Elliot’s hidden a-gender

By Andrew Humphries

Courage is easy to define, easy to spot and easy to appreciate and even laud, but sometimes it’s not easy to find. To have.

The dictionary defines the word courage as “the ability to do something that frightens one; bravery”, and images of firefighters and soldiers and so on readily spring to mind.

But sometimes just being yourself is the hardest, loneliest and most courageous thing you will ever do because if you don’t fit into society’s norms, hostility, ridicule and even violence await you. And that is very difficult for anyone to confront, much less a young man or woman.

Elliot Nicholas knows this all too well, as do his parents, Geelong-based Uniting Church ministers Will and Amanda Nicholas.

Elliot is an impressive young man, the sort of young adult you hope all of your children – especially sons – grow up to be like. But Elliott’s journey to adulthood – he only recently turned 18 – has neither been conventional or easy.

Society has a label for people like Elliot: transgender. But it doesn’t have what people like Elliot need most: acceptance. And this makes what is already a deeply difficult journey even more problematic.

To understand that journey, it is important to start at the beginning.

When Elliot was born, his mother, Amanda, admits to great surprise: after all, she was convinced she was going to have a boy.

“I do remember a moment of surprise when Elliot was born and the doctor said ‘it’s a girl’, because I was sure I was having a boy,” she recalls.

“That has always stayed with me, because I was absolutely certain we were having a boy.”

For Elliot, though, life as a girl never seemed the right fit; something just didn’t seem natural, a feeling that only grew as he got older.

“As a kid, I didn’t really look like a boy or girl, but I would look up to my older brother and his friends and I preferred that (male) lifestyle and version of myself to one that involved wearing a dress or putting make-up on,” Elliot says.

“I didn’t like anything that made me feel feminine.

“I remember at one of my brother’s birthday parties, he had his friends over and it was a really hot day and they were having a great time playing in the sprinklers with their shirts off and I said ‘mum, I want to take my shirt off and hang out with the boys’ and she was like ‘no, you can’t do that because you’re a girl’.

“That was when it hit me and I was thinking to myself ‘OK I think something is happening here and I’m not quite sure how to feel about it’.

“I kind of ignored that at such a young point in my life, but from the ages of  10 to 12, when puberty was happening, my body was telling me it’s time to be a woman and I was like ‘no’.”

Amanda can recall Elliot experiencing feelings of dysphoria from the age of about five, while for Will, there were more obvious examples.

“I have a memory of Elliot at the ‘princess dance’, which was organised by one of our local Pentecostal churches, and all the girls are standing there looking glamorous and Elliot is standing off to one side looking extremely awkward and uncomfortable,” he says.

“So it’s something that we have been aware of virtually all of our lives.”

Elliot recalls a childhood in which the most fun was always had doing the things a boy would, rather than the activities his gender suggested he should be doing.

“I was always a tomboy and I would always want to hang out with my brother and his male friends,” he says.

“It has always been a state of mind.”

Navigating the rites of childhood can be tough at the best of times, so imagine Elliot’s life as the feeling that he had been born the wrong gender continued to occupy his thoughts.

Not surprisingly, school in Tasmania was a nightmare.

“Most of that time it was about wearing dresses and going to formals and that kind of stuff and I was about 14 when I realised that I really didn’t like this,” Elliot recalls.

“At that stage, I wasn’t going to come out as transgender because I didn’t even know what that meant and it would just open up a whole can of worms that I didn’t want to open.

“I was in a rough relationship with my parents and I didn’t have many friends because I would push them away as I didn’t think they would respond to me very well because in the past they hadn’t (responded well).”

For Amanda and her husband, Will, it was almost a case of joining the dots as they began to become fully aware of what was happening with Elliot.

“One of the things that we struggled with before Elliot actually came out to us was that we began to become aware of some of the bits and pieces around what was happening with him,” Amanda says.

“We would go shopping and Elliot would dash off to the menswear section and eventually he wanted to buy different underwear and we said to him, ‘we don’t subscribe to any binary ideals and you have to dress however you feel comfortable and in a way that works for you’.

