According to the Journal of the American Medical Association, transgender surgeries across the country are on the rise as more insurance companies are offering coverage for the procedures.
And it's not just adults interested in that procedure; a growing number of teens are as well.
Oliver Du Bois doesn't take happy dinners with his family for granted.
"I know a lot of transgender kids, they don't get the support of parents or friends or whatever, and I have my entire family supporting me, all my friends support me, I have teachers who support me, and I'm very thankful," Oliver said.
Oliver was born Olivia. His mom says it was middle school when something changed.
"He came to me one day and said, 'I just, I don't feel like a girl. I am not comfortable,'" said Anne Du Bois, Oliver's mom.
"I started to have my friends call me Oliver," he said. "I had them use male pronouns and I realized how comfortable I was."
Oliver is among a growing number of teens investigating transgender surgery. Coincidently, Dr. Suzanne Jackman, who Oliver was seeing for hypothyroidism, specializes in educating teens about the process.
"If they've truly been diagnosed with gender dysphoria after their early stages of puberty, they may be eligible for what is called pubertal suppression, where we prevent puberty from ensuing," Jackman said.
Teens have to be at least 18 to get transgender surgery. Right now, Oliver is holding off on hormone therapy. Jackman warns that the surgery requires several procedures, some irreversible.
"Surgery is not something that you jump to initially, but it is part of the conversation," Jackman said.
Oliver plans to freeze his eggs if he decides to start the transgender surgical steps. His advice to others is simple:
"If it makes you happier, if it makes you who you are, then why not? I know a lot of kids who would have probably not been here if they weren't able to start hormone therapy."
Transgender surgeries range from $20,000-$30,000. Since the procedure for teens raises ethical questions, experts, including Jackman, require mental health evaluations and for those professionals to stay involved with patients through the entire process.
TRANSGENDER SURGERY FOR TEENS: OLIVER'S STORY REPORT #2617
BACKGROUND: Gender identity and expression are central to the way we see ourselves and engage in the world around us. Studies show that familial rejection can lead LGBTQ youth to engage in behaviors that put their health at risk, trigger depression and other mental health problems, and in the worst of cases, result in homelessness or suicide. Moreover, familial support can act as a buffer against bullying and bias outside the home. As child welfare expert Caitlin Ryan has demonstrated, "Family acceptance predicts greater self-esteem, social support, and general health status." Transgender and gender non-conforming youth face challenges at home, at school, in foster care, and in juvenile justice systems. A national survey by GLSEN has found that 75% of transgender youth feel unsafe at school, and those who are able to persevere had significantly lower GPAs, were more likely to miss school out of concern for their safety, and were less likely to plan on continuing their education. (Source: https://www.hrc.org/resources/transgender-children-and-youth-understanding-the-basics and https://transequality.org/issues/youth-students)
PUTTING A PAUSE ON PUBERTY: When someone makes the decision to transition, part of that process can be social, choosing a new name, changing pronouns, wearing different clothes, and part of it can be medical. One of the more recent medical developments is the use of puberty blockers to treat children who are transgender or gender non-conforming. The medications, which suppress the body's production of estrogen or testosterone, essentially pause the changes that would occur during puberty. "That's really what these pubertal blockers do," said Dr. Rob Garofalo, director of the Lurie Children's Hospital's Gender and Sex Development Program. "They allow these families the opportunity to hit a pause button, to prevent natal puberty until we know that that's either the right or the wrong direction for their particular child." Doctors who use puberty blockers say they allow children who experience gender dysphoria (the feeling that they're in the wrong body) the time and space to explore and settle on their gender identity. What makes treatment tricky is that there is no test that can tell whether a child experiencing distress about their gender will grow up to be transgender. (Source: https://www.pbs.org/wgbh/frontline/article/when-transgender-kids-transition-medical-risks-are-both-known-and-unknown/)
STUDIES ON STARTING HORMONES: Puberty blockers have been tested and used for children who start puberty very young, if their bodies start to change before the age of eight or nine. Dr. Courtney Finlayson, a pediatric endocrinologist at Lurie Children's Hospital, said, "We have a lot of experience in pediatric endocrinology using pubertal blockers. And from all the evidence we have they are generally a very safe medication." Doctors say the benefit of using puberty blockers is that they block hormone-induced biological changes, such as vocal chord changes, the development of breast tissue or changes in facial structure that are irreversible and can be especially distressing to children who are gender-non conforming or transgender. The stakes are higher for children who want to continue physically transitioning by taking the hormones of their desired gender. Doctors grapple with when to start cross-sex hormones, and say it really depends on the child's readiness and stability in their gender identity. While the Endocrine Society's guidelines suggest 16, more and more children are starting hormones at 13 or 14 once their doctors, therapists and families have agreed that they are mentally and emotionally prepared. The shift is because of the concerns over the impact that delaying puberty for too long can have on development, physically, emotionally and socially. (Source: https://www.pbs.org/wgbh/frontline/article/when-transgender-kids-transition-medical-risks-are-both-known-and-unknown/)