Throughout much of her childhood, P. felt like something was off. But she didn't know exactly what.
"I felt at odds with myself," the Decatur resident recounted. "Almost like my physical body was trying to push me in one direction but I wanted to go another."
The breakthrough moment came on a family vacation in 2017, when she read a National Geographic cover story about Avery Jackson, a pink-haired 9-year-old who is transgender.
There are no simple paths for transgender children, whose gender identity does not match the sex they were assigned at birth.
Acceptance is not a guarantee. Getting teachers, classmates and school administrators to call them by the correct names and pronouns can be a fight. Arrangements often need to be made for places as basic as locker rooms, school bathrooms and camp bunks — where bullying or traumatic moments could occur.
Many local parents and teens are even more on edge as upwards of 30 states this year have considered — and several have passed — legislation that would affect transgender youths and their support systems. Arkansas took the most aggressive step in April, when it became the first in the country to criminalize physicians who help children under 18 transition genders.
Much of the legislative action is taking place across the South, including Georgia, where two sets of bills were introduced at the Capitol this year and could be picked up again when the General Assembly reconvenes in January.
Such laws would limit the options available to teens like P., who rely on hormones to help align their bodies with their gender identities. Medical associations like the American Academy of Pediatrics and the American Psychological Association say such treatments can be life saving for a marginalized population that's already at a high risk of suicide and depression. Supporters of the proposals say they protect children from making lasting medical decisions before they are old enough to understand the consequences.
The Atlanta Journal-Constitution agreed to identify two minors in this article by their first initials to protect the privacy of the children and their families, who feared being targeted by opponents of transgender rights and spoke on condition of anonymity. One teenager, with his parents' blessing, chose to have his full name published.
Lawmakers zero in
Georgia's transgender community is small yet significant. A 2016 study from the Williams Institute at the UCLA School of Law estimated roughly 55,650 people in Georgia, or 0.75% of adults, identified as transgender, fourth among U.S. states in percentage terms. Among high school students, the Centers for Disease Control and Prevention estimated almost 2% nationwide identified as trans in 2017.
Even as public support for transgender rights has grown, trans kids increasingly have found themselves on the front lines of the nation's culture wars over the last five years.
The first skirmishes involved restroom access. North Carolina's infamous "bathroom bill," passed in 2016 and partially repealed a year later, drew national headlines and boycotts, while closer to home, schoolboards from Decatur to Pickens County contended with the issue.
More recent proposals would require transgender kids to compete on sports teams that correspond with their gender assigned at birth rather than the one with which they identify. Supporters, which include socially conservative and religious organizations such as Alliance Defending Freedom, Duluth-based Faith and Freedom Coalition and Georgia Baptist Mission Board, have argued girls who aren't transgender could be crowded out of sports teams and scholarship opportunities.
Other bills floating around state legislatures would create criminal penalties for doctors who help minors transition by performing gender confirmation surgery or prescribing puberty blockers or hormones.
Blockers delay puberty to give children more time to decide next steps without their bodies developing features they'd want to change later, such as facial hair or breasts. Their effects are reversible, while those from hormone treatments partially are not. The Endocrine Society recommends that doctors wait until a patient has "sufficient mental capacity to give informed consent," usually by age 16, to prescribe estrogen or testosterone. Surgery, meanwhile, is exceedingly rare for children under 18.
Proponents of restrictions say they're trying to protect children, and particularly teenagers, from making permanent changes to their bodies while they aren't emotionally mature.
The government sets a minimum age for getting tattoos and buying cigarettes, and life-altering medical care should be no different, said state Rep. Ginny Ehrhart, R-Powder Springs, the lead sponsor of Georgia's version, which would make it a felony punishable by up to 10 years in prison for doctors assisting in a minor's transition with blockers, hormones or surgery.
A dozen southeastern states have considered sports or medical care proposals this year, according to the Campaign for Southern Equality, despite legal threats from organizations like the ACLU and boycott threats from the NCAA.
Arkansas, Mississippi, Alabama and Tennessee have already signed transgender sports legislation into law. And a dozen states around the country are considering an Arkansas-style ban on blockers, hormones or surgery for minors.
Dr. Izzy Lowell's Queer Med clinic in Decatur would be directly affected by the latter. It serves transgender people in nearly a dozen mostly southeastern states. About 1 in 8 of its roughly 2,000 patients are under 18.
"There's no medical reason for this bill," Lowell said. "There are very significant, very real risks of not giving hormone therapy. In many cases that's a very real risk of harm, both self-harm and harm from others."
Six southern states are mulling proposals that would go even further: penalizing parents who help their children medically transition.
LGBTQ advocates argue that such legislation is inhumane, since research shows just how life saving so-called gender-affirming support, both from family members and medical treatments, can be. More than one in three transgender high school students have attempted suicide, at least four times higher than among non-trans students, according to recent CDC data.
But rates drop by more than 45% when a family is highly accepting of a young person's gender identity, according to The Trevor Project, an LGBTQ suicide prevention group. Use of puberty blockers and hormones are similarly associated with decreased behavioral and emotional problems.
For P., the physical changes were slow to come when she first started taking hormones two years ago. But she immediately felt a mental shift.
"It was kind of this innate psychological thing of like, 'I'm getting there,'" she said. That "slowly but surely I'm on the right track."