“At this stage, we didn’t have the full picture, but there were certainly moments and inklings leading up to it where he was trying to make the expression without being so open about it.

“What we did was say, ‘it’s OK for you to be open about these things and you don’t have to hide anything’.”

In December 2017, Will and Amanda told the family that ministry changes meant they would be moving to Geelong the following year and, for Elliot, this was the best news possible.

Life and school in Tasmania had been difficult and he had been worn down by the constant battle to try and fit in.

Geelong, then, meant a new slate and a new beginning, or so Elliot hoped at the time.

“I wanted to sound sad about it, but I remember feeling really excited because it represented a fresh start for me,” he recalls.

“I promised myself when we moved to Geelong I would really try to make things better and I would work hard at it and I did.”

The move was the catalyst for Elliot to try and take more control of his life.

“We moved in June 2018 and around the time of my birthday in July I said to myself, ‘I don’t want to live like this anymore and I deserve better and to live better’,” he says.

“I made a list of all of the things I didn’t like about my life and put little equations next to them, like how to improve the relationship with my parents and ‘I don’t have many friends, so how can I change that?’ and ‘I don’t like going to school, how can I be more interested in that?’

“It was about looking at all the hard things in my life and asking myself how could I make things easier?”

At this time, Elliot’s conviction that he had been born the wrong gender only grew and, with that conviction finalised in his mind, it was time to find out exactly what options were open to him.

“I did a whole heap of research because I wanted to find out what was wrong with me, because I always thought I was gay and a girl who liked girls, but it was something more than that,” Elliot says.

“I actually didn’t like the body I was in and when I discovered that was a real thing I was almost in disbelief, I was like ‘am I actually faking all of this’, but I knew it was a real feeling.

“I needed to do a lot of research because I knew that when I came out to mum and dad they would be saying ‘OK, how can we help you, how can we make things better for you, what can we do to make you feel more comfortable?’”

November of 2018 marks a pivotal point in Elliot’s journey as, armed with all of the research he had carried out, he came out to his parents, told them he was the wrong gender and wanted to transition to a male.

“I was 15 at the time and, over those summer holidays, we worked out a strategy to affirm that transition,” Elliot says.

For Amanda, an experience within her own family gave her hope that a positive outcome could be achieved for Elliot.

“In terms of the relief, I think one of the things that helped Elliot was that a couple of years before this my youngest sister had come out as gay at the age of 34,” she says.

“When Elliot saw how her family continued to love and support her, that helped him to feel that it might be OK and we could work this out.”

But it was a more practical example that Amanda remembers as a defining moment in Elliot’s journey, a small but symbolic act around change.

“At the beginning of 2018, Elliot decided that he wanted to have all of his hair chopped off and that was a moment where I had to step aside because I recognised that this was going to be a particularly important thing for him,” she recalls.

“I didn’t quite know why or how, but there was just a sense that Elliot was growing up by doing this.

“It seemed to me to be the first outward expression around him being more comfortable in himself by getting rid of about 60cm of hair.

“I think it was a real point of freedom in the sense of getting rid of some of the physical aspects (around being a girl).”

Will admits to a great sense of relief when Elliot came out to them.

“For me, that period of time around the emergence of dysphoria had been one of absolute terror,” he says.

“As the male parent, I had a child who was into all of the things that I was into, like getting into the garden and hiking and fishing, then all of a sudden I had this child who was pulling away from me and I was in terror around the possibility of losing him.

“So all of the things that I loved about being this child’s parent were slowly being stripped away.

“But there was certainly a sense of relief when Elliot came out.”

As the end of 2021 nears, Elliot Nicholas looks forward to a future that offers endless possibilities.

Yet it’s a future that, at one point, he could not imagine and one which seemed unattainable.

His journey towards gender affirmation had become too much to bear and, if there was light, it was almost entirely engulfed by darkness and despair.

The world, he thought, was not a place for him any more.

