Despite the physical changes wrought by the hormones, Abby continued to suffer from a profound self-consciousness about her face. She felt that when she was seen from the front she looked persuasively feminine, and even striking, with abundant hair that framed her face, and wide-set eyes. But when she turned her head she looked far more masculine: the bossing of her brow showed in profile, as did the length of her jaw. She was so conscious of her Adam’s apple that she tucked her chin down, to conceal it, and refrained from turning her head, looking to the side with only her eyes. With her dipped head and her inhibited range of motion, her mannerisms became those of a demure Victorian.

Abby’s self-consciousness in the company of others was nothing compared with the unhappiness she felt when faced with her own reflection. Whenever she passed a mirror, she saw the ghost of her former self, and it appalled her. Though Ousterhout had developed his procedures on the premise that his trans patients wished to move through the world without attracting unwelcome notice, Abby’s desire to undergo the process was more interior. The person whose reaction to her face she most wanted to change was herself.

Abby was not among those trans people who knew from early childhood that their gender identity did not line up with the gender they’d been assigned at birth. As a child, she was aware only that something was off. She was a shy kid, and for a long time she had a stammer, but she was an excellent student. Although she lived in a conservative part of the South, her parents were relatively liberal, and her childhood was quite sheltered. When she was taunted in middle school with the label of “gay”—then the all-purpose slur for any form of gender nonconformity—she knew only that the word meant “happy.”

When Abby eventually discovered what “gay” meant, she knew that it did not apply to her. Yes, she was shy and emotional, attributes that are not stereotypically masculine, but she was definitely attracted to women. Her interest in them had an additional dimension, though. When she played video games, she often chose a female avatar. She wasn’t alone in doing that—boys she knew also did it, because it was more fun to watch a virtual figure in a bodysuit—but later she recognized that her motivation was different. She really wanted to be the girl. Bette, Abby’s mother, later racked her brain, trying to find clues she had missed about Abby’s gender identity, but she came up blank. She knew only that she had an unusually sensitive and intuitive child. Whereas Abby’s younger brother came home from school and talked about his day for just a few minutes, Abby sat down with Bette for an hour or two every night, and shared all sorts of things. What a beautiful young man, Bette thought: one day, he is going to make some woman very happy, because he thinks like a woman.

Abby went to college in the Midwest, where she fell in with a group of progressive students, and joined campaigns for L.G.B.T.Q. rights. In her sophomore year, she had a relationship with a female student. She felt that many of her peers secretly questioned the romance, and were waiting for her to come out as gay. She resented the expectation, while feeling uncomfortable about why the suggestion made her so uncomfortable. Abby forestalled a reckoning, telling herself that, for many young adults, feeling uncomfortable with one’s body was just part of life.

After graduating from college, she began a Ph.D. program in biology, but found that laboring alone in a laboratory was not for her. She completed a master’s degree, and eventually moved to Colorado, both to seek out teaching work and to have the space to figure out her identity. Many trans women go through a masculinization phase before coming out as trans—sometimes by joining the military, sometimes by bulking up through exercise—in the vain hope that, by embracing an extreme of masculinity, they will find relief from the pressing sense of not-rightness. Abby didn’t do this, exactly, but she did become fitter and healthier. She met Sofia, a college student studying math, through rock climbing, and in many ways she felt better about herself than she had in years. But the things that were going well in her life made starker the things that were not.

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Abby had begun to find a framework for understanding her identity, in part because of the emergence of trans celebrities. And on the Internet trans people chronicled their transitions or posted videos about their personal histories. For Abby, it was empowering to discover that she was not alone with these thoughts. Finally, she mustered the wherewithal to acknowledge to herself that she was trans. One Saturday morning in February, 2016, she wrote a twelve-page entry in her journal, and that evening she gave it to Sofia, who read it in bed, with Abby anxiously curled at her side. When Sofia finished it, she told Abby that she loved her, and would support her.

Abby was the kind of person who, once she put her mind to something, was all in. In April, she began hormone therapy. The first effects were mental: she felt a remarkable clearing of the mind. (Other trans women describe a sense of relief that comes from eliminating their masculine sex drive, which had previously interrupted their thoughts like a car alarm that couldn’t be shut off.) Abby’s skin became more vulnerable to bruising. She was thrilled to see the muscles of her back melt away, revealing the sculptural plates of a woman’s scapula.

In the summer of 2016, she went home to see her parents. When she announced that she had something to tell them, Bette thought that Abby was going to tell them she was gay. (Abby later noted, dryly, “I am.”) When Bette heard that Abby was trans, she went through a period of mourning, and she worried about Abby’s safety and happiness, especially after she read of high rates of suicide among trans people. But, the more reading that Bette did, the more she became convinced that the statistics were largely the result of trans people being marginalized by their communities, or rejected by their families. Bette made every effort to understand her child, and, if out of habit she sometimes referred to Abby by the masculine pronoun, she was contrite, and was forgiven.

In the fall of 2016, Abby legally changed her name. Early in her transition, she experimented with wearing makeup and dresses—and she immortalized her first blowout on Instagram—but she preferred not to put on lipstick and foundation, and was most at ease in jeans or workout clothes. She transitioned at work when the new semester started, in January, 2017, and was grateful that the institution was supportive. She also felt that she should be a role model for students who might be questioning their own gender identity. She accepted this as a responsibility to her community, but it was a lot to take on while she was relearning how to move through the world: how to dress, how to carry herself, how to modulate her voice.

By the summer of 2017, Abby had crossed an invisible line, and most new people she met correctly gauged her gender, calling her “Ma’am” or “Miss.” It was exhilarating to go into a restaurant with Sofia and hear the maître d’ address them as “ladies.” Anxiety over which public bathroom to use—the subject of legal victories during the Presidency of Barack Obama, and of disheartening reversals during the Presidency of Donald Trump—abated with time. But Abby remained intensely pained by the vestiges of masculinity in her face. She scrutinized her appearance for changes wrought by estrogen with the obsessive focus of a teen-ager preparing for a date. In many ways, she felt like a teen-ager—as if she were again in the throes of puberty, though this time on her own terms.