It was a gray morning in late October—just ten days before the country’s fourth-largest city would vote on the landmark Houston Equal Rights Ordinance—and Hurricane Patricia, the most intense cyclone ever recorded in the Western Hemisphere, was roiling through Mexico. Already, at 8:30 a.m., the air in Houston was on the verge of a tantrum. But at the fifth-annual Gender Infinity Conference, no one seemed to notice.

More than two hundred medical providers, advocates, teachers, and parents—a mix of suit-clad professionals, millennials with hard-edged haircuts, and earnest T-shirt-and-jeans types—greeted each other as they entered the bamboo-ensconced Council on Recovery, just off Memorial Drive. They had come from all over Texas and beyond to network and attend panels ranging from “Gender 101” to “Know Your Rights: Transgender Youth and the Law.” At the welcome table, registrants were each asked to select a big, round, purple pronoun sticker. The choices were many: “She, Her, Hers”; “He, His, Him”; “They, Them, Theirs”; “Ze, Hir, Hirs”; “Any & All.” Houston judge Phyllis Randolph Frye—a statuesque, gray-haired woman in a sage blouse and dark slacks, and the country’s first openly transgender judge—quipped, “I’m a she, but my preferred pronouns are ‘Judge’ and ‘Your Honor.’”

The optimism in the room was palpable, in large part because 2015 had been a banner year for transgender visibility. Caitlyn Jenner came out as a woman, posing in a white corset on the cover of Vanity Fair. TLC premiered a reality show following the Florida trans teen Jazz Jennings. Amazon’s Transparent, about a family adjusting to their AARP-card-carrying father’s metamorphosis into a woman, won a Golden Globe for best TV series. These sweeping changes weren’t limited to popular culture; across the nation, great strides were made in what is now widely seen as the next civil rights frontier. The U.S. military dropped its transgender ban, allowing trans men and women to openly serve in the armed forces; Medicaid began covering gender-reassignment surgery; and President Barack Obama called for an end to conversion therapy, the dreadfully unsuccessful practice of trying to “repair” gay, lesbian, and transgender youth. After decades of living on the margins—ridiculed, rejected, and disproportionately targeted in hate crimes—trans people had, in just a few years, achieved the unthinkable: increased social acceptance, and even respect.

But in Houston, with the Houston Equal Rights Ordinance headed to the polls, transgender rights had reached a flashpoint. HERO would explicitly forbid discrimination in housing, employment, and public accommodations on the basis of not only race, age, religion, and disability but also sexual orientation and, notably, gender identity. The city council, led by Annise Parker, then Houston’s third-term mayor and the first openly gay mayor of a major U.S. city, had, in fact, passed the measure in May 2014. Similar laws were already on the books in Dallas, Fort Worth, Austin, and San Antonio. But the city’s evangelicals had risen up against the ordinance and succeeded, with the help of the Texas Supreme Court, in having the matter put to a referendum. An ugly battle for public opinion had ensued, with opponents claiming that the measure would allow men to enter ladies’ restrooms by masquerading as women. Sinister black and white TV commercials aired depicting a man lying in wait in a public restroom for a ponytailed schoolgirl. The ads, and widespread opposition by religious conservatives, changed the debate from one about equal rights to one about protecting women and children from sexual predators. After a year of progress, the vote on HERO had come to feel like a referendum on being transgender.

Houston mayor Annise Parker speaks to HERO supporters on Election Day, November 3, 2015.
Houston mayor Annise Parker speaks to HERO supporters on Election Day, November 3, 2015.

At Gender Infinity—the largest such conference in the South—the consensus was that Houstonians would not be swayed by fearmongering, and that HERO would be upheld.  Taped over the men’s and women’s restroom markers were signs bearing purple infinity symbols and the words “This bathroom is for everyone.” In attendance were some of the country’s leading trans experts: Oakland-based psychologist Diane Ehrensaft, the author of Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children, and Jo Olson-Kennedy, the medical director of the Center for Transyouth Health and Development, the country’s largest such program, at Children’s Hospital Los Angeles. Plastic surgeon Peter Raphael had driven in from Plano, where every year he performs more than 150 “top surgeries,” or mastectomies for trans men. An admirer of his, a Houston medical practitioner, approached him in the courtyard to discuss the intricacies of gender-reassignment surgery. As they spoke, the event photographer, a grateful former patient, called out, “I love you, Dr. Raphael!”

