Nine-year-old Rina rummages through a drawer in her room, looking for something creative to do. The room is painted in a shade of pink and is crammed with books and games. She pulls out a class photo from first grade, staring at it for awhile.
“This is what I used to look like,” she says, handing me the picture. “Sometimes it’s hard for me to look at it.”
There she is, standing among her classmates, short haircut, dreamy gaze.
“It’s not hard for me to see myself with short hair,” she explains, sounding surprising mature for someone her age. “Lots of women have short hair, including my grandmother,” she adds, smiling. “That’s not the main thing. The main thing is that I wanted to be a girl. And I was. Inside myself I was a girl, but no one knew it.”
Rina, an intelligent person, an outstanding pupil, inquisitive, full of life and humor, effervescent and very brave – was born a boy and for the first years of her life was raised as her parents’ second son. When she was 7, her parents courageously decided to respect her identity and allow her to grow up as a transgender person.
“When I was about 5, I started to feel not good about my body,” she says. “I was still mostly a happy girl, but I was feeling uncomfortable with my body. When I looked at girls, I felt like I was born with the personality of a girl but in the body of a boy.”
Did you know how to put that into words at the age of 5?
“It was very hard,” she says, with a sad smile. “I felt that I was born a girl, only in the body of a boy – that was the feeling. I saw girls and I understood that I was like them, but I didn’t know if what I felt could exist.”
Did you try to share your feelings with anyone?
“I only tried with Mom and Dad, but each time I would stop. A lot of times I’d say to Mom, ‘I want to tell you something.’ She would ask what, and then I would say, ‘Never mind, never mind.’ I didn’t know how to say it. I didn’t know what they would say or how to explain it.”
What did you want to say?
“Around the age of 5, I wanted to say to Mom and Dad that I felt like I was in the wrong body – that people were treating me like a boy because of my body. I wanted to ask if they could find out if there was such a thing in the world.”
In the living room of their elegant home in the Sharon region, in central Israel, Rina’s family speak openly about the exceptional journey they undertook in the wake of their daughter. It was a journey driven by their choice to support, accept and fight for Rina against all the obstacles society creates.
“We chose to tell our story frankly, because we have nothing to hide,” explains her mother, Dr. Keren Rivkin Nudelman, 38. “On the contrary: We are proud of our daughter. We feel that she is extraordinarily brave.”
Although no official data exist about the number of transgender children and adolescents in Israel, people involved in the field speak of a dramatic increase in recent years. In 2013, when the Clinic for Gender-variant Children and Youth at the Dana-Dwek Children’s Hospital (part of Ichilov Hospital) in Tel Aviv, the largest clinic of its kind in Israel, started out, it had three trans children as patients. Now there are an average of 85 new patients a year: All told there are 200 children and teenagers under the clinic’s care, the youngest a boy of 4 and a half.
“It’s part of a world trend,” says the clinic’s director, Dr. Asaf Oren, a pediatric endocrinologist.
“There is a flood of applications,” says Dr. Ilana Berger, a psychotherapist, social worker and jurist, who was one of the pioneers in treating trans people in Israel. When she started out, in 1996, she treated only adults, “but since 2015, all my new patients are children and teens.”
The reason for the surge, Berger explains, is that “parents are exposed to more information via the media. When their son or daughter stubbornly and persistently expresses distress over their gender assignments, it rings a different bell for the parents.” Accessibility to treatment also promotes change. “The first clinic in the United States dedicated to treating transgender children and adolescents opened in 2007. Today, due to the demand, there are 50 clinics.”
'At age 5, I wanted to say to Mom and Dad that I felt like I was in the wrong body. I wanted to ask if they could find out if there was such a thing.'
Oren concurs. “There is far more discussion of the subject today,” he notes. “That raises awareness and enables people to overcome their shyness about approaching the clinic. People come to our clinic from all over the country and from all socioeconomic classes, including Arabs and Orthodox Jews.”
Similarly, Nora Grinberg, who for 20 years has been advising, supporting and working with trans people of all ages – “I had one person who transitioned at the age of 85” – sees an increase that “boggles the imagination, in trans children who give expression to the situation at a young age, and in families who respect the children’s gender adjustment.”