Her parents, Michelle and Dave, admitted they knew little about transgender people when P. came out to them at 14. They wanted to be supportive, but also quietly wondered whether it was just a phase. As P. began to transition socially and then physically, the couple quickly realized she wouldn't change her mind.
They saw how elated she was the first time she wore a skirt outside the house at Oakhurst's Porchfest, and how she blended right in at a Pride festival they stumbled across while on vacation in Vienna, Austria.
"As a parent, you want to shield your kid from all the dangers of the world as long as you can," said Dave, who asked that the AJC withhold his family's last name to protect his daughter's privacy. "But you also have to recognize that this is the path that they're going down and this is how they can live as their authentic selves."
Peter Isbister leads the metro Atlanta chapter of the support group TransParent, which aims to help parents become "confident caregivers and advocates" for their trans kids. He said there's no universal experience for the parents who show up at his meetings. Some mourn for the little boy or girl they initially raised, while others are quicker to adapt and eager to find ways to support their child.
"Like so many things, it is completely individual," Isbister said.
In worst-case scenarios, parents become estranged from their children. Custody battles have been waged when one parent objects to a child's transition. One such fight over a 7-year-old in Texas became a cause célèbre of the conservative media in 2019, drawing rebukes from prominent voices including U.S. Sen. Ted Cruz and Donald Trump Jr., and helping inspire legislation in at least three states, including Ehrhart's bill in Georgia.
It can be especially hard for families outside of metro Atlanta where LGBTQ people aren't as visible. Lowell said she recently saw one patient who'd been turned away by nearly a dozen other physicians.
LGBTQ health is not taught comprehensively in medical schools today, according to Lowell, and even in metro Atlanta the system of primary care doctors, therapists and endocrinologists who provide gender-affirming care resembles a patchwork.
A few years ago, Suzanne Haerther of Atlanta spent hours on the phone with her insurance company trying to find a local therapist who could help her transgender daughter, who was then in high school. Even many of the counselors specializing in LGBTQ issues told her they weren't experienced treating transgender patients.
"As a parent you have a child who's going through a traumatic experience and you're trying to find somebody who can professionally help them," Haerther said.
At the statehouse, at least one prominent Republican has indicated he's not interested in wading into the fight.
"Sometimes we have issues that come along that are almost solutions in search of a problem," said House Speaker David Ralston, R-Blue Ridge, when asked about the sports bill in April. He hasn't weighed in on Ehrhart's bill, but the measure did not advance past the committee stage last session.
Despite that, some young transgender Georgians have cast their gaze outside the state as they decide where they want to build their futures. Even without passage of the legislation, they feel like they'd be more welcome elsewhere.
P., a high school junior, is looking at colleges outside the South. Sam Schexnyder, a 16-year-old from Decatur, didn't wait until graduation.
Within weeks of coming out as transgender in eighth grade, Schexnyder witnessed his local schoolboard get embroiled in a fight over its bathroom and locker room policies. So he was blown away when, on a trip to the West Coast, he saw how much more accommodating other states were to trans people.
He begged to move in with his aunt in Seattle, and upon starting school there almost two years ago, Schexnyder marveled at all of the gender-neutral bathrooms and multiple options on enrollment forms for pronouns. Teachers were used to trans students — there are a half-dozen in each grade in his new school — and there's no risk of his classmates accidentally calling him by his old name or pronouns since they never knew him pre-transition.
"It's just, it's wildly better here," said Schexnyder, a grin sprouting across his blond, bearded face during a recent video call. "I think that's definitely the most important part of transition, just to know that other people are going to help you along in that period of your life where you're figuring things out and trying to become a better version of yourself."
Isbister, the head of TransParent, and his wife Robyn had resolved to provide that kind of support for their child, E., after he announced at 5 that he wanted to live as a boy. The proclamation didn't come as a surprise. E. had signaled for years that he didn't identify as a girl, eschewing dresses and at one point asking his family to call him Franklin for a month.
In the fall of 2018, the Decatur couple emailed their friends, neighbors and family members — pretty much everyone they could think of who regularly crossed paths with their children — with a request to call E. by his new name and pronouns.
"First and foremost in our minds these days is our ability to provide a safe and loving community for E. so that he does not have to grapple with hatred, shame, societal stigma, or feeling 'less than' at such a tender age," they wrote.
They know they can't shield their son, now 8, from the world forever, but they hope to insulate their happy-go-lucky child for as long as they can. Both parents are lawyers, and they say if Georgia lawmakers limit options for transgender minors, the family is willing to travel out of state to get treatment or fight such a statute in court.
"He has known from the beginning who he was," Robyn said. "It would be a crime to have him living as a girl."
Why we didn't fully name some people in this article:
It is rare for The Atlanta Journal-Constitution to not fully name people it quotes, because identity is an important factor as readers judge the credibility of information. Sometimes, after careful deliberation, the AJC makes exceptions. Several parents interviewed for this article wanted to protect their child's privacy, citing their age and the sensitivity of the topic. The AJC decided it was important to share their experiences while safeguarding minors. Also factoring into the decision: Trans youths suffer higher incidences of bullying, depression and suicide, according to studies. In this article, minors in two cases are identified only by their first initial and some parents are not fully named to protect a minor's identity. The reporter communicated with families several times through a combination of phone and video calls, emails and texts. The reporter, together with an editor, verified family details through online public documents and social media posts. Two editors also reviewed emails and texts between the reporter and families.