So Cute 🥺🥰

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

This!! Yes and yes and yes!!!

It drives me a little spinny when I see people posting “Why Aziraphale doesn’t just keep his books at home if he doesn’t want to sell them” because it seems to me to so clearly be a riff on real life antiquarian bookshops?

I worked in a used and rare book shop for five years, and have frequented them since I was young, and Aziraphale is like, a type of guy who just exists. An older fellow who refuses to keep his books in any sort of order, neglects to write prices in, opens at wildly varying hours, and by all accounts does not seem to want to be in business at all. The answer I found, by the end, was because many of them were doing it as a sort of retirement hobby. They made enough money to keep the lights on and to buy new rare books to look at.

I swear to you: nobody in the book business would bat an eye at Aziraphale. Especially if his shop had been there for generations. They would assume that the occasional loose encyclopedia plate sale would be enough to make rent, or that Mr. Fell had business and land holdings elsewhere.

And I assume that though he doesn’t want to sell them, he would LOVE a curious browser. Antiquarian vendors often adore it when you ask how to find a rare book, because the thrill of the hunt is often better than actually owning the volume. Anyone can have a private library, but owning a quaint little bookshop is a saucy way to brag and chat with other book lovers, and you can’t put that on your shelf at home.

Always! Always, always!!!!!

US Helplines:

Depression Hotline: 1-630-482-9696

Suicide Hotline: 1-800-784-8433

LifeLine: 1-800-273-8255

Trevor Project: 1-866-488-7386

Sexuality Support: 1-800-246-7743

Eating Disorders Hotline: 1-847-831-3438

Rape and Sexual Assault: 1-800-656-4673

Grief Support: 1-650-321-5272

Runaway: 1-800-843-5200, 1-800-843-5678, 1-800-621-4000

Exhale: After Abortion Hotline/Pro-Voice: 1-866-4394253

Child Abuse: 1-800-422-4453

UK Helplines:

Samaritans (for any problem): 08457909090 e-mail jo@samaritans.org

Childline (for anyone under 18 with any problem): 08001111

Mind infoline (mental health information): 0300 123 3393 e-mail: info@mind.org.uk

Mind legal advice (for people who need mental-health related legal advice): 0300 466 6463 legal@mind.org.uk

b-eat eating disorder support: 0845 634 14 14 (only open Mon-Fri 10.30am-8.30pm and Saturday 1pm-4.30pm) e-mail: help@b-eat.co.uk

b-eat youthline (for under 25’s with eating disorders): 08456347650 (open Mon-Fri 4.30pm - 8.30pm, Saturday 1pm-4.30pm)

Cruse Bereavement Care: 08444779400 e-mail: helpline@cruse.org.uk

Frank (information and advice on drugs): 0800776600

Drinkline: 0800 9178282

Rape Crisis England & Wales: 0808 802 9999 1(open 2 - 2.30pm 7 - 9.30pm) e-mail info@rapecrisis.org.uk

Rape Crisis Scotland: 08088 01 03 02 every day, 6pm to midnight

India Self Harm Hotline: 00 08001006614

India Suicide Helpline: 022-27546669

Kids Help Phone (Canada): 1-800-668-6868

FREE 24/7 suicide hotlines:

Argentina: 54-0223-493-0430

Australia: 13-11-14

Austria: 01-713-3374

Barbados: 429-9999

Belgium: 106

Botswana: 391-1270

Brazil: 21-233-9191

China: 852-2382-0000

(Hong Kong: 2389-2222)

Costa Rica: 606-253-5439

Croatia: 01-4833-888

Cyprus: 357-77-77-72-67

Czech Republic: 222-580-697, 476-701-908

Denmark: 70-201-201

Egypt: 762-1602

Estonia: 6-558-088

Finland: 040-5032199

France: 01-45-39-4000

Germany: 0800-181-0721

Greece: 1018

Guatemala: 502-234-1239

Holland: 0900-0767

Honduras: 504-237-3623

Hungary: 06-80-820-111

Iceland: 44-0-8457-90-90-90

Israel: 09-8892333

Italy: 06-705-4444

Japan: 3-5286-9090

Latvia: 6722-2922, 2772-2292

Malaysia: 03-756-8144

(Singapore: 1-800-221-4444)

Mexico: 525-510-2550

Netherlands: 0900-0767

New Zealand: 4-473-9739

New Guinea: 675-326-0011

Nicaragua: 505-268-6171

Norway: 47-815-33-300

Philippines: 02-896-9191

Poland: 52-70-000

Portugal: 239-72-10-10

Russia: 8-20-222-82-10

Spain: 91-459-00-50

South Africa: 0861-322-322

South Korea: 2-715-8600

Sweden: 031-711-2400

Switzerland: 143

Taiwan: 0800-788-995

Thailand: 02-249-9977

Trinidad and Tobago: 868-645-2800

Ukraine: 0487-327715

(Source)

This is very similar to how I invisioned her!

