Gender expression in children: when it's normal, when to talk to a professional

Your son wants to play with dolls. Your daughter prefers trucks to stuffed animals. Your son has asked you to put nail polish on him. Your daughter refuses to wear skirts and wants short hair. A three-year-old child has said, with a seriousness that struck you, “I am a girl.”

And you did what any parent who loves their child does: you searched the internet.

If you are here, it is because you are wondering whether what you are seeing is normal. The short answer is: in the vast majority of cases, yes. But you deserve a longer answer, based on scientific data, that helps you understand what is happening, what is simple exploration, what might indicate something deeper, and above all what you can do for the well-being of your child.

This article is not here to judge you. Worrying is an act of love. It means you care. And the fact that you are seeking information, instead of reacting impulsively, shows that you are exactly the kind of parents your child needs.

Gender expression in children: what developmental psychology says

To understand what is happening with your son or daughter, it is helpful to know how the sense of gender develops in children. Not to diagnose anything, but to put things in perspective.

Ages 2 to 3: the first distinctions

Around two years of age, most children begin to recognize differences between males and females — in faces, clothing, and book illustrations. They begin to label themselves and others as “boy” or “girl.” However, at this age the concept of gender is still fluid in the child’s mind: many believe that gender can change if you change clothes or hairstyle [1].

This is a fundamental point: if your two-and-a-half-year-old says “I am a girl” while playing, they may simply be exploring a concept they have not yet fully understood. It is not cause for alarm.

Ages 3 to 5: gender stability

Between three and five years of age, what developmental psychologists call “gender stability” occurs: the child begins to understand that gender is a characteristic that remains over time. At this age, children also develop their first gender preferences in play, clothing, and friends — and they begin to perceive the social “rules” about what is “for boys” and what is “for girls” [1].

This is why many parents notice worrying behaviors precisely in this age range: the child is becoming more aware of gender and may express this awareness in ways that do not match expectations.

Ages 5 to 7: gender rigidity

Between five and seven years of age, children go through what researchers describe as the most “rigid” phase of gender development [1]. They become very attentive to the rules: “boys do this, girls do that.” They may criticize peers who do not conform and may themselves become extremely careful about behaving according to expectations.

Paradoxically, it is precisely during this phase that some children show nonconforming behaviors with greater intensity — not because they are confused, but because they are aware enough to know what is expected of them and authentic enough to be unable to comply. A six-year-old who, despite peer pressure, continues to prefer activities or friendships associated with “the other gender” is showing a genuine preference, not a passing phase.

How common is gender nonconformity in children?

Much more common than you might think. And this is perhaps the most reassuring piece of data we can offer.

The research numbers

A foundational study conducted by Sandberg and colleagues in 1993, published in the Journal of the American Academy of Child and Adolescent Psychiatry, analyzed a sample of 687 children between 6 and 10 years of age [2]. Parents had to report a list of gender-atypical behaviors: playing with “opposite-sex” toys, preferring friends of the opposite sex, favoring activities traditionally associated with the other gender.

The results showed that about 23% of boys and 39% of girls displayed ten or more gender-atypical behaviors [2]. Not ten behaviors in a lifetime: ten different behaviors in a single observation period.

This means that gender nonconformity is not a rare or marginal phenomenon. It is a normal and frequent aspect of child development. One child in four — or more — shows behaviors that do not match gender stereotypes.

Why it seems more common in girls

You may have noticed that a girl who plays soccer or prefers pants causes less concern than a boy who plays with dolls or wants to dress in pink. This is not coincidental: research confirms that nonconforming behaviors are more socially tolerated in girls [2]. A “tomboy” girl is often considered strong and independent. A “feminine” boy generates more alarm.

This difference does not reflect a psychological reality — nonconforming behaviors are equally healthy in both sexes — but it reflects a cultural stereotype worth recognizing. If your concern is about a son, know that your reaction may be amplified by social expectations, not by an actual sign of distress.

Gender nonconformity and gender dysphoria: a fundamental distinction

This is the most important point in this article, and it deserves the utmost clarity.

Gender nonconformity is about what a child does. Playing with certain toys, preferring certain clothes, choosing certain friends, having certain interests. It is a behavior. It is extremely common. It does not, by itself, indicate anything about the child’s identity.

Gender dysphoria is about who a child feels they are. It is not a preference for certain toys, but a deep and persistent distress linked to the fact that one’s body, name, and the way the world treats you do not correspond to who you know you are. Gender dysphoria involves a much smaller percentage of children.

How the difference manifests in practice

A boy who loves playing with dolls, enjoys putting on makeup, and prefers female friends is expressing gender-nonconforming preferences. If he is happy, socializes well, and shows no distress about his body or name, this is most likely a healthy child with interests that do not match cultural stereotypes. Full stop.

