— Kathryn wanted pants. And short hair. Then trucks and swords.
Her parents, Jean and Stephen, were fine with their toddler’s embrace of all things boy. They’ve both been schoolteachers and coaches and are pretty immune to the quirky stuff that kids do.
But it kept getting more intense, all this boyishness from their younger daughter. She began to argue vehemently, as only a tantrum-prone toddler can, that she was not a girl.
“I am a boy,” the child insisted, at just 2 years old.
And that made Jean uneasy. It was weird.
“I am a boy” became a constant theme in struggles over clothing, bathing, swimming, eating, playing, breathing.
Jean and Stephen gave up trying to force Kathryn to wear the frilly dresses Grandma kept sending. Kathryn wanted nothing to do with her big sister’s glittery, sparkly pink approach to the world. (This story uses the family’s middle names to protect their identity beyond their community, where their situation already is widely known.)
Kathryn didn’t even want to be around other little girls, let alone acknowledge that she biologically is one.
Jean tried to put her daughter’s behavior to rest. She sat down with a toddler-version of an anatomy book and showed Kathryn, by then 3, the cartoonish drawings of a naked boy and girl.
“See? You’re a girl. You have girl parts,” Jean told her big-eyed daughter. “You’ve always been a girl.”
Kathryn looked up at her mom, incomprehension clouding her round face.
“When did you change me?” the child asked.
Was something wrong with Kathryn?
Her little girl’s brain was different. Jean could tell. She had heard about transgender people, those who are one gender physically but the other gender mentally.
“But this young? In kids?” Jean wondered. She had grown up in a traditional family in the Midwest, with a mother who’d gone to medical school after having children. Jean considered herself open-minded, but this was clearly outside her realm of experience.
She went online to see if a book about transgender kids even existed. It did — “The Transgender Child: A Handbook for Families and Professionals.” Its summary read: “What do you do when your toddler daughter’s first sentence is that she’s a boy? What will happen when your preschool son insists on wearing a dress to school? Is this ever just a phase? How can you explain this to your neighbors and family?”
Bingo.
When it arrived at their Maryland home, Jean ripped through it, soaking up every word. But she couldn’t bring herself to share with her husband what she’d read.
She went back online and watched videos of parents talking about their realization that their child was transgender. They all described a variation of the conversation she’d had with Kathryn: “Why did you change me?”
Many talked about their painful decision to allow their children to publicly transition to the opposite gender, a much tougher process for boys who wanted to be girls.
Some of what Jean heard was reassuring: Parents who took the plunge said their children’s behavior problems largely disappeared, schoolwork improved, happy kid smiles returned.
But some of what she heard was scary: children taking puberty blockers in elementary school and teens embarking on hormone therapy before they’d even finished high school.
All of it is a new and controversial phenomenon.
In the United States, children have been openly transitioning genders for probably less than a decade, said Jack Drescher, a New York psychiatrist who is a leader in the field of gender orientation. There is very little to go on, scientifically, to support that approach, and the very idea of labeling young children as transgender is shocking to many people.
But to others, it makes perfect sense.
“In children, gender solidifies at about 3 to 6,” explained Patrick Kelly, a psychiatrist with the division of child and adolescent psychiatry at Johns Hopkins Children’s Center.
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That’s about the age when girls gravitate to girl things and boys to boy things.
And it’s the age when a child whose gender orientation is at odds with his or her biology begins expressing that disconnect — in Kathryn’s case, loudly.
The American Psychiatric Association has an official diagnosis for this: gender identity disorder in children.
Those who have it, according to the association’s Diagnostic and Statistical Manual of Mental Disorders, experience “a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual’s own sex.”
And, it adds, “mere tomboyishness in girls or girlish behavior in boys is not sufficient” to warrant the diagnosis. It requires “a profound disturbance of the normal gender identity.”
The manual is being updated this year, and a task force that Drescher serves on is studying whether to remove the word “disorder” from the diagnosis and instead call the condition “gender incongruence.”
Not just a tomboy
Whatever it’s called, it can’t always be solved by letting girls wear pants or boys wear dresses, psychiatrists say. Many of the kids have gender dysphoria, a persistent dislike of their bodies. They may shower with their clothes on so they don’t have to see themselves. Or demand to know when their penises will grow in. Or, in extreme cases, try to cut their penises off.
Parents who ignore or deny these problems can make life miserable for their kids, who can become depressed or suicidal, psychiatrists say.
Jean didn’t want Kathryn to hate herself or be subjected to hate from others. Maybe allowing her to declare herself a boy in preschool would make life easier in the long run.
Yet not everyone who treats gender identity disorder in children believes in allowing them to transition to the opposite sex when they are young.
There’s some evidence — most of it anecdotal — that gender dysphoria is a phase many children outgrow.
In the United States, it’s impossible to know how many children have gender identity problems because the condition usually goes unacknowledged by parents and pediatricians, said Edgardo Menvielle, who counsels transgender kids at Children’s National Medical Center in Washington. About a dozen children belong to his support group, and hundreds of families across the country are part of his online support network.
In the decade that Menvielle has been counseling such children, he says that about 80 percent end up switching back to what their biology tells them. The rest remain transgender into adulthood.
