Documentary. Louis travels to San Francisco where medical professionals are helping children with gender dysphoria transition from boy to girl or girl to boy.
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This programme contains scenes which some viewers may find upsetting.
Do you think you are happier as Camille or Sebastian?
How do we get this thing off?
But Sebastian was happy too, wasn't he?
-You don't think so?
He was not happy.
What wasn't happy about him?
He did not like...
He wanted to be a girl and then he did not like his name
so he changed his name.
# Whoa-ah! #
'For the last several months, I'd been meeting children who say
'they were born into the wrong body.
'a leading light in gay rights,
'is now blazing a trail for the transgender community,
'helping boys and girls at ever younger ages to transition.'
What is that little thing in there doing?
Making it so I don't go through puberty.
And why don't you want to go through puberty?
Because I don't want to be a girl.
'Intervening early allows them a chance to create the bodies
'they feel they always should have had,
'but it's also fraught with difficulties
'and raises questions about how old a child should be
'to make changes affecting his or her whole life.'
She'll say that she wants a vagina.
She uses the V word?
And what do you say?
Erm, I've just been telling her that when she's old enough
and she's ready to make that decision
that if she still wants one, erm, that she could have one.
'I was with Casey and Eduardo and their child Camille...'
Be careful. Stay out of the road, Camille. Come this way.
'..who until recently had been called Sebastian.'
Oh, my God, that was cool.
'The family were about to have their first appointment with
'Dr Diane Ehrensaft,
'a clinical psychologist
'specialising in transgender children.'
And you can make a story in the sand tray of anything you want.
It's kind of like having a dream or telling a story in your head,
but you get to do it with all the things here,
and then we'll take a picture of it.
To put it simply, what brings you here today?
Well, we have a child who has asked us
if they can be a girl and we want to make sure that we're
fostering the best approach to make it a smoother ride
and to kind of know that we're doing the right thing.
When did this request first come up?
Not too long ago. Erm, we were just sitting on the couch
and Sebastian asked me if...
"How do I become a girl?"
And we had pretty much... The process with us had started in October
when Sebastian had requested an all-girls Halloween costume.
Camille, did you want to tell us something?
It was Monster High. Frankie's my favourite.
Oh, OK. I'm going to spend a little time with Camille.
The first thing we're going to do is draw, OK?
So, Camille, the first thing, I'm going to ask you just to draw
a picture of a person.
That's me. I can draw myself on here.
So when you were born, a long time ago,
your mummy and daddy thought they had a little boy named Sebastian.
Right now, how would you describe yourself?
A girl. Not a boy. I'm a girl.
You're a boy and a girl but you'd like to be a girl and not a boy?
Not a boy and a girl any more.
Not a boy and a girl any more.
And not transgender but, erm, so what shall we call it?
Goodbye, Camille. I hope I'll see you again soon.
How did that go, as far as you were concerned?
As far as I was concerned, it went quite well.
I mean, can you say at this point that she is transgender
and was, as it were, born in the wrong body
and will grow up to be a woman?
I would say it lines up in that direction. So here's what I saw.
This is a child who's been insistent and consistent and persistent
since age 18 months about being gender non-conforming.
But what is not there is a child who from age two,
when then Sebastian, he developed language,
was saying, "I am a girl."
Do you sometimes see that?
I sometimes see children as young as between age two and three
saying things like...
In response to, "Honey, such a good girl."
"No, Mummy, boy," and it starts there, so the answer's yes.
'Aged just five, Camille was on the cusp of a decision that could
'change her entire life.'
-Can I come in?
-Come on in.
A change of outfit! Look at that.
Did we have a nap?
-Did we have a little rest?
-A tiny one?
What's striking looking around is all the photos of Camille
Looking very boyish.
And how old... I mean, I guess it's a he in this.
Is that right or do you read it back into the past and say,
"Well, it was always a she, we just didn't realise"?
I think that's what... Where we're at now,
is that it's always been a girl and we just didn't realise it until now.
And, to me, that one's a tough one because that was the last time
we captured Sebastian.
In honest opinion, that was the last time
we saw that, you know, spiky little hair and the cute little clothes.
I think it was really, for me, kind of saying goodbye.
And I don't... And it's not a bad thing in my mind.
It's kind of like, "Ah! That was a phase. We're done."
What is going on? Camille, what are you doing?
Putting lipstick on.
For how long have you been using Camille
and the she pronoun at home?
-Just a month?
So this is all really new to you, this.
Very, very new. It's... We get confused quite often.
How are you feeling about it?
I... It's just hard getting used to going from one to the other.
It's difficult. It's really difficult.
It's not an easy thing to do.
Do you find it confusing ever?
