Michelle Khela is 18 years old. She lives near Fort York and likes painting, blogging and writing short stories.

She’s also gender-fluid. Born female and comfortable with either gender pronoun, the high school student eased into that designation two years ago largely on her own.

“I actually have thought of transitioning from female to male several times, especially when I was younger,” she said.

“If I had been presented with an opportunity to change my gender when I was younger, I would have taken it and I’m sure I would have no regrets.”

Still, she doesn’t plan to transition in the future. “I’m quite comfortable with the way I am currently.”

Khela straddles the battle line dividing experts on child and adolescent “gender dysphoria” — the anxiety-clad feeling that the body they were born with doesn’t match their true gender identity.

A mini-culture war has flared up in the last few weeks with the controversial shut-down of the Centre for Addiction and Mental Health’s (CAMH) gender identity clinic in December. The clash cuts to the root of how to help gender-questioning children choose the most appropriate path, with turf staked out around two major positions.

One is grounded in a “wait-and-see” model, says Dr. Tom Mazur, an associate clinical professor of psychiatry and pediatrics at the University at Buffalo School of Medicine and Biomedical Sciences.

That approach, embraced by the now-defunct CAMH clinic, encourages transition during or after puberty, but remains apprehensive about “social transitioning” or alternate gender expression at an early age.

“The majority of these children who come in will not persist as gender-dysphoric,” often transitioning into gay or lesbian identities, Mazur told the Star.

The “gender-affirmative” — or “listen-and-act” — approach, on the other hand, backs early transitioning. It aims to avoid so-called “gender policing” while identifying children’s “authentic” gender as early as 3, says Diane Ehrensaft, chief psychologist at the Adolescent Gender Centre Clinic at the University of California, San Francisco.

“The next step is to help them live in their authentic gender … We don’t tell them who they are, or try to bend who they are,” Ehrensaft said.

In different ways, however, both stances profess to make children feel “comfortable in their own skin.” Both back the use of puberty-blocking medication by gender-questioning children aged 10 to 12 and up, with the option of sex hormones further down the line.

Debra Soh, a PhD candidate in psychology at York University specializing in sexual neuroscience, says that “it doesn’t make sense for us to be implementing these changes so early.

“For a young child, it’s a lot to take on. It’s a big decision to make.”

Social transitioning — “difficult to de-transition from,” says Soh — sees children expressing their gender through their clothes, name, hairstyle, activities and friend groups.

It’s been gaining traction for young children in recent years, overtaking the more cautious CAMH model as the preferred protocol of clinicians and activists.

Gender dysphoria remains a relatively untilled field, with a dearth of research into the long-term effects of puberty blockers and the transgendered experience among children and adolescents.

A study published online in a scientific journal last month called for better understanding around the “persistence of gender dysphoria from childhood into adolescence, and a thorough investigation into the impact of interventions for transgender youth.”

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FOR PARENTS

What should parents do if their little boy comes home from kindergarten and says he wants to be a girl? Or if their little girl expresses a strong, persistent wish to be a boy? Experts don’t always agree, and approaches are constantly evolving. Here are some views.

Perk up your ears

Listen to what exactly your child seems to be saying. “If a little boy isn’t allowed to play with girls’ toys, maybe that’s where the distress is coming from,” says psychology PhD candidate Debra Soh.

Go to the pros

Seek out a professional experienced in child or adolescent treatment of gender dysphoria. “Support that child in their transition, as long as they’re into puberty at that point,” says psychiatrist Tom Mazur, who’s opposed to earlier transitional moves. Referral from a family doctor to the Hospital for Sick Children’s adolescent medicine division is one route.

Name that gender

According to some activists and clinicians, a boy who just “likes to wear tutus or the girl who’s an extreme tomboy” can be distinguished as young as 3 from children who inhabit another gender altogether, says psychologist Diane Ehrensaft. “They’ll complain persistently, ‘Can you put me back in your tummy, Mommy, and have me come out the right gender?’ or ‘Why did God get it wrong?’”

Open your arms and your mind

“Just be very supportive of your kids,” says Mazur. “Be open-minded.” Ehrensaft notes transgender identities may run counter to some parents’ values. “But we give our children a great gift when we allow them to carve their own pathway to gender.”

Don’t jump to conclusions

Many children conflate atypical interests with wanting to be the sex associated with them. “If a little boy is interested in using the Easy-Bake Oven, they’ll say I want to be a girl,” says Soh. “Gay men and lesbian women often recall saying, ‘I am a girl, I am a boy.’”