My name is Pax Enstad, and I’m a high school junior, a son, a brother and a friend.

I’m also a transgender boy. When I tell people this, it seems like everyone wants to know: What’s the precise moment when you realized you are transgender? The thing is, there was no single moment, no bolt of lightning that suddenly hit me. It was more of a process of admitting who I am to myself.

When I hit puberty, I felt really gross and unhappy with my body. I stopped swimming and doing things outside, and started wearing baggy shirts. I asked my parents for a chest binder, but I didn’t tell them it was to flatten the breasts I was getting. My body was a thing that I tried to forget about.

I had yet to confront my own fear of being transgender. I thought, maybe all these feelings will go away, but they didn’t. Existing in a body that didn’t feel like mine became increasingly unbearable. Gender dysphoria is the clinical diagnosis, and the distress it caused me was severe; I panicked when I didn’t have my chest binder on. I put off telling my parents about my being transgender. I was embarrassed about it, and didn’t want to say anything until I was totally sure. By the time I finally told them, I knew I needed to have surgery to confirm the gender identity I’ve had all along.

What had been a years-long process for me was for my parents a sudden revelation. They love me and have done their best to be supportive of me. But PeaceHealth, my mom’s employer, refused to pay for the chest reconstruction surgery my doctor prescribed to treat my gender dysphoria, citing an exclusion for “transgender services.” It felt terrible to know that PeaceHealth, a nonprofit health care system, had decided that transgender people like me don’t deserve coverage for the same double mastectomy surgeries it will cover for others. It was treating essential treatment as something frivolous.