For most mothers, their daughter’s 16th birthday is marked by such traditions as a party, preparing for a school dance, or maybe even allowing them to go on holiday with their friends for the first time.
For Elizabeth Thornton, however, the year brought with it a rather different set of demands. First, she was asked by her daughter Sarah to refer to her as ‘Alex’. More recently, she found herself shopping not for a glamorous evening gown, but for a breast restrictor designed to flatten and hide her daughter’s breasts.
Today, instead of looking forward to moments like her youngest daughter’s wedding and the birth of her first child, Elizabeth is contemplating a series of operations that Sarah is determined to put herself through, including a double mastectomy and a hysterectomy.
Now aged 17, Sarah is believed to be the youngest person in the country awaiting a female-to-male sex change operation. She has been living as a teenage boy for the past year, and has now been given the go-ahead by her GP and her psychiatrist for the £106,000 procedure.
Sarah hopes to have the surgery within the next 12 months. This, she says, is the only way she can hope to live the rest of her life with any degree of sanity or happiness.
Her decision has, however, been far from easy for her family. Sarah’s elder sister, 21-year-old Vanessa, cannot accept what is happening, and both her parents are candid about their struggle to adapt to the reality that their little girl is desperate to become their son.
‘When, last November, Sarah told me that she wanted to have a sex change, I nearly choked on the cup of tea I was drinking,’ says Elizabeth, 42, a PA who lives in Newcastle with her husband Vincent, an engineer, and their children. ‘I honestly thought this was some sort of teenage fantasy, and neither my husband nor I took her seriously at all.
‘Then, two weeks later, the psychiatrist that Sarah has been seeing for some time, because she has been so depressed, phoned me on her behalf.
‘She said that Sarah was distraught that my husband and I weren’t listening to her, and that this was no joking matter. I can’t even describe how I felt at that moment. I was devastated. Confused and terrified. ‘I kept thinking what had I done wrong, and was this all my fault. I’d produced this child as a girl, and now she wanted to be a boy.
‘All I could think was if you’re not happy, change your hair, change your dress sense or, at the most, consider cosmetic surgery. To change something as drastic as your sex – well, it was beyond what I or my husband could understand.
‘It just felt all wrong, and certainly not the sort of thing that I’d ever thought would happen to an ordinary family like ours.
‘But at the same time, I couldn’t imagine being in Sarah’s position – of hating yourself every time you look in a mirror. As a mother, I wanted to protect and help my child, and I’d known for a long time that Sarah was desperately unhappy.
‘Vincent and I had been struggling for years to understand what was at the root of Sarah’s depression, but we had never considered she might actually feel that she was trapped in the wrong body.
‘She wasn’t living her life; she merely existed. She didn’t have a job and had very few friends. She was depressed and spent most of her day in bed. If the answer lay in supporting her as she changed sex, well that would be what I, as her mother, had to do.’
Certainly, when Elizabeth first held her youngest daughter in her arms, this was not the future she had envisaged.
‘Vincent and I were overjoyed to have another little girl,’ says Elizabeth. ‘I remember looking at Sarah’s tiny face and feeling full of the highest hopes for her.
‘It was such a magical moment, and all I wanted to do was protect her from the world and make sure she was happy.’
While a set of family photographs depict an ordinary looking little girl, with an angelic face and long, brown, flowing hair, Elizabeth noted from the outset that Sarah was a tomboy.
‘From a very young age, Sarah was a very different child to her elder sister,’ says Elizabeth. ‘She would much rather be outside playing with dinosaur toys or climbing trees than sharing Vanessa’s dolls. If I put her in a dress, she used to pull it off and stamp on it.
‘I would have loved Sarah to wear nice dresses, as she was such a pretty child with lovely hair, but she refused point-blank.
But in those days, I used to feel proud of the way she tumbled around, without a care in the world, and was just tomboyish.’
But by the time she reached six, Elizabeth realised her daughter’s desperation to be a boy set her apart from both her sister and the other girls at her school. She began to insist on being identified as a little boy, and asked her friends to call her ‘Lee’.
This behaviour meant that by the age of nine, Sarah was being badly bullied at school. She started suffering from anxiety to such a degree that her GP referred her to a psychiatrist and put her on anti- depressants, which she took for six months.
Sarah recalls: ‘At school, the other children started to call me “freak” or “man-girl”, and I began to think there was something terribly wrong with me. My natural instinct was to hit out and punch other children, which meant I kept getting in trouble. I felt like everyone hated me.
‘Mum was shocked and disappointed when she heard from the school that I was hitting and punching the bullies. I remember her saying to me that this wasn’t the response of a little girl, and that had she been in my shoes, she would have cried and asked the teacher for help.
‘But that was an alien reaction to me. In hindsight, I understand that the instinct to lash out was typically male, but I didn’t understand that then.’
In a bid to escape the bullies, Sarah was allowed to change schools. However, she continued to stand out from her peers and the bullying resumed.
By the age of 12, things had become so bad that Sarah attempted suicide by overdosing on drugs she found in her parents’ medicine cabinet. She was rushed to hospital and spent three days recovering. In desperation, her parents employed a tutor, who taught her at home for a year. But despite this one-to-one attention, Sarah still struggled to flourish.
‘In all, I spent a year at home – and for the most part of it, I sat in my bedroom playing computer games,’ says Sarah. ‘Socialising with anyone terrified me and would lead to a panic attack. I remember standing at my window watching other children playing in the street, wishing I could be normal, too.’
By now, her parents were beside themselves with worry about their daughter. ‘Her father and I had no idea what was wrong, or where to turn for help,’ says Elizabeth. ‘Sarah underwent a range of tests at hospital, which thankfully revealed no physical problems at all.