Yeah, I think that's kind of par for the course sometimes,
and I think it's that way with kids a lot but, erm,
definitely with discovering who you are as a person.
Trying to figure out what is solid and consistent and dependable
and cater to that and support that.
It is difficult and I'm not going to lie, it's not easy,
this is not a very easy thing.
We may have had not so bad of a time at this,
but it's not an easy road to travel. You...
It's gut-wrenching, honestly.
It's a battle dance.
A battle dance?
You have... You have to dance as best that you can
and you have to do this.
I don't even know if I know what a battle dance is.
Does that mean that...
You have to dance the best.
It's a competition?
MUSIC: Bad Romance by Lady Gaga
'There is a growing trend in America towards enabling trans kids
'to transition as early as possible.
'San Francisco's Benioff Children's Hospital is spearheading
'the approach, under the direction of Dr Ehrensaft
'and Dr Steve Rosenthal.'
So do you prefer boy pronouns or...?
Like "he" or girl pronouns like "she"?
I just want to do it the way you want it.
'Kids identified as trans can hold off puberty using blockers.
'Later, by taking hormones, their bodies can
'mature in the direction of the gender they feel they really are.
'In some cases, the final step is surgery.'
I think hopefully by... When I turn 18,
I'll be fully transitioned, meaning, like, I'll have bottom surgery,
-do you know what that means?
So I'll have surgery that will, erm, change my penis into a vagina.
What's he doing?
A month ago he had another implant put in.
What do you mean by an implant?
Erm, she is on a puberty blocker and he had...
Hi, Shane. Louis.
Can we see that, Shane?
It's under the skin there.
There's some stitches dissolving.
Shane, as you understand it, what is that little thing in there doing?
Making it so I don't go through puberty.
And why don't you want to go through puberty?
Because I don't want to be a girl.
-You don't want to?
Do you know what the next step is on the
medical side of the journey?
I want to go on T, or testosterone, but I have to wait until I'm
14, so that's two years, and this should last for another two
years, so hopefully I'll be able to just transition after that's done.
Get... Go on testosterone.
And what would that do?
It would make me go through guy puberty
and my voice goes deeper and stuff.
'A 14-year-old trans girl had come in for a check-up.'
-Good to see you again.
-Nice to see you.
-Hi, Louis. Gerry.
-What's your name?
At the last visit I saw her, I did increase her oestrogen dose
and so she has, erm... She does have one breast bud,
so she's had some response from that dose increase.
When girls develop breasts, it very frequently starts
on one side and then the other side, so this is normal.
Do you enjoy coming here, Nikki?
Erm, yeah. Yes, I do.
What do you like about it?
Erm, that, like, every time I come here we're, like,
making, like, a step forward, I guess.
I guess, like, I'm just really excited about, like, the future...
Like, you know, and erm...
Yeah, I just can't wait.
Ah, that's wonderful.
'For the first 13 years of her life, Nikki had been Nick.
'Last year, Nick had come home from school
'and found his mum watching a TV programme about trans kids.'
So Nikki had seen this TV show. Were you watching it with her?
I was really debating... And I don't know if it's mother's intuition,
I was really debating whether or not to allow her to watch this show
because I guess I knew deep down inside what was going to happen next
and within 15 minutes, you were like, "That's me," and I'm like...
She said that out loud?
And I'm like... Inside of me, I was like, "Oh."
Nikki, for you, as soon as you saw the show you thought,
"That's what I am. That's who I am"?
Was it a...
What made it important to you to do something straight away?
Probably because, like, I was starting puberty.
Like, my male puberty
and I knew it was going to, like...
Well, I knew it was going to get worse for me
because I didn't want to start male puberty and it would be, like,
really harder for me, like, to do, like, the treatments and I just
wanted to make myself look like a girl and I just...
Yeah, I just really didn't want any...
I just really wanted to start with it fast.
This has all happened quite quickly, hasn't it?
There's two things you can do here. I mean, you can...
As a parent, you can be in denial, which to some degree we were.
You can say, "We can fight it." You know, we could say,
"No, this is not the way you were born. You were born a boy,"
and force that down that path.
There's a good chance Nikki would have conformed to some degree,
for a period of time.
Nikki would have become an adult, and this happens
all the time, right, where people become adults and really still
feel this way and then they learn to transition when they're adults.
Life is a lot harder, in my opinion,
when, as parents, we fail to see that and I see it
as protecting the life of my child, in a way, and taking that right
fork and that's why I justify what I've done here, as a father.
I guess what you're doing here that's a little
different from some other
comparable places is doing interventions relatively early.
Is the risk there that, you know, they may get it wrong in some sense?
The child may not... May think he or she knows who he or she
really is but then five years, ten years on,
having taken the intervention, may change his or her mind.
Is it a risk?