Elliot recalls his early teenage years as the darkest of times, as doubts and confusion about who he truly was, as well as ongoing abuse from fellow students, led to self-harm and attempted suicide.

“The worst time was probably between the ages of 13 and 16,” he says.

“It started as little things. For example, I would grow my fingernails a bit longer and sometimes clench my fists and I would end up with cuts on my palms, so it was doing little subtle things like that every time I got called a name at school or someone picked on me for no reason.

“I didn’t know how to say how I felt because, at that stage, I was in a school that was quite binary and it was quite intimidating for me to say anything.

“So I would say, ‘oh I’m just having a bad day or I haven’t slept enough’. It became harder and harder to deal with everything because people started to become more and more aggressive towards me.

“I would get notes left in my locker and anonymous messages and posts on social media about me, and they started to stack up on each other and I began to believe what they were saying and that I was a waste of space and was stupid and broken, a loser, a weirdo and a freak.

“I was told I didn’t deserve to live. It was terrible. I was so cornered and so lost and I felt like I had stumbled into a dark room and lost the key to get out and I’m stuck there.

“It wasn’t that I enjoyed being upset, it was that it just seemed like the only option. Every time I tried to step up I would be pushed back and I just got to the point where I gave up.”

And so, while his fellow students navigated the more mundane things involved in being a teenager, Elliot had decided his life would progress no further than that.

The hatred and abuse towards him and the pain it created had become too much.

He wanted out of this world.

“I was in Year 9 when I heard about a kid in NSW who was bullied because she was different and had decided to end her life,” Elliot recalls.

“I was thinking ‘I don’t want to do this’, but I kept getting the hate and the bullying and harassment and I thought ‘I know why this girl did that to herself because I feel that is where I need to go’.

“I didn’t want to be here anymore and it felt like other people didn’t want me here anymore. I had tried to take my life twice before we moved from Tasmania to Geelong.”

Amanda recalls a time of great despair, as she and Will began to realise the extent of Elliot’s emotional and psychological pain, and how he dealt with that pain by harming himself.

“The period involving the cutting and suicide attempts was really hard and, for me, the thing that was hardest was there was the moment when we realised the cutting was becoming a daily practice,” she says.

“When you see the physical scars that go with all this, you start to look at how can we get beyond this point to somewhere where Elliot doesn’t need to harm himself anymore?”

Ironically, the very darkest day in 2018 became the catalyst for Elliot’s journey towards the light.

On that day, a distressed Elliot told his parents he was once again experiencing suicidal thoughts and wasn’t sure he could make it through the day.

“I came to them and explained the situation and said ‘I need to be honest with you, I really don’t feel like I can be left alone because I don’t trust myself, I feel if I have the chance I will take my life. I just want to die, I don’t want to be here anymore, it’s too painful’,” he recalls.

For Will, that day was his most difficult as a parent and a major test of his resolve.

“The day when he came to us (and said he couldn’t go on) was probably the hardest point in the journey, but what came next was even harder because it meant I had to switch off all of my training as a Minister and swap seats (to that of a parent),” Will recalls.

“So I said to Elliot, ‘let’s hop in the car and we’ll go to the hospital’, so we went to casualty and told them what was happening and one of the psychiatrists from headspace came in and sat down with us.

“And I was sitting next to Elliot and looking at the person on the other side of him and I thought to myself, ‘I have sat there, where the psychiatrist is, I know how to do that, but I don’t know how to do this (as a parent)’.

“So I now have a greater understanding of what the parent is enduring when they sit in that space because when I sat there with Elliot that day I had absolutely no skills, words or anything that could possibly help me to resolve this.

“I remember just sitting there and praying and saying ‘is there anything I can do’ and I felt a great sense of calm and a voice saying to me, ‘just be here for him’.

“I felt I was doing the wrong thing by taking him to the hospital. You know, I’ve turned up and said ‘I’ve brought my healthy, walking child here because they have just told me they want to kill themselves’.

