SOME people call it “transgender regret”. When you change from one gender to another and then feel, somehow, you’ve made a mistake. Others call it “detransitioning” or a “reversal”.

Zahra Cooper calls it, simply “going back”, as she told the New Zealand Herald .

“It sounds weird so I don’t usually say it. It’s embarrassing. It’s embarrassing to go back.”

Under the table she is holding a smooth round stone, gripping it to try to keep from shaking. She looks at the floor, and hunches her shoulders as if trying to hide herself in her black Batman sweater. Talking doesn’t come easy for Zahra, 21, particularly when it’s about the events of the past year — her transition, her suicide attempts, her eventual Asperger’s syndrome diagnosis.

“If I’m asked, I just say my voice sounds deep, because it is,” she says. “It’s not a thing to say to someone I used to be a boy and now I’m a girl ... again.”

Zahra was born in Kaitaia. As a girl. Or, as they say in the transgender community, she was assigned as female at birth. Photos show a smiling child with an impish grin, dark hair, round cheeks. She was shy, a little naughty. Her family split up, and Zahra moved between Whangarei and Kaitaia.

At school, she struggled to make friends, preferring to spend time with her animals while feeling constantly out of place. “I’ve always struggled with my gender identity, always questioned whether I was a boy or a girl,” she says.

Everyone thought she was a typical tomboy, wanting her hair short, asking her mum if she could wear blue or black clothes. “I knew I was different when I was about 14. I hated my boobs at the time. Everything on the body, I just hated it.”

At first, Zahra thought she was gay. But after searching the internet and watching YouTube videos about transgender people, she realised she felt more like she was trapped in the wrong body.

For four years, she struggled between the genders, being bullied at school and online for being “weird”. At 18, she asked her family to start calling her “Zane” and using male pronouns. She began to think about formally transitioning — taking hormones to become more masculine.

Her first doctor, in Whangarei, refused to even discuss the issue. “He was really transphobic,” Zahra says. “He said ‘you’re a female, you were born female, I pulled you out of your mother’.” Afterwards, Zahra began seeing a counsellor. They wrote a referral for a second GP, who arranged an appointment with an endocrinologist, who could prescribe testosterone — a first step on her journey to becoming male.

It took eight months to see the endocrinologist because of long wait-times in the public health service. During the wait, Zahra was required to meet a psychiatrist, who questioned her about her childhood, and how long she’d been dressing like a male. She was diagnosed with gender dysphoria — feeling at odds with one’s biological sex — paving the way for the endocrinologist to go ahead with the hormone treatment when the appointment came.

In December 2015, Zahra began taking testosterone, at first swallowing pills three times a day, and then via injection. After what seemed such a long wait for treatment, she expected to feel elated. But the euphoria many trans people describe at that point never really set in.

“I started getting really angry from the testosterone, which is a side effect,” she says. “But then I started getting depressed. I was like, why am I depressed? I should be happy.”

As the physical changes began, Zahra grew more and more anxious. She fought with family, often storming out of the house.

“I was getting a deeper voice, facial hair and many other changes but I just wasn’t happy with them,” she says. “I didn’t feel like myself.”

Then eight months in, things hit crisis point. Zahra tried to kill herself. Twice.

Her grandfather, Victor Rakich, found her, comatose after an overdose, and helped to save her life.

Zahra had been living with Rakich, a retired farmer, for four years prior to her transition. He “took her in”, he says, and Zahra loved life at his little farmlet north of the township, where she hand-raised a duck named Ducky, and bottle-fed the sheep.

Initially Rakich, who Zahra calls “Poppa”, struggled to accept his granddaughter’s new identity. He refused to call her Zane, despite wanting to support her. “I couldn’t handle it,” he says. “I said I can’t change. If you want to change, you change, but I can’t. But I wasn’t going to kick her out. I love her.”

They puddled along like that, until Zahra began taking testosterone.

“When she went on to those pills and stuff I could see her going downhill, but no one believed me,” Rakich says. He was concerned she hadn’t seen the endocrinologist again, despite the rapid change in her mood and appearance, and was told it was partially because of their remote location.