Let's call it a possibility, so with that possibility then we'd
think the most important thing is the same exact idea -
to find out who you are and make sure
you get help facilitating being that person then.
We have one risk we know about.
The risk to youth when we hold them back.
And hold back those interventions - depression, anxiety,
suicide attempts, even successes, and if we can facilitate a better
life by offering these interventions, I weigh that
against there might be a possibility that they'll change later,
but they will be alive to change, so that's how I weigh it on the scales.
'I was with Casey on the way to picking up Camille.
'It was the first day she'd been allowed to wear a dress to school.'
Hello there. How's it going?
Finally I got to see you.
How did it go?
Look at you! What a nice dress.
What would you want?
I would like regular chocolate, please.
Whoa! Oreos and sprinkles! I want those Oreos and...
Was it any different wearing a dress than it is normally?
It was actually easier getting her dressed today
because it was something that she wanted to wear.
Did it feel like a big step for you?
It did. I was kind of worried about the reaction from
other parents, cos I know people are going to be gawking
and just looking at Camille a little bit different.
I mean, you don't think Camille's still exploring?
Trying different things?
I don't know.
Honestly, it's been such a quick journey in the last one year
that we've been going through this that it doesn't feel like
there's a lot of exploration left now.
It's big leaps and bounds forward.
I don't think there's any more exploring.
I think this is... This is Camille and this is her coming-out party.
'Casey had told me that
'Camille's transition had caused a rift in the family.
'Back at home I had some more questions.'
You were saying that your father...
..is, erm, is a bit of a sceptic on all this.
I think that they think that she's too young
and that we should wait till she's older to make her decisions
that could affect her life.
He's OK with her wearing dresses around the house
and stuff like that?
Yeah, inside the house is fine but, you know,
out in public where other people could see.
And what about changing the name and changing the pronouns?
They're not happy with that at all.
They think that's a big step for
a five-year-old to have to undertake.
Does he call Camille Camille or Sebastian?
Sebastian, him, he.
Does that bother you?
Yes and no.
I mean, I know it's hard. Like, a lot of people can't...
It's hard to remember to do it,
but when you're blatantly ignoring the fact that, you know,
we're making this transition and you're not listening
to what we're saying, that's disrespectful and hurtful.
So your dad's position is basically, it's Sebastian, it's a he,
and just give it time and see where you get to.
What I say is, it's very different day to day when you're at home with
Camille, that it's not just...
This is not us putting it on our child,
putting so much responsibility on a five-year-old to decide what to do.
All these big life-changing things.
These are things that she's coming to me and saying.
I'm not the one who's, "Are you a girl? Are you a boy?"
No, this child's coming to me and saying,
"I am a girl and I want to be a girl.
"How do I become one?"
'Some trans people become so unhappy with their bodies
'they experience dysphoria, feelings of anxiety and depression.
'For older kids and adults, there is the option of surgery.
'Among the leading surgeons in the field is Dr Curtis Crane.
'He offered to show me some of his handiwork.'
Can I join you over there?
Oh, please. Yes.
This is a thigh as a donor site, giving quite a large phallus.
That's about six and a half inches.
Here's a forearm as a donor site,
giving a five and a half inch phallus.
I'd be hard pressed to see this patient walking around a
locker room and find someone that wouldn't say, "That's not a male."
'One of Dr Crane's patients,
'17-year-old Amaya, had come by for a check-up.'
-Good to see you.
Good to see you again.
Well, very good. So it's been a while since your surgery.
Almost a year, yeah.
Almost a year and how have you healed?
Pretty good. I haven't really been doing much for the scars themselves
-but I mean, they're healing pretty well.
The scars, you know, they take a little while to go away and
they're going to get better whether you do anything for them or not.
It's pretty amazing. All of our friends are saying it.
Well, thank you. You look fantastic.
-Yeah, look at that.
Like I said, they're still there, obviously, but...
-No, they're fading very nicely.
There's a little bit of redness under here.
And will that gradually fade, Dr Crane?
Er, possibly. You know, a scar isn't totally mature for a year
so we're just a little bit before that and then
if it's not to Amaya's liking, there's options of
getting a little bit of laser to take out some of that red.
-Could do that?
-Yeah, it's very easy.
So is that it for you, surgery-wise
or have you thought about or talked about bottom surgery?
For now, that's it. I don't see myself going that route for
a while and I don't know how I'll be in five, 10, 20 years.
But for now, this is all I really needed.
You don't have dysphoria to do with, er, downstairs?
Definitely not as much as upstairs.
How old were you when you changed pronouns?
That was only in the last year or so.
-In the last year or so?
So were you... Before you grew breasts you weren't having
dysphoria to do with your, erm...
