Around age 3, Luna Younger started asking to wear dresses. Since the age of 5, she has insisted she is a girl. Now Luna is 7, and during court hearings, physicians, school staff, and family members have all testified that Luna has consistently, persistently identified as a girl.

While Luna’s mother respects her daughter’s gender identity — letting her wear what she chooses, whether it’s nail polish, dresses, or longer hair — Luna’s father does not. He insists Luna is not transgender. These polarizing differences over how to raise and treat a child are why trans families and advocates, as well as conservatives, have been closely watching the custody battle over the Coppell, Texas, trans girl.

After 15 months in court, on October 22, the jury awarded Luna’s mother, Anne Georgulas, full conservatorship of her daughter. It was a decision that brought relief to the trans community and outraged conservatives who believe supporting a trans child’s gender identity is tantamount to child abuse.

People were so riled up online, some sent threats to Georgulas; she was “viciously attacked and threatened by complete strangers,” her attorneys told the Daily Caller. Several prominent Texas officials even added to the fray, including Republican Gov. Greg Abbott, who promised to order the state’s child protective services to investigate Georgulas. State Rep. Steve Toth said he would propose a bill to “add ‘Transitioning of a Minor’ as Child Abuse.”

Two days after the debate boiled over online, Judge Kim Cooks decided to vacate the jury decision. Instead, she granted the parents “joint managing conservatorship,” which is the equivalent of joint custody in Texas. (Cooks has maintained that she did not make her decision based on any government official’s opinion; she has not responded to Vox’s request for comment.) While Georgulas, a pediatrician, had requested that the court order Luna’s father, Jeffrey Younger, to respect their daughter’s gender identity, Cooks said that “the Court finds that the State of Texas has no compelling interest to justify such interference.”

The ruling has brought more questions than answers: When one parent honors her child’s gender identity and the other does not, what does that mean for the child? More specifically, what will it mean for her socialization, her mental well-being, and who she’s allowed to be?

Trans advocates say Cooks’s decision is a dangerous misstep. “Transgender children are among the most vulnerable members of the next generation,” Gillian Branstetter, media relations manager at the National Center for Transgender Equality, told Vox. “We know they experience any variety of godawful barriers to their own success, including bullying and harassment, including psychological distress, often resulting from such harassment, [and] family rejection. … It does a serious disservice to those kids to give any incentive for a parent to reject their child for who they are.”

On Tuesday, Georgulas filed to appeal the judge’s ruling, according to a press release from a family representative. The mother is asking Cooks to recuse herself after allegedly posting about the case on her personal Facebook while deliberations were ongoing. This is after the judge had placed a gag order on Georgulas and Younger from commenting about the case, acknowledging that the publicity from it was affecting Luna’s and her twin brother’s privacy and well-being. (Georgulas and Younger are still currently under gag order; Younger’s attorney did not return Vox’s request for comment.)

Since the verdict, a representative for Georgulas, Karen Hirsch, said that a rock was thrown through a window at Georgulas’s house while the children were sleeping and that Georgulas has been forced to close her pediatric practice after dead animals and graffiti were left outside the door. Meanwhile, parents in Luna’s neighborhood are afraid to send their children to class after Younger had named the school online — they feel their children could be in danger from those trying to attack Luna.

The case has hit a boiling point where lives feel threatened and trans families inside and outside of Texas feel unsafe — all over whether a child should be allowed to wear a dress and be called “she” and “her.”

Before the custody battle, Luna’s father launched a campaign to “save” his child that’s been championed by the far right

The legal battle over Luna — and, ultimately, how she is allowed to identify — reached a tipping point in August 2018 when Georgulas filed for a restraining order against Younger, specifically seeking to prevent him from entering Luna’s school and telling people “that the gender of Luna is different than a girl named Luna.”

In response, Younger petitioned for full conservatorship that same month. Up until this point, he had been allowed to see his kids once a week for two hours and on the first, third, and fifth weekends of each month since 2017, though court testimony indicates he frequently skipped his visitation days. He also launched a social media campaign to “save” his child from the supposed harm of transitioning. For a child of Luna’s age, this is solely social and consists of keeping her hair long, choosing her own clothing, and using a feminine name and pronouns.

