ST. LOUIS — Chloe Clark lay in her bed, wrapped in a blanket, as she logged in to the virtual personal finance class on her laptop.
The 15-year-old watched as each of her high school classmates joined the class, their names popping onto the Microsoft Teams screen one by one while the teacher took attendance. As always, the students’ cameras were all turned off, and once again, Chloe was reduced to the name on her screen — and the sound of her voice.
The teenage girl remained muted.
“All right, so we’re going to do some presentations today,” said the teacher, wearing a mask and sitting in a half-empty classroom in St. Louis, as most of her students listened from their homes across town. “Does anyone want to go first?”
It was the moment of class Chloe always dreaded, when she — and all her classmates — would have to listen to the part of herself that bothered her most, the part that still didn’t match how the transgender girl felt inside.
A year earlier, Chloe had sat in school with some of these same classmates, feeling more confident in herself than ever before. Her appearance had slowly begun to align with her identity in the months since she came out to her friends and family as transgender at age 13.
She had spoken out on her own behalf, even as conservative legislators in Missouri waged a fight to criminalize treatments for trans kids like her.
Her parents had taken her to appointments with doctors and therapists for months. They helped her shop for a new wardrobe of sweaters and dresses and jeans from the women’s section. Her diverse, inclusive public school embraced her decision to change her name and pronouns. And after many meetings with endocrinologists and pediatricians, Chloe’s parents and doctors agreed to let her take puberty blockers to pause the distressing changes she had been experiencing in her body since middle school. And, at 14, she also began taking estrogen, medication that helped her friends perceive her as who she was — female.
But just months later, the covid-19 pandemic shuttered her school and moved nearly her entire life online. Now, instead of seeing the version of Chloe her classmates all grew to know — the Broadway musical-loving teenager with long brown hair who would walk around school wearing her favorite yellow shirt, big headphones and trendy half-rim glasses — they simply heard her voice. A voice that had already deepened by the time she began taking puberty blockers. A voice that sounded nothing like the other girls in her school.
So instead of speaking in her personal finance class on this Thursday morning in February, Chloe stayed silent.
But elsewhere, others were not silent. In Washington, 800 miles away from Chloe’s virtual lessons on handling money, Sen. Rand Paul (R-Ky.) was denouncing transgender teens and a culture that is “now normalizing the idea that minors can be given hormones.”
He lashed out at Rachel Levine, the physician seated before him in her confirmation hearing to serve as the Biden administration’s assistant secretary of health and human services, a role that would make her the highest-ranking openly transgender official in government history.
“Do you believe that minors are capable of making such a life-changing decision as changing one’s sex?” Paul demanded. “You know, if you’ve ever been around children, 14-year-olds can’t make this decision.”
Fourteen was the exact age at which Chloe, her doctors and her parents made the decision for her to begin taking estrogen, following the medical guidelines for young people diagnosed with gender dysphoria and understanding the high rates of suicide for transgender youth who don’t receive the care they need. But that private choice in Chloe’s doctor’s office was now the subject of legislation across the country, with 17 states weighing bills that would bar or criminalize gender-affirming care for kids. Two of these bills are in Chloe’s own state of Missouri.
The 10th-grader knew the country was debating her right to play sports, to get medical care — debating her right to exist — but she couldn’t bring herself to read the news coverage or to speak out against the legislation. How could she find her own voice when she couldn’t bear to hear it?
As one of her classmates offered to present his team’s project to the class, Chloe tried not to think about her own presentation. She let her mind drift to video games and chess.
Hearing the deep monotone of three male classmates reading a PowerPoint, she recognized each of their voices and visualized their faces. But she wondered if her classmates would do the same during her presentation. How would they see her?
“Excellent, thank you guys,” the teacher said as the students finished their presentation. “All right, who would like to go next?”
When Chloe first came out in April 2019, it was a complete surprise to her parents. They had seen no signs, no moments in Chloe’s childhood that made them wonder whether their only child was a girl, not a boy.
But Chloe had sensed that something was wrong with her body long before she told her parents, before she knew what it meant to be transgender. She remembered feeling a gray cloud over her head as a child. She felt uncomfortable taking showers and panicked seeing the images of the male reproductive system in middle school health class.
Still, it wasn’t until puberty that Chloe realized she was transgender. As she grew taller, as her voice dropped and her facial hair arrived, Chloe became depressed and withdrawn. Her grades plunged. She had few friends and struggled to get out of bed in the morning.
Then, at a summer theater camp before eighth grade, she was cast in a female role — a witch-like stepmother. She stepped in front of the audience wearing a purple dress and red wig and felt empowered. The next Halloween, she dressed in drag again. One night, she came home, stood in front of the mirror in her bedroom and imagined how her body would look as a female. She started watching YouTube videos about “how to tell your parents you’re transgender.”
