The Whites’ extended family aren’t as supportive of Rachel, often calling her Trey and semi-boycotting family events, including her birthday party on May 14.

Markham, the Spokane therapist, doesn’t know Rachel, but she works with 40 or so transgender kids in the Spokane area.

“Today I’ve seen five trans people,” Markham says. “Tomorrow I will see eight and each one of those people, sadly, is dealing with residual trauma.”

Supportive families like Rachel’s are rare, Markham says, and don’t automatically mean that “this kid is going to come out of it unscathed.”

But for now, Rachel is sitting on the couch playing a game on her mother’s tablet called “Hair Salon Makeover.” It’s Monday, May 9, and it’s her eighth birthday. She just got home from school. She styles an avatar’s hair with a flick of the finger, changing the color, length and volume. Next to her on the couch sits a remote-controlled car—a birthday gift from her grandmother.

Rachel doesn’t want to talk about transitioning. She doesn’t want to talk about school, or her future, or what bathroom she’ll use when she’s older. Instead, Rachel wants to style hair, dress nicely and maybe later drive a remote-control truck around her backyard.

When asked what it was like telling her parents she’s a girl, the 8-year-old says, “It wasn’t even that hard.”

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