It looks like any other childhood. Days in the park, your head in the sun, reading stores and fairytales in a world you've made all your own. No worries, no stress, except that is not especially true for this young child. "I could die or bleed to death." "So now you know better not to do that, right?" "I want to, though." Her name is Josie Romero and for as long as she can remember, Josie's been trying to break free from a nightmare that few children will ever know. "Do you want a hug? I'm sorry." To help Josie, her mother Vanessa is prepared to go to lengths most parents could not imagine. "I was in such a desperate state to get my child okay." Their story begins in 2001 when Vanessa gave birth to a son, Joey. He was the center of a loving, blended family with stepfather Joseph, an air force engineer, and later an adopted baby sister, Jade. But the family scrapbook doesn't show the problems Joey was having by age three. "Temper tantrums, awful. Glass shattering, piercing yelling, crying fits." "What did the doctor say was wrong?" "Joey's depressed, let's give him Prozac." "Prozac?" "Yeah." "Okay, what else?" "We needed medication to help Joey sleep." Doctors also prescribed medicine for anxiety, ADHD, and Tourette syndrome. "There were 14 different medications, 17 doses a day." "Okay, that sounds insane." "It was. My child was broken and there was something really wrong, I just wanted it fixed." But there was something else about Joey, something Vanessa never thought was a problem to discuss with doctors. Her son seemed to prefer his little sister's toys and clothes. "If we'd go into the store, Joey would already start heading over to the little girl's clothes, even just for socks, anything, and I'd say, 'no we're here for you not your sister,' and start dragging my child over to the boy's socks or t-shirts or whatever." Vanessa didn't see a connection between Joey's obsession with dress up and his behavioral problems until a routine physical changed everything. They were wrapping up the visit when the doctor noticed the way six year old Joey was playing with his toy. "Joey lifts his shirt and starts breastfeeding the doll and the doctor said, 'I think your child may have gender identity disorder.' And I'm like, 'What?' And the doctor said, 'You know, like transgender.'" As you may have figured out by now, Joey is Josie. Born a boy, but now living as a girl. "When you were little did you feel like you were trapped in the wrong body?" "Yeah." "How old do you think you were when you started feeling like that?" "When I started to know?" "Yeah." "Always. I always knew." Back then, the family was living on a military base in Okinawa, Japan far from any specialist, but Vanessa learned more about the condition from online support groups. It seemed to just click, so she decided to try something radical: buying her child a new girl wardrobe. "So we went over to the girl section, Joey lead and I followed." "And he just bought the things he wanted?" "He started carrying it, wouldn't even put it in the cart, you know, he wanted to hold it." Her son began dressing as a girl at home, but now it wasn't a game. "Joey said, 'Okay, you can't say "he" anymore, you have to start saying "she" so we had to correct our pronouns. That took a little bit more effort." "And that may be where parents watching this go, 'What's going on over there?' You know, the kid's ruling the roost, that's where it tips over into something that they don't understand." "That's understandable, because I would have too." Even Vanessa's husband was having a hard time accepting the change in his child. "We went to this photo studio and Josie's looking through all the dresses and she looked at me and pretty much asked, 'Daddy, is this okay? Can I do this?' And at that point all of this became a reality for me. No longer did I have a son and I had to put all my feelings aside to embrace my daughter." "What I remember is my dad giving me thumbs up and I felt like I was going to cry I was so happy." After that they say a profound change happened to their child. No more tantrums, no more sleeplessness, no more medication needed. And a few months later they decided to take another leap: send their child to school on the military base in a dress. "She's no longer having these fits and no longer screaming and crying and so I thought, 'The teacher is going to love this.'" "But that was not that at all." "That was not the way it went." Parents protested, the family received death threats. "Did you think to yourself, 'You know what? She could have been herself at home and just gone to school as Joey.'" "No. Initially when we first started then I was like, 'Yeah, that'll work.' But then when I let her out, I wasn't going to shove her back in." "But what was happening later worse?" "It was worse for me, but not for her." "I felt proud of myself that I turned into a girl. It doesn't matter what they say, they can do whatever they want, I'm just going to do what I think is right." Because of the controversy, the military moved the Romeros back to the US to Tucson, Arizona. They decided to home school Josie and she began seeing a psychologist who supported the decision to let her live as a girl. The Romeros changed her name legally. Josie Claudine Romero. "When I got my girl name I felt like everything was done, but apparently not." Not done, not by a longshot because by age 9, Josie was filled with anxiety again. This time over something neither her, nor her parents could control: her own growing body. "I'm changing, like, boy-style." Josie Romero was born a boy, but has been living as a transgendered girl since age 6. When we first met her in 2010 she was 9 1/2. And she seemed like any happy kid, but in fact, Josie and her parents were now facing a problem they had not fully anticipated. "Your mom says that you're looking in the mirror a lot these days." "Yeah, because I'm looking if I have any hair on my neck, on my face. I'm changing, like, boy-style." Josie, who had passed easily as a girl for years, was now terrified of her growing body. Afraid puberty would soon turn her into a man. "She scrutinizes her image in the mirror every morning when I'm doing her hair and so she looks for facial hair or an Adam's apple. It's a swan's neck, there is no bump there. Nothing else is as important to her as getting