Grinberg, who is 69, underwent gender transition when she was 48, after having been married and having two children. One of the most active members of the community in Israel, 15 years ago she got the Interior Ministry, by way of a public campaign, to amend the procedure for name changing, so that trans people were no longer required to have sex-reassignment surgery in order to change their names to reflect their gender identity.
“I grew up in such a different world, where trans children were not thought to exist,” Grinberg says. “In my view, trans children haven’t changed – what has changed is society’s attitude.”
Dresses and nail polish
Rina is the second child of Keren Rivkin Nudelman, a psychologist, and Guy Nudelman, 42, who works in customs clearance. The couple divorced when their elder son, Dror, was 4 and Rina was 2. A short time later, Keren met her present partner, Baruch Rivkin, 46, an emotional and psychodrama therapist, who was previously married and is the father of a girl. They were married three years ago.
Keren remembers clearly when the first signs appeared. “At the age of 3-4, there were flickers,” she relates. “It came and went, there was nothing consistent. For example, one time the children went to shop for clothes with their grandmother. When Dror went to the boys’ section, my mother noticed that Rina was looking at girls’ apparel.”
At the Passover seder when Rina was 4, she found the afikoman, the piece of matza that is hidden during the meal for the children to discover. Her father asked what she wanted as a prize for making the find. A princess’ gown, she said.
“He was pretty dumbfounded,” Keren recalls. “He consulted with me, and finally bought her a dress like the one worn by Elsa, the heroine of ‘Frozen.’”
Guy, Rina’s father, adds that he was definitely surprised, but thought “she was testing the limits of her own gender. Not for a moment did I think she was transgender.”
Keren, too, says she didn’t think there was a trans identity issue. “I had no idea that children could express clearly that they were transgender at such a young age,” she says. “I thought, ‘Fine, children play, dress up, try out things.’”
Rina wore the dress once or twice, Rina says, and then lost interest in it. Rina, asked how she felt the first time she wore the dress, replies perfectly naturally, “I felt confident.”
“There was another day when she wanted me to paint her nails,” Keren says. “I said to myself, ‘So she’s not such a gender conformist – fine,’” she says, laughing, emphasizing that she didn’t yet understand the signals. “She was delighted with the nail polish.”
At the age of 5, the signals Rina was sending out became more frequent. “Suddenly she wanted to wear an earring,” her mother says. “I agreed, and one ear was pierced the way they do for boys. Coming out of the store, she asked for the other ear to be done, too. I let her do it. The saleswoman was uncomfortable. Today I realize that that’s what Rina wanted from the start, but that she didn’t dare ask. She led us on gradually. She didn’t want to have her hair cut, and started to grow it long. She wouldn’t let anyone touch her hair.”
Keren recalls Rina’s grandfather telling her that when he was a student at the Technion in Haifa, he also grew his hair long, as he showed her in a photograph. Rina asked him, “Grandpa, when you grew your hair, did you also want to be a girl?”
Signs of distress
Around this time, the child also started to show clear signs of distress. “When I came to say good night, it was clear that something serious was weighing on her,” Rina’s mother recalls.
“She would cry. I tried to understand what was going on, and she would reply, ‘I don’t understand, I don’t know.’ Sometimes she would say, ‘Mom, I feel different.’ I asked her, different in what way, and she couldn’t explain it. In the everyday, she behaved regularly. In school everything was fine, she was happy and sociable. The distress was internal. She gradually closed up, became less talkative, sadder.”
Keren continues: “I started to connect the dots – wanting to wear a dress, use nail polish, have earrings in both ears, not cutting her hair – and I understood that I needed advice. I didn’t know a thing about trans children and had no idea that it was that. I studied psychology, but at university I never learned about trans children. I think there’s a huge lack of accessible knowledge on the subject; and psychologists, social workers, teachers and physicians don’t get trained in it.
“I looked for a therapist who specialized in gender, because I had a feeling it was related to that. I contacted Lee Reuveni Bar David, a social worker who deals with LGBT people and an instructor for parents on gender issues. At first I went alone – I wanted to understand what it was all about.”
Bar David asked about Rina’s body image, the games she played, whether she played more with boys or girls, whether she related to herself as a girl.