“The hospital staff responded straight away and said ‘this is serious’ and got us into a room and, from that point, our GP, headspace, and the GP, sociologist and psychologist at Elliot’s school were all around us and there was no need for Amanda and I to try to be experts in this field.

“We were cared for by this incredible team that I call a cloud of witnesses, but I think it’s important to recognise this really dark period when Elliot reached a point where he decided, ‘I don’t want to live like this’.

“It’s important that we don’t skip those dark periods because Elliot’s statement, ‘I don’t want to live like this’, actually has two arcs to it and I think it is really courageous that Elliot has chosen the arc that he has and pruned the other one.”

The medical process towards gender affirmation for Elliot began in 2018 with an appointment at his local GP.

Amanda takes up the story.

“After Elliot came to us and said ‘I think this is who I am’, we decided the first step was to see our GP and so we said ‘this is what we think we need to do’,” Amanda explains.

“The GP wrote the referral that got us to the gender clinic and, because there were a couple of issues around trauma, they wanted to be able to define whether the dysphoria that Elliot was feeling was to do with any trauma.

“There was a long wait before a few sessions with a psychologist (gender therapist) at the Royal Children’s Hospital’s Gender Service and, when she was able to come back and say that Elliot’s dysphoria wasn’t associated with any trauma, she then made the referral to speak to Gender Service director Michelle Telfer.

“By the time somebody sees Michelle, the process is quite certain and, from there, it has moved fairly quickly.”

For Elliot, acknowledgement that his gender dysphoria had nothing to do with trauma or mental illness confirmed everything that he had believed for many years.

“It’s a very in-depth and thorough procedure (and when) I was told there were no signs of residual need for therapy in terms of gender identity, it was great to hear that from someone,” he says.

“So an appointment was booked with a gender therapist and there were a couple of consultations with her and then I was put in touch with Dr Telfer.

“She said to me, ‘what you are doing here is a fantastic thing, you are very strong, capable and confident and you know what you need. But this will be a long process and you need to understand that it will happen over years’.

“The RCH and what it offers has been a game-changer for me. It has made me feel more comfortable in myself, despite many things still needing to happen for me.

“I feel that every day, that someone automatically says I’m a guy (is great).”

Like Elliot, Amanda recalls a great sense of relief knowing there was confirmation of something Elliot had known for many years.

“One of the defining moments for me was hearing the validation of Elliot’s feelings by the psychologist,” she says.

“So you have someone highly trained, who knows what questions to ask, go through the process of validating the feelings and dysphoria and for me that was a really reassuring thing.

“Hearing that validation made me feel that they weren’t going to put us aside until we had finished whatever process we had come in to begin.

“They will talk to lots of kids who are exploring their gender without it involving the sort of process that Elliot has gone through.

“They will take everybody through the process and assist them to get to the point of recognition and understanding that the individual needs to be at.

“For Elliot, that was about beginning the gender affirmation process as he believes he is in the wrong body. For us, it’s been a process of discovering and affirming the gender that Elliot innately feels within himself.”

Will says it’s important to recognise that a green light for someone in terms of gender affirmation only comes after a huge amount of investigative work by RCH staff.

“A lot of people have this misapprehension that this all happens very quickly, but there is a huge amount of triage and processing that happens beforehand,” he says.

Elliot’s journey is continuing with gender-affirming hormones, while he is considering making a booking to consult a specialist to discuss a transgender mastectomy.

At the end of this year his treatment will shift to the RCH’s adult gender centre, located at the Royal Melbourne Hospital.

As Uniting Church Ministers, Will and Amanda have a deep faith, but it was tested at times as they tried to be present with Elliot on every step of his journey.

Perhaps, thinks Will, it was a reminder of what being a follower of Christ really means.

“It’s a very complex thing because I don’t really have anything to compare it with,” he says.

“I look at other men in similar situations and they want a fix to something like this, and what comes to mind is a song by Coldplay called Fix You, and there is something in the lyric of that song that speaks to me of the idea that every part of my being says ‘you have to fix this’, but I found that really hard and really terrifying.

