The baseballs slammed into the child’s glove like an assault on her soul.

Megan Garcia had been born into a boy’s body in a traditional Cuban family in 1962. Her parents fled Cuba in 1964, soon after the Castro revolution and the frightening Cuban missile crisis. The family moved to Mexico, an equally conservative country, where roles for men and women were sharply divided.

Megan always felt different, like there was a pebble stuck in her shoe. From the time she was in elementary school, she gazed longingly at flouncy, forbidden dresses and innately knew that something was off. She felt the pebble every single day but couldn’t shake it loose.

Her dad seemed to sense something was wrong. His solution was to try to pound masculinity into Megan. He’d take her out to throw baseballs. He loved the sport. She didn’t. Instead of a bonding experience, games of catch hurt Megan physically and emotionally.

“He was trying to make me a man. He had a great arm. He would throw the ball at me hard. I was really scared,” Megan said.

She was equally scared that someone might find out that instead of playing baseball, she longed to wear dresses and get her nails done.

As a child, she knew that one of her mom’s friends who struggled with mental health challenges had been sent to an insane asylum and received electric shock therapy. If anyone found out she wasn’t a boy, she feared she’d be next.

As a teen, Megan tried playing baseball.

“I wasn’t very good at it,” she said.

She found she liked running and has completed 14 marathons.

“I’m not competitive. I like the health aspect of it,” she said.

At age 18, she moved from Mexico to Miami, where Cuban machismo still dominated the culture.

As women passed in colorful outfits in the streets, Megan found herself wanting to dress like them not to date them.

“A male would be looking at the woman. I’d be thinking, ‘Oh, what a beautiful dress. Her shoes are awesome.’ Your mind doesn’t rest. It doesn’t go away.”

Even so, she did all she could to fit in.

“You behave like you’re supposed to,” Megan said. “You get very good at pretending.”

At age 25, still appearing male to the world around her, Megan married a woman in a traditional Catholic wedding. Soon the couple had two children, whom Megan adored.

But at age 30, she could no longer bear submerging her true self. She thought her wife might understand. But, just as she feared, when Megan began to reveal the truth about her gender identity, her world blew up. She suffered devastating shame and lost her entire community of friends and family, along with thousands of dollars spent fighting for shared custody of the couple’s children.

Lonely and distraught, Megan stuffed her femininity back into hiding for decades. She lived as if she were male and moved away from Miami.

“I had to make a choice. If I stayed, I was going to die,” she said.

Eventually, she settled in Colorado.

Medical care and a supportive community offering transgender help

Finally, in February of 2020, just before the pandemic rocked the world, Megan happened to learn about the UCHealth Integrated Transgender Program at the University of Colorado Hospital. She researched their award-winning interdisciplinary care and felt a jolt of hope.

“Oh my God,” she thought to herself.

“I suddenly felt empowered. I might not have to hide anymore.”

An accountant, Megan was working at the time at the University of Colorado in Boulder. She researched her rights and benefits as an employee and learned that both the university and the state of Colorado protect people from discrimination based on gender identity.

“The next day, I walked into my boss’ office and said, ‘I feel this way. I would like to start expressing myself as myself.’”

Megan received a warm response.

“From all I’ve heard, people who do that are happier at work,” her boss responded.

She had the green light to begin transitioning. (The Ludeman Family Center for Women’s Health Research at the University of Colorado Anschutz Medical Campus first shared a story about Megan’s journey in 2021. Read the Ludeman Center’s story about Megan.)

The relief was overwhelming.

“You feel there’s no shame. You can finally be you. When I was reading about the clinic’s offerings and services, I thought, ‘Oh my goodness. I can take off the shoe. I can take out that rock.’”

Within days, Megan started wearing women’s clothes to work, although she still didn’t own a wig.

“You take it step by step,” said Megan, now 60.

She began seeing a therapist, and in an ironic twist, as the pandemic was forcing businesses and countries around the globe to shut down, Megan’s world opened up.

She became a patient at the transgender program, where she found stellar medical care, a new community and a warm embrace. Even with forced closures that prevented in-person visits during the spring of 2020, Megan was able to quickly connect with endocrinologist, Dr. Sean Iwamoto, and started taking testosterone blockers and estrogen.

She was thrilled.

“It just frees you up and takes a big weight off of your back,” Megan said as tears welled in her eyes. “You start flourishing. The last three years have been the best of my life.”

Colorado transgender program unique in U.S.: Patients can see multiple providers per visit for one co-pay.

The Colorado program is unique among national clinics for transgender patients.

