Kasey Fraize wasn't afraid any more.
One day early in his freshman year at Florida Gulf Coast University, he entered the campus wellness center intent on finding ways to fit in.
"I walked right up to the desk and asked what kind of resources they had for the transgender community," Fraize, now 20, recalls. "She handed me a dusty old pamphlet that was so bad."
It used the scientific but sometimes negatively charged term "hermaphrodite" to describe transgender people.
The moment propelled Fraize to get involved, and to prod his new school toward a better understanding of students like him. But he says it never would have been possible without help from an unexpected source.
Planned Parenthood, best known for reproductive health services including abortions, had just started a program to offer hormone therapy at many of its Florida health centers. Fraize discovered the program, and got a prescription for testosterone from a Planned Parenthood doctor not far from campus.
After struggling to find acceptance back home in Pasco County, where some still call him "Cassandra," the therapy brought welcome changes to his body and helped him feel more like himself.
He got a job at FGCU's wellness center and began to host forums about the transgender community and other issues. This year, he ran for a seat in student government.
"Maybe it was the hormones," Fraize says, "but I was on a mission."
• • •
Transgender people often rely on testosterone or estrogen hormones to begin the process of transitioning to another gender. While Planned Parenthood has for years offered hormone therapy in many more liberal-leaning states like California and New York, it didn't offer the service in Florida until 2016 — and only then in places with the highest need: the southwest and central parts of the state, including Tampa Bay.
Last year, the organization expanded the program to include minors, with many in their early-to-mid teens receiving treatments.
"Our motivation for expanding this was actually driven by parents who were calling us," said Dr. Suzie Prabhakaran, vice president of medical affairs for the Planned Parenthood Southwest and Central Florida affiliate. "They were having trouble finding access to where their transgender children could start hormone therapy."
More than 600 people have received hormone treatments at Planned Parenthood centers in Florida since the program began. Of those, 29 are younger than 18. Just one patient is under 14.
Most of them are 18 to 24, around Fraize's age.
The therapy is supported by the American Medical Association as safe for patients who need the care, Prabhakaran said.
Last year, the AMA revised some of its policies to broaden how gender identity is defined in medicine, improve how transgender patients are treated, and oppose laws that discriminate against them.
Such laws cause "statistically significant increases in mental health and psychiatric diagnoses," according to the AMA.
"Every patient has a different path, but for the vast majority of patients, starting hormone therapy is the first step," Prabhakaran said. "For some, it's all they want or will be able to do. Fewer patients go on to have surgery."
The program fits in with Planned Parenthood's goal of providing much-needed care that can be difficult to get, she said.
Fraize didn't find it until he was 19. But he says he could have saved himself years of grief and confusion had he been able to start sooner.
Early on at River Ridge High in New Port Richey, he identified as a gay woman. He hadn't yet heard of anyone being transgender.
That changed at age 15, when he discovered a blog that documented the author's journey through hormone therapy.
"I knew right then," Fraize recalled. "There was no denying what I am after that."
• • •
When he moved into his FGCU dorm room in Fort Myers, no one knew him as Cassandra. He was free to be Kasey.
Even so, he struggled to feel comfortable. He dressed like a man but still looked like a woman.
"When you're not 'passing,' people notice," he said. "It compromises your safety."
"Passing" meant being recognized as a man while walking to class or ordering food in the cafeteria.
"It's something you have to think about wherever you go," Fraize said. "So I don't use the bathrooms on campus. I just hold it until I get back to my dorm."
Passing became his goal. He decided to seek out hormone treatment, but insurance issues and worries that his parents would never approve made it tricky.
At one point, he paid out of pocket for a therapist so he could get a prescription for testosterone. But the doctor wrote that he had a "gender identity disorder," a term Fraize rejected.
He threw away the note and found Planned Parenthood.
• • •
In launching its program, Planned Parenthood worked with the LGBTQ advocacy group Equality Florida to train health practitioners on the confidentiality and cultural needs of patients from the transgender community.
Awareness of that community and demand for hormone services is greater now than it's ever been, especially among younger people, said Gina Duncan, Equality Florida's director of transgender equality.
She attributed that to provisions in the Affordable Care Act that prohibit sex discrimination.
Still, care can be expensive, sometimes adding up to hundreds of dollars a month for tests, blood work and other services.
Planned Parenthood requires patients under 18 to have the support of a parent or legal guardian to begin treatment, which Prabhakaran said is a barrier for some.
The decision to turn to hormone therapy, which causes significant changes in the body, can be complicated for families, said Dr. Diane Straub, a pediatrician and division chief of the University of South Florida's College of Medicine pediatrics program.
"There are kids out there who know. They know that they are in the wrong assigned gender, and I think they know that when they're very young," said Straub, who regularly treats transgender children.
But it's a different decision for children who may be unsure.
While most effects wear off over time if hormone use ends, there are some longer term risks, according to the Vanderbilt University Medical Center. Testosterone use over time can damage the liver, and estrogen can increase blood pressure and blood clotting.
"It's a big step to take hormones, and you are biologically altering your body," Straub said. "For kids who are gender fluid, it's important to stress that their development will be forever changed by this."
• • •
Away at college and after months of injections, Fraize was becoming the person he wanted to be. His breasts started to shrink, and his menstrual cycle stopped. Facial hair began to grow, and his voice started to change.
He thought about his parents, and ended up telling them.
"I was home for Christmas and I knew the next time they saw me, I was going to look different," he said. "My dad told me that day, 'I'd always be his little girl.'"
The topic remains a struggle, he said. "I know they love me, even if they don't understand."
Nikki Kirdahy, a friend and graduate student from FGCU, hired Fraize to work part-time at the school's prevention and wellness center — the same place he encountered the antiquated transgender pamphlet.
As he began to feel more comfortable, he became more passionate about talking to others on campus about himself and the transgender community.
"I struggled to find my place here at first," he said. "There's a huge gap between the students. So I wanted to fill it."
Earlier this year, he hosted a "trans 101" public forum where students could ask him sensitive questions anonymously. More than 90 people came.
Recently, he met with a class of senior nursing students to guide them on how to appropriately treat transgender patients. He's also helped lead programs on sexual assault and alcohol abuse.
And he got rid of the wellness center's old pamphlets.
Kirdahy said the work takes an emotional toll on Fraize.
"Comments are made, and they can be hard on him," she said.
"But he still goes out every day to teach people. So the next time they encounter a trans person, they might treat them with a little more kindness and not make the same mistake."
Entering his junior year and working toward a degree in public health, Fraize says he is saving up for surgery to remove his breasts. He knows that one day he'll have to have a hysterectomy, too. But hormone injections have become an everyday part of life.
After college, he sees himself pursuing a role as a public health advocate and educator.
First things first, though.
"For now," he said, "I just want to create a space on campus where other trans students can feel safe."
Contact Justine Griffin at firstname.lastname@example.org or (727) 893-8467. Follow @SunBizGriffin.