Zucker said his goal was to "help these kids be more content in their biological gender" until they are older and can determine their sexual identity.
One of the most controversial issues concerns the use of "blockers," hormones used to delay the onset of puberty in cases where it could be psychologically devastating (for instance, a girl who identifies as a boy might slice her wrists when she gets her period). Some doctors disapprove of blockers, arguing that only at puberty does an individual fully appreciate their gender identity.
Catherine Tuerk, a nurse-psychotherapist at the children's hospital in Washington and the mother of a gender-variant child in the 1970s, says parents are still left to find their own way. She recalls how therapists urged her to steer her son into psychoanalysis and "hypermasculine activities" like karate. She said she and her husband became "gender cops."
"It was always 'you're not kicking the ball hard enough,"' she said.
Tuerk's son, now 30, is gay and has two children, and her own thinking has evolved since she was a young parent. "People are beginning to understand this seems to be something that happens," she said. "But there was a whole lifetime of feeling we could never leave him alone."
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