But fifth grade was different. When the other girls had started to talk about getting their periods, Pagonis was ashamed to learn hormone replacement pills would be needed to experience other aspects of puberty, including a growth spurt and breast development. In keeping with medical practices at the time, Pagonis had only been told the bare minimum about their medical situation: that doctors had removed some "tissue" — actually their internal testes — when they were little, that they couldn't have babies and that they couldn't menstruate.