“But it was my faith that said to me that this (sort of challenge) is what following Christ is all about.”

Amanda reflects on faith, friendships and the support of their respective congregations as very important in helping them deal with everything thrown at them.

“Our faith, and some really good friends, got us through,” she says.

“We made a decision at that time that we weren’t going to take this journey on our own and there would be a couple of people we would contact and say ‘it’s going to be a really tough day today and can you please pray for us’. So those people walked along this journey with us.

“I felt ill-equipped to deal with a lot of it at times and did handball a lot to Will because he had been doing a lot of work with the Defence Force and a lot of practical stuff around mental health awareness training.

“I think part of it revolved around the fact that the congregation probably didn’t understand fully what was happening, but they were just happy to accept that we were having to deal with something as parents so complex that we couldn’t even get our heads around it at that stage and we just needed them to pray for us, and that was certainly my experience.”

Support came in many forms for Will and Amanda and, for Will, a lunch he attended the day they got Elliot back from hospital remains a wonderful example of the fellowship offered by his congregation.

“We got Elliot home from hospital and he went to sleep and we were basically on suicide watch,” Will recalls.

“So it was about making sure he wasn’t going to harm himself, because the hospital had said to us, ‘this is what you do, Elliot can’t be by himself and you have to remove anything that might cause harm because we have identified factors of suicide’.

“I asked Amanda to keep a watch on Elliot and I went to a lunch that had been scheduled with some people from the congregation and sat at the table and said to them, ‘well, this is what my morning has been like’, and they had such compassion and I was blown away by it.

“We just sat there and they bought me a beer and we talked. For me, the faith aspect comes into it in the sense that I have a community I can rely on, they won’t call me weak or try and fix me.

“It’s so ironic because only recently we took Elliot to the same place as that lunch to celebrate his 18^th birthday and when we walked in I looked at the table I had sat at that day and thought ‘wow, this is how far we have come, we have come such a long way’.

“The support of the community is where the faith came from for me. There was an element of being still and knowing that God is there and how do we make sense of the universe and, likewise, knowing there is a community there that will support me no matter what is the other aspect.”

Will is adamant he could not have continued as a Minister had they been in any other church than the Uniting Church.

“I don’t think I would have survived in another church,” Will says.

“My experiences with other churches I have been involved with denominationally, particularly in Sydney, was that they had always been very hostile towards my belief systems and understanding of God.

“My relationship with other denominations has been fraught from the very beginning and I don’t think I could have survived both in ministry and faith in another denomination, other than the Uniting Church.”

Amanda, too, credits the Uniting Church with supporting her and her faith when life seemed darkest.

“The Uniting Church has left open a space for people to co-exist in terms of diversity, without putting hard and fast barriers around things,” she says.

“I have always subscribed to a very simple faith in that if I’m created in God’s image and God loves me, that is everything. That core element hasn’t altered for me.”

While their faith hasn’t wavered, there is a fundamental question that Will and Amanda have been forced to consider.

If we accept that every child is a gift from God and it is God who determines the gender, how do we reconcile it with the child who wants to change that gender?

“I didn’t need to do any reconciliation because I believe in a God who has intricately created every one of us as being so unique that we each are the expression of God within our own being,” Amanda says.

“If that expression can be as diverse as each one of us, whether it’s because of our physical appearance or ability or any of the others, then surely the same God has to extend that creativity and love to gender and sexuality as well.

“So, for me, there was no reconciliation that needed to happen and part of the preparation that came with that was that when Elliot was quite young, we had a friend who was transitioning and lived with us for a number of months.

“When that person came out to their family as female, the family actually disowned them and there were only three people who stood by them when they really needed support.

“It wasn’t just their family, it was also their church (that disowned them).”

Will takes up Amanda’s story.

“That is why they came to live with us, because no one else would even talk to them, so that meant we had seen the worst of it and knew how badly some churches and families and people can respond in these situations,” he says.

