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But Selva had never recommended a 15-year-old for surgery. The Endocrine Society's guidelines suggested waiting until a patient was 18. But Selva and other doctors had started to think allowing teenagers to have chest surgery earlier was OK. He tried to make his handwriting sloppier like a guy's.
She believed affirming a child's gender identity could save their life. "Let me think about it." Jay spent the summer fine-tuning himself.
"What they see is a boy." "It's not lying," Jay said. But he couldn't think about girls or school or anything else until the breasts were gone. And in August, eight months after his first dose of testosterone, he started injecting the shot himself. Two doctors, two nurses, a psychiatrist and a psychiatric nurse practitioner worked together to decide when teenagers were ready to take irreversible steps. The therapist he had seen didn't specialize in transgender kids.
He and his best friend Maddie spent afternoons working out in the school weight room. The office had expanded since Jay first visited two years before.
He leaned against a Bob Marley poster and watched the interview on his i Phone. For the past year, the reporter said, Jenner had lived "in a white-hot vortex of cameras, questions, speculation, jokes and ridicule." That was how most people thought of transgender people, Jay knew. After four months of testosterone, his voice cracked with the first hints of puberty. In that operation, Thakar would make small incisions in the nipples, then draw out most of the breast tissue. "The other thing is your nipple sensation has a better chance of being maintained. Jay played dumb, but the girl showed the yearbook around school. He ran a finger over the black spray-painted crown. Jay left the crown on the table and dragged himself to his bedroom. It felt like the girl at school was trying to trap him, like she wanted to prove the person in the photo was the real Jay. When the letter came in May 2016, Jay's mother tore it open. A week later, Medicaid stopped paying for his puberty blockers - ,000 a shot. He woke up every morning terrified that his period would return. He gained weight, and his chest looked fuller, he thought. His birth certificate still listed his old name and marked him as female.
He walked to class, and his brain looped reminders. But Jay had never knowingly seen another transgender person in real life. "You are by far the youngest guy I have seen for this," Thakar told Jay. Jay's body would grow and change for another few years. In May, she signed Jay out of school for a doctor's appointment. A barber re-shaped Jay's spikes, then Nancy told him it was time for school.
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When someone answered, Nancy unleashed years of frustration. " Jay is a boy, Nancy told the insurance worker, just like any other. Parents packed school board meetings and begged officials across the country to keep boys like Jay out of locker rooms. They fought one afternoon over text, and that was it.
"If anybody can say no, it's going to be me because I gave birth to him," she told the woman who answered. I couldn't even sleep at night -- he was kicking me. Every woman dreams of seeing their daughter marry in a church with a white dress.
"I'm thinking about top surgery." Nancy had struggled at first to accept that her oldest daughter was a boy. One syringe, two needles and a small vial of testosterone. The surgeon was willing to meet him to decide if she did, too. They stopped for coffee, then strode into the licensing office all smiles. She needed to talk to someone who could be discreet, she explained. He needed to apply for a gender change through the department's headquarters. "I scanned in his old ID, the application from the health department, the mental health professional's letter." The worker was friendly but hamstrung by bureaucracy. Selva suggested Jay discuss surgery with Valerie Tobin, the clinic's psychiatric mental health nurse practitioner. Others had bigger issues that needed to be treated before surgery. Even anesthesia could induce a depressive episode, and Jay's mental health history suggested he was more at risk. "It's just going through another puberty," Jay told him. Later, at home, Jay told his mom the trip had gone well. When they went to the mall, they spent hours browsing. That Thanksgiving, he saw a picture Maddie's mom posted on Facebook. When the Medicaid letter arrived a week before Christmas, Jay texted Maddie first.
"That's who I am." It'd be easier to be open, Jay thought, if his body looked more like he wanted. "I've been on testosterone a while," Jay told his mom in April. He picked up the supplies at the Fred Meyer pharmacy, then laid them on the kitchen table. She and his counselor both believed Jay should have the surgery. "We're dealing with transgender." The receptionist lowered her voice to a nearly inaudible level, then disappeared. Jay had a state identification card from childhood that listed him as a girl, she explained. A counselor, a doctor and a surgeon had all agreed he was ready. "You have to go to 100 different doctors and explain to them 100 different times in 100 different ways," he complained. Together, they had treated more than 150 young people. Surgery would be emotional and painful in ways Jay couldn't yet comprehend. He had tried beard oil to thicken his facial hair and took a daily dose of men's vitamins. Jay scanned the crowd as they walked, hoping no one could hear their conversation. "Expect your emotions to run crazy, but it settles down." They tried talking about music and dating, but those conversations fizzled, too. His friend was pansexual with plenty of boyfriends and girlfriends. "The only thing we have in common is the fact that we're trans," Jay said.