Margie Fishman

The News Journal

PART 1: A child's journey to "truegender"

For years, the child born as a boy repeatedly begged his mother for medicine to make him a girl.

Two weeks before Christmas of 2015, DeShanna Neal strode confidently into a hearing at Highmark Insurance to appeal the company's rejection of her 12-year-old child's requests for puberty blockers.

With DeShanna and her pastor on one side of a long table and a half dozen insurance executives on the other, the impassioned mother explained what was at stake: A happy girl or a dead boy.

Suicide is the leading cause of death among transgender youth, she pleaded.

Three days later, the insurer's decision arrived in a form letter.

Denied.

The treatment wasn't FDA approved for people like Trinity, Highmark explained.

Stunned, DeShanna and her network of advocates sprang into action.

Daniel Doyle, Trinity's A.I. duPont endocrinologist, immediately contacted the Gender & Sexuality Development Clinic at the Children's Hospital of Philadelphia, a magnet for the region, to prepare a new appeal. It was forwarded to state Medicaid Director Stephen Groff; Rita Landgraf, then-secretary of the Department of Health and Social Services; and Rep. Paul Baumbach, who had been working for the Neals behind the scenes.

Baumbach would say later that he couldn't let Highmark's repeated refusals stand because they were based on outdated research.

It was time to call in the governor.

"They had to raise their game," the Newark Democrat explained. "I knew (Jack Markell) would have a sympathetic ear to this."

Less than three years earlier, Markell had signed a state law to protect transgender people from discrimination. It wasn't an empty promise.

"I tried to mobilize the team," Markell said in a recent interview. "If you're going to pass an act like that, it has got to mean something."

Days later, a conference call was hastily arranged between Highmark and the Neals, a low-income Wilmington family. This time, both Groff and Landgraf were on the line.

"So, how are we going to fix this for her?" said Groff, the state Medicaid director.

"We just want to make sure the child is legitimately transgender," a Highmark executive stammered. Trinity would need to go to CHOP for a second opinion, the insurer concluded.

DeShanna and Trinity did as they were told, and CHOP doctors affirmed Doyle's diagnosis.

On April 6, 2016, nearly eight months after her battle with Highmark began — nearly a decade after announcing, "I am a girl"— Trinity Neal became the first transgender minor in Delaware to be covered for puberty blockers by Medicaid.

STORY: Victim sues Delaware daycare over sex abuse

A terse letter, omitting any form of "congratulations," informed the preteen of her right to receive quarterly Lupron injections. She would need to request reauthorization from the insurance provider every three months.

“There wasn’t established best practice to follow," Groff would say later. "I won’t say that every decision was made ultimately as it should have been, or as timely as it should have been.”

Highmark Health Options relies on "nationally-recognized and clinically-supported medical policies and standards," Gregory Busch, the company's chief medical officer, told The News Journal in a statement. "In caring for the health care needs of the transgender community, as well as any member, our first priority is to protect their safety when it comes to medical and pharmaceutical interventions."

Securing puberty blockers was a hollow victory for DeShanna, one that involved multiple follow-up phone calls to ensure Trinity's coverage remained current. Last summer, Trinity's insurance authorization arrived just two hours before her scheduled shot.

At the same time, Trinity wasn't reacting well to having a giant needle jabbed into her buttocks every few months. She could barely sit after her appointments, yet she refused to discontinue treatment.

"No matter how painful it is," she said, "I want to achieve my goals."

Doyle prescribed Supprelin, a matchstick-size implant inserted in the inside of the upper arm. The treatment can last up to two years, but it costs $27,000.

With little fuss, Medicaid approved it. Trinity had made First State history twice over.

By that point, she had visited the White House wearing the fuzzy rainbow wig her mom made her. DeShanna cried during the photo opportunity, when former First Lady Michelle Obama nudged the shy warrior and whispered, "You're beautiful, baby."

Trinity was interviewed by The New York Times, "Essence," and "National Geographic," reflecting changing norms about gender. She met Jazz Jennings, a 14-year-old transgender female with a hit reality series, and befriended actress Laverne Cox of "Orange is the New Black," who became the first transgender woman to grace the cover of "Time" in 2014.

DeShanna also thrived as an outspoken advocate for transgender rights, co-leading a Delaware parent support group, joining the national Human Rights Campaign's parents council and appearing in gender-affirming documentaries with her daughter. Recently, she traveled to Dover to promote a bill to ban conversion therapy, a discredited therapeutic method that purports to change a person’s sexual orientation or gender identity.

"We represented something you didn't see often," mom recalls, "which was that a family of color accepted a trans child."

Earlier this year, Trinity and DeShanna visited with Doyle to discuss next steps. Wearing a pink pussy hat knitted by her mom in honor of the Women's March on Washington in January, Trinity sat with eyes downcast, hands clasped on her lap. Two years prior, she had been diagnosed with high-functioning autism, which explained her stilted speech and blunted enthusiasm.

"Can I get estrogen?" she asked gingerly.

Doyle flipped through his Pediatric Endocrine Society guidelines, which recommend delaying cross-hormone therapy until age 16. He mentioned the risk of sterility. We'll reassess after another year, he offered.