Not that I can remember, at least. It was really that, you know,
sixth, seventh grade when I was 11 or 12 was really
when I started to develop and when all of those dysphoric issues
started to come up and then progressed from there.
And what was that like?
It was tough. It definitely kind of hurt my own mental health
a little bit, I guess I could say.
It didn't make me want to be very social.
It kind of gave me a little bit of an anxiety issue and
it just didn't help anything in terms of me going out in public
and having to deal with it.
It definitely made me have a bit of a struggle, in that sense.
It just didn't feel like it was you
or you didn't like the way it felt or looked or...?
I didn't like mainly the way other people were perceiving me
and so it was a lot of how I was perceiving myself plus
how others would see me just on the street, people that didn't
know me necessarily and how they would think of me.
'The path of transition, rarely easy, becomes even less clear
'when parents don't see eye to eye.'
'I was about to meet a child whose parents'
'divorce had made her true gender a matter of dispute.'
-You've got a daughter called Crystal.
Is that... Would you...?
Well, she was born Cole.
But she was born Cole, with male anatomy?
At what point did you switch to using, erm, female pronouns?
We go back and forth, and it's difficult because at school
or in places where she's a he, we can trip over ourselves.
At school it's he, it's Cole?
Er, and it's Cole and then at home...
-..Crystal and she?
Is there a reason you haven't transitioned at school?
Because her father and I,
I don't think see this from the same perspective.
So Crystal or Cole hasn't expressed a clear preference, it sounds like.
She has said, privately with her therapist, that she is a girl,
erm, almost 100%.
When I've sat down and had private conversations with her and said,
"Would you ever be interested in hormones, blockers,
"they need to be started soon, right?"
So, erm, you know, I've had to have more serious conversations.
"Do you... Let me explain to you how your body's going to change.
"Do you want to stop that? How do you feel about it?"
Erm, and her answer is,
"I can't... I can't do that, Mummy.
"I have to be a boy,"
and I enquire further as to why and she says,
"Because I'm Poppy's only son and it would destroy Poppy."
How you doing? Can I say hello?
Louis. What's your name?
Crystal. But you've got another name. What's your other name?
Do you have one that you like better?
Your mummy was telling me that one is sort of for school,
is that right?
And one is what, more for home?
So that's different.
Is that fun having two names?
But what about maybe going outside and, erm... Do you like to pogo?
OK. I'll just have to get on my shoes.
Hang on, no hands? Isn't that dangerous?
Two hands, one leg. I like that.
How many can you do?
I have a small record.
Go on, let's see you.
I just fall off.
So what do your sisters call you?
Er, either Crystal or Cole.
Either one? Maybe I should ask them. What's your name?
I call Crystal Crystal
and sometimes Cole when, erm,
when she wants to be called Cole.
Do you think of them as a boy or a girl?
Cole usually is a boy and Crystal's a girl.
Doesn't that get confusing?
So how do you decide?
I decide on what clothes I'm wearing, like, that day.
Like, if I want to wear these kind of clothes, I'm a girl.
If I want to wear, like, those kind of clothes, I'm a boy.
Like, it depends on, like, what I feel like doing that day.
And do you prefer one?
No, I don't.
And do you think at some point you'll decide one way or the other
or do you think you might just keep kind of going back and forth?
I'll just decide one day.
You think you will?
'I was making a follow-up visit to Nikki and her family.'
-How are you?
-Yeah, good. How are you doing?
-Good to see you.
-Bit of an early start.
'Since our first meeting, four months earlier,
'I'd been curious about the progress of her transition
'and its impact on the rest of the family.'
Hi, Nikki. How are you doing? Nice to see you.
So you're allowed to wear make-up to school?
Yeah, but I don't wear that much,
cos I don't like wearing a lot of make-up,
cos it's really, like... It takes for ever to put on a lot.
Since I last saw you, your hormones were increased.
Yeah, they have. Like, I'm starting to see a lot of changes
and pretty much...
Cos, er, last time when I saw you guys
was when I just, like, started on it, I think.
Like, it was a month I started in on it,
but I've been, like, seeing and, like,
feeling a lot of changes to that.
Erm, like, erm...
Well, I've been, like, getting...
Well, I've been getting a lot of mood changes.
Because a mood's brought on by the hormones, do you think?
Yeah, it brings you, like, certain feelings that you don't
want to go out into the world because it's who you are
and just get, like, so scared. I don't know.
I started, like, feeling that when I started hormones.
I started getting more, like, sad and emotional a lot of the times.
And there are maybe things that...
When you're in a mood that...
that are bringing you down a little bit?
I just want to, like, stay away from everyone.
Yeah, and sometimes I don't, like, really want go back to school.
Like, they don't get it.
They call me, like, faggot, like a fag and stuff and, erm, yeah.
