Achievement and distraction. These were the coping techniques that have proved both useful and life-saving for Dr. Kristine Coons, who has struggled with gender dysphoria for as long as she can remember. Now happily married to her wife of 20 years, and working as an internal medicine physician at a hospital among supportive coworkers, Kristine has found her stride.
Growing up in western Washington in the ‘80s as a middle child of five was especially complicated for Kristine. An older brother had contracted HIV from a bad blood transfusion, and as it was the height of the AIDS crisis, Kristine’s parents frequently moved jobs and homes to get their son the care he needed while trying to give all their kids enough fresh starts in new schools that they could overcome the stigma of being “the family of the kid with AIDS.” Kristine, who with Laura is now a parent of four kids ages 18 to 8 (Ben, Rachel Lizzy and Alex), marvels at all her parents endured.
As a young child, Kristine sensed her parents didn’t need one more thing to worry about, so she tried to lay low and battle her gender dysphoria alone. But every day, she experienced an intense quandary of wondering why she felt like she was a girl in a boy’s body. She says it felt “like a pressure cooker in which you’d stuff your emotions, lock them in place, and watch as the steam built to the point you felt like exploding.” Not wanting to cause trouble, she worked really hard in school while also striving to minimize the static coursing through the headphones of negative self-talk she endured. Sometimes the static is louder than others, sometimes softer, but Kristine says, “Never being able to take off those headphones with the constant noise drains you. It’s absolutely exhausting.”
Kristine’s hard work in school paid off, and she went on to a semester at BYU Provo where she met her future wife, Laura, before leaving for her mission to Phoenix, Arizona. While serving, she and Laura faithfully wrote to each other; the two married shortly after Kristine returned. Of their marriage, Kristine says, “Laura’s amazing, we are head over heels for each other. I love my wife.” As a newlywed, Kristine quietly negotiated her dysphoria, rationalizing something might fix it or make it go away—she trued prayer, fasting and study. She even attempted herbal remedies she’d heard might dampen the emotions, but found no fix. Alas, she threw herself into what she knew best—hard work.
While Laura and Kristine started having children, Kristine graduated in food science with minors in chemistry and business. She then entered medical school. Though she promised Laura they would not return to Phoenix after her mission because of the heat, the Coons moved back so Kristine could attend the Arizona College of Osteopathic Medicine. They eventually moved to Ohio for her to continue her training and residency. There, Kristine balanced working 24-hour shifts, moonlighting on her one night off at an urgent care, serving as chief resident which required scheduling duties and teaching interns, and helping rewrite training manuals once it was decided the osteopathic and medical world would merge. Kristine now calls this harried time “a perfect distraction from myself.” On their rare down time vacation, the Coons would take road trips during which Kristine would insist on driving so she could keep her mind focused on the road and elaborate math problems or mind games she’d play so her brain stayed busy—distracted away from the gender dysphoria.
As Kristine’s graduation day approached, it hit her that all the distractions she created were about to disappear. With a pending fresh schedule and new start, Kristine would have to face all she’d been battling and it scared her. In March 2014, standing alone in her kitchen, Kristine recalls an overwhelming spiritual impression wash over her. She felt the words, “Have you ever considered accepting this as part of yourself?” No, she hadn’t. Instead, Kristine says she’d spent years trying to pray, fast, wish, read, and study her gender dysphoria away, hoping it would just disappear. While the idea of acceptance had seemed foreign thus far, suddenly it felt right, even intentional. At that moment, Kristine had the strong impression to go confide in Laura—right then.
This was terrifying, as the few times her parents had found her cross-dressing as a child had been very bad experiences, as had reading what happened to relationships with a transgender spouse. Laura found Kristine on their couch, shaking and trembling as Kristine admitted she couldn’t keep up the secret any further. She had to tell someone—for the first time ever, at age 32. Laura listened patiently as Kristine shared two very important truths: 1) that she wanted to follow God as much as possible, and 2) she didn’t want to do anything to hurt the family. Those confessions opened up communication lines between the couple, as they both aligned with wanting to keep their family together, continuing their relationship, and working together to figure out what were the right next steps.
Kristine did not transition right away. Instead, this was a time of the self-reflection of navigating a difficult course. How does one manage gender dysphoria, maintain a marriage relationship, follow guidelines arranged by The Church of Jesus Christ of Latter-day Saints, and interact with a world and community? For Kristine, abruptly transitioning felt drastic and even overwhelming, but she knew it was important to work it out. The course of understanding herself and her family relationships required a significant amount of thought, prayer, and communication with Laura about what felt right and what didn’t. As the Coons moved to Spokane, WA for Dr. Coons to start her first official job in the fall of 2014, she began hormone therapy. She fondly remembers Laura saying it felt like Kristine had finally come alive, suddenly more present and engaging with their children and family life. Kristine concurs that this awakening allowed her to feel more authentic and able to bond with those in their family. In the midst of these transitional years, Laura was thoughtful, loving, kind and patient. However, Kristine’s transition still had its difficult moments for the relationship. In the end, they found working together and with God helped them most in navigating uncharted waters.
Starting hormone therapy has its physical side effects. As Kristine wasn’t trying to work toward transition or reveal herself to the world yet, it became necessary to hide the effects of hormone therapy under a daily uniform of baggy scrubs at work. There were occasional glances from co-workers Kristine noticed which made her wonder, “Do they know?” One observant nurse suggested maybe she should get her hormones checked, while another patted her on the back in a way she could sense the nurse was checking for a bra strap. Kristine laughs, “Yep, she found it.” Over time it became harder and harder to hide the effects of hormone therapy.
