Real Men Give Birth

In this first article for Gays With Kids on transgender fatherhood, journalist E.J. Graff investigates the experiences of two transdads who each carried and delivered their own child.

The Men: Paul and Stephen

From the time he was little, Paul Smith wanted kids. That didn't change when puberty brought the agony of breasts, menses, and all the curves that his female body started to deliver, which he hid with binders under young men's clothes, ignoring the feminine clothes his mother bought for him. Nor did it change when he was 14 and learned there was a word and a solution for him: He was transgender,* and as soon as he was a legal adult, he could transition into fully visible manhood. Which he did. Immediately on hitting 21, while a student at Drexel University, he made an appointment at the Mazzoni Center, Philadelphia's LGBT health care and wellness center, and started testosterone.

* Transgender is the currently preferred umbrella term for those whose gender identity or presentation differs from what is typically associated with the sex they were assigned at birth. Use it as an adjective, not a noun. Note: Do not use the word transgendered. This word was in use for a few years but is now considered disparaging, implying that someone has been changed from what they were into something different.

That's when he realized that if he wanted to be a biological parent, he had to do it sooner rather than later. “They had me sign a paper that said, among other things, that I acknowledge that the testosterone might make me sterile," Paul told me. Sure, it was just a legal disclaimer, and his medical team noted that some transmen could conceive and give birth after years on testosterone, but Paul didn't want to take any chances.

Even more, once he started developing the new, masculinized body that gave him so much joy and relief, letting him show up in the world in a way that was recognizable and accurate to everyone around, he wanted to forge ahead quickly. The longer he waited to get pregnant, the longer he would have to put off completing his transition. He couldn't have a hysterectomy or lower surgery (reconstruction of the genitalia to match gender identity more closely), which not all transmen undergo, but which he wanted profoundly. Was he really willing to wait two or three years before he reached the manhood which he'd been waiting for for so long? Did he want to risk being one of those whose ovaries were harmed quickly by testosterone?

Paul had met his boyfriend Chris in their small circles of fellow queer nerds; Paul worked in IT, and Chris was an accountant. They'd only been dating a few months when Paul launched a conversation that can ordinarily take years: I am going to try to conceive. Do you want to do this with me or am I on my own? Am I looking for an anonymous donor, or are we going to try to have a baby together?

Chris and Paul

Chris, a cisgender* gay man, was startled, said Paul. “He was like, 'Whoa, having kids is kind of crazy at my age, I just graduated from college.'" But Chris was troubled by the idea that Paul might use someone else's sperm. He quickly decided, as Paul put it, “'If you are going to have a baby, then it would be cool if it was my baby.' It was just like our relationship kept growing as we were having the conversation." Underneath the words, it turned out, they weren't talking just about parenthood; they were talking about how deeply they wanted to be together. “And then he asked me to marry him, and I said yes."

* Cisgender refers to someone whose assigned birth sex and gender identity have always matched. The word cisgender was coined by sociologists as the companion to transgender, using the Latin-derived prefix cis-, meaning "on this side of," which is an antonym for the Latin-derived prefix trans-, meaning "across from; on the other side of."

Stephen Stratton took a different path, both to transmanhood and to parenthood—although looking back, he sees that his childhood held signs of both. “I played with bikes and I ran around the woods and you know did what some people would call stereotypical boy things," he said. “But on the flip side I was asking for babies as soon as I could talk. Dolls were my favorite things to play with." He was deeply uncomfortable with puberty as his body changed him to female, but he didn't know there was another option.

And so in high school he identified as female and dated boys (who, interestingly enough, later came out as gay). While at Rhode Island College he came out as a dyke and tried dating girls, but he was still very unhappy. It didn't feel any more right than being a straight girl. He came across the website of a young transman who was in mid transition, and was hit with relief: that was who he was.