Do you like what you see when you look in the mirror?
I mean, I like it.
Erm, I wouldn't exchange it for anything.
This is Daniella.
-Hi, Daniella. I'm Louis.
-How do you do?
What's this been like for you?
It's been an experience.
It was hard at first,
erm, but then I really got used to it
and then I just really learned to, like, love her.
You had a brother, or thought you had a brother, called Nick.
Who you were quite fond of, I imagine.
I didn't want to accept the fact that she was transitioning.
I didn't. I just said, "No. Like, I'm not OK with this."
Erm, because it was kind of like
I was the only girl in this family and I wanted to be the first
to wear make-up, the first to do all the girl stuff, erm,
and now I wasn't going to be because she's older than me and she's going
to be doing all that stuff first and I just...
I've been living my whole life with Nick and I really...
I didn't want anything to change.
Did you know that she felt that?
Yeah, I kind of did.
Erm, it was really, like... She was really confused
when my mum told her.
-It feels quite normal now, does it?
Yeah. It's just Nick is gone and I'm OK with that now
and Nikki is, like... I don't know,
I just feel like she was Nikki her whole life.
See you later.
One thing that had come up when I was talking to Nikki was that,
erm, some of the kids weren't fully accepting.
A lot of her peers don't really get it.
They don't really understand what transgender means.
-They think she's gay.
Erm, and it's really hard for Nikki to explain that to them
because she's so quiet
and she doesn't like to create, like, problems or get into arguments
or... Not that she would have to, but she'd rather just let it go.
A lot of that will be alleviated moving forward
because we have made movement.
We've gone through the court to officially change Nikki's name.
Did that feel like a big step?
Yes, it was a big step for...
I mean, for her too, she was very happy.
I was... It was bittersweet for me
but I know I'm doing the right thing.
As a matter of fact, we just got her
new birth certificate two days ago and the first thing
she pointed out was her gender, and she was very happy.
Bittersweet for you in what way?
That I don't have my son any more.
It's...it's hard sometimes.
You know, I have to refer... I have to look... I'm sorry...
There's always, you know,
there will always be a sense of, erm, of grief. Even though
it's not a total loss, you, erm, you go through that
and you have a, erm, for ever memory, you know?
Because anybody that has children, you had them as babies and you did
things when they were little and you're not going to...you can't
just erase those memories. And many times they were boy memories
and erm, you know, that... You know, that's not going to go away.
Isabel, how would you explain the sadness?
I don't know, I guess just that I won't...
You know, like, I often wonder, like, what would Nikki be as Nick
as a teenager, you know? I know her life is going to be a little harder,
you know, she will always have something that she has to overcome,
you know, erm, and it...
Her future scares me a little bit,
I'll be honest.
I was visiting the reconstructive surgeon Dr Crane again.
This time I was hoping to find out about his more ambitious
surgeries and also get a perspective on childhood
transition from his older patients.
-Good to see you.
-Good to see you.
Another day in the office.
Yes, it is.
You've got some candidates coming in.
Yes, we've got a lot of patients today.
-Nice to meet you, Louis.
-What's your name?
So tell me, erm, what brings you here today?
I'm doing a pre-op appointment for, erm, I guess the final stage
of my phalloplasty, doing testicular implants and glansplasty.
So you've already had a... a shaft made?
And how did that go?
It went really well, actually.
It was a lot different than I expected it to be,
but, erm, the results are amazing.
I'm very happy with it and it... it's, erm, what's the word?
That's great. How old are you, Ketch?
I am 36. I'll be 37 in five days.
And you were assigned female at birth?
Which is hard to believe, looking at you.
Which I guess is a good thing, right?
It's a wonderful thing.
I've been meeting kids mainly who are trans
and in the process or figuring out whether they are trans,
and some of them are transitioning as kids
and taking pubertal blockers and cross-gender hormones.
Looking back, does it seem to you that that's something you wish,
erm, you'd done earlier?
When I was a kid, I'm like...I felt that was a missing part of me.
You know, erm, going to the bathroom and having to sit down or
to stand up, that, you know, that really bothered me
cos in pre-school, the kids would all go to the same bathroom.
You know, you have the teachers there supervising and I'm like,
"OK, so why's he standing? Why don't I...? I have to sit down," you know,
and so I would for years and years and years find a way
-to try to fix that, you know, so...
Erm, just try different devices to, you know, stand and pee.
Correct me if I'm wrong, but it's more just the act of wanting to
stand and pee maybe even more than...than the sexual side of it.
Oh, it's definitely more than that because after I, erm,
I had top surgery, it still... I still wasn't complete, you know?
Going to the beach and, you know, feeling like
somebody's looking at me like, "Oh, you know, you look like a guy
-"but, you know..."
