The following is a short excerpt from my doctoral dissertation, "The Relationship of Gender Identity Disorder, Guilt and Shame in MTF Transgender Individuals."

According to Coates (1992), gender identity disorder emerges in a limited early childhood window of development, possibly around the ages of two to three. Sometimes GID in boys occurs concurrently with a traumatic experience. It has been shown to be usually associated with a separation anxiety issue, and typically emerges in the context of family psychopathology. Boyhood GID may also occur with children of specific temperament characteristics such as those with a dislike of rough-and-tumble play (Coates, 1992). Such boys may demonstrate an interest in behaviors and activities that are typical of girls, such as dressing in girls' clothes, playing with dolls, and taking the role of a girl in play-acting. They may communicate feelings of self-loathing sometimes expressed in a wish to be rid of their penis. Boyhood GID is characterized by its intensiveness, pervasiveness, and duration (Coates, 1992).

The impact of GID is mirrored in the following statement of a transgender adult male who has struggled with gender identity dysphoria for his entire life:

"As a child of five I was a rather sensitive soul, extremely close to my mother. It was around this time I began to feel out of the mainstream, different from those around me. I was obviously a boy, yet a tantalizing longing to be a girl permeated the very fabric of my being. I couldn't understand it then, but one day I came to realize that I was suffering from gender identity disorder." (used with permission of client)