He moved to Portland, Maine to live in a supportive trans community, and at 21 in 2003, started on hormones. “Before I went on hormones," Stephen said, “I thought long and hard about parenthood." Back then, he didn't know any openly pregnant transgender men, and assumed that transitioning would rule out being a biological parent. He decided, “I am okay with that, and I will find another way to be a parent. I never thought that being trans meant I couldn't be a parent."

At the time, Stephen says, he felt tremendous community pressure to be a certain kind of very masculine straight man, so it took him a few more years before he realized that as a transman he wanted to – and could – date men. As he jokes, “I was a straight girl, a gay girl, a straight man, a gay man … I've done it all." Today, considering all his variations in identity, he calls himself a queer man.

By age 30, Stephen was single and wondering: When was he going to have the family he'd been longing for since he was 2? By then he knew that getting pregnant might be an option. In 2007, Thomas Beatie had made his pregnancy public, including going on “Oprah" and becoming known nationwide as “the pregnant man." Stephen had known transmen in various online communities who had safely conceived and carried healthy children. But he realized that both testosterone and time were taking a toll. Even in natal women, fertility declines rapidly in the thirties. He made a pact with himself: By age 32, with or without a partner, he'd find a way to have a child. Not long after his promise to himself, a friend introduced him to the man who is now his partner. For both Paul and Stephen, the pursuit of pregnancy began.

Pregnant Manhood: Medical Issues

Medically, as long as transmen retain their body's original reproductive organs, getting pregnant is fairly straightforward, explains Dr. Timothy Cavanaugh, medical director of the transgender health program of Boston's Fenway Health. Cavanaugh explains that testosterone quickly masculinizes the body, changing musculature, redistributing hair, enlarging the Adam's apple, and deepening the voice, among other things. While the powerful hormone does affect the reproductive organs and will at some point make the transman sterile, the medical community doesn't yet know how long that takes—which is why trans health clinics try to be very clear that they cannot guarantee continued fertility. “We see changes in the ovary on testosterone that resemble PCOS (polycystic ovary syndrome), where essentially the ovary becomes less responsive to hormonal stimulation and is not going to ovulate as easily," says Cavanaugh. “It's really difficult to say when, and it's very variable actually, how long someone may have before they can no longer ovulate and conceive." To be safe, it's possible for transmen to harvest and freeze eggs before they transition. But that procedure is tremendously expensive and invasive; in Cavanaugh's experience, few transmen do it.

But in his near-decade of working with scores of transgender patients, Cavanaugh says, he's rarely seen a transman who couldn't still conceive if he tried within three years, either on his own or with the help of medications to prompt ovulation. In fact, Cavanaugh notes, transmen can theoretically get pregnant even while they are still on testosterone, which is not a fully reliable contraceptive.

But Cavanaugh warns against that: Testosterone could damage the developing fetus in those early and critical weeks. Transmen need to be careful that all injected hormones have left the body before attempting conception. Fortunately, that won't take long. Once testosterone is stopped, it leaves the body within about a month, Cavanaugh says. Transmen's bodies will retain the structural changes that testosterone has already wrought, such as male-pattern body and facial hair, enlarged Adam's apple, and a deeper voice. But the bodily processes suppressed by testosterone will resume. As long as the ovaries and uterus are still functioning, he says, menses should resume within three to six months, if not much sooner.

For Paul Smith, who at 21 was only seven months into taking testosterone, “much sooner" was exactly right. His menstrual cycle returned immediately, “which was crazy, because if you saw my body at the time, it was already getting pretty masculine." He and Chris waited a few months to be sure all the effects of the hormone were out of his system – and then tried for conception bodily, without any medical intervention. “We didn't normally do sex that way because that would bother me," said Paul. “I was not comfortable with that. That was difficult. That was not fun." Fortunately, both of them were young – and they got pregnant on the first try.

