Zahra Cooper speaks to the Herald about her three-year journey.
From girl to boy and back again - a young woman has reversed her decision to become a male in what is believed to be one of the few cases of transgender "detransition" in New Zealand.
Zahra Cooper, 21, spent almost a year on testosterone treatment and had been livingas a man for three years when she decided to go back the gender assigned to her at birth.
It was a harrowing journey that led through anger, depression and attempted suicide, but one she has decided to share to raise awareness of the complicated nature of gender.
"At first I came out as lesbian but then I realised I was transgender," she says.
At age 18, she asked people to start referring to her by a male name and pronouns. Age 20, she went on an eight-month wait list to see a specialist, and then was prescribed testosterone - and began what is known as a "medical transition".
"I was getting a deeper voice, facial hair, and many other changes but I just wasn't happy with them," she says. "I didn't feel like myself."
After much soul-searching, which included an Asperger's Syndrome diagnosis, and huge support from her grandfather and transgender boyfriend, Zahra decided to stop the drugs and is now living as a woman again.
However she says she will never be a "girly girl", and that for many people, gender isn't a binary concept.
She also wants to ensure her story is not used by those who are anti-transgender.
"There's people out there who think it's just a phase. But it's not. It may have been for me but it isn't for someone else. Everyone is different."
Around 1.2 per cent of young people in New Zealand are thought to be transgender, although with the increasing social acceptance of gender diversity that number is expected to grow as more young people come out earlier.
International figures put those who detransition at just 1 per cent.
Auckland sexual health specialist Dr Rick Franklin, one of the country's transgender experts, says Zahra's case is incredibly rare.
"In hundreds of patients I can only remember two. Occasionally it will happen, even with the very best provision of service, although it does happen more frequently when pathways are not followed," Franklin says.
Zahra Cooper and Victor Rakich (Poppa). Photo / Michael Craig
Guidelines used by the Auckland health boards required patients to see a mental health expert before having a specialist appointment, and recommended a follow-up with a specialist every six months.
They also advised extra caution for those transitioning to male, as many of the effects of testosterone - such as a deeper voice and fertility changes - were irreversible.
However the guidelines were not hard and fast rules, and successive studies have found large variation in how transgender patients are treated within New Zealand - particularly in rural areas.
Zahra and her family have raised questions about the care she received during her transition - she only saw her endocrinologist once in nine months, and was able to quit counselling of her own volition. She was told she would have had better access to care if she lived in a main centre.
Northland District Health board say her care was satisfactory, and that Zahra was seeing her GP for follow-ups, if not the endocrinologist. They said they had visiting clinics to Kaitaia and enough resources to work with complicated cases like Zahra.
Agender New Zealand president Tracee said it was pushing for more consistency nationwide, but there had been little progress because being trans was seen by man factions as a "choice".
"That's unfair because they're not trans by choice, it's a biological drive. That's where it can become really really cruel," they said.
Dr Theresa Fleming, an adolescent health researcher at the University of Auckland said those struggling with complex gender identity needed a more holistic model - rather than being shunted between specialists.
"Historically lots of services have been based around people that are already sure. But sometimes young people are just wondering," she said. "They need someone who understands adolescence and gender identity and mental health - not a specialist but a generalist who can talk to them. They need information."
Where to get help:
• Lifeline: 0800 543 354 (available 24/7) • Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7) • Youthline: 0800 376 633 • Kidsline: 0800 543 754 (available 24/7) • Whatsup: 0800 942 8787 (1pm to 11pm) • Depression helpline: 0800 111 757 (available 24/7) • Rainbow Youth: (09) 376 4155 • Samaritans 0800 726 666 • If it is an emergency and you feel like you or someone else is at risk, call 111. • For transgender support: Outline: 0800 688 5463 ry.org.nz agender.org.nz
