As Nelson-Cave points out, the physical treatments Jay is receiving are just one part of his transition. The social side is often just as important, and just as difficult.
“Oh, his mental health is so bad right now,” Nelson-Cave said of her son. “He has been through a lot and it's taking its toll. I mean, he has really bad insomnia. He's always struggled with anxiety, which has gotten worse … He has been hospitalized a couple of times during the pandemic for psychiatric emergencies. So yeah, it's definitely had a profound effect on his mental health. It is just not easy to be a kid going through everything that he's going through.”
But despite these struggles, Jay told Rocky Mountain PBS—and Nelson-Cave agreed—that he is much more confident since he started his transition.
“Mentally, my confidence has always been a problem area, both before and after me coming out. Coming from a social standpoint, it was definitely rough at the beginning,” Jay wrote in an email to Rocky Mountain PBS. “More recently, it’s been a lot easier since more of my peers are either LGBTQ+, or exclusively have known me by my preferred name and pronouns.”
Jay found a lot of support through Rainbow Alley, The Center on Colfax’s program serving LGBTQIA+ youth. Nelson-Cave said Rainbow Alley “was a place where [Jay] could go after school for a few hours, hanging out with a bunch of kids like him and then come home happy and tired.
Due to COVID-19, however, the program has had to shut down at various points throughout the pandemic. “And we're still feeling that hole in our lives,” Nelson-Cave said. “Like I wish that I could take him to Rainbow Alley every day.”
Kvach said like medical treatment, family and community support like the kind Jay receives at Rainbow Alley is vital to to the resilience and wellbeing of transgender youths. According to the same Trevor Project survey, transgender and nonbinary youth who have their pronouns respected, were able to legally change their names and/or “had access to spaces that affirmed their sexual orientation and gender identity” all reported lower rates of attempting suicide.
Nelson-Cave and Kvach agreed that there is still a long way to go, even if gender-affirming care is now guaranteed for hundreds of thousands of Coloradans.
“Having improved coverage doesn't automatically equal access to care,” Kvach said. “And so I think we still have a lot of work to do to make this care equitable for all trans and non-binary folks in our state and country.”
Part of that work is educating doctors. At Denver Health, Kvach said the staff has “worked really hard to train a lot of our providers to be able to offer this care. And initially these were trainings that were provided after hours when people weren't being paid and people opted in. So we've had over a hundred providers in our system who have stepped forward to get this training because they recognize that there was a gap in their medical education that they received, and that they really wanted to be able to step up and offer this care to the community and recognize its importance.”
She continued: “I think we have worked hard to make it so that any LGBTQ person, but certainly trans and non-binary folks can walk anywhere into our system and receive affirming care, regardless of if they're in the emergency department or a specialty department or primary care. We're not perfect, but it's a journey and we are constantly striving to improve the care that we're offering to the community.”
Nelson-Cave was encouraged to hear about the Denver Health training program, but said proper care shouldn’t depend on doctors educating themselves in their free time. Medical schools should have mandatory classes on treating transgender individuals, she said. “There needs to be a dedicated curriculum to fill in these gaps in care,” Nelson-Cave continued. “Ideally it would be made part of the national curriculum.”
Nelson-Cave has seen first hand what reliable gender-affirming care and community support has done for her son.
“He was definitely more confident after he started dressing like a boy and I stopped correcting people who were calling him a boy,” Nelson-Cave said with a big smile. “Every time he gets called ‘sir’ or ‘young man,’ you can see the chest puff out a little bit and he's walking a little taller. It's so cool. I love seeing that.”
Nelson-Cave said her son is a very compassionate person. And she wants him to maintain that mindset even after she’s gone. His health care, she said, is a big part of that.
“I want Jay to grow up to be a happy, healthy adult,” she said. “It makes the world a better place, and feeling comfortable existing as a person is essential to that.”
Kyle Cooke is the digital media manager at Rocky Mountain PBS. You can reach him at firstname.lastname@example.org.
Brian Willie is the content production manager at Rocky Mountain PBS. You can reach him at email@example.com.