When he first started thinking about parenthood seriously at age 30, Stephen Stratton wasn't sure what path he would try: pregnancy, fostering to adopt, or private adoption. But once he could imagine getting pregnant and carrying his own child, he started realizing that was the right choice for him. His new partner was a cisgender gay man. That meant, he realized, “We have the option to make a baby together, which most queer people don't get to do. That was really something that was pretty amazing: We could have a person that is part of me and part of my partner."

He gave himself his last testosterone shot in November 2012, his 31st year. He and his partner Josh waited some time to be sure the hormones were out of his system, but didn't actively start thinking about scheduling sex or making a baby. That August, two weeks after Stephen's 32nd birthday, they went to a wedding and “had a lovely night," as Stephen puts it. And Rowen was conceived.

Josh and Stephen. Photo credit: Erin Clark

To be sure, not every transman is able to get pregnant as quickly as Paul Smith and Stephen Stratton were; bodies are variable, and time, testosterone, and genetic and medical conditions all affect the reproductive organs differently. Each transman will have to consult with his own medical team.

Dr. Cavanaugh notes that while there generally aren't any other medical concerns documented in the literature, medicine is still in the early stages of working with transmen and pregnancy. He does mention one potential issue: muscle thickening in the uterus or pelvis. Testosterone causes all skeletal muscles to thicken and grow. For some transmen, that results in pelvic pain; the theory, he explains, is that as the pelvic floor muscles get stronger, they contract too hard. “You could theorize that if those muscles are bulkier, are stronger, are thicker, that that may have some impact on carrying a pregnancy and the delivery process," he says. For some transmen, that may mean delivery happens more easily – stronger muscles can push harder – or it may lead to complications. “We just don't know."

Pregnant Manhood: Socio-Emotional Issues

But while getting pregnant was comparatively easy for both Stephen and Paul, being pregnant was an entirely different thing. Pregnancy is an especially strong female marker. “As the guys are pregnant everything is focused on them," explains Dr. Ruben Hopwood, a psychologist and the coordinator of Trans Health Program at Fenway Health in Boston. “All the discomfort is on them, the focus, the scrutiny, the criticism, any of the prejudices and biases all come into play."

For Paul, being pregnant brought back the gender dysphoria (extreme discomfort with one's apparent gender, to the point of affecting daily and social functioning). He hated being pregnant so strongly that he emphatically wants never to do it again; if they want another child, he says, they will foster or adopt. The first half of the pregnancy he calls “horrible." “I couldn't bind my chest, for the first time in years and years and years," he said. “As soon as I got pregnant, it was rock hard and really big." His chest, which had been a bra size of about A or B and had flattened out with the testosterone, suddenly flung up “these gigantic breasts right up in my face. I did wear a nursing bra because it was very painful not to, so painful that I wanted to cry. It really hurt. It was really gross for me."

And that was just the beginning. “The physical changes were so shocking to me, and so big. My skin changed. It got really soft. My acne went away, which was cool but made it more noticeable that my face was so round." Since he'd been on testosterone for only a few months, much of the masculinization he'd enjoyed went away. “But then at the same time, I had a pretty deep voice and an Adam's apple," Paul said. “So people would just be like: 'Whoa, your pregnancy made your voice go deep.'"

Since he didn't yet have a beard but was continuing to dress in his men's clothes, he knew that he was going to be perceived as a pregnant lesbian, and had to accept that. His mother and sister were excited in distressing ways, assuming that he had come to his senses and decided to embrace womanhood—which was even more alienating than their earlier distance from him. Fortunately, “my friends were very aware, like painfully aware that I was not comfortable with my body during that time," so he could lean on their support.

Halfway through the pregnancy, he says, he accepted that it would be awful and that he just had to ride it out. That decision, he says, while essential for his survival, “was isolating because it made me not want to be friendly or go out where I would have to meet new people." Meanwhile, he was afraid of trying harder to present as a man, lest he be attacked, literally. He says that he knew a very masculine, bearded transman who, on going into labor, was assaulted in the ambulance by EMTs because “they were not happy with him being so obviously male and pregnant at the same time."

