Parents expect to raise the child born to them. So, when a child takes on a different gender identity, they take on a unique set of challenges.
With heightened public awareness of transgender issues, an increasing number of parents are facing these challenges.
Debi Jackson is one of them. Her daughter transitioned socially (as opposed to medically) to a girl at four years old.
Debi thought she was raising two happy, healthy young boys when at about the age of three, the older one – who now goes by Avery — started asking for sparkly shoes and princess dresses. She only wanted to shop in the girls department.
“Then she got to the point when she very directly told us, 'you think I’m a boy but I’m a girl inside.'”
The family immediately sought out therapists, and talked to the school about what was going on.
At school, the kids were OK, but the parents stopped talking to Jackson and her husband when they dropped Avery off. Their Southern Baptist church community abandoned them.
Experts say accepting a transgender child can feel like losing a loved one. There are stages — denial, grief, anger and depression.
Jackson says it’s not really mourning the loss of the child, but the ideas we have for those children when we give birth.
“As soon as they’re born you start to imagine the prom dress, the wedding dress, and playing on the football team. We have ideas of what life will be like raising a boy and what life will be like raising a girl. And those milestones ... so many of them are gender specific that suddenly you have to swap.”
Lynn Barnett and her partner Gina Barnett adopted a one-and-a-half year old girl from China. Lynne says they didn't recognize anything out of the ordinary until the child was six or seven.
"Then he started wearing tuxedos to dress up events and going only to the boys department," she says of her son, Issac.
One weekend, the Barnetts took Issac to a gay pride event and he met a female to male transgender man.
"He came home and said 'you know, if I dress like a boy for five years I’ll grow a penis and be a boy.’”
He struggled for years after that – trying to live like a girl. Long hair, dresses, even a boyfriend.
"About the time he was 16, he said ‘OK I can’t be a girl anymore. I tried my hardest. I’m really a boy and I want to be known by a male name, so he became Isaac.'"
Why Isaac? As a girl he was Sara Beth. “Everyone knows Isaac came from Sara,” he told his parents referencing the Bible.
Michael, who didn't want to use his last name, is also a parent of a transgender kid.
He explains his situation is a bit different. His young son never let on he felt he was living in a woman's body. Not until he left home.
"Zoe told us about three or four years ago that she born in wrong body," he says. She is now 25.
“Up until the age of 21 or 22, we were raising a son.”
Michael says he and his wife were stunned by the announcement.
There were some difficult behaviors growing up but nothing he thought of as atypical.
"She would just 'hit the wall' real easily and become frustrated with herself physically and emotionally," he says.
Zoe was small kid, a bit behind socially, but she played sports. She was the sports editor for the school paper. She bonded with her older brother over the family passion for the Chiefs and the Royals.
Later on she revealed she was just trying to fill the role of a good brother and son.
"She came to tell us later that behind the scenes she had interest in girls clothing, that she envied girls' freedom to dress up and do those things," says Michael.
I asked Michael if it's hard to go back and look at pictures, family movies or talk about family experiences from when when Zoe was considered a boy.
Michael tells a story about a picture — a pencil drawing Zoe did of herself in high school.
It's an amazing likeness of what she used to look like, he says. She's in a suit and tie. Michael keeps it on his wall in his room — no one sees it but him.
He says one of the hardest things about this process is balancing his wish not to offend Zoe, but to remember the past.
He seems sad when he talks about this struggle, but says he keeps the picture to remind himself that Zoe is the same person underneath and her happiness is what's most important.
Dr. Jill Jacobson, a pediatric endocrinologist at the Gender Pathways Clinic at Children’s Mercy Hospital, says the clinic draws patients from all over the Midwest for it's multidisciplinary treatment of young people with gender dysphoria.
Jacobson tells patients one thing at the outset.
“Raise the child you have rather than the one you expected," she says. "I think sometimes that can sound harsh, but it's a message I give to families.”
But that's not so easy to do. Parents often see their children defying gender stereotypes – which are changing anyway.
Jacobson acknowledges research shows some 45 percent of those taking on another gender will revert back to their birth gender before puberty. So how's a parent to know when to trust their child's behavior?
Heather McQueen, a clinical social worker at Gender Pathways, says clinicians look for a pattern of behavior.
"We look for three things — consistence, insistence and persistence," she says. Basically, that a child keeps saying the same thing.
But here’s another haunting statistic. Around 40 percent of those with gender dysphoria have attempted suicide, according to the Journal of LGBT Youth and a report by The National Center for Transgender Equality and the National Gay and Lesbian Task Force, among others.
The parents I spoke to say it's hard, but for the most part, their kids are thriving.
Eight-year-old Avery is homeschooled, a Brownie Girl Scout and takes martial arts classes.
Isaac is now 19 and goes to Johnson County Community College. He plans to go to law school.
Zoe is 25. She’s recently started school in Boulder, Colorado. She wants to be a therapist working with the transgender community.
Laura Ziegler is a community engagement reporter and producer at KCUR 89.3. You can find her on Twitter, @laurazig.