When asked what the best thing about being a girl is, Melissa replies "everything."

When asked what the best thing about being a girl is, Melissa replies "everything."



But the path to preadolescence for this 11-year-old Seacoast resident has been far from easy.



Melissa was born a boy and named Peter by her parents, but she is transgender and says an accident of birth did not change who she was intended to be.



"When I was little, I thought other people were different and then I realized it was me who was different," she said. "At first I was confused and even angry, but now I know a lot about it and I am happy to be who I am supposed to be."



Melissa's friends are mostly, but not all girls and she says they are supportive about who she is. "Sometimes they asked questions, especially at first," she said. "I just explain it and now they don't even ask anymore."



Melissa's parents support her. The decision to let her child be who she is was the right one, her mom Linda said, while admitting it was not easy.



"We had one very unhappy child on our hands," Linda said. "She realized who she was supposed to be, that who she was on the inside did not match her outside body by the time she was 3 or 4. She was miserable. She asked why God made her a boy. She asked when her penis would fall off, or she wanted to cut it off. She said, 'I am a girl.'"



Gender Identity Disorder



The Merck Manual, the world's best-selling medical textbook, states that childhood gender identity problems are usually present by age 2. Common signs include children preferring to dress like the opposite gender, insisting they are of the other sex, persistently wanting to participate in typical games and activities of the other sex, and having negative feelings toward their genitals.

The term Gender Identity Disorder, or GID, was coined by Dr. Kenneth J. Zucker and describes people who believe they were born into the body of the wrong sex. The cause of GID continues to be contested among experts.



The Merck Manual reports that theories suggest GID is caused by genetic abnormalities, endocrine problems like a testosterone or estrogen imbalance in the womb, social factors like parenting or some combination of issues.



According to WebMD, GID appears more frequently in males than in females and the Merck Manual estimates 1 in 30,000 adult males and 1 in 100,000 adult females seek gender reassignment surgery, a treatment chosen by some people with GID.



The life of a girl



As with any young girl, Melissa's activities with her friends include having sleepovers and doing each other's nails and makeup. She loves to shop. "I like to shop for clothes, wigs and makeup," she said. "I love makeup. I just got my ears repierced because they closed up."



Melissa, who will soon turn 12, made her transition in 2011, as she entered fourth grade. Transitioning means she decided to attend school and live life completely as a girl. She is now in sixth grade, and says she loves school and her life.



In efforts to be a girl, Melissa, then living as Peter, wore her hair long. She turned T-shirts into skirts by making the neck hole a waistband.



"She was very decorative and could turn anything into a dress," Linda said. "Girl toys made her happy. If she got boy toys for gifts, she was disappointed. Melissa had a fascination with mermaids, because they are ambiguous sexually. She wore tops with her trunk bathing suits, to not show her breasts."

At home, Melissa dressed female. Her older siblings didn't mind and would tell their friends that this was their brother Peter, who liked to dress as a girl. Then they'd go outside and play football while Melissa tried to interest them in a tea party.



"We bought boy costumes at Halloween, but she wanted to be a princess," Linda said. "There comes a point you must realize that this is not a phase. No one teaches a parent how to go from one gender to another. I birthed a boy and now I have a daughter. Melissa doesn't want to see pictures of Peter because she doesn't want any reminders that she was ever a boy."



The difficult decision



The choice for Linda and her husband Mark was clear, they said. They could choose a happy, healthy daughter, or they could watch an unhappy boy sink into depression and possibly suicide. The suicide rate among transgender children is high, Linda said.



"Right-wing religious groups have called what we are doing child abuse," Linda said. "They should try being in my shoes. You have to let the kids direct you. They didn't choose this. It's hard enough approaching teenage years without fitting the mold. This is the hardest road I have ever seen. We just want her to be happy, and to be here because we love her."



Francie Mendel is director of mental health services for the Gender Management Services (GeMS) program at Children's Hospital in Boston.



"Self-harm is very high — cutting, mutilation and pills," Mendel said. "I'd say at least 25 percent of the kids who are transgender or exploring it participate in self-harm at one time or another. But very, very few of them change their minds about who they are. If they do, it's usually at puberty. "



Mendel said gender treatment follows strict guidelines.



"To be seen, the child must be at least 10 years old," Mendel said. "We require letters from the parent and the child's therapist. We require ongoing therapy. Hormone treatments must be through an endocrinologist."

Linda said she conducted online research on transgender issues. "At first, I couldn't find much. Now there is a lot," she said. "There are lots of Web sites. The first thing I saw was a TV special with Barbara Walters about Jazz, a transitioned transgender. I showed it to Peter and asked if this was how he felt. We moved forward."



Though rare, Melissa is not alone in dealing with the tumult and struggles of being transgender.