There was at least one benefit: When Paul and Chris went to city hall to get married two years before same-sex marriages were performed and recognized in Pennsylvania, they didn't have to worry that Paul presented as too masculine to marry another man. One look at Paul's pregnancy, and the clerks issued the license and performed the marriage.

Stephen Stratton found pregnancy somewhat less difficult, for a variety of reasons. His gender dysphoria had peaked right after puberty and through his early years in college, he explains. “By the time I was actually ready to be pregnant, I had become much more comfortable in my skin than I was as a 20-year-old," he explained. He had been on hormones for ten years already. “I knew that my beard wasn't going to go away, my voice wasn't going to change, I was still going to build a path in the world as a man." Being a man, he says, made it possible for him to tolerate pregnancy. “I was never going to be a pregnant woman. The gender dysphoria – that would have been way too much for me to handle."

Which is not to say he found pregnancy easy, both for the usual reasons – pregnancy is physically challenging and often very uncomfortable – as well as for gender-specific reasons. It discomfited him to have his body doing something so strongly coded female. Stephen didn't walk around telling people he was pregnant and getting the congratulations and encouragement that pregnant women can expect from strangers, whether that's welcome or not. “I don't know what people thought. But I happened to be most pregnant in the winter," he says, which in Maine meant being buried under many layers of clothing. And so he felt fine going wherever he needed to go, assuming that most people perceived him as an overweight guy with a big beer gut.

Of course, at work – he's a nanny – and within his community of friends, everyone knew and supported him. Ruben Hopwood agrees that the conflict between a male identity and a female bodily activity like pregnancy can be extraordinarily difficult for some transmen. “For a lot of folks anything around reproductive issues, menstrual cycles in particular, can become almost unbearable" to begin with, he explained. On top of that, pregnancy involves “all of the exams that are drawing attention and focusing on reproductive organs and genitals that a person may just deeply detest and not allow anybody near. That can be very traumatizing and extremely difficult to manage."

He recommends building and leaning on a supportive community, as both Paul and Stephen did, and finding an array of “grounding and relaxation techniques and skills that they could use to handle the emotional and physical discomfort." The next challenge is finding sensitive medical professionals and a clinic or hospital that's ready to help. The Mazzoni Center, where Paul got his medical care, did not offer obstetric care. He had decided to have his baby at Abbington Memorial Hospital, located in a Philadelphia suburb.

And so he was tremendously relieved when, that year, he went to the Philadelphia Trans Health Conference towards the end of the pregnancy, and saw three people from his OB-GYN team that he had been seeing for prenatal visits at the hospital. The people who were going to care for him were not just trans-friendly; they were actually giving seminars on trans-sensitive gynecologic care.

He approached them and reminded the team that he'd been to see them. When he told them he had been afraid to disclose that he was trans for fear of mistreatment, they welcomed and reassured him, and promised he would be well cared for. That's when, Paul says, “I realized that there are people out there who know that transgender people have babies. Yeah, it was really cool."

And when the day actually came, labor was so overwhelming that he didn't feel any gender dysphoria or notice his treatment. “I was really not aware of anything. It was impossible not to focus entirely on my body convulsing and having the baby." And then there he was, after all that effort: baby Brad. Paul says that holding him was very peaceful. “It was a very quiet, happy time."

Paul with Brad

In Portland, Maine, Stephen actively sought out a trans-friendly healthcare team. He was recommended a group of certified nurse midwives, the Backcove Midwives, who had worked with same sex couples before. Though they hadn't had a trans client before Stephen, they welcomed him warmly and immediately put him at ease. Before he had to go for ultrasounds, he reached out to a queer friend who worked in that office. The friend talked to the office staff in advance and was reassured that Stephen would be treated respectfully.

Then, as his delivery date neared, he worried about how he and his partner would be treated at Portland's Mercy Hospital, where he would deliver. But when he mentioned his fears to his midwives, they were way ahead of him. They had already met with the head of the hospital's nursing staff to advocate for him. “They did all the work for us," says Stephen. “We didn't have to educate anyone, which was exactly what we needed and exactly what we didn't think we would ever get."

