Gender confusion, known medically as gender identity disorder, affects children of both sexes but boys much more so, at least in North America. One clinic reported a ratio of 6.6 boys for each girl, the sex imbalance being attributed partly to greater intolerance of feminine behavior in boys (Zucker et al., 1997). This disorder seems to be partly heritable, although we face a similar problem of perspective here as with the referral statistics (Heylens et al., 2012). To what degree does the heritable component reside in how these children objectively behave, and not in one behavior that may or may not alarm another person, usually a parent? In practice, it’s the latter. It’s whatever behavior that makes a parent bring the child to a clinician’s office.
The transgender community likes to talk a good talk about “gender fluidity.” Ironically, such fluidity is reduced by gender reassignment, which imposes a relatively unchanging adult dichotomy on prepubertal individuals who are going through rapid physical and psychological change. This brings us to a second irony. The transgender community complains about how it was once medically pathologized. Yet here it is pathologizing cases of gender confusion that are not unusual among young children and that are consistent with normal child development.
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