I meet Emily at 8:15 a.m. Paris time on a Monday, a slot that always smells of coffee and dog. It’s 7:15 where she lives on the north coast of England. She logs in from bed, short blond hair wild, eyes puffy. The terrier under the duvet usually noses onto her pillow halfway through and reclaims cuddles. I’ve grown to like them both. Emily is uncannily smart for seventeen, and the dog is a charm. The way she squeezes his warm body reminds me—painfully—how impossible ordinary touch feels for her with humans.
We’ve met weekly for six months. I’ve spoken with her parents on their green sofa: her British father, jaw clenched, eyes on the carpet; her Russian mother, answering every question half a beat too fast. As a child—tomboyish, outdoorsy—Emily trailed her father to the pier and the shed. Puberty changed the script. He hoped for “a real lady.” She cut her hair, wore black three sizes too big, and went quiet. He withdrew to the pub. Her mother stayed inside, reading and chatting with invisible friends back home. Emily worships her and can’t get close; her Russian is shaky, her reading poor.
What “T” Would Fix
Emily keeps a list in a desk drawer. The first item is testosterone. The request is crisp, practiced—the kind of sentence said to the mirror or into a phone. I ask what T would fix first. “The staring,” she says, touching the neckline of a black T-shirt with a sad teddy on the front. Her breasts are large and she hates them. Apart from that, she barely speaks of her body. When I ask how connected she feels to it, she snaps, “I’d rather not have it.”
Her best friend is ChatGPT. She spends hours talking with the bot. In that conversation she is freed from her physicality. She writes romance there: the hero is always a glorious boy—strong, brave, protective of the sweet girl he’s pursuing. That’s the kind of man she imagines being. I ask to whom she is attracted. “Girls,” she says. The pretty, popular ones. The girls who ignored or harassed her. They date equally popular boys. To attract a girl like that, Emily feels she must become that kind of boy. Any other option? “A life without romance—asexual, maybe?” she shrugs, looking for a side door out of the maze.
School means daily exposure. She misses classes, stays in bed. Periods make corridors feel like public noticeboards. The bathroom is a problem she solves by not going. She looks, in her words, like a fourteen-year-old boy. At the door to the girls’ room, she gets confusion at best, disgust at worst. Online, the algorithm is tender: progress photos, the promised relief of flatness, a deeper voice that cancels a certain kind of danger. Offline, the bathroom remains the bathroom.
I’m not here to argue with the algorithm. My job—this is the frame I set with families—is to slow the story enough that its parts can breathe. I tell Emily I will ask annoying, obvious questions. What does “boy” make possible that feels impossible right now? If we started T today, what would be better tomorrow? What might be worse? If “boy” could be tried on without consequence, what would you try first? She shrugs in the practiced way of seventeen. “I’d walk to maths and not look at the floor.”
The urgency around adolescence hovers like a clock. I name that too: the timeline feels real. So does the risk of letting urgency decide the meaning.
Two Ancient Stories
Two ancient stories sometimes sit quietly at the edge of my sessions. I don’t bring Ovid into the room, but I let his questions into my listening. In one, a girl named Caenis, after being assaulted, begs a god for a body no one can ever enter again. The wish is granted: she becomes Caeneus, a warrior whose skin cannot be pierced. It is perfect safety—but also perfect solitude.
In another, Iphis is born into a family that cannot afford a daughter, so she is raised as a boy to survive. As a teenager, she falls in love with a girl, Ianthe. To make their love possible, a goddess changes Iphis’s body to match the role she has always lived. Neither tale is about diagnosis. They are parables of longing. Is “boy” here armor against injury—or a passport into belonging and desire? Or both?
Something shifts when I ask, “If armor is the wish, what would it keep out?” “Eyes,” Emily says. Then, after a pause we let be long: “Hands.” Suddenly we’re not debating identity as a grand essence. We’re talking about corridors, weekends, the geometry of seats on a bus. That’s workable.
By the end of the hour, nothing is decided. The list is still the list. But she’s sitting up a little straighter, breathing a little deeper. We add a few experiments that are micro-reversible: try a different route to school; ten minutes without headphones on the walk home to notice where panic starts and whether it moves; the same romance written twice—once with a boy, once with a girl. None of this rejects transition. It refuses only the idea that a single, simple story hides inside the sentence, “I’m a boy.”
