For years, J. kept a folder of items to remind himself that he existed.

Inside it was a place card from a formal dinner he attended, name tags, handwritten letters from a friend, a pink envelope with his name on it, a note from a teacher, a birthday card from his parents. The name on these items is not the one he was given at birth, but one he chose as a teenager to align with his gender identity.

J., who requested that the Weekly only use his first initial to protect his privacy, is a transgender man who transitioned from female to male as a student at Gunn High School. He told the Weekly that he often felt marginalized in a world so defined by binary notions of gender — that people are born either male or female without a recognition of any fluidity between the two. The contents of this folder affirmed to him that existing beyond the binary is valid.

"You're living in a society where it's formatted for you to not exist in it — the language is structured, the bathrooms are structured, the way people interact are structured, the clothing is structured, the kids' toys are structured, the shampoo is structured," he said.

J., now a college student, is one of many transgender youth in Palo Alto grappling with both their internal identities and their place in a world that is still playing catch up to changing societal norms around gender.

The Palo Alto school district is likewise scrambling to prepare for the growing number of students of all ages coming out as transgender or gender non-conforming.

For years, district parents of transgender students have been advocating for better support for their children, more comprehensive policies, more teacher training and more community education around LGBTQQ (lesbian, gay, bisexual, transgender and queer or questioning) issues.

Their efforts appear to be resulting in a slow-but-visible evolution throughout the district this year.

After more than two years of fits and starts, a new, comprehensive gender-identity policy will come before the school board for discussion next Tuesday. The policy takes a more intentional, inclusive approach to ensuring that transgender and gender non-conforming students' rights are protected.

Just two weeks ago, new "all-gender" signs were installed outside newly designated single-stall, gender-neutral restrooms at Palo Alto High School and Terman and Jane Lathrop Stanford middle schools. (The signs are also on their way to Gunn High and Jordan Middle School, and a conversation about the elementary school bathroom signage is forthcoming, district staff has said.) This is a change that J. and other Palo Alto students and parents of transgender youth have pushed for for years, as bathrooms are a nexus of discomfort and often peer harassment for transgender students.

The school district's primary online student-records system, Infinite Campus, as of this fall has new options for preferred name and gender. Before these additions, the district relied on an ad-hoc approach to accommodate students who wanted to change their names or genders on school records, meaning a student's given name might appear in another system, be used by a substitute teacher who is unaware of the preferred name, or a new name could be written on letters sent home to parents who might either not know about their child's identity or not accept it. For transgender people, being called the name given to them at birth — sometimes referred to as their "dead" name — can be a source of enormous anxiety, transgender students in Palo Alto and mental health professionals say.

Students at both high schools' Gay Straight Alliance groups recently decided to change their groups' names to be more inclusive of all gender identities and issues — Gunn to the Gender and Sexuality Alliance and Paly to the Queer Straight Alliance. Gunn's student government also voted this fall to make homecoming court more inclusive, breaking with decades of tradition by removing the typical awards of "king" and "queen." Even Gunn yearbook polls like "best smile" that are typically awarded to one female and one male student will this year instead simply go to the top vote-getters.

Two school district librarians, one who has a transgender family member, are working to raise awareness and facilitate communication around transgender issues. Terman Middle School librarian Kristen Lee and Juana Briones Elementary School librarian Julie Griffin together created what they say is the nation's first open-source library guide dedicated to LGBTQQ-specific books, videos and other resources for elementary and middle school students, parents and teachers. Many of the books are also available in libraries as "honor" books, meaning students can take them home anonymously, without officially checking them out and leaving a record of their name. The district is also working with Palo Alto's TheatreWorks to create an educational play that all elementary students will soon see, in which a theater director struggles with traditional gender norms when assigning roles in a play.

Yet, Palo Alto families and transgender students say there is still a long way to go. Transgender and gender non-conforming students in Palo Alto experience peer harassment at school, are frequently misidentified by teachers and other parents, face being accidentally "outed" by teachers to other students who might not know that they are transgender, are forced to participate in many gender-based activities in schools (which can be as simple as a teacher separating a class by boys and girls, or lines entering a school dance that are broken down by gender) and, until the recent creation of gender-neutral bathrooms, had to forego something as basic as using the school bathroom to avoid potentially outing themselves or fielding questions from peers or even staff.