“I set my mind at the time to saying ‘I don’t care who the person is, this is not how people deserve to be treated’.

“So, whoever the person is, I’m going to love them and no matter who they are or what they do, I believe they are created in the image of God.

“I’m not going to allow my limited thoughts and my binary thinking to allow me to accept or reject someone.”

As they reflect on their journey with Elliot, one which has taken them to some of the darkest places, it is Amanda who talks of the light that lies ahead as their beautiful son makes his way in the world.

It’s a story of hope and love and faith and one she hopes might guide anyone else dealing with what Elliot has been through.

“A number of people have told us that they feel we have been very brave and courageous but, for me, I don’t feel it is bravery and courage that have done it, it is more a sense of being true to our calling,” she says.

“We have a story we can share with others about the sort of love we have been able to offer to each other and to Elliot during what has been a very challenging time.

“We can offer a positive story here (and it would be wrong) to shut it away and not share it within the world.”

Placing positives above prejudice

As Uniting Church Ministers, Will and Amanda Nicholas often see the very best qualities in people.

But as their son Elliot has undertaken the long and complex journey involving gender affirmation, they have at times seen the very worst in people.

People who, because of conservative, judgmental and narrow-minded thinking, are unable to accept that there might be a positive ending for someone who knows they have been born in the wrong body.

While it hasn’t been easy, Will and Amanda have refused to let the critics win, using their own faith and the knowledge they are on the right path to guide them.

Will admits, though, that criticism of what Elliot, and others like him are undertaking, sometimes leaves him angry.

At times, he says, some of that criticism has also come from a small minority of people within other churches.

While their own Uniting Church has been very supportive, some from other churches have been unable to see past their own prejudices.

“I do sometimes feel angry (whenever something negative is said), but not necessarily in a violent way,” says Will, who uses the Biblical story of Jesus and the temple money-changers to illustrate his feelings.

“The story of Jesus and the money-changers, for me, in a theological sense, has a deeper meaning around the church (sometimes) creating a barrier for entry to salvation, freedom and liberation,” he says.

“So Jesus disrupts the activity that is taking place in the temple and that is the kind of response I get when I’m faced with people criticising the process around gender affirmation.

“That response is one of ‘how dare people create a barrier, how dare they make a decision to edit the good news of the Gospel and the unconditional love of God, to a point where that love becomes accessible to some, but not others.

“Elliot’s story about what led up to his feelings of suicide was all about the experience of ‘I am being denied love because of who I am and how I was made and maybe I will never experience love’.

“For any church’s voice to be a part of that just makes me want to rush into the temple (like Jesus did) and turn the tables and scatter coins everywhere.”

Will says any response to an issue like Elliot’s gender affirmation needs to be framed within a social justice context.

“Churches are very good with social justice when it comes to something like the issue of starving kids in Africa, but social justice at its heart is about what it means for me here and now within my own family,” he says.

“When I can sit down and talk to people, that anger becomes grace, so I say to people, ‘do you know anyone, have you met anyone, have you sat with anyone and heard a first-hand story of someone’s journey (like Elliot)?’.

“Until you have taken the time to listen to that first-hand story, you are not qualified to pass any kind of judgment. My response (to criticism) is an anger tempered by grace.”

Amanda takes great comfort in the fact that in her heart she knows every step of the journey with Elliot has been a worthwhile, and carefully considered, one.

It’s a journey, she says, with a positive message and positive ending.

“The process that we have undertaken with Elliot has been a very well thought-out and lengthy,” she says.

“It has also been a well-supported process and I just ask people to look at the positive story around Elliot.

“It’s a positive story that I want to share widely and I have become more active in fields like social media so I can actually perform an advocacy role, so that what we are hearing is not just the negative or more conservative voices in this space.

“I want to hear the voices of those with a lived experience around this and who can share, with real authority, the way the process (around gender affirmation) works.”

Michelle offers hope

In Victoria, one woman has come to represent a beacon of hope for children like Elliot Nicholas, who know they have been born the wrong gender.

