Grace Powell was 12 or 13 when she discovered she could be a boy. Growing up in a relatively conservative community in Grand Rapids, Michigan, Powell, like many teenagers, didn’t feel comfortable in her own skin. She was unpopular and frequently bullied. Puberty made everything worse. She suffered from depression and was in and out of therapy.

“I felt so detached from my body, and the way it was developing felt hostile to me,” Powell says. It was classic gender dysphoria, a feeling of discomfort with your sex.