He was amazed at how well he was treated, from the moment he arrived. The security people were prepared for his arrival. The nurses brought him all his meals so that housekeeping never had to come to his room, “so nobody would be asking questions. We were taken care of from start to finish." Stephen marvels, “I was kind of incredulous about it."

Some people, of course, have a more difficult time. Ruben Hopwood talked about a transman who was “completely stealth," in the lingo – living his life without feeling an obligation to disclose his full medical history – and who went to a fertility clinic to try to conceive. Fertility treatment is hard enough: It involves giving oneself shots and enduring hormonal surges, mood swings, swelling, and other physical discomforts.

On top of that, with no one in his life who knew he was trans besides his medical professionals, this man had the dissonance and social isolation of showing up regularly in a clinic office where the other patients – all women – would stare, visibly wondering why he was there without his wife. Even the medical professionals who were treating him sometimes could not stay aware of what they were doing, says Ruben. One nurse showed the transman how to give himself the ovulation-stimulating shots and then asked him to get a particular piece of information from the child's mother. Imagine the transman staring at her and thinking: What about me trying to ovulate don't you understand here? “And that was just a tiny experience," Hopwood explained. At those moments of disconnection, he said, it helps to have a sense of humor.

Hopwood strongly recommends that transmen have at least a few close friends they can lean on to get through some of the pregnancy's difficult moments. That includes someone to talk with, of course, but also friends who can come along for emotional support and “possibly even to run interference if it's too upsetting for you to stand up and advocate for yourself." Just having a female friend who will sit with you in the waiting rooms can deflect scrutiny, even if the man is the one visibly pregnant.

Oh My God, We Have a Baby!

Stephen and Josh's daughter Rowen was born at 10:30 at night. Josh caught her and put her directly on Stephen's chest. All night, they took turns holding the amazing creature who had arrived in their lives as if she had always been there. As a professional nanny, Stephen says, he had “loved a lot of kids." The feeling he had for Rowen eclipsed that feeling completely. “Love is not an accurate word. It's so much more than that," he says.

Top to bottom: Josh, Rowen, and Stephen. Photo credit: Sarah Bostick

“As soon as I saw her, I felt like I had known her my entire life. It was amazing. Being a pregnant man wasn't always easy, worrying about what she would feel about all this. After having her, I cannot imagine doing it another way. She's our baby and she found us when she was ready. She's been the best thing that ever happened to us."

Feeding the Newborn

Since Brad was born, Paul has nursed for the past two and a half years. After the first eight months, he could no longer stand being perceived as a lesbian; he got a male haircut, started binding his chest again despite the risk of mastitis (a milk duct infection), and gave away all his maternity clothes. He was again perceived as a young man, getting comments like, What a good big brother! After almost two years, two pediatricians told him he could begin taking testosterone again, as long as he and Chris monitored Brad for testosterone exposure, just as they would if someone in the house used a testosterone gel for a medical condition. (Dr. Cavanaugh advises against taking testosterone while nursing, however, so individuals should check with their own medical teams.)

While he is proud to have nursed his baby, Paul says that the year and a half without testosterone were horrible. From the first, it had been painful to watch all the muscle he had gained melt away, to see his back getting big and his hips and legs looking curvy and feminine.

Getting back on testosterone and regaining his masculine shape was a great relief. “I am never going off, ever again. Everything is a lot better now. Being on testosterone is my little lifeboat. It changes so many things. I have been back on for about seven and a half months now." His body has started bulking up again into a man's body. He feels like himself.

Dr. Tim Cavanaugh, M.D., Medical Director of Trans Health Program at Fenway Health

While Dr. Cavanaugh recommends against nursing while on testosterone, he sees no other reason to wait after giving birth. “If somebody has had a normal and uncomplicated pregnancy," he says, “there is little downside to starting their testosterone as soon as they would like to."