@langwrites I doodled Kei!! I hope you don’t mind!

This, but I didn't get mine until age 24, and the rules are different even then...

For the drivers test person: I know in the state of Texas you just need someone over 21. I’ve accompanied like three people trying to get their license bc their parents wouldn’t go with them.

Exactly! It differs from area to area so before you get discouraged go check on the fine print

This, I'm bad at speaking up about anything (don't deal well with conflict of any sort) but it really is easier each time.

kids remind me, often, of the things i've taught myself out of.

i have a big dog. he looks like a deer. he is taller than most young children. while we were on a trail the other day, a boy coming our direction saw us and froze. he took a step back and said: "i'm feeling nervous. your - your dog is kind of big."

goblin and i both stopped walking immediately. "he is kind of a big dog," i admitted. "he's called a greyhound. they are gentle but they are pretty tall, which is kind of scary, you're right. their legs are so long because they are made for running fast. i am sorry we scared you. would you like us to stand still while you move past us, or would you feel more safe in your body if we move and you stay still?'

"oh. i didn't know that about - greyhounds. i think i ... i want to stay still," he said. at this point, his adult had caught up to us. "i'm nervous about the dog," he told her, "so i'm - i'm gonna stay still." she didn't argue. she didn't make fun of him. she just smiled at him and at me and held his hand while goblin and i, with as wide of a berth as we could make, crept our way through.

behind us, i heard him exhale a deep breath and kind of laugh - "he was really big, huh? she said it's because greyhounds have to go fast."

"he was big," she said. "i understand why that could have made you a little scared."

"yeah. next time i - next time do you think i could maybe ask to touch him? when - i mean, next time, maybe, if i'm not nervous."

later, going to a work event, in the big city, i stood outside, trembling. my social anxiety as a caught bird in my chest. i took a deep breath and turned to my coworker. she's not even really my friend yet. i told her: "i feel nervous about this. i am not used to meeting new people, ever since covid."

she laughed, but not in a mean way. she said she was nervous too. she reached her hand out and held mine, and we both took another deep breath and walked in like that, interlinked. a few people asked us - together? - and i told the truth: i feel nervous, and she's helping. over and over i watched people relax too, admitting i feel really kind of shy lately actually, thank you for saying that.

the next time i go to an event, and i feel a little scared, i ask right away: wanna hold hands? this feels a little dangerous. i hesitate less. i don't hide it as much. i watch for other people who are also nervous and say - it's kinda hard, huh?

i know, logically, i'm not good at asking for help. but i am also not good at noticing when i need help. i've trained myself out of asking completely, but i've also trained myself to never accept my own fears or excuses. i have trained myself to tamp down every anxiety and just-push-through. i don't know what i'm protecting myself from - just that i never think to admit it to anyone.

but every person on earth occasionally needs comfort. every person on earth occasionally needs connection. many of us were taught independence is the same thing as never needing anything.

each of us should have had an adult who heard - i feel nervous and held our hand and asked us how we could be helped to feel safe. no judgement, and no chiding. many of us did not. many of us were punished for the ways that we seemed "weak".

but here is something: i am an adult now. and i get nervous a lot, actually. and if you are an adult and you are feeling a little nervous - come talk to me. we can hold hands and figure out what will help us feel safe in our bodies. and maybe, next time, if we're brave, we can pet the dog that's passing.

This just reminds me of the question 'are alcoholic people more flammable than normal people?' this was just due to the fact that most of my family are pyromaniacs and that we have a significant amount of Irish in us...

Neil Gaiman about David Tennant: He's a wonderful man. He's one of our finest actors. He's really funny. He's astonishingly Scottish. He's a great father to his kids. He's extremely flammable.