That’s because patients are at the center of the care model. Other programs might offer a variety of specialists who can care for transgender patients. But at the UCHealth program, a patient can come for a single in-person visit (or online appointment) and see multiple providers on the same day for a single co-pay. The experts range from endocrinologists to internal medicine doctors to gynecologists, psychiatrists, psychologists, surgeons and social workers.

“It’s very powerful,” Iwamoto said of the interdisciplinary care model. “In other places, patients might see an endocrinologist or a primary care provider, then have questions about surgeries, then have to wait weeks or months. Then they might need a behavioral health provider and have to wait weeks again. You’re having to go all over the place for gender-affirming care.”

In Colorado, patients can see all of the specialists they need in a single day. And they can feel fully supported during their visits.

For someone like Megan — who once appeared to be male — visiting a gynecologist’s office could have been uncomfortable.

At the integrated clinic, anyone at any stage of their transition is welcome. The setting is gender neutral and the high quality care is seamless.

Dr. Micol Rothman and colleagues from various specialties co-founded the clinic in 2017.

“Transgender health is an area of medicine where a team approach is crucial. During transition, there are so many things going on: hormonal, psychological and dermatological, for example,” said Rothman, who is a professor of endocrinology at the University of Colorado School of Medicine on the Anschutz Medical Campus and serves as medical director of the program.

“Having everyone on one team thinking about challenges together is key.”

Services at the clinic include these resources for transgender people:

• Gender-affirming hormone therapy
• Primary care
• Behavioral health care
• Sexual health and screening for sexually-transmitted infections
• Surgical and dermatologic care
• Fertility preservation

Transgender program provides medical care, research, education and community engagement

Since the program launched, the experts have worked to become leaders in the field so they can provide knowledge and best practices to providers around the U.S. and the world.

Clinical care is central to the program’s mission and a vital component of gender diversity programs at the University of Colorado School of Medicine. Three additional pillars guide providers at the transgender program. Altogether, the four pillars are:

• Clinical care
• Research
• Education
• Community engagement and advocacy

Video appointments, which expanded dramatically by necessity during the pandemic, have been popular with patients. No-show rates dropped significantly. Being able to see a provider online removed barriers for some patients. The clinic is serving people from communities across Colorado.

“We’re seeing patients from places like Pueblo and the Western Slope. Video appointments have been a lifesaver for people who are unable to drive all the way to Aurora or prefer to skip a long trip,” said Iwamoto.

“We’ve all been surprised by how quickly our program has grown. The program is an important part of the community. This is lifesaving care,” Iwamoto said. “Many of our patients tell us, ‘I didn’t think I’d be able to survive. Thank you for being there during my darkest days.’”

Along with his work as a clinician, Iwamoto also is an assistant professor of endocrinology at the University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center. He’s also a scholar for Building Interdisciplinary Research Careers in Women’s Health, a program of the National Institutes of Health. Multiple entities fund his research including: the Ludeman Family Center for Women’s Health Research, the Colorado Nutrition Obesity Research Center and the Colorado Clinical and Translational Sciences Institute.

One of the issues Iwamoto is studying is the impact of hormones on cardiovascular health.

“Cardiovascular disease is higher in the trans community, particularly among transfeminine groups when compared to the general population,” Iwamoto said.

The question is whether hormone treatments increase cardiovascular risk. Iwamoto theorizes that cardiovascular disease risk already may be higher among people in the transgender community due to other causes like gender minority stress and barriers to accessing affirming health care and routine screenings.

“We don’t want to deny care to patients. We are trying to identify risks and learn what we can do to mitigate them so people can receive lifesaving and affirming hormonal therapies while decreasing cardiovascular risks,” Iwamoto said. “Working with, not on, the transgender and gender diverse community is really important.”

Transgender program gave her courage and confidence ‘to be who I always was’

Iwamoto became an expert on transgender care by chance. Before and during medical school, Iwamoto, who is gay, volunteered for The Trevor Project, a suicide prevention and mental health program for young LGBTQ people.

During his residency in San Francisco, he cared for his first transgender patient as a primary care provider. Later, as he applied for fellowship programs, he looked for mentors who would support his interest in caring for additional transgender and gender diverse patients like Megan — and found himself at home at University of Colorado’s Division of Endocrinology, Metabolism and Diabetes.

Watching Megan and other patients blossom has been extraordinarily gratifying, Iwamoto said.

“She’s so confident in who she is. Her care has empowered her to lead a full, meaningful and impactful life,” Iwamoto said.

