The problem of transgendered feelings typically begin early on, Leach explains, and it is not atypical for a boy or a girl to start identifying with the opposite gender from the age of three.

“We’re talking about a human soul that is damaged,” he said, “and there are both spiritual and psychological issues involved. But it begins with a deep-seated envy of the other gender, as well as an association of the hated gender with a negative role model.”

GID is also, Leach says, a place to hide from early childhood trauma and the responsibilities that come with a specific gender.

“You’re running away as fast as you can into that which brings you a sense of relief and refuge,” he explains. “It’s an escape into a fantasy world, an escape from the responsibilities of manhood… The problem is, if you do it regularly, it becomes second nature. And once you start taking hormones, you lose all sexual desire for the opposite gender.”

Dr. Warren Throckmorton is director of college counseling and associate professor of psychology at Grove City College. He has seen close to 4,000 clients since he began counseling in 1980.  Approximately 1-2 percent of his caseload involves people with “significant gender concerns” – a number that is about the same as the general population, he says.

Throckmorton believes that cultural misconceptions about gender are an important element driving GID and other gender issues like homosexuality.

“Just because [a boy] likes to dress up in girls’ clothes doesn’t mean that he was intended to be a girl,” Throckmorton says. “He might like color, color combinations and style. He might like certain aspects of what it means to be female, like sexual power, friendships and other things that are seen as typically female. He might look at that and wish he could be that way. There are boys who are not interested in trucks, sports or WWF. Some kids in the nursery are rough-and-tumble, while other kids prefer to sit and be held, or look at pretty things.”

These exceptions to the cultural rule can create a problem for some parents, Throckmorton says.

“We all know that it’s okay for girls to be tomboys, and a lot of guys like it when girls go out for softball and soccer,” he says. “But what we don’t tend to do well with is boys who are interested in music or the arts. Some boys just don’t like NASCAR but they do like music or art or drama, and they need the support of their fathers.”

The absence of that support, Throckmorton says, can give birth to the seeds of gender dysphoria.

A former president of the American Mental Health Counselors Association, Throckmorton is convinced that the overwhelming majority of GID cases are fueled by “nurture,” not “nature.” Prevailing cultural attitudes, the media and peer expectations also play a huge role.