Brenda Carrillo, the school district's director of student services and chair of a standing LGBTQQ committee made up of school staff, parents and community representatives, said the district is making progress in many areas — moving closer toward adopting a more comprehensive policy, opening true gender-neutral bathrooms, increasing staff training — but acknowledged the work is far from complete.

"There's a lot of work to be done," Carrillo said, "but we are fully committed and aware of what needs to happen and are making every effort that we can to be forward-thinking about this while knowing that there is uniqueness in each of these situations."

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For many children, identification with a gender begins around age 2, according to the American Psychiatric Association (APA). They might begin to experience gender dysphoria, which the APA defines as "discomfort related to their bodies not matching their internal sense of gender."

That term, gender dysphoria, replaced "gender identity disorder" only recently, in 2013, in the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard classification of mental disorders used by mental health professionals in the United States. In making the shift, the APA recognized that terms can "impact how people see themselves and how we see each other."

When J. was young, a pink "It's a girl" poster announcing his birth hung on a wall in his room. He remembers "despising" the poster, but not knowing why. When he was about 4 years old, he said he took a blue marker and drew all over the pink poster.

As he grew up, he continued to consistently express, in various ways, that he identified with the opposite gender. When he was 8, he remembers really wanting to wear swim trunks. He kept his hair short and liked being viewed as a boy. He quit ballet because the instructor said he would have to grow his hair out and put it in a bun.

It wasn't until middle school that J. first heard of a transgender person — a student who had graduated from the school years before, he said.

"My initial reaction was just jealousy because, in my head, all girls want to be boys," J. said. "It didn't dawn on me that most girls' reactions to hearing about a trans guy is not 'Sign me up.'"

Parallel to that, he started to realize that most girls actually liked being girls — that being female wasn't an "inherently negative" part of their identity, as it was for him. In seventh grade, he said, he "put two and two together" that he was transgender, but — being in denial — he didn't talk to anyone about it.

"I just didn't feel like I could," he said, "and I think I was still hoping it would go away. I think that saying it out loud made it real."

A breaking point came in eighth grade during a unit in his English class on gender identity. He said he brought up the existence of transgender people and the teacher told him that wasn't an appropriate discussion to have in that class.

"I was angry about that and I started ranting to a friend of mine about it after class and I don't remember what I said, but somehow in the process of that rant it just kind of came out," he remembered.

He came out to another friend, and later his parents. By the end of eighth grade, he was presenting outwardly in a masculine way — wearing more masculine clothes and keeping his hair short, for example.

J. decided to socially transition his freshman year at Gunn, meaning he started to go by his first initial, "J." He asked teachers and friends to use his preferred masculine pronouns.

J. described his own gender dysphoria as a "brain-body disconnect" so intense that "all of the societal judgment, the medical appointments ... all of that is better than being trans secretly.

"That is why people transition. It's not because they want to; it's not because it's a guy that likes to wear dresses. It's because being who you are is worth it, because suppressing who you are is worse than all of that."

He said the dysphoria was even worse than the social pressure to not present in his true gender.

"As hard as the social aspect was, potentially starting to panic every time I heard the echo of my voice or saw my reflection in a window was worse," J. said.

The parents of a transgender high school student, "Scott," whose name has been changed to protect his privacy and who transitioned from female to male at school this year, wanted him to wait to transition until he graduated from high school. But, he said, the dysphoria became unbearable. Before he transitioned, he would hide a pair of boys' shorts in his backpack and change once he got to school. He slowly started asking friends to use male pronouns.

Years before, in middle school, Scott had told his parents, "I think I'm a boy."

"It was the 'I think' that kind of left some open room for me to go back on it later when I was like, 'I'm not quite sure,'" Scott said. "I wish I had said, 'I am a boy.' But I wasn't quite ready to say that yet."

It wasn't until his sophomore year when he saw a YouTube video created by a transgender boy that he more fully identified as transgender.

