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DALLAS – Evan Singleton is like many 12-year-old boys in Dallas. He rides scooters and roughhouses with his friends. But unlike most boys, he’s biologically a girl. Evan’s parents had only recently permitted their daughter, Evie, to openly identify herself as Evan, a boy. They were desperate and didn’t know where to turn.
Evan, 9 at the time, was severely depressed – and even sometimes felt suicidal. He was a boy trapped in a girl’s body.
“Nobody would listen to me,” he said. “I would even yell, ‘I’m a boy!’ But they wouldn’t listen.”
His parents attempted to explain his odd behavior as that of a tomboy. Then, when he was 9, his mother, Mela, got into an argument with him about a new bicycle they got for him.
“It was too girly,” Evan remembered. “I didn't want it, because it was pink with flames on it.”
It wasn’t until he screamed about the bike again that it finally dawned on her what he’d been trying to communicate for years.
“It was like, ‘Poof! I get it,’” she recalled, sobbing. “He'd been saying it for five years…I kept trying to make him not be a boy.”
Mela Singleton quickly dropped her opposition and took Evan shopping for new clothes and to get a haircut. Evie became Evan, changing his emotional state dramatically. While his family had come around – his mom says he “became a much easier kid to raise” – life at school wasn’t as easy.
“It wasn’t great. It was awful,” he said. “I’d sit alone. I’d eat alone. I had no one to talk to. It hurt very much.”
He added: “[My classmates] hurt my feelings…they tried so hard to make me break down and do something and to make me lose control.”
But that wouldn’t be the only challenge. His parents realized that short hair and boys’ clothes wouldn’t be enough to camouflage the physical changes on the horizon. Puberty was rapidly approaching for Evan, and because he was biologically female, he would soon begin looking more and more feminine every day.
“I felt panicked,” Evan’s mother recounted. “Evan had indicated that self-mutilation was absolutely on the list of possibilities should he develop breasts and stuff like that. He was like, ‘I'm cutting those off.’ And I was like, I'd better do something because in my head I thought, ‘Breasts are coming, Evan. I don't know what to tell you.’”
She tried more than 100 doctors, but none would agree to see Evan. Few American medical schools teach how to treat transgender children.
Desperate for help, the Singletons approached Children’s Medical Center Dallas. There, they met Dr. Ximena Lopez, a pediatric endocrinologist who had never seen a transgender patient. But after listening to the family’s story, she was persuaded that what Evan was experiencing was more than just a phase. Shegathered research from a medical project in the Netherlands called the Dutch Protocol, a program designed to delay puberty in transgender adolescents.
“They had just published their research data that showed that once the 70 patients who’d gone through the protocol were in their early 20s, their psychological well-being and the quality of life was similar or better than that of the general Dutch population,” Lopez said.
It wasn’t great. It was awful. I’d sit alone. I’d eat alone. I had no one to talk to. It hurt very much.
Shortly thereafter, Evan was diagnosed as suffering from gender dysphoria, a condition in which one’s emotional and psychological identity is the opposite of one’s biological sex. Doctors believe thousands of people have gender dysphoria, but it often isn’t recognized or treated, especially in children.
Lopezassembled a team at Children’s that today is known as the Genecis clinic - GENder Education and Care, Interdisciplinary Support. It’s a program specifically designed for transgender children and their families – and the only pediatric clinic of its kind in the Southwest. The program uses puberty blockers to prevent patients from developing the physical features of the gender they are born with. The program also buys families’ time for the children to mature enough to make decisions about the future.
“Look, let's be honest,” Mela Singleton told us of her decision to have Evan begin puberty blockers. “Children make terrible self-decisions, like ‘I’ll eat Twinkies. I'll go to bed late. I won't do my homework.’ Nobody would say, ‘Sure, I'm going to let my child do whatever they want.’ But when you are a parent, and you put in a minimal amount of research into this, you realize the studies indicate very clearly that these children benefit from pressing ‘pause.’”
Yet, not all doctors are comfortable using puberty blockers. Even Lopez admits not enough rigorous research has been done on its long-term effects. Still, she says, the alternative can be deadly.
“When these parents come to see us, they’re desperate and they tried everything any parent would try,” Lopez said. “…When your child wants to die and not live anymore, that’s what changes parents.”
Difficult and emotional
As one of the first clinics of its kind in the country, Genecis initially expected two or three new patients a month from around the Southwest. Today, the clinic receives an average of 25 new patients each month from the Dallas area alone.
In addition to offering medical and psychological treatment to help patients through their transition, Genecis recognizes that the parents of transgender children often have their own difficult emotional transitions to make.
One of Lopez’s new patients, 12-year-old Roxy Castro, has had an easier transition than many. When she was 8, Roxy’s parents, Angie and Mario Castro, allowed Roxy to begin identifying as a girl. Because she transitioned so young, she hasn’t experience the same kind of depression that many transgender children have faced.
But it hasn’t been easy for her parents. Originally from El Salvador, raising a transgender child was a test of their strict Catholic beliefs.
“Masculinity, it’s very important in our culture,” Angie Castro said. “I think when you come and you tell this to people that gender is a spectrum and that we can all fall in different places, they cannot grasp that idea.”
Both Evan and Roxy are taking puberty blockers, which prevent their bodies from developing the features of their biological sex.
“I’m fearful of growing or developing male features, because I want to identify myself easily as a female,” Roxy said. “If I have a beard or sideburns, pubic hair or chest hair, then it’ll just make it hard for me.”
Evan’s concerns are similar: “If I went through puberty, I probably would have been one of those kids who just slice off their breasts. And then, my mom would come in and be like, ‘Oh my gosh!’ and then I’d probably go to a mental institution. It [would] probably be really awful.”
The next big decision for the Castros and Singletons is whether to start Roxy and Evan on cross-hormone therapy. Usually administered around the age of 16, cross-hormone therapy would enable the children to develop the features of the sex they identify with. For Evan, that would mean taking testosterone to develop facial hair and a deeper voice. For Roxy, estrogen would allow her to develop breasts and a more feminine figure. But such therapy is irreversible and leads to an even more dramatic decision. When they turn 18, Roxy and Evan can choose to undergo gender reassignment surgery.
For now, they’re just enjoying being children.
“My parents are doing a great job raising me. I do my chores, I clean my room and I help out,” Evan said.
Roxy added: “I think I’m excited, because I finally get to blossom into the beautiful flower I am.”