Amber, a soft-spoken, feminine 12-year-old who loves Hello Kitty and fashion design, lives with a secret. It is a secret most sixth-graders can't fathom, one she hides behind pink skirts and makeup. It is a secret that led to all her baby pictures being tucked away as though her childhood had never happened.
Amber was born a boy.
When she was 10, she stopped going by her given name, Aaron, and began dressing as a girl. Last year, she started taking medication to keep her from going through puberty.
"I can be who I am," Amber said. "I can be a girl."
An increasing number of children like Amber are realizing they are transgender and seeking care at clinics around the nation. Because of their age, the complex and emotional journey is as much their parents' as their own. Families are forced to make tough decisions about therapy and medication, and about what to tell friends and relatives. They are trying to give their children a normal upbringing with summer camps and sleepovers while protecting them from harm and embarrassment.
"How do you move through society with a gender-variant child?" said Nancy Quay, a psychotherapist at the University of Michigan gender services program. "What do you tell your neighbors? How do you keep your child safe?"
For Amber's parents, Michelle and Jamie, the last few years have been a roller coaster of emotions — guilt for not recognizing earlier that their daughter was transgender, grief over losing Aaron and worries about Amber's future.
The family's last name is being withheld at Amber's request. They all agreed, though, to both a video and photographs. Michelle said their family and others close to them know about Amber's transition.
Telling their story, she said, "is the right thing to do.... Hopefully it will bring more awareness and help other families."
Michelle said she believes that letting Amber take the medication and live as she wants is the only real choice. "We are confident this is her authentic self," she said.
Jamie is supportive but not quite as sure. "This is some pretty serious territory," he said. "As a parent, you are always second-guessing yourself."
Just a few clinics around the nation serve transgender children. It wasn't until about five years ago that doctors began treating them with puberty-blocking drugs to give them time to explore their gender identity before taking hormones whose effects would be irreversible.
The medication is approved by the Food and Drug Administration for children who start puberty prematurely but not for transgender adolescents. Two professional organizations that study hormonal and gender issues recommend the drugs' use in certain transgender cases, but doctors remain divided on whether to prescribe the controversial and expensive medication.
Supporters say the drugs can prevent the devastation a transgender girl feels when she grows facial hair or her voice drops and when a transgender boy develops breasts or begins menstruating. They can reduce depression and anxiety and eliminate the need for some future surgeries, said Jo Olson, Amber's doctor and the medical director of the transgender clinic at Children's Hospital Los Angeles.
"Puberty in the right body is hard enough," Olson said. "Puberty in the wrong body is really hard."
Other doctors, however, express caution based on a lack of research. Walter Meyer, an endocrinologist and psychiatrist in Texas who works with transgender patients, said that puberty blockers are helpful for some adolescents but that knowing which ones is sometimes difficult. Not all children who identify with the opposite gender end up as transgender adults, he said, and giving medication to those may be going too far.
The drugs are administered through a surgical implant in the arm or monthly injections. They suppress the production of sex hormones, making it easier to pass as the opposite gender, Olson said. If the youngsters stop taking the drugs, they will go through puberty.
Olson acknowledged that doctors are making clinical decisions based on instincts and observations rather than research. "That's what makes this incredibly difficult," she said. Olson said she prescribes blockers only to adolescents who are in counseling and have been persistent about their gender identity.
Amber's father said he thinks of the puberty suppressors as a stopgap to "make sure everybody is 100% on board with the way it's going."
But Amber insists she never wants to be male. "Why would I have started if I am going to change my mind?"
Aaron was a toddler when he first made his preferences clear. He didn't like cars or trucks, choosing Barbie dolls and dress-up clothes instead. Early on, he was attracted to "really glamorous, glittery, pretty things," Michelle said.
Getting dressed was a battle. He refused to wear shorts or pants, begging every day to wear his version of a dress — an oversize white T-shirt with a belt. On Halloween, he wanted a girls' costume, like Tinker Bell.
Jamie and Michelle thought he would grow out of it. They arranged play dates with boys, but Aaron only liked girls. Jamie tried to engage his son in sports, but Aaron didn't want to play.
The parents tried to be supportive, at least in their San Diego County home. They bought him pink Izod shirts and let him have the toys he wanted. For one birthday, they put a pink ice cream cake on a table decorated with glitter. A few times, though, they tried packing the girl toys away.
