San Francisco Chronicle,
Sunday, April 8, 2007

Let them be

What's the proper parental response when faced with a kid who's gender variant?

By Sarah Hoffman

In the gymnastics studio lobby, my 4-year-old son stood staring
mournfully at the rack of hot pink velvet leotards. "I'll never wear
one of those," Sam whispered. Reluctantly, I asked, "Do you want to?"
He answered, slowly and sadly, "Yes. Yes, I do."

I'd said no before, to pink dresses and sparkly lip balm. It would be
so easy to say it now: "No, that's for girls. Look at what the other
boys are wearing."

Other pink boys

Sam is the only boy in his gymnastics class who asks for a leotard,
the only boy in his preschool who likes nail polish. It's tough on
Sam, because kids make fun of him. And it's tough on me and my
husband, because people question our parental judgment. Worse, we
fear for Sam's safety.

While looking for a ballet class where Sam could wear his tutu, I met
another mom of a boy like Sam. She told me about a group of parents
of pink boys and tomboys who e-mail every day on an electronic
listserv hosted by the Outreach Program for Children with Gender-
Variant Behaviors and Their Families, a program of Children's
National Medical Center in Washington, D.C.

The program, started by child psychiatrist Edgardo Menvielle and
psychotherapist Catherine Tuerk, is the first of its kind. Tuerk's
own gender-variant son was born in 1968, and she and her husband
spent many painful years discouraging his desire for Barbie dolls and

More than 200 families communicate via the listserv. The program also
connects parents with face-to-face groups across North America and
publishes a parent guide. Their message is twofold: accept your
child, and teach him or her to survive in a hostile world.

Not an easy road

On the listserv, I met the Iorillo family from Boston. "There was
always something different about Tony," Gloria Iorillo tells me about
one of her 9-year-old fraternal twin sons. At 2, Tony twirled around
the living room pretending to wear a dress, and turned Gloria's
curtains into "long hair." Tony preferred his sister's girlie toys to
his twin brother's trucks.

Gloria and her husband were raised in traditional, Catholic homes,
and were unnerved by these persistent behaviors. "I steered him
firmly toward more typical boy things. I thought I was teaching
him ... appropriate behavior."

But Tony became defiant and difficult, and the feminine behaviors
escalated. He started kindergarten with a pink lunchbox and a girlie
T-shirt; he was Tinker Bell for Halloween. At Christmas, Tony asked
Santa to make him a girl. Gloria wondered, "Why don't I have to teach
my other son [how to be a boy], and I have to teach Tony?"

One day, Tony tried on his sister's dress-up clothes. "I ... freaked
out," recalls Gloria. "I said 'No! You can't put that on.' He started
to cry, and asked, 'Why?' I said, 'Because you have a penis, and
you're a boy.' And he said, 'But I love these clothes, Mommy. I want
to be a girl.' "

What does it mean?

Parents of gender-variant kids are often asked -- by family, friends
and strangers -- if their children are gay or transgender. It's an
impossible question to answer.

While the correlations between biological sex, gender identity and
sexual orientation have not been extensively studied, experts rely on
the research of psychiatrist Richard Green from the 1960s and '70s.
Over a 15-year period, Green studied two groups of boys: one gender-
variant and one typically masculine. He published his findings in the
1987 book, "The 'Sissy Boy Syndrome' and the Development of
Homosexuality." The first group, 66 boys in all, preferred girls'
clothes and toys, gentle play with girls and identifying as female
characters in imaginative play. The second group, of 56 boys,
preferred boys' clothes and toys, rough-and-tumble play with boys and
male characters.

Three-quarters of the "feminine" group that was followed to young
adulthood was gay or bisexual; one was transgender. All but one of
the masculine group was straight. Green's study, while flawed and
dated, says this: Gender-variant boys are likely, but not
overwhelmingly, to be gay; they rarely grow up to be transgender.

The truth is, no one can tell by looking at the clothing or hairstyle
of a child how the distinct elements of their gender, identity and
sexuality will come together. "This is something nobody can predict,"
Menvielle says. "We have to be open to changes -- or no changes -- in
the variety of ways the life of a child may unfold."

Whose fault is it?

