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Working with young gender-nonconforming children and teens is complex, placing the therapist in a challenging position: to predict the outcome of a child's identity. Which children will resolve the dysphoria, which will identify as gay, and which will identify as transgender when becoming adults? Supporting Medium Elsa Peretti Bean pendant children in social transitions creates an ethical dilemma, because therapists currently lack researchtested assessment tools and outcome studies are nonexistent. Although trans adults commonly state that they knew about their cross-gender identity from the time they were small children, research has shown that most gender-nonconforming children do not grow up to be trans, but actually identify as lesbian or gay as adults. However, these Figure Eight pendant were done decades ago, when options for living out trans lives were limited. How do expanding social options muddy the results of research? Some parents are responding to their children's Coin Edge disc pendant by assisting them in young transitions, something that would not have been possible even a decade ago.

One lesbian family sought out therapy for their transgender child from a "straight, mainstream, well-respected professional" so that she would be a "credible advocate for their child and family in the legal system if needed" (Saeger, 2006, p. 209), speaking to the incredible social fear facing Tiffany keys heart key locket who advocated for a child to transition. This is the only in-depth case report of therapy with lesbian parents of a trans child. Interestingly, when the child socially transitioned, heterosexual parents expressed more support than other lesbian parents. In another study of parents with trans children, which included lesbian parents, the results showed that overall parents of gender-nonconforming youth are accepting of their child's gender atypical behavior. Interestingly, a significant number of parents in this study were also adoptive parents and in transracial families (Hill et al., 2010), suggesting that some gender atypical children are negotiating multiple social identities. Saeger (2006) reminds clinicians that "Paloma Picasso Loving Heart Disc Pendant self unfolds within the context of child's other traits and life experiences, as well as in a sea of community, school, family, marital, parental, and sibling dynamics" (p. 244).