The texts and phone notifications just kept coming.
For hours after Duane wrote, “Well, looks like I’m gonna be a daddy” on Facebook, friends showered Liam and Duane with hundreds of “likes” and “Congratulations!”
“That’s gonna be one gorgeous and beloved baby,” one friend said. “Children are a blessing! Enjoy,” said another.
But then, someone admitted: “I’m confused.”
“Who exactly is pregnant and how does all that stuff work?”
And below that, a woman asked, “How did this happen?!”
Duane wrote back, explaining how they conceived: “Well the sperm fertilized the egg and now ... Liam is pregnant. He is a transgender man.”
Weeks later, they shared pictures of Liam’s first trimester. One was of Liam on the couch with their cat, Biscuit resting on his growing belly. Another showed Liam holding his phone near his stomach, playing bluegrass music for the baby.
Above all the photos, Duane wrote: #TeamPregnantDad.
Their friends were supportive. But at work, Duane was peppered with questions.
“Do you think once Liam has the baby he’ll become a woman again and transition back,” one person asked. Duane, annoyed, told her: “No.”
Then another asked more pointed, personal questions — prompting Duane to write angrily on Facebook:
“Just FYI it’s rude to ask me what genitals my spouse has.”
Fitting in nowhere
The questions from strangers take Liam back to being a teenager, scared and self-conscious, wondering who people saw when they looked at him.
Before Liam came out as trans, he’d just tell people he was a lesbian.
The truth, he remembers, was impossible to explain. And the world had shown Liam it would never accept him.
It was obvious, he says, he wasn’t a “girly girl” — he wore baggy pants and had shaved off the long, chestnut hair that once hung down to his waist.
Underneath his clothes, Liam would wrap medical bandages tightly around his breasts to make his chest appear flatter. Still, he felt he didn’t quite “fit in with the guys.”
At 17, it was hard to see life getting any better.
One night Liam wondered what it would be like to just leave.
Research has shown more than half of all transgender males have suicidal thoughts during their teenage years.
In the darkness, Liam intentionally took too much medication, then fell asleep — hoping he wouldn’t wake up.
The next morning, though, he stared at the ceiling again. Alive, he told himself he had to find a better way.
Liam discovered his place in a whole new world after high school.
He still lived with his parents but he joined a rugby team and enrolled in community college. For the first time in his life, he had friends who never thought of him as female.
The rugby team played in a women’s league but everyone there called Liam by male pronouns: he, him, his.
He was accepted, safe — free. Still, at home, he was “she.”
Liam told his parents at 19 he was transgender and he asked them to use his new name and masculine pronouns. But he says this rarely happened. It was frustrating and embarrassing.
More than that, though, Liam wondered: What would it take for the people he loved most to see him as a man? He found an answer in a Borders bookstore as he flipped through the pages of a book about human hormones.
Injections of testosterone, Liam learned, could gradually replace the estrogen that his ovaries produced. When he tried to get a prescription, though, several doctors rejected him. They said they were uncomfortable prescribing testosterone to a trans man, Liam says. He didn’t stop looking until he found one who agreed to start him on a weekly dose.
At first, his voice cracked like a preteen boy going through puberty. Then after a few months, Liam’s vocal chords settled on an even baritone.
He remembers standing in front of the mirror again, this time at age 20, studying the changes in his body from hormones. His arms and legs were bulkier, his shoulders muscular. The curves around his waist were less noticeable. And Liam saw dark, thick body hair in new places.
Even his face was different.
Standing in the shower, working a face wash into a lather, Liam felt his cheeks were firmer. His jaw more rigid. And there was stubble under his chin.
“One day,” he says, “It was like, ‘This is what it feels like to feel okay.’”
Liam’s second trimester
As Liam’s pregnancy progresses, he struggles with keeping his blood sugar stable, at times he’s faint and unable to eat or drink. In January and February, Liam twice went to the emergency room.
Now March, he is 14 weeks pregnant and Liam and Duane rush — for a third time — to the hospital.
Being pregnant, Liam says, seems to have exacerbated health conditions he’s struggled with for years. He has high blood pressure and was diagnosed with diabetes around age 7. For much of his adulthood, he couldn’t afford health insurance and even when he had coverage, he often avoided going to a doctor — worried he’d be misunderstood or mistreated because he’s trans.
This time, it’s the flu.
The ER doctor examining him says Liam’s vomiting over and over again is a dangerous cycle for him and his baby. In the last few hours, his blood sugar levels have swung uncontrollably high and low — which, if left unmanaged, could hurt the baby’s development.
Medicine will help, the doctor says, but Liam will have to be admitted to the hospital’s high-risk maternity ward.
Upstairs, Duane sits beside Liam’s hospital bed as they wait for nurses making rounds.
Liam remembers the door was cracked and he could hear several people just outside his room: “So, what do we call him?”
He wants to intervene but his body is too weak.
Then, he hears a man interrupt sharply: “It’s ‘he’ or ‘him.’ ”
Later, Liam learns that after nearly a decade of all of his official documents saying “male,” his medical chart now says “female.”
The change, Atrium Health explains, happened automatically at Liam’s first prenatal appointment because its hospital software system requires patients be listed as female if they receive obstetrics or gynecology care. This technology is in place to help doctors provide appropriate services and it streamlines insurance claims.
But this high-tech system also creates a problem for transgender people as hospital patients. Medical staff in the maternity ward — who are accustomed to calling almost all of their patients “she” — see nothing in Liam’s chart to indicate he’s trans. His pronouns, “he” or “him,” aren’t listed either.
Atrium’s chief diversity officer, Dr. Kinneil Coltman, says this is a top concern for transgender patients and the hospital is working on fixing the problem internally. For now, though, Liam’s stuck.
He finds himself explaining, multiple times a day when nurses and doctors have shift change, that he goes by “he/him/his.”
Not everyone gets the message, though.
On Day 2 in the hospital, the phone rings inside Liam’s room. Duane picks up to a woman speaking on the other end.
“Hold on,” he tells her.
Liam asks, “Who is it?”
“The cafeteria,” Duane whispers.
“She wants to know, What does ‘Mrs. Johns’ want to order for her dinner?”
Later that night, Duane falls asleep on the small padded bench under a window in Liam’s hospital room. Every night, for the entire week Liam is there with the flu, Duane stays with him.
“He’s my rock,” Liam says. “Having to advocate for yourself when you’re sick - it’s just horrible.”
It’s not just the hospital, though. At home, Liam’s family and even some of his oldest friends call him “Mama.”
Read “’Mothers’ only,” Chapter 3 of #TeamPregnantDad.
Read about changes since Liam’s pregnancy at Atrium Health.
BEHIND OUR REPORTING
Reporter Anna Douglas and videographer Diedra Laird spent more than a year chronicling the lives of Liam Johns and husband Duane Danielson through Liam’s pregnancy and the birth of their child.
Almost all of the conversations and details in #TeamPregnantDad were personally witnessed by Douglas or Laird. In story scenes containing flashbacks or details the journalists did not witness, the Observer has reconstructed that information following extensive interviews with Liam, Duane, their healthcare providers, friends and family.
Liam had previously been featured in 2016 in an Observer profile called “Becoming Liam,” which was published around the time North Carolina lawmakers passed HB2. The law (which was later repealed) restricted access to public restrooms for transgender people who had transitioned but had not changed the sex listed on their birth certificate.