However, the conservative campaign spread incorrect fears that Georgulas was seeking to immediately “chemically castrate” the child — a misinformed, scary-sounding reference to hormone medications that would suppress Luna’s testosterone production and replace it with estrogen, which would typically be years in Luna’s future, according to standard medical guidelines. The only plans Georgulas had, according to court transcripts, was to take Luna to a Children’s Health clinic for transgender kids in Dallas. There, they would discuss a plan for potentially starting her on puberty blockers, which are reversible, in the next few years if Luna’s gender dysphoria persists. (The clinic did not return Vox’s requests for comment.)

Seizing on Younger’s narrative of Georgulas manipulating her child, right-wing media outlets like LifeSiteNews and the Daily Wire also accused Georgulas of forcing Luna to be transgender “because she wanted a girl.” But that claim seems rather flimsy because Georgulas has two older daughters from a prior marriage.

In court testimony, Georgulas said that she would prefer if Luna were not transgender, but she supports her child’s gender identity regardless of her own feelings. “From my knowledge as a pediatrician and also from the research I’ve done, it is better to affirm for the psychological well-being of the child … [doctors recommended] that we affirm the child’s choices, whatever those choices are,” she said.

Meanwhile, Younger made the conservative media circuit rounds, insisting it was Georgulas who was forcing Luna to present as a girl. Luna “presents as a boy with me and [she] presents as a girl with his mom,” Younger told LifeSiteNews, a conservative Christian website, in September. “[She] gets dressed as a boy at [her] mother’s home and [she] comes out to me as a boy. That means that [she’s] comfortable as a boy at [her] mother’s home.” Georgulas and others who have testified have disputed this latter part, saying it was Younger forcing Luna to present as a boy.

Maternal blame appears to be common when it comes to trans children of estranged couples. While data on the number of trans children involved in custody disputes doesn’t yet exist, a Family Court Review study released earlier this year examined the cases of 10 divorced mothers who affirm their child’s trans- and gender non-conforming identities. In each of the 10 cases, the child’s father blamed the affirming mother for “causing” the child to be trans, and courts gave a favorable ruling to the father in four of those cases. However, “parents probably have little or no influence on the child’s core feelings that define him or her as gender typical or gender variant,” the study said.

Overall, conservative media has used the custody case to not only bash transgender people (“When they come for your kid” blared a headline in the American Conservative, which was followed by a roundup of disinformation), but to demonize a mother and small child. “It has resulted in threats, harassment, and even vandalism of my client’s property,” attorneys for Georgulas told the Daily Caller in a statement.

Despite how the far right has painted Georgulas, it is Younger’s character that has come under legal scrutiny. According to court documents of the annulment of his and Georgulas’s marriage, the court found that Younger lied about multiple aspects of his life: his career, his previous marriages, his income, his education, and even his military service. It was enough for a Texas court to annul their six-year marriage because it was entered into under fraudulent terms.

Judge Cooks also called out Younger for profiting off a violation of his family’s privacy. “The father finds comfort in public controversy and attention surrounded by his use of unfounded facts and is thus motivated by financial gain of approximately $139,000 which he has received at the cost of the protection and privacy of his children,” she wrote in her judgment, referring to a crowdfunding and merchandising scheme launched last year by Younger.

Even conservative pundit Glenn Beck expressed concern over Younger’s past. On his radio show, he read the court’s findings of fact showing that Younger acted aggressively toward Georgulas’s older daughters, withholding their possessions, locking them in their rooms, and forcing them to do “plank push-ups” until they agreed to follow house rules.

That aggressiveness was also directed at Luna, according to Georgulas’s attorney Kim Meaders. “[Luna] has said to CPS that she is afraid of her father,” she said in her opening statement. “Her brother has said that she is sad and her father makes her sad. By making her dress in boys’ clothes, that makes Luna sad.”

What’s currently at stake is Luna’s social transitioning

Perhaps the greatest falsehood of all, according to official court records, is that Luna hasn’t been clear about how she identifies.