Colt lectures at the Gender Infinity Conference in Houston on October 23, 2015.
Colt lectures at the Gender Infinity Conference in Houston on October 23, 2015.

But the luminary whom everyone was most eager to see was one of Gender Infinity’s founders, Colt Keo-Meier, a clinical psychologist and Texas’s preeminent researcher on transgender issues. At 9 a.m., registrants crammed in shoulder-to-shoulder to watch his presentation, “Development of Gender Identity and Sexual Orientation,” until some had to be turned away. Just 32 years old, Colt was the first researcher in the country to demonstrate the psychological effects of testosterone therapy in trans men over time, and his findings had informed the American Psychological Association’s first guidelines for the clinical care of transgender patients. Wearing slacks and the purple button-down shirt that had become something of his signature, he took in the crowd with his sea-colored eyes and smiled. Then he proceeded to explain the difference between sex (one’s anatomy), gender identity (one’s perception of one’s male or femaleness), gender expression (how one outwardly presents oneself through clothes and body language), and sexual orientation (whom one is attracted to). It was a talk he had given at countless hospitals and medical organizations in Texas and across the country.

Over the course of the day, Colt greeted surgeons and psychologists, ob-gyns and general practitioners, lawyers and community activists, answering questions and often responding with an encouraging “Riiight!? ” By virtue of the fact that he wears so many hats—he currently teaches at Baylor College of Medicine, Southern Methodist University, and the University of Houston, where he runs the Transgender Health Lab—he knows a wide cross-section of the trans community. But despite his stature in his field, Gender Infinity remains a homegrown labor of love. When ten-year-old keynote speaker Alex Bryson performed his viral rap about coming out as a trans boy, it was Colt who was standing in the sound booth, holding up his fingers to indicate how many minutes the tween had left.

For Colt, the most poignant moment of the conference came after Alex finished singing. As the boy, who was flanked onstage by several family members, took questions, a singular female voice rose up from the right side of the room. “I’m a woman four generations older than you,” Judge Frye began, turning heads. Colt bolted out of the sound booth so as not to miss a word. He was familiar with her story: As an Eagle Scout, Texas A&M cadet, and Army lieutenant, Frye had secretly longed to be a woman. After failed attempts to “correct” her gender identity with drugs, hypnosis, and aversion therapy (during which she was induced to vomit while holding women’s underwear), she had been forced to resign from the military, fired from several engineering jobs, and separated from her son. “I love who you are,” Frye said, looking at Alex. Then she turned to his family.“Most trans people of my generation lost our parents and siblings. We were tossed out. We were thrown away. So I wanted from the bottom of my heart to tell you, Mom and Dad and Sister, how”—her voice broke—“special you are.”

Around the room, eyes went wet. (“You work so hard to plan the darn conferences,” Colt told me later, “but you can’t plan that.”) Frye’s words reminded him of the urgency of his work—of why he made the time to see patients two evenings a week after long days immersed in research, and why he often stayed up until 3 a.m. reviewing studies, preparing lectures, and organizing Gender Infinity. Though he knew that he was living in a new era of trans acceptance, he was also well aware that one in four Houston LGBT teens was still kicked out of their homes when they came out to their families. Colt felt an obligation—particularly as someone whose own family had embraced his transition nine years earlier—to do everything he could to help those who weren’t as lucky.

Boy. Girl. Man. Woman. These terms reflect a binary view of gender. Our language doesn’t allow for the in-between. And yet there are girly girls and tomboys; fey men and macho ones. As the trans community has become more visible, it has become clear that gender, like sexuality, can exist on a spectrum.

Nevertheless, the very first thing that Colt’s parents, Bob and Pam Meier, learned about their only child was which distinct category he fell in. “It’s a girl!” the obstetrician announced as she delivered Colt into the arms of his mother one August day in 1983. And it was on this bit of information that Bob and Pam—a psychologist and an ob-gyn, respectively, both admired in their community—began hanging their dreams and expectations.

Colt’s understanding of himself would turn out to be considerably different. Like many who are transgender, he felt the devastating disconnect between, as he put it to me, “the gender others tell you you are and the gender you know yourself to be.” In keeping with Colt’s wishes, I will refer to him only as Colt, even though his parents gave him a more feminine name when he was born. And I will refer to him only as a “he,” even though it took him quite some time, growing up in Beaumont, to embrace his masculine identity.