Scott's mother, "Susan" — who asked for a pseudonym so as to protect her son's privacy — said she and her husband worried about him openly transitioning in high school. They wanted him to instead wait until after graduation. He said he couldn't wait.

"It was frustrating for me because at that point — the dysphoria was so bad that I just couldn't anymore," Scott said. "I couldn't handle it."

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Transitioning, a yearslong process that looks different for each transgender person, can include coming out to one's family and friends, name and pronoun changes, dressing differently, hormone treatments and possibly surgeries.

Professionals say that for transgender and gender non-conforming students, a daily barrage of small encounters that emphasize a disconnect between society and their identities — an inappropriate question from another student in the bathroom, a substitute teacher who says a student's given name without knowing that they go by another — can accumulate and have deep emotional and psychological impact.

"It is the difference between a child feeling relaxed, happy, confident and able to learn and the child who feels inhibited, self-conscious, socially anxious and unable to learn," said Diane Ehrensaft, the director of mental health and founding member of UCSF's Child and Adolescent Gender Center and a clinical psychologist who sees many patients from the Palo Alto area. "It's really a dramatic difference depending on whether there are positive policies and practices in place."

J. transitioned before not only major changes were made within the Palo Alto school district this year, but also the passage of AB1266, a landmark California law that ensures transgender students have access to facilities and activities, especially sports, based on their gender identity. The new law passed in 2013 and went into effect on Jan. 1, 2014, in the middle of J.'s senior year.

Before this year, Palo Alto schools took a mostly ad-hoc approach to complying with AB1266. Gunn unlocked select single-stall staff restrooms for student use J.'s senior year. Before that, he was allowed to use the boy's bathrooms but said he avoided them altogether or used them during class when he thought they would be minimally occupied. Other transgender students said they shared the strategy of using bathrooms that were less trafficked.

At Paly, staff typically gave transgender and gender non-conforming students keys to single-stall staff bathrooms. Some elementary-age students were given access to the nurse's office bathroom. Both groups of students said they were reluctant to use those facilities because doing so would call attention to their status.

J. also struggled to get his name changed on school records before Infinite Campus allowed staff to enter "preferred name" and "preferred gender." The mother of another transgender student said she decided to change her daughter's name on her birth certificate because she knew the Infinite Campus change wouldn't come soon enough for her child.

Many of J.'s teachers also struggled to consistently use the correct pronouns, he said. School teachers and staff are now required by law to use a student's preferred name and pronouns.

One teacher just didn't use pronouns in reference to him, J. said. Another suggested in front of another student that J. should apply to Smith College, an all-girls school, he said. Other teachers tripped over pronoun usage and apologized in ways that made him feel even worse — with an "undertone of, 'you are too complicated for me to understand your existence,'" he said.

He came up with an analogy: "It's as if you stepped on someone's foot. Rather than going, 'Sorry,' you went, 'Oh, I'm sorry, you just stand at such a weird position; I didn't think that your foot would be there. I just have trouble grasping the concept of feet.'"

J. said the best way to apologize for using the wrong pronouns is to simply correct one's self, apologize and move on.

J. and other students say they feel isolated and alienated by sex-separated activities as commonplace as pairing students off for an activity. Transgender students and their parents in Palo Alto are also pushing their schools to move away from heteronormative activities, like separating a class by gender.

"When we told the administration, 'We really don't want you to break down by gender,' their response was well, 'you can pick whichever one you want.' That wasn't the point," said "Mary," the mother of a transgender elementary student in Palo Alto. "The point was it depends on the day; it depends on the hour. Sometimes she doesn't feel like either one of them. Why are we forcing kids to do that?"

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At one Palo Alto elementary school, an outside organization needed to step in to ease a transgender student's transition. "Anne," whose name has been changed to protect her privacy, transitioned from male to female at her elementary school last year. This came after she grew her hair out, started wearing dresses to school and asked her parents to use the female pronouns at home. Anne's mother, "Julia," whose name has also been changed, said their family lived a "double life" for several months: Anne, then 8 years old, was using the female pronouns at home and at outside-of-school activities, but was still known as a boy at school.

