Sometimes a Dress Isn't Enough

I wish I could wholeheartedly recommend Jacob's New Dress by Sarah and Ian Hoffman.

There are so many things about it that are wonderful. First of all, just to see a picture book about gender non-conforming children is great. The main character, Jacob, is a preschool boy who loves to wear dresses. When his teacher asks him what he wants to imagine being while playing dress-up, he says "proudly, 'I'm the princess.'"

Not only that, but the book shows Jacob's parents and teacher being accepting and supportive of his desire to wear a dress, and even addressing the bullying that he inevitably receives. "There are all sorts of ways to be a boy," Jacob's mother says while helping him to make a dress to wear to school. "It's not what I would wear, but you look great," Jacob's father says when he sees him in the dress. When the class bully wonders why Jacob is wearing a dress, the teacher points out that "Not long ago little girls couldn't wear pants."

At the same time, the book doesn't sugarcoat things. It shows the bullying and anxiety experienced by kids like Jacob - male-assigned kids who like "girl" things, whom the authors call "pink boys." Jacob is teased at school whenever he dresses up in dresses, and experiences a "can't-breathe feeling" as he embarks on wearing a "real dress" to school. The book even depicts the mom's trepidation about Jacob wearing a dress to school, as she hesitates before answering him when he first asks. A realistic reaction and probably something that will resonate with parents of GNC kids, no matter how supportive.

While bias and harassment are an unfortunate reality for a lot of GNC people including youth, these problems are particularly severe for those assigned male who want to present in "feminine" ways, due to society's misogynistic attitudes. So, it's great to see a book taking this on, and at a kid's level, where it can help those most vulnerable (GNC kids) and also maybe open up the eyes of other kids and parents.

So after all this good, I was super disappointed when I got to the end of the book, almost the very last line. On the last page, the authors, Ian and Sarah Hoffman, explain that their son "had long hair, wore dresses, and loved the color pink" as a preschooler. They talk about how they educated themselves about GNC children so they could support their son, and point out that "Studies also show that support and acceptance from family, peers, and community make a huge difference in the future health and mental health of these kids." But then they go on to say, "And it's not possible to know whether a gender-nonconforming child will grow up to be gay, straight, bisexual, or transgender. (Actually, we think it's too early to know this about any young child.)" (emphasis added)

Whoa! After all that heartfelt acceptance and support of GNC kids, I'm suddenly hearing denial of transgender kids' identities. I almost put the book back on the shelf at the library, not wanting to bring that message home with me.

While googling about the book and about pink boys, I stumbled upon this essay by Alice Dreger which shed some light on the authors' stance. Trying to ignore the references to "gender identity disorder" (which is no longer the accepted term for transgender leanings - the accepted term is now "gender dysphoria" - and the old term has surprisingly started to get under my skin) I read through it. And I find I agree with the gist of Sarah Hoffman's and Alice Dreger's thoughts on acceptance of GNC children, but I wish they wouldn't formulate them at the expense of children who are indeed transgender.

It's funny because I often find myself on the opposite side of this issue, blasting the stereotype that trans people know from a young age that they're "in the wrong body." Because I didn't. But some trans people do. Jazz Jennings and Tyler, a trans boy profiled by the Washington Post, are two examples who made the press.

Hoffman and Dreger, meanwhile, are worried that kids may be pushed onto a trans treatment trajectory unnecessarily. I can see how Hoffman might have experienced pressure in this direction as the parent of a GNC boy, which might have prompted her to say (as quoted by Dreger):

Most of these gender-nonconforming kids are just kids who don't fall to the most-masculine or most-feminine ends of the spectrum, and that's okay. They don't need treatment, they don't need sexual reassignment, they just need a supportive home life, schools with anti-bullying protocols, and therapy for any harassment they face for being different.

In the essay, she and Dreger both campaign for "more space for boys to fully express who they are," including in ways that are traditionally deemed feminine. That's something I can certainly get behind, being a masculine person with waist-length hair who wears eyeliner or tight pink tops on occasion.

But just as GNC kids should have the chance to be who they are, so should trans kids. If a male-assigned kid wants to wear a dress, cool. And if a male-assigned kid wants a "girl's" name and to be called "she" - shouldn't that also be ok?

What Hoffman and Dreger seem to be really pushing back against is transgender medical treatment, which can indeed start pretty early, as the article about Tyler shows. He was getting checked out to start puberty blockers at age 8. This is still years away from starting hormone replacement therapy, though, and about a decade away from the possibility of gender confirmation surgery, which Dreger makes out to be potentially devastating: "Surgical sex change will render a person infertile, in need of lifelong hormone replacement therapy, and carries significant risk to sexual function and physical health."

While these points are technically valid, I think bringing them up in a discussion of preschool children is fearmongering. Even among adults, most trans people can't afford gender confirmation surgery, which means that at this time these side effects don't even affect most trans people. Much more dangerous to trans people is the bias, harassment and violence they face from an intolerant society.

Lifelong hormone replacement therapy (HRT), meanwhile, is something that many more trans people are faced with, seeing as it's much more affordable than surgery. But how is this any different from any other chronic condition that requires lifelong treatments to stay alive or maintain quality of life? I compare my own fate of having to take a testosterone injection every week, probably for the rest of my life, to diabetics having to take insulin shots. If they deal with it, so can I.