"We were always thinking ... that through socialization it was going to change," Jamie said. "The opposite happened. The socialization would cause anxiety."
School didn't go well. In kindergarten, a frightened Aaron cried all day. They switched to a private school. That ended poorly when a teacher handed them a video about how not to raise a homosexual boy.
Michelle, a real estate agent, and Jamie, a musician, decided to home school Aaron. But the emotional issues got worse. He rarely wanted to go out and was increasingly anxious, often refusing to eat. His parents worried about his health.
When Aaron was 9, a friend suggested to Michelle that he might be transgender. She and Jamie did research, met with a therapist and watched a television show about transgender kids.
Michelle decided to try thinking of Aaron as a girl and letting her live life that way. So they bought girl clothes and talked about a different name. Ashley? Alexandra? They decided on Amber.
"Once I realized what was going on, it was a huge relief to know there was something we could do to help her," Michelle said. "I just wanted her to be comfortable who she was."
Amber, who is tall with ruddy cheeks and smooth skin, grew her hair and decorated her room with Hello Kitty wall decals, beaded pink curtains and a pink ballerina blanket. She started playing with makeup.
Jamie found the change and giving up his expectations for a father-son relationship difficult. But he saw that Amber was much more confident and happy. "As uncomfortable as it is for a father to see his son dressing as a girl, I knew we were heading in the right direction," he said.
A monthly support group helped Michelle and Jamie. The parents talked about their feelings and traded information about schools, doctors and medications. "Being in the group has reinforced our thought process and the choices we are being forced to make," Michelle said.
Michelle had read the research about how common depression, anxiety and even suicide were among transgender adults. So last fall when Amber turned 12, they went to Children's Hospital Los Angeles and got a prescription for the blockers from Olson. Michelle prepared the first injection, but her hand was shaking too much to put the needle in. She handed it to Jamie.
Amber's phobias and insecurities quickly began to fade. She became a "totally different kid," Michelle said.
Amber decided she was ready to go back to school. She continued to be home-schooled part time but three days a week went to a campus for other students receiving instruction at home. "I wanted to start a new chapter and meet friends," she said.
She soon wanted to have a new friend over. As soon as the girl arrived, she started trying on Amber's clothes. Amber knew not to do the same, but it reminded Michelle how complicated even a play date could be.
At school, Amber kept her secret. Her teacher and principal knew, but friends didn't. The school was supportive but set one rule — Amber couldn't use the girls' bathroom. She used one for both genders.
Amber liked school, but the bathroom rule made her uncomfortable. She made up stories, like seeing cockroaches in the girls' bathroom. One day, she was hanging out with friends when they all went into the bathroom to talk. She followed. Her teacher saw the girls go in and pulled Amber aside after she came out. Amber felt angry and upset.
The family is weighing where she should go to junior high school and researching where she could be openly transgender. Sometimes Amber thinks it would be cool to be around more kids like her. But other times, she wishes she could keep the truth hidden forever, saying it is "embarrassing and personal."
Over lunch recently, Michelle told her, "Someday you will have personal relationships and they'll need to know."
"I would like to have the surgery early so I can have a relationship without anybody knowing," Amber said.
"But you won't want to have secrets," her mother said. "If people love you, they will love you for who you are. We do. We love you."
Amber hopes to begin cross-sex hormones when she turns 13 and wants to have surgery at 16.
"Right now I can fit in with the push-up bras and stuff," she said. But she wants to take hormones "so I can grow a female anatomy and stuff."
This summer, Amber is going to a sleep-away camp for transgender kids. Her parents hope it will help her feel more comfortable sharing her secret.
One afternoon, Amber and Michelle went to the mall to begin shopping for camp clothes. At one store, Amber picked out rainbow socks and a charm necklace. At another, Michelle held up a pair of zebra-striped shorts. Amber laughed and shook her head.
"I like this," she said, holding up a green ruffled skirt. "It's cute."
Then Michelle took her daughter for a treat: a manicure. At the nail salon, Amber picked out a design, Hello Kitty faces with sparkly purple bows.
As the manicurist painted her nails, Amber's hair fell onto her face. Sitting beside her, Michelle gently tucked her daughter's hair behind her ear.
"You look pretty," Michelle said.
Amber smiled. "Thank you."