Jazz, age 15 years, is a transgender teen, activist, book author, reality-TV show star, and so far the youngest national transgender spokesperson in the United States. She and her parents, Jeannette and Greg (“Jennings” is not their real last name), were invited by the American Association of Clinical Endocrinologists to participate in several sessions on transgender medicine at the organization’s annual meeting in Orlando last week.

When asked by an audience member what she wishes medical professionals knew, Jazz responded: “A lot of people think it’s a choice being transgender. I would want any professional I’m with to understand that this is the way I am….I would want them to provide the necessary care in order for me to feel like my best self.”

In addition to two Meet-the-Expert sessions and a press briefing with the family, the AACE meeting also featured a 2-hour 45-minute in-depth symposium, “Transgender Medicine: What an Endocrinologist Should Know,” covering both pediatric and adult treatment. All the sessions drew large audiences.

The intention in inviting Jazz and her parents, AACE past president Mack Harrell, MD, told Medscape Medical News, “was to introduce endocrinologists to a real live transgender 15-year-old who’s doing great, with really supportive parents and a healthcare system that provides care. Unfortunately, she is the exception. A lot of children and adults who are transgender cannot get care.”

The meeting sessions were co-chaired by Vin Tangpricha, MD, PhD, associate professor of medicine at Emory University, Atlanta, Georgia, an endocrinologist who has been treating transgender adults for over 15 years, and pediatric endocrinologist Stephen M. Rosenthal, MD.

Dr Rosenthal is co-founder of the Disorders of Sex Development Clinic at the University of California, San Francisco (UCSF) and founder and medical director of the UCSF Child and Adolescent Gender Center.

The focus on the adolescent reflects current thinking, Dr Tangpricha told Medscape Medical News. “There are a lot of good data showing that hormone therapy earlier helps quality of life. It’s associated with very few adverse outcomes, and people do much better under appropriate endocrine care.”

He noted that in the past decade the age at which patients present for hormonal treatment has been dropping.

“People used to present in their 40s, because they didn’t know who to go to. Now, families are realizing there are things that can be done earlier. I think this is going to be more of a pediatric condition than an adult condition 10 years from now. I think the adult providers won’t really be initiating hormones but just continuing them.”

Jazz was born with physiologically normal male genitalia but began calling herself a girl as soon as she was able to speak. “I was always a girl. I was never anything else,” she asserted.

“Gender-Affirming” Approach

Dr Rosenthal described the “gender-affirming” medical approach to children and adolescents with “gender dysphoria,” the current official diagnostic term.

He summarized information from two documents: Clinical practice guidelines from the US Endocrine Society that are currently under revision (J Clin Endocrinol Metab. 2011;DOI:10.1210/jc.2009-0345), and Standards of Care from the World Professional Association for Transgender Health. He also drew from a review article he wrote on the subject (J Clin Endocrinol Metab. 2014;99:4379-4389).

After a psychological evaluation to determine the patient’s readiness, those who are in early adolescence (Tanner stage 2 or 3) are prescribed a puberty-blocking agent, typically a GnRH agonist, given either by injection (leuprolide acetate or triptorelin acetate) or as an implant (histrelin acetate).

These agents prevent the child from going through the “wrong puberty” and, because they’re reversible, provide less pressured time for further consideration. None of the agents are currently approved for this indication by the US Food and Drug Administration. “I’ve been working with pharmaceutical companies to get them to move forward on this,” Dr Rosenthal noted.

The next step, at around age 16 but sometimes sooner, the patient is given cross-sex hormones — ie, estrogen for those transitioning to female, testosterone for those transitioning to male.

Jazz had been living as a girl since the age of 5, without medical assistance. As puberty neared, a long search by Jeanette finally located a surgeon who would implant histrelin acetate into Jazz’s arm at age 11, and a pediatric endocrinologist who prescribed her estrogen beginning at age 12 years 6 months.

Asked about those experiences, Jazz said: “I know that having the blocker really helped make me happy. To know that I’m in the body the way I feel on the inside is just so reaffirming.…I could definitely see myself being suicidal if I couldn’t be blocked and had to develop as a male with a beard and mustache and all those secondary-sexual characteristics. I would just be so devastated.”

And as for the estrogen, she said she started sooner than the 16 years recommended in the guidelines because she was going through depression not related to being transgender, and she, her family, and her healthcare providers thought the hormone might “help balance things out.”

Indeed, she said, “It did.…I’ve now been on estrogen for about 3 years and I’m developing and I’m just happy in my body and I think all kids should feel that way.”

Dr Rosenthal noted that the clinical-practice guidelines “are only guidelines, not rules.…There may be very compelling reasons not to wait till 16.” In fact, the age of 16 was chosen only because that’s the age of legal medical decision-making in Europe, not because it has anything to do with physiology or mental health. Whether or not the new Endocrine Society guidelines will modify that age is currently under debate, he said.

