Izzy, kicking a ball during soccer practice, has always preferred Batman to Barbie. The 5-year-old offers a special reflection on a gender spectrum that complicates our most ingrained cultural attitudes. Credit: Kristyna Wentz-Graff

SHARE Video Loading... Chat Jennifer, Izzy's mother, answers questions about her experience in a chat at noon Thursday. Submit questions. Uniquely Human Part 1 : 'I Boy': A family's challenge to understand gender

: 'I Boy': A family's challenge to understand gender Part 2: 'The true me': A quest for acceptance Go to section. How we reported this story To complete this story, reporter Mark Johnson and photojournalist Kristyna Wentz-Graff followed Izzy over the course of eight months as the child played at home, participated in youth soccer, prepared for the first day of school and celebrated turning 5 years old. They conducted numerous interviews with Izzy's mother, Jennifer, and other family members. They also interviewed a dozen experts from the U.S. and Canada, including some at a national forum for the group Gender Spectrum, and read hundreds of pages from scientific and medical journals and textbooks. At the request of Izzy's mother, the Journal Sentinel is not using the family's last name. The child's mother agreed to having Izzy photographed. Some scenes and dialogue were reconstructed from detailed interviews with the participants. Quotation marks have been used for comments that the reporter or photojournalist witnessed and in rare instances when the participants were certain of the accuracy, such as "I boy."

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Isabella, a pink-cheeked lightning bolt in a Dora the Explorer shirt, uttered her first sentence around age 2; it was nothing her parents had expected. The two little words foretold a struggle over a fact of her birth.

"I boy."

When those two words had a chance to sink in, the child's mother, Jennifer, remembers thinking: Well, that might explain the interest in Matchbox cars. Maybe, Isabella just wanted to be like the other kids at day care; most were boys. Or maybe the child was simply confused.

At least it was only a phase, the mother told herself. It would pass.

That summer, clothes became a problem. Isabella kicked and screamed when Mom adorned her in pretty pink dresses. The child spilled salsa all over them, something that never seemed to happen when Isabella wore shorts and T-shirts.

Jennifer arranged her daughter's long brown hair in ponytails and pigtails, inserted bows and barrettes. And the first chance she got, Isabella yanked out the bows and freed her hair. When mom grabbed the brush, Isabella pushed her arm away.

When they shopped for clothes, Jennifer would hold up a dress, a sporty girls' outfit, a bright red T-shirt. No, said Isabella. No. No. Then came the tears. Then the walk over to the boys' department.

Don't you want to be a pretty girl, the mother would ask.

The child would not say, I want to run like a boy, or throw like a boy, or climb trees like a boy.

Just: "I boy."

One day last fall, two years after that first sentence, Jennifer made a decision. She took Isabella to Cost Cutters.

We need a short haircut, the mother said. I mean razor short. Like a boy.

She began dressing the child in boy's clothes.

Isabella became Izzy.

Of course, the name and haircut were just the beginning.

Gender dictates how we see children in the most fundamental ways - everything from the toys, books and clothes moms and dads buy, to the proms, weddings and other milestones they imagine. While girls and boys attend school together, they are conditioned to separation in bathrooms, locker rooms, gym classes, sports teams, even sections of the cafeteria.

These social conventions operate on a pair of assumptions: that there is always certainty about who is a girl and who a boy; and that every girl and every boy will look and feel and act the part.

But suppose you found yourself, as Jennifer did, dealing with a child who does not fit the assigned role - what would you do?

Her dilemma, while rare, appears more common than you might suppose. A large study of Dutch twins published in 2006 found that between 0.9% and 1.7% wished they were of the opposite sex. A national advocacy group estimates that between one-quarter of 1% and 1% of the American population - 780,000 to 3.1 million people - believe they have been assigned the wrong gender.

Still, experts say there is really no reliable figure. The census does not have a category for people who live on these margins and even if it did, many would just as soon avoid the label - and the stigma.

