Supporting Boys or Girls When the Line Isn’t Clear

Jim Wilson/The New York Times

A boy, 5, left, who identifies as a girl, plays witha friend in Northern California. He began emulating girls shortly afterturning 3.

By PATRICIA LEIGH BROWN

Published: December 2, 2006

OAKLAND, Calif., Dec. 1 — Untilrecently, many children who did not conform to gender norms in theirclothing or behavior and identified intensely with the opposite sexwere steered to psychoanalysis or behavior modification.

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Dr. Kenneth Zucker, a psychologist at the Center for Addiction andMental Health in Toronto, encourages children to be content with theirgender.

But as advocates gain groundfor what they call gender-identity rights, evidenced most recently byNew York City’s decision to let people alter the sex listed on theirbirth certificates, a major change is taking place among schools andfamilies. Children as young as 5 who display predispositions to dresslike the opposite sex are being supported by a growing number of youngparents, educators and mental health professionals.

Doctors, some of them from the top pediatric hospitals, have begun toadvise families to let these children be “who they are” to foster asense of security and self-esteem. They are motivated, in part, by thehigh incidence of depression,suicidal feelings and self-mutilation that has been common in pastgenerations of transgender children. Legal trends suggest that schoolsare now required to respect parents’ decisions.

“First we becamesensitive to two mommies and two daddies,” said Reynaldo Almeida, thedirector of the Aurora School, a progressive private school in Oakland.“Now it’s kids who come to school who aren’t gender typical.”

Thesupportive attitudes are far easier to find in traditionally tolerantareas of the country like San Francisco than in other parts, but evenin those places there is fierce debate over how best to handle thechildren.

Cassandra Reese, a first-grade teacher outsideBoston, recalled that fellow teachers were unnerved when a young boyshowed up in a skirt. “They said, ‘This is not normal,’ and, ‘It’s theparents’ fault,’ ” Ms. Reese said. “They didn’t see children assophisticated enough to verbalize their feelings.”

As theirchildren head into adolescence, some parents are choosing to blockpuberty medically to buy time for them to figure out who they are —raising a host of ethical questions.

While these children arestill relatively rare, doctors say the number of referrals is risingacross the nation. Massachusetts, Minnesota, California, New Jersey andthe District of Columbia have laws protecting the rights of transgenderstudents, and some schools are engaged in a steep learning curve todismantle gender stereotypes.

At the Park Day School inOakland, teachers are taught a gender-neutral vocabulary and are urgedto line up students by sneaker color rather than by gender. “We arecareful not to create a situation where students are being boxed in,”said Tom Little, the school’s director. “We allow them to move back andforth until something feels right.”

For families, it can be along, emotional adjustment. Shortly after her son’s third birthday, PamB. and her husband, Joel, began a parental journey for which there wasno map. It started when their son, J., began wearing oversized T-shirtsand wrapping a towel around his head to emulate long, flowing hair.Then came his mother’s silky undershirts. Half a year into preschool,J. started becoming agitated when asked to wear boys’ clothing.

Enroute to a mall with her son, Ms. B. had an epiphany: “It just clickedin me. I said, ‘You really want to wear a dress, don’t you?’ ”

Thusbegan what the B.’s, who asked their full names not be used to protecttheir son’s privacy, call “the reluctant path,” a behind-closed-doorsstruggle to come to terms with a gender-variant child — a spirited5-year-old boy who, at least for now, strongly identifies as a girl,requests to be called “she” and asks to wear pigtails and pink jumpersto school.

Ms. B., 41, a lawyer, accepted the way her sondefined himself after she and her husband consulted with a psychologistand observed his newfound comfort with his choice. But she feels theprecarious nature of the day-to-day reality. “It’s hard to convey therelentlessness of it, she said, “every social encounter, every time yougo out to eat, every day feeling like a balance between your kid’sself-esteem and protecting him from the hostile outside world.”

Theprospect of cross-dressing kindergartners has sparked a deepphilosophical divide among professionals over how best to counselfamilies. Is it healthier for families to follow the child’s lead, orto spare children potential humiliation and isolation by steering themtoward accepting their biological gender until they are older?

Bothsides in the debate underscore their concern for the profoundvulnerability of such youngsters, symbolized by occurrences like themurder in 2002 of Gwen Araujo, a transgender teenager born as Eddie,southeast of Oakland.

“Parents now are looking for advice on howto make life reasonable for their kids — whether to allowcross-dressing in public, and how to protect them from the savagery ofother children,” said Dr. Herbert Schreier, a psychiatrist withChildren’s Hospital and Research Center in Oakland.

Dr. Schreieris one of a growing number of professionals who have begun to think ofgender variance as a naturally occurring phenomenon rather than adisorder. “These kids are becoming more aware of how it is to bethemselves,” he said.

In past generations, so-called sissy boysand tomboy girls were made to conform, based on the belief that theirbehaviors were largely products of dysfunctional homes.

Among therevisionists is Dr. Edgardo Menvielle, a child-adolescent psychiatristat the Children’s National Medical Center in Washington who started anational outreach group for parents of gender-variant children in 1998that now has more than 200 participants. “We know that sexuallymarginalized children have a higher rate of depression and suicideattempts,” Dr. Menvielle said. “The goal is for the child to be welladjusted, healthy and have good self-esteem. What’s not important ismolding their gender.”