“At the end of the meeting,” Keren says, “she told me that it was impossible to know how things would go – that she might grow up to be gay, trans or none of the above. She gave me important advice: to let things happen, to allow whatever she wanted and not to block anything. But very quickly I discovered that that wasn’t enough.”
When a dancing class that Rina went to held a sale of dance gear, “I realized that she was looking at the leotards for girls, but that she didn’t dare ask about them,” her mother recalls.
“I asked her whether she wanted me to buy them, to try them on, and her eyes lit up. You had to give her the courage, the knowledge that it was all right, and then she would really go for it. I also gradually started to see that when she did things the way girls do, or dressed like a girl, she radiated relaxation.
“When she was 6, and asked if she could visit relatives wearing a dress and with her hair in ponytails, I prepared her mentally. I told her that people might ask questions and make comments, that I didn’t know how they would react. But she was determined. To protect her, we told them ahead of time that she would be coming in a costume. Everyone told her that the dress looked great on her, and she beamed with pleasure.”
Keren returned to the therapist, now with Rina. “I felt that her distress hadn’t passed. She would put on nail polish, be radiant with happiness, and after an hour or two it would fade. She cried at night. I felt we had to look into the matter in depth.”
At one point, the mother continues, “the therapist asked her very naturally, ‘Would you like us to address you in the feminine form?’ Rina replied with an enthusiastic yes. I felt that a heavy load was being lifted from her shoulders. I saw that something was freeing up. You couldn’t miss it. She responded with an excitement I’d never seen before.”
Rina, who is sitting next to her mother now as she talks, and looking at her with love, describes her feelings at that time with surprising clarity. Her language ranges from the phrases you would expect from a child her age to jaw-droppingly sophisticated explanations.
“The therapist asked me whether wanting to be a girl was stronger in me than wanting to stay a boy,” she says. “I answered her that wanting to be a boy had gone down and wanting to be a girl had gone up. I said that every day wanting to be a girl was getting stronger. She also asked if it might pass. I didn’t know how to answer that.”
What do you think today? Will it pass?
'Listen to your child. Don’t panic. You are not causing damage, but the opposite. Studies show that damage occurs when children are not allowed to be what they are.'
Rina: “I don’t know yet. But my sense of confidence is getting stronger every day, and so is the thought that I did the right thing.”
I notice that this question wasn’t comfortable for you. Right?
“Yes,” she smiles. “Because there are people who think it’s a sickness and that it will pass. Some people think that, if it’s a disease, it might be catching.”
Keren started looking for studies on the subject, and films, in an attempt to better understand it. At one point, she and Rina watched a film together about transgender children. “I’m like that, too,” Rina said. “They are like me, I am a transgender person.”
Keren also watched a clip of a conversation that Belle Agam, an Israeli trans woman, conducted with preschool children, who asked questions about her identity.
“In the clip, Belle Agam said she’d always felt she was a girl and that she did the change when she was 15. I wanted my daughter to watch, so she would know that the option existed. Many parents are afraid that if they talk to their children about it, they will want to do it. I think that’s mistaken,” says Keren.
“I showed all the clips to my older son, too, and he never expressed a wish to transition to another gender. Once I asked him as a joke whether all the clips and discussions on the subject made him want to make a change. He gave me a stunned look.”
In the clip, Belle Agam says that the first person she told about her identity was her mother. “I was really afraid to tell her,” she recalled. “I was afraid she wouldn’t love me anymore. [But] she gave me a huge hug and said she accepted me and loved me the way I am.”
Keren relates that both she and Rina cried at that point in the clip. “Rina very much identified with Belle Agam, and that connected us very strongly,” she says. Rina nods, and adds, “It really gave me strength. It was a sign that there are more people like me. It was a sign that what I wanted was possible.”
The entire family gradually came to terms with Rina’s identity. “It’s important for me that people understand that despite the openness and the understanding, it wasn’t immediate,” Keren notes. “They had to learn and get used to it.”
Baruch, Keren’s partner, also says it took him two or three months, though his support was always there. “Once I understood that it’s something internal, I expressed a lot of support, which came from understanding,” he says.
Guy, Rina’s father, adds, “I accepted it from the first minute.”