According to a transcript of a July 10, 2018, hearing in the case, Luna’s twin brother, a CPS worker, a therapist, and a pediatrician all attest to Luna’s gender identity as a girl. The medical professionals who have seen Luna have recommended she be affirmed and treated as a girl, and it’s Younger who refuses to accept his child’s gender identity.

In April 2017, Luna asked to be referred to by the name Luna. At age 5, Luna was diagnosed by a qualified professional therapist as having gender dysphoria, distress stemming from a mismatch between her birth sex and her gender identity. Her pediatrician noted that at both her 5-year and 6-year checkups, Luna presented as a girl and has been persistent in her gender identity throughout her childhood.

Thousands of New Yorkers gathered in Times Square to protest President Trump’s call to ban transgender people from the military on July 26, 2017.

Michael Nigro/Pacific Press/LightRocket via Getty Images

“The father doesn’t follow the recommendations of the counselor or the pediatrician, and he shames her to try to make her feel bad for wanting to dress as a girl,” Meaders, Georgulas’s attorney, told the court. “Even though the father knows she wants super-long hair, he shaves her head when he has the opportunity and leaves the other twin boy’s hair long,” referring to her twin brother Jude.

It is the hair-shaving detail that stands out as especially cruel to trans people and advocates. “Luna’s father has been very insistent on cutting her hair extremely short, and that is like one of my daughter’s biggest dysphoric points,” Jane, a Dallas-area mother of a trans kid who knows Luna (and whose name has been changed for this story) told Vox. “For her, all of this is about the fact that Luna is being forced to have short hair. She doesn’t understand all the other ramifications.”

Luna’s hair figures so prominently in this case because at age 7, hair is often the only differentiating physical indicator of a child’s gender. Clothed, boys’ and girls’ bodies at that age are essentially the same, having not yet undergone any effects from puberty. A trans child at age 7 does not make permanent changes to their body, despite what Younger claims Georgulas wants to do.

Ultimately, the dispute at this current stage — and several years into the future — is over Luna’s social transition: how she wears her hair, what clothes she wears, her name, and pronouns.

“There is no medical intervention of any sort prior to someone hitting puberty,” Dr. Joshua Safer, executive director at the Center for Transgender Medicine and Surgery at Mount Sinai and president of the United States Professional Association for Transgender Health, told Vox. “So small children do not get medicines and small children do not get surgeries, for sure.

“The standard approach when kids are gender expansive — when they say they’re transgender, when they think they’re transgender, whatever that might happen, to get a clue that this might be going on — is pretty much to listen to the kid and to kind of follow their guidance in terms of what they want to do, what the child wants to do,” he added.

Safer says it’s important to develop an individualized plan for mental and physical health for gender dysphoric kids and adolescents. Varying degrees of family support for transition means coexisting mental health issues are important to examine for any trans child; there’s no one-size-fits-all solution for all kids. Most of all, the child must feel comfortable with the plan.

Genecis, the Children’s Health clinic where Georgulas wanted to Luna to receive care, makes it clear on its website that it does not perform gender-related surgeries. In providing comprehensive, age-appropriate mental health and hormonal care for trans youth and adolescents, it follows established guidelines from major medical associations in its treatment. The jury’s decision, before it was overruled by the judge, would have allowed her to Luna to receive care at the clinic without Younger’s approval. Now she won’t be able to.

According to court transcripts, Younger had missed several appointments with medical professionals who have worked with Luna, claiming to want opinions from other providers. However, at the time, he hadn’t followed through on those requests.

Over the past decade, medical experts have moved from “watchful waiting” to a gender-affirming approach for trans children

Boiling under the surface of the custody battle is a medical dispute over how best to treat and support children with gender dysphoria. Younger claimed in court that he supports the “watchful waiting” approach to dysphoric youth. Watchful waiting wasn’t given its name until 2012, but it’s based on an older approach developed by Dutch and Canadian clinicians in the mid-to-late aughts that suggests that parents must ensure their children perform the role of their assigned sex at birth.