According to Jazz, who won’t turn 16 until October, “I can’t imagine not being on estrogen right now.”

The third step, gender-reassignment surgery, isn’t universally undertaken. Jazz said she hopes to have it done when she’s 17 or 18.

Dr Rosenthal emphasized the importance of a multidisciplinary approach to the transgender adolescent. “A transgender adolescent is first and foremost an adolescent. No one person has all the expertise to provide sensitive and comprehensive care.”

At UCSF, Dr Rosenthal directs the medical component that includes a primary-care adolescent specialist, along with specialists in mental health, education, advocacy, and an attorney for legal services.

Insurance plans are increasingly covering the treatment, and some states mandate it, he noted.

Family Support Essential

Of course, family support is critical for transgender children and adolescents. For Jazz’s parents, it was “an evolution,” her father said.

“Jazz was expressing her true identity very early at a young age. Jazz has the gift of being extremely intelligent and articulate.…It made it easier for us to understand her, but it wasn’t an easy path.…There wasn’t a great deal of information out there,” he explained.

Eventually, though, “Through listening to our child and speaking to medical professionals, we came to realize that there was really one path, notwithstanding how society might view that path.”

Today, Jazz and her family — including an older sister and twin brothers — star in the US reality-TV show I Am Jazz, now in its second season on The Learning Channel.

She has also written two books, and in 2007 with her parents founded the TransKids Purple Rainbow Foundation, which assists transgender youth. Since Jazz is also a typically busy high school student, Jeannette answers as many of the emails that come in for Jazz as she can, sometimes consulting Jazz about what to say. (She always lets them know she’s Jazz’s mother.)

Jazz Jennings said that some kids have written to tell her that were it not for her example they would have killed themselves: “That shows me that I’m doing the right thing by sharing my story.”

During the session, Dr Rosenthal, who switched his entire pediatric endocrinology focus to transgender medicine just 7 years ago, commented, “I have never loved anything as much as this work.” Turning to the Jennings family, he added, “When I meet a family or a kid like you, I think this is why I do what I’m doing.”

Dr Tangpricha, Dr Rosenthal, and Dr Harrell have no relevant financial relationships.

For more diabetes and endocrinology news, follow us on Twitter and on Facebook.

American Association of Clinical Endocrinologists 2016 Annual Meeting; 2016 Annual Meeting; May 28, 2016; Orlando, Florida.

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However, this day is about celebrating the living and showing our pride. It’s a day to look back at how far we’ve come and what we’ve accomplished and make plans to go even further in the coming year.

Despite some setbacks, we certainly do have a lot to celebrate.

Visibility Wins

Lavern Cox Proves She Isn’t Going Anywhere

Ms. Cox made waves when she hit the scene three years back by being cast as Sophia Burset in the Netflix series “Orange is the New Black”. What you might not know is that the talented 31-year-old actress has been working steadily for several years now leading up to her star-making turn. She has had roles in 13 movies, and many TV shows including two of the Law and Order series, and the Mindy Project. Not to mention she has been cast as Dr. Frank-N-Furter in the upcoming remake of the Rocky Horror Picture Show. We are so excited for her success and we believe we can count on Lavern Cox being around for a long time. Hopefully, we will see her playing more women (period), and not just transgender women.

Our First Transgender Oscar Nominee

Anohni was the first transgender performer to ever be nominated for an Oscar. She was nominated for best original song for “Manta Ray”, which was a collaboration with J. Ralph and used in the documentary, “Racing Extinction”. A historic moment to be sure.

However, there is a loss in there too. Which you’ll see below.

Lilly Wachowski Joins Her Sister

We first reported about Lilly Wachowski, one half of the Wachowski directing duo, coming out as transgender a few weeks back. You, of course, know Lilly and Lana as the directors of the Matrix trilogy, V for Vendetta, and Cloud Atlas. While her hand might have been forced in coming out, it’s a tremendous moment of visibility to have two high-profile directors like the Wachowskis both come out and further show, we aren’t on the fringe- and we will no longer settle for being put there.

Caitlyn Jenner Brings High-Profile Visibility

Despite her many…uh…flubs (we will get to them), Caitlyn Jenner made huge waves with her coming out this year. Never before had the community gotten so much mainstream media attention. While she has brought some negative attention as well, she has contributed by sparking a conversation about transgender people and forcing mainstream media to acknowledge us. And her magazine cover was pretty awesome too.

Larger Visibility in Politics

It has been a tumultuous year in politics for transgender people. However, there have been highlights. Mostly, the discourse and discord in politics over transgender people has really brought out who our allies are and who are at least willing to admit transgender people aren’t a clear and present danger. Even republicans like Stephanie Clayton (R) from Kansas, who spoke out against some egregious legislation that puts a bounty on trans students heads. She is opposing the bill, reminding congress that perhaps they should be more worried with keeping schools open and the dire financial situation they face, rather than worry about who is using what restroom.