Michelle Telfer runs the Royal Children’s Hospital’s Gender Service, which offers support to children who are experiencing gender dysphoria, the medical term for “the distress that a person may experience when there is an incongruence between their gender identity and their gender assigned at birth”.

With Michelle’s role comes a fierce spotlight and often harsh criticism from some of society’s more conservative, or narrow-minded, elements, a fact she acknowledged in an episode of the ABC’s Australian Story earlier this year.

“There have always been critics and you don’t go into this area of medicine without being warned about becoming a target,” Michelle says.

“I have certainly made myself a very big target.”

For Elliot, Michelle and the hospital’s staff in general have been an enormous support during every step of his journey, and he has her back when it comes to any criticism of her.

“(What I would say to people is) have you met Dr Telfer, is she the monster that you think she is and is she manipulating kids and converting them (with) experiments?” he says.

“Have you actually had that conversation with her, because I feel that if you haven’t you don’t understand and can’t mount an argument, because you haven’t seen the whole perspective.

“If it wasn’t for the (gender affirmation) program, Dr Telfer and the RCH staff, I definitely don’t think I would be here and, while that might sound terrible to say, that is the reality.”

Michelle’s journey towards medicine began as a promising gymnast who, at the age of just 16, won a bronze medal at the 1990 Auckland Commonwealth Games.

During her time in gymnastics, Michelle met sports physicians and saw the power of what they could do, steering her towards a career as a doctor.

“I was trying to decide between doing paediatrics or psychiatry and then in paediatrics I found adolescent medicine, which is that perfect combination of paediatrics and mental health,” she told Australian Story.

“I found the place I wanted to be with adolescent medicine.”

But something happened in 2012 that represented a major turning point in her career.

“I came back from maternity leave and took this full-time job as the clinical lead of adolescent medicine at the Royal Children’s Hospital,” Michelle says.

“I was asked to take over this group of trans children and their care, and I jumped at it.

“I had never met a trans child before I started this job, and one of the first children I saw was a young boy called Oliver.

“I said to Oliver, ‘how do you know you are a boy, when did you start thinking of yourself as a boy?’.

“And he was 10 at the time when he told me his story.”

Oliver says that any time he had a birthday or someone asked him what his three wishes would be, he would always wish that he could be a boy.

“It was such a beautiful story and I thought to myself, ‘I can help this child have a boy’s body’,” Michelle says.

“How many people can do that?”

In 2019, there were 336 referrals to the Gender Service and that number had grown to 473 just 12 months later.

However, Michelle says more than 20 per cent of the hundreds of children who come to them never go beyond that first assessment.

“We have helped them to understand that it is OK to have behaviours that are not consistent with what we would expect stereotypically of being a boy or girl,” she says.

“But that doesn’t mean that they are trans.”

For someone like Elliot, the journey towards gender affirmation through the RCH is a long and supportive one.

“For those who do feel that medical affirmation is necessary for them, they will see a mental health person, either a psychologist or psychiatrist, at least three times before they see anyone like a paediatrician or endocrinologist, who might start to consider whether medication is going to be something that will help them,” Michelle says.

“So the time taken from referral to seeing a paediatrician is about two years.”

Michelle says long-term regret rates for those who have transitioned are very small, about 0.5 per cent.

“So if you are to avoid providing care to everyone to try and get that regret rate down to zero, it means that you are denying 99.95 per cent of all people who come to you the benefits of treatment,” she says.

As the public face of the RCH’s Gender Service, Michelle has been the target of regular attacks in the media, with News Corp, and its daily newspaper The Australian, leading the charge.

“From August 2019 to now, The Australian has written nearly 50 articles about me and my work,” Michelle says.

“The newspaper is inferring that clinicians like me are harming children, that it is experimental and the care is novel and that (the children) are potentially mentally ill and not really trans.

“One of their criticisms is that they can’t provide a balanced story because I haven’t engaged with them, but I feel very strongly that it is certainly not in the best interests of some of my patients to engage with the newspaper.

