When Sally was two years old, he found things he could stick between his legs to represent a penis. While he didn’t have the words to describe it, he was distressed by the lack of a penis there, something he noticed his brother had, and he tried to convey that to his parents with grunts and cries, but they simply didn’t understand, as much as they loved him.

Sally’s mother would lovingly comb his long hair each morning. When she pulled Sally’s hair back into a braid or a ponytail, Sally would tug the hair free until it hung loose on his shoulders. Sally’s mom stopped trying to style his hair.

Sally’s father would help dress Sally every morning, in white tights and a pink dress perhaps. Sally would cry and fidget until the tights were off, and would clutch and pull at the dress with his little fingers. Finally they would dress him in shorts or jeans and a T-shirt instead.

Sally’s parents assumed they had a very willful daughter.

When Sally turned 4, his distress grew worse. At home, he was allowed to play with trucks and blocks and tools. He hated the sight of a Barbie doll or a makeup kit or a fairy princess. At home, he could use the bathroom just fine, but in public, he refused to enter the women’s restroom, instead marching into the men’s. His dad was fine with that, but that only worked when Sally was out in public with dad; when he was with mom, she would have to take Sally into the women’s, and Sally would fidget and cry and scream and wail.

When Sally turned 5, he was spending more and more time frustrated, crying, and angry. His parents attempted to put him in daycare, but he couldn’t go, he would cry and scream and throw tantrums all day. They couldn’t figure out what was wrong. Sally began getting angry whenever they used the name Sally to address him, so they tried out nicknames. He hated ‘sis’ and ‘princess’, so they tried out Sam. He liked Sam just fine.

A few months after his fifth birthday, Sam went into the kitchen medicine cabinet and found a bottle of extra strength Tylenol. He took it to his mom and asked her to open it. When his mother asked him why, he said it was because he wanted the pain to go away. She found him holding the bottle again a few days later. And Sam’s parents realized it was time to get him help.

It took the therapist only two sessions to realize that Sam was a boy. The mental health diagnosis is Gender Dysphoria, a condition in which a person shows significant distress with their assigned gender. Simply put, Sam was a boy trapped in a girl’s body.

Over the next few months, the parents learned everything they could about transgender kids. They cut Sam’s hair. They let Sam dress like he chose, in jeans, in ball caps. They continued to let him use his own toys. And they started using HE instead of SHE to describe him. And almost immediately, Sam’s emotional and behavioral problems went away. Sam started smiling, and playing with other kids, and being sweeter to his parents, and getting along with his brother. When he was upset, his behavior was within normal reactions, a short cry or a stern word, but at vastly reduced levels compared to his previous behavior.

Sam was soon enrolled in kindergarten. The parents were extremely nervous and they had a long conversation with the principal and the teacher about Sam and his condition. The faculty was surprisingly supportive. Although they had to enroll “Sally” in the classroom, they introduced him as Sam, and a boy, and Sam made friends quickly. He continued working in therapy and he began to understand what being transgender is.

Sam used the boy’s bathroom at the school until one of the other teachers learned he was transgender. She demanded Sam use the girl’s bathroom, and the school felt they had to comply given the complaint. Sam cried every time he used the girl’s bathroom. He began just holding it all day, to the point he felt ill, but it was easier for him to be sick than to be called a girl. He looked like a boy, and the other kids were confused when he went in the girl’s bathroom. And that was when the teasing started.

Sometimes Sam’s older brother called him Sally, or called him a girl, in order to antagonize his little brother at home. But he learned quickly that whenever he did, Sam seemed overcome with anger and sadness and would rush to his room crying. So he stopped doing that. He loved his little brother.

Working with the parents, the school started letting Sam use the teacher’s bathroom instead of the girls’. That helped a little, but it was uncomfortable. He was the only kid in class who used the teacher’s bathroom. He didn’t want to feel different from the other kids, even though he was. He wanted to fit in with the other boys like he had before.

Sam’s parents kept fighting the school on this, but they felt their hands were tied. They considered home-schooling Sam, but knew he needed the social interaction, and they felt he deserved the right to have an education with his peers. He was only five and he had already been through so much.

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Though I have changed the name and left out identifying details, Sam is a kid that I know. Not every transgender person experiences such gender distress at such a young age, but many do. And while some kids have passing phases, where they want to be more masculine or feminine for a brief period of time, Sam is an example of a child who is most definitely transgender.

When we see the transgender bathroom issues being debated on the news and on social media, I want you to think of Sam. Every kid in every class deserves to belong and to feel safe. It’s a much bigger deal than you think.