Once she felt ready to socially transition at school, Anne requested one condition: that Gender Spectrum, an Oakland organization that provides education and training around gender to schools and other institutions, come in to speak to her class and others at the school. She had grown tired of routinely fielding questions on the playground about her gender. Students she didn't know would ask, "Are you a boy or a girl?" More questions and harassment came when she went to the bathroom, to the point where she didn't use the restroom at school for four months. Students also peppered her older brother with questions like, "Why is your brother wearing a dress?" Julia said.

"It's not so fun to explain (it) all the time to people," Anne told the Weekly. "If someone asks you something over and over and over again nonstop and it's different people but the same question, it really bugs me."

But that fall, Gender Spectrum couldn't come to the school right away, so Anne was still going by male pronouns at the start of the school year, while being recognized as female at home. Doing so caused a "crisis," Julia said. Normally a happy child, Anne was angry, "like a different person," and would break down every day after school.

Julia almost pulled Anne out of school to homeschool her. They instead decided on a stopgap: She would transition just in her classroom, going by female pronouns, until Gender Spectrum could come.

The next month, Joel Baum, Gender Spectrum's senior director of professional development and family services, visited Anne's school, leading a parent-education night and speaking to students. He read to classes "Be Who You Are," a children's picture book about a biological boy who identifies as a girl. He explained gender expression and identity in an age-appropriate way.

Anne remembers that in her class, he drew a line on the board with "boys" and "girls" at each end. Pointing to the line, he told the class, "all of these things are possible."

Baum said in an interview with the Weekly that Gender Spectrum's goal — whether by speaking to a class of elementary-age students, training teachers or leading a parent-education night — is to not only support transgender and gender non-conforming students but also expand people's notions of gender and gender roles.

He often tells parents: "(If) you think we're here to talk about some 'other' child, we're talking about your child because your child is getting messages about what it means to be a boy or girl that are really damaging, too."

"This isn't about 'other.' This is about all of us," he said.

Anne, now 9 years old, said she felt her transition at school went well.

"It felt like I was controlling who I wanted to be, like I wasn't letting anyone force me to be who I didn't want to be," she said.

Julia said that harassment by other students completely stopped after Gender Spectrum came in. She couldn't have imagined how her daughter's transition would have gone without the additional education and support.

"You can't have a welcoming and supportive environment if the teachers haven't been trained," she said.

As a member of the district's LGBTQQ committee Julia and other parents have been pushing for the district to implement training around gender issues in a more systemic, intentional way.

For the past eight years, Adolescent Counseling Services' LGBTQQ+ program, Outlet, has trained new teachers in the district in two-hour sessions offered once a year. Last year, Gender Spectrum came in for the first time to lead a second training, also about two hours long, district staff said. Outlet also provides workshops for Paly's and Gunn's Living Skills classes, and, as recently as two weeks ago, did a training with all school psychologists. Schools typically contact the organization throughout the year to provide other training and education for staff, or students, or on a consultation basis as needs or questions arise, according to Outlet Program Director Anthony Ross.

The district has said it also plans to train classified staff, like secretaries. Gender Spectrum will also be leading a training at Paly in January, at the district's request. Baum said there are more and more schools and organizations requesting trainings — so many so that Gender Spectrum is restructuring its services to meet the high demand.

J. himself led a staff training at Gunn his senior year. He explained different terminology, what it means to be transgender, what would make him feel more welcomed at school (from using the right pronouns and gender-inclusive language to mentioning transgender figures in history or the news). One bullet point on his presentation read, "What you do as a teacher can make a world of difference in the life of a trans student."

Ever since Anne's gender expression became markedly more female, Julia would talk with her school about which teachers they think might be the best fit for her daughter each year.

"I might be told that some teachers, because of religious or cultural background, aren't as accepting of gender non-conforming children as other teachers, so the pool of available teachers to entrust my child to can be cut down considerably," Julia said. "This is frustrating and not OK. But at the same time, I'm very grateful that the school is making sure my kid isn't going to be put with a teacher who can't accept an 8 year old for who she is."