When a pair of twins, raised in the same environment, come out so
differently, it's hard to imagine that the child's parents could have
influenced their gender behaviors. Yet this is something that many
parents worry about.

Computer professional George Bley of Brooklyn, describes himself and
his wife as "normal, heterosexual, boring-type people." Their 8-year-
old son Max has long hair and presents like a girl. At 5, Max cried
himself to sleep at night, wailing, "Why didn't Mommy make me a
girl?" George fears that he somehow caused Max's gender variance by
not conforming to stereotypes himself. "Maybe if I liked sports more,
or if [my wife] was home cooking more, or if I was a lumberjack ..."

Many parents share similar fears. Mothers who used fertility drugs or
egg donors worry about pre-conception hormones; one mom imagines an
illness during pregnancy must be the cause; one father thinks it was
because he had wanted a baby girl. While such questions weigh heavily
on parents' minds, there is no evidence that parents or the
environment have anything to do with a child's fundamental gender

Dr. Herb Schreier, child psychiatrist at Children's Hospital &
Research Center Oakland, has been working with gender-variant
children for 20 years. "One look at the families (of gender-variant
children) and you see these behaviors are not coming from Mom and
Dad. This is simply a natural variation."

Can we, should we, 'fix' them?

Parents on the listserv frequently report hearing the admonishment
"Stop encouraging him." It sometimes appears to outsiders that all
that is needed to make a child conform to traditional gender norms is
some discouragement. This idea is linked to the notion that these
children will be gay adults and that changing their gender expression
in childhood will prevent that outcome. But there is no indication
that such an approach works -- and there is plenty of evidence that
it is harmful.

The American Psychiatric Association removed homosexuality as a
mental illness from their Diagnostic and Statistical Manual of Mental
Disorders, or DSM, in 1973. In a peculiar twist, a diagnosis of
childhood mental illness called gender identity disorder (GID) was
added to the DSM that same year. [The preceding statement is in error: GID was introduced to the DSM-III in 1980, 7 years after the APA voted to delist homosexuality from the DSM-II.] A child is considered to have this
disorder if he or she wants to wear the clothes of, participate in
the games of, form friendships with and in some cases be, the
opposite gender. When I first read the entry, I thought: That's Sam.

The Green study indicates that GID is often a precursor to adult
homosexuality. While the APA continues to assert that homosexuality
is not pathological, the inclusion of GID in the DSM implies that
"pre-homosexuality" in children is. But, as with adults, scientific
evidence of efficacy of "treatment" is lacking, and evidence of harm
has been proven.

When parents seek mental health consultations for their child's
gender-variant behaviors, they are often told, Menvielle says, to
restrict "gender inappropriate" activities: "Throw away his Barbies;
make her wear a dress." But children do poorly with that approach.
"What typically happens is kids get very upset, very secretive," he
says. Changing their deepest desires "is not something that works. We
never see that. We see kids who are depressed, or very angry, or shut
themselves in their room and play secretly, or have suicidal thoughts."

The Family Acceptance Project, conducted by Dr. Caitlin Ryan at San
Francisco State University, examines how family attitudes affect the
health, mental health and well-being of lesbian, gay, bisexual and
transgender young people. The study (publication forthcoming) shows
that LGBT young adults who experienced high levels of parental
pressure regarding gender conformity report significantly higher
levels of depression, illegal drug use, suicide attempts and unsafe
sex than their peers who report little or no pressure.

"Parents want the best for their children," says Ryan. Those who try
to suppress gender-variant behaviors "may think they're helping their
child survive, but really they're forcing them to devalue a core part
of who they are -- which will ultimately hurt them, and increase
their risk."

Mainstream medicine now understands that homosexuality is a normal
variation of human sexuality. So why is GID still considered a
disorder? The diagnosis states, "The disturbance causes clinically
significant distress or impairment in social, occupational, or other
important areas of functioning." In other words, it's tough to be
different. Bley, who believes there is nothing wrong with his son,
Max, jokes darkly, "We could call it persecuted minority syndrome:
people need therapy because the rest of us are mean to them."

Let pink be

Most people don't like being different in ways they haven't chosen;
parents understand that the life of a gender-variant child may not be
as easy as a conventional life. But given that being gay -- only one
of several potential outcomes for pink boys -- is a natural variation
of human sexuality that cannot be "cured," what are we afraid will
happen if we let a little boy wear the proverbial pink leotard?

