For many people who identify as transgender, it starts at a very young age - boys thinking they're girls and vice versa. For some, it's temporary; for others, not at all. That's one reason Seattle Children's is providing emotional and medical support to families through what can be difficult years.

Seven-year-old AJ is at home in her roller skates with her princess dresses and figurines.

We ve had some pretty nasty things said about us, said AJ s dad. My concern is protecting her so she s safe.

AJ was born a boy. At three-and-a-half, things changed.

Sometimes they at three think, they feel they are the opposite gender male or female, said Dr. David Breland.

He didn t want short hair.

Screamed and fought and I got out the clippers. I got one cut down the side and it was just tears and it was like torture, said AJ s mom.

Dr. Margarett Shnorhavorian is part of a team approach at Seattle Children s

You need to start early and it needs to be developmentally appropriate, holding the family and parents hands as well as the kids as they go through that journey and that it s not this big aha at puberty. It really starts a lot earlier, said Dr. Shnorhavorian.

AJ longed to wear dresses and jewelry. His parents refused at first. Then it was much more than wanting to wear dresses.

There s not been a lot of research. There s some speculation that increased maternal hormones during pregnancy of either hormone testosterone or estrogen - but we really don t know. It hasn t been proven, said Dr. Breland.

When she was about four we were going to the bathroom in Target and I was holding her hand and we were walking toward the boys bathroom. This was when she lived as a boy. She stopped about two feet from the bathroom and was like, dad, I can t go into the boys bathroom. I m a girl, said one dad.

Dr. Shnorhavorian steps in when these children reach puberty and families have had time to accept and adjust.

They will have seen the psychologist. They will have seen the endocrinonologist and they will have decided that this is a family and a kid who might benefit from hormonal suppression at puberty. In other words, we stop the clock, said Dr. Shnorhavorian.

You buy that time while they continue to make sure that s the process they want to go towards once they enter the age of puberty, said Dr. Breland.

It s not something that we wish for. It s not something that we wanted it just happened. My thought process all along was that I d rather have a happy healthy little girl than a suicidal dead son, said one dad.

Transgender children are more prone to depression and anxiety, so it s important to intervene early. Surgery is not considered an option until adulthood.

The Gender Odyssey National Family Conference takes place in Seattle beginning Friday. Seattle Children s also has a support group that runs year round.

Resource links:

Gender Odyssey Family

Seattle Children's support groups

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