In 2007, there were few medical experts on transgender people, but Dr. Norman Spack had just opened the Gender Management Service at Boston Children’s Hospital. He had begun his career as a pediatric endocrinologist and had worked at a nonprofit group that served homeless youth in Boston. Spack noticed that he seemed to see the same kids over and over—those who said they were gay or who were, he came to understand, transgender.
Spack’s personal journey to become a specialist for transgender children is another example of the idea that gathering information is the best way to help those who face discrimination. Contrary to Wyatt’s experience, kids are often kicked out of their homes simply because of their gender identity—and Spack aims to help them.
Spack agreed to treat his first transgender patient, a transgender man who was a student at Harvard, on the condition that he teach Spack about being transgender. Soon, Spack began to travel to learn more about the treatment of transgender people in other countries, particularly in the Netherlands. There, an endocrinologist named Louis Gooren taught Spack about the possibility of treating transgender kids before they go through puberty.
Spack tries to gather knowledge from the best possible source he can: first, from someone who is transgender, and from someone in another country who is a leader in the field. Armed with this knowledge, Spack is then able to help others in the United States. He is able to recognize, just as Nutt has detailed, that the treatment for transgender patients lies in a medical solution.
In 2006, Wyatt becomes one of Spack’s first American transgender pediatric patients. Spack puts Wyatt at ease by telling him that he can take puberty-blocking drugs and would never have a visible Adam’s apple, deepened voice, accelerated height, or facial hair. At 12, Wyatt will take puberty suppressants; at 16, he can take female hormones; and at 18, Wyatt can have sex reassignment surgery.
The initial steps for Wyatt’s transition already put him at ease, as Nutt describes here. Spack alleviates much of Wyatt’s anxiety by detailing how they can transform his body in order to match his gender expression and identity. This will allow him to live comfortably and completely as a female, both mentally and physically.
Wyatt asks why he can’t start the hormones immediately. Spack tells Wyatt that it would stunt his growth, and so they will have to wait until it looks like Jonas is beginning puberty. Jonas is happy to contribute somehow to Wyatt’s transition. For Wayne, he finally realizes that Wyatt’s transition is going to happen “with or without him.” For Kelly, she is relieved to have someone who is knowledgeable and to whom she could entrust her child’s care.
This moment is a turning point for the family as they all gather together to support Wyatt’s transition. Additionally, Kelly is thrilled by Spack’s presence because for so long she had been trying to wade through information alone. Now, she has a supporter and someone whose information can help her take care of her child.