Under watchful waiting, a prepubescent trans girl like Luna would be forced to maintain short hair, wear stereotypical boy clothes, form friendships with boys her age, maintain her birth name and pronouns under the belief that it’s statistically likely that her dysphoria will desist by the time puberty begins. If Luna’s dysphoria does persist, only then would she be given puberty blockers, so she can mature before making a more permanent decision on hormone treatment.

Political forces opposed to social transitions for children are fond of saying “let kids be kids” — but watchful waiting seems counterintuitive to that goal.

“Watchful waiting is a deceptive term,” said Kelley Winters, a writer and consultant on issues of gender diversity in medical and public policy, told Vox. “There’s nothing neutral. It’s meant to sound effectively neutral, and there’s nothing neutral about forcing trans kids to spend their childhoods in the closet and grow up with absolutely no memories of being authentically present in their entire childhood.”

The approach is based on older statistics that as many as 80 percent of children with gender dysphoria will eventually desist and grow into cisgender adults. But those numbers, according to Safer, are flawed.

“In terms of that desistance 80 percent comment, that’s an old Dutch study where they didn’t ask the blunt question about your gender identity to these kids,” he said. “They kind of danced around the topic with a bunch of other questions and kind of assumed they knew the gender identities, but I don’t know that it shows much of anything. It just shows that 80 percent of kids who answer questions in a stereotypical way, that you think might be associated with gender identity, end up not being transgender. But there’s a lot of bias in the questions.”

At issue is the fact that when the Dutch and Canadian studies were conducted, the official diagnosis for gender-variant kids was “gender identity disorder.” In order to be diagnosed with GID, a child merely had to display cross-gender dress or behavior, regardless of whether they declared themselves to actually be a member of the opposite sex. The effect of this diagnosis is that cisgender gay and lesbian children, who also frequently display cross-gender preferences without declaring themselves to be the opposite gender before puberty, were caught up in the clinicians’ studies and so of course they would “desist” later on.

Even Thomas Steensma, a researcher and clinician at the Center of Expertise on Gender Dysphoria in Amsterdam and a proponent for watchful waiting, has noted the earlier samples may have included “milder cases” that are “hard to compare with the clinical samples we see now in our clinics,” in an interview with KQED last year. But he still urged caution with social transitioning of prepubescent children. “With certain steps like a name change or a pronoun change, with a result that maybe others will only perceive you as a girl — that’s somewhere where we say, ‘Okay, maybe you should explore things without taking steps that are hard to reverse.’” (Steensma hasn’t returned Vox’s request for comment.)

In 2012, gender identity disorder was changed to the less stigmatizing term “gender dysphoria,” distress resulting from a mismatch between the child’s natal gender and their internal sense of their gender identity. Nowadays, in order to qualify for a gender dysphoria diagnosis, the child must be persistent, insistent, and consistent in their gender identity over a long period of time, criteria that didn’t exist under the older diagnosis.

Similarly, watchful waiting as a concept has been pushed to the fringes in American medicine as of late, as it is seen as needlessly punitive to the child. Instead, what’s more commonly recommended is the affirming method, which allows gender-expansive children to more freely experiment with their gender expression, trying on new names or pronouns as needed. It’s an individualized approach without permanent outcomes. Rather than attempting to fix a prepubescent child’s perceived gender-related “disorder,” the affirming approach, which recommends social transitioning if the child wants it, seeks to lessen the actual dysphoria experienced by the child without medical treatment.

The affirming model has been recommended by nearly every major American medical association, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, the American College of Obstetricians and Gynecologists, and many others. “What is most important is for a parent to listen, respect and support their child’s self-expressed identity. This encourages open conversations that may be difficult but key to the child’s mental health and the family’s resilience and wellbeing,” wrote Jason Rafferty, a doctor at Hasbro Children’s Hospital in Providence, Rhode Island, and a professor at Brown University, in a key AAP statement on affirming the gender identities of trans youth released last October.

“The kid isn’t going to brainwash him or herself into being transgender [if their gender identity is affirmed],” Safer said. “They’re going to say how they feel and you can pretty much be respectful and they won’t be railroaded into anything, which I think is the anxiety that people still have, and there was some anxiety in the past in the medical establishment, but I think the medical establishment is getting more and more comfortable that that does not seem like a likely event.”

