I remember thinking even then that something must be wrong with my daughter, a stomach bug or the first symptoms of the flu perhaps. Whatever it was, she looked pale and unwell sitting across from me. I half-expected her to vomit.

“So, what’s this all about?” Zack asked her. “What’s going on with you?”

She danced around it for a while as we sat there, waiting for her to say something meaningful.

Eventually, she came out with it: “I have gender dysphoria; I feel more like a boy than a girl. I’ve always known something was wrong with me. Now I’ve discovered what it is. I’m going to start living my life as a male—my authentic self—and I want you to use he/him pronouns when you refer to me.”

I stared at her. The things she was saying were so ridiculous that I almost laughed. As a psychiatrist, I’ve been trained not to do that, but still, it almost happened. She could have said, “From now on, I’m going to communicate only through puppets, and I’ll be wearing a hat with rotting fish on my head,” and I would not have been more surprised than I was in that moment. Zack shifted in his seat, as if he was experiencing a bit of intestinal malaise, and again I almost lost it. The laughter wanted to bubble out of me, but I pushed it down and told myself to be still. I wonder what might have happened if I hadn’t. How would she have responded if I had laughed out loud and said, “Okay, cut the shit and tell us what’s really going on with you.” How might that have changed everything that followed?