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Middle-class parents today tend to actively help their children get settled on a path in life, and often subscribe to the notion that “early intervention” is best for all kinds of conditions.

Many therapists have begun to speak of even very young children as transgender (a category that few clinicians of past generations would have applied to them).

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In the past, females who wished to live as males rarely sought surgery, in part because they could “pass” easily enough in public; today, there is a desire for more thorough transformations.

Skylar took hormones and underwent “top surgery” at a much younger age than would have been possible even a decade ago.

Alice Dreger, a bioethicist and historian of science at Northwestern University, says, “The availability of intervention and the outspokenness of the transgender community are causing a lot more people to see themselves as transgender, and at younger ages.” A recent survey of thirty-five hundred transgender Americans found that, the younger the respondents, the more likely they were to have had “access to transgender people and resources at a young age,” and to have identified as trans at a young age.

In a follow-up survey, more than two-thirds of the respondents between the ages of eighteen and twenty-two said that they had known other transgender people before adopting the identity themselves, compared with a quarter of those fifty-three and older.

Skylar lives in an affluent, wooded town near New Haven, a liberal enclave where nobody seriously challenged his decision to change gender. As he explained in his application essay, classmates kept telling him, “This is the most fundamental essence of who you are, Skylar.