Of course, if there are complications like gestational diabetes or elevated blood pressure, physicians would most likely want to wait for the condition to stabilize before introducing the hormone. Otherwise, transmen can go back on it as quickly as they went off, eliminating menses, regaining their physical shape, and reaffirming their gender identities.

In hopes of adding to their family someday, Stephen chose not to go back on testosterone, in order preserve his fertility. But long before ever considering pregnancy as a viable option he had had top surgery, so he was not able to nurse his daughter. Nevertheless, little Rowen has been been fed – wait for it – on breast milk. When she was born on May 20, 2014, she was unable to digest formula. He and his partner put out the word among friends who were in lactation groups or otherwise connected to nursing mothers, and women started donating their excess breast milk to help. Stephen says that Rowen, now 8 months old, was on breast milk exclusively for her first three months; since then, she's had half breast milk and half formula. Stephen's family had tapped into a milk-sharing community called "Human Milk 4 Human Babies" that thrives in many cities, often with a Facebook page, he explained. “We've met some wonderful moms. It's been really amazing having folks that are willing to do that for us."

Being Dads

With their healthy babies around them, both Paul and Stephen have been able to focus on being the best dads they can. Hopwood explains that once transmen have had their babies, the focus on their bodies goes away. Nobody can tell just by looking that they gave birth. “They don't ever have to disclose to anybody who doesn't know already that they physically had this child. They are not being questioned about their gender anymore. They may be questioned about where the mother is, but they are not going to be questioned about who they are. And so the integrity of their body is kind of restored at that point."

Family Portrait: Josh, Stephen, and their daughter Rowen

What Do You Tell Your Child?

What's left, then, is the question of whether, when, and to whom to come out as the person who bore the child – including to the child. Paul said that he and Chris plan “to tell Brad about everything." They're not going to doctor the photographs; Brad will know that Paul is trans, because he's fully out in his community and to his family as a transman. Paul is relieved that Brad won't have any conscious memories of him as a woman, and will always perceive him as a dad.

What Paul finds disturbing is that his birth name is on Brad's birth certificate and can never be updated, not even once Paul's own birth certificate is finally amended to identify him as male, after he has medically completed his transition.* “It's almost as if the person who had him doesn't even exist. It's supposed to protect the child, but in reality that makes it a useless document because it just doesn't seem like it has me on it."

* Completed transition: For each transgender individual, the medical interventions involved in transition will vary. For instance, some take hormones and undergo no surgeries. Nevertheless, some states and government agencies continue to require that transgender people who want to update their identity documents must have had “sex change surgery," which is no longer the medical standard of care. The National Center for Transgender Equality is working on updating state and federal government policies to ensure that identity documents are updated when a doctor certifies that you have had “appropriate care."

Day to day, he and Chris navigate other people's perceptions of their relationship to Brad much as any gay men do. There is the occasional complication when Paul's biological connection to the toddler is misunderstood or dismissed entirely. At their first pediatrician visit, Paul says, Chris identified himself as Brad's father—and the nurse “was like, 'Who are you, his uncle?'" Paul was floored. “Oh my god. I dedicate all of my time to raising and having this child. There is no way I am just his 'other dad.'" After that the couple went into any meetings with an advance strategy. Whenever anyone asks who's the father, Paul speaks up first, and Chris then identifies himself as the other dad.

Otherwise, especially before Paul went back on testosterone, they would look at him “to try to figure out who you are. I don't want people to get into a highly curious place where they'll ask questions that might make me uncomfortable."

Now that he's regaining his masculine form, he sometimes gets questioned about how old he is – as if he's too young to be a father. He's been trying to adjust his clothes to be read more consistently as his actual age of 25. Maybe it's because he lives in Mt. Airy, a groovy and LGBT-friendly neighborhood of Philadelphia, but so far, Paul says, everyone they've come into contact with has been trans-friendly. “For example, Brad and I joined a music class for toddlers. It turns out that class's teacher has a 4-year-old transgender daughter. She was so happy to meet me! Everywhere we go in this neighborhood we end up meeting more transgender people and kids."

