Michelle describes herself and her husband Nick, a computer programmer, as "really liberal." But she had trouble. "It was kind of overwhelming," she says. "I couldn't for a very long time even bring myself to call her [Hannah]."
Many parents of transgender girls report an early insistence on being called by "she," on wearing feminine clothing. Michelle says there just wasn't much of that for Hannah.
She was into videogames, riding her bike, and pretend gun play. She still is. Hannah tells me that Borderlands 2, on Xbox, is a favorite.
But Hannah, now 12, sitting on the family couch in a pink T-shirt, pink shorts, and pink lipstick, recalls the "strange" and powerful feeling that came over her when she donned girls' clothes in the occasional game of dress-up. "I was still little and I thought maybe it was kind of wrong to do it," she says. "But it felt fun."
After Hannah's announcement, Michelle ordered some books. Read up on the Internet. Sent her son-turned-daughter to a therapist. This past summer, Hannah began regularly dressing as a girl. And the impact was startling.
Her Tourette's ticks, often triggered by stress, were less frequent. And an unexplained bout of vomiting came to an end. The stress of living as a boy, it seemed, was lifting.
In July, Hannah saw Dr. Forcier for the first time. And the pediatrician offered a vital jolt of confidence. "She's awesome," Hannah says of her doctor, "she makes me feel good, [telling me] 'you're beautiful — and no matter what, you will always be.' "
Michelle had already done some research on puberty blockers, more formally known as gonadotropin-releasing hormone analogues, and was pretty convinced that they were right for Hannah.
Doctors have used them for years to stave off precocious, or early, puberty. And their effects are entirely reversible: stop taking them, and puberty in a child's assigned sex begins right away.
But if the family was ready for the blockers — prepared to put off male puberty and spare Hannah the anxiety that might come with it — two more daunting mileposts were in view.
Hannah was about to attend school as a girl for the first time. And with her peers set to enter puberty, the Rinis had to decide whether to administer the cross-hormones that would start her on the path toward a female body.
'YOU DON'T HAVE TO PROVE TO ME'
Dr. Forcier is sitting behind a long, curving table just before her lecture to the Brown medical students when I ask her the big questions: Are 10-year-old kids really ready to declare themselves transgender? And are the doctors who attend to them qualified to play God?
There is some controversy about these questions. Dr. Kenneth Zucker, who runs an internationally known gender identity clinic in Toronto, is the most prominent spokesman for a more traditional approach.
He urges parents to prevent their kids from dabbling in clothes, toys, and behaviors associated with the opposite gender. And he worries that doctors who give kids puberty blockers are sending an implicit message that there is no real alternative to a full transition.
Ultimately, he says, children who remain aligned with their biological sex will avoid the travails of sex reassignment surgery and the harassment of a still intolerant society.