TABLE 1.

Definitions of Terms

Term	Use in This Article	Other Uses, Terms, and Comments
Transgender	In this article, we use “transgender” to refer to children who have a binary identity (male or female) and for whom this identity is not aligned with their sex at birth. This means natal boys who identify as girls and natal girls who identify as boys. In our sample, these children have all socially transitioned as well.	“Transgender” is often used to mean a broader range of people—anyone whose gender identity does not align with his or her sex at birth. This categorization can include, for example, people who identify as male and female, neither male or female, or somewhere between male and female. The sample included in the current work does not include such children, hence our use of a narrower version of this term.
Social transition	This phrase is used to refer to a decision by a family to allow a child to begin to present, in all aspects of the child’s life, with a gender presentation that aligns with the child’s own sense of gender identity and that is the “opposite” of the gender assumed at the child’s birth. Social transitions involve changes in the child’s appearance (eg, hair, clothing), the pronoun used to refer to the child, and typically also a change in the child’s name.	Social transitions are currently controversial in clinical psychology and psychiatry, but are increasingly being pursued by parents. More and more pediatricians, therapists, and teachers are supporting these transitions as well. Importantly, these transitions do not involve any medical, physiologic, or hormonal intervention.
Natal sex	We use this term to refer to the sex assigned by a physician at the child’s birth. This phrase is meant as a synonym for “anatomical sex,” “biological sex,” or “sex assigned at birth.”	The term “natal sex” is controversial, with many using the phrase “sex assigned at birth” instead. However, the latter term is still unfamiliar to many people with limited exposure to transgender individuals. Because this paper is aimed at reaching a broad audience of pediatric health professionals, we use the more commonly understood term “natal sex.”
“Opposite” gender	We occasionally use the phrase “opposite” gender in this article when describing our sample of transgender children. Children whose gender is the “opposite” of their natal sex refers to natal boys who identify as girls and natal girls who identify as boys. Because the latter phrasing is longer and more awkward, we opted for the former.	This phrasing of “opposite” gender implies that gender is binary, when in fact it is not. There are many people who do not identify as male or female. We use this phrase because most readers will be more familiar with this terminology, and our goal is to reach a broad audience of pediatric health professionals.
Gender identity	We use this term to refer to a child’s sense of his or her own gender. Although in most children, gender identity “aligns” with a child’s natal sex, in transgender children, it does not.	Gender identity is often separated from gender presentation or gender expression (ie, the gender one appears to others as, or how a child expresses his or her gender identity). In this study, however, participants’ gender identities align with their gender presentation/expressions because children have socially transitioned.
Gender Identity Disorder (GID)/Gender Dysphoria (GD)	Until 2014, GID was the official diagnosis given to children who had behavioral preferences and identities (or desires to be) the “other” gender. With the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, this diagnostic category was renamed gender dysphoria (GD) after substantial debate about whether this is or is not a “disorder.”	The term GD describes a broader segment of the population than children qualifying as “transgender” for the current study. For example, a natal male who wishes to be a female, who behaves in accordance with female cultural stereotypes, and who has considerable concern about his identity but who does not believe he is female, would be diagnosed with GD but would not count as transgender in the current study.