The Associated Press spoke to gender experts to answer some of parents' most commonly asked questions.
MY SON LIKES TO WEAR DRESSES. IS THIS A PHASE OR SOMETHING MORE?
"My answer is, we don't know," says Diane Ehrensaft, a developmental and clinical psychologist, director of mental health at the University of California, San Francisco's Child and Adolescent Gender Center and author of "The Gender Creative Child."
"What we know is, you have a son who likes princess dresses. I would say get him the dresses. Have your child feel free to choose. Maybe they'll stop wearing dresses. Maybe they'll grow up to be gay."
Transgender children will be insistent, consistent and persistent about their gender dysphoria, she says.
"It's not something the child says one time and it goes away."
For critics who question whether preschool-age kids should be allowed to "socially transition," Ehrensaft says: "We expect a 2-year-old to know 'I am boy. I am girl.' So why can't that also apply to transgender children?"
DISTRESS VS. HAPPINESS
"If I'm a kid who occasionally wants to put on my mom's high-heeled shoes or wear my mom's princess dress, I'm not the kid who wants to live as a girl. I'm the boy who occasionally wants to wear girl's clothes," says Johanna Olson-Kennedy, medical director of The Center for Transyouth Health and Development at Children's Hospital in Los Angeles.
The important thing to ask is whether your child is in distress.
"Are you having daily battles about clothing before school?" Olson-Kennedy says. "There are some things that are pretty universal. Is this the kid that everyone is trying to give Mutant Ninja Turtles to, and what they really want is the gifts their sisters are getting?"
Using a child's happiness and health as a guide is critical, she says.
GO AWAY FOR A WEEKEND
It can also help for parents to get away somewhere with their child and allow the child to call the shots in terms of their gender, such as letting them use a different pronoun or wear a dress or other clothing of their choice, Olson-Kennedy says.
"Do it somewhere where you're not going to see people you know, if that's an issue for you," she says. "Do a weekend as a different gender, and see what you learn.
"People have said this over and over again: 'Oh, my God. I saw a side of my child I had never seen before.'"
HOW CAN YOU TELL?
Though there are no set rules, Ehrensaft says some early signals can provide information about whether a child is transgender. They include:
- Certain actions at a very young age, such as toddlers pulling barrettes from their hair, grabbing for their sister's dress and dolls, or throwing away their trucks.
- The use of verbs regarding gender. Instead of "I wish I was a girl," a transgender child will say, "I am a girl."
- Frustration over their genitals. By around age 3, children understand "penis equals boy, and vagina equals girl," Ehrensaft said. "Often those are the kids who cry out, 'Why did God get it wrong? Mommy, can you put me back inside so I can come out like my sister?'"
- Taking "gender expansion play" seriously. Many young boys like to play dress-up in their sisters' princess costumes, twirling around and then moving on to other toys, Ehrensaft said.
A transgender child "also wants to get into his sister's closet, but he's not going to go for the princess dress - he's going to go for her school uniform," she says. "He's going to put on her everyday clothes because he wants to be a regular girl, not a pretend princess."
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