Critics of the affirming model fret that cisgender kids may unknowingly get caught up in a gender transition that they will later come to regret, but according to Safer, the key is to be cautious and keep communication open with kids. The ones who are sure of themselves will continuously tell you so.

Nearly every major American medical association has recommended using the “affirming method” for gender-expansive children, rather than the “watchful waiting” method.

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Safer has said that within his previous practice in Boston and his current one in New York City, he’s seen less than 1 percent of his own patients, among several hundred cases, end up desisting. “We certainly don’t want to be taking transgender kids and not treating them because we know we’re not perfect in our understanding,” he said. “There are opportunities, again, to go slow and there’s a real range. The kids who are certain of their gender identity, those are not the kids who come back 10 years later and say that it was wrong to do the treatment.”

According to a 2016 University of Washington study of 73 children with gender dysphoria, trans kids who are affirmed in their gender identity showed typical rates of depression and only slightly elevated rates of anxiety compared to their non-transgender peer groups. “These findings suggest that familial support in general, or specifically via the decision to allow their children to socially transition, may be associated with better mental health outcomes among transgender children,” the study said.

Meanwhile, a 2018 study shows that using a trans child’s chosen name and pronouns significantly reduces suicide risk.

By the time Luna persists to the stage where her family would need to consider puberty blockers, which according to Georgulas’s testimony is sometime between the ages of 9 and 11, she would have been persistent, insistent, and consistent in her gender identity for at least six years, with another two or so years to go before having to make a decision about whether to pursue puberty as a girl through the use of cross-sex hormones.

While puberty blockers merely act as a pause on an adolescent’s natal puberty, cross-sex hormones would be used to initiate the puberty of the opposite sex if the teen’s dysphoria still persists. Blockers are a tool to keep permanent changes from natal puberty from taking place so that adolescents age 9 to 14 can be more mentally mature before deciding on the course of their permanent treatment when the time comes, according to Safer. Cross-sex hormones would mean testosterone injections for trans boys and a combination of a testosterone blocker in addition to estrogen for trans girls. Safer says it’s a careful and cautious system that also respects the autonomy young trans people should have over their own lives and bodies.

However, ultra-conservatives and trans-exclusionary radical feminists, along with some extreme sexologists, have other ideas for those children’s futures, lobbying to ban puberty blockers and cross-sex hormones for all minors. While they’ve tried to appropriate the “watchful waiting” description, their approach is more traditionally known as the “reparative method,” a form of conversion therapy. They appeal to the fallacy that natal puberty is natural and therefore necessary for all kids.

But this approach would force trans girls into male puberty and trans boys into female puberty without their consent, and brings along its own permanent changes, which could only partially be reversed through painful and expensive medical treatments in adulthood. Trans women forced through male puberty would then have to undergo painful and expensive electrolysis to remove facial hair and may be left with a body frame (shoulder and hip width) that would be unchangeable by any surgeries. Trans men would have to have surgery to remove their breasts and, like their trans female counterparts, be forced to live in an unwanted body frame for their entire lives.

Then there are the repercussions of depriving adolescents of social transitioning. Forcing trans people to wait until adulthood deprives them of a childhood where they can be their full selves. Gendered socialization is also missed, dumping adult trans people into a new gender role without the experience to handle delicate gendered social situations such as dating or employment. Trans women are often perceived as too aggressive after transitioning in the workplace, thanks to sexist gender expectations. Allowing for an earlier social transition would let trans adolescents learn how to handle these situations on the same time scale as their cisgender peers.

However, those most invested in maintaining a strict gender dichotomy are the same crowd that’s ardently opposed to the existence of trans people, especially trans kids.

Luna’s case has fueled the conservative war on transgender people

Beyond the larger questions over how to treat gender expansive and dysphoric children, the Luna Younger case serves as yet another battleground in the conservative war against the transgender community at large. What concerns Jane, the Dallas-area parent of a trans child, though, is how powerful state and federal officials have taken aim at individual trans children in order to push their political agenda.

“I’m really concerned about what this looks like moving forward in politics that our politicians here in Texas, our legislators that are supposed to be protecting all children, are explicitly targeting a 7-year-old for their own political gain,” she said. “That’s really frightening that they’re stooping to those levels.”