It’s not that weren’t any doubts. “It was all very scary,” Keren admits. “The greatest fear was what people would do to her, how society would react. I can give her all the love in the world, but every time she walks out the door she will be at constant risk. I was afraid she would be laughed at, beaten up, that she would be miserable her whole life, that no one would accept or understand her. I wanted to protect her. I also thought that maybe she would forget about the whole thing and get over it – that also occurred to me.”
Formulating a plan
“In medical terminology, it’s known as ‘gender dysphoria’ – discomfort and distress stemming from a mismatch between gender identity and the gender assigned to a person at birth,” Dr. Oren, from the children’s and youth clinic, explains. “Gender dysphoria can bring about a rise in morbidity that takes the form of depression, anxiety, suicidality and social difficulties.”
Treatment of pre-adolescent trans children begins by offering help to them and to their parents.
“We talk to them about the fact that there are a great many more children like theirs, and explain that they are not alone,” Oren explains. “We show them studies about the importance of family support and give them information about the future plan – if we actually get to that stage.”
That plan, which includes pharmaceutical-hormonal intervention, is relevant only in adolescence. “We do not give medical treatment before adolescence,” Oren emphasizes. Hormonal treatment for adolescents who wish to receive it requires the signed consent of both parents and the diagnosis of a mental health professional with experience in this field.
“The first stage,” he continues, “is inhibitory treatment, to halt sex hormone production in adolescents by means of blockers that stop development of secondary sex characteristics. That is a completely reversible process. The next stage involves administering a sex hormone according to the desired gender, which is in part not reversible. That is only done after the age of 14 for those found suitable, and not across the board.”
The increasingly dominant approach in the treatment of trans children advocates respecting their wishes, says Ilana Berger, the psychotherapist. Thus, “social transition” is achieved at a young age, involving changing names, gendered pronouns and adapting the child’s exterior to their new identity.
“This is the child’s authentic choice,” she says. “It’s an approach that says, in a nutshell: Listen to your child. Don’t panic. You are not causing damage, but the opposite. Studies show that damage occurs when children are not allowed to be what they are.”
A different approach, one no longer accepted, was to leave the child in the birth gender. A leading advocate of this approach is Dr. Kenneth Zucker, a Canadian psychologist whose methods, says Berger, resemble “conversion treatment” for gays. “If, let’s say, a boy wants to play with dolls, he [Zucker] instructs the parents to hide them and not allow him to do that,” she relates.
This approach is now completely rejected. Zucker was ousted from the Toronto clinic he directed, and the clinic was shut down. (Zucker later sued the clinic, which as part of a settlement, apologized for the way it handled his case.) .
“Why suppress the will of a child that is expressed stubbornly and consistently?” Dr. Berger asks. “When a boy or a girl starts to give it expression at the age of 4-5 persistently and is denied, the distress can take many forms – attacks of rage, crying or anger, social anxiety, insularity, social regression. Some children internalize the prohibition and express it in depression, quiescence and obedience. They are snuffed out, self-hating, have suicidal thoughts and even make suicide attempts. I had a trans patient, who is now 18, but at the age of 5 he ran into the road with the intention of being hit by a car.”
On the other hand, Berger says, “When parents allow a child to be what they are, that child will grow up to love themselves and trust their surroundings.” The children, she says, are mentally healthy – the main work is with the parents.
“Many parents experience it as a crisis. There are always guilt feelings, even shame. What always comes up on their part is what they did wrong to produce a trans child. Most parents express sincere concern about the child. They are really anxious about what will happen to him. I always leave the decision to the parents, but I say that the best protection is acceptance. Proof of this is that as soon as they are allowed to make the change, they blossom.”
Berger relies on her long experience of monitoring children and teens who continued to be in her care as mature individuals as well. She also draws on new studies, noting in particular the latest research by psychologist Kristina Olson, of the University of Washington, involving a longitudinal comparison of trans children aged 3 to 12 with two control groups, one of non-trans children, the other of brothers and sisters of trans children. No differences were found between the children in all the mental-health parameters examined. “The study found that as long as the child is allowed to live in the gender identity they express, they have the same inner resilience as other children,” Berger says.