One problem is that the public tends to confuse gender and sexuality. Desiring to be a different gender is not related to homosexuality. It isn't about sexuality, but identity, says John Kryger, chief of pediatric urology at Children's Hospital of Wisconsin and the Medical College of Wisconsin.

"Gender is who you go to bed as," he says. "Sexuality is who you go to bed with."

Blurring of the two may explain the visceral reaction many have to transgender, a word first coined in the 1960s and now used to describe people who have crossed, or wish to cross, the gender border. This dividing line is not, as we often assume, between the legs.

"Gender lives in the brain," says Stephen Rosenthal, medical director of the Child and Adolescent Gender Center at University of California, San Francisco. "Gender is defined as your perception of who you are."

J. Michael Bostwick, a professor of psychiatry at the Mayo Clinic, agrees that gender identity is "brain-based," but adds that researchers have yet to learn much about the specifics. "I think we have very crude instruments for looking at something that's very complex."

Children form their perceptions of gender very early in life, long before sexuality appears on the radar. The awareness arrives in stages. Even before 6 months, some babies can identify males and females by their faces and voices and can correctly connect the male voice to the male face, according to a 2011 paper in the journal Social Science & Medicine. It takes a little longer before children can label their own genders.

"It is my experience that very, very small children, when they get language, they speak up. Usually it is in between the first and second year," says Diane Ehrensaft, a clinical psychologist who has studied the subject for more than 40 years.

Genes play a role in gender identity. So do hormones. So does the brain. Upbringing, environment and culture may also play a part, according to some experts.

How all of these factors fit together is a mystery science is only beginning to unravel.

***

Even the language of gender, the vocabulary that confronts Izzy now and awaits in adulthood, is continually evolving.

The surgery to alter a person's gender has gone from "sex change," to "gender reassignment," to the politically correct-sounding "gender confirming."

People deeply unhappy with their sex are described as having "gender identity disorder," according to The Diagnostic and Statistical Manual of Mental Disorders. Families dislike the label, and its classification as a mental disorder. Yet many accept the diagnosis in order to receive medical services.

Editors of the manual are considering a recommendation to remove "disorder" and rename the condition "gender dysphoria" for the fifth edition, due out in May.

The search for ways to explain the gender dilemma has proved equally unsatisfying.

"There's one very popular narrative, that someone has been born in the wrong body," says Scott Whipple, a clinical social worker in Manhattan who has spent more than 15 years studying gender identity. "I think it's very different for different people."

Izzy has been given a narrative. Borrowing loosely from American Indian legend, Jennifer told her child this story:

Twin spirits, a boy and girl, were waiting for a body.

Only one was available. The boy said, You go first. You have the body.

I can't be without you, said the girl.

The boy pushed the girl into the body, but at the last moment she dragged him in with her. The child was born with a girl body and a boy heart. The parents could see the girl.

They did not know about the boy inside.

***

The first to know about Izzy were not Jennifer and her husband, Diego, who had, by then, separated.

Instead, the boy appeared to big sisters Yasmine (or Yazzy), who is nine years older, and Angeliah (or Angel), who is five years older. There were hints in Isabella's rough style of play, but it was really "the game" that clued in the sisters.

The older girls would ask Isabella, Are you a boy or a girl?

It was funny because whatever they said last - that's the one Isabella picked.

Not quite 2, the child seemed lovably confused. After a while, though, Isabella's answer never wavered.

Boy.

Mom, the girls called. Look!

They showed her how Isabella answered. It had to be deliberate; when they pointed to other children, Isabella knew who was a boy and who was a girl.

The older girls thought about how Isabella played when they took their dolls out in strollers. Yazzy and Angel were gentle with the dolls. Isabella? She rammed the stroller around their Monona house, fast as a race car.

Jennifer had noticed the way Isabella roared into the living room making explosion sounds and firing pretend lasers.