But his 13-year-old patient's patience was wearing thin. Her best friend had developed buds on her chest, and she wanted them, too.

"This body isn't my body," she persisted. "It doesn't fit me."

Of the 20-odd people in the New Castle County courtroom, Trinity was the only one with a mouth full of pink-and-red braces.

She slumped in the last row with her mom and two brothers, her vacant stare fixed on the witness stand. Dad and her youngest brother, Thane, waited outside.

The judge was running 30 minutes behind. Across the aisle, a young man wearing all black and a choker fidgeted on the hard bench.

All the requests were personal: A Spanish-speaking couple preparing for an upcoming baptism, a woman with a thick accent excited to wed a much older man; a stoic teenage boy, who hadn't seen his father in years, wanted nothing to do with his last name.

And then DeShanna approached the bench, wearing hip glasses and multiple piercings.

What is the reason for the name change? Court of Common Pleas Judge John Welch pressed.

"She's transgender," DeShanna responded, matter-of-factly.

Had the hearing occurred just one month prior, Trinity would've been able to change her name –– but not her gender marker on her birth certificate. In February, Delaware became the 14th state in the country to allow transgender people to change the genders on their birth certificate without undergoing gender-reassignment surgery.

After inquiring about whether the Neals had a criminal record and asking both DeShanna and Chris to testify in support of the move under penalty of perjury, Welch granted Trinity's request in under five minutes.

Dad gave his delighted daughter a high-five and promised lunch at Lucky's. The man with the choker thanked DeShanna for supporting her daughter's transition, but she deflected credit.

"I'm doing what parents are supposed to do," she said.

Days earlier, DeShanna's friends had met with Education Secretary Betsy DeVos in Washington, DC, to discuss school protections for transgender students. DeVos nodded politely, DeShanna had learned but made no promises.

"They make up excuses to find a way out," Trinity explained flatly. "The people who don't like us."

After Donald Trump was elected president, her eldest brother Lu cried for his sister, for his Muslim friend and for himself, a young black man.

Trinity responded with characteristic detachment: "I don't like it when bad people win," she said. "Do I have to be a boy now?"

DeShanna, too, is frightened, but she tries not to let on.

If Congressional Republicans succeed in repealing the Affordable Care Act, gender dysphoria could be lumped with other pre-existing conditions that don't warrant insurance coverage. In December, a federal judge in Texas issued a nationwide injunction against a key ACA provision, ruling that anti-discrimination statutes only prohibit discrimination based on biological sex.

The transgender community has won hard-fought civil rights protections, but that doesn't stop a Twitter troll from firing off, "Well if she still has a P, then he really is a he.”

"Why is an adult man concerned about a child's genitalia?" DeShanna fired back. #pedophile.

Aware of Trinity's precarious position, DeShanna redoubled her outreach. In March, she delivered a speech that drew a standing ovation from the national Human Rights Campaign in Washington.

"My worry is that someone will murder her and that I will have to bury her," DeShanna told the audience, her voice cracking. "She is my Trinity. She is my everything...I brought this beautiful life into this world in hopes that she would be treated like any other American."

Last year, Trinity found her mom distraught over the death of Dee Whigham, a 25-year-old transgender nurse who was fatally stabbed in a hotel room near Biloxi, Miss.

The preteen wondered: Why would anyone kill someone who did nothing wrong?

DeShanna gathered her in her arms, her wet cheek resting on top of her daughter's head. It was time for the talk.

"I told her to be careful," she recalled in her blog. "To feel people out before telling them. To tell them with someone present so she'd have protection just in case they lost their cool."

What DeShanna was really thinking, but didn't say, was this: "Tell them anything to hide yourself. That way they will never know and won't hurt you."

But mom held back. She's proud of her beautiful, accomplished daughter. After meeting the Obamas, Trinity aspires to be the first black trans female president.

"She will change the dialogue where she's no longer seen as a question," DeShanna insists.

Before that happens — and before she's legal to vote — Trinity will face a tough choice. After taking estrogen for at least a year, she will qualify for gender reassignment surgery, which could involve breast implants and removing most of her penis to form a largely functional vagina. It's premature to discuss that option, DeShanna says, or to grill Trinity about sexual orientation.

"I don't know who she's attracted to. It's too early," she adds. "As long as it's not a Dallas Cowboys fan."

Trinity no longer has nightmares about her voice tumbling an octave. What keeps the 13-year-old up at night now are shadow monsters spewing hate. Then the sky clears, the monsters disperse and her mom's outstretched arm appears to lead her home.

"Even when I'm older," Trinity said recently, "I still like mom to hold my hand."

It took three weeks for her new birth certificate to travel 51 miles from Dover. DeShanna had to submit a copy of the court order, a copy of her ID, Trinity's original birth certificate and a notarized letter from Trinity's doctor.

When she called to check on the status after a week, she was told to fill out one last form, attesting that she and Chris really, truly supported their daughter's transition. The bank teller who notarized the statement had a picture of Jesus and a statue of an angel on her desk.

