Diane Ehrensaft

The cover of my review copy of Dr. Diane Ehrensaft’s new book, Gender Born, Gender Made might have been made from one of my family’s snapshots. The presumably male-bodied toddler with the tutu worn over his pants peers quizzically into the camera’s eye, evoking a shiver of recognition. I know that kid. He could have been my son six or seven years ago.

As the father of what Dr. Ehrensaft’s refers to as a ‘gender creative’ child, a boy who liked, well, loved, girl things, my family spent a decade working through the issues discussed—without the aid of this, or any other, book. The existing literature on transgender people, books like True Selves, spoke only of adults, and only of adults who had been viciously suppressed as children. The end result—misery. While True Selves showed us how not to raise our kids; there were no books to tell us what we should be doing.

We had a two-color trifold pamphlet from the CNMC, the Children’s National Medical Center and its gender and sexuality education and advocacy program founded by Catherine Tuerk and Dr. Edgaurdo Mienville, who writes the introduction to Gender Born, Gender Made. The trifold, as well done as it was,  was a slim reed upon which to  base our support of our child’s gender nonconformity. As one of a few dozen families on the the CNMC list serve, we had to make do with our small community of supportive professionals, a handful of studies, and the hundreds of anecdotes shared among our group of like-minded parents.

As it turns out, Dr. Ehrensaft shared our experience of raising a gender-non-conforming kid without a roadmap. Her son was a pink boy. She writes of the benefit, or curse, of her psychoanalytic education in the books “Relearning Gender,” chapter. While many of us were learning what little was truly known about gender development, Ehrensaft was busy unlearning what she thought she knew based on the bizarre arm-chair ‘science’ of Sigmund Freud and his ilk.

Ehrensaft’s previous book, Spoiling Childhood, which admonished parents to stop being wimps and exercise more authority over their kids, would seem a far stretch from the ‘follow your children’s lead’ message of Gender Born, Gender Made. This books PR release included a Q&A in which Ehrensaft noted the difference between a kid who refused to make his bed, and a kid who insisted he was something other than his assigned birth gender. Point taken. One has to wonder queasily if some families might have generalized strategies from  her previous book into gender policing their non-conforming kid.

Ehrensaft notes that older studies of childhood gender development are tainted by antiquated psychoanalytic models and homophobic cultural bias. Newer research based on self-selected groups of supportive parents is fragmentary and inconclusive. But parents need to make decisions now, about the children they have now, and the fact that the science can’t keep pace with the culture doesn’t diminish that need one iota. Gender Born, Gender Made, speaks to this reality.

If you are the parent of a gender non-conforming child, you can skip the rest of the review. Just buy it. Buy one for your pediatrician, and one for your kid’s school teacher as well, while you’re at it. I’m going to keep talking, though, because I’ve never read a book before where I knew pretty much all the experts personally, and had consulted on many of the articles quoted.

So Instead of incontrovertible science, parents of gender creative children must be informed by the hundreds or thousands of anecdotes assembled by the experts. adds a second volume to this slim stack of books. Following Stephanie Brill and Rachel Pepper’s “The Transgender Child,” Ehrensaft’s book shares the supportive parenting model, but its title seems a better choice. While Brill’s book has an excellent chapter on gender non-conforming kids who do not go on to feel they are born in the wrong body, the “trangsgender child” title will probably ensure it is never read by many of the families who need it most. The title alone makes Ehrensaft’s book a valuable resource, one that may prove more accessible than Brill’s book, when trying to educate educators, caregivers, or relatives.

There isn’t a non-pathologizing language for talking about gender non-conformity, so Ehrensaft is compelled to create one. Eschewing the term ‘gender variant’ as too close to ‘gender deviant,’ she makes heavy use of the word ‘creative.’ Gender creative kids are gender non-conforming kids creating an identity out of a combination of nature, nurture, and culture Gender creative parents are the parents that let them be, while helping them to navigate the non-supportive landscape outside the family bubble; obstructive parents put obstacles on the path of the gender creative child’s development. The goal is to prevent the creation of a dominant ‘false gender self,’ to allow the child to create a true gender self.

