Girl/Boy Interrupted

At age five, the discord between her identity and body seemed to take its emotional toll. At times she would play recklessly, and at other times, seem withdrawn and preoccupied. Marty's parents took her in for a psychiatric evaluation, and she was prescribed antidepressants. She told Margaret that if she had to be a girl, she'd rather die.

But one topic seemed to cheer the kid up. One day, Janet, the attorney, told her that a friend's daughter had started transitioning to manhood in her 20s. Marty lit up, pelting Janet with questions. How? It involved hormones and a surgery. Can I have it now? Can I get my penis? Janet said they would support her in whatever she decided, but that she would have to wait till she was older.

But the parents soon learned that interventions can start much earlier than that. Marty's pediatrician pulled the mothers in after the child's annual checkup: We all see what's going on here, don't we? Every year, the girl was presenting more and more like a boy. The doctor said the parents should find an endocrinologist who delays puberty for transgender kids. When puberty hit, the family didn't want to be caught off-guard.

Janet was skeptical. Although she'd trumpeted lesbian causes for years, she knew little about transgender people. How permanent could this really be in a seven-year-old kid? She and Margaret started attending a support group for parents of gender-variant children, and discovered one couple was calling their son "she." Janet thought it was a little odd.

"You would think of all people, I, who came out and went through all of this hullabaloo with my parents, would have the consciousness to understand people are who they are," Janet says. "But for me, with Marty, it didn't translate."

But that would change after two years of the support group, a barrage of books, Internet searches, and an Oprah episode on transgender kids that Marty watched a dozen times. When Schreier, the support group's psychiatrist, explained there was no way that parents could have made their kid this way, any last remnants of guilt dissolved.

"Look, we're a lesbian couple,"Margaret says. "Even if we didn't think we did, I know a lot of other people would think we influenced his gender identity."

Finally last summer, at age eight, Marty said she wanted to be considered "he." A boy. Their son.

"I finally got it," Margaret says. "This is an identity."

They were both sad to part with their idea of a daughter, but any final doubts faded after seeing how Marty seemed to glow in his new role, going to a new school as one of the boys.

But puberty?

The mothers had heard talk of "blockers" flung around in the support group, and had done some initial Googling on treatments. They attended a seminar this spring where Spack, the doctor from Children's Hospital Boston, explained the treatment for delaying puberty. Having been prescribed Lupron herself for fibroids years before and ballooning 50 pounds in four months, Margaret wasn't thrilled about the drug choice. (Indeed, women prescribed the drug for the approved uses for endometriosis or fibroids fill Internet message boards with complaints of hot flashes, mood swings, memory loss, and pain.) But the most common side effect in kids is irritation, sometimes including a sterile abscess, at the site of injection.

The idea of the injections was initially a relief to the parents. Something could be done, and with Janet's salary as an attorney, they could afford the approximately $1,800 shot four times a year even without help from insurance, if need be. But the option also added pressure. With Marty too young to fully grasp the implications, the decision to start was going to fall on them. The mothers knew they had altered the course of Marty's life the day they adopted him, changing his status from a Chinese orphan to an adopted Chinese-American child of gay parents. Now they faced taking the first step in what could become a transition to an identity even further from the mainstream: transman. All along, they had figured that decision would still be some years off.

But Marty turned nine and his breast buds demanded attention.

Give Marty a couple years without the shots and he might look something like the girl who sat before Dr. Henriette Delemarre-van de Waal at the Free University Medical Center in Amsterdam in 1986. Referred by a psychologist who diagnosed GID, the 12-year-old ace student was depressed about her growing breasts, which she had been binding to her chest to disguise. She wanted to be a boy.

The endocrinologist had never worked with a patient with GID, but a drug known as a GnRH blocker, the same compound as Lupron, had recently gone on the market and was being used to delay puberty for kids who developed too soon. The solution seemed obvious.

"She was crying for help, so I thought, let's try," Delemarre-van de Waal says. The treatment greatly alleviated the patient's distress, according to the doctor. At 17, the patient began taking testosterone, and later underwent sexual reassignment surgery. He is now a veterinarian.