-There's no bulge.
-Literally, yes. Yeah.
I'm out at the beach and...
You've got...you know it's something that people,
-if they're looking that way...
-If they're looking.
..there'll be something there.
Yeah, definitely. It's functional, it's very functional, so...
-It feels good?
-Hi, hello, Minerva.
-You must be Minerva. How're you doing?
-It's good to meet you.
-And, Tristian, yes.
-Nice to meet you.
-Pleased to meet you.
What kind of questions can I answer for you?
Specifically, I mean, I've known for sure, like, I want an orchiectomy.
I've been hearing things from a friend of mine
who I think recently got done here, like, a kind of...
She was calling it a no-depth vaginoplasty.
An orchiectomy is the removal of the testicles
and phallus as well?
No, just testicles.
And, erm... But I heard you say a no-depth vaginoplasty.
It's essentially, erm, you construct a vulva
and a clitoris, erm, but the vulva doesn't lead to anywhere.
There's a lot of options. You know,
I very much tailor the care of my patients to exactly what they want.
I... Basically I'm a... I see my job as a counsellor
and she can have anything.
And so at this point... We said this at the beginning but you have
a pretty clear idea of what you... what the destination is for you?
Yeah. Financially, I think... I think I'm going to
spring for the orchi, I think, right now.
I'm not... Which is a, it's... It's a good middle ground, I think,
because that is definitely something that I want and it doesn't preclude
any other options if, you know, what I need changes as I grow older.
So then you're in a kind of, sort of, erm, middle stage,
-I mean, I could, I could...
I'm not going to, you know, make guesses
as to what me in 20 or 30 years would want, but, erm,
for now I would be absolutely happy with an orchiectomy.
-And keep the phallus as is.
There's no dysphoria around her phallus, so why surgically
remove it, you know? We're trying to solve dysphoria, we're not
trying to put everyone in a box that the rest of society believes in.
Are you in a relationship, may I ask?
Mm-hmm, this is my girlfriend.
-Nice to meet you.
-Nice to meet you too.
And so, Tristian, may I ask you, how do you self-identify?
Well, I'm also a woman.
And have you had any surgeries at all?
Yeah, I did experience much more, erm, dysphoria and emotional pain
around my genital configuration than Minerva does,
erm, so I did have a...
full reassignment or reconfiguration, erm, last summer.
How's that working for you?
It's, erm...it's working out pretty well.
it's been a lot better, a lot better since.
He's going to make it. Yep, you're going to make it.
I was back with Crystal.
Unlike her mum, her dad Erik has been reluctant to embrace
Crystal's female identity and so this was a Cole day.
Oh, too much.
That one's going in. There you go.
So now you can try and get a hole in one.
Yeah, free game.
So we met Joy and we talked to her a little bit about Cole
and she sort of has a point of view on that,
is that the best way of putting it?
Yeah, I look at it a little bit different.
I might be a little bit more conservative
and approach things as, you know, Cole or any of my kids,
you know, might want to have... are going to have certain things
that they want to do and, you know, I have limitations on that.
Do you feel you're putting up a little bit of resistance?
You know, in the sense that, are there times when Cole might say,
you know, "I'd like to buy some make-up," or do this and that,
and you might say, "Well, I don't think that's such a great idea."
I think he's clear, kind of, on what he can
and can't do at his mum's and kind of what,
how he...what he can and can't do when he's with me. Erm, I mean...
But I've had the conversations with him that, you know,
"I don't want to prevent you from being who you are,
"I just feel there's a time and a place for who you want to be
"and how you want to express that."
If he truly were transgender, if you thought you
were seeing that, would you...? What would be your view then?
I don't want to be in the position where I've made a decision
and then a few years later, it's like, it was something
that he may not have wanted to do. Or at least that his mind-set,
when he's 18, 20 or whatever, you know, "I didn't want this."
And I don't want to have to carry
that burden that I made that choice for him and then he changed it.
Whoa, and it just floats?
'Back at Mum's house, I was hanging out with Cole-slash-Crystal.'
Oh, my God.
We didn't really talk about what I should call you, either.
So, is this your area?
-Talk me through what you have in here.
OK, so, this is practically my light and it has, like, little things,
thingamajiggers in here.
This is my perfume. I don't know where the top went.
This is one of my favourite movies.
Oh, yeah, that's a Japanese animation.
Yeah, it's by Miyazaki and then... I'm really into Japan too and
so this is my kimono and it's really pretty.
-And it's really silky too, so...
-Does that feel nice?
It feels very nice and sometimes I sleep in it. And then this is
my very, very special dress, and it's really good
and I really like it.
When do you wear that one?
Well, I just got it, so I haven't had the chance to wear it yet.
