STEVE INSKEEP, HOST:
In this country, a lot of discussion in the fall election centers on transgender kids. It's not the main issue, but it's there in laws passed by some legislatures and in the rhetoric of many candidates. This morning, we'll hear how that issue is experienced by one teenager in Tennessee. Here's Blake Farmer of our member station WPLN.
BLAKE FARMER, BYLINE: People used to call Adams a tomboy. His mom never liked that, but he certainly is adventurous. At a wooded park in Nashville, he stumbles upon two young deer lying in the tall grass.
ADAMS: The mom went down there.
ELIZABETH: Oh, yeah, I see. Look. I wonder if they're brothers or sisters.
FARMER: For the last few years, gender has dominated life for 14-year-old Adams and his mom, Elizabeth. We're only using their middle names because they fear harassment. Adams was assigned female at birth.
ADAMS: Like, if I could choose not to be trans, I probably would. Like, if I...
ELIZABETH: (Laughter). It would be easier, wouldn't it?
ADAMS: Yeah. If I could choose to just be a cisgender girl, I probably would.
FARMER: Adams came out to his mom a few years ago. As puberty began, his body started fighting his brain, growing breasts and menstruating. So Elizabeth began working to get him into a local pediatric transgender care clinic at Vanderbilt University Medical Center. It took nearly a year to get an appointment and another year of consultations.
ELIZABETH: A little selfishly, I'm kind of holding back because I know once the testosterone is started, we start puberty all over again. And I'm not handling round one real well.
FARMER: But she's given Adams the green light for hormones once they can get their therapist to sign off. What Elizabeth's not quite ready for is any kind of surgery. Adams is still on the young side to be eligible for what's known as top surgery - in his case, removing the breasts he binds to his chest every day.
ELIZABETH: I don't want to be close-minded and say it's just a phase 'cause I don't think it is. But I just - surgery just seems drastic to me right now.
FARMER: In the end, though, Elizabeth says her son feels like he's in the wrong body, and that feeds into his depression. He's already confronted some scary times.
ELIZABETH: I want to ease that for him. I mean, that's what I would say to a parent who's terrified and who's wanting to shut these clinics down. I would say, it's scary, but in the end, it's going to save your kid. I mean, the suicide rate is off the charts for trans kids.
FARMER: But the hope they find in gender-affirming care now faces some fierce resistance in Nashville and a growing number of cities and states. An anti-trans activist put out a supposed expose that claimed Vanderbilt was butchering children, despite Vanderbilt following the medical standards of care. But conservative politicians quickly picked up on the misleading report, demanding the clinic halt all surgeries and threatening other regulations. Then came the radio ads targeting liberals.
(SOUNDBITE OF POLITICAL AD)
UNIDENTIFIED PERSON: They push girls to take testosterone so they grow facial hair.
FARMER: There's now a political rally planned for this week, which has attracted some of the state's top elected officials. Vanderbilt has agreed to pause surgeries, though the medical center revealed just how few occur on minors - roughly five a year and never on genitals. Vanderbilt would not make anyone available for an interview, but the clinic's director, Dr. Cassandra Brady, has said they are more cautious than clinical guidelines even recommend. She told state lawmakers just last year that the clinic goes above and beyond with parental consent.
CASSANDRA BRADY: So that means if parents are divorced and one disagrees and one agrees, then that child cannot have the hormone or hormone-blocking therapy.
FARMER: The situation for Elizabeth and Adams is a little more straightforward. Sadly, Adams' father died from an accidental drug overdose a few years ago. But she's been cautious.
ELIZABETH: Even if it was the process to just say, yep, sign me up, I can't imagine any parent would just jump into it headfirst, no matter how open they may be.
FARMER: As teenagers tend to be, Adams is ready to get going, even though he acknowledges his young brain is not great at fully processing long-term consequences.
ADAMS: Everyone's just like, oh, well, why don't you just be a girl again? And then, like, I went through that phase before, like, a couple of years ago. I went through that phase just like, oh, maybe I'm just a girl, and I'm just - it was just - it was the worst year of my life...
ELIZABETH: Oh, baby.
ADAMS: ...When I did that.
FARMER: Elizabeth is genuinely concerned about the health and safety of her son and of all trans teens if politicians make gender-affirming care off-limits.
For NPR News, I'm Blake Farmer in Nashville. Transcript provided by NPR, Copyright NPR.