When your anatomy says you’re one gender, but early on you know you’re not, what can you do? Where can you go for help?

Meet a 15-year-old North Texan and her mom who talk about their journey -- and the help they’ve received from a hospital that says it's the only one in the Southwest handling all aspects of treating kids with what’s called gender dysphoria. [Note: This story contains language that some could consider graphic.]

This condition, which used to be called gender identity disorder, is rare. Dr. Ximena Lopez is the endocrinologist at GENECIS. The acronym stands for Gender Education and Care Interdisciplinary Support. It’s a joint effort of UT-Southwestern and Children’s Medical Center.

“The prevalence that’s been reported in the literature ranges from one in 10,000 to one in 300, depending on where it’s done,” Lopez says. “I think that the prevalence is definitely higher than what people think.”

Lopez says gender dysphoria demands both physical and psychological care.

“We do treat it as a medical condition because it can lead to psychological problems such as depression, anxiety,” Lopez says. “In children, especially adolescents that are not supported by parents, their rate of suicidal attempt is very high, almost 50 percent. Fifty percent compared to 4 percent in the general adolescent population.”

Bill Zeeble / KERA News

'It was kind of my little secret'

That brings us to Kammie – we’ve agreed not to use her last name. Kammie and her mother wanted to share their story because they hope to help others in the same situation.

Kammie has had strong family support to help her deal with bullying and name-calling -- and the feeling all her life that she’s a girl with male anatomy. She thought she must be gay, and told her mom in second grade. She was 7.

“I had to go through third and fourth grade -- it was kind of my little secret, like I didn’t really tell anybody," Kammie says. "Other people knew, because I was a lot more flamboyant than the other boys."

Kammie's mother, Christina Pippin, noticed differences in Kammie much earlier.

“Kammie, from the time she was 2 or 3, from the time she potty trained, she was sitting to go to the bathroom,” Pippin recalls. “She wouldn’t stand to go to the bathroom. She was covering her genitals in the bathtub with a washcloth. She told me her penis wasn’t supposed to be there.”

'Her biggest nightmare was puberty'

At 5, Kammie wanted earrings and had to write a convincing argument for mom to allow them. She succeeded.

Childhood nightmares didn’t include monsters, her mother says.

“Her greatest fear was growing a beard. Other kids are dreaming about Freddie Kruger and the Boogey Man. Her nightmare is growing a beard, having an Adam's apple, getting a deep voice," Pippin says. "Her biggest nightmare was puberty.”

That was six years ago. Soon, Kammie started medically-approved hormone blockers for those diagnosed as trans or transgender. Lopez says that’s a reversible first step.

“It can be a phase in some children,” Lopez says. “Many of those children actually end up being homosexual and not end up being all the way transgender. The children, that, by the time puberty starts, persist with this gender dysphoria, those are very likely to persist actually into adulthood.”

Strong family support

Kammie has never changed her mind. But it affected the family. Her mother, a Mormon, says she was excommunicated. Kammie’s dad and three brothers also accepted Kammie’s decision. Her oldest brother says Kammie has always been a girl.

Still, it all took time.

Early on, Pippin saw Kammie’s condition as a curse, and mourned the loss of her son, before emotionally embracing the blessing of a daughter.

“I think the worst fear that any parent has is losing their child to a hate crime or their child growing up and being misunderstood. Maybe never being able to experience the joy of getting married or having children,” Pippin says, tears starting to fall. “And she deserves that because she’s an incredible girl. So I don’t say 'if,' I say 'when ... she finds the right man.' They will know who she is and they won’t be bothered by that. I don’t say 'if she has kids,' I say 'when you have your children, you’re going to be a great mother.'”

Wanting to 'feel more complete and comfortable'

For now, Kammie is taking what are known as cross-sex hormones. The next step is surgery. She’s still a minor, a high school freshman. But since fourth grade, when she started researching it, she’s been convinced she’ll want what’s called sex-reassignment surgery.

Eventually, there may be more hormones, possibly other operations, while doctors watch for cancer, a concern from taking the hormones.

“It’s something that I feel like I need to move on to the next chapter in my life," Kammie says. "So I can feel more complete and comfortable in my own skin."