As a child, Colt hated Barbie dolls, long hair, and anything overtly feminine. When the family’s real estate agent said that he was a pretty little girl and that she would nominate him to be a princess at the annual Neches River Festival once he was old enough, three-year-old Colt replied, “No, thanks. I want to be king.” Because he wriggled out of dresses as soon as his mother had slipped them over his head, Pam got permission from the principal of his Catholic school to fashion him a modified school uniform: overalls made out of the same plaid fabric used for the girls’ pleated skirts. Once he ran around his ballet class giving girls loving kisses. “Ew, that’s gay!” said another four-year-old, leaving Colt hot with shame. Before his first confession, at the age of seven, Colt prayed in his pew: God, please don’t make me a lesbian. He didn’t know what a lesbian was, but he got the sense that it wasn’t good.

In high school, Colt was a straight-A student, a Eucharistic minister, and a black belt in tae kwon do. He still refused to wear dresses, but to avoid scrutiny, he grew out his hair. Though he had boyfriends, he never wanted to be intimate with them. It wasn’t until the summer after his sophomore year at Rice University that his best friend, a girl in his Catholic youth group, helped him figure out why. Standing in the upstairs hallway of Colt’s parents’ house late one night, the friend leaned in and kissed him. Then she ran down the stairs, afraid of how he might react. He stood in shock for a good minute, his body lit. Then he ran down the stairs to kiss her back.

Colt was ashamed of what this meant, because the church had taught him to believe that homosexuality is a sin. Yet the love he felt suggested otherwise. More than a year later, when he told his parents about the relationship, they were accepting, though Bob was certain it was a passing phase. Then twenty, Colt made a similar assumption; he was not a lesbian, he believed. He just loved this one girl. But after they broke up, he fell for another woman. A fellow student at Rice, she was proud to be a lesbian and encouraged Colt to be proud too.

In 2006, several months after Colt graduated with a degree in psychology, he and his girlfriend attended a one-man show at the Rice Student Center. Scott Schofield, now an actor on The Bold and the Beautiful, took to the stage to dramatize how he had come out as a lesbian and then later as a trans man over the course of several Southern debutante balls. Sitting in the dim hall, Colt was transported back to his forced appearance, as a sixteen-year-old in a poufy white dress, at the Neches River Festival. Colt had only ever heard the word “transgender” used as a slur, but looking at Schofield—who was blond, Texan, and transgender—Colt saw himself.

Colt grappled with this revelation in stunned silence for weeks. Schofield exclusively used “he” pronouns, and Colt realized, with exhilaration and dread, that he wanted to do the same. In a last attempt to jettison his thoughts, Colt brought up the play with his girlfriend: “Don’t all lesbians want to be men?” he asked. She stared blankly back at him.

Later that fall, Colt phoned his father and told him that he’d read the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders—at that time, the fourth edition, known as the DSM-IV—and found that he met every single criterion of what was then called “gender identity disorder.” His dad tried to comfort Colt. “That diagnosis,” Bob said in his warm twang, “was probably just put together by some little subcommittee and ramrodded through.” Then Colt told his mother. “That makes sense,” she said. “I never had a little girl.”

Remarkably, Pam wasn’t unfamiliar with the concept. In the seventies, the University of Texas Medical Branch at Galveston had been one of the first institutions to perform gender-reassignment surgeries, and during her residency there, in the eighties, she had done a rotation with one of the field’s pioneering surgeons. She was aware that trans people elected to transition in different ways. Some were content to simply “socially transition”—that is, change their presentation, names, and pronouns. Others—especially those for whom it was important to “pass,” or not be perceived as transgender—sought cross-gender hormone therapy: testosterone for masculinization, and estrogen plus an anti-androgen, or testosterone-blocker, for feminization. A fair number of trans people experienced such extreme discomfort with their bodies that it was necessary to surgically align their physiques with their internal identities.

Colt knew that he wanted to pass as a man. In December 2006, Pam set up a conference call with Walter Meyer, an endocrinologist she knew from UTMB decades earlier, who had helped author the standards of care for the World Professional Association for Transgender Health. During the call, Colt expressed his concerns about the psychological side effects of hormone-replacement therapy. He had heard the rumors about testosterone causing “ ’roid rage,” the anger induced by taking too many steroids. “How do we know testosterone is right?” Pam asked Meyer. “The only way you’re going to find out,” he said, “is if you try it.”

