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Nine-year-old Rose is seen in her bedroom at her parents home in Hamilton, Ontario.

Matilda Gruner wears a boy's snowsuit.

The blue-and-yellow striped suit used to belong to her four-year-old brother. Their mom, Marion, thought that dressing Matilda, now 16 months, in hand-me-down jeans and T-shirts was frugal and eco-friendly. She didn't expect it to be so exhausting. "Almost every time we go out someone says 'what a beautiful boy,'" says Gruner. "Sometimes I correct them, but everybody gets so uncomfortable."

Gruner, who lives in Guelph, Ont., is trying to raise her children to believe that girls – and boys – can do anything, and her son plays with dolls as well as trucks. "People often talk about the issues around equality that you face with a daughter, but I think it's just as important with a son, maybe more so," she says.

Snips and snails and breadwinners, housewives made of sugar and spice: It used to be simple to separate girls, boys, men and women into neat pink and blue categories. That doesn't work for adults any more – according to StatsCan, 12 per cent of stay-at-home parents are fathers, for instance. And it doesn't work for kids either – increasingly, ever-younger children are rejecting the strict rules of gender, too.

Doctors and therapists say they're seeing a dramatic increase in families with gender-curious children. Even the most accepting parents must learn how to navigate these new waters – is their child showing the early signs of transgenderism, or just going through one of childhood's many experimental phases?

Noting the rapid rise of gender-identity referrals to American pediatricians, an editorial in the March, 2012, issue of the journal Pediatrics suggests a connection to the explosion in media coverage. While cross-gender behaviour in children is relatively common, Dr. Walter Meyer writes, "The more parents hear about childhood GID [gender identity disorder], the more they question if their child may need to change gender."

Daniel Metzger, an endocrinologist at B.C. Children's Hospital, works with tweens and teens who don't feel at home in the genders they were born to. "It's a bit of a deluge happening, more and more kids are coming forward," says Metzger. Since 1998, he has put 109 pre-pubertal children on the hormone blocker Lupron. "The first 10 years were quite slow, but just this year I had 30 new referrals," he says. In B.C., youth who want to see an endocrinologist about gender transition must first spend years talking to a child psychologist, and be considered free of depression or eating disorders.

Rose, of Hamilton, Ont., is almost 10. She was born a boy, but always preferred traditionally feminine clothes and toys. By age three, she regularly told her parents that she wished she were a girl. "If I'm a girl I can truly know and be who I want to be," says Rose, who wears her blond hair shoulder-length, and likes art, music and Dinky cars.

Rose's mother, Barb (the family requested that their last name not be used), and her husband, Bill, used to hide her girl toys and clothes from visitors. Barb says they feared she would be bullied, and remembers a toy red convertible that Rose's brother Luke, now 12, adored when he was younger. "It happened to be a Barbie car, and my neighbour said, I cannot believe you would let your son play with that," she says.

Not sure what to do, the family talked to LGBT organizations. They learned about the sky-high rates of depression, drug abuse and suicide faced by many trans people. They've attended Hamilton's Pride parade, and taken Rose to visit Toronto's LGBT 519 Community Centre.

This past summer, with her family's support, Rose made a full transition to girls' clothes and a female name. "We want the future to be more diversified and accepting," says Bill. At the first signs of puberty, Rose plans to take Lupron.

Lupron chemically staves off the physical changes of hormonal puberty, giving gender-questioning kids a few more years of childhood. Metzger says that Lupron's main risk is bone loss, which is counteracted with calcium supplements. He considers Lupron fully reversible, since stopping it allows puberty to take its course. Around age 16, youth on Lupron decide whether to go through biological puberty or use hormone supplements to transition to the opposite sex. Metzger says three of his 109 patients decided not to transition.

Gender fluidity comes naturally to children, at least until school, segregated washrooms and peer pressure, says Helma Seidl, an Ottawa therapist who works with gender-non-conforming kids. By then, most act out their assigned roles. For some, that feels painfully unnatural. "Some kids get really confused and anxious about how to present themselves," she says. "They can't concentrate in school because they're always thinking 'how do I not show what I feel?' "

Seidl has sometimes counselled well-meaning parents against pushing their child to physically transition to the opposite sex. "Some of them will grow out of their gender questioning and say 'I was born a girl and now I'm happy to be a girl' … This is a black and white society, but the grey areas of gender are an important developmental part of childhood."

Jane Lacoste lets her son Michael, 6, dress and play the way he wants to. She lives in Calgary with him and her daughter Paris, who is 4 (these are also pseudonyms). Michael wears his hair longish, likes feminine clothes, and is often taken for a girl in public. His past Halloween costumes include a witch and a princess. Other days, he dresses just like a boy. "We are just making sure we expose him to all possibilities so that he knows he truly can decide for himself," says his mom.

Relaxed gender boundaries are important to Lacoste, who didn't come out as a lesbian until she was 28 and divorced from her kids' dad. "To be honest I didn't know that [being gay] was a possibility or an option when I was growing up," she says. She wants Paris and Michael to grow up without such limits – and with the ability to take care of themselves. "I don't want either of my kids to see the world as a place where little girls sit around in towers waiting for their prince to come rescue them."

Just as kids raised stereotypically might be transgendered, those raised carefully neutral might well end up traditional. Paris Lacoste likes stuffed animals and wearing dresses. Matilda Gruner loves dolls. "She really has gravitated to rocking the baby, cuddling the baby," says Matilda's mom. "There's nothing wrong with their interests, it's just making sure they aren't latching on to something pushed at them."

Gruner didn't want to dress Matilda in girly clothes just to make strangers comfortable, but eventually, she capitulated a little. "Not dresses, but shirts with pleated sleeves," she says, laughing. But she still didn't know what to do about the blue-and-yellow snowsuit.

"Then someone gave us a pink snowsuit with flowers on it," she says. "I was almost relieved, but it also makes me feel not very brave."

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