He finds that’s often the case. Many patients not only do well physically and emotionally. They also start thriving in other areas of life.

Megan is a textbook example. She has continued to grow professionally. She now works for the Colorado Governor’s Office of Information Technology. Along with managing her transition and full-time work during the pandemic, she also earned a second master’s degree in information science. Her previous master’s is in accounting.

“I have concentrated on building myself,” she said. ‘I feel empowered being myself. The clinic gave me the confidence to be who I always was.”

On top of work, Megan enjoys doing Zumba classes, traveling and spending time with close friends and her three beloved dogs: Oliver, Olivia and Lila. They are King Charles and poodle mixes.

“I love them. They’re my babies,” Megan said.

She also serves on the community advisory board for the UCHealth Integrated Transgender Program and volunteers as a study participant for Iwamoto’s research.

She has completed her bottom surgery and is looking forward to having top surgery soon.

While the physical challenges of transitioning are profound, Megan has been incredibly grateful for the support she has received from friends and doctors alike.

Christina New is a clinical psychologist with the transgender program who has provided excellent support for Megan throughout her transition.

Anti-trans politicians make a big deal about bathrooms and sports teams.

Megan said there are far more significant issues to face, and New has helped her cope with many mental health challenges.

“You always live in fear. Your body has the wrong equipment,” said Megan, who years ago was viciously attacked and punched in the face by a stranger at a Walmart store in Rifle, Colorado.

She suffered a suborbital fracture of the left eye but recovered over time and worked hard to ensure that her attacker faced prosecution and time behind bars.

While she has encountered more supportive people in recent years, the physical challenges of transitioning are painful and demanding.

“Surgeries really kick your butt,” Megan said. “Regardless of what I have been going through, the team has been there to offer kind support.”

Sometimes she’d dare to be herself and play the ‘Superman game’

For decades, Megan tried to resist her heart’s pull toward femininity.

“In the Cuban and Mexican cultures, there’s a lot of pressure to be ‘normal.’ You feel shame about all of your feelings and who you are. You feel like you should be able to fight your feelings and put them aside,” she said.

She felt most free when she played what she called “the Superman game.”

Sometimes, as a younger person, she’d take a big risk and would buy some female clothes.

“You’d have it all hidden and wait until everybody left. Then when you were brave enough, you’d go out dressed up like a woman. You’d be afraid that the police would stop you and you might go to jail. But you can’t help it. You’d make an appointment, and get your nails done.

“Then it would be such a waste of money. You’d have to get rid of all of the evidence,” Megan recalled. “You wanted so much to express yourself. You’d have one night out, then feel so much shame.”

Religious traditions add another layer of complexity. Megan was raised Catholic and felt pressure from the church to be a traditional male.

Interestingly, now that she is moving through her transition, she goes to Mass at a Catholic church and never has suffered disapproval from fellow parishioners.

While attacks on transgender people have escalated nationally, Megan mostly feels a cocoon of support in the Denver metro area.

One of her role models is the actor Laverne Cox, a trans woman who became famous through the Netflix show, Orange Is the New Black.

Cox is fond of saying that it’s “revolutionary for transgender people to be seen.”

Adds Megan: “You cannot cancel the existence of someone who refuses to hide. That’s why I share my story, and why I live my life openly now.”

Among other roles at work, Megan leads a group for LGBTQ people.

“I share my story at work. People are always very positive. They tell me that they understand people like me a lot better,” she said.

Integrated Transgender Program: Safe place for a difficult journey

While Megan knows her life would have been much easier had she simply been born into a female body, she’s proudly embracing her role as a transgender spokeswoman.

“I don’t want anyone else to go through what I’ve gone through. All we need is a little more awareness and a little less politics of fear,” she said.

“So many people feel they have to hide. I want them to know that they don’t need to be afraid,” Megan said.

The Integrated Transgender Program is unique and special, she said.

“It’s a safe place where you can do difficult work,” Megan said.

Transitioning is far more complex than simply seeing a surgeon who will “slap breasts on you.”

“You need a specialized place. If you have cancer, you go to a cancer center. If you break a leg, you go to a bone doctor. If you are a woman stuck in a man’s body, you need a place where you can go to get that rock out of your shoe,” Megan said.

Being born in the wrong body has cost Megan dearly.

“My mother is alive and doesn’t want to have anything to do with me,” she said.

Megan tries to stay close with her children, but strong cultural and family forces drive a wedge in relationships.

Thankfully, Megan has built strong bonds with many other people, including her doctors.

Said Megan: “They are a family to me.”