In 2009, Spack co-authored the Endocrine Society's first-ever clinical guidelines on treatment of transsexuals, and this year Pediatrics published an article in which Spack describes GeMS and his clinical approach; this article — the first time treatment of trans kids has been described for a general medical audience — was a real coup, since primary care pediatricians are often the first person a parent turns to for help with a gender-nonconforming kid.

Alongside Spack's pragmatism and his protectiveness of his patients — his insistence that taking care of them is just like taking care of any other patients — is an enduring sense of wonder at stories like Kyle's, at the kinds of transformations that something as simple as hormone re-regulation can help facilitate. This is a source of great comfort and satisfaction for Spack as he looks toward his retirement.

It feels good, he says, "watching kids move confidently through life. Feeling that they're not crippled. But that's also a dual thing. That's both a hormone and a receptor, you know?" he asks, ever the endocrinologist. "The kid is the hormone who's had changes that enable them to be accepted, but they're also entering a world that's more accepting."

Beth Schwartzapfel can be reached at beth@blackapple.org.

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