When Pauline Moreno and Debra Lobel adopted their son Thomas, they found that he seemed shy and often depressed. He didn’t like playing with other kids, would often sit alone indoors. In photos Thomas’ smile seemed forced, his eyes vacant and glazed over. He preferred reading Wonder Woman comics to Superman, wanted to wear rhinestone-studded hairbands rather than baseball caps, and preferred dolls over action figures. Then one day, he told his mothers that he wanted to cut off his penis and the two women realized he needed professional help—they had a transgender child who needed their help.

Even though various studies say that anywhere between 1 in 1,000 and 1 in 30,000 people are transgender, parents often find themselves at a loss at how best to help their transgender children. Though these children feel born into the wrong bodies, some parents confuse “gender identity” with “sexual orientation” mistaking who their children are with who they want to have sex with. Doctors haven’t determined whether gender identity lays in a person’s physiology or their psychology (though its likely a combination). Parents must then make decisions on how to transition their child in name, activity, dress, and hormone therapy—decisions that society might disapprove of or even violently oppose.

Transgender psychological experts agree that forcing trans children into conforming with their biological sex can lead to depression and even suicide. But they also say that not addressing a child’s transgender identity could really damage a kid too.

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