There’s a brief discussion of hormone blocking and treatments, which might be useful to read on your way to the pediatric endocrinologist. My own son’s development tacked away from a transgender identity as puberty approached, as did Ehrensaft’s. Ehrensaft cites the proven safety record of Lupron, the puberty-blocking drug used to buy time for the pre-pubescent child, without mentioning the ‘gotcha’ which plague parents considering this path. While it is possible to go off of Lupron and resume a normative puberty in a child’s birth gender, to date no one ever has. This may simply mean, of course, that the screening process has been, to date, perfect. However, this does make Lupron’s reversibility almost a moot point.

Because this intervention, of course, lies at the core of the controversy surrounding these kids, the fact that has drafted them and their families into the culture wars. Ehrensaft describes how parents of gender-non-conforming children emerging as transgender are presented with a choice; allow normative puberty to forever mark our children in ways that are often irreversible (height, hair, adams apple, hands, feet, and face) erasing that child’s ability to pass as their affirmed gender, or, make irrevocable decisions on their behalf, sterilizing them in many cases, and exposing them to the various risks of hormonal therapies. (By and large, surgery is left for later with trans kids, letting most parents off the hook for that decision but even there, among the firmly committed, families find themselves pushing for controversial treatment.)

Ehrensaft explores this difficult reality, the fact that there are no easy answers, and that many parents of gender non-conforming kids will have to learn how to live with ambiguity for protracted periods of time. Not all gender non-conforming kids will go on to identify as transgender; in fact, if the past is any guide, most of them won’t. Erhard’s own experience of a gender non-conforming son who would one day go on to claim a gay male identity, informs this book as strongly as her experience working with kids who feel born in the wrong body. On the flip side of this coin, Ehrensaft also shares anecdotes where apparently gender normative children emerge suddenly as transgender at puberty.

In Gender Born, Gender made, Parents of younger gender non-conforming children are urged to accept their children as they are, keep them safe, while simultaneously permitting them the space to learn, grow, and change over time, though every parent hears the puberty clock ticking in the background, knowing at some point in the future they will have to make a choice, to act, or to let nature take its course, which will have life-long, irrevocable consequences.

She tells us that gender creative parents will have to be brave; they will have to struggle with their own feelings of ambivalence and confusion. She tells me things I already know, but which I’m glad to see in print, as she addresses the various audiences to whom this book is directed.

As to the nitty gritty of dealing with a gender creative child, Ehrensaft says it isn’t the role of the therapists to make these decisions for a family, but to facilitate the conversations which identify the necessary compromises. Should my male bodied child be allowed to wear a dress to first grade?Should we conceal our chid’s birth gender from his classmates? Each decision must be made in accordance to the families own logic and circumstances. No professional wants to advise a family to hide a child’s gender status, to create this huge secret, but in some places this deception may prove the lesser of two evils.

I find it odd that Ehrensaft devotes only a single paragraph to the notion of parental support groups, and provides no contact information for them; perhaps she knows that the parents who can be helped by such groups tend to seek them out, but I was disappointed that she did not come out more strongly for this form of support and community. In the absence of much hard science, in a world of anecdotes, is is the parents themselves who are the experts, and support groups contain a great deal of practical advice and information on dealing with school systems, bullying, and finding supportive professionals.

The book has good chapters on sibling issues, on caregiver issues, on confronting one’s own gender history. Of particular interest to me was the mention of what she calls ‘the flight to health’, in which parents (who may have been trans or homophobic) suddenly embrace a gender non-conforming child, and rush towards transition.

In this she shares the concern of some professionals with whom I have spoken, that a family may fast forward towards a transgender outcome for a non-conforming child out of a discomfort with the ambiguity of a gender creative child who may eventually end up identifying as gay, or straight, or gender queer.

Ehrensaft’s experience as a therapist working with gender creative children, and her own experience of a parent of a gender non-conforming child, makes this book unique. She’s a double expert, both parent and supportive professional, and while we wait for the research to trickle in, for the science to come-of-age, it is people like her to whom we should listen when it comes to understanding this exquisite mystery of male and female, mind and body, love and identity.

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