her body to match who she is." "What are you thinking?" "It's getting frustrating." "Do you want a hug?" Josie felt so much anxiety over her changing body that she once tried something drastic. "Did I tell you that I want to get my own surgery? My own self-surgery?" "She was in the bathroom and she's standing in the shower and she's got her penis in one hand and her nail clippers in another hand. It was like she was building up her determination to go through with doing it. Then I ran in, literally, and grabbed the nail clippers from her hand and squeezed her to me." "I could die or bleed to death." "So now you know better than to do that, right?" "I want to, though." So what will happen to Josie? Even if her parents would allow it, doctors in the US do not perform sex reassignment surgery before age 18, but some have been experimenting with new hormone therapies for transgender kids. Drugs that can start the gradual process of reshaping a child's body from one sex to another. It is a radical treatment for someone Josie's age. "I'm just really eager for her to feel at peace and if she takes estrogen she'll see her body respond to that and she'll have that peace." It is a two-step process. First, drugs called "blockers" that suspend puberty, in Josie's case, blocking the release of testosterone. Then, a more controversial step, she could be given estrogen to make her body develop like an adolescent girl's. "They're talking about giving you hormones and doing blockers and all that kind of stuff. Is that something that you want to do?" "Yes." "Can you tell me why?" "It's going to make me not have big hands and big feet and get boobs and.." "You want boobs?" "Yeah!"
"That's something most people feel like you got to wait until, really, a child is much older." Dr. Margaret Moon is a pediatrician and bioethics professor at John's Hopkins University. She says drugs that delay puberty, "blockers", may be helpful in some extreme cases, but that second step, giving opposite sex hormones, is alarming at Josie's age. The changes are irreversible and include rendering the child sterile as an adult. "Any change you make that's irreversible is harder to justify when the child is young." Even among the doctors who specialize in treating transgender kids, there is debate about when and whether opposite sex hormone therapy is okay. "We have lots of very well-informed, very well-intentioned people looking at the same data and coming away with very different ideas." "Is this an over diagnosis issue?" "Potentially. It's potentially an over diagnosis issue." But for Vanessa, there was no debate. She felt certain that not only would female hormones help Josie, but forcing her to go through male puberty could be psychologically devastating. Transgender young people are 5 times more likely than their peers to attempt suicide. "Whenever people ask me how can I just let her do this, I'd rather have a living transgendered daughter than a dead son." Having been unsuccessful in finding a local doctor who could help, Vanessa set out with her daughter for Children's Hospital in Los Angeles in September of 2010. "So you're thinking about gender all the time?" "All the time. Night and day." Dr. Johana Olsen, whom the Romeros traveled to see, is one of the few medical doctors in the US who treat kids with gender identity problems. "Our patients aren't mentally ill. There's an alignment issue between their internal gender and their body." "If I were a parent and I see my child and I notice there are some gender issues you would think that a) it's a phase or b) maybe they're gay." "And they'd be right. Those are very, very common occurrences. What I look for is persistent, consistent, and insistent. These are the profiles of kids that have very, very solid gender identities." Dr. Olsen had already consulted with Josie's psychologist. And after her own examination, she could decide to give Josie hormone blockers, an effect pushing the pause button on her male puberty. "How old were you when you transitioned?" "About 6." "Okay." Or she could also prescribe estrogen, the far more extreme option to being Josie's female development. "It seems like puberty, the idea of impending puberty is a little scary to you." "I just want to get it done." "You just want it to get done?" "Yeah." "What does that mean?" "Like I want to get surgery right now, but you can't." "Let's say you could wake up and have whatever you wanted on your body, no penis, you want a vagina and breasts, all that stuff. I've made you giggle. Would that be a yes?" "Yeah." "I hear you." After their one hour conversation, there was a physical exam and then mother and daughter waited for Dr. Olsen's decision. It was not what they expected. "So a little bit of alleviation of concern of this impending puberty coming down the pike right now." "Uh-huh." "It's not happening right now. That's a good thing. That's a good thing. You don't want your kid to go through puberty at 9." Josie was too young even for blockers. "I don't want her trying to modify her body." "No body modification on your own, no body modification without talking to doctors. The worry is we want to go through girl puberty now even if our body is not ready to go through puberty." "Do you want a hug?" "I want to go through puberty." "You do? Why?" "So I can be like all the other girls."
"When she really understands that she's not going to walk out the front door with breasts I think she's going to be really disappointed." Back home in Arizona, Josie clearly was disappointed. "Well, I want to be like all the other girls. It's not too long then, yes, it'll be a little longer." Nearly a year went by at the Romero household. Josie's dad returned from a tour in Afghanistan. Josie was still waiting impatiently for the estrogen treatment, which is controversial at her age. Guidelines developed in Europe suggest waiting until around age 16 and bioethicist Dr. Moon says the few studies that do exist suggest young kids with gender identity problems often grow out of them. "A lot of those kids that start out as children and who are saying, 'I'm in the wrong body' end up finding out by the time they're middle adolescents that they're actually fairly comfortable with their own gender." But Josie is not one of those kids. Or is she? "Maybe I'm a boy inside and a girl outside."
