CHICAGO -- From the time they are born, we put our boys in blue beanies and our girls in pink ones. It's a societal norm, an expectation even, that you just are what you are born -- a boy or a girl.
From early on, we divide toys and activities by very distinct gender lines, with superheroes and trucks and muck on one side and princesses and dolls and all things frilly on the other.
Many children land, enthusiastically, on the expected side. Others dabble in both "girl" and "boy" things. But what if your kid, even from an early age, mostly showed interest in doing opposite-gender things? More importantly, what if they wanted to BE the opposite gender -- or a less-defined mix of both? And what if they wanted to test those limits in public places, like school?
Would you let them?
It's not, of course, that pat of a process. Parents don't just decide to let their kids switch genders. But, whether parents are dragged through the process, or if they decide to work it through more openly, more kids are challenging the boundaries of traditional gender, and going public at younger ages.
And they are doing so with the guidance of a growing faction of medical experts who no longer see this as something to be fixed. Last year, the American Psychiatric Association removed "gender identity disorder" from its list of mental health ailments.
Some experts predict that views on gender will evolve in much the same way they have for sexual orientation, since homosexuality was removed as a mental illness nearly four decades ago. Today, the gender spectrum includes those who are transgender, who see themselves as the opposite gender, and those who are gender variant, or gender nonconforming, whose gender is more "fluid." For kids, it means they identify part of themselves as boy and part as girl.
"Now these kids are beginning to have a voice and I think that's what's been making things interesting and challenging -- and difficult, sometimes -- depending on the family, the kid, or the school," says Dr. Robert Garofalo, director of the Center for Gender, Sexuality and HIV Prevention at Lurie Children's Hospital of Chicago.
While the numbers are relatively small, it means that, increasingly, schools are having to figure out how to accommodate them, some more successfully than others.
The questions often start with the basics: Which bathroom do they use? Where do they change for gym class? What if teachers or students don't want to use the pronoun, "he" or "she," or a new name the student prefers?
It can be difficult, and uncomfortable. In Colorado, for instance, the parents of a 6-year-old transgender girl are suing their school district for trying to make her use a separate bathroom.
The center at Lurie opened recently, in part, to meet the demand from parents seeking guidance for children who are questioning their gender identity and to provide support to older transgender youth who sometimes struggle more in adolescence, even facing a greater suicide risk, especially if they have no backing from family and others around them.
The center also serves as a resource for schools with transgender and gender variant students.
Increasingly, those students are making the transition as early as elementary school, if not before.
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Ryan, a fourth-grader in suburban Chicago, is one of those kids.
Most people, upon seeing her big blue eyes, long lashes and flowing blond hair, would never know she's anything but a girl. But underneath, she is still physically a boy.
Doctors call that gender variant, though Ryan prefers to call herself a "tomgirl."
"I feel that I'm a girl in my heart," she says, "and a boy in my brain."
Though the decision to publicly express as a girl happened at the end of kindergarten, Ryan had slowly been becoming "she" at home for a long time, even when she still had a crew cut.
Six months after her second birthday, her parents say Ryan was drawn to all things pink and sparkly. Ryan, the boy, wore pajama pants on his head, pretending it was long hair, or acted out girl roles from movies.
By kindergarten, Ryan would bolt through the door of the family's suburban Chicago home, leaving a trail of boy clothes up the stairway -- then quickly changing into a skirt and matching T-shirt.
Ryan's parents, initially told that Ryan had gender identity disorder, tried to get their child more interested in traditional boy things. But Ryan preferred chasing butterflies instead of footballs. Her dad scheduled extra "father-son" time, thinking that might have an influence. But nothing changed.
"The next step was to eliminate all girl things -- can't write about girl things, can't draw girl things, can't talk about girly things ... and that just didn't feel right," says Sabrina, Ryan's mom.
They decided to stop resisting and allowed Ryan to start taking small steps into the outside world, at a nearby park, for instance, where she wore her girl clothes.
For her kindergarten Halloween party, Ryan dressed as a princess and, shortly after, asked her parents to refer to her as "she," a request to which they agreed, though it took a few months to adjust.
Their first support came from a pediatrician who specialized in gender, as well as other parents with children like Ryan, many whom they met through an online listerv. They are, as they call themselves, "affirming parents."
"There's a realization that it's not a phase or something that's ending when the preschooler gets to kindergarten," says Kevin Gogin, the program manager for school health programs at the San Francisco Unified School District, which recently added a transgender category in student health surveys. The survey found that 1.6 percent of high school students and 1 percent of middle school students identified as transgender or gender variant. Elementary students weren't in the survey, but Gogin says the district has seen more young transgender and gender variant students, too.
Sixteen states and the District of Columbia have transgender rights laws, according to Michael Silverman, the executive director of the Transgender Legal Defense and Education Fund in New York City. He is representing the family of Coy Mathis, the 6-year-old transgender girl in Colorado.
But even in states that don't have laws, he says districts are often open to guidance.
"There is definitely more awareness," says Kristyn Westphal, vice principal at Grant High School in Portland.
There, they've established a student support team to determine how well the school is meeting the needs of transgender and other students. Earlier this year, the school also created individual gender-neutral bathrooms that any student can use.
Bathrooms often become a focal point because, when children are young, the transition is often more "social," a change in clothing and hairstyle.
As some kids move into puberty, they might use hormone blockers and, eventually, start hormone therapy to help their bodies transform from male to female, or vice versa. But any kind of surgery, experts say, is still relatively rare, even in adolescence.
Scott Morrison, a transgender student at Grant High School, says having support at home and at school, as he did, will make a big difference for kids like Ryan.
Morrison, a graduating senior, moved to Oregon from Virginia three years ago.
"Gender identity is probably the most important part of me," Morrison says. "It's the most important discovery I've made about myself."
He transitioned from female to male a year later and says support from his mom, his friends and his new school -- and help from a counselor -- likely prevented him from committing suicide.
According to a 2010 National Transgender Discrimination Survey, 41 percent of transgender people surveyed said they had attempted suicide. That figure rose to 51 percent for those who said they'd also been bullied, harassed, assaulted or expelled because they were transgender or gender nonconforming at school.
With more support and an ability to live more openly, however, some wonder if it will be better for Ryan and this up-and-coming group of transgender and gender variant kids.
"I'll be really curious to see what this next generation looks like," says Masen Davis, the executive director of the Transgender Law Center, a civil rights and advocacy organization based in San Francisco. "I'm hopeful."