After coming out to Laura, Kristine and Laura slowly expanded the circle of who she told. Laura needed someone to confide in and share her feelings and Kristine needed to work to overcome her fear. Sensing they would be the most accepting, Kristine opened up to Laura’s family first, and they proved supportive. She mustered the courage to eventually tell her parents via an email and was grateful to have her parents accept her. After receiving the email, her dad called immediately and stated, “First thing, we love you.” Eventually, Kristine, with the support of Laura by her side, explained her gender dysphoria to the bishop and stake president. During these initial encounters with church leaders, Kristine stated she was trying to do her best to balance her reality with the recommendations from church policy (which currently prevent transitioned individuals from holding the priesthood and entering the temple). Unfortunately, that attempt at balancing turned into a “massive list of do’s and do not’s.” The constant worry of potentially doing something wrong intensified and depression led Kristine to a dark place. “I felt trapped. I felt stuck between a rock and a hard place with the pressure of maintaining policy and trying to be myself.” The pressure and depression became so intense she considered taking her life. She recalls, “The thought came, ‘There is a way out, why don’t you take it?,’ which scared me as for so many years I’d prided myself on never getting to that point.” But the feeling became palpable one day while dressing for work. In her closet, Kristine found medication from a past surgery and thought, “All I had to do was take those pain meds and it would all go away.” She lay there looking at the medications, thoughts racing. One of the things that helped her finally get up was her patients in need at that very moment.
As Kristine worked through her morning shift, the floods of thoughts of all the other people who would be affected entered her mind--her wife, her family. She realized something needed to change. She went out to her car, “cried a lot,” and tearfully called the suicide hotline. She says it was a very encouraging call that led her to go home and talk with Laura about what had happened and figure out how to make this work. Kristine continued to get help from her doctor, and her mental health improved. Both Kristine and Laura knew some things needed to change. Through continued work together and through prayer, there were intense spiritual experiences that offered Kristine assurance. “I sensed He knows me, sees me, and that my task was to continue to try as hard as I could to negotiate this pathway; and that through the spirit, it could work.” In 2022, with the help of Laura and spiritual guidance, Kristine decided to transition. The morning after she made this decision, Kristine woke up feeling a “huge weight off my shoulders.” The mental clarity allowed her to think and feel; gone were the suppressed emotions of anger, happiness, and sadness. Kristine says, “To start feeling those emotions and have them mean something was incredible.” Kristine stated she knew the struggle would continue, but this was her first glimpse at feeling real.
Kristine began the process of changing her name and markers, and lauds her medical community of bosses, coworkers, and patients who have in all but one or two cases been extremely kind and supportive. When she walks into a hospital room, she says, “Most patients don’t even bat an eye.” Using her medical experience, Kristine became curious about her own genetics and obtained a whole genome sequencing study. Using prior abnormal hormone levels before transition along with journal articles linking abnormal congenital bone growths, leading to eight hip surgeries, Kristine was able to link a diagnosis of congenital hypogonadotropic hypogonadism to her gender dysphoria, with the help of her primary care doctor. The results fascinated Kristine and she delved into an intense study of our genetics and human development. This work demonstrated gender dysphoria and even intersex conditions don’t always derive from one gene. Often, it’s multiple genes working in concert in a massive orchestration of hundreds of genes that lead to a clinical effect.
As Kristine has expanded her research, she started joining online forums where people discuss gender dysphoria, transgender concerns, and intersex conditions. She has even helped others study and decipher their own genetic testing. At the forefront of her mind, Kristine teaches that the problem is not that a child is born intersex or with gender dysphoria, but how do we care for that child so they can grow and be respected and loved in a way that’s meaningful? Kristine now regularly gives presentations to medical students, residents, medical schools and conferences. She shares her own story with colleagues and church members, educating others about our incredible genetic makeup and development that leads to an amazing human diversity to be loved and respected.
Because Kristine works every other Sunday, she tries to be as active in her ward as possible, where she is called “Sister Coons” (as is Laura). Kristine serves as ward organist. She says, “My prior spiritual experiences have helped me navigate muddy waters, and they are muddy. I find some policies hurtful, but I also know I need to keep going. My faith has grown as I see so many who have been wonderful, kind and thoughtful. I am grateful for my stake president who has said he’s seen a huge change in our stake just from me being present. The vast majority are open and curious in a good way.”
The Coons family lives near many relatives who they enjoy spending summers with, boating on the lake or skiing during the winter. Kristine says, “My kids like to brag they have two moms. Laura goes by ‘mom,’ I go by ‘madre.’ My kids are amazing. They stand up for me. I stand up for them. We have a great family.” All four of the Coons’ children are on the autism spectrum and Kristine says, “Their spirituality differs from what you’d expect from many other people. They believe in God and know their Savior… whether they keep going or not, I think they’ll navigate that while having a relationship with Christ.” Kristine has become involved with the political scene in states like Florida and Utah among others, contributing her medical research and opinions to policymakers. Because of laws in certain states, Kristine has been hesitant and even fearful of traveling to other states where things are not favorable for the transgender community. But she asks, “How do you negotiate or interact with a group of people who are fighting against you? The perspective I’ve found to be the most successful is to just do the next right thing. One step at a time. A lot of work, a lot of change – one step at a time, along the way – will have positive outcomes. I have to be hopeful with this, look for next right thing, and stand up for what’s right.”
“My work and efforts aren’t finished. I’ve been Kristine Coons now for two years, and I feel and love myself. I love me, I love seeing me, and even more importantly, I love helping others to see themselves.” At work, Dr. Coons has observed that “for some reason,” she is often assigned the transgender patients. “I wonder why,” she laughs. “But every time I interact with these wonderful humans and see what they go through and have to fight for, the more I want to share and work to make sure we have a voice and can stand up for those who don’t.”
