‘The hospital for queer people’
A trans patient’s journey through the UCLA Gender Health Program
A week after Wyatt came out to his parents as transgender, he experienced a mental health crisis that required hospitalization.
The realization that he was trans, paired with attention deficit/hyperactivity disorder (ADHD), anxiety, depression and the process of coming out during the COVID-19 pandemic caused him “mental turmoil,” he says.
It “ultimately led to me being in Resnick [Neuropsychiatric Hospital at UCLA],” says Wyatt, a 17-year-old trans boy whose name has been changed to protect his privacy.
There’s no one playbook for families who must help their children navigate their gender curiosity, questioning or path to transitioning. For some, the pandemic further complicated matters.
Many of Wyatt’s peers, especially those who identified as queer and are arts-focused, had negative experiences, Wyatt says, from coping with the shift to remote learning to social isolation, anxiety and depression.
According to data from the Centers for Disease Control and Prevention (CDC), in 2021, more than a third of high school students reported they experienced poor mental health during the COVID-19 pandemic, and 44% reported they persistently felt sad or hopeless during the past year.
The risk of depression, anxiety, substance abuse and suicidality was even higher among youth transgender and/or nonbinary youth, according to research from The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ young people.
Alexa, Wyatt’s mom, was surprised when he came out to her.
“It ended up feeling a little adversarial,” she says. “It was very unusual for us because we’re quite close.”
Wyatt says this was because he wanted to get it over with because the idea of coming out was new and scary. He was concerned about what she would think.
“I was at the edge of this giant realization about myself and also super concerned about what she was thinking,” he says. “I was like, I’m just gonna tell her and that’s going to be it. I remember how she stared at me and it felt like the worst moment of my life, because it was so hard and weird.”
Because Wyatt had attention deficit/hyperactivity disorder (ADHD), depression and anxiety, he had a therapist and psychiatrist on hand.
Alexa called them both.
“They both said not to lean into it and not to lean away from it, but to just go with it. So that’s what we did,” she says. “We didn’t make it a thing and we didn’t avoid it.”
Alexa says she thought coming out would ease Wyatt’s anxiety and depression, especially because his parents had a positive reaction. However, he had recently started a medication for depression that was making his condition worse.
A week after Wyatt came out, his therapist called Alexa and said she needed to take him to the emergency room because he was having suicidal ideation.
Additionally, Wyatt was struggling with gender dysphoria, a sense of unease due to feeling a mismatch between one’s gender assigned at birth and one’s gender identity. This feeling can result in a negative sense of well-being, poor self-esteem, anxiety, depression, and an increased risk of self-harm and suicidality.
Wyatt was admitted to a 7-day stay at Resnick Neuropsychiatric Hospital at UCLA.
He graduated to a nine week outpatient program of therapy five days a week, totaling about 30 hours each week. He tapered down to 9 hours a week, just as school was starting, and was introduced to the UCLA Gender Health Program.
“Once I was there, I felt immediate support from the staff,” he says. “The focus became what’s next for me.”
Wyatt was introduced to Jessica Bernacki, PhD, pediatric psychologist and director of behavioral health for the UCLA Gender Health Program, in a virtual intake session.
After his goals for medical transition were established, he was referred to Nupur Agrawal, MD, MPH, a pediatric internist at the UCLA Gender Health Program, to evaluate Wyatt for testosterone therapy.
When patients begin hormone therapy, they can expect to see changes in four areas: physical, emotional, sexual and reproductive.
Wyatt noticed the physical aspect almost immediately, experiencing a distribution of body fat and increase in body hair.
“Starting testosterone was so helpful because not only is it affirming your identity, but your body is becoming what you feel that it should be,” he says. "It gives me something to look forward to.”
Every milestone is a big deal.
“For me, the voice was the most important part of it, because I'm an actor and a very vocal person,” he says. “It was always so hard when I wanted to speak out because my voice felt wrong.”
Wyatt says before testosterone his voice felt too high and too feminine. “There wasn’t congruence between my voice, who I am and how I wanted to sound,” he says.
Thirteen months after starting hormone therapy, Wyatt began a consultation for top surgery, also known as chest reconstruction, with George Rudkin, MD, a clinical professor and program director of the UCLA Division of Plastic Surgery.
Dr. Rudkin explained the risks and benefits of surgery and the process of recovery, and provided a recommendation to Wyatt and his family on the technique for the procedure. Then they went over the insurance approval process together.
The insurance approval requires a mental health evaluation as a pre-requisite.
“They wanted me to wait until I was 18, which sucked because I would be in college across the country by that point,” says Wyatt. “Dr. Rudkin ended up actually meeting with a representative from the insurance and contested my case.”
Dr. Rudkin, who has a clinical interest in gender-affirming surgery, says he and his colleagues at UCLA Health advocate for all their patients and try to make recommendations on surgeries that will lead them to outcomes best suited to their bodies and goals.
“If I think that the patient can benefit from top surgery and that's something that their mental health specialist feels is the right thing for them, then yes, I will advocate for them to their insurance company,” he says.
Wyatt had surgery in Jan. 2022. He couldn’t be happier with the results – he loves being shirtless, he says.
“There’s a lot of trans guys at my school – which is great, but we all have had different experiences with the hospitals that we went to,” Wyatt says. “My friends are jealous because I have the best stories. UCLA Health is like the hospital for queer people, because there, you just belong and there’s actually queer people there, too.”
At a time when gender-affirming care is under attack, Wyatt says people like Amy Weimer, MD, pediatric internist and co-founder of the UCLA Gender Health Program, are making a difference in people’s lives.
“Dr. Weimer is so enlightened and understanding,” he says. “You just look around and you don’t have to be worried.”
The gift of freedom
Wyatt says at this stage of his life, he feels the most acceptance where he is now – in a diverse metropolitan city at an accepting and open-minded high school, surrounded by friends and family who love him.
“For a lot of people, that’s not a real situation,” he says, referring to the anti-trans and anti-LGBTQ policies taking root across the U.S.
Due to the restricted access to gender-affirming care in Arkansas, Texas, Ohio and 12 other states, Wyatt had to carefully plan where he would apply for college.
“There were schools in Ohio that I was actually applying to, but I had to pull my application because they outlawed trans health care there,” Wyatt says. “I basically stuck to the coasts.”
Alexa says the restrictions are very concerning to her as a parent.
“I feel like on the one hand there’s a lot more representation in media, but then on the other hand, backlash from conservatives is forcing us 10 steps backwards,” she says. “For now, our strategy is to avoid Texas and Florida, which is a shame because we would like to travel to Florida and we have family in Texas.”
On the whole, Wyatt and Alexa found that their family and friends were accepting, even people they didn’t think would be.
“My position has been that if I tell someone and it doesn’t go well, then we really don’t need that person in our lives,” Alexa says. “It’s very simple.”
What is surprising, however, is the amount of people who tell her that she is “brave” and “such a good mom.”
“She is a great mom,” Wyatt says, “but her acceptance isn’t what makes her a great mom, it’s her love and willingness to drive to the end of the Earth for me. There are so many other things that make her a great mom.”
The worst thing a parent can do is ask their child to pretend to be something other than who they are, Alexa says.
“Honor what your child is telling you,” she says. “Listen and have an open mind.”
Wyatt says the greatest gift his parents have given him is the freedom to explore his gender.
“To understand the complexities of gender is such a gift for you as a human, even if you might not end up having a trans identity,” Wyatt says. “To just be able to question is an affirming thing.”
Learn more about the UCLA Gender Health Program.