The Rosenberg Clinic, in Galveston, where Meyer was an adviser until it closed last fall, generally abided by what is called the “gateway model” of care, in which a patient must see a psychologist for six months before he or she is granted—or denied—a therapist’s note permitting hormone therapy to begin. (Other doctors use the “consent model,” in which patients are informed about treatment options and allowed to make their own decisions.) In the spring of 2007, Colt began six months of therapy at the clinic, which was in a blue two-story house. He also underwent ten months of counseling in Houston. “It was overkill,” Colt told me, “but I wanted to be really sure about transitioning, because the church said that God will always see you as your assigned sex.”

Colt bought his first pair of boxers and started wearing a “binder,” a nylon-and-spandex vest, to compress his breasts. He attended his first trans group-therapy session, and while everyone went around the room introducing themselves, he racked his brain for a masculine name, quickly picking “Colt.” At the University of Houston, where he matriculated as a psychology Ph.D. student in August 2007, faculty and students addressed him using male pronouns. He used the men’s restrooms on campus without any issue.

Finally, in October, after Colt’s sixth month of therapy in Galveston, a psychiatrist handed him what people in the trans community call “the letter,” which permitted testosterone therapy, and Colt received his first prescription. Colt nearly ran to the CVS catty-corner from the Rosenberg Clinic to fill it, his mom keeping pace beside him, and when the pharmacist handed him the white prescription bag, he was overwhelmed with emotion. It had been almost a year since his epiphany at Scott Schofield’s one-man show. Now, at last, he could feel the vial through the crinkly white paper, and he slowly rolled it between his fingers. He didn’t want to wait to drive home to Houston for his first shot, so he asked Pam if she would administer it. Seeing the urgency on her child’s face, she agreed. But when they returned to the clinic, it was locked for lunch. So while they stood on the porch of the blue house, she had him tug down one side of his pants, and then she quickly injected the testosterone.

Over the next year, Colt kept an online journal about his transition. Every few weeks, he posted a picture. After three months, fuzz sprouted on his arms and legs. A small cropping of acne burbled on his face. By six months, his shoulders had begun to broaden and his voice had deepened. The last characteristic to develop, several years in, was what he most wanted: a passable beard, blond and wiry. Less obvious were the subtle changes to his mood and personality. Once, at a Subway where he was a regular—but where he was always called “ma’am,” despite repeatedly correcting his servers—he burst out, “I’m a man!” He was taken aback by his own boldness. “When you’re transitioning, you’re not your normal self for a bit,” he said. “It’s like you’re going through puberty. It just looks a little weirder on somebody who’s grown.”

Bob and Pam, meanwhile, went to Parents and Friends of Lesbians and Gays meetings in Houston and attended monthly gatherings at a church in Nederland for Catholic families of LGBT youth. “Knowing you’re not the lone ranger is very helpful,” Bob said. One afternoon, when Colt was home for the holidays, Bob picked up one of the glass vials of testosterone. “It’s so interesting that this little bottle can change you,” he marveled. Though Bob had been slower to accept Colt’s masculine identity than Pam, he had eventually thrown himself into researching trans issues and was now educating others through videos he posted to YouTube. Pam meanwhile opened her Beaumont office several Saturdays a year to Colt’s trans friends so that they had a safe and respectful place in which to receive gynecological exams.

At his therapist’s recommendation, Colt penned a letter in which he came out as trans. He sent it to members of the community he had grown up in, including Father William Manger, his childhood priest at St. Anne Catholic Church. “This has not been easy for me, as things that are true for me are not mainstream nor are they socially acceptable in many parts of the country,” he wrote. “I am very different, and I did not ask to be.” His parents sent out their own letter as well. Though a couple of Bob’s fishing buddies maintained that changing genders was a choice, and a self-destructive one at that, the majority of people whom Colt and his parents heard back from were surprisingly supportive. “I will try my best to walk with you,” wrote a friend of the family. “We are led by God in this to where He wants us to be.” Another friend sent Bob and Pam an email that said, “Thanks for your willingness to educate others by sharing your experience. I believe God has a plan for all of us and this seems like it may be part of God’s plan for you.” But the biggest solace came from Father Manger’s response. “That is a brave letter by a brave person,” the priest wrote. “I have never particularly paid attention to your gender but you have and that is entirely what you must focus on.”

