What can you do for a transgender child?

If your son insists he is a girl, what should you do? Eric Vilain, professor of human genetics and pediatrics at the University of California, Los Angeles, and J. Michael Bailey, professor of psychology at Northwestern University, pose dueling scenarios:

You could persistently tell him he is a boy and try to put an end to behaviors such as cross-dressing and telling others he is a girl. Or you could let him be a girl: grow long hair, choose a new name, and when it is time, obtain the necessary hormones and surgery for a female body.

In the short run, Vilain and Bailey say in an op-ed they wrote for the Los Angeles Times, the child whose parents try to keep him from transitioning will experience more psychological pain as he tries to accept that he can't be a girl.

In the long run, the boy who transitions will need serious medical intervention, including puberty-blocking medication, life-long estrogen, and perhaps gender-reassignment surgery.

"Each path has obvious advantages and disadvantages," Bailey said in a phone interview. But in his view, "gender dysphoria (the medical term for being transgender) in young children is far from fixed, and attempts to reduce it through psychosocial treatments are likely to be successful." He says as many as 80 percent of children who report gender dysphoria "will grow up adjusted" to their birth gender.

"This is a separate issue from conversion therapy for homosexuality, which doesn't work and to which I am opposed," he says.

"When parents learn their children are trans, they experience a mix of emotions - shock, sadness, embarrassment, fear that their child will be mocked, anxiety about their safety," says Kenneth K. Maguire, a psychologist with Philadelphia's Council for Relationships. "It is not unusual that each parent will respond differently. I encourage them to take a deep breath, take a step back, and educate themselves. No matter what, parents usually want what is best for their children."

Bailey and Vilain studied "transgirls" - children whose birth gender is male. "There are fewer studies on transboys, but I think the same findings would apply," Bailey said.

Linda Hawkins at the Gender and Sexuality Clinic at Children's Hospital of Philadelphia thinks parents should take seriously any child who is questioning birth gender.

"The majority of children who believe they are transgender are not going through a phase," she said. "There is an increase in their psychosocial well-being when they are validated for their identified gender. What does growing up 'adjusted' mean? Are they merely alive and surviving? Have they turned to drugs or alcohol? Are they depressed and anxious and struggling to understand why? Or are they happy and having healthy relationships?"

Even Bailey won't say what a parent in this situation should do. "At this point," he said, "I can say with certainty that no one knows what is better for your child."