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Isaac, age 12.  

This is a major concern for some parents facing the decision. Frieda—as I’ll call her—is an 11-year-old biological girl who has always been very boyish, and who for the last two years has insisted on being called “he.” Frieda’s parents try to sidestep the fiat by forming awkward sentences like “Frieda will be over at six, and Frieda will bring Frieda’s bathing suit.” Despite resisting the male pronoun, they have no problem with Frieda’s preference for boys’ clothing, haircuts, and activities. If Frieda were a lesbian, her father says, “we’d embrace that, of course. That doesn’t push my buttons at all.”

But Frieda appears to be sailing in deeper waters. Though she’s fully knowledgeable about female physiology and development, she insists that she will not get her period; as proof, she points to other girls, like her sister, and says, “Am I like them?” To which her parents can only agree that she’s not. “Then I’m not a girl,” she concludes.

“And I don’t say, ‘Frieda, that’s impossible, you are a girl, it’s coming, get ready, deal with it,’ ” says her father. For the moment, his concerns are less about biology than philosophy. “The thing that does worry both me and my wife, as feminist parents,” he says, “is that we don’t want her developing bad ideas about being a girl. We want her to have pride in being a girl, and to know that a lot of great pro-girl stuff is happening.” The problem is that Frieda isn’t interested, and forcing the issue seems eerily similar to the social pressure that feminism is meant to counteract.

“Perhaps it’s cowardly of us not to intervene more forcefully,” says her father. (Frieda’s mother preferred not to be interviewed, and Frieda was off-limits.) “But we’ve elected to just go with it. When she and I are out together, she likes to go to the men’s room with me, and I let her. It doesn’t raise any eyebrows because she’s very boy-looking now. But that’s all going to change.”

For an 11-year-old girl, that change is fast approaching, and Frieda, despite her irrational certainty that she will never menstruate, got excited when her parents told her about puberty blockers. “Luckily, so far, she hasn’t said anything further about it,” her father says, “but I wish we hadn’t raised it” because he’s “adamantly opposed.” Partly, his objection is to turning what he sees as a personality trait into a medical issue. “I don’t want to mess with her chemistry. If she’s interested in changing herself physically when she’s 18, despite the fact that she might have to do some awful surgical interventions, that’s up to her. I don’t want to enable that now.”

Many parents feel the same way. Though they would not hesitate to treat their child with serious drugs for a serious disease, they often see gender transition as frivolous or elective, and the blockers as mysterious, possibly destructive chemicals. In fact, they are synthetic versions of naturally occurring hormones, and have been used for decades to treat endometriosis in women and prostate cancer in men. Dr. Hembree tells parents that aside from the rare allergic response and the ­occasional hot flash, there are no adverse consequences, and that the puberty-­suppressing effect is completely reversible merely by ceasing treatment. To him, and to many parents for whom the blockers buy time to see how their child’s transgenderism develops or doesn’t, it’s a miracle treatment, albeit an expensive one; each monthly injection of Lupron, the most commonly used brand, costs about $600 in the United States, and is not always covered by ­insurance. A typical treatment lasting six or more years may add up to more than $50,000.

But for Frieda’s father, cost is not the issue, nor simply his distaste for medical mucking around. “I’m kind of a knee-jerk anti-­capitalist,” he says, “and I see this fetishism about taking dramatic decisions earlier and earlier as a bit like all the junk we get fed as parents to do better with the best toy and best therapy and personal coach. I guess my view is more like: Hey, let it ride. We all are in this world to struggle with a million things, and we don’t have to try some fancy new solution. Even if she said, ‘I really need this, I need to get rid of these breasts,’ I don’t know … I don’t think … I don’t see that as a solution for her crisis … not crisis, it’s not a crisis … for her exploration.”

He pauses after the struggle with that sentence and changes tack. “But it’s really cool territory she continues to explore. Personally I hope she does that in such a way that she doesn’t have to fuck with her body. If she started to be insistent, that would be interesting. But we’ll drive off that bridge when we come to it.”