And how do you see yourself in that way?
I don't know.
I mean, cos most people would say I'm either a boy or a girl,
some say they're somewhere in between.
I'm somewhere in between.
Do you feel pretty happy? Are you happy?
Do you think you feel like you're happy?
Yeah, I'm happy, I have a fine life.
And as far as... Because, you know, we met your mum.
-It's Joy, isn't it?
-And then your dad is Erik.
And I get... From meeting both of them, I get the impression
that you do more of the girl type things when you're with your mum
and you do less of them when you're with your dad.
I would do, like, things that, like, are, erm,
something that a boy could do and a girl could do too.
Do you have any sense of whether when you're grown up
you'd like to be Crystal full time?
Actually, when I grow up, I'm thinking of being Cole.
So not like Crystal, like this. This is, like, practically till
I'm, like, out... When I'm practically out of high school.
When you think of yourself as a grown-up,
do you think of yourself as more of a man or more of a woman?
Uh-huh, and that's... I think about life like...
Oh, well, I don't know why,
but I think of having a wife and two children
and like this... Like, you know how in Japan there are
these really weird houses, like with the pointy-end roofs?
I want a house like that because I'm really into Japan now.
I love their clothing and their style and everything and I love...
Yes. Well, silk actually came from China.
So, how have you been doing vis-a-vis Cole-slash-Crystal?
Feeling like we don't need to make any decisions right now
and that, erm, we're not - at this time, anyway -
going to really pursue any kind of hormone,
or anything like that.
Do you think it's possible you were wrong before about
what your child wanted?
I don't think...
I don't...I don't think I was wrong about what she wanted.
I think what's changing is being able to be who she is as Cole
and being accepted that way.
She's Cole and when she's Cole - a boy at school, right? -
she can still have her mannerisms
and her likes and her dislikes and all of these things,
and she has friends who love that in her and, erm,
she's happy and doesn't have to take on the role of a female
to be who she is.
In her bedroom just now, she, erm...
she or he was saying that he intends to be a man when he grows up.
I think that he, being Cole, isn't all that miserable
and quite honestly, that's the easy road and I hate to say that,
but that's the easier road.
So if she can be happy in that skin as a boy...
..that's the preferred route for, you know, safety.
And socially, unfortunately, it's still that way, so I support that.
Having spent time with both Cole
and Crystal, I was still unsure as to which was the truer identity...
..whether she'd had her true nature repressed
or had never been trans in the first place.
At the Benioff Children's Hospital,
Nikki and her family were back for her check-up.
For me, it was a last chance to see Nikki
and get a sense of how she was faring in her transition.
-Hi, Gerry, hi, Isabel.
How you doing, Nikki? Nice to see you.
I have some questions because I just want to pick up
-the first time we ever met...
..until today, cos I want to just find out that space in between.
I don't know, I've been feeling more excited about all these,
like, medication and everything. I'm more happier, definitely,
than I used to be. I can be, like, different, like, emotions.
Do you two see the same thing?
She does get emotional. You know, sometimes we have very
good days and some days she gets sad because she finds it a little hard.
In what way, would you say?
The fact that she has to take her medicines, she has to come here,
you know, and do the doctor thing every three months.
So I think that kind of makes her feel...
sad, you know,
in knowing that this is going to be pretty much the rest of her life.
So the notion you have to kind of medicate to be who you are,
Is there anything else, do you think, that we should touch on
in terms of things that could make your life better right now?
Erm, maybe, like, having God with me because I don't feel that
he is always with me and I've been, like, losing hope.
And, like, I'm losing faith because, erm...
I don't...I don't see it like how my parents do
or anything because I just feel that he, erm, he's never there.
She feels that she's a mistake and I tell her, you know,
"God doesn't make the mistakes - you were born to be who you are..."
..you know, and, "We love you." And I know she also worries
about finding someone and being married and being a mum.
Those are...those are worries that she has as well.
You know, all I tell her is
it is going to get better, it is going to be OK.
But I think right now she just doesn't believe it.
Well, no, not really. I don't see any, like...
-I don't, like, see my future yet, I guess.
It almost sounds like you're 14, you know?
Just what life is going to be like in high school
and what life is going to be like in college and having...
If you're going to find that right person and I'm hearing a...you know,
some things that I hear from a lot of 14-year-olds too.
- Did I get that right, or...? - Yeah.
- Yeah. - I think, yeah, that's right.
That felt, erm...
quite emotional, didn't it?
I think Nikki's, erm, struggling a little bit.
The kids that I work with who know before they go into puberty that
they're transgender, and that many of them have already
socially transitioned and they're looking like
they're having a good time, they're happy,
they hit this age - 12, 13, 14 -
when everybody's bodies are changing
and when you do start to think about your future a little bit,
and they don't tank, but they slow down, and I just saw it in Nikki.
