Supporting a Transgender Patient

Medical Matters, Lane County Medical Society

*Names were changed in this article to preserve the identities of the sources.

The Quinn family could be anybody’s neighbors. James and Angela are working parents, and Taylor is their 11-year-old daughter. They practice their faith alongside their community, and Taylor’s classmates come to her birthday parties. On any given Tuesday night, you would find them at home together. James might be putting dinner together in the kitchen, while Taylor does her homework in the living room. Taylor just also happens to be a transgender child.

Simply put by her mother, Taylor’s gender identity just doesn’t match what is on her birth certificate. Angela describes Taylor’s early life: she always had a feminine identity, even as a toddler. There were instances where she would be sent to preschool in the boy’s clothes that were picked out for her, but when she got home, she would take off her pants in favor of a tutu instead. “She just had a real feminine identity that she indulged all the time at home, and not very much out in public,” Angela says of that time. “She’s always had a loose interpretation of gender. She even had an imaginary friend who was non-binary—” 

“I did?” Taylor interrupts.

“Yeah,” Angela says to Taylor. “You told me Mona was a boy-girl.”

According to Angela, about half way through kindergarten, Taylor wanted to start wearing some of the dresses she had at home to school. In second grade, she requested that people use feminine pronouns when referring to her. “Which we had sort of started doing around home, but second grade was when she wanted that at school,” Angela says.

Taylor’s gender identity unfolded just as naturally as any other phase in childhood development, and her parents treated it as such. James and Angela describe being surrounded by a supportive community, with a school administration that acknowledged Taylor’s correct pronouns.

“When she was in second grade and had requested a pronoun change—she had been wearing feminine clothes for several years at that point—it was pretty clear to us that we may have a future in which we would want certain levels of intervention,” Angela says.

“She’s always had a loose interpretation of gender. She even had an imaginary friend who was non-binary.”

- Angela Quinn about her daughter, Taylor

When they first started looking for a reproductive endocrinologist, the Quinns were frequently told that they would have to go to Oregon Health & Science University in Portland. OHSU has a program and clinic specifically for transgender children. “But the idea that a doctor’s trip required a four-hour round-trip drive doesn’t really allow you to feel like everything’s normal,” Angela says.

Thankfully, there is a doctor right in town at the Fertility Center of Oregon—Dr. Douglas Austin. James, who works as a health care practitioner, had already referred multiple trans patients to Austin’s practice. His reputation preceded him, not only within the medical community, but in the Eugene community at-large. “He is simply known for being very open and supportive of the trans community,” James says. “He’s kind of the main transgender endocrinologist in town.”

“And they go to the same gym,” Taylor chimes in.

Taylor had her first appointment with Austin when she was nine years old. For that first year, she was only in consultation with him to chart her growth, discuss possible options and plan out what the future would look like. When she turned ten, Taylor started taking Lupron, a puberty-suppressant treatment.

“One of the things that we have discussed with him at every appointment is the idea that we want to leave Taylor as many options open as she could possibly ever want,” Angela says. “He’s been really great at helping us understand what those options are, and when the windows of opportunity are open.”

“It feels like I don’t have to, like, make a lot of decisions,” Taylor says about being on the Lupron. “I can just be like, chillin’.”

Overall, she likes Austin’s office. She feels safe and well cared for by staff. Taylor’s current treatment plan requires a doctor’s visit every three months, and, according to her, it also requires a big needle. Despite all of the adult conversations about planning and options, Taylor is still only 11 years old, and what kid isn’t afraid of needles? “At first, I wanted to stop getting them,” Taylor says. “But we started icing the shots, and now it’s gotten better.”

According to the World Professional Association for Transgender Health (WPATH), the consensus on when to start an adolescent on cross-hormone therapy is age 15. “When Dr. Austin said that to Taylor in our last appointment, she went, ’15?! What?!’” Angela says. “She was not pleased to think that she had to wait that long. We don’t have to wait until she’s 15, but this is what the guideline suggests.”

The Quinns recognize that they are lucky to have access to comprehensive care for Taylor. Their insurance covers her Lupron shot. For perspective, James describes the high-deductible plan he gets from his work, and that if the first thing they did at the beginning of every year was buy one Lupron shot—and Taylor needs four a year—they would clear their deductible and their out-of-pocket maximum for the year. “We couldn’t afford the shot if we didn’t have health insurance,” James points out. “Not every health insurance covers it either. This is something available to trans kids with good health insurance and the ability to pay out-of-pocket. I believe the Oregon Health Plan covers this as well.”

In the meantime, the Quinns say the Lupron shot is manageable. Driving across the Ferry Street bridge for a doctor’s appointment takes no less time out of their day than going to the grocery store. Treatment is un-intrusive, and Taylor is able to grow through her childhood alongside her peers, with the full support of her family and community.