Father Time

The parent of a trans kid sees past his paternalism, and recognizes the limits of patience in gender-affirming care.

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I don’t recall exactly how I felt at first about the gender-affirming surgery our 16-year-old told us they were hell bent on having, but I knew I wanted them to wait.

Back then, about three years ago, I urged patience and exploration, advocating for a “Sleep on it and see how you feel about it in the morning” approach, only for a few hundred nights.

If this sounds paternalistic, it’s because it is.

And all I can say is: I’m a father. Paternalism is kind of what we do. But I can also say that I was wrong.

What most parents want, or what one hopes they want anyway, is whatever is best for their child over time, regardless of anyone’s current wishes or fears or fashion. But teenagers are impatient, impulsive creatures. Their judgement is limited by an undeveloped frontal lobe—a fact every 21st century parent has hauled out as an excuse to undermine their kids’ autonomy—and they tend to prefer speedy medical solutions to the long-term conquest of personal challenges, all of which can conspire to make someone like me urge caution and inaction.

What I didn’t understand about trans kids like mine was the urgency they felt. That when you finally identify the thing that you’re convinced will make you feel whole, harmonized, more connected to yourself, you want to be that self as soon as possible. I didn’t see that then.

I had no intention of standing in their way, even if I could have, but I wanted to manipulate the timeline. Our ideal timelines—theirs and mine—were wildly different and in constant conflict. Where I saw a big, irreversible life choice, they saw an immediate existential solution to their internal conflict, a lasting cease fire to the war they’d been waging on themselves since puberty, if not earlier.

What I didn’t understand about trans kids like mine was the urgency they felt. That when you finally identify the thing that you’re convinced will make you feel whole, harmonized, more connected to yourself, you want to be that self as soon as possible. I didn’t see that then.

And while I never denied, I did want to delay. As it turns out, delays are already baked into the transition process. Reconciling our competing timelines was nothing compared to the actual timeline of caregivers. Wending our way through the appointments and waitlists for surgery was an ongoing and occasionally crushing process. And that was before the federal government started meddling in the process.

The Trump administration’s efforts to ban gender-affirming care for minors under 19—and their effective bullying of hospitals that still provide it—underscore just how fragile the timeline for trans youth can be. A federal judge has temporarily halted the President's executive orders, but it hasn’t prevented some caregivers—including the one where my kid was a patient— from quietly cancelling appointments and denying gender care for kids under 19.

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Last fall, after three years of consultations and evaluations, hoops jumped through, and insurance requirements demanded and met, my child’s place on a waitlist came up and they had the top surgery they believe further aligns their physical self with their actual self. It finally happened in late October, a week after their 19th birthday, and a week before the Presidential election. Throughout the procedure and recovery, our family never stopped giving thanks to the professional, unfailingly compassionate people at NYU Langone’s Center for Gender Affirming Care.

Now the Center has begun cancelling appointments for some of its patients who are minors without explanation. It seems to be an example, increasingly common among organizations and institutions these days, of preemptive obedience to the whims of a mercurial administration. And it may be illegal. (Although it’s not clear that that matters as much as it once did.) As New York attorney general Letitia James said back in February, denying care to transgender youth is a violation of New York’s anti-discrimination laws. NYU is choosing instead to preserve the federal funds the hospital and university receive from the National Institutes of Health (around $815 million last year) while denying or delaying care they’ve promised to patients who have organized their lives around receiving it. The already fragile timeline of gender affirming care is now much more fragile.

Someone experiencing gender dysphoria has almost certainly been experiencing it in one form or another far longer than they, he, or she has been talking about it and advocating for it. And once their mind is made up about who they are and how they intend to get there, they are eager to get it done. They want to start being. In too many cases, their very survival is at stake. Every day their treatment is delayed is another day they’re living in a body that’s not fully their own.

