Everyone knows the job of being a parent is one that can be unfathomably hard. A heartbreaking example was on a recent episode of Dateline about a six-year-old boy named Joey who, after years of acting out and being depressed, was determined by a doctor to likely be transgender. Despite facing a lot of criticism from their community, Joey’s parents decided to let Joey live as a girl and go by the name of Josie. Making that decision must have been hard, but it was nowhere near as hard as the decision they have ahead of them.

Josie, who has been better-adjusted since identifying as a girl, is approaching puberty and frightened she might change into a man with a deep voice, Adam’s apple, and large hands. Since Josie wants to remain as feminine as possible, her parents looked for a doctor who would be open to the possibility of giving Josie a treatment that would stop her from undergoing male puberty. They found one, but then something unexpected happened: Josie made a comment that she still might be a boy on the inside. Suddenly, Josie’s parents were no longer 100% convinced the treatment would be the right thing for her. But if Josie is to avoid going through male puberty, they are going to have to make an irreversible and staggeringly difficult decision very soon.

I was riveted by this episode and felt sick to my stomach watching these parents agonize over the decision ahead of them. They have two options:

OPTION 1: Have Josie undergo the treatment

PROS: Josie would be able to avoid male puberty and experience female puberty (including the development of breasts). For a transgender person, being able to reach adulthood looking as much like the gender they identify with is ideal.

CONS: The treatment would not only stop male development, but render Josie infertile through the injection of estrogen. If Josie later decides that she is indeed a boy on the inside and wants to live as one, she would be in a tough position to do so as she’d lack many masculine characteristics and be infertile.

OPTION 2: Do not give Josie the treatment

PROS: Josie would remain fertile and not have an irreversible treatment performed at a young age. Once she turns eighteen she could have gender reassignment surgery if she chooses.

CONS: Josie would go through male puberty and reach adulthood with overtly masculine characteristics. Even if she chooses to have gender reassignment surgery then, she would not look nearly as feminine as she could have if she’d undergone the treatment.

The experts on the show were split as to what should be done. One said true transgender persons know they are transgender at a very young age, and therefore should be allowed to decide to have this treatment before the onset of puberty (note: blockers can postpone puberty a couple years and give extra time to consider this large decision). Another said that transgender identifying children as young as Josie have been known to later revert to identifying with their original gender, so treatment at that young age is unwise.

The part that made me the most anxious is that regardless of which option Josie’s parents choose things could backfire horribly. I can see an adult Josie who underwent the treatment screaming, “I was just a little kid! How could you give me that treatment? I’ll never be the man I could have because of you! You’ve ruined my life!” I can also see an adult Josie who didn’t undergo the treatment screaming, “I told you since I was six-years-old I was a woman! How could you not give me that treatment? I’ll never be the woman I could have because of you! You’ve ruined my life!”

I am no expert on transgender issues, nor do I have any personal experience dealing with transgender children. All I know is that I hope Josie and her family are happy with what they decide, and that the thought of having to make such a difficult decision regarding Annabel’s future scares the crap out of me. Josie seems like a bright and loving child, and her parents seem like good people. I doubt they ever imagined being faced with such a difficult situation before becoming parents, and yet here they are. And here we all are.