A child who insistently says “I am a girl” (or a girl who says “I am a boy”), who shows suffering when called by their given name, who feels anguish about their body, who withdraws socially because they feel they are not recognized for who they are — this child may be experiencing something deeper that deserves specialized attention.

The 2013 study by Steensma and colleagues identified a particularly significant indicator: the difference between children who wished to be the other gender and children who stated they were the other gender [5]. Those who expressed an identity statement — “I am” rather than “I wish I were” — had a significantly higher likelihood of maintaining that identity over time [5].

Most gender-nonconforming children are NOT transgender — and that is fine

This is a piece of data that should be presented honestly, because it is important for parents seeking information.

What studies say about persistence

The most recent and methodologically sound research offers a nuanced picture. The longitudinal study by Olson and colleagues in 2022 followed 317 children who had undergone social transition (that is, children who actively identified as transgender) for five years [4]. Of these, 97.5% continued to identify with a gender different from the one assigned at birth (94% as transgender, 3.5% as nonbinary). Only 2.5% had returned to identifying with the assigned gender [4].

However, this study involved children with an already consolidated transgender identity to the point of having undergone social transition. For children with gender-nonconforming behaviors — who represent a much larger group — the situation is different. The vast majority of these children will grow up identifying with the gender assigned at birth. Some will turn out to be homosexual or bisexual. Some will identify as nonbinary. And some will indeed be transgender.

The problem with “desistance” studies

It is worth knowing that the most frequently cited studies on so-called “desistance” — those claiming that 60-90% of children “stop being trans” — have significant methodological problems, as documented by a systematic review published in 2022 [12]. Many of those studies included children who simply displayed gender-nonconforming behaviors without ever identifying as transgender. Counting a child who played with dolls as “formerly transgender” because they identified as male as an adult is a classification error, not evidence of desistance.

The practical message for parents

If your son or daughter shows nonconforming preferences or behaviors, the statistical probability is that this is a child with interests different from stereotypes, not a transgender child. There is no need to medicalize exploration. But if the child expresses a different gender identity in a persistent, consistent, and insistent way, then it is important to listen and, if necessary, seek professional support.

When it is time to talk to a professional

This is probably why you are reading this article: you want to know if what you are observing is a signal that requires attention. Here is a guide based on the recommendations of major international scientific organizations [6][8].

A professional is NOT needed when:

• Your child plays with toys traditionally associated with the other gender (a boy with dolls, a girl with trucks)
• Your child prefers friendships with children of the opposite sex
• Your child chooses clothes or colors not traditional for their gender
• Your child plays dress-up occasionally — putting on mom’s heels, dad’s hat
• Your child expresses curiosity about gender roles (“what would happen if I were a girl?“)

These behaviors are part of normal development and do not require clinical intervention.

Consider consulting a professional when:

• The child expresses a gender identity different from the one assigned at birth in a way that is persistent (for months, not days), consistent (in different contexts — at home, at school, with friends), and insistent (with conviction, not as a game)
• The child shows significant distress related to gender: cries when called by their given name, is distressed about their body, refuses to participate in activities because they force them to present in the assigned gender
• The child withdraws socially or shows signs of depression, persistent anxiety, or sleep disturbances connected to the gender issue
• The child expresses discomfort with their physical characteristics in a way that goes beyond normal childhood curiosity

Who to consult

The right professional is a psychologist or child psychiatrist with specific experience in gender identity in developmental age. Not a generic “child psychologist,” but someone trained on these specific topics. The role of this professional is not to decide what the child is, nor to change them: it is to listen with the right tools and help the family understand and support them.

The guidelines of the American Academy of Pediatrics and WPATH recommend an exploratory and affirmative approach: creating a space where the child can freely express who they are, without pressure in any direction [6][8].

What NOT to do: mistakes to avoid

Research is clear on certain parental behaviors that can cause harm. These are not moral judgments — they are scientific data.

Do not punish and do not shame

Punishing a child for their interests or gender expression does not change who that child is. It only changes how safe they feel with you. Studies on family acceptance show that LGBTQ+ youth who experience negative reactions from family have a significantly higher risk of depression, anxiety, and suicidal ideation [9].

A boy who is scolded for playing with dolls will not stop wanting to do so: he will stop doing it in front of you. And that means you have lost his trust, not solved a problem.

Do not force conformity

Forcing a child to behave according to gender stereotypes — making a boy play soccer when he prefers drawing, preventing a girl from climbing trees — does not produce “normal” children. It produces children who learn to hide who they are.

The American Psychological Association has taken a firm stance against any intervention aimed at modifying a child’s gender expression or gender identity to make it conform to the gender assigned at birth, classifying it as an unethical practice [10].

Do not ignore the distress

The opposite of overreaction is minimization: “it’s just a phase,” “they’ll get over it,” “don’t think about it.” If your child is communicating something important about their identity, ignoring it will not make it go away. Unrecognized distress does not dissolve: it becomes internalized. And the damage of internalization can manifest years later.

