Margie Fishman

The News Journal

His first word was Mama.

His first sentence: "I am a girl."

He never felt at home in his body. Once, he tried to castrate himself with kiddie scissors.

This Wilmington toddler knew he was all wrong.

And that absolute certainty sent the boy and his mother on a decadelong struggle for him to be recognized and live as his "truegender."

It was not a well-beaten path for the boy's mother, DeShanna Neal. With her baby barely out of diapers, she mounted a campaign to convince family members, daycare providers, educators and ballet instructors that her little boy had the heart and spirit of a girl.

DeShanna wasn't the type who ached for marriage or kids, much less a high-maintenance girl. She fancied herself a feminist.

So, when the ultrasound tech announced that her first-born would be a boy, there were lukewarm congratulations and a baby blue shower.

DeShanna and her then-fiancé, Chris, both comic book geeks, named their baby Xavier after the founder of the X-Men, who promoted peaceful coexistence and equality between humans and mutants.

Trinity would be the baby's middle name, in a nod to the fierce female hacker from "The Matrix" who escapes simulated reality. The idea came to DeShanna in a dream. The expectant mother was surrounded by blue wallpaper on all sides until the paper ripped into shards, exposing a patch of pink.

DeShanna thought nothing of it as she embraced her two-week-old baby, his pudgy arms encased in wool sleeves. In that moment, she didn't care who he'd be or whom he'd love. She only knew that her love didn't come with asterisks. And that anyone who tried to hurt her little boy would face the wrath of "Momma Bear."

But when her three-year-old pointed to a picture of a boy and said, "This is my body," before pointing to a picture of a girl and declaring, "This is who I am," DeShanna had no inkling how it would all unfold.

Was this just a phase? And if it wasn't, who would they go to for help and how would they pay to alter the balance of hormones coursing through the child's veins? Xavier was about to join less than one percent of the U.S. population and be branded with a big bullseye.

An estimated .6% of adults, or about 1.4 million people, identify as transgender in the U.S. There are no reliable statistics for youth. In Delaware, more than 4,500 adults identify as transgender, the ninth-highest percentage of population in the country.

Forty-one percent of transgender people nationwide have attempted suicide, compared to less than 5 percent in the general public, a study by the American Foundation for Suicide Prevention and the Williams Institute shows. The national Human Rights Campaign counts nine American transgender women who were murdered in this year alone, all of them women of color. That doesn't include an untold number of victims of violent crime whose genders were misidentified by police.

DeShanna kept slamming into brick walls while buffering her child from society's lack of understanding and empathy. The journey would severely test her mettle.

She drew strength from her child, who believed society just needed to catch up. People grow and evolve.

And isn't love tucked into the word evolve?

"What is your name?"

"Xavier."

"How old are you?"

"Three."

"Are you a boy or a girl?"

"I'm a girl."

"You need to fix your child," the Wilmington daycare worker scolded DeShanna and Chris. "Your child is going to be gay."

Xavier wasn't allowed back. Neither was his younger brother, Lucien, after he bit a classmate who called Xavier a "sissy."

At first, DeShanna disregarded the teachers' warnings. It was just innocent make-believe for a toddler to steal his mother's silky nightgown. Toys had no gender, so if Xavier wanted a dollhouse and he was good, he got the dollhouse. She watched his brown eyes sparkle as he played with the miniature family until Lu clobbered them with his monster truck.

While Xavier blossomed at home, he alternated between throwing tantrums and acting withdrawn at his new preschool. He scored in the 98th percentile for clinical depression, according to his pediatric psychologist. He despised his body, declaring it "all wrong."

The family consulted a child therapist, who instructed DeShanna to find work outside the home so that Xavier would stop emulating her. Low-key Chris needed to be "more masculine," and they both had to smack their child whenever he behaved like a girl.

"All I heard was that this was my fault," DeShanna remembered. "Everything I had believed when pregnant for the first time — that I'd be the worst kind of mother — had come to pass."

At a loss, the professional debt collector scoured the Internet. "My son says he's a girl," she punched into the computer keyboard.

All the articles dealt with teenagers and adults. Until she found Jazz.

In 2007, Jazz Jennings appeared on "20/20" with Barbara Walters as the brave and beautiful face of a child born into the wrong body. Obsessed with mermaids and cheerleading, she had socially transitioned from a boy to a girl at age 5, making her the youngest transgender person to become a national celebrity. Jazz confirmed for DeShanna that Xavier's "phase" didn't have an expiration date.