Many parents, despite initial reactions of surprise or distress, have
found that affirming and supporting their gender-variant child leads
to positive outcomes. When Gloria's son Tony told her that he wanted
to be a girl, "I flipped," she remembers. After learning about gender
variance, Gloria decided to allow Tony to wear what he wanted at
home, and bought him his own girl toys. She told him, " 'I didn't
know that little boys would like this so much. I understand that
now.' And he just gave me the biggest grin, and hugged me and
immediately went and grabbed his sister's dress, and didn't take it
off the whole day."

Gloria's husband, Emile, "was very reluctant at the beginning." One
night, "I told Emile that if we don't support Tony, we're going to
lose him. There's an elevated risk of suicide and depression. We
can't let that happen."

The next morning, Tony sat drawing at the kitchen table on paper he'd
divided in two. On one side, he drew himself as a girl alongside his
sister, his mother and a happy, shining sun. On the other side, he
drew his father, his brother and dark rain clouds. Emile got it.

When his father began to accept him, the change in Tony was
significant. After behavior issues and extreme jealousy of his
sister, Gloria reports, "he became very loving toward his sister. ...
They started to play together all the time ... giggling with delight.
It was music to my ears! He calmed down, he was at peace with himself
and the world."

Parenting a gender-variant child is challenging, Gloria says, not
because there's anything wrong with the child "but because of how
they are perceived, and how our parenting skills are perceived, and
how our morality is perceived." But, she says of Tony, "We are
blessed to have him. He has changed our lives. He has opened our eyes."

 From her new vantage point, Gloria believes that gender-variant
children need extra support because of the challenges they will face.
"If we don't make them strong, they are going to fail. And the only
way to make them strong is to make them feel proud of who they are.
There is no other way."

Back at the gym

The longing in Sam's face that afternoon was so intense, the
certainty that he could not wear that pink leotard so embedded in his
features, that I decided to say it: Yes. One brief word, and that boy
lit up in a way I rarely see.

Once he'd wriggled into the leotard, a little girl looked at him and
said in a superior, I'm-a-teenager-in-a-5-year-old's-body tone, "He's
going to wear that?" I said, cheerfully, "Yes, he is!" She looked
down her nose and said "Weird!"

Sam seemed unfazed by the girl's intolerance, and did well that day
in his leotard. He does well most days in his leotard. It's still not
easy, for Sam or for us, but it's worth it to let him be who he so
clearly is.

And it turns out, Sam looks gorgeous in a leotard. Hot pink is really
his color.

Names, places and other identifying details in this article
(including the writer's name) have been changed to protect the
identities and safety of the children and their families.
What is gender variance?

According to the Children's National Medical Center, gender-variant
behaviors refer to strong and persistent gender-typed actions and
interests typical of the other sex. It may be expressed in behaviors
such as choices in clothing, games, or playmates, and verbalization
of a wish to be of the other sex.

Some experts used to believe that gender variance represented
abnormal development, but today many have come to believe that
children with gender-variant behaviors are normal children with
unique qualities -- just as children who develop left-handedness are

What if there were more than two?

People who feel they don't fit perfectly into the popular culture's
definitions of "male" and "female" sometimes lament that our binary
gender system is too limiting. Australian cultural anthropologist
Sharyn Graham Davies explores a culture that recognizes five distinct
genders in her book "Challenging Gender Norms: Five Genders Among the
Bugis in Indonesia." These include makkunrai (feminine woman),
calabai (feminine man), calalai (masculine female), oroan? (masculine
man), and bissu (embodying both male and female energies, revered as
a shaman).

Davies writes of the Bugi belief -- contrary to much of Western
thought -- that one's gender, even if different from one's biological
sex, is unalterable, predetermined by God. One calalai explained, "If
your kodrat (fate) is to be calalai, you have no option but to be
calalai." -- S.H.


Outreach Program for Children with Gender-Variant Behaviors and Their Families

Children's National Medical Center

The Family Acceptance Project

Parent Group at Children's Hospital Oakland

Stephanie Brill, facilitator


TransYouth Family Advocates

Sarah Hoffman is a Bay Area writer. She can be reached at