Daisy Renazco, a Gunn teacher and the school's longtime Gender and Sexuality Alliance adviser, said it often takes hearing a student's personal experience to cause a shift in teachers' understanding and practices.

"I think a lot of it has to do with awareness and understanding," she said. "To an adult that isn't connected to a trans student or (doesn't) understand what that perspective is, it seems really new. 'Why do I need to do this?' It doesn't make sense until you start to really hear the stories."

"To shift hearts and minds takes time, in order to shift a culture," she added.

Baum said beyond being required by California law to support transgender and gender non-conforming students, teachers have a "moral responsibility" to their students.

"What we're talking about here, at the end of the day, is all kids deserve to be treated with kindness and respect," he said. "As an educator, you do not get to decide which child is safe and which one isn't."

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Rapid and recent shifts in the biological, environmental and societal understanding of what shapes gender identity, particularly at a young age, mean that parents whose transgender children came out even just four years ago struggled to find adequate resources and informed psychological support in the area.

The first child psychologist that Julia and her husband saw, who they were referred to by their pediatrician, told them during their first session that transgender children were so rare, she'd never come across one, Julia said.

They brought a photo of Anne, who was then presenting as a boy, and the psychologist told them that she could tell by Anne's bone structure that she was, in fact, a boy.

The psychologist instructed Julia, a stay-at-home mother, to distance herself from Anne and become less feminine — to not wear dresses or jewelry or paint her nails — to "break the emotional bond" between them. The psychologist also said that Anne should only be allowed to play with boys.

"I was supposed to kind of retreat into the background and not pay much attention to her," Julia said, while her husband was supposed to become "this amazingly interesting person doing all the fun things with my kids."

"But I was supposed to ... give the impression that I found my daughter 'not very interesting,'" she continued. "This psychologist in that one visit concluded that, since I was a stay-at-home mom, I'd 'over-bonded' with my daughter and so she wanted to be female like me."

Anne's parents reluctantly followed the psychologist's advice. It didn't feel right, but she was the expert, Julia said.

At the time, Julia had no idea that a child so young could be aware of gender identity. Other information, resources or other parents going through the same thing were scarce.

Following the psychologist's advice for several weeks turned out to be a disaster, Julia said.

The next psychologist was not much more helpful, despite having several transgender patients. After a year of sessions, when Anne still saw herself as a girl but had learned not to express it directly, the psychologist told Julia and her husband that "being transgender is a very lonely thing, (and) you want to try to avoid your child becoming transgender if possible."

At that point, they had bought Anne a dress, which she wanted to wear all the time, Julia said. The psychologist told them to pretend the dress was in the wash, limit how much she wore it and to not buy any more dresses.

"Emily," whose name has been changed to protect her privacy, is the mother of a Palo Alto transgender student. She had a similar experience with a child psychologist who told her, "this happens to a lot of kids" and instructed her not to allow her daughter to wear dresses.

This now outdated approach didn't work for either family, but they said they didn't know where else to turn at the time.

"As health providers, we don't have a good track record," said Maria Porch, a Los Altos psychotherapist who treats transgender and gender non-conforming adolescents and adults. "We don't have a positive history. It definitely has impacted how trans people seek care — or how they don't seek care."

Porch is a member of a growing — though still small — pool of local mental health professionals with experience and expertise in gender-identity issues. The pool is even smaller for parents seeking support for younger children rather than adolescents.

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Parental attitudes play a critical role in the lives of transgender youth. Still at the forefront of new laws, school policies and societal acceptance, many parents become staunch advocates for their children, pushing schools to put in place the required accommodations and support. But not all parents are able or willing to do so, leaving some students to navigate the changing tides on their own. (For students in this position, having comprehensive policies in place like the one coming before the Palo Alto school board are of critical importance, parents say.) Transgender youth under 18 who do not have their parents' acceptance also cannot do things like legally change their name.

Parents also work through their own process of understanding their child's identity.

Alan Marcum, the father of a transgender man who transitioned after transferring out of Paly, said his son's transition eventually catalyzed a change in his own understanding of gender norms.