By that point, her son had developed an anxiety-induced Pica eating disorder, gnawing on wood splinters from his bed and chewing holes in his sheets and denim dungarees.

Heartbroken that she couldn't wave a wand and grant Xavier a vagina, DeShanna located one of the few gender therapists in Delaware who would agree to evaluate a four-year-old.

The therapist immediately diagnosed Gender Identity Disorder, a tidy classification for an agonizing conflict between biological sex and expressed gender identity. It would be another five years before the American Psychiatric Association replaced the term with the less stigmatizing Gender Dysphoria.

Gender identity is established in the brain as early as age 2, according to medical research. Studies of transgender people's brains have found that they more closely resemble the brains of their self-identified gender, not of their sex assigned at birth.

There is no official cause for why a person is transgender or gender non-conforming, but doctors have concluded that it isn't acquired through exposure. Rather, it is interwoven with a person's biology, possibly caused by scrambled hormones or a gene involved at a stage of fetal development.

Xavier belonged to the first generation of Americans to grow up with transgender role models. More than a decade after the word "transgender" entered widespread use, members of Generation Z were articulating their gender identity at a much younger age.

For those who are transgender, "I wish I were a girl" isn't a fleeting thought like "I wish I were a rap star." Medical providers say it's a consistent, persistent and insistent belief that you deserve a do-over in utero.

Responses from authority figures like "man up," or "quit being a tomboy" won't help struggling children, experts say.

More: More transgender youth demand medical treatment

Research shows that transgender children with supportive parents have better outcomes for emotional well-being than those locked into pre-determined roles. A 2012 Canadian study found that transgender teenagers who were rejected by family members were more than twice as likely to exhibit symptoms of depression and more than 90 percent as likely to have attempted suicide.

"It's most important for kids in pre-puberty to encourage them not to pigeonhole themselves," said Brett Herb, one of the few therapists based in Delaware specializing in transgender issues. "Let them direct where they're going."

Xavier's gender expert suggested that he experiment with gender-neutral clothing, swapping his lumberjack flannels for blue T-shirts with just a hint of a ruffle.

With no improvement after four weeks, the couple returned to the therapist's office.

"Help us," DeShanna beseeched her through strangled sobs. "Help our child."

The gentle woman with the bob cut looked gravely at DeShanna. Then at Chris.

"Do you want a happy little girl or a dead little boy?"

Mom relented: "Guess we're going shopping."

By the time they arrived at Wal-Mart, DeShanna was full-blown frazzled.

"What do girls wear?" she grilled Chris, who stared back, incredulous.

A deli manager at BJ's, Chris wasn't entirely sure what being transgender meant. But he understood that the XX and XY he learned in biology class didn't account for fluid gender roles.

Raised Catholic, the thirty-something grew up in a time when talk show host Maury Povich paraded around transsexuals in swimsuits, asking his studio audience to vote on "male or female?" Men "pretending to be women" functioned as empty punchlines and reviled villains in mainstream films. Happy Meal toys were either hulking action figures or sparkly unicorns.

Back then, bathrooms weren't battlegrounds.

Chris recalled "Bible thumpers" in the African American community who believed fervidly that rejecting your God-given genitalia meant that you were destined for damnation.

"You don't give up on your kid," he consoled himself. "It's basic common sense."

After ransacking the girls' department for frilly pajamas, panties and Mary Janes, DeShanna and Chris beat the school bus home.

Lu hopped off first, chirping about all the Play-Doh he had ingested earlier that day. Xavier hung back, thumb firmly lodged in mouth.

DeShanna attempted small talk: "How was your day? What did you do?"

No response. (As usual).

"Trinity, how was your day?" mom pushed, trying on his middle name for the first time since his birth certificate.

"It was fine," came the meek reply.

Emboldened, DeShanna continued: "Daddy and I have a surprise for you. It's in the bedroom."

She let Xavier go alone to discover the My Little Pony dress and leopard-print leggings, laid out on his Spider-Man sheets.

He lingered there for several minutes as mom became increasingly agitated.

What if this doesn't work? she fretted. What if it drives him deeper into a black hole?

But when Xavier re-emerged, he was a vision in pink with a gummy smile. DeShanna hadn't seen her son beam like that in years, not in the snapshots of him wearing football jerseys or plopped next to Legos.

