For most people, the journey to “who” begins at “which.”

Pink or blue? Girl or boy? But what if checking the corresponding box isn’t a reflex?

What if your gender identity doesn’t align with your biology or the male/female binary culture where — and when — you were raised?

The decision to come out as transgender is a highly personal and individual one, but it’s informed by and refracted through a public prism that has evolved dramatically in recent years.

Colorado Springs residents Jamison Courcy and Cornelius Kelley both began the transition from female to male two years ago, at age 14 and 38, respectively. Their experiences are their own, but they also tell a generational story about growing up and coming out in a city once — and arguably still — considered among the nation’s most socially and faith-based conservative.

Evolving perceptions, understanding and opportunities aside, the evangelical presence remains a powerful force in the Springs, home to institutions whose programs and rhetoric earned the city a reputation as a so-called “conversion therapy” capital.

“A lot of people who have been my clients, year over year, have been feeling more OK about coming out in Colorado Springs, whereas before it was quite a hostile area,” said Dara Hoffman-Fox, LPC, a gender therapist, advocate and author of “You and Your Gender Identity: A Guide to Discovery.”

“What a huge difference the internet has made in terms of making it easier for people to get their questions answered. That’s one of the best changes that I have seen that’s happened. There’s still a lot of work to do and a lot more education that’s needed.”

The expansion of rights and information and the dialing back of “outwardly hateful messaging” has led to a more welcoming environment, here and nationwide.

But transitioning still is not an easy, linear process, on a personal or societal front, said Hoffman-Fox, who began working with the city’s LGBTQ community in 2004 through the Colorado Springs Pride Center.

Hoffman-Fox opened a private practice, The Bohemian Sanctuary, on the city’s west side in 2008, about the same time Colorado passed a law forbidding discrimination based on sexual orientation or gender identity in public places.

Five years later, in 2013, those liberties were confirmed in a landmark civil rights ruling in favor of Coy Mathis, a 6-year-old transgender student who’d been barred from using the girls bathroom at her Fountain elementary school. Such protections are still in place, despite a 2017 reversal of federal guidelines under the Trump administration.

The changing cultural and information landscape, combined with advances in medical science and hormone research, mean “people are now feeling a lot more supported in being able to transition” when they’re ready to do so, often at an earlier age, said Hoffman-Fox, who identifies as gender non-binary.

For a transgender person, going through the “right puberty” is critical to physical, psychological and emotional development. Those who come out as adults, often face more challenges and complications.

“The older they are, the more they potentially have made decisions that could be affected by their transition: marriage, career, kids,” Hoffman-Fox said. “Some decide not to transition because of not wanting to rock the boat in their lives so much.”

Although children who are questioning their gender identity can take puberty-delaying drugs to give them more time to decide, most of registered nurse Deborah Tuffield’s transgender clients are teenagers or young adults.

“It’s kind of a big deal working with a person’s gender preference,” Tuffield said. “We have to track everything closely to get the desired effects without the side effects.”

As a primary care provider at HealthCircle Primary Care Clinic, she conducts a detailed health assessment and guides patients on what’s involved in hormone treatment, how it works, is it what they really want, what they can expect, and other information.

Tuffield, housed at the Lane Center for Academic Health Sciences at the University of Colorado at Colorado Springs, is part of the center’s fusion of mental and physical health services and university education, research and specialty care programs.

She also teaches at UCCS’ nursing school, the Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences.

She’s one of the few providers in Colorado Springs who does the medical side of transition therapy. Tuffield says she didn’t intend to focus on the field.

“We had a patient email the front desk and ask if we took care of transgender people, and I was the only one who said I’m willing to learn,” Tuffield said. “A couple of months later, we had our first transgender person, male to female.”

That was three years ago, and her client base of transgenders, along with gays and lesbians, has grown from one to about 50, or 8 percent of the clinic’s population.

Some transgender people were misidentified as a boy or a girl at birth because of problems with genitalia, or they have been discriminated against by nurses and doctors as they’ve tried to figure out what’s going on with their minds and bodies, Tuffield said.

Some have encountered “a flat-out, ‘What you’re doing is gross and disgusting,’ attitude,” she says. “Others may agree to help but won’t do the hormones.”

There’s no negativity or judgment in Tuffield’s office.

Old-school hormone therapy was that the person had to live for a year as the preferred gender, in dress and behavior.

“It put a lot of people at risk,” Tuffield said. “A man who’s dressing like a woman and who has a 5-o’clock shadow, prominent Adam’s apple and deep voice would undergo harassment at work and in public from people who just don’t know what they’re going through.”

That’s why that process has “gone out of favor.”

The new way of treatment is if a person understands all the risks of taking gender-affirming hormones and consents, it’s a go.

Some medical providers believe a psychological evaluation is necessary before starting treatment, Tuffield says, and some insurance companies require it.

Most insurance providers, including Medicaid, cover hormone injections, she said.

Having a support system at home makes the ordeal easier, Tuffield said, because the process is mentally, physically and emotionally rigorous.

Hormone therapy can enable trans people to “feel like they’re starting to live the life they feel like they are,” she said. And while “younger people, especially, seem to transition just fine,” those who do so at a more mature age “often get such a bad rap from the community, and they don’t deserve it. They’re trying to muddle through life like the rest of us, and they have this added personal struggle to deal with.”

Some aspects — such as females transitioning to males not being able to get pregnant — can be irreversible.

“We encourage egg banking or sperm banking beforehand,” Tuffield said.

The male transition to female is more common than vice versa. Hormone therapy develops breasts and alters hair growth but also might decrease libido.

Testosterone injections for transitioning from female to male can stop menstruation, increase acne, cholesterol levels and facial hair, lower the voice and enlarge the clitoris to become more like a penis.

Follow-up, maintenance and preventive care also become part of the course of action.

“We want to see how they’re doing, not just physically, but also psychologically, emotionally and socially,” Tuffield said.

Transgender people who want surgery to alter their breasts, genitalia, vocal cords, Adam’s apple or buttocks usually have to be on hormone therapy for one year, she said.

Surgeons can be found in Denver, and Tuffield said UCCS is creating a gender course for nurse practitioner students, which could start next spring, pending approval.

A doctor who took over a transgender surgery practice in Trinidad — the erstwhile “Sex Change Capital of the World” — closed the office years ago.

“The community was very bad to her,” Tuffield said.

Reporter

Stephanie Earls is a news reporter and columnist at The Gazette. Before moving to Colorado Springs in 2012, she worked for newspapers in upstate NY, WA, OR and at her hometown weekly in Berkeley Springs, WV, where she got her start in journalism.

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