NPR has a terrific and nuanced story on a difficult and challenging topic. One issue to dispose of right away, the story is headlined Two Families Grapple with Sons’ Gender Preferences, which may suggest to some that those boys make a choice about their gender identity.

As their story makes clear, little choice is involved. To people of my sexual identity (I self-identify as gay) using the words gender identity in the title would be more precise. Please forgive the quibble and let’s move on… Why on earth would any child ever choose to go through this:

Bradley had always had a preference for girls’ things. From his earliest days he had chosen girls’ dolls, identified with female characters and gravitated toward female children. But Carol had never thought to care. As far as she was concerned, it wasn’t a loaded gun; it wasn’t a lit cigarette. She says it had really never crossed her mind to say, “I’d really rather you played with a truck.” […]

It was a single event that transformed her vague sense of worry into something more serious. One day, Bradley came home from an outing at the local playground with his baby sitter. He was covered in blood. A gash on his forehead ran deep into his hairline.

“What had happened was that two 10-year-old boys had thrown him off some playground equipment across the pavement because he’d been playing with a Barbie doll — and they called him a girl,” Carol says. “So that sort of struck me, that, you know, if he doesn’t learn to socialize with both males and females … he was going to get hurt.”

Carol decided to seek professional help. Bradley’s school referred her to a psychologist in Toronto named Dr. Ken Zucker, who is considered an expert in gender identity issues. After several months of evaluation, Zucker came back with a diagnosis. Bradley, he said, had what Zucker called gender identity disorder.

Zucker’s treatment for children younger than 10 is to behaviorally move them back to the gender they were born with. No more dolls for Bradley. He would only be allowed to play with trucks from here on out.

Another family, another treatment:

Jonah was 2 when his father, Joel, first realized that no amount of enthusiasm could persuade his child to play with balls. Trucks languished untouched. Fire engines gathered dust. Joel says Jonah much preferred girl toys, even his stuffed animals were female. […]

Then around the age of 3, Jonah started taking his mother Pam’s clothing. He would borrow a long T-shirt and belt, and fashion it into a dress. This went on for months — with Jonah constantly adjusting his costume to make it better — until one day, Pam discovered her son crying inconsolably. […]

Joel and Pam also ended up in front of a gender specialist — Diane Ehrensaft, a psychologist in Oakland. Joel remembers an early session when Pam talked about her concerns.

“I remember her talking to the therapist and saying something to the effect of, like, you know, ‘I’d be OK if Jonah just was gay, I just don’t want … him to be transgender.’ And the therapist just laughed, she said, ‘You know, 15 years ago, I had people on this couch saying, ‘I don’t mind him being a little effeminate, as long as he’s not gay,’” Joel says.

In fact, Diane Ehrensaft’s approach could not have been more different than the approach of Bradley’s therapist. Like Zucker, Ehrensaft is a gender specialist…

Ehrensaft, however, does not use that label. She describes children like Bradley and Jonah as transgender. And, unlike Zucker, she does not think parents should try to modify their child’s behavior. In fact, when Pam and Joel came to see her, she discouraged them from putting Jonah into any kind of therapy at all. Pam says because Ehrensaft does not see transgenderism itself as a dysfunction, the therapist didn’t think Pam and Joel should try to cure Jonah.

Which approach would you choose? We have to have empathy for these parents because there is no clarity among the experts they turn to for help. Advocates of Ehrensaft’s approach use the history of cultural assumptions and acceptance of homosexuality as a model and a guide:

Thirty-five years ago, homosexuality was considered a mental illness — a pathology so severe that it required aggressive therapeutic intervention. According to Jack Drescher, former chairman of the American Psychiatric Association’s committee on gay and lesbian issues, one treatment was to try to condition homosexuals out of their sexual preference by attaching them to electrical shock machines and shocking them every time they were aroused by homosexual pornography.

Today, however, the APA’s position is that therapies that try to turn homosexuals into heterosexuals are unethical. Homosexuality is now considered to be a normal variant of human behavior, so though a therapist might treat a person because they struggle with the stigma associated with homosexuality, therapists who practice in accordance with the guidelines established by the association don’t treat the behavior itself.

Because Ehrensaft sees transgenderism as akin to homosexuality, she says, she thinks Zucker’s therapy — which seeks to condition children out of a transgender identity — is unethical.

But that isn’t how Zucker sees it. Zucker says the homosexuality metaphor is wrong. He proposes another metaphor: racial identity disorder.

“Suppose you were a clinician and a 4-year-old black kid came into your office and said he wanted to be white. Would you go with that? … I don’t think we would,” Zucker says.

A gay man, my sympathies are with Ehrensaft. Zucker’s approach, however, continues to thrive and I suspect is dominant.

I would add that I am adamantly opposed to surgical interventions for children. And that opinion is informed both by the professional work my partner did with transgender people in NYC, and the excellent 2001 Nova documentary, Sex Unknown, which comes at this issue from an important, opposite angle.

In that documentary we get the story of Max Beck:

When I was born, the doctors couldn’t tell my parents what I was: They couldn’t tell if I was a boy or a girl. Between my legs they found “a rudimentary phallus” and “fused labio-scrotal folds.” They ran their tests, they poked and prodded, and they cut open my belly, removed my gonads, and sent them off to Pathology. My parents sat in the hospital cafeteria, numb, their hearts as cold as the Manhattan February outside. […]

After five weeks of study and surgery, they weren’t any closer to the truth; mine was a fuzzy picture. Not even the almighty gene provided any clear answers, since it was discovered that I was a mosaic, with some cells in my body having the XY genotype and others having XO. The decision was made to raise me female.

Here the doctors made the decision, a physical decision (in Zucker’s terms, they chose whether Max would be black or white), and with that decision the story begins.

The parents tried desperately to do as the doctor ordered and raise Judy (now Max) as a girl, even as he knew - as only he could know, from the knowledge deep inside him of his essential self rather than from any external signals or anything anyone said - that he was a male.

This story lends credence to Ehrensaft’s view. I urge you to view it. read about it. (Unfortunately, Nova’s not available online. It is, however, in heavy reruns!)

Right now Morning Edition has Part 2 of their story on air. I’ll have more to say after listening.

Thanks Holly!