Trinity had been drowning, she realized, waiting for her mother to summon the nerve to rescue her.

In her blog, "Through Her Eyes," DeShanna shared this insight years later: "It was never Trinity that transitioned because she already knew she was a girl. It was her father and I that needed to take off the blinders and open our eyes."

STORY: No more 'fronting:' Transgender inmate embraces new name

The apprehensive child reveled in the empire-waist gown and accessories. She asked her mother: "Is this mine? Will I wake up tomorrow and they'll be gone?"

"No," DeShanna assured her. "These are all yours now."

She hesitated before asking Trinity one last time.

"I just need to know. Are you a girl or a boy?"

"I'm a girl," came the resolute reply.

Alright, then. "Lu, this is your sister," Deshanna motioned to her only son.

"Yeah, I know."

That was a Friday. By Monday, DeShanna had notified the preschool that Xavier was Trinity now and she'd be wearing a dress. Confused, the school administrators went along with it — to a point.

When it came time for class pictures, there was a radiant girl with white flower barrettes pinned to her close-cropped hair above the label Xavier Neal.

Trinity's classmates, meanwhile, seemed oblivious.

"They don't know hate at that age until they learn it from an adult," DeShanna reasoned.

With Trinity racking up gold stars for her behavior, her parents figured they had dodged a bullet by the time kindergarten rolled around.

DeShanna met with a Wilmington public elementary school, which she declined to name, to discuss adding Trinity's name to the official school roster to avoid pronoun slips, along with giving her access to the girls' bathroom. It was eight years before President Obama mandated that public schools allow transgender students to use bathrooms matching their chosen gender identity, a decision that was recently reversed by the Trump administration.

Trinity had never set foot in a boy's bathroom, so school officials struck a compromise. She could use the nurse's bathroom on the other side of the school. When riding the bus, she would be forced to wear a school ID identifying her as Xavier, and male.

No exceptions.

"Guess we're homeschooling," mom decided.

She quit working at the bank and the family dipped below the federal poverty line. They rented a dreary apartment in a complex near Canby Park where a stabbing, not Santa, heralded Christmas.

But that was nothing compared to the assaults, masquerading as questions, directed at the Neals.

DeShanna recalls her family's initial "emotionally constipated" reaction to Trinity's transition, which soon degenerated into accusations of unfit parenting, mental illness or a "split brain," sexual abuse and references to a long-lost grandson. Some referred to the child simply as "it."

DeShanna declined The News Journal's request to interview members of her family, explaining that they'd prefer not to go public.

"My family thinks we're leaving him out to dry," she wrote in her blog. "Leaving him to the wolves."

"What is really getting to me," she confessed, "is the question of, 'What did you do that has made your child this way?' "

DeShanna's mommy group, one of her few social outlets, disowned her.

"Maybe you should consider a late-term abortion because there's something obviously wrong with your uterus," a tattoo artist sneered at DeShanna, then seven months pregnant with her third child.

But the most common line of interrogation began with this: "How does she really know?"

When did I know I was a girl? DeShanna asked herself. How old was I?

"I just knew."

Gender identity is not the same as sexuality or even sex, which has more to do with chromosomes and gonads, DeShanna calmly explained to Trinity's critics. Gender identity is who you are inside, not just how you feel, but what you know: Male, female, a blend of both, or neither.

It was a hard sell, like trying to persuade our ancestors that the Earth was really round.

"The very idea that we've been wrong (about gender)," DeShanna said, "that scares people."

But she also knew that the simple act of switching pronouns, a change that some family members vigorously resisted, made her child feel "happy and whole."

Eventually, some retrained their grammar. Others DeShanna had to let go.

By age 7, Trinity, too, was demanding answers, not oversimplifications. She had joined the soccer team and wanted the correct terminology for what society would call her and people like her.

DeShanna's first inclination was to sugarcoat it, to repeat to her daughter that she was born a boy like her brothers, but that her heart and soul were all girl. She had shielded her from the label, concluding that it was unnecessary and potentially lethal.

"You are transgender, Trinity," DeShanna blurted out finally, the word sitting like bitter dirt on her tongue.

"Transgender," the girl whispered over and over before scooting off to play, her chest puffed out.

Her dreads wrapped in a side ponytail, the 9-year-old leaped out of the car like a gazelle clad in purple sweats to join the other ballerinas.

