Seattle Children's hospital opened one of the first clinics for transgender kids in the state nearly a year ago, and now hundreds of patients from multiple states are seeking its services.
For many kids like Michael Hefferan, the Gender Clinic has opened the door to a new life.
"It was about ninth grade that I came out to everyone at school with my family," Hefferan said.
The 17-year-old remembers hearing about a doctor at Children's who treats trans teenagers and demanded to see him.
"I was pretty much like, 'We need to schedule this as soon as we can. I don't care if it's on my birthday. We need to go in and we need to meet him,'" he said laughing.
Now more than 10 appointments in, Hefferan is here on a Tuesday for a routine checkup.
A nurse takes his vitals, checks his height, weight, and his blood pressure. As part of his transition, the Bothell High School student has been on hormone replacement therapy.
"My voice has gotten a lot deeper," Hefferan said. "I've grown some facial hair. I guess I feel more masculine in my body. I don't know how or why, but I do."
He keeps his medication in a plastic box. A syringe, a notebook where he keeps track of all his injections, his small bottles of testosterone, and band-aids. He administers the shots to himself once every two weeks.
"I just do it right in my stomach, an inch away from the belly button," he said.
This doctor's visit will help determine how the hormone therapy is working.
The appointment is mostly an open dialogue between doctor and patient. Dr. David Breland, who heads up the Gender Clinic at Seattle Children's, asks Hefferan how he's feeling, checking in on Hefferan's physical and emotional health.
"Are you dating anyone?" Breland asked.
"No," the teen answered.
The doctor also checks on the impact of the testosterone. Hefferan said he's been noticing facial hair. Breland notes his patient doesn't seem to have any acne.
Hefferan's mom has witnessed dramatic changes in his mood.
"He is so much happier," said Rayna Hefferan. "He's not as mad or as angry at times as he used to be."
Happiness is the goal, according to the clinic's director, and to have the outcome of the particular hormone.
"For testosterone, a lot of my patients want a deeper voice, they want some hair, they want more muscle mass, etc.," said Breland. "And a lot of my patients want to be as 'stealth' as possible. They want to be in the community and perceived as that gender."
"My chest is one of the things that make me most uncomfortable with my body," said Hefferan.
He now binds his chest, a technique used to minimize the appearance of a person's breasts.
"Top surgery is something I've always really wanted from the beginning," said Hefferan. "Just because I bind every day and it's not always the most comfortable."
Seattle Children's does not offer surgeries but provides referrals. For Hefferan, the procedure is on the horizon.
For now, Breland tells him to stay on the same dosage of testosterone, as they wait for his blood test results.
Hefferan is thankful to have a clinic who treats his true self.
"It's really important for the younger kids who come here to have that affirmation that you're okay," he said. "That there is nothing wrong with you for not feeling comfortable with the gender you were assigned when you were born."
Each patient goes through a mental health readiness assessment before starting treatment.
The Gender Clinic now has 250 active patients and hundreds more inquiring about treatment.