Sitting in St. Anne’s pews on Palm Sunday in 2008, Colt listened to the reading from the Book of Mark. In it, Jesus commands two disciples to untether a colt on the outskirts of town so that he may use it to ride into Jerusalem. Colt leaned forward—a colt!—so as not to miss any of the words that followed. “Untie it and bring it,” Jesus instructs. “If anyone should say to you, ‘Why are you doing this?’ reply, ‘The Lord has need of it.’” Colt knew then that the name he thought he had chosen for himself had really been chosen for him.

Though transgender people have existed as long as literature—they appear in epic poems as ancient and geographically diverse as Ovid’s Metamorphoses and the Sanskrit saga the Ramayana—they make up only an estimated .2 to .3 percent of the U.S. adult population. Still, even that tiny percentage adds up. More than half a million Americans, and more than fifty thousand Texans, are born with anatomy that does not match their gender identity.

How this population has been perceived by the medical establishment has changed radically in the past few years. Just as the popular understanding of homosexuality shifted in 1973, when the DSM-II stopped classifying it a mental illness, so too, four decades later, in 2013, did the DSM-V  lift transgender people out of the shadows. What was formerly labeled “gender identity disorder” was reclassified as “gender dysphoria,” a condition in which “people whose gender at birth is contrary to the one they identify with.” (A diagnostic term couldn’t be dismissed altogether, because it protects access to medical interventions like hormone-replacement therapy and surgery.)  By eliminating the term “disorder,” the board behind the most influential diagnostic tool in America aimed to free the condition of its pathologizing baggage.

Yet despite this momentous shift, there was still very little research available on transgender populations—a problem that Colt urgently wanted to address. Take testosterone therapy, the leading intervention for trans men. Concern over its psychological impact was something Colt frequently encountered when counseling patients. Just as Colt had wondered when he was on the verge of hormone therapy, his patients wanted to know: Would testosterone change them? Would it make them angrier? Aggressive? Impulsive?

In fact, Colt suspected that testosterone therapy actually improved the well-being of trans men. He was eager to test his hypothesis, since anxiety and depression are more common among trans men than among men in the general population. Intuitively, this makes sense, since persistent discomfort with one’s body is necessary to receive a diagnosis of gender dysphoria. Moreover, when trans people don’t pass, they are likely to face bullying and discrimination—something they come to dread.

So in early 2008, Colt reached out to every LGBT professional, trans friend, and online trans community he could think of, trying to find female-to-male trans people who were on the verge of initiating testosterone therapy. Colt also gathered two control groups: one made up of women and the other of men. For his diagnostic tool, he chose the widely respected Minnesota Multiphasic Personality Inventory. Operating on a shoestring budget, with a slew of small grants and a little bit of his own money, Colt found 48 trans men to participate, making it the largest longitudinal study of its kind ever conducted. Colt would go on to publish his findings in 2015 in the prestigious Journal of Consulting and Clinical Psychology.

The results of the study were dramatic. Before starting testosterone, transgender men were roughly twice as likely as male and female controls to meet clinical thresholds for symptoms of mental illnesses. Otherwise, their psychological profiles were very similar to those of women: both groups had higher rates of anxiety, depression, hysteria, and paranoia when compared with men. But after just three months on testosterone, trans men fared significantly better than the female controls on these scales. A year later, these findings remained unchanged. Testosterone, it was clear, significantly increased trans men’s quality of life. (Looking at these results, a woman might wonder whether she shouldn’t start taking testosterone, but the masculinizing effects—sprouting a beard, say—would beset a woman with gender dysphoria. The effects of feminizing hormones on the psychology of trans women, meanwhile, still need to be studied.)

There are nevertheless critics who believe that gender dysphoria is a mental illness, and that helping trans people alter their bodies is unethical. Paul R. McHugh, a University Distinguished Service Professor of Psychiatry at the Johns Hopkins University School of Medicine and a noted Catholic conservative, argued in the Wall Street Journal in 2014 that trans people, like anorexics and bulimics, share “disordered assumptions” that “depart from physical reality.” Just as people with eating disorders believe they are overweight instead of dangerously thin, he argued, so too do trans people believe that their gender “differs from what seems given in nature.” The following year, McHugh wrote that administering hormone-replacement therapy or performing gender-reassignment surgery on trans patients was no different than doing liposuction on an anorexic.