It had been two years since Trinity had attended the family-owned dance school, where teachers but no one else knew her secret. The pirouettes ended abruptly after the birth of her second brother, Hyperion (from "The Avengers").

That day, one of the teachers pulled DeShanna aside as she was preparing to leave.

"Does Trinity still have her male genitalia?" she prodded.

Mom nodded, jaw dropping.

"Well then, she won't be allowed to dress in the main room with the other girls during the recital. She'll have to dress in the utility closet."

DeShanna rushed home, compared notes with her online support network, then drove back, fuming.

How dare they treat her child like a predator, especially one who was so self-conscious about her genitalia. Apart from being discriminatory, isolating Trinity would likely undermine five years of progress toward self-acceptance.

The school's "safety" concerns weren't registering with the incensed mother, so the owners took a different tact. They threatened to "out" Trinity to the other dance parents.

DeShanna broke the news to her ebullient daughter on the car ride home.

"Trin, you won't be going back to that dance school."

"Why? I did my steps right and everything?"

DeShanna murmured something about finding a better fit, a more "loving and caring environment."

"It's because my body got all mixed up, isn't it?" her child demurred.

"Yeah, baby. I'm sorry."

Then puberty hit.

Within eight months, Trinity's hormone levels spiked to stage 2 on the widely-used Tanner scale of physical development, when pubic hair and testicles begin to grow. Her testosterone was going gangbusters.

This alarmed Trinity; she had assumed she would go through female puberty like the other girls.

She had nightmares about growing a beard, her voice plunging to Barry White depths. She willed her body to cooperate, but her renegade brain kept signaling "Change!"

In late 2015, less than a month before Trinity's 12th birthday, Daniel Doyle, chief of the Division of Pediatric Endocrinology at Alfred I. duPont Hospital, ordered puberty blockers for his patient.

Trinity was the youngest transgender person the Rockland doctor had treated over a career spanning nearly three decades. He could count the others on one hand.

Pragmatic with incisive, deep-set eyes, Doyle knew that he and the Neals had painstakingly assessed this next step. He wasn't about to let them down.

“It’s not something that they take lightly and will change their mind," he said of the family.

Puberty blockers involve suppressing the release of two hormones, LH (luteinizing hormone) and FSH (follicle stimulating hormone), from the pituitary gland. The treatment, endorsed by the Pediatric Endocrine Society and offered at more than 35 clinics nationwide, stops testosterone from being released from the testes, and estrogen from being released from the ovaries, thereby halting sexual development.

In essence, blockers buy more time for a transgender youth who is transitioning, since the effects are reversible once a person ceases treatment. Youth are spared from the anguish of watching helplessly as their developing bodies subvert their gender identity.

Not being exposed to one’s own sex hormones also offers a blank slate for cross-hormone therapy, which is the point of no return. For Trinity, that meant achieving a curved, feminine shape without enduring surgery later on.

Doyle outlined these arguments in a letter to Highmark Health Options, a Delaware Medicaid provider. He recommended the drug, Lupron, which is injected in the upper buttocks every three months at an average annual cost of more than $9,000.

Highmark's denial came a week later. DeShanna didn't miss the reference to Xavier "Trinity" Neal, as if Trinity were a fun nickname.

The state's largest insurance provider concluded that the blockers weren't medically necessary for Trinity's diagnosed gender dysphoria. They were only FDA approved to treat precocious puberty among youngsters.

Had her daughter suffered from cancer or diabetes, Medicaid wouldn't dare deny treatment, DeShanna huffed as she began strategizing an appeal. Eleven days later, another letter arrived, informing her that the appeal window was now closed.

Stupefied, DeShanna attended a service at her Unitarian Universalist Fellowship of Newark, where she shared her family's struggle. Hurtling toward puberty, Trinity was tormented and frightened, she told the congregation.

State Rep. Paul Baumbach, a former treasurer of Equality Delaware who was in the audience that day, empathized with the testimonial. The Neals didn't live in his district, but the lawmaker and financial planner offered to intervene.

Baumbach got in touch with Sarah McBride, an old friend, Wilmington native and national transgender advocate. McBride, who made history last year as the first transgender woman to speak at the Democratic National Convention, hooked up Baumbach and the Neals with the latest medical research on the effectiveness of puberty blockers.