The toys, the play style, the game, they were all signs. The sentence was a declaration.

"I boy."

***

Boy and girl seem such easy concepts in high school biology. A single pair of chromosomes settles the question - XX and you're a girl; XY, you're a boy.

But it's not that simple. A complex cascade of genes and hormones during the first 12 weeks in the womb determines whether we develop the gonads, internal ducts and external genitals of a male or a female.

Sometimes biology sends mixed signals.

A child can be born with the Y chromosome, yet develop as a woman. In a condition known as androgen insensitivity syndrome, the child is born with a mutation that sabotages a gene. The gene is supposed to make receptors for male androgen hormones to bind onto. But the mutation disables the receptors. The androgens have no place to go.

Without androgens, the body is blind to the Y chromosome. Sexual features develop as if the child were a girl. At puberty, the child appears female, but has no uterus and no monthly period. If this were not confusing enough, the syndrome has a "partial" version, which can result in ambiguous genitals.

Mother Nature spins other variations.

Some children are born with a mutation that disrupts development of the hormone cortisol. The chemical that is supposed to become cortisol is instead diverted down the pathway that fires up production of male hormones. The body is flooded with testosterone and other male hormones. The condition occurs in both boys and girls, but only affects genital development in girls.

A girl with the mutation has ovaries. She also has "masculinized" genitals, which can range from an enlarged clitoris or partially fused labia to a penis and scrotum.

The result: a child who looks like a boy but isn't. Long-term studies have found that most of these children end up choosing to live as females, but roughly 1 in 20 chooses to be male.

Such mutations are rare. Most people with gender conflicts never know the cause.

Comminglings of male and female are unusual, but not unnatural. The animal kingdom includes types of zebra finches and butterflies that are essentially half and half. The butterflies have a male color pattern on one wing, a female pattern on the other. Biologists don't know what causes the rare phenomenon of half-male/half-females, known as gynandromorphs. They suspect genes play some role.

There is an important difference, though, between the male-female mixes in the human world and those in the rest of the animal kingdom. In most of nature, male and female are concepts largely confined to mating behavior.

"Humans are a unique case," says David Crews, a professor of zoology and psychology at the University of Texas at Austin. "The issues about transgender, gender identity and role preferences - those are all human concepts. In animals all you can say is that there are alternative reproductive strategies."

The human concepts support the idea that at some deep level gender identity resides in the brain, a point reinforced by a few recent studies.

A 2011 paper in the Journal of Psychiatric Research examined the white matter, or connecting fibers, in the brain. Scientists found that in transsexuals desiring to go from female to male this tissue was already more similar to that of a man before any treatment.

A 2009 study published in the journal NeuroImage examined gray nervous tissue in the brain, comparing male-to-female transsexuals with control males and control females. Although the transsexuals most closely resembled other males, the authors wrote that one section of the brain, the putamen, "was found to be feminized," in transsexuals.

***

For now, Izzy is a mystery.

There has been no test to determine whether there might be a biological explanation for the child's gender dilemma.

Jennifer's feeling is that the causes are not as important now as how Izzy behaves and is treated by others. If doctors find no telltale mutations or hormone problems, it will not change the child's insistence. Such things mean nothing to a 4-year-old. Nor do they change the child others see.

Izzy has broad shoulders, friendly brown eyes and a layer of childish pudge that for some reason looks "male." The child is shy with strangers, but playful. Izzy likes Spider-Man, cars, football, fire engines, tool benches and Star Wars LEGO video games.

Once, the mother caught her child trying to stand at the toilet. The clothing, the floor, the child's legs - everything was wet. Izzy, then 3, was upset.

Jennifer grabbed Diego, who was at the house, and had him explain that boys sit down on the toilet too.

She wondered: Does Izzy realize that standing won't work because the genitals are wrong? Or does Izzy think poor potty skills are to blame?

The truth is she cannot be certain how much her child understands.

One day recently the mother asked: "What do you want people to call you?"

