For the first nine years of his life, Aileen Smith's son hated his name. It's a girl's name, and not only couldn't he bring himself to say it aloud, he couldn't even be friends with girls who shared it. When he first went to see Spack, the boy — who later named himself Kyle — had a flat chest and lanky body. But he was only nine. That would soon change.

Spack told them that Kyle would get his period within a year and a half. He'd also start developing. He would likely be a C cup.

You can almost hear Kyle's breath catch in his throat as his mom recalls this visit. "Geez," he whispers. He sinks deeper into the ottoman where his legs are folded underneath him.

Now 15, Kyle is a sensitive young punk kid with a floppy brown Mohawk, a blue lip piercing, and a set of rainbow rings around his neck. He is happy and easygoing, well-liked at the lefty private high school where he's just finished his freshman year, and close with his family. When he first met Spack, though, he had for years felt so uncomfortable in his own skin, that he developed paralyzing anxiety; he refused go to school, lest he'd have to talk to someone, or worse, introduce himself.

Kyle only recalls his first appointment in bits and pieces. Many memories of his life before age nine are this way. He can't — or won't — remember them. But he does remember looking at Spack as "some kind of god" when he told him that there was another way. And he does remember when Spack told him that without intervention he was going to be, physically, a well-developed young woman within the year.

"Shit flew off the hook," Kyle says.

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