Adding Layers of Representation
Working with gender-questioning teens today means practicing in a world that rewards speed and certainty. Online, the path looks linear and bright: binder → T → top surgery. In real life, nothing is linear, least of all adolescence. Much of what shows up in my office is not an abstract claim about essence but a bid for survival: a grammar to live in. Just like in the two ancient myths, for some, “boy” reads like armor—impenetrability after too much unwanted gaze or touch. For others, “boy” is a passport—legibility in a peer world with narrow categories and high penalties for misfit. Sometimes it’s both at once.
And then there are the families—confused, frightened, and entangled in their own cultural histories and personal narratives. Some quietly prize boyness; others enforce a narrow, pretty version of girlhood. Some are distracted or depressed. Most are simply scared. The internet steps in with a ready-made community and vocabulary. That lifeline is real. I don’t cut it. I widen the map it comes with.
I also try not to collapse every problem into gender. With many of my teenagers—especially those who are neurodivergent—symbolic problems tempt literal fixes. If breasts trigger panic, remove breasts. If period equals “woman,” stop the period. Part of my work is to add layers of representation—what else might this stand for besides itself?—while still respecting the immediate distress: sleep, anxiety, safety, pain.
I keep an open mind about where this work may lead, including transition, with or without medical steps. My role is not to predict the outcome but to make sure every choice has room to mature. The point of exploratory work is not to gatekeep; it’s to de-literalize just enough to hear the many stories bundled into one sentence. I try to be more of a translator than a customs officer. Some will keep this language and make it home. Some will switch tongues. Many will be bilingual for a while.
The myths help me hold two cautions at once. Like for Caenis, hardness can protect and isolate; even the invulnerable can be crushed under weight. Like for Iphis, social legibility can comfort and coerce; the relief is real, and sometimes it arrives by conforming to a rigid order. These are not arguments for or against transition. They’re reminders that the logics inside a transition wish are plural—and workable—now, while futures remain open.
Presence in the Face of Uncertainty
A second, quieter task in therapy is cooling the temperature. When the culture war gets loud, everything looks like a battlefield. That’s where slowing down matters most. We set the armor and the passport on the table and feel their weight together. What have they protected? What have they cost? Where do you need entry this week, and what toll will you pay to cross that border? If we move, we aim for the minimum effective step—a conversation with one teacher, a safer bus route, two pages of a story told in two grammars—and then we pause again. In the pause we check who is burning: the young person, the parents, sometimes the clinician. Cooling the fire is shared work.
Emily returns after midterms with a new haircut. She stepped into a barbershop and asked for what she’s always wanted. She turns to show me the close-shaved neckline. It’s the first time I see her liking something about her body. I say I’m proud of her. She beams. The T-list remains, but so does a new sentence: “I don’t know if I want to be a boy or I want not to be a girl.” We try the armor and passport frames; one fits on Monday, the other on Friday. Meanwhile, she tries a different hoodie, eats a sandwich, texts a gay classmate she trusts, joins boxing. None of this answers the why in a headline-friendly way. But plurality begins to show, and with it, relief. If becoming a boy is about safety, we can start building safety now. If it’s about loving girls, we can practice desire-literacy now. If it’s both—and often it is—we can hold both without rushing the ending.
From time to time she asks, bluntly: “Why shouldn’t I just start T now, like my friend Chloe? Her voice is deeper. Would I be better off?” The urgency in her voice is familiar. She wants the pain to stop, and I want that for her too. Can I honestly say yes? I can’t. So, I say, “I don’t know.” It disappoints her. We stumble forward anyway. We practice resisting the actions that promise immediate relief. Each time I manage a candid “I don’t know,” she learns that uncertainty doesn’t have to crush you. That you can breathe inside it.
After six months, the fantasy of a single escape route is loosening. There are more options on the table—college, distance from home, a different social world. She agrees to a family session. We prepare what she wants to tell her father, what she wants to ask her mother. None of this is magic. It’s slow human work.
The gods in Ovid change bodies with a word; in my office, metamorphosis looks like a human dance—awkward at first, then more fluid. Some teens will transition; some won’t. My contention is simpler: the most ethical thing we offer is time enough, questions enough, and a room where neither certainty nor urgency runs the show.
Identifying details have been changed and this vignette is a composite to protect privacy.