It took her over a year to finally tell them, even though she knew they would be accepting. And they were. Her parents, Lisa Bruce and Guy Clark, who are divorced, began taking her to the Washington University transgender clinic at the St. Louis Children’s Hospital, where she was diagnosed with gender dysphoria. They tried their best to use her new name and pronouns and made sure her new high school would allow her to use the girls’ bathroom.
Transgender children are coming out to their parents earlier and earlier, allowing them to consider puberty blockers that can temporarily pause the deepening of the voice among trans girls or the development of breasts in trans boys. The medications are reversible, allowing trans children to stop using them and continue puberty if they change their mind. Access to puberty blockers during adolescence is associated with lower odds of transgender young adults considering suicide, according to a study from Harvard Medical School and the Fenway Institute.
But by the time Chloe started taking puberty blockers, she was already taller than most of the other girls in her grade. Her shoulders had broadened, and her voice had deepened.
Her parents struggled with whether to let her take estrogen treatments, which, unlike puberty blockers, would lead to more permanent changes in her body, and could someday impact her ability to have children. But after researching the benefits of gender-affirming treatment and many long conversations, they decided it was Chloe’s body, not theirs, and she should be allowed to make the choice.
As the hormones began to take effect, her parents could see it was the right decision for Chloe’s health and happiness. Her grades and mood improved drastically. She became more extroverted and made close friends with a group of other LGBTQ students through her school’s “Rainbow Alliance.”
On a shopping trip at Urban Outfitters early last year, her face lit up as she flipped through racks of rompers. In her computer programming class, she sat at the front of the room, asking her teacher for new coding challenges and beaming as she solved each one. On a Friday after school, she walked around downtown St. Louis with her friends, posing for Instagram photos in front of museums and churches.
After years of feeling trapped in the wrong body, Chloe was beginning to feel free.
Then headlines began appearing about politicians in her state — and across the country — trying to take away the treatments that had given Chloe this newfound confidence. A national debate soon emerged about transgender girls like Chloe and whether they should be allowed to play on sports teams corresponding to their gender identity.
To Chloe, it was yet another reminder of the hostility facing transgender people, but especially transgender girls and women.
In St. Louis, about 80 percent of the transgender children referred to the pediatric transgender health clinic at St. Louis Children’s Hospital are transgender boys. Only about 20 percent are transgender girls, said the clinic’s co-director, Christopher Lewis. His hypothesis for this gap is rooted in a society that still values masculinity over femininity, even for children who aren’t transgender. It’s okay for a girl to be a “tomboy,” but it’s not okay for a boy to wear a dress. Because of this stigma, Lewis believes trans girls are less likely to accept their own identity and less likely to have the family support to seek out medical care.
Chloe had fought against all of that. She thought about driving with her mother to Jefferson City, Mo., to testify against the anti-transgender legislation in her state, to use her voice to tell lawmakers why these medications were so important in her life.
But that was before the pandemic changed everything — and changed Chloe.
‘Don’t think too much’
Chloe touched her chin, then her belly, focusing intently on her breathing and posture. Facing a bright blue wall in a small room at St. Louis Children’s Hospital, she stretched her arms above her head and around in circles, softly releasing a “shhh” sound.
“And you remember why you do this?” said Mary Blount Stahl, a speech-language pathologist, in what would be their final session before the pandemic shut down everything.
“It releases the tightness in here,” Blount Stahl said, touching her throat. “We’re going to ask these muscles to change how they’re working.”
Chloe nodded, relaxing her shoulders. She knew this already — she had been coming to these appointments for months. The sessions were expensive, exhausting and sometimes discouraging, and her parents wondered if they were worth it. But Chloe hoped the lessons would bring her closer to a voice that matched her femininity.
Could she make it sound breathier or make her pitch go a little higher?
“That male voice tends to go down at the end and the female voice up,” Blount Stahl said.
“That one's so hard because it's just such a subtle thing,” Chloe said.
The pathologist motioned for her to sit down at a microphone in front of a computer screen and to count to five. “One two three four five, one two three four five,” Chloe said into the microphone, speaking with a slightly softer, breathier voice than usual. She cringed as Blount Stahl played the recording back.
“Don’t think too much about what you want your voice to sound like,” the speech pathologist said. “Let’s see what comes out easy.”
“One two three four ahhhhh,” Chloe said into the microphone. She looked at the screen and saw the number listed for her average pitch: 174.
“For the female voice, we want it between 190 and 260,” Blount Stahl said. “If we can get close to that, then we’re going to get more of the feminine voice that resembles you, that meets your personality.”
Listen to Chloe’s voice session
Chloe tried it once more, with a bit more breath.
“How comfortable did that feel?” her pathologist asked.
“That actually wasn’t that hard,” Chloe said. “There was a little, tiny bit of tension here, but not a lot.”
