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About a Girl: Coy Mathis' Fight to Change Gender

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The national headlines have inspired debate over whether this is a laudable move to recognize the needs of trans kids – or a wrongheaded manifestation of overindulgent parenting. After all, what does a child really know about authentic identity, or about what's best for them? However, any reasonable discussion on the subject has been drowned out by conservative Republicans, who have staked out a position that is reflexively anti-trans. "Is that not the craziest thing you've ever heard?" Mike Huckabee asked at October's right-wing Values Voter Summit, speaking of California's anti-discrimination-schools law; California Republicans have already targeted its repeal as a top priority. Earlier this year, House Republicans tried to strip the Violence Against Women Act of its protections for transgender women, and Arizona state Rep. John Kavanagh introduced a bill that would have made it a crime for trans people to use their preferred bathrooms. Fox News commentators vehemently oppose any accommodation of trans kids in schools, something Bill O'Reilly calls "anarchy and madness."

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Perhaps no one is more outraged, however, than the religious right, of which Focus on the Family reigns as a dominant force. On Focus' 81-acre Colorado Springs campus, some 600 employees put a chunk of their $90 million annual budget to work creating LGBT intolerance on every front, including fighting "safe-school" anti-bullying initiatives and pushing reparative therapy. Leading Focus' charge to push people back into the closet is its "gender-issues analyst" Jeff Johnston, himself a proud "ex-gay" – now a married father of three boys – who blames what he calls the "sexual brokenness" of LGBT people on a combination of poor parenting, molestation and original sin. In his newsletters for Focus, Johnston treats trans people in particular with amused pity. "Male and female are categories of existence," he wrote this year. "It is dehumanizing to categorize individuals by the ever-proliferating alphabet of identities based on sexual attractions or behavior or 'gender identity' – LGBBTTQQIAAFPPBDSM – however many letters are added. No. We stand with the truth."

And yet despite all the opposition, the movement toward early transition continues forward, driven largely by a school of thought within the medical community based around the idea of harm prevention. Indeed, studies show that the threat to transgender people is very real: One study showed more than half report being bullied in school; 61 percent are physically assaulted; 64 percent are sexually assaulted. Trans people have sky-high rates of unemployment, homelessness, substance abuse and suicide: Forty-one percent of transgender people attempt suicide, with trans teenagers the highest at-risk group. Given those staggering odds, many clinicians are anxious to try something – anything – that might mitigate that harm.

"Kids that are supported from early childhood look very different from kids that come in here at 18," Olson says of her practice of 250 children and young adults. "The kids who come in at 18, 19, 20 are highly traumatized." How differently would they have turned out, she wonders, if instead of enduring years of conflict and rejection, they'd been met with support?

At three and a half, Coy turned sullen. He'd spend days on the couch, wrapped in the fuzzy pink security blanket he'd commandeered from his sister. He didn't want to play, or talk. He especially didn't want to go outside; any enthusiasm Coy might show for a trip to the playground would disappear as soon as he'd catch sight of the boys' clothes he was expected to swap for the dresses he wore at home. The only thing Coy hated more was the prospect of getting a haircut; the last time his parents had suggested it, Coy had taken to his bed for days, listless and tearful.

"It was like what you see on commercials for severely depressed people," remembers Kathryn, a slender woman of 27. Her career as a photographer took a back seat to motherhood after the couple's assisted efforts to have a second child had yielded unexpected triplets. Little by little, Kathryn began letting Coy leave home dressed in a pink shirt – anything to pry him from the house with minimal fuss – and soon enough, with pink sneakers to match. Jeremy drew the line at letting Coy wear colorful hair clips outdoors. "I was trying to avoid a negative experience," recalls Jeremy, who is even-tempered and stocky with rimless glasses. "Someone going, 'Why are you dressing your son up as a girl?'"

On her online parenting message boards, Kathryn asked for advice. A transgender parent volunteered that Coy's behavior sounded awfully familiar. "I knew when I was two or three," he wrote, a line that resonated with Kathryn. She thought about the fact that Coy hadn't wanted to be seen naked since age two, oddly modest while his siblings pranced around oblivious to their own nudity. She thought about the disappointment on Coy's face when he asked her, "I'm a girl – why are you calling me 'he'?"

Kathryn broached the subject with her husband. "Coy is saying, 'I don't want to have a beard.' Maybe he's – transgender or something?" she asked, testing the word.

"Yeah," Jeremy considered. "Probably." It made so much sense that they barely discussed it further – and yet the implications felt so huge that for a moment Jeremy was overwhelmed. Their household was already bursting with complications. Jeremy had bounced around jobs after his military stint had been cut short: He'd been discharged from the Marines not long after basic training for a hip injury severe enough that when he'd tried to re-enlist after 9/11, they wouldn't take him. Two of their children were special-needs: Their oldest, six-year-old Dakota, was autistic, and one of the triplets, Lily, had been left severely brain-damaged by a bout of viral meningitis as an infant. The Mathises had also just had another baby, a girl named Auri – their fifth child. Taken in perspective, Coy's gender confusion was hardly their most urgent family matter. The Mathises resolved to deal with it the way they dealt with everything: by staying calm, tackling one crisis at a time, and keeping an open mind.

At Coy's wellness visit with his pediatrician, the Mathises lightly brought up his gender issues. Not long ago, the dogma on how to treat such children was to urge them toward conformity – a treatment model paralleling the now-discredited "reparative therapy" aimed at "curing" homosexuals. The American Psychological Association and the American Academy of Pediatrics have rejected the forced-conformity approach for gender-dysphoric patients, saying that not only are such efforts doomed to fail but that, says the American Psychoanalytic Association, they "often result in substantial psychological pain."

But despite having jettisoned the old model, few health professionals are comfortable urging parents to let their preschooler pose as a different gender. There is not yet a standard screening model to separate the small percentage of truly trans kids from the merely gender-variant (though studies suggest that extreme dysphoria in early childhood can be a predictor of transgenderism). But gender nonconformity doesn't necessarily mean that the kid will turn out transgender: A 2012 Harvard School of Public Health study found that 85 percent of children who expressed some form of gender nonconformity actually grew up to not be LGB or T, but straight.

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Lacking hard data and facing so much uncertainty, practitioners are eagerly awaiting an American Psychological Association committee's expected release of guidelines in 2014. In the meantime, clinicians refer to the standards of care set by the World Professional Association for Transgender Health, which advocates the cautious but loving approach that Coy's pediatrician suggested, known as "wait and see." The Mathises were told to hold off on decision-making and to simply express support for Coy and his choices, follow his lead and see where it might take them.

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