“They certainly weren’t using published and peer-reviewed evidence to balance out their articles (and) I felt that they were never going to give me a fair hearing.”

Michelle says there is a risk involved if nothing is done to support a child seeking gender affirmation.

“When the short-term risk of not providing care is severe depression and anxiety, self-harm and young people attempting suicide, we know that we can’t do nothing,” she says.

“Doing nothing is actually exposing young people to the risk of harm. Society has for hundreds and hundreds of years tried to ignore and dismiss trans people but now, that we are affirming them, look at what they can do.”

Speaking from experience

While Elliot Nicholas isn’t sure what career path awaits him, he is certain of one thing.

The Newcomb Secondary College Year 12 student intends to be a strong voice for those people often marginalised or left behind in society.

And not just a voice, but a loud and persistent one, as he campaigns with heart and head for a better deal for the LGBT+ community.

He is proud to say his name loudly, not his birth name, but the one that gives him strength and suits him best.

“Before I came out, I made a list of first names and middle names that I wanted to change to,” Elliot says.

“I then sent a photo of my face and the list of names to my closest friends and the most popular response was Elliot.

“I liked it too, so I chose Elliot for the first name and Tiberius for the middle name, as my birth name was originally a character from a Star Trek TV show, so I kept the nerdy inside joke and used Captain Kirk’s middle name, which is also Tiberius.”

The 18-year-old is already making a significant mark as a spokesman within his school and the wider community, as a vice-captain at the college and in his role as Greater Geelong Junior Mayor, as part of the city’s youth council.

Elliot is also a member of Geelong-based gender group GASP, which has been operating since 1996.

Under the theme of ‘As you are … as you want to be’, GASP is a safe and inclusive space for same-sex attracted, transgender, gender diverse, and intersex young people aged between 12-25 who live, study, or work in the Geelong region.

“During the years, I’ve noticed that my friends have grown more accustomed to my identity and have even become more accepting of the community as a whole,” Elliot says.

“In terms of a supporting community, I visit GASP and have benefited heavily from it.”

Royal Children’s Hospital’s Dr Michelle Telfer believes Elliot can be a positive spokesman for those like him tackling gender transition.

“What we have seen with Elliot over the past year is this thriving young man who has been incredibly positive in terms of influencing his own community,” Michelle told the ABC’s Australian Story earlier this year.

It’s a role and responsibility Elliot is more than keen to take up.

“(Making a difference) is why I have been trying to be as loud as I possibly can, that’s why I’m talking to you and was part of the Australian Story episode and am part of the Geelong youth council,” Elliot says.

“I am trying to show people who might disagree and say that ‘all this (gender affirmation) is wrong and you are being cruel to children’, that (without this) intervention my life was terrible, but now it is better than it has ever been because I have had all of these people supporting me and this program at the Royal Children’s Hospital in place for me.”

And it is people’s perceptions that Elliot knows need to change if progress is going to be made.

“We still live in a society where being transgender or gender fluid or non-conforming is considered alien and strange,” he says.

“I really want to get through to people that gender is not just about male and female, it’s anything and everything.

“I feel that if you haven’t met someone who has gone through these issues, you can’t know (what they have had to deal with).”

Most of all, Elliot is excited about a future that has endless possibilities around creating a better world for our youth.

“I’m really excited because during my time on the youth council one of the things we have been heading towards with the Geelong Council is creating a youth-dedicated space,” he says.

“I see part of that space as consisting of different areas that can accommodate different denominations of people.

“You might have Aboriginal and Torres Strait Islander people, LGBT+ people and people of different religions, as well as international students (feeling welcome in this space).

“I have always felt there is a need to advocate for LGBT+ people and their rights, especially those of children, both worldwide and within Australia.”

And, who knows, perhaps a political career beckons for Elliot.

“I definitely have a lot of passions and there are many things that I want to do,” he says.

“Next year, I plan to have a bit of a break, but there will be plenty of campaigning, including with the local Labor Party, because I’m really getting behind (what they represent).”