In addition to Governor Abbott, Texas Sen. Ted Cruz and the president’s son, Donald Trump Jr., a frequent commenter on trans issues, also chimed in on the case, both calling Luna’s transition “child abuse.”

Riding the wave of conservative outrage, Texas legislator Matt Krause has floated the idea of banning the use of puberty blockers in gender dysphoric children in the state, a move which, if replicated in other states, could rip thousands of adolescents off of gender-affirming treatment and force trans girls like Luna to develop facial and body hair in addition to stereotypically male secondary sex characteristics without her consent. Or it could force her to travel hundreds of miles out of state to seek the same treatment.

Sen. Ted Cruz (R-TX) is one of several conservative politicians who have equated affirming transgender children’s identities with “child abuse.”

Sergio Flores/Getty Images

Fellow Republican legislator Steve Toth promised on Twitter that the first bill in the next legislative session in 2021 would aim at designating affirming a trans child’s gender identity as child abuse under state law. This would mean the state would legislate the clothes, name, and hair of a child.

The movement against trans kids has also spread beyond Texas state lines. Early last week, Georgia Republican state Rep. Ginny Ehrhart proposed the “Vulnerable Child Protection Act,” which would make it illegal for medical providers to consider any treatment which would result in “sterilization, mastectomy, vasectomy, castration and other forms of genital mutilation,” many of which are not treatments considered for trans adolescents. However, Ehrhart’s bill would also ban puberty blockers and cross-sex hormones for every individual under the age of 18. A similar bill has also been floated by a Kentucky state lawmaker following the Younger case.

Among the disinformation tossed around by conservative media recently was a report that the puberty-blocking drug Lupron was responsible for the death of thousands of people. However, an NBC News report on the controversy found that the drug’s primary usage is to treat hormone-dependent cancers such as terminal prostate cancer and the drug was used as part of treatment and was not the cause of death in those cases.

Branstetter said that the Younger case in particular is dangerous because it’s so personal for one family. “This has been a constant disinformation war amongst a legion of conservative media sites that has sought to disparage transgender people and to fear-monger about our health care,” she said. “To play into those hands, as the governor has done in this case, it’s exploitative. It is using a family and a child as a means to score political points and you’re doing so without their consent.”

Jane said the attention to the case has given her serious doubts about her public advocacy as a parent of a trans child in Texas. She has hired IT professionals to monitor her family’s tech and installed additional security cameras around her house. “It’s been really, really stressful, intense,” she said. “And lots of tears, lots of sleepless nights. And lots of phone calls from other people figuring out how they can support this family.”

Already, the attention from state and national conservative politicians has had a chilling effect on trans-supportive parents. Several Texas-based parents of trans kids declined to speak with Vox for this story because they were specifically afraid of the governor calling CPS on them. Branstetter notes that many parents of trans kids keep what’s called a “safe book,” which documents every instance of observable gender dysphoria and every medical and psychological appointment because strangers who disagree with allowing children to socially transition often call CPS with accusations of child abuse. One clinician who was approached for an interview for this story had been told by their institution not to comment for a piece that mentioned “ongoing litigation.”

While Texas families with trans kids fear official government retaliation for supporting their children’s transitions, the family at the center of the case is left to deal with the fallout. Lost in the media frenzy and the court dispute has been Luna’s own voice on the matter. “In her young mind, what this boils down to is she thinks that all of this court stuff is so she doesn’t have to cut her hair anymore,” Karen Hirsch, a family friend of Georgulas who is acting as a media contact, told Vox. “That’s what it comes down to for her. She just wants to be a girl. She doesn’t want all of [this] conflict.”

As of last week, Judge Cooks granted Younger an extra school day of custody a week. Hirsch said that Younger dressed Luna as a boy and sent her off to class on Tuesday. When she arrived, “the teacher had extra clothes and said that if you want to change, you may change,” Hirsch said.

And when mom and dad weren’t around and couldn’t influence Luna one way or the other, what did she choose to do?

Hirsch said Luna chose to wear the dress.