When the call came, my brother was at work in the open office in Cambridge, Mass., he shares with seven colleagues who, like him, help run clinical trials for a drug developer. The phone number came up blocked, so he knew it must be the doctor. He stood up, unsteady on his feet. Was he a little nauseous? Or was that just adrenaline? He ducked into the hallway in search of quiet.
My brother Evan, 35, is a stocky guy of medium height with a trimmed, fuzzy blond beard and two gem studs in each earlobe. He usually wears a Red Sox hat, and when he’s nervous, he’ll remove it and obsessively bend the rim. But on that September afternoon, both of his hands were clutching his phone, the right one cupping the left for privacy. “Hello?”
“This is Dr. Kowalik,” said the voice. The identification was unnecessary. Ania Kowalik is a reproductive endocrinologist at a clinic called Fertility Solutions in Dedham, Mass. They’d spoken regularly for more than six months. Evan, who was born female, had wanted to be a parent since he was very young, when he played with dolls just a bit longer than the other kids. He’d helped pay for college by nannying triplets. And when he first came out to friends as transgender at 19, changing his name and beginning his long physical transformation, he didn’t stop adding to the list of baby names in the back of his journal: Kaya, Eleanor, Huxley.
Evan knew he should feel excited. But instead, he felt a chill of anxiety and anticipation. He’d wanted this for so long, he later told me, and had been close to getting it. Then, four months earlier, he’d miscarried after Kowalik told him she couldn’t find a heartbeat during his first ultrasound.
She was brief: Evan was pregnant. Kowalik told him he had low levels of progesterone, a hormone that helps maintain a healthy pregnancy, and prescribed some pills for him to start taking right away. “Congratulations,” she said after a pause. “This is a good start.”
Evan isn’t sure how long he stood in the hallway after the call. People from other offices brushed by him, caught up in their work. He called his partner, and her gasp was loud enough that Evan held the phone away from his ear momentarily. He pulled up a calculator to figure out his due date.
I’d have no reason to tell you about this moment in my brother’s life were it not for the fact of his gender. Now that gay marriage is legal, the social battleground has shifted to new frontiers, frontiers that include the most private aspects of people’s lives. Transgender Americans have gained greater visibility and acceptance as stars like Caitlyn Jenner and Laverne Cox have trained a pop-culture spotlight on trans issues. Corporate leaders across the Fortune 500 have moved to protect their transgender employees. And in May, the Obama Administration declared that all public schools must treat students equally regardless of their gender identity, classifying inner feelings of maleness and femaleness as protected by the government. We have come to the point where the President of the United States can candidly and comfortably discuss gender fluidity.
We have also come to the point where the backlash against these rapid changes has manifested in sometimes surreal fashion, as it did earlier this year during the so-called battle of the bathroom, when about half of all states joined lawsuits against the Obama Administration. There have been reports of increased violence directed at transgender people. At least 21 trans Americans were murdered in 2015, according to the Human Rights Campaign, up 62% from the year before. And that was before the mass murder in June at an Orlando nightclub, the deadliest incident of violence against LGBT people in U.S. history.
Pregnancies like Evan’s—and the many that are likely to follow—will stretch our cultural perceptions of gender norms even further. Americans are just starting to open up to the idea that you may be born into a female body, but believe that you are really a man. But what if you are born into a female body, know you are a man and still want to participate in the traditionally exclusive rite of womanhood? What kind of man are you then?
This question can bother people. It can make them uncomfortable. That’s partly why, when Evan texted me to say, “I’m pregnant!” I was excited for him, but also frightened. I thought about what strangers might say to my bearded, big-bellied little brother when he was nine months along. And I wondered, Would he be safe?
I am six years older than Evan. We also have a middle sister, Katje. As a trio, we’ve always resembled one another, but Evan and I were the most alike. We still have the same patterns of speech and the same slight roll to our shoulders that we inherited from our grandmother on our dad’s side. Once, when Evan was in college at Oberlin and I was in grad school at the University of California, Berkeley, he flew across the country to visit me. When he got off the plane, we were both wearing the same thing: puffy down vests over long-sleeved ultimate-frisbee T-shirts and baseball caps worn backward.
