I legitimately forget sometimes that my daughter used to live as a boy. In our everyday routine of school, homework, video games, chores, dinner together, and finding lost shoes, my daughter is just wholly, completely, and happily my daughter. We admire Jazz Jennings in our household. A lot. We talk about transgender heroes and role models like Laverne Cox and the groundbreaking work they have done to raise awareness and acceptance of being transgender. But my daughter chooses not to be out as a transgender girl. She does not want to be a role model, an advocate, or a hero. She wants to be a girl. Plain and simple.

So sometimes I forget that she was ever considered a boy.

I see how happy she is since she transitioned to living her truth full time, almost two years ago. The child she is now is light years away from the child she was, anxious and angry and unhappy. Her light shines bright these days and it is very easy to fall into that light and think that everything is okay.

But every year we have a well child check-up and I am forcefully reminded that even though she is happy as a girl, she is not okay with being transgender. It’s called gender dysphoria. My daughter is deeply unhappy with the male aspects of her physical body. When she is going about her daily life and is accepted — when she “passes” — as a cis-gender girl, she feels good. When she is forced to acknowledge that she has a penis, she feels deep anxiety and anger. She doesn’t want anyone else to ever see her private parts. You can be transgender, not take any hormones, not have any surgeries, and be fine with the body you’re in. That’s being transgender without having dysphoria. My daughter falls into the more common category — being transgender and also having dysphoria about the body she was born into. (You can be transgender and experience dysphoria, use the medical interventions available to have a body that matches your gender, and then no longer have dysphoria, but not everyone fits this category, either, and any transgender child has to wait until they are old enough for medical intervention.)

As you can imagine, this makes checkups at the doctor super fun. Before she transitioned, we knew there was some gender fluidity going on, but it was tangled up in undiagnosed Asperger’s syndrome, sensory issues, anxiety, and seeming shyness. We didn’t know why at the time, but it was very clear from early on that she did NOT like doctors and she was NOT going to take her clothes off for one. For years, our doctor’s office let it slide. None of us were willing to cause her so much stress just to check her bits. Instead, I would be given instructions on what to look for in terms of infection or abnormality at home, while she was bathing and more comfortable with being naked. I could surreptitiously make sure everything was ok and call my observation in.

Parenting can put you in some weird situations.

Now that my daughter is almost nine, we’ve started looking for signs of puberty. If her level of anxiety over having male genitals is already so high, puberty is not going to be kind to her. It is very, very important that she start hormone blockers at Tanner Stage I or II so that she doesn’t develop secondary male characteristics, like an Adam’s apple or facial hair. Given her level of dysphoria, her therapist feels that she is a high suicide risk if we allow her to go through puberty without intervention. Those are hands-down the hardest words my parent’s heart has ever had to hear. My child is at risk of suicide. In order to get a prescription for blockers, she has to undergo a brief, non-invasive examination of her genitals once a year until she reaches the correct Tanner Stage of puberty to start treatment.

We attempted this last year, at our first visit to a gender clinic. It did not go well. We, as parents, had no idea what the initial visit would entail, and so we did not prepare her for the possibility of having to get naked and I hadn’t really thought about how problematic it would be for her. We’d never needed to force the issue before. The clinic was running late, so she had to sit in a waiting room for over an hour before being seen. The clinic space wasn’t dedicated to gender issues, so we were grouped together with families waiting for a visit with their endocrinologist or urologist, families who were potentially unfriendly toward anyone with gender variance. The clinic was also fairly new, so they were still on the learning curve. There was no place on the paperwork for us to write anything other than her legal — male — name, so I had to write in an explanatory line in the margin, which significantly raised the risk of staff accidentally outing her against her wishes in front of a crowded waiting room when they called her back. For a child with Asperger’s and anxiety, that’s pretty much a guarantee that the visit will be a failure before you even start.

And oh, it was. Despite being matched with a very kind female doctor and staff, the request to let the doctor examine her turned into two hours of panicked screaming, flailing, and throwing of objects in the exam room. They had not gotten the heads up that she has anxiety (though I suspect that should be anticipated in any young transgender patient) or Asperger’s, and they were not expecting her to have on a one-piece swimsuit under her clothes. (Neither was I! Smart kid.) I made the decision no parent ever wants to make and eventually held her resisting form still so the doctor could get a 5-second look, just enough to determine that she was not in puberty yet. I forced my child to let an adult look at her naked body. I came away with the advice to desensitize her to having doctors examine her genitals, because it’s a reality of her future.

Her therapist agreed. We need to get our child used to letting certain adults look at her body. I say again, parenting can put you in some weird situations.

I had enough cognitive dissonance over that one that we really didn’t push it. We’ve talked more about her being transgender and what her options are as she heads into puberty. We got her some story books about other transgender kids so she can see that she has community. She’s not alone in this. We’ve talked frankly about the clothes she chooses, and how if she doesn’t want to have a conversation with her friends about how she has a penis, she should choose this swimsuit over that one. And that peeing on trees might be a giveaway. “But I’m marking my territory!” says the child fascinated with dogs and wolves. Oy. But I didn’t push the being naked part of things very hard.

Her nine-year well child visit was last week and we took the opportunity to work on getting her used to showing her body to a doctor. We warned her ahead of time that she was getting to the age where having your bits looked at is part of a medical checkup. The doctor explained to her that it’s a normal part of a checkup and she’d like to give it a try. Nope. No way, no how. That got us a child hiding in the corner, facing away from everyone, curled up on herself.

When the doctor left the room, I cuddled her on my lap and explained again how she has choices about how her body develops. I asked her if she wants to grow a mustache and a man’s body like her dad, or boobs and hips like her mom. She whispered, “Number 2.”I told her that we can’t get blockers unless she lets a doctor look at her private parts. She said ok, but not today. That was when I realized how much of a gap we’re facing between her joy in being a girl and her acceptance of being transgender. She couldn’t even say the words to choose her preferred body.

It’s daunting. Our medical path forward is actually quite clear, and I am grateful for that. Parents a generation ago did not have our options. Hormone blockers, then hormones, leading to less surgery later on, an easier social transition, and less dysphoria. But just getting to the place of cooperation with the doctors is going to take hard work on her part and ours, some uncomfortable desensitization, and a lot of conversations. In her best world, there would be no doctors and we would both forget that she wasn’t always seen as a girl. I wish I could give her that world.