Was Kathryn going through a phase? After many hours of research and another full summer of bathing-suit fights, Jean didn’t think so.
Kathryn was 4 when Jean finally broached the subject with her husband.
“Have you noticed that Kathryn wants to be a boy?” she remembered asking one night as she and Stephen were washing the dishes after putting the kids to bed.
“She’s just a tomboy,” Stephen replied.
Jean shook her head.
“No, Stephen, I’m pretty sure Kathryn is transgender. She’s not just a tomboy,” she said. “And I think maybe we should start letting her call herself a boy.”
Stephen thought she was nuts. “I told her she was making too much of this,” he recalled.
Despite his resistance, Stephen promised his wife that he would pay closer attention to Kathryn’s behavior and really listen for her “I am a boy” anthem.
It didn’t take long.
“We were in the car. I was driving,” Stephen said. Kathryn was in the back and grabbed a book off the seat.
“Daddy, I’m going to read you a story, OK?” Kathryn said, opening a random book and pretending to read. “It’s about a little boy who was born. But he was born like a girl.”
Stephen nearly slammed the brakes, then listened as the story unfolded about how unhappy the little boy was.
“OK. I’m listening, Jean,” he said after he got home.
They took Kathryn to a psychologist outside of Philadelphia who specializes in treating the transgendered. Michele Angello confirmed what Jean had long suspected: Kathryn had gender dysphoria. She recommended that Kathryn be allowed to live as a boy, a prospect that filled Stephen with dread but his 4-year-old with elation.
Kathryn wanted to be called “he” right away. And Kathryn wanted to be called Talon, then Isaac, but finally settled on a permanent boy’s name in the fall. ( For this story, the name Tyler is being used. That is the name his parents say they would have given him if he’d been born a boy.)
“When we finally let Tyler shop in the boys’ clothing department, it was like the skies opened up,” Jean said.
They switched to saying he/him/his and stopped using the name “Kathryn” at home.
It was a huge upheaval, a change Jean and Stephen had to remind themselves of every day. Then came the next challenge: telling family, friends, teachers and other parents that their daughter had become their son.
Tyler made his public debut at Sunday school at their Presbyterian church.
The pastor there was so supportive of the family that she invited a panel from a transgender support group to come just before services and explain what Tyler and his family were going through. The room was packed.
Between cookies and coffee after the presentation, many came over to hug Jean.
When it came time for Tyler to make the switch at preschool, Jean and Stephen had to write a very uncomfortable letter to all the parents explaining what was happening.
“If I had a child with autism, I wouldn’t have to do this,” Jean sighed.
They struggled with whether to include the words “gender dysphoria.” “I didn’t want them to think there was something wrong with our child. Just something different,” she said.
They kept the medical term in there so other parents wouldn’t think this was just loose and creative parenting. “I don’t want people to think I’m just indulging a phase. That’s not what this is.”
Tyler’s sister, who’s 8, was much more casual. “It’s just a boy mind in a girl body,” she explained matter-of-factly to her second-grade classmates at her private school, which will allow Tyler to start kindergarten as a boy, with no mention of Kathryn.
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Staff members recently had a training session on gender identity disorder to prepare not only for Tyler but also for other transgender students who may be arriving. This year alone, at least two other families have contacted the school about enrolling their transgender children, according to its director of admissions.
Present and future issues
Not everyone has been accepting of what Jean and Stephen are doing. Some members of Stephen’s family were incredulous when he sent them letters about Tyler’s transformation.
More than once, Jean has come home from the gym infuriated because someone was gossiping about her child. Just the other day, she spotted a co-worker and another adult pointing and laughing at Tyler, who finally got to wear just swim trunks at the pool.
Jean marched over to them and said, “I can provide you with a lot of information about transgender children if you like.”
They clammed up.
A recent family trip to Disney World raised the issue of how to handle the plane tickets. What if they booked the ticket in Tyler’s name, but the TSA did some kind of a full-body scan and saw that Tyler’s biology is female?
Like a peanut allergy mom with her EpiPen, the transformation of Kathryn to Tyler means the family always travels with a “safe folder.” It has birth records, medical records and the all-important diagnosis of gender dysphoria and the doctor recommendation that Kathryn be allowed to live as a boy. Jean never knows when an encounter with Tyler could result in a grown-up freakout or even a call to Child and Family Services Agency.
Other issues lie ahead. In about five years, Tyler’s parents will have to decide whether to put Tyler on puberty blockers to keep his body from maturing and menstruating. Using those drugs represents a leap of faith, psychiatrists said, though the effects are reversible.
The much tougher call comes when kids are about 15 or 16. At that age, they can begin hormone injections that will make them grow the characteristics of the opposite biological sex.
Those hormone treatments essentially create a nearly gender-neutral being, making sex-change surgery far less painful and expensive for young adults. But the hormones also make people infertile, a daunting, irreversible decision for parents to make.
But Jean and Stephen aren’t harboring doubts about what they are doing now.
“If Tyler wants to be Kathryn again, that’s fine,” she said. “But right now, this works. He’s happy. I just want my child to be happy.”
As for Tyler, he is reveling in his new identity. The constant nagging, fighting, obsessing about being a boy is gone.
And the family picture wall now features a prominent photo of Tyler in short hair and a red polo shirt. He is smiling.