"Izzy."

"What is your name?"

Long pause.

"Why did Mom name you Isabella?"

Silence.

"Is Isabella a girl name or a boy name?"

Finally an answer.

"Boy name."

On another day, there was no pause. Jennifer was rearranging the living room, moving the framed photographs of the children on the wall when Izzy pointed at one.

That's when I was a girl, the child said.

***

The before-and-after world that Izzy sees is more difficult for a mother to explain. Whenever Jennifer discusses her child's gender, she always faces one question.

How do you know?

The mother has a standard response: When you were 4, did you know you were a girl? Did you know your father was a boy? Well, that's how Izzy knows. The same way.

But how do you know?

After all, parents don't take a child's word when deciding whether it's safe to play with matches. Why follow the judgment of a 4-year-old?

Izzy has been diagnosed with gender identity disorder. A doctor has judged that for at least two years Izzy has been strong and persistent in rejecting the female gender.

No dresses. No dolls.

Fire engines and footballs.

How do you know? What if a 4-year-old is strong and persistent now, but later reverses course?

"I've seen a lot of children who mislabel themselves when they're young," says Ken Zucker, head of the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto. "Lots of these children can be helped to feel better about the gender that matches their birth."

To get some idea of how young children understand development, ask them this: If you grow long ears, will you grow up to be a rabbit? Many will say "yes," Zucker explains.

Several studies have found that less than 20% of the children who experience severe unhappiness with their assigned gender continue to feel this way during and after puberty. However, a 2011 study in the journal Clinical Child Psychology and Psychiatry reached a dramatically different conclusion: about 55% of the children surveyed maintained discomfort, and many reported that the feelings intensified.

Izzy's mind might change, Jennifer says. But it will be Izzy's mind. Better to deal with a change down the road than to force a child into a despised role.

Jennifer did not wish for this. It bothers her to think how much harder her child's life could be.

It bothers her that the transgendered have a much higher suicide rate than the general population (about 40% of transgender people have attempted suicide, a recent survey found). It bothers her too that fulfilling a wish to be fully male may shorten Izzy's life span (testosterone treatments can raise cholesterol and blood sugar, and surgery comes with a high risk of complications, according to the American Psychological Association).

Moreover, as a male, Izzy would be sterile. Having children would be possible only by keeping the uterus and ovaries intact - by, in effect, taking advantage of the sex previously abandoned. The mother wonders if Izzy will be old enough at puberty to appreciate the significance of being unable to have children.

In her view, the questions and uncertainties boil down to a single test: What does a mother do to love her child?

***

In public, gender sheds its complexity. We don't see the genes, the brain, the upbringing, the things that live inside us. We see what's on the outside. We see clothes and a haircut.

For Isabella, the clothes came first. Jennifer dressed the child in boy clothes but left the hair long, sometimes in pigtails. The mother agonized. She wept as she talked with her sister. The world would judge her decisions about Isabella.

The world be damned, her sister said. You know your child. Nothing you're doing cannot be undone.

The crucial change took place in October 2011 as Isabella's fourth birthday approached. The child asked for a haircut. Jennifer and Isabella looked in a book and found a photograph of a boy haircut. They showed it to the stylist at Cost Cutters.

Jennifer worried the stylist would try to talk them out of it, or even refuse service. The mother listened to the sound of the scissors and clenched her fingers. Jennifer looked down and saw her knuckles growing pale.

Then she looked at her child.

Shorter? she asked.

The child smiled. The stylist kept cutting.

"As his hair got shorter and shorter, his smile got bigger and bigger," Jennifer recalls. "I think that's when I finally got it."

***

Izzy celebrated a new self by dressing for Halloween as Darth Vader.

For others in the family, the change brought a mourning period. Diego said he thought about the traditional Latin American quinceañera celebrating a girl's 15th birthday. He thought of the beautiful dress he would never see descending from Isabella's shoulders.