Nora Grinberg agrees. “Being cisgender [feeling comfortable with the gender one was assigned at birth] or transgender doesn’t in itself ensure whether one will be happy or unhappy. What matters is whether people can live their life without running away, without hiding and without being ashamed of who they are. If they can, then their chances for a better life are greater.”
Always a girl
When Rina was 7 and a half, her family allowed her to express her identity, at home.
Rina’s family has gleaned two clear lessons. 'First, you need to listen to the child,' Guy says. Second, it’s very important for the parents to understand that they are not alone.
“We let her wear whatever she wanted. Her hair grew and we addressed her in the feminine form,” Keren says. “We wanted to see how it affected her. We said we would hold on for her coming out at school, because that still frightened us.”
The way matters developed surprised Keren. “I saw things were good for her for a day or two, and then she reverted to behaving as a boy. I thought she possibly didn’t really want to transition. I asked her, and she looked at me and said, ‘Mom, I can’t be a girl at home and then go to school in the morning and be a boy, and then come home and be a girl. It’s too hard for me. You said, not in school, so I don’t want to [at all].’
“I was stunned. I grabbed my head and said, ‘You call yourself a psychologist?’ We had put her in an impossible position. The message we sent her was that she should conceal it outside, that it wasn’t all right, so it was being kept a secret. I promised her that we would deal with it, that she should hang on until the end of the school year.”
Rina completed the second grade. Then, a week into the summer vacation, she went angrily to her mother and confronted her. “You asked me to wait. The school year is over, the vacation has started and there’s no school now, so starting today I am a girl every day,” she told her mother.
What form did the change take?
Keren: “She had long hair which she continued to let grow, she wore dresses and clothes that were pink. We started to address her as a girl, and very quickly she also asked to change her name to Rina. She herself chose the name, and we registered it officially in the Interior Ministry.”
At this stage, Rina’s parents started to tell the extended family about their daughter’s transformation. “I invited the whole clan one day,” Keren recalls. “We put it to them as a fact. We didn’t ask for their opinion, we made a statement. We gave them time to ask questions and express concerns.”
Nahman and Rosa Tsabar, Keren’s parents, are playing with their granddaughter during their weekly family visit. Rina is dancing and singing a song in Russian, which she started to learn on her own in the wake of her grandparents, who immigrated to Palestine in their youth from Russia. Both of them respect and support Rina’s gender transition. “We have been to three Gay Pride parades with her,” they say with delight. “We walked the whole route from the start.”
Rosa adds that she also attended a demonstration held last year in protest of Education Minister Rafi Peretz’s comments in favor of conversion therapy, remarks that elicited a large public outcry. “I told people there that I am the grandmother of a trans girl, and I joined the educational efforts of a transgender organization.”
Did you both accept it from the start?
“I didn’t know anything about trans people,” Nahman says, “but from the moment my daughter shared the news with me, I accepted it immediately. There was no question, because Rina put it stubbornly and consistently. She even fought for it. I am against suppressing things. I only had to get used to addressing Rina in the feminine form. That took me a bit of time. I was confused at first, but I got used to it.”
Rosa notes that she too accepted the new situation immediately, “but I was in a state of shock at first. I admit that it was hard for me. It was hard for me to see her in a dress. I started to read about trans people and to learn about the subject. At first I felt a sense of loss, a certain mourning. I loved her in her identity as a boy, I loved the name they had chosen for her. Along with accepting her, I suddenly asked myself: Who is Rina? Where is the grandson I knew? What is my connection to this girl?”
The positive change that occurred in Rina was of great help to her grandmother in coping with the new situation. “She became a freer and happier girl,” Rosa says. “As soon as I saw her dejection disappear, that strengthened me and it was clear that I was going to go along with her.”
The grandparents shared the news with their friends, and they say that they all reacted favorably. “We shared with my mother, Rina’s great-grandmother, who is an elderly woman,” Rosa smiles. “We showed her a film about trans people, and then we told her ‘Rina is a trans girl, too.’ At first she cried, but then she accepted it.”
When Keren informed the school that both Rina and her brother attend, she says, “The principal was very supportive. We organized a meeting in the school with the principal, the homeroom teacher, the school psychologist and representatives of the Education Ministry’s Psychological Service.