By then, my brother had already come out to himself and friends as trans, but he didn’t tell me until 2003, when he started taking hormones. He called me to say that when he came for my graduation, I should call him Evan.
Over the next few months, I watched his body change. He started binding his chest with a thick bandage wrap. His hair began to thin. His hips disappeared and were replaced by thick muscles around his chest. But mostly, I remember his hands. We both have the same small hands, the same indelicate, stubby fingers. I watched the hair grow thick over his knuckles, which were my knuckles. I felt sad that, feature by feature, I was losing my doppelgänger.
The transition was messy. Our parents were supportive but distracted. They were in a protracted divorce after my father had, at 50, come out as gay. Katje and I dated women, and I would kid Evan that being gay wasn’t rebellious enough in our family; he had to do us one better and change gender. Looking back, I regret these jokes. They were a crass way to cover the pain of knowing that the childhood we all shared–the one in which we were three round-faced, pigtailed girls in matching dresses–had been a charade for my brother.
I said the wrong things all the time. That first year Evan looked strange to me, like a butch lady or a girly man. He went through a sped-up version of puberty that brought changes to his voice and testosterone-fueled impulses he didn’t understand. I often she’d him by accident. I’d forget and call him by his given female name, or refer to him as her. And in an attempt to sound interested and supportive, I asked him invasive and personal questions, often in mixed company. Once, during a brunch with our extended family, I asked him about whether he planned to alter his genitals. “Jessi,” he said, raising his right eyebrow in that way we both do. “I don’t talk about your vagina in front of Aunt Rosie.”
Thirteen years later, no one mistakenly she’s my brother. Physically, he is transformed. He’s 5 ft. 6 in., just tall enough that he makes a respectable short guy. Before his pregnancy, he injected hormones into his thigh once weekly to lower his estrogen while boosting his testosterone. He elected not to have top surgery, the double mastectomy that many trans men undergo, because he is allergic to most antibiotics. Also, he knew he might one day want to nurse a baby. So he wears two compression-tank binds made by a company called Underworks beneath his shirt. “It hurts, but I’ve gotten used to it,” he told me. “I imagine it’s like some women getting used to high heels.”
We have come to the point where the President of the United States can candidly and comfortably discuss gender fluidity.
His transformation is as much social as it is physical. It’s not just that Evan looks like a guy. For nearly a dozen years, the world has responded to him as a guy. At first, particularly when he was with other men who didn’t know he was trans, this made him nervous–like he would somehow say the wrong thing and out himself. But now he’s comfortable. To medical professionals, he’s a trans guy, but to the rest of the world and to himself, he’s just a guy.
In 2013, when Evan made an appointment with his primary-care physician at the Boston LGBT health center Fenway Health, he was the first prospective birth father his doctor had seen. Several years earlier, a few trans men who, like my brother, had undergone hormone treatment but kept their reproductive organs, had begun consulting physicians about pregnancy and speaking openly about wanting to give birth. In 2008, Thomas Beatie posed for People magazine, bare-chested with a rotund belly, and went on Oprah to talk about his pregnancy. Trans men began to trickle into fertility clinics more frequently. When Andy Inkster was turned away from a Massachusetts clinic in 2010 because he was told he was “too masculine” to have a baby, he sued for gender discrimination. The case settled a few years later; Inkster sought out another clinic and later gave birth to a daughter.
What happened to Inkster is not uncommon. Medical care of all kinds is complicated for trans Americans. Roughly 1 in 5 have been turned away by a medical professional at some point, according to the National Transgender Discrimination Survey. Published in 2011 by the National Center for Transgender Equality and the National LGBTQ Task Force, it is one of the largest surveys about trans people, with 6,456 respondents. Half of them reported that they’d had to teach the medical professionals they visited how to treat them. That’s why, until my brother tried to get pregnant, he mostly avoided doctors.