One day in 2016, my 23-year-old son sat me down and said simply, “Mom, I’m a girl.”
My reply: “Oh. What do we need to do about that?”
Honestly, I was more surprised than shocked by this revelation. I was now learning that, in addition to clinical depression, attention deficit disorder and learning disabilities, Caroline had also been suffering from gender dysphoria. According to her, the first signs of discomfort began during puberty and grew throughout her undergraduate years.
Early on, I’d say to my son, “I can’t wait to meet your first girlfriend.”
“You and me both!” he’d respond.
At 23, Caroline had just earned her degree from the Evergreen State College in Olympia, Washington, and was working the night shift as an unpaid lab tech assistant at a local hospital through a program for disabled people sponsored by Main Line Health. My days were flexible—and if there’s anything I’m good at, it’s paperwork and reading fine print. I buried my concerns and set about helping her any way I could.
“Caroline saw no less than seven therapists—and not necessarily by choice. In her view, she’d spent 10 years figuring all of this out by herself.”
In the first months of her journey, I didn’t learn much of any value from medical studies, therapists or books. Meanwhile, Caroline saw no less than seven therapists—and not necessarily by choice. In her view, she’d spent 10 years figuring all of this out by herself.
One of the most difficult tasks was finding an endocrinologist willing to help with a 15-month pre-surgical hormone treatment. I scoured her health insurance network and contacted group practices. One after the other told me they didn’t have anyone trained to treat transgender patients. Planned Parenthood wasn’t yet offering such care, and the major hospital systems in our area had no advice to offer. Finally, a helpful receptionist recalled hearing about a doctor who might work with transgender people. The tip paid off.
Caroline needed monthly blood work to track everything—especially her estrogen and testosterone levels. Initially, her fear of needles was so severe she required anti-anxiety drugs. Fortunately, Caroline overcame her phobia by the time the most critical tasks were at hand: vulvoplasty, labiaplasty, breast augmentation, a tracheal shave, forehead surgery from hairline to eyebrow, and rhinoplasty.
We attended a national conference featuring a dozen qualified surgeons, who covered the procedures in graphic detail. We went with a surgeon in Arizona who is also transgender. Surgery wouldn’t be for a year, but Caroline had to head out there as soon as possible due to insurance restrictions and standards of care. At the time, she didn’t have a single stitch of female clothing. That was remedied by a shopping spree for shoes, post-mastectomy bras and other necessary apparel. It was a joy to see her off running errands on her first day out as a female. She had a long way to go, but she was beautiful with her new clothes and long hair.
In addition to changing her name and gender at the local, state and federal levels, Caroline wanted to update her Oklahoma birth certificate, which required a court order. With Caroline at the courtroom podium, the Pennsylvania judge balked. I approached the bench with my daughter, explaining that Oklahoma, unlike Pennsylvania, only recognized gender changes via court order. The next day, the judge granted her gender change.
“Caroline needed monthly blood work to track everything—especially her estrogen and testosterone levels. Initially, her fear of needles was so severe she required anti-anxiety drugs. Fortunately, she overcame her phobia by the time the most critical tasks were at hand.”
After some effort on our part, her health insurance provider agreed to cover four of her surgeries at the highest reimbursement tier. But less than 48 hours before we left for Arizona for the first of five surgeries, the insurance company downgraded its approval to the lower-paying third tier. Infuriated, I reached out to a supervisor by phone. How could they drastically reduce coverage when none of the eight reasons for denying coverage spelled out in the contract were applicable? When I threatened to go to the media with my story, they finally backed down.
Once in Arizona, the two of us stayed at an Airbnb close to the surgeon’s office, the surgical center and a local hospital. After her first five surgeries, I provided care for a month. It was intimate and intense. One night, early in the second week, Caroline experienced post-operative delirium, seeing and hearing things that weren’t there. We took an Uber to the ER, where her condition was resolved with IV meds.
There was also the permanent— and painful—removal of unwanted hair follicles. Caroline had 38 laser procedures and four electrolysis appointments. A dermatologist removed hair from her genitals. Between that and the surgeries, witnessing my child endure so much pain was excruciating.
After a successful four-year transitioning process, Caroline is now going about her life as a young woman—and she’s content to have me tell her story. Even so, Susanna Blake is the pen name I use to protect her privacy. I’m grateful for a lot of things. Not least, she afforded me the opportunity of a lifetime to dig deep into a human experience I hardly knew existed. Until now.
Malvern’s Susanna Blake (she, her, hers) is a proud cisgender mother of a young transgender woman. Her story has been the basis for seminars at Main Line School Night and presentations to other local groups. You can reach her at susannablake4@gmail.com.
Related: Female Physicians Lead the Way Around the Main Line
