ABSTRACT
The controversies surrounding treatment of gender-expansive pre-adolescents center on two things: early social transition, and puberty blockers. Arguments against these interventions are often centered on the oft-repeated myth of 80 percent desistance, the myth that 80 percent of gender-nonconforming children will eventually cease to identify as or want to be the opposite sex. Because it is not easy to determine whether a gender-expansive child is, in Ehrensaft’s terms, an ‘apple, orange, or fruit salad’, treatment of the pre-pubertal gender-diverse child can be more difficult than working with older transgender people. The most important thing when working with gender-expansive children is to ensure that they are validated and supported by their families and schools. This always involves work with parents, and often means that the therapist has to advocate for the child with a school system that may have never encountered a child like this before, may be unsupportive, and may actually fail to protect the child from bullying.