The teller stared quizzically at the form, signed it, and spoke about how "God sees everything and knows everything."

"You just made a little girl really happy," DeShanna replied, turning on her heels to exit.

"I want the world to come to a time where everyone goes, 'It is what is is,' " she said recently, her voice rising in exasperation. "And the only concern is are you a decent human being."

"Why wasn't this happening yesterday?"

During a recent speech therapy appointment, DeShanna's two-year-old, Thane declared, "I pretty girl."

Mom was nonplussed. She's exhausted by society's fixation on gender, drained by the decade she spent with her nervous hands balled into hard fists. It doesn't matter if he is or if he isn't.

"We have clothes now," she quipped.

Today, the Neals own their own home, a nondescript brick row, in a community that dead ends into a Sunoco. Cars park on the sidewalk. A pinwheel and a drowned strawberry plant welcome visitors.

On a recent afternoon, Trinity was busy unwrapping a blueberry Pop-Tart when her mom passed her an envelope.

There it was: Trinity Xavier Skeye Neal blazing above an official gold seal.

"That's female," DeShanna chirped, pointing to the bold "F."

"It suits me," replied her daughter, shoulders shaking. "I'm here finally."

This fall, Trinity plans to attend a Delaware charter school –– one DeShanna vetted for its transgender policies.

STORY: Protecting transgender students is a federal responsibility

No longer will her daughter be homeschooled in her basement cocoon, alongside her brothers, RuPaul (the family's Jack Russell mix), and Peter Porker, the miniature potbellied pig who is neutered and, therefore, "nonbinary."

On Oct. 28, the teenager with her own publicist will turn 14, marking 10 years as her authentic self. The family is planning a big bash with an "It's a girl" balloon.

Trinity is now a talented game developer, who hopes to earn a scholarship to MIT. Her bright orange fingernails glide over the keys as she smashes boulders, sidesteps lava, drops a bomb and jumps two levels.

Her diminutive bedroom is decorated with fuchsia fringe curtains, a "Hello Kitty" pillow, a "Girls Rule" poster, a photo from "Kinky Boots" autographed by playwright Harvey Fierstein, and a transgender symbol. There is a circle with an arrow (for male), a cross (for female), and an arrow merging the two.

A brown curly wig partially obscures a terrarium that belongs to her tarantula, Jake.

"Is he still alive?" Trinity asks, tapping the glass. A hairy leg slips out from under an igloo.

DeShanna doesn't display her daughter's old photos, but tucks them into Trinity's red "safe folder." It's straining under the weight of drawings, letters and evaluations by neurologists, therapists and social workers. Taken together, the documents frame a counter argument directed at "the uneducated and purposely ignorant," DeShanna says.

The folder also functions as a legal record in case the government ever tried to take Trinity away, DeShanna admits. When Trinity turns 18, it will be passed on to her.

Recently, DeShanna retrieved one of the few androgynous photos that Trinity let her keep. It shows a one-year-old wearing a halfhearted grin under a buzz cut.

"Aw, Trinity," she cooed to her daughter, who wrinkled her nose and turned her head.

"Yes, I mourned," DeShanna confessed in an earlier blog. "I had to bury the memory of the son I had brought into this very world."

"Her story has some hiccups," she acknowledged last month. "But mostly it's a lot of hope."

"She made me a mom. She showed me that parenting doesn't come out of a straight path."

At the New Castle Social Security Office, the clerk gasped.

"A 13-year-old is changing her gender? Oh, I've never heard of this."

Trinity had won her puberty blockers and her female birth certificate. But she still needed a new Social Security Card to be "legal" in the eyes of the federal government.

DeShanna's first Social Security appointment went nowhere; the agent with the scrunched-up face cited insufficient documentation.

Mom detected a "why are you letting this happen?" subtext.

Now the 36-year-old Momma Bear is back, swerving her van with the burnt-out tail light into the Social Security parking lot. Slung over her shoulder is a purple tote that reads, "This is what an advocate looks like."

Heavy elevator doors shut in her face. Upstairs, she grabs number 950 in the congested waiting room. Children wail. Adults study their smartphones.

"Things are about to get crazy up in here," DeShanna deadpans.

In reality, she's planning to kill them with kindness. The sweeter you are, the more money they agree to pay back, she recalls from her bank collector days.

Twenty minutes go by. DeShanna rearranges her mound of proof, including Trinity's new pink school ID that her mom/teacher/principal designed and printed off the computer.

Number 950 is summoned to booth 4.

"It's me!" mom announces to the sullen clerk. (The same one from the last appointment).

DeShanna fiddles with her lip gloss as the woman scrutinizes the homemade ID, loudly clicking her mouse.

The clerk excuses herself to consult with a supervisor.

DeShanna imagines the McDonald's milkshake she's going to inhale after this. She'll drink it in the car so that her kids don't confiscate it.

The clerk returns 10 minutes later. "OK, you're good."

DeShanna receives an unofficial copy of the card. She scans for the F. "That makes me happy."

Heading for the exit, she passes a little girl with white ribbons in her hair who waves goodbye.

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