STORY: Trans woman's road to DNC included ties to Markell, Biden

Meanwhile, DeShanna, an author of erotic fiction, had persuaded Highmark to grant her an appeal hearing by penning a clever response that was copied to multiple state health leaders and Baumbach. In it, she cited a provision of the Affordable Care Act, which prohibited discrimination based on gender identity in federally funded programs. It was a veiled legal threat.

"Your kids aren't asking for much except to know you've got their back," she would explain later. "And maybe an allowance."

On Dec. 11, 2015, DeShanna strode into the Highmark conference room to face off against a half dozen health care officials representing the insurance giant and the state. With her husband busy watching the kids, DeShanna brought along her Unitarian reverend, Andrew Webber, who offered to wear his clergy collar to elicit sympathy. Doyle joined by phone.

Wearing a pained "I don't want to be here but this is my job" look, a Highmark executive turned to an oft-repeated 20-year-old study: In 1995, researchers found that of a sample of 45 gender-nonconforming children, 80 percent were not transgender by the time they entered high school.

Doyle interjected, explaining that new guidelines released by the Pediatric Endocrine Society recommended early medical interventions for transgender youth experiencing severe distress.

The executive then grilled the doctor about his scant record treating transgender youth.

As the hearing wore on, DeShanna grew increasingly agitated. Didn't her daughter deserve the same respect as any other low-income child seeking medical care?

Her indignation masked a mother's guilt. She could roar and clog up email inboxes. But she couldn't afford to save Trinity.

By the time the state took this seriously, she worried, it would be too late for Trinity and all the other black transgender kids deserving of unconditional love.

Their Black Lives also mattered.

STORY: Delaware prisons beef up transgender protections

That day, the reverend had the final word.

"I hope you think deeply in your heart and make the right decision," he urged the bureaucrats holding the purse strings.

Tucked into their packets was a handwritten note from Trinity. Cramped lettering revealed a timid child who didn't understand why everything had to be so complicated.

"I don't want to be a boy or I'll be sad for the rest of my life," the letter read. "Please give me my blockers."

"It'll be a dream come true."

Part 2 of 2: Transgender teen pushes boundaries to be "legal"

Contact Margie Fishman at (302) 324-2882, on Twitter @MargieTrende or mfishman@delawareonline.com.

An estimated .6% of adults, or about 1.4 million people, identify as transgender in the U.S. There are no reliable statistics for youth. In Delaware, more than 4,500 adults identify as transgender, the ninth-highest percentage by population in the country. Trans people are more likely to be from racial and ethnic minorities.

Definitions:

Sex: The classification of a person as male or female assigned at birth, based on the appearance of external anatomy.

Gender identity: A person's internal, deeply held sense of their gender.

Sexual orientation: A person's enduring physical, romantic, and/or emotional attraction to another person; this is not the same as gender identity.

Transgender: A person whose gender identity is different from their biological sex.

Gender-nonconforming: A person whose gender expression is different from conventional expectations of masculinity and femininity; not all gender-nonconforming people identify as transgender and vice-versa.

Gender dysphoria: Previously called gender identity disorder, gender dysphoria is the feeling that your body does not reflect your true gender. It can cause severe distress, anxiety and depression. To be diagnosed with gender dysphoria, a patient must exhibit several signs for at least six months, including a repeated insistence of belonging to the opposite sex and engaging in cross-sex roles, a strong dislike of one's sexual anatomy and of the typical toys and games played by one's sex, and a strong preference for playmates of the other sex.

Cisgender: A person whose gender identity matches the biological sex.

Sources: Williams Institute 2016 report, "How Many Adults Identify as Transgender in the United States," and the Gay & Lesbian Alliance Against Defamation.

Resources:

"The Transgender Child" by Stephanie Brill

"If You Are Concerned About Your Child's Gender Behaviors," a Q&A guide produced by Children's National Medical Center.

The Human Rights Campaign offers a comprehensive online resource for transgender children, their families and care providers at www.hrc.org.

The Trans Youth Equality Foundation provides legal and educational resources for parents of transgender children at www.transyouthequality.org/for-parents.

PTK Delaware, Parents of Trans Kids and Support Group, meets monthly in Wilmington. For more information, email PTKDelaware@gmail.com. PFLAG Rehoboth Beach meets monthly in Lewes. For more information, visit www.pflagrehobothbeach.org or email pflagrehobothbeach@gmail.com.