Some states now cover the cost of medical treatment for people who are transgender. Oregon is one of them. But, since January, Oregon is going one step further.
It now pays for drugs that suppress puberty in children who think they might want to change their gender - if they're on the Oregon Health Plan.
An upcoming story will look into the medical pros and cons of the therapy. But first, here's a look at how a 13-year-old and her family came to the tough decision to suppress puberty.
Michael was born biologically male 13 years ago in the community of Grand Ronde.
Michael's Mom, Dee, remembers bringing three dresses home for three cousins when Michael -- who now goes by Michaela -- was about six.
"When she saw those dresses, her eyes just lit up. And she said, 'who are those for?' I'll never forget it. And I said, 'well, these are for the girls. Do you like them?' And she said, 'yeah.' So I said, 'well do you want to try any of them on? If any of them fit you, do you want to wear them?' And she said, 'yeah.'"
"She just twirled and twirled in that dress it was so wonderful," Dee says. "And that's when I knew. At that point. I'm not wrong here."
To protect her privacy, OPB has agreed not to use the real names of Michaela or her mother.
When Michaela turned seven, the family went on a trip to California where she wore dresses and went out in public as a girl.
"She had the best week of her life up to that point," her Mom says. "And she was so open and had just so much fun." But there were problems. "She wouldn't wear her pink and purple to school anymore, like she used to," Dee explains. "She was starting to get teased, which was way too hard for me to take."
"I don't really remember any of that," says Michaela crying, "...other than some of [what] Ray's friends did." Ray is her older brother.
The family decided to move to Portland so Michaela could attend a school where people only knew her as a girl.
"Any boy who wants to look like a girl can just grow your hair long and put some mascara on, put a dress on and they'll look very female," says Doctor Karin Selva. She is Michaela's pediatric endocrinologist at Randall Children's Hospital in Portland. "But as soon as puberty hits, that's when the body pretty much turns on someone who is transgender." So for Michaela that would mean growing an Adam's apple, facial hair and a heavy male body structure.
Dutch researchers, in a study published in the journal, Pediatrics, found that puberty suppression gave transgender youth, "the opportunity to develop into well-functioning young adults."
So last year, when Michaela started to experience the first signs of puberty, Dr. Selva started puberty suppression injections.
Michaela's family has private health insurance. But for someone on the Oregon Health Plan, the hospital says Lupron - the puberty suppression drug - costs about $7,500 for three months.
Dr. Selva says now they need to discuss how long to keep Michaela on the suppression drugs and whether she wants to start taking the female hormone, estrogen. "Some people are ready and want the cross hormones yesterday, and they're 12. Well, we're not going to do that. That's a little young for our comfort level."
"But around 14, 15, we'll discuss with the parents and patient and talk about long term," she continues. "Because once you start cross hormone therapy, that is the permanent changes that can affect fertility and there are some things we do not know about long-term outcome for prolonged hormone exposure." As Dr. Selva tells Michaela, the important thing is that she can develop as she wants to develop, and in a way that doesn't attract unwanted attention. "No one in your school knows? Right? Does anyone know? No one has to know." The state estimates that about 175 people will use some kind of transgender treatment under the Oregon Health Plan this year, but it doesn't have figures on how many of those people might be seeking puberty suppression.
Look for a story, Wednesday, on the pros and cons of puberty suppression therapy.