At age 4, Nathan Fabian came to his mother with a perplexed look.

“Why did God make me a boy?” he asked.

There was a sadness to the question, something beyond a child’s simple curiosity, said his mother, Andrea Fabian.

Nathan later would tell people he felt born in the wrong body. Just before his freshman year at Madison West High School, he began presenting himself as a girl. He asked to be called Mindy and to be addressed using only feminine pronouns.

It was not an easy path, and on Oct. 13, Mindy’s journey ended. A little before noon, she jumped to her death from a Downtown apartment building. She was 18 and a high school senior.

Her suicide jolted the transgender community and its allies, illuminating the challenges of being transgender and spurring a new effort to support transgender youth.

Many people, including Mindy’s parents, caution against generalizing from her story, saying her emotional problems were complex and that she was not known to have been the target of bullies at the time of her death. Yet many aspects of her life ring true to those who have traveled a similar road.

“A death like this is always horrible. At the same time, I understand the pressures as well as the joys that come with transition,” said Vivienne Andersen, 38, of Madison, a former Lutheran pastor who transitioned from male to female as an adult and knew Mindy.

Mindy’s death comes as initiatives across the community — from new policies at Madison schools to groundbreaking research at UW-Madison — are rapidly improving the landscape for transgender youth. First-ever data suggest the scope of the issue. On a recent survey, 1.5 percent of Dane County high school students self-identified as transgender, or about 250 teenagers out of 17,000.

Umbrella term

As a child, Mindy — then known as Nathan — was drawn to stereotypical female activities and often sought to wear traditionally female clothes, her parents said.

Such stories are not uncommon among those who go on to change gender, yet playing dress-up is a normal part of childhood and does not mean a child is transgender, said Dr. Jennifer Rehm, a Madison pediatric endocrinologist who specializes in treating transgender youth.

Transgender is an umbrella term for anyone whose gender identity or expression is inconsistent with cultural norms related to his or her biological sex. It includes those who have undergone sex reassignment surgery — historically referred to as transsexuals — as well as those who may never take that step, said Rehm, who works at the Pediatric and Adolescent Transgender Health Clinic at American Family Children’s Hospital.

The clinic, opened in 2012, is one of only a handful in the country that combines psychological guidance with hormonal assistance for children and adolescents considered “gender variant,” though medical services for transgender youth are becoming more common, Rehm said.

Gender identity and sexual orientation are separate yet often confused, said Dr. Kathy Oriel, a family physician with UW Health who has treated transgender patients for 20 years. Gender identity is a person’s private, internal sense of male or female, which may conflict with biology, she said. Sexual orientation is who a person is intimately drawn to and sexually active with.

Research suggests only 20 percent to 30 percent of young children who dress in non-traditional ways become transgender, Rehm said. That figure leaps to 80 percent or higher if the feelings and behavior persist into puberty.

That’s when the risk of self-harm surges, Rehm said. The 2011 National Transgender Discrimination Survey of nearly 6,500 respondents found 41 percent had attempted suicide, compared with 1.6 percent of the general population. Younger transgender people were most at risk.

“Growing breasts at age 12 freaked me out,” said Ja’Mel Ware, 25, a prevention specialist at the AIDS Network in Madison who said he felt betrayed by his body and sank into a deep depression before transitioning from female to male. “When my mom bought me training bras, I cried at the store. I bought a pair of SpongeBob SquarePants boxers to balance it out.”

Anger problems

Long before her transition to female, Mindy had been seeing doctors and therapists for serious anger and anxiety, said her father, Tony Fabian, a data analyst for Dean Health Plan.

“In hindsight, I’m sure everything was tied together,” he said. “I can’t imagine getting up every morning and not wanting to be in the body you have.”

Health officials seldom agreed on how to treat their child’s rage, said Andrea Fabian, an administrative secretary at UW Health.

“About the only thing we could do was love her and keep providing her with as much support as we could, both medically and in the community,” she said.

Despite the Madison School District’s liberal reputation, Mindy’s freshman year at West High School was rough, her parents said. School officials refused to change her school ID to “Mindy.”

“So on the first day of class, the teacher is calling attendance and says, ‘Nathan,’ and a girl in a dress stands up. That was mortifying for her,” said Tony Fabian.

Mindy initially was required to use the school’s handicapped-accessible bathrooms, which are single-stall and lockable. But there were just two in the large building, and Mindy sometimes didn’t have time between classes to get to one, Andrea Fabian said. Mindy began using the regular female bathrooms, but a female staff member objected and kicked her out.

Neither of those scenarios would be allowed to happen today, said Nancy Yoder, who oversees student services for the district.

Students with a consistent, deeply held gender identity are to be identified by their preferred names and genders publicly on such things as school IDs, even if they haven’t changed their names legally, Yoder said. And they are to have access to the restrooms that correspond to their gender identity if that is their choice, she said.

If a staff member or classmate objects, it falls to the district to find another accommodation for the person who complained, not for the transgender student, said Liz Lusk, the district’s resource teacher for students who are lesbian, gay, bisexual, transgender or questioning (LGBTQ).

The same approach goes for access to locker rooms, which might suggest a multitude of complications, yet the opposite has been true, Lusk said. Most physical education classes in the district no longer involve showering, and the trend everywhere is for locker rooms to provide greater privacy — curtains, stalls — for all students, she said.

