A five-year old boy who has been living as a girl for more than a year has once again sparked the debate over whether children can know that they are transgendered.
Zach Avery started living as a girl since he was three years old and was diagnosed with Gender Identity Disorder (GID) after his mother consulted a number of physicians.
Says Theresa Avery, "He just turned round to me one day when he was three and said: 'Mummy, I'm a girl.' I assumed he was going through a phase and just left it at that. But then it got serious. He used to cry and try to cut off his willy out of frustration."