGBTQ Services clinic, which includes the Gender Affirmation Program, sees hundreds of patients a year.
Fein, 33, said that when she was a student at the University of Miami Miller School of Medicine, “the word ‘transgender’ was not commonplace or understood.”
“Now, as the person at UM who provides most of the education to the medical students regarding transgender health, the amount of knowledge they have coming in far surpasses that level I had as a medical student.”
Currently, there is “a very big interest in caring for these patients and providing equitable care. It’s wonderful,” Fein said.
Her UHealth team also includes experts in plastic surgery and urology. “We also have an ear, nose, and throat surgeon and a speech pathologist for voice training and modification surgery,” she said.
Fein said that beyond her role as physician, she often provides patients with emotional support.
“Your job becomes even more important as someone they can come to. You have to develop a greater trust with the patient,” she said. “For those patients, it’s extremely important that they are connected to mental health care in some fashion and community organizations that offer social support.”
Patient Faye Hill, who graduated two years ago from Miramar High School, describes Fein as “a breath of fresh air.”
“She understood me and understood the position I was in,” said Hill, whose mother is a UHealth nurse who works with Fein.
“Ever since I was younger, I always knew something was different about me,” said Hill, 18. “I didn’t like being a boy. Society tells you that if you’re more feminine or if you don’t want to be a man, that you’re gay. I assumed that. My mom knew that I was obviously in the LGBT community. She assumed I was a gay boy who was very effeminate.”
Hill came out as transgender while a freshman at Miramar High.
“It was horrible,” Hill said. “I was bullied daily, not just by the students but by the staff. It was me against the whole school. I’d have people throw food at me. My senior year was a critical worst. I was the first black transgender high school cheerleader in the whole area. … I felt in physical danger. I was afraid walking home, on the street.”
Hill began hormone therapy at age 16. “It was kind of hard going to that school, in that environment, taking hormones. If I didn’t have a supportive environment at home, I don’t think I would have made it. I’m still getting support through Dr. Fein.”
Before hormone therapy, Hill said, she was self-conscious about her looks.
“Hormone therapy changed my appearance drastically. I’d get looks and stares and I’d frequently get misgendered back then,” she said. “Now I hardly ever get misgendered and now people find it pleasing to look at me. I’m getting more male attention in public.”
Hill now attends Palomar College near San Diego, California, where she studies education and is a member of the California All Stars San Marcos competitive cheerleading club.
She said the UHealth Gender Affirmation Program has “given me the opportunity to live the life I always wanted to live” and proudly speaks of her transition: “My whole body is very feminine. I’ll just need bottom surgery and I’ll be complete.”
Journalist Steve Rothaus covered LGBTQ issues for 22 years at the Miami Herald.
South Florida Resources
Broward Health Pediatric Endocrinology: 954-888-3666, https://www.browardhealth.org/services/pediatric-endocrinology
SunServe transgender services in Wilton Manors/Fort Lauderdale: 954-764-5150, https://www.sunserve.org/programs/transgender-services/
UHealth LGBTQ Services: 866-436-3786, https://umiamihealth.org/en/treatments-and-services/lgbtq-services
YES Institute Gender Resource Guide: https://yesinstitute.org/resource/gender-resource-guide/