These policies follow recommendations from the national Gay, Lesbian & Straight Education Network. While the district had been implementing them on a case-by-case basis for many years, it codified them in 2012, making them district policy and enforceable across all schools, Lusk said.

That’s critical, because it means transgender students no longer must luck into a sympathetic staff member, still the case in too many districts, said Brian Juchems, program director for the Gay Straight Alliance for Safe Schools (GSAFE) in Madison.

“They are definitely leading the charge here in Wisconsin,” Juchems said of the Madison School District. The district hosts a monthly support group for parents of transgender students, something Juchems said he has not heard of elsewhere in the state.

Bullying

Mindy sat on GSAFE’s youth leadership board and also attended Teens Like Us, a support group for LGBTQ youth run by Briarpatch Services. Both gave her confidence to confront bullying, which was an issue, especially when getting to and from school, her father said.

In a video Mindy made about a year before her death, she holds up index cards showing some of the names she was called as a freshman: “fag,” “ugly man,” “MAN-dy,” “fat whore.” Christina Aguilera’s “Beautiful” plays in the background. Mindy’s final index card reads, “I am beautiful.”

Even in the most tolerant communities, transgender teens often face high levels of name-calling and harassment, said Anne Urbanski, who knew Mindy and is a board member of the Madison chapter of Parents, Families and Friends of Lesbians and Gays (PFLAG).

“These kids are so brave,” Urbanski said. “They’re navigating a world that doesn’t understand them, rarely even tolerates them and is often openly hostile to them.”

The local PFLAG chapter is seeing a gradual evolution, with the newer members tending to be parents of transgender children rather than gay children, she said.

At least twice at West High School, Mindy filed written grievances against classmates, and administrators intervened, Tony Fabian said.

“They did what they could given the situation,” Tony Fabian said. “It would be very easy for me to say they didn’t do enough, but I don’t know what they could have done differently in a school of 2,200.”

The district’s anti-bullying policy requires principals to follow up on all complaints and document what action, if any, is taken, Yoder said.

Mindy spent most of her sophomore year at Shabazz City High School, a district alternative school. She loved it there but couldn’t cut the academics, her parents said. At the time of her death, she was enrolled in West’s SAIL program, an off-campus alternative program combining work and academics.

In 2012, Mindy’s parents voluntarily placed her in foster care. She had become physically violent at times, jeopardizing the safety of family members, her father said. The Fabians stayed closely involved in her life.

Mindy dined with her family the Wednesday prior to her Sunday death. Her mom last saw her two days before her death, when they met for lunch.

“We were having such a good time I didn’t want to go back to work,” Andrea Fabian said.

Final hours

On the day she died, Mindy was staying at The Towers apartment building with a female friend she’d just met. She’d given up her foster home setting, opting instead to couch surf or seek housing on Facebook. Her situation was not uncommon.

As many as 40 percent of the youth who are homeless identify as LGBT, and many of those are either transgender or gender non-conforming, said Tim Michael, a GSAFE staff member. Lots of factors are in play, he said. Some youth have no choice — they’ve been kicked out of their homes — while others may be engaging in high-risk behavior as a reaction to the societal stigma and rejection they face, he said.

Mindy left no known suicide note. Among her many diagnoses over the years was histrionic personality disorder, characterized by a pattern of attention-seeking behavior and extreme emotionality. She was bright and bubbly but also reactive and impulsive, her mother said.

“I think the second her last foot left the rooftop, she regretted it,” Andrea Fabian said.

Mindy had not yet undergone sex reassignment surgery. The Fabians believe the stigma and social rejection their daughter sometimes faced contributed to her suicide, but they said they likely will never know to what degree.

“She wanted to be wholly female, and it wasn’t happening fast enough,” her mother said. “She wanted to be wholly loved for who she was, and she wasn’t finding that everywhere.”

As a direct response to Mindy’s death, GSAFE is launching a mentoring program to connect transgender youth with transgender adults who have been through the trials and emerged in a better place — people such as Laura Gutknecht, 60, technical director for WSUM, the student radio station at UW-Madison.

“It can be rough, and it can be lonely,” said Gutknecht, who began transitioning from male to female nearly 20 years ago, “but I am so much happier today living my authentic self.”

Honoring Mindy

A month after Mindy’s death, her parents gathered in a Dane County courtroom with members of what had become known as “Team Mindy” — mentors, social workers, friends, foster parents.

Just prior to her death, Mindy petitioned the courts to legally change her name. She did not live to see the hearing date.

Her parents felt the best way to honor her was to follow through with her wishes.

Usually, such a proceeding is perfunctory. Toward the end of this one, one of Mindy’s social workers tiptoed up to attorney Charles Squires and whispered something in his ear. Squires turned to Judge Juan Colas.

“Your honor, I have an unusual request,” he said. “They’d like to hear you officially pronounce her new name.”

Colas, who had shepherded the Fabians through the hearing with gentleness, said he would be glad to do so.

“I find all conditions have been met for granting the name change,” he said. “I therefore order that, henceforth, the name of this person is changed to Amanda Georgina Fabian.”

The courtroom broke into applause.

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