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Transgender at five

By Petula Dvorak,

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 school teachers and coaches in Maryland 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 that Grandma kept sending. Kathryn wanted nothing to do with her big sister Moyin’s glittery, sparkly pink approach to the world. (Moyin attends school with my son, which is how I came to know the family. The Washington Post is using 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.

The questions begin

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. Who hadn’t caught the transgendered Chaz Bono drama on “Dancing With the Stars”?

“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 what she’d read with her husband.

Jean, 38, and Stephen, 40, had met at a Washington area gym, where both taught classes. They married in 2001.

Jean eventually quit teaching to stay home with her kids and continue her education. Stephen, who comes from an immigrant family, teaches science at a public high school, where he is beloved by many of his students. His Facebook page floods with their hellos and happy birthdays. He is vocal about encouraging girls to buck the stereotypes in science.

Still, Jean wasn’t sure how he’d react to her suspicions that Kathryn might be transgender. She decided she wouldn’t voice them unless she was totally convinced herself.

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?” “God made a mistake with me.” “Something went wrong when I was in your belly.”

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.

That’s about the age when girls gravitate to girl things and boys to boy things. It’s when the parents who ban baby dolls or toy guns see their little girl swaddle and cradle a stuffed animal or watch in awe as their boy makes guttural, spitting Mack truck sounds while four-wheeling his toast over his eggs, then uses his string cheese as a sword.

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 sits on is studying whether to remove the word “disorder” from the diagnosis and instead call the condition “gender incongruence.”

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. Outside their homes, the transgendered are frequently marginalized and scorned, pushed into an underworld, outside of the mainstream. More often than the rest of the population, transgender teens and adults are harassed, assaulted and even killed. Remember that beating caught on video at a Baltimore County McDonald’s last year? Or the off-duty D.C. police officer who was accused of standing on the hood of a car and shooting a transgendered woman through the windshield?

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.

Kenneth Zucker, a child psychologist in Toronto who is serving on the psychiatric association’s task force, advocates neutrality for kids struggling with their gender identity.

Children who see him get the Barbies or toy soldiers replaced by puzzles and board games. His theory is that kids should be allowed to grow into a gender and not be categorized.

There’s some evidence — most of it anecdotal because so little research exists — that gender dysphoria is a phase many children outgrow.

In the U.S., 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 the District. About a dozen children from the area belong to his support group, and hundreds of families around the country are part of his online support network.

In the decade that Menvielle has been counseling such children, he estimates that about 80 percent end up switching back to what their biology tells them. The other 20 percent remain transgender into adulthood.

‘Not just a tomboy’

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 dinner 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,” Stephen recalled.

As a teacher, Stephen knew how cruel kids could be. He imagined his child walking into the social battlefield that is school, insisting she was a boy when under her clothing, she wasn’t.

What about bathrooms? P.E.? The prom? How would all that go?

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 told me.

Kathryn was in the back and grabbed a book off the seat.

“Daddy, I’m going to read you a story, okay?” 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.

“Okay. I’m listening, Jean,” he said after he got home.

The diagnosis

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. (The Post is using Tyler, 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.

The reaction

Tyler made his public debut at Sunday school at their Presbyterian church.

The teenagers who help out in class laughed that it took Kathryn’s parents so long to figure out they had a Tyler.

The pastor there was so supportive of the family that she invited a panel from a transgender support group to come just before services one Sunday in January and explain what Tyler and his family were going through. The room was packed.

“We’re so happy to be here. They usually put us in the basement,” said Catherine Hyde, the leader of the group and the parent of a transgender teenager with a tough story.

At 4, Will told his mom: “Something went wrong in your belly. I was supposed to be a girl,” Hyde said.

She and her husband wheedled the Barbie dolls out of Will’s hands, told him over and over again that “You can’t wear tutus!” They put all their parental might into erasing his behavior.

In response, Will threatened suicide when he was 6. He hated the five years of relentless karate lessons they insisted on to toughen him up. Given the chance to decorate his own room, he came up with “the pinkest, pom-pomiest bedroom in Howard County,” Hyde said.

They went to therapists, who said Will was probably just gay. Hyde and her Marine husband could live with that.

“You can be as gay as you want, but if you go trans on me, it’s on your own money, your own time and out of my house,” she remembered telling her son, then 15. Hyde gives lots of speeches and presentations about her journey. Each time I’ve seen her speak, she still tears up a bit when she recounts what she told her child.

It was years before Hyde and her husband acknowledged their child’s agony. They finally asked Will if he wanted to take puberty blockers. He said yes. And eventually, a whole new child, now 18, emerged.

All those years of pain, therapy, suffering and strife, that is what Jean wants to avoid.

She hoped the people at the church would understand. Between cookies and coffee after the presentation, many came over to hug her.

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 about describing her transgender sibling. “It’s just a boy mind in a girl body,” Moyin 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.

Staff members recently had a training session on gender identity disorder to prepare not only for Tyler but also for other transgender kids who may be arriving. This year alone, at least two other families have contacted the school about enrolling their transgender kids, according to its director of admissions.

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.

Jean and Stephen got into a huge fight with Tyler’s gymnastics coach, who insisted he keep wearing a leotard to practice because his registration form said “female.”

Tyler was miserable pulling on a leotard when the boys in class all got to wear shorts and a T-shirt.

“Finally, we just got someone to change F to M on the paperwork,” Jean said angrily. “Why does the coach care so much about what’s in my child’s underpants anyways?”

Jean has come home from the gym more than once 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.

“You never meant to, but you become this advocate. All day, every day,” she told me, clearly exhausted.

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 freak-out or even a call to Child and Family Services. It’s always a fear looming over the family.

Difficult decisions

Tyler doesn’t really like to talk about Kathryn or even acknowledge she existed.

“I’m not transgender,” he fumes when he hears the word, often spoken by his mom as she explains things. “I. Am. A. Boy.”

During one of my visits a few months ago, he showed me their family picture wall, full of pictures of two girls in lovely dresses.

“No Tyler,” he pouted.

Those are issues that are easy for Tyler’s parents to fix.

But in about five years, they 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 if the puberty blockers are halted.

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.

That’s a method being pioneered by Norman Spack, the director of one of the nation’s first gender identity medical clinics at Children’s Hospital Boston and an advocate of early gender transitions. 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 and irreversible decision for parents to make when a child is 15 or 16. Only a handful have opted to do so, Spack said.

Jean e-mailed me an article about the drug controversy late one night, the time that many parents stay up and fret about their kids. “See what we’re facing?!” she wrote.

She acknowledges anxieties about what lies ahead. 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. Tyler is just Tyler, a high-energy kid with a Spider-Man-themed bedroom.

On my last visit, he took a brief break from playing with my boys and their endless supply of space cruisers to show me a new addition to the family picture wall. It now features a prominent photo of Tyler in short hair and a red polo shirt. He is smiling.