Yazzy and Angel missed Princess Day. That's what Jennifer called the day when she would gather her daughters, buy earrings for all three, take them to a hair salon, then have their photograph taken.

"That pretty much ended," Angel said.

Subtle adjustments ran deep.

The two older girls stumbled over pronouns, calling Izzy "she," catching themselves, switching to "he." The mother faced a similar problem. "I had to change," said Jennifer. "I said, 'my girls.' Now it's 'my kids.' "

He or she?

The pronouns loomed on the horizon, on the school paperwork Jennifer would have to file when Izzy entered kindergarten for 4-year-olds; it was less than a year away. Pronouns would be important in class. Teachers had to know how to refer to Izzy. Pronouns would determine which line the child stood in for the bathroom.

In 2012, Jennifer picked a pronoun. She began to fill out "male" on all of the forms for school, youth soccer, anywhere someone wanted to know Izzy's sex.

She decided to send Izzy to the Madison schools instead of those in Monona. Madison, she felt, was better prepared to deal with her child. During the summer a representative from a California nonprofit, Gender Spectrum, had flown out to Madison to train school staff for two days on gender issues. The staff discussed everything from handling gender on school forms to creating classrooms that are comfortable for all the children, including those who find themselves outside the gender norms.

"The district has just been incredibly thoughtful about this," the group's director of education and training, Joel Baum, said after his visit. "It was not even a matter of: Are we going to do this? It was: How are we going to do this?"

Even so, Jennifer said she worried: What am I forgetting? How will my choices to do this or not do it affect Izzy?

One of those choices was the decision to tell Izzy's story. She wanted there to be a story out there for other moms that would tell them, "Here's what you have to prepare for, but don't worry. It can be OK."

At the same time, she thought about Izzy at 15, at 18, at 21, and imagined a potential employer running a computer search of Izzy's name, finding this article and discriminating against her child. She realized that in trying to help other families with transgender children she might harm her own. The idea upset her terribly. She changed her mind. She insisted that the Journal Sentinel not include the family's last name.

The decision brought home just how exhausting and scary Izzy's journey has been, a point Jennifer was determined to see that school officials understood. So she went to a meeting of Madison Metropolitan School District principals. She brought a PowerPoint presentation.

The first slide showed a recent photo of her smiling, short-haired child. The photo was labeled "My Son."

Other photos showed a progression: a baby "born a girl"; a little girl who seemed unhappy in a dress; a child who wore Spider-Man outfits and baseball caps; a kid who played with hammers, drills, wrenches. The child in the photos looked less and less like a little girl.

"Now try thinking if this was your child . . . " one of the slides said. "Think about constantly defending your choices and their right to exist . . . I love my son no matter what. I think if you were me you would too. Please, I need compassion and support. My son is entering 4K this year and I am scared to death . . . "

***

A month of school passed, then a second. So did some of the fear.

There is a unisex bathroom that the child uses. The mother has been low key, telling only the school's principal about Izzy.

So far, none of the teachers have said anything about gender. Jennifer suspects they know about Izzy. Like many 4-year-olds, Izzy still has the occasional accident.

But none of the other children have asked Izzy awkward questions or made hurtful comments. The child has been free to make friends, sing songs, learn letters and numbers and take part in all of the other routines of kindergarten.

"People have been waiting years and years for policies to protect their kids," Jennifer said, "and we get to walk into it."

After school one afternoon, Izzy went to soccer practice for 3- and 4-year-olds. There were eight girls, six boys and Izzy.

The children scampered across the field, stumbling into each other's paths, chasing the coaches, sometimes winding up inside the goals. Jennifer watched Izzy, a lightning bolt in a soccer shirt.

As her eyes followed the child, the image registered in her mind:

"A boy," she said.

***

Monday: Bill Jutz and the nurture side of the equation.

Thursday: Izzy's mother, Jennifer, chats online about her experience at jsonline.com/chats.