The instructor pointed to the screen. “Did you see that? Your average?”
Chloe whispered, “239.” She beamed, bouncing slightly in her chair. It was higher than she had ever gone before.
“That’s telling you that the vocal mechanism can do that, we just don’t want it strained all the time,” Blount Stahl said. “A believable voice is one that keeps going, that can be authentic. If you can get up to the highest on pitch for a female voice, but you can’t sustain it, then it isn’t really you.”
“Then what’s the point?” Chloe said, nodding.
‘Are you okay?’
Almost a year later, Chloe sat at her mother’s kitchen table, eating mac ‘n’ cheese, as her parents tried to suggest things that would lift their daughter’s mood.
Sitting next to her, Chloe’s father suggested she get back to practicing piano. What if she tried exercising or leaving the apartment more often?
They needed to try something. Ever since the pandemic first shuttered her school, Chloe had barely managed to keep her grades afloat. She went from earning almost straight A’s in her competitive magnet public school to hardly turning in a homework assignment on time. When she first started Microsoft Teams classes, Chloe’s legal name — the dead name that she couldn’t bear to see — had appeared on the screen. Her parents had to work with the principal and teachers to change the name in the system.
In the months since, Chloe’s teachers had been patient with her, allowing her to turn in assignments late or sometimes not at all. But after nearly three semesters, her parents worried their daughter would keep falling behind.
“How are you feeling about it, sweetie, about school and not being in the classroom?” Bruce asked as she ate Ethiopian food.
“It is horrible,” Chloe said, fidgeting with her belt and barely touching her food. “I use up all my energy going through all the classes and doing some of the homework, and then I still have things to do. And everything takes up so much energy.”
“Can I ask you a question? There’s zero consequence,” her mom said. “Would you want to go back into the school?”
“Motivational wise, I think it’d be good for me, but also it’s a risk,” Chloe said.
Metro Academic and Classical High School was transitioning to a hybrid approach, allowing some families to choose to send their students into the classroom. Chloe and her parents had decided against it, because of the risks of exposure. But now they wondered if it was necessary for their daughter to feel like herself again.
Chloe spent most of her time on the computer, playing chess and video games and talking to her friends on Discord. She hardly left the apartment while staying at her father’s place, and Clark had caught her sleeping through two of her classes. Her parents worried she was becoming depressed.
Her mother said Chloe’s doctor had suggested that the teenager find a therapist. “If you had someone you could check in with once a week that would be helpful,” Bruce said.
“I guess,” Chloe said. “But that’s not necessarily the problem. It’s the lack of real human contact, and I don’t think talking to a therapist is going to help.”
What Chloe really wanted, she thought, was to go back to seeing her friends and classmates in person, to feel like they could see her as who she was, and not just what she sounded like on Discord or in virtual classes.
She wished she could take her next step in her transition: breast augmentation surgery, a procedure that would make her feel more comfortable in her own body. But her parents insisted she needed to wait until she was 18, as is generally recommended for transgender young people considering surgery.
Three more years felt so far away to Chloe. She worried about what could happen during that time. Would lawmakers take away her access to her medications? She had managed to get an implant for her puberty blockers, which would cover her for at least two years, but she continued to take estrogen pills. If Missouri passed its bills criminalizing trans health care for minors, would Chloe lose access to this treatment?
She didn’t know what would happen. But she knew she didn’t feel like talking about it, or thinking about the homework she’d have to do later that night.
The teenager yawned, placing her chin in her hands.
“Are you okay?” her mother asked. “What’s going on?”
“I honestly don’t know,” Chloe said.
‘You’re drifting away’
While Chloe finished up her virtual classes for the day, Bruce was getting ready to drive to Jefferson City for her first shot of the coronavirus vaccine.
Her mother had decided that Chloe needed to go back to school in person, even if it meant putting their family at risk.
“I feel like you’re drifting away,” Bruce told her.
She feared that the pressures around Chloe, and her reluctance to leave the apartment, were making it easier for her daughter to hide.
She worried that Chloe was no longer doing the voice therapy exercises that could help her feel more comfortable about it. She wondered if her daughter’s voice would ever sound the way she wanted it to. But she also wished there was a way for Chloe to find peace with her voice the way it was.
“What I try to say — and it has not gone over particularly well,” Bruce said, pausing. “My hope is that she will love herself through every step of the way. I understand her body does not match who she is. But I wish she could love herself through it all.”
Chloe had zoned out of her AP World History class as her teacher talked about how to write short-answer questions on the AP exam.
“Something to keep in mind, there are two weeks left in this term” until spring break, the teacher said. “I can help you, I can take late work all day long until the term closes. But if you’re sitting on a bunch of stuff, you might want to turn it in. Some is better than none.”
One by one, the students logged off. The school day ended, and Chloe still hadn’t said a word.