Cooper, an 18-year-old from Dover, was born female. The teen, whose last name is not being included, graduated in June from Dover High School, where he ran on the boys track team. He is now at the University of Vermont studying secondary education.



"I think I always knew," Cooper said. "I was seeing a psychologist for something else and my mom found some writing I did about what I wanted to be. I had mixed emotions and it wasn't easy. I was angry that I thought she was snooping. I was frustrated but we finally came to a place where it was OK. Then it was a sense of relief."



Cooper's mom Julie said he was never a "girlie" girl but she didn't have a name for what he was going through.



"He had boy friends," Julie said. "For Halloween he wanted to be boy characters, Harry Potter and Batman. When he was about 15, I found his blog. I approached him with the information and it was clear he had known what it was about for a long time."



Cooper said he was in high school when he transitioned. He said most of the teachers and some very understanding guidance counselors helped him along the way.



"It was an adjustment," Julie said. "Teens are a tough age anyway. I was afraid of offending him because I didn't know enough about what to say. But Coop is finally happy and outgoing socially. He is comfortable in his own skin. He was moody and withdrawn before so my husband and I are totally on board."

"I have great friends and one even made a documentary of my experiences," Cooper said. "I also have a really big family and have received endless support."



Cooper made his transition too late to block puberty as a girl. He is now on testosterone therapy to encourage male characteristics.



The medical transition



Melissa's name has been legally changed. She will soon begin hormone blocking therapy, to delay puberty until she can make a decision about surgery. Linda said she is sure that will happen, but if it didn't the hormone blockers are reversible. If she stopped using them, Melissa would begin puberty, as a boy.



"I am nervous about puberty," Melissa said. "I do not want all the gross boy stuff."



Sergio Zullich, pharmacy clinical manager at Portsmouth Regional Hospital said hormone blockers are safe and for most people are completely reversible should they change their minds.



"The decision to use the therapy must be made before puberty," Zullich said. "Otherwise, different therapies are indicated. Hormone blockers are reversible although it may take a bit of time depending on how long they are using it. Some delay may happen and it may not be 100 percent without impact in all cases. Some might see sperm reduction later in life for example or it could affect egg release."



The treatment is usually a monthly injection of a gonadotropin release hormone. Zullich said it is costly. After puberty, treatment for male to female is a combination of estrogen and an anti-androgen agent. For female to male, it is testosterone, as Cooper is currently doing.



All medication carries some risk. Zullich said testosterone can increase aggressive behavior. Estrogen risks include blood clots, increased triglycerides and heart issues.

Treatment is an option open only to people who have the financial means. Neither the hormone treatments nor the later options are covered by insurance. Linda is a stay-at-home mom and her husband Mark is a vice president in a high-tech sales company, where he has been since 1980. She said they are fortunate to be able to help Melissa.



Linda said Melissa "absolutely" wants to have gender reassignment surgery someday.



The road ahead



When Melissa made her transition in the fourth grade her parents sent a letter to every parent in the school district. They explained and encouraged anyone with questions to contact them directly. The school and the community rallied in support of Melissa, Linda said.



"Sometimes the kids would call me the wrong name, my old one," Melissa said. "I told them it's OK and knew they would get used to my new name."



"I gave her school a copy of a great book, 'The Transgender Child — a Handbook for Parents and Educators,'" Linda said. "They returned it after buying six copies for the school. The biggest issue we faced was where she was going to use the bathroom. Now it's all set and they have made a change to two single-stall bathrooms that are no longer labeled girls and boys. They are unisex."



That's not to say everyone is on board. Linda said she met difficulty with her parents, who are staunch Catholics. Because they love Melissa, her grandparents are working through their reservations, Linda said.



"I admit I have a protective bubble around our family," Linda said. "I have lost friends over this. One time, a best friend asked me to tone down Melissa's girliness when we came over. We don't go over anymore. Another time one of Melissa's friends outed her to a new child, who was mean to her and made fun of her. We have to take that in stride."

Bullying can be an issue, said Dr. Jamuna Theventhran, a psychiatrist at Portsmouth Regional Hospital. She did her residency at St. Vincent's Hospital in Greenwich Village and saw similar cases.



"Bullying and homophobia are there," she said. "It's hard, especially for the older populations when gender identity is not congruent with physical anatomy. In all of the cases I have seen, the person told me they knew what their issue was from a very young age. "



Dr. Malcolm Beaudett, chief of psychiatry at Portsmouth Regional Hospital, said they have not seen a lot of cases, but he would worry about bullying.



"Anytime a child is different, that possibility exists," Beaudett said. "I think the more open the kids and families are, the better is the support. Hiding this would make it very hard for a child or teen to have a positive view of themselves."



Hiding is not something Linda believes is an option.



"I would rather have an alive, happy child, no matter what," she said. "We love her. People should see her for what she is, my happy, well-adjusted daughter. My hope for her life is that she always be happy."