Do not label prematurely

The opposite mistake is equally important to avoid. If your son plays with dolls, it does not mean he is transgender. If your daughter dresses “like a boy,” it does not mean she is transgender. Do not apply labels based on behaviors: listen to what the child communicates about their identity, if and when they do.

The position of all major scientific organizations is clear: do not force in any direction. Not toward conformity, but not toward an identity the child has not expressed either [6][8][10].

The role of stereotypes: pink versus blue, dolls versus trucks

Much of parental anxiety arises from an implicit belief: that certain toys, colors, and interests are inherently “for boys” or “for girls.” But science tells a very different story.

The history of pink and blue

Until the early twentieth century, newborns of both sexes were dressed in white. The association between pink and feminine, blue and masculine, is a relatively recent cultural phenomenon — and in its early stages it was actually reversed: in 1918, a trade publication recommended pink for boys (a “strong and decisive” color) and blue for girls (a “delicate and graceful” color).

The idea that pink is “for girls” has nothing biological about it. It is a cultural convention that solidified only in the second half of the twentieth century, largely thanks to marketing by the toy and clothing industries.

What research says about toys

A meta-analysis published in 2020, which analyzed 75 studies on toy preferences, confirmed that there are average differences in play preferences between boys and girls, but also a very wide individual variability [7]. In other words: yes, on average boys tend to prefer vehicles and building sets and girls tend to prefer dolls and nurturing games, but there is enormous overlap between the two groups. Many boys prefer dolls. Many girls prefer trucks. And this is entirely within the norm.

The same meta-analysis highlighted that the differences increase with age, suggesting a strong role for socialization: children are not born with an innate preference for blue or pink, but they learn very quickly what society expects of them [7].

What this means for you as parents

It means that if your son loves dolls, he is not violating a law of nature: he is violating a cultural convention. Dolls develop empathy, nurturing skills, and narrative abilities — important competencies for any human being, regardless of gender. A boy who plays with dolls is exercising the same emotional capacities that will one day make him a better friend, a better partner, a better parent.

And if your daughter prefers trucks to princesses, she is developing spatial, mechanical, and problem-solving skills that will be useful to her throughout life. Neither is doing anything wrong.

Sexual orientation is a different matter

Many parents who see nonconforming behaviors in their child ask themselves: “will they become gay?” This question deserves a direct and honest answer.

Gender expression and sexual orientation are two distinct dimensions of a person. A child may have behaviors considered “feminine” and grow up heterosexual. They may have perfectly “masculine” behaviors and grow up homosexual. The correlation exists statistically — children with gender-nonconforming expression have a slightly higher probability of identifying as homosexual or bisexual as adults — but it is not a reliable predictive factor for any individual.

That said: even if your child were to grow up gay, bisexual, or any other orientation, it would not be a problem. They would be your child. The question to ask yourself is not “what will they become” but “how can I love them for who they are, right now?”

Resources for parents

If you feel the need to speak with someone or to learn more, here are the main resources available.

Specialized psychological support

Specialized centers in gender variance in developmental age follow the network coordinated by ONIG (National Observatory on Gender Identity), which since 2008 has been working with children and adolescents with gender variance [11]. These centers are present in several cities and offer psychological support pathways for the child and the family. The model provides exclusively psychological pathways for children, without any medical intervention, and possible access to pharmacological treatments is only provided in adolescence with family involvement [11].

To find the closest centers, you can consult the Infotrans.it portal, the institutional website of the Italian National Institute of Health dedicated to transgender individuals and their families [13].

AGEDO — Parents’ association

AGEDO (Association of Parents of LGBTQ+ individuals) is present with 32 branches throughout Italy and offers welcoming, listening, and self-help groups for parents. In recent years, AGEDO has welcomed a growing number of parents of transgender and nonbinary children and adolescents. The national website is www.agedonazionale.org.

AGEDO is not a clinical organization: it is a place where you can talk with other parents who are living the same experience. Sometimes, knowing you are not alone is the most important first step.

The pediatrician as a starting point

If you do not know where to begin, your pediatrician can be a first point of contact. Not all pediatricians have specific training on gender identity, but they can direct you to the appropriate services in your area.

A final message for parents

If you have made it this far, you have done something important: you sought information before reacting. You chose knowledge over fear. And this, regardless of what you discover about your child, is the first act of love.

In most cases, what you are observing is a healthy child exploring the world without the limitations that society imposes. A child who plays with dolls, who puts on makeup, who prefers friends of the other sex, who experiments with clothing. A child who is growing, as all children do, trying to understand who they are.

In some cases, rarer but no less important, what you are observing is a child telling you something profound about their identity. If so, that child needs you to listen, to love them, and to guide them toward the right resources.

In both cases, the answer is the same: love your child for who they are. Not for what you expected, not for what society tells you they should be, but for the unique and unrepeatable person growing before your eyes.

Science is on your side. Love is on your side. And your child needs both.