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to do with how a person
feels.
Did Wyatt feel like he was female? Most people who are born with the anatomy of a male also identify as male, and most born with the anatomy of a female identify as female. But not everyone. Some people grow up feeling like the gender opposite of the one they were born into. Others have physical characteristics of both genders. Kelly didn’t pretend to understand it all, not by a long shot, but “transgender” sounded more like Wyatt than anything else.
    She kept reading. Although a sense of self is innate and established by the age of four, some children express dissatisfaction with their birth gender as early as two years old. Those who do, and in whom the dissatisfaction persists, are said to have gender identity disorder. The diagnosis was changed to gender dysphoria in 2013 in the fifth edition of the
Diagnostic and Statistical Manual of Mental Disorders,
or DSM-V, maintained by the American Psychiatric Association. Gender dysphoria is the state of unease that results when a person’s sexual anatomy doesn’t match up with his or her inner sense of gender. This was more than just a shift in language by the APA, it was a watershed moment akin to the elimination of homosexuality from the DSM-II in 1973.
    In the DSM-V, the general diagnostic criteria for gender dysphoria lists eight traits or behaviors a child must manifest for at least six months, including:
    • A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).
    • In boys (assigned gender), a strong preference for cross-dressing or simulating female attire.
    • A strong preference for cross-gender roles in make-believe play or fantasy play.
    • A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.
    • A strong dislike of one’s sexual anatomy.
    There must also be present “clinically significant distress” or an impairment in functioning. This last indication is important partly because of what it doesn’t say but implies. The distress transgender people feel when their anatomy is in conflict with their gender identity is different from the distress, for example, of a depressed person. In the latter case, the distress is part and parcel of the condition of depression, but that’s just not the case with transgender people. If there is an inner distress it arises from knowing exactly who they are, but at the same time being locked into the wrong body and therefore being treated by others as belonging to one gender when they really feel they are the opposite. The dysfunction arises not from their own confusion, but from being made to feel like freaks or gender misfits. Kelly shuddered when she thought of the torment other kids were capable of inflicting on someone like Wyatt. All in all he was a happy child, but when he wasn’t, it almost always had to do with being a “boy-girl,” which is how he referred to himself.
    Out of the blue, he’d ask Kelly, “When do I get to be a girl?” or “When will my penis fall off?” The questions almost seemed natural, as if it was just a matter of time before he became a girl. If Kelly could only see into Wyatt’s brain. Did he believe he’d emerge as a “she” from this boy chrysalis stage he was in, like a human butterfly? Maybe Wyatt really did believe that some babies were born female, some male, and some could change from male to female when they were still young. He was impatient, though, and that’s where the unhappiness seemed to come from, from wanting to push the process he thought must be as natural as caterpillars transforming into butterflies.
    Wayne wanted to be close to both his sons, but he couldn’t get his mind around Wyatt’s gender-bending behavior, so he retreated—to the woods to cut down trees, to the gym to work out his frustrations, to the pool or the lake to swim until he was exhausted. He