“Lee Reuveni Bar David, Rina’s therapist, came to the meeting and explained things, and they asked questions. I asked the school to change her name to Rina on all the documents, that she be addressed with female pronouns and that they be very alert to cases of bullying.”
Keren notes that “not every trans person receives the support Rina was given in school, and not all the principals and teachers are capable of leading a change like that.”
She adds that she regrets that the Education Ministry has no policy on the subject. For example, there is no obligatory directive to adjust pronoun use for pupils' request or to allow them to use the bathrooms that match their gender. “Every principal behaves differently, with the result that many parents are witness to distress, discrimination and dropping out of their children,” she adds.
A spokesperson for the Education Ministry told Haaretz that “the ministry offers the schools recommended responses to be given to transgender pupils, and even provides support and supervision for schools that request assistance in this matter. In parallel, the ministry is working on a document on the subject together with external professionals in the field. This requires study and time in order to formulate a policy that will apply to the entire education system.”
Ahead of the opening of the 2018-19 school year, Rina’s parents sent a letter to the parents of all the children in the third grade, explaining that their daughter is a trans person and inviting them to ask for more information if they wanted. The school also sent a letter to the parents.
Rina came out to her classmates about the transition she had undergone over the summer, as her mother waited for her outside.
“I told everyone that I am a transgender girl,” Rina recalls. “I had a few pages that I read out and I asked them to address me only as a girl and I told a little about what I went through in the summer vacation. I told them, ‘My family respects it, I will be happy if you respect it, too.’”
Rina felt that the children were proud of her. Most of them respected her new identity, she says, but “some started to bug me pretty soon. Some of them would tell me, ‘Go back to being a boy.’ There is also a minority who annoy me and speak to me with male pronouns on purpose. That hurts me, especially when they do it on purpose.”
In the initial period after her coming out, Rina relates openly, her social status suffered somewhat. “Some children won’t play with me during recess,” she says, and admits that sometimes she spends recess reading or alone in the classroom. In some cases, when she tries to join in a game, she is told, “This is a game for boys only.” “I was also called names and cursed,” she adds, “and one boy tried to take off my earrings.”
Dror, Rina’s 11-year-old brother, says that he often stays close to his sister during recess. (Haaretz spoke with Rina and her family before the schools shut down during the health emergency.) “If she is alone, she is more exposed to violence,” he says. Rina has also begun to train in self-defense.
“It gives me a feeling of security,” she says. “I saw clips where trans children tell how they were hit in school, so I thought it might happen to me, too. I wanted to learn how to defend myself so if I get hit, I will know how to fight back.”
She adds, “I don’t know why children bully me. I am just like them. In the end, I will be popular again at some point. The same way there is an end to the popularity of many children, there will also be an end to my unpopularity.” The situation now is much better, she says. The children have got used to the idea and hardly harass her.
Lessons to be learned
Rina is now in the fourth grade; a year and a half has gone by since her transitioning. “I feel I was born a girl, and always was one, I feel a big relief,” she says. Her family is also very much aware that a burden has been lifted from her. “She is a happier girl, self-confident,” her father says.
Keren adds, “She lives like any girl now. The subject only comes up when we need to see a doctor, say, or deal with an organization that doesn’t know her, and then the question of how to tell them arises. And, of course, when she reaches adolescence new questions will come up.”
For the past year, Rina has had a friend who’s a trans boy. “We like playing computer games together. He sends me poems he’s written that he dedicates to me. I call him about seven times a day and he doesn’t always answer,” she laughs.
“I am in love but I am not really thinking about the future yet,” she adds with a dreamy smile. “I think I want a small family – no more than one or two children.”
Rina’s family has gleaned two clear lessons from their journey. “First, you need to listen to the child,” Guy says. Second, everyone agrees that it’s very important for the parents to understand that they are not alone.
“At first we felt that it was only happening to us,” Keren says, “but today I know that many families have the same experience. I recommend that parents consult with experts or talk to other parents of trans children. We were very much helped by the Aguda – Israel’s LGBT Task Force, by the Ma’avarim organization and by the Lioness Alliance Group. We also received support from the community we live in, which was very meaningful. The main thing is not to be alone.”