“I kept saying, why isn’t anyone monitoring her? Why isn’t anyone coming in? If you were in Auckland they’d do it, but since you’re in Kaitaia you can’t do it.”

Rakich says after the suicide attempts he pushed for Zahra to see another mental health specialist. This time, she was diagnosed with borderline Asperger’s syndrome, a mild form of autism.

“That’s when everything clicked,” Zahra says. “And that’s when I started doing some deep thinking.”

On the internet, she learned Asperger’s people commonly struggle with gender identity issues. Experts say this is because of a tendency to think in black and white, to have a very fixed idea of the rules, and therefore look for reasons why they don’t fit in — often landing on gender dysphoria as an answer.

Back at home with Poppa, Zahra’s thinking period lasted about a month. She watched more YouTube, began to look for other people who had detransitioned. It began to dawn on her that she too wanted to go back.

There was, however, an issue. Zahra had begun dating a transgender boy called Tyson Kay.

Tyson is 17. He too was assigned female at birth, and at the time of Zahra’s breakdown was in the middle of his own transition to male.

“I didn’t know how he would feel,” she says. Going off testosterone meant more mood swings, and an unpredictable end result. She didn’t know whether he would want to hang around, and worried over how to break the news. In the end, Zahra texted him saying: “I’m going to transition back”.

Tyson was at his mum’s house when he got Zahra’s message. Initially he thought she was kidding.

“I thought it was a prank,” he says. “Because you wouldn’t think someone would just do that.”

Tyson has short brown hair and bright blue eyes, broad shoulders and wrists. His voice is yet to drop, but he’s hoping it will soon. His beard is just coming in. He has always felt male, and waited for years to finally be allowed to take testosterone, which he loved from the first injection. Because of this, he struggled to understand Zahra’s decision.

“It kind of upset me because being transgender you go through a lot of struggles to be who you are today, and then someone switches back and people think you’re going to do that,” he says. “You have to live with the fact that people think you’re going to switch back but you’re not.”

Statistics on trans people are hard to find. The Youth 2012 survey found of 8500 New Zealand secondary school students, 102 were transgender and 212 were not sure of their gender. Statistics from Britain estimate a prevalence of 20 per 100,000.

There are no local figures at all on detransition. Overseas, trans advocates usually say it’s less than 1 per cent of trans people, though transphobic groups sometimes say it’s as high as 30 per cent.

Auckland sexual health specialist Dr Rick Franklin, one of the country’s transgender experts, says the phenomenon is incredibly rare. “In hundreds of patients I can only remember two. Occasionally it will happen, even with the very best provision of service, although it does happen more frequently when pathways are not followed.”

For Zahra, her main worry about transitioning back was that it would reflect poorly on other trans people, like Tyson, or provide extra fodder for the anti-trans lobby. “There’s people out there who think it’s just a phase. But it’s not. It may have been for me but it isn’t for someone else.”

Eventually, she decided she had to act in her best interests, even if it meant attracting scorn from others.

As a boy, Zahra says she looked similar to how she does now. A short pixie haircut, black jeans, paired with sneakers and T-shirts. A darker moustache. More body hair.

She had breasts, but would hide them, as “top surgery” — to create a flat chest — requires a long wait in New Zealand and can be expensive. Getting a full gender reassignment is near unheard of through the public system, with funding for only one female to male operation, and three male to female, every two years through a high-cost treatment pool.

There are no photos of “Zane”, because when Zahra decided to go back, she quit cold turkey, and deleted all evidence of her male self, including her YouTube clips. “I just stopped taking everything. They said that I would probably get really angry because of the testosterone wearing out. I kind of did but it wasn’t that bad.”

At the start, she went on some kind of female frenzy — buying makeup, wearing “girly” stuff, but it didn’t last. “I’m just not a girly girl,” she says.

She shrugs. She still lacks confidence but Tyson is helping with that. She’s also studying, with the hope of becoming an animal handler. Tyson and Zahra have moved in together, a two-bedroom off the main road, with two little birds in a cage, and a tiny black kitten named Hazel.