‘Psychologically, though, we knew things were not right. We felt as though our daughter was drifting out of reach, and we had no idea how to help her.’
With puberty, Sarah began to think of herself, privately, as a gay.
Physically, she also started to make her appearance more masculine – although at the time she had no idea of the concept of feeling trapped in a body of the wrong sex.
‘When Sarah was 13, her appearance totally changed,’ recalls Elizabeth. ‘She had her hair cut into a short boyish style. At first I was devastated, because she really did start to resemble a young boy.
‘Even so, I never would have guessed where this would have taken us. I honestly thought it was just a phase.’
At 15, Sarah lost her virginity to a male friend, but says that by then she had no doubt that she was attracted to women. That year, she told her parents she was a lesbian.
By now, she had reached an emotional low, and frequently punched holes through doors and walls. She also started self-harming, and once more tried to kill herself with an overdose of flu tablets.
‘When Sarah told me she was gay, I wasn’t that surprised,’ says Elizabeth. ‘She was terrified that we were going to hit the roof, but we’d had our suspicions for a while. And we had bigger things than her sexuality to be concerned about. Sarah’s troubles by now seemed to be so deep-seated, and she seemed so profoundly unhappy, that Vincent and I were at our wits’ end.
Every second of every day I thought about Sarah and worried about her constantly. Our GP suggested she go back on antidepressants, but her father and I were worried about her taking drugs.
‘We decided to send her to karate lessons, instead, hoping it would be a way to vent her anger and channel her aggression. And for a while, that seemed to work. In retrospect, I don’t think I would have been so shocked had this aggression come from a teenage boy. It just seemed so unnatural coming from a girl, and that was what troubled me so much.’
Sarah says that by now she was battling more than ever to find any happiness in her life. As her body developed, she found it increasingly difficult to look at herself in the mirror. Even now, she describes herself as being ‘cloaked in a costume that is not my own’.
‘I was filled with self-loathing from the time I entered puberty and my body started to become more womanly,’ says Sarah. ‘I’ve always loved swimming – but I felt awkward in a costume and longed to wear swimming trunks instead.
‘In the pool, I would look at flatchested girls with envy, and actually fantasise about cutting off my own breasts. In the end, I stopped going swimming at all.
‘By 15, I’d also stopped using an ordinary mirror. Instead, I’d look at myself in a tiny hand-held one, so that I couldn’t see my whole face at once. I hated everything about my appearance. Whenever I saw my reflection, I felt as though I was wearing some sort of hideous Hallowe’en mask.’
In fact, it wasn’t until last November, while watching a programme about sex change operations, that Sarah finally started to see a way out of her despair. Immediately, she identified with the people being followed by the documentary.
‘Everything the individuals said on the programme rang true for me,’ says Sarah. ‘For instance, I had always thought that it was wrong to say I was a lesbian, because I’d never felt as though I was a woman attracted to women. Now I understood that, in fact, I was attracted to women simply because I should have been born a man.
‘I knew right away that I would have to undergo a sex change operation if I wanted any chance of happiness. I was terrified about what my parents would say, but by now I was 16 and an adult. I knew that a sex change operation was right for me.’
Days later, Sarah told her parents that she believed she should have been born male. Their reaction, however, was not what she had hoped for.
‘Mum just stood there with her mouth open and gave a sort of nervous laugh, and Dad even joked that I could do what I wanted as long as I was paying for it,’ says Sarah. ‘I was furious. I felt completely let down by their attitude.
‘In desperation, I went to speak to my psychiatrist and told her that I wanted to change my entire body, and that unless my parents listened to me, I thought I’d kill myself.
‘Thankfully, my psychiatrist was supportive and agreed to speak to my parents on my behalf.’
In January, having had some time to come to terms with Sarah’s decision, Elizabeth decided to show her daughter support by buying her a breast restrictor and a number of DVDs and books about people wanting to change sex, and the surgery involved.
Vanessa, however, has struggled to understand her younger sister’s decision, and relations between the two of them have become very strained. In particular, she gets upset when her family call Sarah by her new name of Alex.
‘I struggled to purchase the breast restrictor, especially as my elder daughter disapproved,’ says Elizabeth. ‘But I knew Sarah’s naturally large 34F breasts were really getting her down, and I wanted to show her that I still loved her, and that I would support her no matter what.
‘But that’s not to say there weren’t many nights that I didn’t feel utterly desperate about what was happening. I felt like I’d failed as a mother, and I also felt guilty and ashamed. I used to lie in bed, tossing and turning, wondering what on earth we had done as parents to cause our daughter not to be happy with her sex.
‘My husband feels the same way as me. It’s been impossible for both of us to shake off the sense that we’re losing our little girl, and we felt incredibly sad that all the moments we’d looked forward to, such as her wedding day and her having children of her own, now won’t happen.
‘I found it hard to call Sarah “Alex” too. I try my best, but I even now I still slip up sometimes.’
Subsequent assessment by both Sarah’s GP and her psychiatrist has led them to believe she will qualify for a sex change on the NHS. They hope to make an application for funding within the next few months.
Complete surgery is thought to cost around £106,000, which includes £16,000 for a double mastectomy and £90,000 for a hysterectomy and change of sex organs.
‘If I could have had the operation done yesterday, then I would have done,’ says Sarah. ‘Even the thought of having it makes me feel better, and I’m just looking forward to the day I can start leading my life as a man.’
For Sarah’s parents, though, the future feels very uncertain.
‘Her father and I don’t like looking at what the future holds. Neither of us can envisage Sarah as a man. All we can do is take each day is it comes, and do our best to be there for our daughter as she embarks on her journey to become our son.’