Atom Edwards is a high-school junior who carries himself with a confidence that not all his peers possess. The youngest of four siblings, he has a lanky frame and a hi-top fade that lightens at the tips like icing on a cupcake. He makes A’s and B’s; plays guitar, piano, and saxophone; and sits on the Teen Council at Duke’s Nasher Museum of Art. He counts his friends by the dozen.
Atom inhabits his seventeen-year-old body with grace, but it’s a hard-earned grace. Assigned female at birth, he rejected, early on, every marker of femininity. When he was five, his parents walked into the living room and found him with scissors in his hand and thick hair scattered at his feet. “He had a stoic look on his face,” says his father, Derlvyn, a mill worker. “It reminded me of that scene from X-Men when the little boy went in the bathroom and cut his wings off because they said he was a mutant, and there were feathers all over the floor.”
When he was younger, Atom clung to his older brother, favoring him over their sisters. He wanted to look like his brother, learn karate together, and play the same Dragon Ball Z video games. By seven, he refused to wear dresses. “No big deal,” recalls his mother, Delores, a state employee. “I didn’t wear dresses. I grew up as a tomboy, so I was cool with it.”
What did concern Delores was that her youngest child was a loner. “All the [other] kids had little friends that they would stay over and spend the night with,” she says. “Atom never had friends.” She knew he was different. But she didn’t know how.
“I think you were in denial,” Derlvyn tells Delores.
“I was in denial,” she agrees.
Atom, for his part, was muscling through big questions. “In sixth grade, I had a little sit-down chat with myself,” he says. “Am I gay? Am I straight? I was trying to understand myself better.” There was something about his identity he couldn’t quite discern, and it went beyond his penchant for thrift-store neckties: “Everyone else, it seemed, knew themselves.”
During his freshman year at Hillside High School in Durham, Atom figured it out: He was a boy. By then he was no longer solitary. He had joined theater and the marching band, and he was expressing himself through visual art and photography. Toward the end of that year, he began telling classmates he was transgender and asking them to use his new name and male pronouns. The reactions were uneven, he says: “It was a mixture of students who were really accepting and students who were very shunful, or students who didn’t know how to feel.”
The next step, Atom believed, was aligning his body with the new identity he was carving out. In March 2016, shortly after he turned fifteen, he and Delores met with their family physician, who gave them a referral. That’s how he found his way, a few months later, to the Duke Child and Adolescent Gender Care clinic and its pediatric endocrinologist, Deanna Adkins.
Pediatric endocrinologist Deanna Adkins co-founded the Duke Child and Adolescent Gender Care clinic.
Adkins, at the time, was still relatively new to transgender medicine. In 2014, while working at Duke, she had received a call from a fellow endocrinologist in New York. “I have this patient,” she recalls him saying. “They’re from Chapel Hill. They are coming to see me for potential hormonal transition. I would really like to refer them to someone closer to home. Do you think this is something you could do?”
Adkins had grown up surrounded by medical culture. Her single mother was the chief financial officer at a hospital, and young Deanna spent a lot of time at that workplace. “I kind of lived there,” she says. “We ate meals there. I got used to that environment.” Still, when she entered Georgia Tech, Adkins followed her friends into engineering instead.
As part of her studies, Adkins worked at a chemical plant—a disillusioning experience, she says. “Some of the women in the plant had bloodwork done every so often to look at their lead levels. They had to make sure they didn’t get pregnant. I was beginning to think, ‘I’m not sure this is the environment I want to spend the rest of my life in.’ ”
She shifted her focus to medicine, a return to her family roots. At the Medical College of Georgia, she realized that endocrinology suited her temperament. “The engineer in me was like, ‘Oh, look. You increase this hormone and that hormone goes up,’ ” she says. “It all fit together in little puzzle pieces.”
Adkins arrived at Duke in 2004 as a clinical instructor. She has worked with hormones ever since, treating children with a wide range of disorders. But when the New York doctor called, she had never used hormones to help patients conform their physical traits to their gender identities. (This is called gender-affirming therapy.) “I don’t really understand it,” she told her colleague. “I don’t know how to do it. They didn’t teach me that.” During medical school in the 1990s, Adkins had learned about gender dysphoria, the stress some people feel when their assigned gender conflicts with their experienced one. But treating transgender youth was a new arena in the United States, and she had not kept up with the literature.