In Defense of Watchful Waiting

I am a trans adult. I currently live in Missouri, where lawmakers have been debating a moratorium on youth gender transition for several months. Many trans people and their families are making moves to relocate to states they perceive as friendlier and more affirming.

I am not going anywhere. In fact, I hope the moratorium goes forward.

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While I began my medical transition at 18, as an adult, I could’ve been labeled a “trans kid” like many others. I had significant gender dysphoria that dates back to my earliest memories. Before I was even old enough to attend kindergarten, I was demanding to be called a male name. I was the only female Buzz Lightyear in my second-grade class’ Halloween parade. I chose to portray Olympian Jim Thorpe in my fifth-grade class’ living wax museum. I fought with my parents about every haircut, down to the shape of the “sideburns.” When my school pictures came back, I was thrilled that I looked like any other elementary school boy. I was just as excited when strangers would ask my parents about their little boy, finding myself upset when they were ultimately corrected.

My parents were mostly confused and upset. What the heck was going on with their kid? They didn’t understand what was going on. It never occurred to them that this was a medical issue. They thought I was a tomboy, maybe a young soon-to-be-lesbian, but they never asked a doctor about my behavior. What they were sure of was that I was distressed, and they were frustrated. 

My parents attempted to push me toward a more typically female presentation, but I always resisted. After awhile, the arguing stopped and my family was willing to offer some concessions. We met somewhere in the middle. I was allowed to wear unisex clothes and have my hair cut short until I could shop for myself and cut my own hair in the bathroom sink.

I can now understand that they were throwing everything at the wall to see if something would stick. In the end, nothing really stuck. None of the arguing or the bargaining changed my trajectory, but it did give me a lot to think about.

Photo by Kunj Parekh on Unsplash

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As a teenager, I started to search the internet for why I felt so different. Like many others, I found language I had never heard before. I learned about transsexualism. I read the WPATH Standards of Care (v6 at the time) and felt like I met the diagnostic criteria. I wanted to talk with a professional, so I asked my parents to set me up with a therapist.

My therapist was affirming but inquisitive. He used my chosen name and pronouns, and we discussed my issues with gender. We spent a lot of time talking about what I imagined my adult life would be like and what transition would or would not do to help me achieve those goals. We talked about what was going on in my life that might or might not have contributed to my gender issues.

Meanwhile, I started to ask a few friends to use my chosen name and pronouns in private. I did not ask my parents or my school to make any changes. I wanted to take things slow and see how I felt. Looking back I realize that I only wanted a few people to know so that I wasn’t locked in. I didn’t want the stress of asking everyone I knew to change how they saw me until I was ready myself.

I saw my therapist for three years before pursuing hormones. I began the “real-life experience” requirement shortly after turning 18, and about three months before arriving at the gender clinic with a diagnosis and a letter of support in hand. A decade later, I have no regrets about my medical transition.

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They didn’t know it at the time, but my parents’ overall strategy has a term: Watchful Waiting. This is a wait-and-see approach that allows time to pass and therapy to take place before using more invasive interventions, like prescription medications and surgeries. It is not a term used exclusively in gender medicine, although it is quite contentious in this space.

Watchful Waiting was a key component of my success story. I spent many years with a foot on both sides of the gender “spectrum,” learning to tolerate the distress of being referred to by my birth name and sex-based pronouns, while also having the opportunity to explore being referred to differently. I was able to see the sharp contrast that occurred in my head and my heart when I was referred to as male vs. female.

While my first memories of gender dysphoria occurred over 15 years before I medically transitioned, not once did I feel like I wasn’t transitioning quickly enough. Not once did I feel like I was at risk of suicide or suicidal ideation because my transition wasn’t moving toward a medical pathway in early adolescence. (It helped that there weren’t any adults in my life suggesting these things back then).

Experiencing and processing my dysphoria for all those years (with a therapist) allowed me to make a confident decision in early adulthood that I do not regret. My folks have noticed that I am much happier now as an adult trans man. These days, we often talk about the discomfort I was experiencing as a child, and how they didn’t know any other way to help me navigate it. I continue to remind them that they did the right thing by getting me connected with a therapist and letting me be free to express myself however I wanted through simple changes like clothing and hairstyle. That is what I needed.

When I read about bans or moratoriums on gender transition for minors, I remember my time as a gender dysphoric young person. I needed that time for processing, not medicalization. I needed support grounded in the reality of transition – an imperfect solution to an issue I’d experienced for as long as I could remember. I needed the adults in the room to guide me toward reasonable expectations.

My hope for Missouri is that kids with experiences like mine can have the time they need to process their distress and work through what they hope to achieve through transition. I hope they come to understand their gender dysphoria. I hope therapists will step up to meet this need and work with these young people until they decide to transition, or not, as adults.

Maybe they will transition as adults. Maybe they will find ways to navigate the world without medicalization. The choice ought to be theirs, when they are mature enough to make it — in adulthood – and only after they’ve had sufficient time to think.

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