At 10 years old, Josie Romero believes she was born in the wrong body and her parents have been seeking a controversial hormone therapy that would start chemically changing her boy body into an adolescent girl's. Estrogen treatment is irreversible and would make Josie sterile, but Josie and her mother never doubted it was the right thing until an unexpected conversation happened one afternoon. "But on the inside, where nobody else can see, are you a boy? Or are you a girl?" "Maybe I'm a boy inside and a girl outside." "Really?" "Yeah, is that true?" "Only you know the answer to that. So if you wanted to grow up to be a man, would you tell me?" "Yeah." "If you wanted to grow up and be a man, you could." "I want to be.. Sometimes I think that I'm a boy, sort of, but I want to be a girl. Will you love me if I'm a boy?" "Of course. I would love you no matter what, I always have and I always will." It was the first time Vanessa ever heard Josie sound uncertain. "I feel like, maybe, there's a part of you that's afraid to tell me what you really want. What if I said, 'Oh please don't be a girl.'" "Well, I guess I would be a boy. I don't know." "No, honey." "I need to listen to you. You're my mom." "Well, yeah, you need to listen to me about what's healthy to eat and you need to listen to me about what time to go to bed, but you are the one, I have to listen to you." "Yeah, but what if you said that I need to be a boy and you made me? I'd have to." "No. No."
"For her to have any indecision now I don't know what it's rooted in and I really need to find that out."
"You look like you're about to cry." "I'm just kind of surprised by these answers today. It's the first time you've given them to me."
"Everything I thought I knew is kind of in question." Had Vanessa's wholehearted, unwavering support of Josie's transition actually pushed her child too far, too fast? "The thought of her having made such a huge decision in her life all based on what she thought I wanted, that would be traumatic for me." Bioethicist Dr. Margaret Moon who opposes opposite sex hormone therapy for kids Josie's age says most 9 and 10 year olds are not mature enough to participate in life-altering medical decisions. "They're not sure who they are and they can't really offer their parent that sort of reassurance." Even Dr. Olsen says there is no exact science that can determine who is truly transgendered. "What's missing in the data right now is these exact characteristics mean that this person is for sure going to be a trans adolescent and adult? We don't have that data." "Now, the estrogen thing I find concerning. A decision is being made whether or not Josie will have children, her own biological children in the future." "That's why the role of blocker sis so important. They get an opportunity for two years, three years to really work with a mental health therapist on what it's going to mean to be transgendered." "But that could still put you at age 12. To me, it seems ridiculous to have a kid at age 12, 13, 14 deciding whether they want to have biological children when they're 20, 30, or 40." "Well they make the decision to kill themselves at 12 and 13 that's a pretty powerful decision. We take an oath, first do no harm. If doing nothing is doing harm, you have to do something."
"You and your mom were talking, she was combing your hair and you said to her, 'Would you still love me if I was a boy?'" "Oh yeah, that." "Why did you ask her that?" "You know, my dad, he when I started to change he was a little sad because he wanted his little boy back. I didn't want the same thing to happen to my mom, like being sad all the time." Josie and her psychologist discussed that moment of wavering and just a few weeks shy of her 11th birthday she told us she never really changed her mind. She still really wants to be a girl. "Now what about people, Josie, who watch this and say, 'You know what, she's going through a phase in her life.'" "I say no, I'm going to stay like a girl because this is who I truly am."
"So what do you think? Are you starting, are you seeing any signs?" "Yeah." "Okay, and how are you feeling about that?" "I'm a little anxious." Fifteen months after her first visit, Josie was back with Dr. Olsen. After examining Josie in private, Dr. Olsen had a decision. "You are in the perfect place to start on blockers." And she promises to begin giving her estrogen, female hormones, in two years. "Around 13. That's what I think. Yes, you're not going to develop breast buds on the blockers, but you're not going to wait until 16 to start, you know that, okay?" Josie received the blockers as an implant in her arm. So with all the bravery she could muster, Josie held on tight as another chapter opened in this young girl's life. "A lot of times it strikes me that had this happened just 20 years ago I wouldn't have been able to give her blockers and she would have had to go through male puberty. That terrifies me. I don't know that she would have survived male puberty. How is she going to prove to somebody that she is a girl? At best she would have been shaving every day and been the man in the dress and that might be great for some people, but it certainly wasn't who she is." So much about this child's life is yet unwritten, but Josie has predictions of her own. "When I grow up, I'm going to help save animals, habitats, like the ice for the polar bears. As an adult, my hair will be very long, blond, wavy, and super pretty. I'm going to marry a boy. I'll be a tiny bit taller than my mom. I want to be a mommy. I'm going to be very beautiful."