The medical consensus, however, is the opposite. In 2008 the American Medical Association declared that research overwhelmingly proved that hormone therapy and surgery were necessary for trans people, and that barriers to treatment were unethical. The American Psychological Association concurred last year, when it released its first guidelines for the care of transgender patients. Citing Colt’s testosterone study, the APA advocated promptly treating gender dysphoria, arguing that doing so could help alleviate existing mental health issues. That is critically important, Colt told me, “because trans people are at the highest risk for suicide, period.” A recent study conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality found that the prevalence of lifetime suicide attempts among respondents was a terrifying 41 percent, almost ten times as high as the general population. “Prescribing hormones is not very complicated,” Colt told me. “The fact that it can save people’s lives is not something that you can have a neutral opinion about.”

But at how young an age should one be allowed to medically transition? This is a particularly thorny question now that teens and even elementary-school-age children are more readily self-identifying as transgender. To be considered trans, children must demonstrate “a pervasive, consistent, persistent, and insistent sense of being the other gender,” states a fact sheet on gender-diverse kids that Colt helped compose for the APA. Still, can parents feel confident in the conviction of a nine-year-old? How can they be sure that their twelve-year-old won’t change his mind a few years down the road?

In recent years, doctors have been able to buy such patients more time. In cases of children who have experienced sustained gender dysphoria, Colt—in keeping with most clinicians who work with trans children—recommends prescribing hormone blockers to delay puberty. Such blockers have been used for years to treat women with endometriosis and men with prostate cancer. Taken at the first sign of puberty, between the ages of nine and twelve, they can stave off sexual development for up to six years, allowing teens to confirm that they’re making the right choice and enabling preteens to only have to go through puberty once, rather than twice.

Still, not everyone approves of blockers. Some medical providers, like Fred Berlin, the director of the Sexual Behavior Consultation Unit at Johns Hopkins, prefer waiting to medically intervene in any way until a time of “mental maturity,” or what is generally considered to be eighteen years of age. “I tend to not to want to suppress puberty,” Berlin told me. “I respect those who think otherwise, but I don’t think delaying intervention presents obstacles that we can’t overcome.” Yet the longer one goes through adolescence without intervention, the more unwanted secondary sex characteristics—such as enlargement of the Adam’s apple or widening of the hips—one acquires, and the harder it is to pass after transition.

From Colt’s perspective, the cost of caution is too great, given the extraordinarily high suicide rate in the transgender population. Unlike a medical doctor, Colt can’t actually prescribe hormones or blockers himself. But in his capacity as a psychologist, he can provide a letter recommending such treatment. First, Colt reviews a patient’s psychological history; then he conducts what he calls a “gender history,” looking at “the trauma he or she has experienced as a result of being gender diverse in a cisgender world.” (“Cisgender” is the opposite of trans; that is, it describes people whose biological sex and gender identity match.) Finally, he informs the patient about the effects of hormones and blockers. He does not require his patients to undergo six months of therapy, as he did. As Colt sees it, some patients will need more counseling before proceeding, while others will need less.

The most challenging consideration for his teenage patients is their future fertility, or lack thereof, since transitioning essentially bars them from having biological children. Female-to-male transgender teens who want to reproduce in the future must delay hormone therapy until they can freeze their eggs, a costly and unreliable endeavor. Male-to-female trans teens must delay hormone therapy until they can save sperm. (To capture sperm, a trans girl has to masturbate, and “most trans girls,” Colt told me, “are too disgusted by that to do it, God bless them.”) Generally, Colt told me, it’s the parents who express concerns over fertility. Most let go of the idea of grandkids when confronted with the anguish that Colt routinely hears about in his office on Wednesday and Thursday evenings: teens who have beaten their breasts until their bodies ached and children who have tried to amputate their penises—one using a pair of nail clippers. As Colt goes about his work, their torment is never far from his mind.