"I used to see gender as highly binary and not completely but very strongly correlated with sex," he said. "It's much clearer to me now that though many of us identify at one end of the spectrum only, or another only, there are those who identify in other parts of the spectrum ... and still others who are highly fluid, not just around the center but around a much broader area of that."

But, this was a process for Alan, whose son, Rayden, came out to his parents in a concise note left on a whiteboard on the refrigerator before going out of town for the weekend. It read: "I'm transgender; please use male pronouns."

Alan said he was not upset — nor totally surprised — about Rayden's identity but about the way that he communicated it to his parents.

"If I had a magic wand, I would have Rayden sit down with us and explain it and let us ask a lot of questions — potentially even talk with us with someone else there who could help answer questions. Because my questions were not meant to attack or disagree; they were meant to understand. That's all I wanted to do, to understand."

Mary, the parent of an elementary-age transgender girl, said her advice to other parents to is "trust their gut."

"Although you hear different messages from people or people telling you, 'She's too young to make this decision'... it's just letting her be who she is," Mary said. "Parents who have a kid like this know that it's who they are, and if you just let all the noise fall away and follow your gut, I feel like it leads you in the right way."

Parents said they sought understanding of their children's identities by reading anything they could get their hands on — information that in the past wasn't always reliable or readily accessible — and by calling health care and mental health professionals, legal experts, LGBTQQ advocacy organizations.

"When I first came to realize that I had a transgender kid, I didn't know anyone who was transgender, much less any parents of transgender kids," Emily said. "It was really isolating. Even having the support of wonderful staff and teachers, it can feel daunting. How do I know I'm doing the right thing? Will people love my kid? Will she find acceptance? Will she be safe? All those things that every parent worries about for their kid."

There is now a strong parent support network in Palo Alto. Earlier this year, Julia started a monthly play and support group for parents of young transgender children. (This was also a new development in the area; Julia said previously, the closest groups were in Oakland and Santa Cruz. There is an existing support group for parents of transgender teens and young adults that used to meet in Palo Alto but now is in Sunnyvale. More information about local support groups is available at santaclaratransfamilysupport.net.)

There are now more than 40 people, about 30 families, from throughout the Peninsula who are part of the group Julia organizes. Many of the Palo Alto parents are now active members of the district's LGBTQQ committee and have been deeply involved with the new policy coming before the school board next week.

Transgender students and their parents are hopeful that the signs of sea change throughout the Palo Alto district will continue. The most important might be the new gender-identity policy, which, if approved, they hope would help codify a new culture in Palo Alto.

Parents say there are pockets of empathetic, supportive, gender-affirmative teachers and administrators that they view as true allies for their children. And small shifts do continue to happen, like Emily's daughter's teacher switching from starting her class by saying, "alright, boys and girls," to using terms like "scientists," "artists," or "authors," depending on the subject they're learning. Some Gunn teachers this year added a preferred pronouns sections on their beginning-of-the-year "get to know me" sheets.

As for J., he no longer relies on his folder full of items to remind himself that he exists. He recently almost saved a Starbucks cup with his name on it to put into the folder.

"I realized that it had hit a point in my life where I was me more often than pretending to be someone else, (and) that I didn't need to do that anymore," he said. He left the folder at home when he went to college this fall.

But until across-the-board, institutional culture change is accomplished, parents and students continue to advocate, so that they can live fully authentic lives, wherever they are.

"Everyone's journey is different, and you can't know, especially in the beginning, where the journey will lead," Emily said. "My daughter has to be the one who figures out where her path leads. I see my role as helping clear the boulders and sharp sticks out of the way so she can navigate that journey more easily, and then putting a helmet on her, so she has the resiliency to overcome the obstacles we can't foresee or change.

"Fortunately there are people along the way to help her, and she doesn't ever have to walk alone. ... The most important thing is knowing you are not alone."

Related content:

• Gender terms and definitions

• Palo Alto school district eyes new gender-identity policy

• On privacy, early intervention and medical advances

• Outlet offers LGBTQQ youth a place to be

• Stanford Children's Health begins to offer transgender health care