What would you do if your 10-year-old son told you that God had made a mistake, that he had been born into the wrong body, that he is and always was a girl?
Bob Bradley believes he had only one choice: To listen. "I loved my child unconditionally, and more than anything, I wanted him to be happy and healthy. If that could happen only if he lived as a girl, my wife, Debbie, and I would support him with love."
Aly is a pretty 17-year-old who talks easily about being transgender. It is impossible to guess that she was born male; her facial expressions and the grace with which she moves are typically female.
"I knew, as early as when I was three or four, that I was a girl," says Aly, who changed her name from Luke seven years ago when she "outed" herself to family, friends, and classmates. "Even when I was a toddler, I played with Barbies and pushed around a toy vacuum sweeper. I'd watch television and always picture myself as the princess or the queen."
Luke went to school in jeans and plaid shirts like the other boys, but played only with the girls. The minute he got home, he exchanged the pants for his favorite outfit - a purple party dress with sparkly sequins. His brother, Billy, two years older, insouciantly explained to his friends, "My little brother likes to dress up in girls' clothes."
"They didn't pay much attention," Aly says now.
Shortly before entering fourth grade in Stratham, N.H., Luke confided to his parents that he was not male, could no longer pretend, and declared that he would not continue to go to school as a boy.
Aly is one of a growing population of children - some as young as three - who insist that they have been sabotaged by the bodies they were given. No one knows if the numbers are rising because there are more transgender youth or whether increased media attention and shifting attitudes have made transgender people more willing to reveal themselves.
An annual survey by the Gay, Lesbian & Straight Education Network found that 8.3 percent of LGBT youth identified as transgender in 2011, up from 3.2 percent a decade earlier. Endocrinologist Norman P. Spack, head of the transgender clinic at Boston Children's Hospital, believed to be the first in the country, suggests that one in 1,000 children and adolescents may be transgender.
"We are shocked by the growth of our organization," says Kim Pearson, director of training for TransYouth Family Allies, an internet support and educational group she helped found in 2007 when her son Shawn, now 22, who was born female, told his mother that he was transgender. Allies started with 15 families; today, there are nearly 500 nationwide.
On the other hand, the number of teens and young adults who participate in a weekly transgender support group at the Attic, an LGBT youth center in Philadelphia, has remained a constant 15 to 20 for years.
"Even in a support group, it is difficult for many of them to feel safe and comfortable," Attic executive director Carrie Jacobs says. "Some of our kids change their clothes when they get here, then change back again before they leave. They may be hiding who they are from their parents or from their communities where they wouldn't feel safe walking around in the gender they believe they are."
In January, Children's Hospital of Philadelphia opened a Gender & Sexuality Development Clinic, one of several dozen across the country. About 50 children ages six to 21 who identify as transgender have been seen for psychological and medical assessment and support. Most are accompanied by parents; some over 18 come on their own. Clinic codirectors Nadia Dowshen, a physician who specializes in adolescent medicine, and Linda Hawkins, a counselor and gender specialist, believe that children are identifying as transgender at younger ages.
"In the past, they may have presented with depression and anxiety, but couldn't identify what was causing those symptoms," Hawkins says. "Now the children tell us, 'I don't know why God gave me this body' or 'When people look at me, why don't they see that I'm really a girl?' It is so genuine, so from the heart. Their words are pure to who they are."
Being transgender is not the same as being gay, lesbian, or bisexual, terms that refer to sexual orientation (transgender people may be lesbian, gay, bisexual, or straight). Transgender people feel that the gender with which they identify does not match their sex at birth.
Their transition usually is gradual. Some, such as Aly, receive hormones to suppress puberty; others take them later to reverse male or female characteristics. During transition, most dress as the opposite gender. Some go on to have sex reassignment surgery.
Spack says that being transgender has something to do with the wiring in the brain. It could be a gene that comes into play at a certain stage of fetal development, or hormones that became scrambled during gestation.
