The California wildfires were still raging last fall as Jennifer Bilstein and her 15-year-old son inched their way down Highway 101, a two-hour drive in ordinary times that took four hours through the smoke-filled air and yellow sky. She was determined to get Jacob to his doctor's appointment on time.

It was his second visit to the adolescent gender clinic, where Jacob — a shy boy with pink cheeks, a cowlick and black oversize glasses — was being medically evaluated to begin taking testosterone.

He had already gone through puberty as a girl, an experience that made him conclude he had been born into the wrong gender. "I was always uncomfortable calling myself 'she' or 'her,' " he explained. "It made my skin crawl."

At 13, Jacob — then called Samantha — had informed his mother, sending her the news in a Facebook message after being dropped off at school one morning in Ukiah, one of Northern California's iconic hippie towns.

Now, the two sat in an examination room at the University of California at San Francisco, or UCSF, as Jennifer Bilstein signed her name to a seemingly endless succession of medical forms. Bilstein acknowledged that she initially had trouble accepting the news.

"I didn't understand the words coming out of my child's mouth," she said. "To raise a beautiful daughter to 13 and then have her tell me she's a boy . . . "

As she spoke, her child studied his hands, legs swinging back and forth under the examining table. "But the reality is that Jacob's my child, and regardless of gender or whatever, my child always comes first in my life," she said. "And realistically, it's not about me. It's about Jake."

As they navigate the rough shoals of the trans life, the Bilsteins are putting their hopes in the Child and Adolescent Gender Center at UCSF. Founded in 2012, it is one of 40 or so such clinics around the country, seeing patients as young as 3 and as old as 25.

It is also one of the busiest, encompassing four disciplines: medical, mental health, patient advocacy and legal services. Although surgery is not available at the center, its clinicians maintain close ties with local surgeons to whom they refer patients upon request. Read more via Washington Post