Even his mother has brushed away earlier reservations about Paul's manhood; eager to see her grandchild, now she “never, ever messes up a pronoun or my name. She knows how to be diplomatic when she wants to."

He realizes that coming out as transgender will get more complicated and more out of his control once Brad is older. “I don't want him to be in a position of being ashamed or afraid to share about his family or anything like that," Paul says. On the other hand, he assumes Brad will discover the option of disclosing what he wants to disclose and will simply not mention anything that seems too complex for a particular interaction. He will be able to make his own choices.

Before they tried getting pregnant, Stephen Stratton and his partner Joshua talked a great deal about what they would tell their child. “We wanted our kid to just grow up knowing their story and hopefully feeling very proud of who they are and where they came from," he said. That meant, he continued, “I have to be proud of our story. I have to be open and willing to share the story. That means that I am out in a different way than I was before. It means that I don't lie about where she came from. It hasn't been easy to be such an open book. I wasn't hiding my gender, but it wasn't something that just came up in everyday conversation."

Paul and Chris with Brad

Now it does. Recently at the playground, he ended up talking with another parent. When Stephen mentioned his partner, the mom said, “Oh, so did you two adopt or use a surrogate?" Stephen answered straightforwardly, “Actually, I'm transgender, and I had her." The mom said she'd heard that was possible, but had never met anyone who'd done it. “It was the first time I just blurted it out like that," he explained. “Sometimes we say, 'Oh, it's a longer story than that,' or, 'That's actually personal and we don't want to share it right now.' But it just came out. And it was a perfectly fine exchange."

Paul and Stephen, of course, are unusually open people: They agreed to talk with a reporter, on the record, for an article about their trans-parenthood. Not everyone will be that far along the spectrum of openness. Ruben Hopwood believes that far more transmen are “stealth" about their trans identity. “There are those who are completely wide open," he says, “and there are others that aren't open at all, and their children never know." He mentioned one transman, now in his mid-60s, who adopted his son, parented solo, now has a grandson, and has never told. Says Hopwood, “I am the last living person who knows he is trans." When that man dies, his son will be confronted with a surprise – but it will be too late to ask questions.

For those who do tell their children, Hopwood advises that they must become ready to have “anybody and everybody" know. Once you tell a child, he explains, “it's no longer your information to control, because they are going to tell random people when the mood strikes them. The individual has to be comfortable having lost control of that information. You don't just explain it once. They keep coming back and asking more. And they tell their friends."

Dr. Ruben Hopwood, M.Div., Ph.D., Coordinator of Trans Health Program at Fenway Health

At the same time, Hopwood also notes that it's important to start preparing the children with basic information when they're younger than 6, before “being different than everyone else becomes a real big problem socially. Don't wait until age 12. As soon as they start asking questions, which is about 2 or 3, about bodies and whose bodies look like what, start interjecting information that will help you down the road that will explain to them who you are."

That said, Hopwood advises giving children only the most age-appropriate information, information that that particular child wants and is ready for. “Give them little bits of information when the child starts asking," he says, but avoid forcing too much information on them “when they are not asking and not ready." For some children, he said, “just explaining that they are genetically related is enough. Leave details vague. As the child ages, of course, they begin asking a few more questions and wanting to know what exactly does that mean." The answers will vary with the child's follow-up questions and with the level of the transman's own “comfort explaining their own body makeup."

For help, he advises turning to some of the books written about discussing trans issues with children, such as Bear Bergman's The Gender Wish Fairy and Backwards Day, and the video No Dumb Questions, in which three girls gamely work to understand why and how their Uncle Bill is becoming their Aunt Barbara, each with questions appropriate to their ages. “It's an excellent short film about talking to kids."