HRT does also have the effect of making a person infertile, at least temporarily, by stopping sperm production or menses, but it can sometimes be reversed, as the many stories of trans men having babies go to show. Also, if sperm banking and egg harvesting were more easily available to trans people, that would also improve their ability to have children. It's not that trans people can't have children, but that the social and medical supports they need aren't there.

To address Dreger's last point, gender confirmation surgery does carry a risk of going wrong, as does any major surgery. But on the particular point of sexual function, my girlfriend and I are both expecting an even more satisfying sex life after her surgery. Just being on hormones has done wonders for our sexual satisfaction, especially hers. She physically couldn't function having sex in a male role. Now that she has a more feminine body, she can finally have sex that she enjoys. Obviously, this is just her experience; other trans people's may differ, but I hardly think most transitioned trans people feel as dismally about their post-transition lives as Dreger would make out.

Lastly, all this is irrelevant to a discussion about young transgender children, because preschool kids are years and years away from these treatments. Surgery is generally not allowed until the age of majority, i.e. 18 in many places; hormone replacement therapy isn't usually started until adolescence (around age 16); and puberty blockers don't come into the picture until puberty begins, around age 9 (WPATH Standards of Care v. 7). For preschool children, all we're talking about is letting the child dress and be treated as a member of their preferred gender - something that can be easily reversed if the child has different wishes later on. The child, family and their mental health provider will have years to assess whether medical transition is necessary. There is no need to raise the specter of the risks of HRT and gender confirmation surgery when we're talking about preschool kids.

I do agree with the basic point that we, as a society, need more space for boys who like feminine things. And Dreger and Hoffman make a good point that some parents may want to "normalize" their effeminate male-assigned child by having him transition into a girl, which might give the child more of a "normal" life. What they are saying is in fact even more radical than supporting trans kids - it's supporting kids of any gender to express themselves however they want.

I just don't like that this is worded in a way that could cast doubt on the actual transgender feelings of some kids. Trans kids need our support just as much as GNC kids. There has got to be a way to support both.

To Dreger, this is an intractable problem:

The problem is, it just isn't clear which children are children like them [transgender people], the children in whom significant gender dysphoria will persist.

What we know is that, in a large percentage of children, gender dysphoria appears to go away (or maybe to become accepted as part of their personalities, so that the pressure to change stops?). We also know that a significant number of gay men report having had interests in wearing typically-feminine clothes and doing traditionally-feminine activities as children. So how on Earth can we know when a boy who wants to wear a dress will need an endocrinologist? Or even a psychologist? It's not that simple.

It is actually really simple. Listen to the kid. There is no way for another person, even the child's parent, to know whether their kid is trans. The only one who can know is the kid themselves.

I understand, of course, that it's not always clear even to the person themselves. I'm still sorting out my own gender identity, after a year and a half of intense reflection and over a decade of submerged questioning. But several things have become clear to me - that using male pronouns and a technically male name, taking testosterone and living as male are infinitely better than what I was doing before. I'm definitely trans, definitely happier having transitioned (because that is possible without surgery, even without hormones - it's called social transition). I'm just not sure exactly what type of trans person I am, so I live under the broad labels "transmasculine" and "genderqueer."

And although I prefer living masculinely, I do have a "feminine" side, too - to the point that I want to go out in a short skirt someday when it'll be clear I'm in drag. So I certainly understand and support wanting a space for boys who like dresses.

And I can see why Hoffman might feel the need to push back against a certain pressure for "feminine" boys to transition - after all, being a boy who likes dresses is perhaps even more stigmatized and at risk for harassment than being a trans woman.

But just because a certain group - pink boys - needs their space, doesn't mean that trans kids don't need theirs, too.

Toward the end of the essay, Dreger quotes Hoffman writing:

I want to be clear that I believe that people who are truly transgender should have societal support and access to whatever therapeutic care they need. If my own son were transgender, I would love and accept him as I do my gender-normative daughter, just as I will love them whether they are straight, gay, or bisexual. My position does not come out of lack of trans acceptance, it comes from wanting to see broader social acceptance for the entire spectrum of gender expression so that kids can really figure out who they are and not be pushed into a box that doesn't fit.

I don't like the way she uses "truly" - it makes it sound as though she is the arbiter of who is "truly" transgender, when this is not something for cis people to decide, not even cis people who are the parents of GNC or transgender kids. But I agree with her on the need for "broader social acceptance for the entire spectrum of gender expression." It should be more open, so that we can have boys who like dresses as well as male-assigned kids who become girls, and all sorts of identities and expressions in between.

And again, I can see why Hoffman might feel the need to push back against pressures to label her son trans or gay, but I'm still disappointed that she chose to end a book that was supposed to be a tool for creating that "broader social acceptance for the entire spectrum" with a statement that negates the experiences of transgender children. Sarah Hoffman's son may not be trans, but there definitely are young children who know that their gender is different from what they were assigned, and who need the full-out change of living as their preferred gender. For all the good that the book Jacob's New Dress may do, I fear that that comment at the end may actually limit the acceptance and support for those kids for whom a dress is not enough.