It’s just passed their one year anniversary. To celebrate they went to McDonald’s, and shared a Big Mac, just like on their first date.

It is in stark contrast to this time last year.

“When she was Zane she was really angry and would always lie to me about small things,” Tyson says. “She just wasn’t a happy person. But when she changed back she was much happier. She smiles a lot. Doesn’t lie.”

He isn’t bothered that he’s now dating a girl — Zahra was the first male he’d been with, so it was unusual for him, he says. “I care about the person not the gender anyway, so it didn’t matter to me.”

Poppa is happier too. He still slips and calls Zahra the wrong name sometimes and she teases him about it. “How would you like it if I called you Victoria instead of Victor?” she says.

Rakich answers: “You’ve called me worse things than that!” Mostly, he calls her “bub”, to be on the safe side.

Despite the improvements, Zahra, Tyson and Rakich have lingering questions about Zahra’s care. Access to transgender health, trans activists say, is an ongoing issue in New Zealand, where the availability, accessibility, acceptability and quality of medical services required to transition — particularly outside of main centres — has long been problematic.

As yet, there are few regional specialist services, and no national guidelines for transgender health. The most recent guidelines from Counties Manukau District Health Board in 2012 do, however, lay out a preferred pathway for those wishing to transition — including counselling, psychiatry services and a period of “lived experience” before going on hormones. None of those are compulsory, however.

For those wishing to transition to male, the guide says “a high standard of consent” is required, given many changes caused by testosterone are irreversible — including a lower voice and potential infertility.

It urges ongoing monitoring of the patient and vigilance around side effects, particularly in young people. Patients are required to be seen every six months by the endocrinologist — something Zahra says did not happen despite her requests. Suicidality is a particular safety concern.

Rakich says he does not think the required standards were met. “She couldn’t talk to anyone. I don’t think she got enough support. I personally think when they prescribed those pills they should have checked up on her,” he says. “I hate seeing young lives wrecked. You’ve got to give them more attention, not just medicine.”

Dr Theresa Fleming, an adolescent health researcher at Auckland University, says while not all transgender people are suicidal, they do need a lot of support — and often, rather than specialist services, that means support and people to answer questions.

“Historically, lots of services have been based around people who are already sure. But sometimes young people are just wondering. They need information.

“They need someone who understands adolescence and gender identity and mental health — not a specialist but a generalist who can talk to them.”

Fleming says it is increasingly understood that gender, like sexuality, is on a continuum.

Just because someone has questions about their gender does not mean they are trans. They could be what is known as “non-binary” — or neither — or both.

“It’s very difficult. People who are transphobic will see cases like this and think liberal health services are pushing kids who ask questions to be trans. That’s not true. But it is hard if you don’t fit one box because we have a system based on specialities.”

For Zahra, it is frustrating to think her Asperger’s might have been picked up earlier, though she’s unsure if it would have had an impact on her gender journey. “I would have got help through school and would have had a teacher aide and wouldn’t have failed school. I would have understood myself more.”

Slowly, she is coming to terms with the fact her gender might always confuse some people.

Recently, she took a trip to a clothing shop to get a bra, and the shop ladies were visibly shocked when they heard her voice — which sounds similar to a teenage boy’s, and is likely to stay that way.

“At The Warehouse they call me “sir” because of my voice too, even though I’m dressing as a girl,” she says.

“Sometimes it pisses me off.”

More hurtful is the abuse doled out to her and Tyson, who was also bullied and they can get depressed and anxious when people call them names or judge them.

“It sucks because we can’t hold hands in public because people think I’m a guy even though I dress female,” Zahra says. “I would love to be seen more as a female ... but sometimes I can’t help it.”

She points at her throat, then looks at the floor. But then she laughs. “I don’t care they can judge me all they want. Everyone is different.”

Readers seeking support and information about suicide prevention can contact Lifeline on 13 11 14.

This story originally appeared in the NZ Herald and is republished here with permission.