Another show of support came in from Rep. Mike Honda, who proudly displays the transgender pride flag outside his office in Washington D.C.

I'm proud to display the #transgender flag outside my DC office on International Transgender Day of Visibility #tdov pic.twitter.com/EBnUFqmlK0

— Rep. Mike Honda (@RepMikeHonda) March 31, 2016

The entire city of Calgary, Alberta, Canada is showing their support by lighting up the city in pink, white and blue. That’s a lot of visibility.

Companies Standing Against Bigotry

There is currently some legislation in Georgia that threatens to remove any protections that are offered to LGBT people, in particular transgender people. While that is certainly not a win, there is a huge win that has come from it. Several businesses have stood up and said they will boycott the entire state including several studios threatening to cripple the Georgia Film Commission. Despite the lucrative incentives provided to draw studios to film there, many studios have stated that if the bill is passed that they will no longer be producing in Georgia. Marvel and Disney in particular have come out as strong opponents, as well as the producers of the hit show “The Walking Dead” who have threatened to pull all production.

Visibility Losses

Photo by Alice O’Malley

The Oscars Cut Anohni

While her nomination was a huge achievement and a great win for our community, it was soured by the Academy subsequently cutting Anohni’s performance at the Oscars in favor of other nominees in the category like Sam Smith, Lady Gaga, and the Weeknd. It was a strange move to not include this nominee when others were invited over her. Especially given the good will and visibility it would have given. Even if the Academy wanted to look at it selfishly, it would have been great publicity.

Now however, they have a different publicity as Anohni declined to attend the event due to her exclusion. She wrote about her reasoning for Pitchfork.

“I am the only transgendered performer ever to have been nominated for an Academy Award, and for that I thank the artists who nominated me,” the essay begins. Anohni adds: “I was in Asia when I found out the news. I rushed home to prepare something, in case the music nominees would be asked to perform. Everyone was calling with excited congratulations. A week later, Sam Smith, Lady Gaga, and the Weeknd were rolled out as the evening’s entertainment with more performers ‘soon to be announced.’ Confused, I sat and waited. Would someone be in touch? But as time bore on I heard nothing.”

Legislation Hasn’t Been Kind

Transgender people have gotten a lot of bad visibility in the form of legislation that seeks to target trans people and paint a target on their back. One such case, as we mentioned before, is in the form of legislation in Kansas that puts a $2500 bounty on the head of every trans student if they are caught in the “wrong bathroom”. And we would be remiss if we didn’t mention the outrageous legislation that actually passed in North Carolina. The bill essentially undid the protections provided to transgender people in the state. However, it has been called out by the North Carolina Attorney General who called it “A national embarrassment.” The legislation is currently the focus of a lawsuit against the state and the governor that challenges their decision.

Caitlyn Jenner Won’t Shut Up

At first many were excited to see such a public figure as Caitlyn Jenner come out as transgender. After all, this is an Olympic athlete we are talking about. That’s huge! Then she talked. She has repeatedly put her foot in her mouth about other transgender people, criticizing their journey. Apparently everyone is supposed to just go schedule all of their surgery immediately and not worry about employment or homelessness. She has blasted less-fortunate transgender people for their use of public aid and lack of drive.

Not to mention that Caitlyn, a staunch Republican has publicly praised Donald Trump for president. She claims that he would be fantastic for women’s issues. A move that has baffled most multi-celled organisms. However she has stated that she hasn’t actually endorsed anyone and will instead be voting for whoever the Republican candidate winds up being. Jenner has also made comments condemning gay marriage, and stating that the Republicans would do so much more for transgender people.

She was recently quoted as saying, “I get criticized more for being a Republican than being transgender.”

Gee Caitlyn, I wonder why…

Our Visibility, and Our Future

While I and TOL honor the accomplishments of those that came before us and all the sacrifices they have made, I personally believe this is the single most important time in our history for transgender people. We stand on the precipice of something great. We have hit a “tipping point” in entertainment, we have youngerand younger people coming out and being encouraged and supported, we are part of a national conversation, and we have more public support than we’ve ever had. We are finally beginning to be taken seriously.

This is the time to seize the opportunity. We have to keep our momentum going and capitalize on how much we have going for us. No, it’s not perfect. Yes, we have so far to go. But we cannot ignore how far we’ve come. Those that came before us blazed an indelible trail. It is our time to pave that trail and take our place in society as valued and vital individuals.

We can do great things, if we work together. No more bickering and fighting. No more judging each other because their journey is different than yours. We are equals, we are brothers and sisters. We must hold each other up if we are to have any chance at winning this war.

Let’s see how great we can make the next 365. See you March 31st, 2017.