What is it, do you think?
When you get to this age, you start being able to think abstractly,
you can think in larger constructs,
you have a different sense therefore of yourself.
You have to deal with reality and you understand what reality means
so in this case, we have a girl who doesn't have a uterus
who wants to be a mummy.
We have a girl who will grow breasts but she hasn't gotten them
yet and she has to do them by coming here to a clinic,
and the reality of that has set in.
And you start thinking about your romantic self -
"Who's going to want me?"
You know, in this case -
"I'm a girl with a penis. How am I going to do that?"
So all of that, I saw right there in Nikki's
kind of almost tearfulness.
I'm not surprised. I was a little sad myself to see
Nikki in that slope down, and I do think that what Meredith said
was right, it will get better, and I think she knows that as well.
Nikki, do you feel any better after that upstairs?
-I do, yeah.
Good. And what about you, Isabel?
How did that go for you?
You seemed quite concerned in there.
I just, you know... because I see her when she's up
and I see her when she's down and I just want to make sure
we're doing the right thing and, you know, being there for her and...
When I was up there, I was thinking about how, when I was 14 and
turning 15, that was probably the hardest year of my life.
It really was.
It's hard, yeah.
Cos you're thinking about, how do I fit in?
And you're not a child but you're not a grown-up
and it's a very confusing...
-it's a very confusing and lonely time sometimes.
-Is that how you feel?
Do you feel you're on the right path?
Yeah, I guess mostly, yeah, I do.
I said goodbye to Nikki with a feeling of trepidation
for the difficult journey she was embarked upon
but also confident that with her family's love and support,
she'd have the best chance of making her transition
as painless as possible.
I had one last appointment.
When I'd first met Casey, Eduardo and Camille,
they'd just started their journey towards transition.
Four months on, I wondered how it was going.
Will you come and pour me some tea?
Oh, wow, lovely.
That tastes delicious.
Do you remember why we're making this TV programme about you?
I get everything.
Are you one of those transgender people, do you think?
How do you know?
Because I'm turning into a girl.
Do you think you were always trans...transgender?
How did you realise it?
Because of myself.
Because being myself turning into a girl.
And do you think someone who turns into a girl
can turn back into a boy?
I would never do that.
You're going to stay girl, is that what you're saying?
Is that because it's more fun being a girl?
And you also feel that that's who you really are, is that right?
And do you think you were always a girl
or that you are turning into a girl?
Always a girl. I will always be a girl for ever.
How confident are you that, erm,
this is how it will be from now on, you know, for the rest of her life?
Every single day, it reinforces it for me.
I'm...I would say I'm 99% sure this is where we're at.
I mean, I don't care either way if something does change
-in a few years.
-You'd be OK with that?
I think the biggest thing is, she's taught me
personally how to be more authentically myself.
It's something that I never... I mean, I've always thought,
you know, just be yourself, but that's different when you have
a child that's telling you, "Well, I was born a certain way,
"but this is really who I am," and you kind of re-evaluate yourself too.
So if that means in five years she's Sebastian,
well, what do I care?
So you wouldn't mind, it wouldn't be an issue for you were it ever
to come to that, that she wanted to be Sebastian again?
To me, it's the same as if she's Camille.
It's the same thing.
Why would it matter going the other way, if that was the case?
I think we've been through a lot and we can pretty much handle...
-handle most changes at this point.
There's a sale going on, Camille. Lucky you.
-Look at that.
-Is that too cute or what?
Yes, that's too cute!
In our time together, I'd been moved by Casey
and Eduardo's readiness to support their child's choices but also
aware of the heavy responsibility of the decision they were making.
These are too cute.
The choice to transition involves the possibility of social
rejection and a lifetime commitment to medication,
but it is also a chance to exercise the most fundamental right
we have - the right to be ourselves.
In the end, the hardest part of the challenge may be knowing
who it is we really are.
-This one's your favourite?
Pink and purple.
It does look great on you.
Louis Theroux travels to San Francisco where a group of pioneering medical professionals help children who say they were born in the wrong body transition from boy to girl or girl to boy at ever younger ages.
At the Child and Adolescent Gender Center at UCSF Hospital Louis meets children who have been diagnosed with gender dysphoria. Louis is told that children as young as three can show signs of rejecting the gender they were assigned at birth, leaving parents with a difficult dilemma - do they start transitioning a child who is still developing their own identity or do they wait and risk making the change once their body has gone through the transformations of puberty?
It is a decision that can be the start of a complex series of medical interventions, from puberty blockers to hormone replacement therapy and eventually gender reassignment surgery. Louis spends time with children and their families as they negotiate their way along this life-changing journey.