In the March 18, 2013, issue of The New Yorker, staff writer Margaret Talbot takes a careful look at the phenomenon of transgender teenagers – ambivalently gendered individuals choosing hormone treatments and surgical interventions at ever-earlier ages. In the late seventies, drugs were developed to forestall puberty, aimed at children who suffered from extremely precocious puberty. Then, starting in 2000, doctors began administering puberty blockers to kids struggling with gender identity. The advantage for those who go on to transition is that these drugs prevent the development of breasts and menstrual periods for FTMs and facial hair, Adam’s apples, and masculine facial structures for MTFs: “Puberty suppression and early surgery made for more convincing-looking men and women.” Because of exposure in the media, more kids with gender-identity issues identify themselves earlier.

As a longtime feminist, I’m happy to observe how the emergence of transgender identity has liberated people of all ages to embrace the gender expression that feels intuitively right for them. Gay identity has morphed from lesbian and gay to LGBTQ, and in more sophisticated circles (the West Coast, especially the Bay Area, and in certain college enclaves), the stream of gender rebellion has acquired many tributaries and gender-queer sobriquets. The farther you deviate from recognizable social norms, though, the more courage it takes to walk your own path – much easier said than done. Schoolkids are notoriously cruel when confronted with difference; many pockets of adulthood are no less welcoming to non-conformist gender behavior.

One sensitive area that Talbot tackles carefully yet directly is the overlap between transgender individuals and those who simply decline to conform to heteronormative expectations.

There are people who are sympathetic to families with kids like Jazz [who was born a boy and socially transitioned while still a toddler and appeared on “20/20” at age 6] but worry about the rush to adopt the trans identity. They point out that long-term studies of young children with gender dysphoria have found that only about fifteen per cent continue to have this feeling as adolescents and adults. (And these studies, which relied on data from Dutch and Canadian research teams, looked only at children who were referred to a clinic for gender issues – presumably, many more kids experience gender dysphoria in some measure.) The long-term studies have also found that, when such kids grow up, they are significantly more likely to be gay or bisexual. In other words, many young kids claiming to be stuck in the wrong body may simply be trying to process their emerging homosexual desires.

Walter Myers, a child psychiatrist and pediatric endocrinologist in Galveston, Texas, has prescribed puberty blockers and considers them worthwhile as a way to buy time for some kids. But, in an editorial that ran in Pediatrics last March, Meyer urged families not to jump to the conclusion that their fierce little tomboy of a daughter, or doll-loving son, must be transgender. “Many of the presentations in the public media…give the impression that a child with cross-gender behavior needs to change to the new gender or at least should be evaluated for such a change,” he wrote. “Very little information in the public domain talks about the normality of gender questioning and gender role exploration, and the rarity of an actual change.” When I called Meyer, he said, “What if people learn from the media and think, Hey, I have a five-year-old boy who wants to play with dolls, and I saw this program on TV last night. Now I see: my boy wants to be a girl! So I wanted to say in that article that, with kids, gender variance is an important issue, but it’s also a common issue. I’m saying to parents, ‘It may be hard to live with the ambiguity, but just watch and wait. Most of the time, they’re not going to want to change their gender.’”

Eli Coleman, a psychologist who heads the human-sexuality program at the University of Minnesota Medical School, chaired the committee that, in November, 2011, drafted the latest guidelines of the World Professional Association for Transgender Health, the leading organization of doctors and other health-care workers who assist trans patients. The committee endorsed the use of puberty blockers for some children, but Coleman told me that caution was warranted. “We still don’t know the subtle or potential long-term effects on brain function or bone development. Many people recognize it’s not a benign treatment.”

Alice Dreger, the bioethicist, said, of cross-gender hormones and surgery, “These are not trivial medical interventions. You’re taking away fertility, in most cases. And how do you really know who you are before you’re sexual? No child, with gender dysphoria or not, should have to decide who they are that early in life.” She continued, “I don’t mean to offend people who are truly transgender, but maybe a kid expresses a sense of being the opposite gender because cultural signals say girls don’t shoot arrows, or play rough, or wear boxers, or whatever. I’m concerned that we’re creating feedback loops in an attempt to be sympathetic. There was a child at my son’s preschool who, at the age of three, believed he was a train. Not that he liked trains – he was a train. None of us said, ‘Yes, you’re a train.’ We’d play along, but it was clear we were humoring him. After a couple of years, he decided that what he wanted to be was an engineer.”

I was grateful to Talbot for laying out these factual and ethical considerations because I’ve wrestled with them a lot, trying to understand them myself. In my teens and twenties, I spent a lot of time and energy and study investigating my own masculinity and femininity and forging a healthy gay identity at odds with the mainstream world and the family that I grew up in. Much as I support the right to do with your own body what you will, I’ve worried sometimes that the practice of surgically altering your body so that you look like “the boy/girl that you feel like inside” might wind up reinforcing the rigid gender-role stereotypes that oppress everyone. Who says what a man or a woman is supposed to look or feel like? Why can’t a butch girl be a butch girl or a femme-y boy be a femme-y boy? When Cher’s lesbian daughter Chastity transitioned to become Chaz Bono, to me it felt like a defeat in some way, as if Chastity couldn’t tolerate being publicly gay. My wise boyfriend pointed out to me, “She went from an identity you understand to one you don’t understand.”

Mostly, I’m aware that whatever advances we’ve made in terms of freedom of choice in sexual practice and gender expression, the pressure to conform to traditional gender-role expectations continues to wound and scar people. In my practice I hear these stories every day. The gay 28-year-old South Asian student for whom completing his graduate degree means he must go home and get married or risk losing his family. The thirtysomething Italian professional emotionally traumatized by his father’s saying to him, “Are you a fag? Because if you’re a fag, I’m going to get a gun and I’m going to kill you first and then myself.” The 70-year-old bisexual executive still at the mercy of childhood religious teaching that the only permissible way to ejaculate is during intercourse with your wife. It takes a huge amount of courage, support, and self-compassion to work through these issues one step at a time.

The full text of Talbot’s article is available online only for subscribers to The New Yorker but her blog post accompanying the article includes links to a number of videos in which transgender adolescents share their individualized journeys on the road to personal freedom.