Finding gender-affirming care: Elijah’s story

elijah, a transgender patient, stands on the beach
Now in tenth grade, Elijah is an extroverted teen who enjoys hanging out with her friends and being outdoors.

Elijah de la Torre and her family recently relocated from the second-largest state in the U.S. to the smallest. But their move from Texas to Rhode Island has revealed more differences than just geography. “When it comes to Elijah’s care, it’s like night and day,” says her mom, Sarah. But she recognizes the benefits of her former home as well: “If it wasn’t for our doctor in Texas, we never would have found the Gender Multispecialty Service.”

Elijah, now 15, and her parents started looking for gender-affirming care before she entered puberty. But they found that it was difficult to find clinicians in their area who were well versed in treating transgender patients, particularly children and teens. “There just didn’t seem to be a lot of local medical resources for trans kids back then,” says Sarah.

Elijah, who receives gender-affirming care, smiles at the camera

When Elijah’s family first discussed moving to New England, they worried about starting all over again in their search for optimal care.

The long journey for care

The family was eventually able to locate a great physician — but there was a catch. The clinic was located in Dallas, a 10-hour roundtrip drive from their home. What’s more, care wasn’t covered by insurance. Nevertheless, they made trips to Dallas monthly, where Elijah’s doctor prescribed her an implanted puberty blocker, a type of medication that inhibits the hormones that trigger puberty.

For the next few years, the travel — and out-of-pocket cost — was worth it. Still, says Elijah, it was challenging to be referred elsewhere for services the clinic didn’t provide, such as bone scans. In an area that seemed less than trans friendly, “We kind of always felt like we were sneaking around,” she remembers.

Elijah, a transgender patient, stands on a brick sidewalk in Rhode Island.

“We’re so grateful for the opportunity to get Elijah the best care,” says her mom.

Making a change

When the family first discussed moving to New England, they worried about starting all over again in their search for optimal care. But Elijah’s doctor in Texas was happy to refer them to a colleague, Dr. Jeremi Carswell, who directs the GeMS clinic at Boston Children’s Hospital. “We were able to transfer Elijah’s care to Dr. Carswell,” says Sarah. She offers the following advice to other families looking for similar care.

Do your research. Sarah recommends putting in the effort to find a clinical team that works for your child. For her family, that meant looking outside their local area. When the time came to relocate, she began researching again — and found that GeMS checked all of the boxes Elijah needed. That included having related services right onsite. “It’s really cool because we can get everything I need, like blood tests and bone scans, in one place,” says Elijah. “Everyone knows who I am and why I’m there.”

Look for a well-rounded team. In addition to seeing her physician and social worker at GeMS, Elijah has taken advantage of other resources. “We were concerned about fertility preservation,” says Sarah, referring to a sometimes-overlooked aspect of care for trans patients. This process allows patients to preserve sperm or eggs for future use so they may one day have a biological child. Fortunately, Dr. Carswell was able to recommend that Elijah meet with a Boston Children’s urologist to discuss her options. “He was sensitive to our questions and concerns,” says Sarah. “It’s a great example of having the right experts on hand when we need them.”

Make connections. In Texas, Elijah and her family were active in support groups for trans youth and their families. “Parents were at a lot of different stages in the process of understanding and acceptance,” Sarah remembers. “We would just try to help each other the best we could.”

Now in tenth grade, Elijah is an extroverted teen who enjoys hanging out with her friends and being outdoors. Since her move, she’s been using estrogen in addition to a puberty blocker, which she says is a nice change. And her parents are happy, too. “We’re so grateful for the opportunity to get Elijah the best care,” says Sarah. “It’s just a huge relief.”

Learn about the Gender Multispecialty Service.

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