I'm okay with not having an AO3 app, since it works fine as a mobile site. My sister's eldest only knows how to use any browser due to us taking the time to teach them how. Their 18...

So this was originally a response to this post:

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Which is about people wanting an AO3 app, but then it became large and way off topic, so here you go.

Nobody under the age of 20 knows how to use a computer or the internet. At all. They only know how to use apps. Their whole lives are in their phones or *maybe* a tablet/iPad if they're an artist. This is becoming a huge concern.

I'm a private tutor for middle- and high-school students, and since 2020 my business has been 100% virtual. Either the student's on a tablet, which comes with its own series of problems for screen-sharing and file access, or they're on mom's or dad's computer, and they have zero understanding of it.

They also don't know what the internet is, or even the absolute basics of how it works. You might not think that's an important thing to know, but stick with me.

Last week I accepted a new student. The first session is always about the tech -- I tell them this in advance, that they'll have to set up a few things, but once we're set up, we'll be good to go. They all say the same thing -- it won't be a problem because they're so "online" that they get technology easily.

I never laugh in their faces, but it's always a close thing. Because they are expecting an app. They are not expecting to be shown how little they actually know about tech.

I must say up front: this story is not an outlier. This is *every* student during their first session with me. Every single one. I go through this with each of them because most of them learn more, and more solidly, via discussion and discovery rather than direct instruction.

Once she logged in, I asked her to click on the icon for screen-sharing. I described the icon, then started with "Okay, move your mouse to the bottom right corner of the screen." She did the thing that those of us who are old enough to remember the beginnings of widespread home computers remember - picked up the mouse and moved it and then put it down. I explained she had to pull the mouse along the surface, and then click on the icon. She found this cumbersome. I asked if she was on a laptop or desktop computer. She didn't know what I meant. I asked if the computer screen was connected to the keyboard as one piece of machinery that you can open and close, or if there was a monitor - like a TV - and the keyboard was connected to another machine either by cord or by Bluetooth. Once we figured it out was a laptop, I asked her if she could use the touchpad, because it's similar (though not equivalent) to a phone screen in terms of touching clicking and dragging.

Once we got her using the touchpad, we tried screen-sharing again. We got it working, to an extent, but she was having trouble with... lots of things. I asked if she could email me a download or a photo of her homework instead, and we could both have a copy, and talk through it rather than put it on the screen, and we'd worry about learning more tech another day. She said she tried, but her email blocked her from sending anything to me.

This is because the only email address she has is for school, and she never uses email for any other purpose. I asked if her mom or dad could email it to me. They weren't home.

(Re: school email that blocks any emails not whitelisted by the school: that's great for kids as are all parental controls for young ones, but 16-year-olds really should be getting used to using an email that belongs to them, not an institution.)

I asked if the homework was on a paper handout, or in a book, or on the computer. She said it was on the computer. Great! I asked her where it was saved. She didn't know. I asked her to search for the name of the file. She said she already did that and now it was on her screen. Then, she said to me: "You can just search for it yourself - it's Chapter 5, page 11."

This is because homework is on the school's website, in her math class's homework section, which is where she searched. For her, that was "searching the internet."

Her concepts of "on my computer" "on the internet" or "on my school's website" are all the same thing. If something is displayed on the monitor, it's "on the internet" and "on my phone/tablet/computer" and "on the school's website."

She doesn't understand "upload" or "download," because she does her homework on the school's website and hits a "submit" button when she's done. I asked her how she shares photos and stuff with friends; she said she posts to Snapchat or TikTok, or she AirDrops. (She said she sometimes uses Insta, though she said Insta is more "for old people"). So in her world, there's a button for "post" or "share," and that's how you put things on "the internet".

She doesn't know how it works. None of it. And she doesn't know how to use it, either.

Also, none of them can type. Not a one. They don't want to learn how, because "everything is on my phone."

And you know, maybe that's where we're headed. Maybe one day, everything will be on "my phone" and computers as we know them will be a thing of the past. But for the time being, they're not. Students need to learn how to use computers. They need to learn how to type. No one is telling them this, because people think teenagers are "digital natives." And to an extent, they are, but the definition of that has changed radically in the last 20-30 years. Today it means "everything is on my phone."

Absolutely! One of my coworkers has this, and one of my former highschool classmates has it, too. I don't think there's any other group of people that I admire more.

Said 11 notes for mine. 🤣😂

I found this camera on the subway and look what was inside...