When Luke was five or six, before he or his parents could put a name to what he was feeling, they saw a therapist. "I used to think that one day I would wake up and I would be a girl," Aly recalls. "When that didn't happen, I began to get night terrors. I kept dreaming that someday I would become a grown man with facial hair and an Adam's apple. It scared me."
Aly was lucky. Although her parents struggled to make sense of what they describe as their "incredibly difficult and unusual situation," they respected and supported their younger child right from the start.
"I'm a mellow guy," says Bob Bradley, a sales manager for a gasoline distributor who has a close relationship with his daughter. "I never said, kicking and screaming, 'No child of mine is going to be transgender.' "
In December 2007, he and his wife, who passed away four years ago, wrote a letter to their friends and relatives:
. . . We realize that many of you will find this news shocking and confusing. . . . Luke has been diagnosed with gender identity disorder, a devastating condition that can turn the life of a child upside down. Biologically, Luke is a boy. But in every other sense, she is a girl. . . . We now call her Aly.
We recognize that this change will take time to get used to. What we're asking from you is compassion for something you may never understand.
The administration at Luke's elementary school had just sent a Thanksgiving letter to parents explaining that a boy in the school would be presenting as a girl. When Aly returned to school after the holiday break, dressed in capris and a pink shirt, almost all her classmates were welcoming, even excited. And while at first she was not able to use the girls' restroom, the unlabeled bathroom in the nurse's office was available. She was bullied by only one girl who kept insisting, "You're not a girl. Why are you in girls' clothes? You look stupid." Aly says she followed her mother's advice - she walked down the hall, looking straight ahead and ignored her mean-spirited classmate.
Aly was one of the first children to be seen by Norman Spack in Boston. "I have this image of Aly as a little girl," Spack remembers, "a round face, just adorable."
After thorough evaluations and consultations with the pediatrician confirmed that the 10-year-old was, indeed, transgender, not just going through a phase, Spack started puberty-suppressing hormones. "We put a pump in her upper left arm just under the skin which continuously released small amounts of the appropriate hormones," Spack says. "Within a couple of weeks, her pubertal hormones were totally suppressed and she never experienced the dreaded trauma of puberty in a gender she rejected.
"These kids can't even look at the genitals they were given," Spack says. "When I'm doing a complete exam, almost without exception those who are born female but identify as male are wearing boxer shorts. The boys who see themselves as girls are almost always in girls' underwear - often those that are printed with the day of the week. No one else sees that, but it is important to these kids."
Aly had sex reassignment surgery six weeks ago at Lower Bucks Hospital in Bristol. "Dr. Spack brought me to this part of my life," she said softly six days later, tucked under the covers in the bed where she was recovering nearby. "He did everything to help me be a girl."
Sherman Leis, a Bala Cynwyd surgeon, has performed more than 3,500 operations on transgender patients, including facial feminization procedures, breast removal or augmentation, and sex reassignment surgery. Aly was his second-youngest patient, on the verge of 17.
"I was excited about the surgery and couldn't wait to have it. But the morning I was scheduled, I put on the hospital gown and began freaking out," she says. "Once they gave me anesthesia, I remember nothing until I woke up and asked my dad, 'Is it over?' "
Aly says she was reassured because she could leave the hospital three days later and recuperate in comfortable private quarters arranged by Leis.
She is recovering well but is restless, eager to return to swimming and hiking, and happy to be back in high school, where her favorite subject is English.
"Today, it's hard for me to even picture Aly when she was a boy," her father says. "She is much more in place as a girl."
Aly says she feels as though a new life is opening up to her, but she is not expecting magic to happen.
"Most of us who are trans have issues with our appearance," she says. "You constantly wonder if someone can tell, if you are passable as the gender you identify as. I think - I hope - that now that I've had the surgery, everyone will accept me fully as a girl. But that's not likely to happen. You have to have the surgery for yourself, not just to fit in.
"I know the operation was expensive," Aly says (it was not covered by insurance), "but it's made me feel whole." She smiles and glances at her father, who nods his head. "Twenty thousand for a happy life! It's so worth it!"