My child was not a minor when they eventually received care, but they were only 16 when they put the wheels in motion. Their surgery was the result of a deliberate, yearslong process, a process that would likely have been cancelled or postponed today. Usually, when parents ask their kids to practice patience and respect a timeline that’s longer—but ultimately more rewarding—it makes logical sense. We persuade them to forego the short-term gain for the greater accomplishment down the line. For kids who were born a few years (or even months) later than mine, the sudden disruption of their care is not only a refutation of that practical, universal value, but waiting for care is unbearable.

Time is a complicated, often intrusive factor, particularly for minors. Someone experiencing gender dysphoria has almost certainly been experiencing it in one form or another far longer than they, he, or she has been talking about it and advocating for it. And once their mind is made up about who they are and how they intend to get there, they are eager to get it done. They want to start being. In too many cases, their very survival is at stake. Every day their treatment is delayed is another day they’re living in a body that’s not fully their own. For trans kids approaching puberty, being denied puberty blockers amounts to the federal government mandating that they accept development within a gender that is not their own.

When my child—born female with a blessedly gender-neutral name—shared their intention to take the first steps toward transitioning, it wasn’t a surprise. Part of it was presentation—short hair and a wardrobe consisting exclusively of Official NBA—and a part was in bearing. The walk, the talk, the way they draped an arm around my shoulder or lept up to tap every reachable height as countless growing boys have, I suspect, for millennia. Gender is a spectrum and this child occupied an in-between space their cis peers did not.

I was supportive as my child evolved, but when their gender expression shifted from pronouns and appearance to physical modification, I got wary. I wanted to make sure it was not just an aesthetic choice, but an existential one. (Again, with the paternalism.) What I most wanted was for them to avoid any surgical regrets and I thought the most obvious path was a slow one.

And so it was. Everything took forever. Their first appointment at NYU Langone was in 2022. Even booking that took some doing. “Someone will call you,” we were told. And someone eventually did, and they went into the center for an initial meeting, then a meeting with a social worker, then another with a gynecologist. They were put on a list. Estimated wait time: three years.

But at least they were on a list and sometimes, we were told, that list got shorter. After that momentous appointment confirming a future surgery, my wife and child decided to get off the subway and walk over the bridge back to Brooklyn. It was a sunny, hopeful day. The two of them held hands while they walked, quietly celebrating the city and all it offered someone like my kid. How lucky to live in a city where there was a place like the Center for Gender Affirming Care and a community that valued the kind of care they gave. (It’s worth noting that similar care is banned in more than half of the U.S. states.)

The process crawled along: wait lists for surgeons were long, the pre-op consultation process was slow and thorough, the work my wife did in organizing the insurance coverage was heroic. Still, it would take time—a year, eighteen months, maybe two years—and I was grateful for every minute of it. Life went on. There were proms and breakups and summer jobs. There were fights and reconciliations and crucial conversations. They graduated and went off to college.

Paternalism had met its match. For the first time in this yearslong process, I didn’t welcome the delay. More time wasn’t going to change their mind or shake their commitment. There was nothing more for them to earn, nothing more to prove. This was happening, and we were lucky enough to live in a place where it could still happen and where the process can start even when the patient is a minor.

When they came home that December, the whole family went to the Center for the first time together. We talked to the social worker and met the surgeon. She was calm and professional, and just warm enough. I was standing behind my child when they asked: When? How long?

“At least a year,” the doctor said.

I leaned forward to peer inside their hoodie, that ever-present sweatshirt they retreated into in difficult moments. It wasn’t exactly anguish that I saw in their twisting face but it was more than just hopes dashed. It was a denial of who they are or who they could be. Themselves, delayed again.

Paternalism had met its match. For the first time in this yearslong process, I didn’t welcome the delay. More time wasn’t going to change their mind or shake their commitment. There was nothing more for them to earn, nothing more to prove. This was happening, and we were lucky enough to live in a place where it could still happen and where the process can start even when the patient is a minor.

Ten months later the waitlist opened up, and they had surgery in late October. It went perfectly. Witnessing the relative peace on their face as they recuperated, and later, watching a video of them running into the ocean—free of the ever-present sports bra and the feminine chest that once confined them—was all the reassurance I’d need. We’d done the right thing and on the right timeline, even if it was never my timeline to begin with.

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