On November 3, ten days after Gender Infinity, HERO was finally put to a vote. Across Houston, members of the city’s LGBT community gathered in living rooms, barbecue joints, and bars to watch the returns and—they hoped—to celebrate. Colt had received more invitations to election-watching parties than he could count, but Tuesday nights were the only time he had to catch up on notes from his therapy sessions. And so, on what had become the most anticipated day of the year for many in his circle, he opted to stay in. He was at his apartment near the Texas Medical Center, typing at the kitchen table, when his spouse, Becca Keo-Meier, arrived home.

Colt had met Becca at the University of Houston in early 2010, when she was a dapper, androgynously dressed psychology major with a soft face and full lips, her jet-black hair styled into a fauxhawk. Most of the lesbians Colt was drawn to had not been attracted to him since he had transitioned, but Becca was attentive when he stopped her to talk. They began meeting for coffee, and when he brought Becca to the Transgender Unity Banquet—a popular annual fundraiser for the trans community—they danced late into the night. Twelve days later, while Becca was hanging out at Colt’s apartment, he presented her with a rainbow-hued bouquet and played Keith Urban’s “Making Memories of Us” as he held up flashcards with personalized  lyrics. The last card read, “Will you be my person?” Becca said yes. In 2013 they wed in California and merged their last names, “Keo” and “Meier.”

Though Becca had had little exposure to the trans world before meeting Colt, she became the biggest supporter of his work. Not long after they started dating, she helped him get the first Gender Infinity Conference off the ground. She wrote her senior thesis about the relationship satisfaction of partners of trans men, and as a graduate student at U of H she began exploring the use of apps to study attitudes toward transgender people. Colt and Becca’s lives revolved around their work; they went so far as to celebrate their honeymoon in Cambodia after attending a World Professional Association for Transgender Health conference in Thailand.

On election night, they settled in to watch the returns. They both stared at their screens—Colt at his laptop, Becca at her iPhone—toggling back and forth between Facebook and the live polling numbers. The early numbers did not look good, but their friends, many of whom were social workers and community activists who had fought for the passage of HERO, remained positive online. (“If you have some lucky underwear, tonight would be the night to wear them,” read one post.) But soon, their friends fell silent.

The issues at stake in HERO were resonant for Becca. Several years earlier, at the gym, a woman had charged toward the toilets just as Becca entered a stall. “Is there a boy in here?” the woman demanded. No one responded, and Becca realized the woman was referring to her. “No, no boy,” Becca said in her distinctly feminine voice. “Are you sure?” the woman demanded. Rattled and ashamed, Becca hurried out of the stall. The restroom ads that played on television elicited memories of that moment when she had been cast as a pervert.

By 9 p.m., Facebook posts had begun streaming in again: not only had HERO failed, but voters had rejected it by two-to-one margins in ten of Houston’s eleven districts. Distressed, Colt and Becca read along as their friends voiced their frustration and disappointment online: “The most diverse city in the country voted to legalize discrimination.” “Fear and hate prevailed.” “I’m horrified and humiliated at the decision my community made today. It’s not the city I know and love.” They watched online as Mayor Parker took the stage at Jackson Street BBQ, behind Minute Maid Park. “It was clear when we passed the ordinance in council,” she said, “that if we had agreed and said, ‘Oh yeah, we’ll take the words “gender identity” out of the ordinance,’ [the opponents] would have gone away. That would have been wrong then and it would be wrong now and it will be wrong in the future!”

Colt, so constitutionally optimistic, crumpled in Becca’s arms. He was angry—at those who didn’t vote, at those who didn’t understand what was at stake, at those who did not hesitate in voting against it. That evening, h­e set aside his work and spent the night cuddling with Becca.

The next day, Colt received calls from a mother who was struggling to be supportive of her gender-nonconforming child and from a school psychologist who was concerned about a mentally ill, transgender teen. “I am still committed to doing the work in my grief,” Colt wrote on Facebook. In fact, he was doing more than ever. He had already started organizing more frequent meet-ups for the families of transgender youth. He was writing a book on trans care for children with the Oakland psychologist Diane Ehrensaft. The HERO vote, he told me, had only further motivated him. “I realized that I live in a bubble, because I surround myself with supportive people,” he said. “Now I see that my work is nowhere near done. We are just getting started.”

Colt had even applied to medical school, so that one day he would be able to do everything, short of surgery, for his patients. A couple of weeks after the HERO upset, he sat down at his laptop and typed a Facebook post that would garner 536 likes. “Just received my first acceptance into medical school,” he wrote. “UTMB Galveston!!!”