When my son was in preschool, there was this kid who was convinced he was a train. Actually this child—let's call him Thomas—believed he was a locomotive. "Train," I learned from Tommy, is technically the engine plus all its attached cars. One person couldn't be a whole train, Tommy explained to me. That would just be silly!

And this definitely wasn't about being silly. This was no one-day play identity for Tommy. As I recall, Tommy spent over a year being a locomotive, day in and day out. And not just any loco. Tommy was—and he seemed convinced he would remain—the type of Union Pacific articulated steam locomotive known as a "Big Boy."

I had to hand it to Tommy. He made about as convincing a locomotive as a kid could be. He blew his whistle in advance of crossing paths and rang his bell when he came into "stations." On really cold days, he couldn't move forward until his firebox had warmed enough to make a good head of steam. Once he could really see his breath, then he'd chug along.

The other preschool parents thought this was so cute. I kept wondering whether, by the time Tommy grew up, there was going to be a surgeon who would offer to transform him physically into an engine. I wasn't sure what that would look like, but I had already met a surgeon interested in using his craft to provide people with wings. I figured that surgeon, 20 years later, might be willing—given enough cash and a firm liability waiver—to try to approximate a Big Boy, trademark infringement on Union Pacific notwithstanding.

Before I get slaughtered by the trans activist community (again), let me be clear that I don't think being a transgender adult is like being a child who imagines he is a locomotive. There's no analogue to the engine-wish among adult humans. Meanwhile, most adult humans do seem to have gender identities, and we know that some people grow up with genders that don't match their body types. I support the right of people to determine their own genders, and even to change them repeatedly. I don't see a lot of reason why governments need to keep as close track of our gender identities as they do. And if a person is found by a qualified mental health professional to be likely to be left better off in terms of mental health by "sex change" interventions, then I think those interventions should be paid for by the same insurance systems that pay for treatment of depression and anxiety.

Some will label me anti-trans for opening with my story of Tommy, but I'm not. I just think the way some putative progressives are dealing with trans right now among kids is—well, it's kind of transphobic.

Changing a kid's name and gender identification at the age of 5 or 6? This approach takes gender claims of little children so seriously that it's actually beholden to a ridiculously strict notion of gender. No meaningful trans really allowed.

Fact is, kids don't always mean what we mean when they make seemingly firm identity claims. Let's go over some other uncomfortable facts. The great majority of young children who declare they are a gender that doesn't match their birth sex grow out of the mismatch. Most boys who declare themselves girls or act girly grow up to be ordinary gay men. These men may occasionally crossdress for fun using drag handles like "Helvetica Bold," but they won't seek to have their penises and testicles removed and replaced by estrogen and a vulva.

Young girls who declare in word or behavior that they are boys end up all over the place, which at some level proves to me most really are females. (As a general rule, males end up more specific about identities and interests, while females have broader interests and greater flexibility of experience; so we would predict that males would have clearer clusters of outcomes than females do.) Some gender-bending little girls will end up as men—gay, straight, bi—but a fair number will end up as lesbian, bi, and straight women who have no sense of having been "born in the wrong body."

Sex-changing interventions are nontrivial. They involve substantial physical risk, including major risk to sexual sensation, and a lifelong commitment to trying to manage hormone replacement. Most people seem to get how serious sex-changing interventions are when we're not talking about transgender. A couple of weeks ago, a man writing into Savage Love mentioned that he had voluntarily been castrated—a fetish, don't you know—and the commentators went, well, nuts. And most people get that it was wrong for doctors in the past to take baby boys born with small penises and sex-change them with genital surgeries and hormonal interventions.

But somehow if we wrap these major interventions around gender identity, we're supposed to believe they are not that big a deal in terms of planning for a child's future? And the clinician who tries to get a gender dysphoric kid to learn to like her or his innate body really is a Nazi? Not buying it.

Look, I am certainly not suggesting we go back to the UCLA Sissy Boy Experiment days of George Rekers and try to metaphorically or literally beat the sissy out of boys and the butch out of girls. But I am also sick and tired of trans-rights advocates acting like a certain current-day endocrinologist is ever-so-progressive because he essentially starts prepping genderqueer kids for surgery the moment they are presented by their distraught parents. Reminds me a little too much of Iran, you know?

So what do we do with these kids?

For over a decade, my friend and colleague Paul Vasey has been studying the fa'afafine people of Samoa. These are biological males who, as the word fa'afafine translates, live "in the manner of women." These folks were born male typical, but from pretty early on they seemed quite girlish—girl-typical in activities, dress, play, and general self-identity. The Samoans get that this happens. They just give these kids a way to be—they say, "you're fa'afafine"—without sending any message that their bodies aren't appropriate to their senses of self.

Paul's research, comparing the Samoan experience with the North American, indicates that the stress genderqueer kids here feel is not inherent to them. Being genderqueer doesn't make you distressed. Distress arises from the push and pull of the people around who just can't deal.

So "What do we do with these kids?" is the wrong question. There's nothing inherently wrong with them. The problem is us and the way we demand certainty from them, the way we insist on conformation to a two-sex model as early as possible. The problem is the bullies and gender-obsessed adults, not the genderqueer kids.

What if a boy could go to school in a dress and still be a boy? What if a girl could declare she's going to grow up to be a man without being dragged to a clinic for a cure and/or prep? What if we made the bullies go get mental health interventions first (or, at least, too)?

You know what? We don't have to force our little locomotives to pick one track or the other. They just want love, reasonable-but-not-infinite space to try stuff out, and a nice warm roundhouse to come home to at the end of the day. We can wait to see where they need to go tomorrow. recommended

Alice Dreger, PhD, is professor of clinical medical humanities and bioethics at Northwestern University Feinberg School of Medicine. Her personal website is www.alicedreger.com.