Stephen Stratton does stay current with the blogs and books, and also looks to other trans-parents around him for insight into what's ahead. Some men he knows have kids “who are teenagers, who are adolescents, who are explaining to soccer teams and telling other parents," and he is learning from what they tell him. He believes that the more trans-parents come out to their communities, they make things easier for those behind them. He also maintains his own blog.

Not so long ago, the country went into paroxysms over Heather's two moms; today in many regions of the country, two moms or two dads are not even worth blinking over. Says Stephen, “I hope that someday we get to that place." Right now, Stephen is working at home, taking care of his daughter and another family's 2-year-old. His partner, a cook at a local restaurant, is home every day by two. “We spend a lot of time together as a family," says Stephen. “And we just love it. It's better than anything I had ever hoped for."

Matt Wood, Staff Attorney at the Transgender Law Center in San Francisco

Sidebar: Legal Issues for Transmen Conceiving and Carrying Children

For this article, I asked Matt Wood, staff attorney at the Transgender Law Center in San Francisco: What legal issues, if any, should transmen be aware of before launching into pregnancy? He came up with a list of possible issues for me. But he began by saying very clearly that, to the best of their knowledge, no one had ever contacted him or the Transgender Law Center with these concerns. They are ready to consult, however, if you face these situations, as are any of the LGBT legal groups. The phenomenon of transmen giving birth is new enough that it's worth doing some reconnaissance lest you encounter:

  1. Discrimination, disrespect, or harassment by healthcare providers. You may have recourse if you are called “she" or “the mother" – not accidentally, as in the example in the story, but maliciously – and most certainly if you are assaulted or otherwise mistreated as a man carrying a child.
  2. Breach of medical record privacy. Check in advance to be sure that your transgender status will be disclosed only to those who are providing care. If you will be giving birth in a teaching hospital, make sure hospital staff know that you do not want medical students coming through to be introduced to your case (unless, of course, it's okay with you).
  3. Discrimination or harassment from your insurance carrier. Check to be sure your insurance carrier will cover all medical needs during the pregnancy. Medical necessity should trump gender exclusions here, but denials still occur. Keep in mind that, as most plans say, prior authorization is not a guarantee of coverage. Seek help if you can't get that changed by contacting the insurer's call center, and if appropriate, by making an appeal to any state agency that regulates your insurance plan.
  4. Inaccurate birth certificate information for your child. Different states have different forms. You may want to check ahead to see if you and your partner can be listed accurately on the form, as “parent" and “parent."
  5. Relationship to your child not recognized by authorities. If your relationship is not recognized by your state or nation (which is of course changing by the moment), and if only one of you is genetically related to the child, investigate whether the other father should go to court to adopt the child legally (as a second parent), just to be certain that his parentage is recognized. That's all more complicated, of course, if you have used donated eggs. Wood advises contacting a family law specialist in your state who can talk to you about the conception and adoption issues related to your reproductive situation.

If you do encounter any of these, Wood recommends:

  • Making discrimination complaints to the state agency that regulates the provider, whether that's a hospital or insurance agency. In some cases that might be the federal Department of Health and Human Services. If you experience discrimination or harassment by medical staff, consider making a complaint about the individual to the relevant state licensing agency (such as a state medical, nursing, or pharmacist board) or to the Joint Commission for other hospital staff.
  • Contacting the most relevant LGBT legal organization for help. In the U.S. those include the Transgender Law Center, ACLU (American Civil Liberties Union), GLAD (Gay & Lesbian Advocates & Defenders), Lambda Legal, and NCLR (National Center for Lesbian Rights) each of which has a robust transgender rights project.

Matt Wood adds, “It's hard to simultaneously protect your rights and engage in this amazing, beautiful process. If it's necessary, contact someone who has experience and can help you. Don't try to do it on your own."

Some names and identifying details have been changed to protect the privacy of individuals.

Posted by E.J. Graff

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