The literature on adults who aretransgender was hardly consoling to one parent, a 42-year-old softwareconsultant in Massachusetts and the father of a gender-variant thirdgrader. “You’re trudging through this tragic, horrible stuff andrealizing not a single person was accepted and understood as a child,”he said. “You read it and think, O.K., best to avoid that. But as aparent you’re in this complete terra incognita.”

The biologicalunderpinnings of gender identity, much like sexual orientation, remainsomething of a mystery, though many researchers suspect it is linkedwith hormone exposure in the developing fetus.

Studies suggestthat most boys with gender variance early in childhood grow up to begay, and about a quarter heterosexual, Dr. Menvielle said. Only a smallfraction grow up to identify as transgender.

Girls withgender-variant behavior, who have been studied less, voice extremeunhappiness about being a girl and talk about wanting to have maleanatomy. But research has thus far suggested that most wind up asheterosexual women.

Although many children role-play involvinggender, Dr. Menvielle said, “the key question is how intense andpersistent the behavior is,” especially if they show extreme distress.

Dr. Robin Dea, the director of regional mental health for KaiserPermanente in Northern California, said: “Our gender identity issomething we feel in our soul. But it is also a continuum, and itevolves.”

Dr. Dea works with four or five children under theage of 15 who are essentially living as the opposite sex. “They aremuch happier, and their grades are up,” she said. “I’m waiting for thestudy that says supporting these children is negative.”

But Dr.Kenneth Zucker, a psychologist and head of the gender-identity serviceat the Center for Addiction and Mental Health in Toronto, disagreeswith the “free to be” approach with young children and cross-dressingin public. Over the past 30 years, Dr. Zucker has treated about 500preadolescent gender-variant children. In his studies, 80 percent growout of the behavior, but 15 percent to 20 percent continue to bedistressed about their gender and may ultimately change their sex.

Dr.Zucker tries to “help these kids be more content in their biologicalgender” until they are older and can determine their sexual identity —accomplished, he said, by encouraging same-sex friendships andactivities like board games that move beyond strict gender roles.

Thoughshe has not encountered such a situation, Jennifer Schwartz, assistantprincipal of Chatham Elementary School outside Springfield, Ill., saidthat allowing a child to express gender differences “would be verydifficult to pull off” there.

Ms. Schwartz added: “I’m not sureit’s worth the damage it could cause the child, with all the prejudicesand parents possibly protesting. I’m not sure a child that age is readyto make that kind of decision.”

The B.’s thought long and hardabout what they had observed in their son. They have carefullychoreographed his life, monitoring new playmates, selecting acompatible school, finding sympathetic parents in a babysitting co-op.Nevertheless, Ms. B. said, “there is still the stomach-clenching fearfor your kid.”

It is indeed heartbreaking to hear a child say, as J. did recently, “It feels like a nightmare I’m a boy.”

Theadjustment has been gradual for Mr. B., a 43-year-old public schooladministrator who is trying to stop calling J. “our little man.” Hethinks of his son as a positive, resilient person, and his love andadmiration show. “The truth is, is any parent going to choose this fortheir kid?” he said. “It’s who your kid is.”

Families are caughtin the undertow of conflicting approaches. One suburban Chicago mother,who did not want to be identified, said in a telephone interview thatshe was drawing the line on dress and trying to provide “boyopportunities” for her 6-year-old son. “But we can’t make everything apower struggle,” she said. “It gets exhausting.”

She worriesabout him becoming a social outcast. “Why does your brother like girlthings?” friends of her 10-year-old ask. The answer is always, “I don’tknow.”

Nila Marrone, a retired linguistics professor at the University of Connecticutwho consults with parents and schools, recalled an incident last yearat a Bronx elementary school in which an 8-year-old boy perceived aseffeminate was thrown into a large trash bin by a group of boys. Theprincipal, she said, “suggested to the mother that she was to blame,for not having taught her son how to be tough enough.”

But the tide is turning.

TheLos Angeles Unified School District, for instance, requires thatstudents be addressed with “a name and pronoun that corresponds to thegender identity.” It also asks schools to provide a locker room orchanging area that corresponds to a student’s chosen gender.

One of the most controversial issues concerns the use of “blockers,” hormonesused to delay the onset of puberty in cases where it could bepsychologically devastating (for instance, a girl who identifies as aboy might slice her wrists when she gets her period). Some doctorsdisapprove of blockers, arguing that only at puberty does an individualfully appreciate their gender identity.

Catherine Tuerk, anurse-psychotherapist at the children’s hospital in Washington and themother of a gender-variant child in the 1970s, says parents are stillleft to find their own way. She recalls how therapists urged her tosteer her son into psychoanalysis and “hypermasculine activities” likekarate. She said she and her husband became “gender cops.”

“It was always, ‘You’re not kicking the ball hard enough,’ ” she said.

Ms.Tuerk’s son, now 30, is gay and a father, and her own thinking hasevolved since she was a young parent. “People are beginning tounderstand this seems to be something that happens,” she said. “Butthere was a whole lifetime of feeling we could never leave him alone.”

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