Yesterday a commenter tried to lay the creation of transgender identity at the feet of "a loving mommy" who encourages a little boy to play with make-up, nail polish, and cross-dressing while "disparaging male boding activities with a daddy she resents."

This ticked me way the Hell off. Not only does it completely ignore the existence of trans males, it has absolutely no scientific foundation.

Doctors at Boston Children's Hospital combed through their patient records and discovered that 8.2% of the young people treated at the clinic between 2007 and 2015 were being raised by adoptive families. This compares to a rate for the general public of 2.3%.

Before I started seeing transgender kids, it would not have occurred to me that we might see more adopted kids.

--Dr. Daniel Shumer, formerly of BCH, now with C.S Mott Children's Hospital, Ann Arbor Michigan

It turns out this had not gone unnoticed.

People have been talking about this for a long time.

i often hear colleagues around the country say, "We have a lot of kids who are adopted in the gender clinics.

--Dr, Johanna Olson-Kennedy, Center for Transyouth Health and Development, Children's Hospital of Los Angeles

I am seeing the same thing is my work as a gender specialist in the San Francisco Bay Area.

--Diane Ehrensaft, psychologist and author of Gender Born, Gender Made: Raising Healthy Gender-Nonconforming Children.

No one seems to know why. But there is some agreement about possible explanations.

First, it may be that there's a higher percentage of trans adopted children who get care, rather than a higher rate of trans kids who are adopted. That idea seems to be based in fact.

Adopted people of all ages, especially children, are disproportionately represented in clinical settings.

The majority of adoptions today are from foster care. Then add to those the children adopted from institutions abroad and you have a population who suffered early trauma, so of course they are disproportionately represented in clinical settings.

--Adam Pertman, National Center on Adoption and Permanency

When parents have biological children [who] are transgender, what happens is a blame game, like whose fault is it. I’ve heard many families say well, you know, 'My husband has two gay cousins' or 'my wife has a trans aunt.

Adoptive parents seem to let go of this fault piece.

--Olson-Kennedy

Adopted children who are aware of their adopted status also have an easier time being 'other' than their parents and therefore find greater ease in being forthcoming in expressing their true gender selves.

--Ehrensaft

As adoptive kids are becoming teenagers, they may more actively consider their gender identity in the context of their overall identity [than kids who aren’t adopted]. This might help them identify that they have a gender difference more frequently than kids that aren't adopted, that aren't going through as rigorous an identity formation thought process.

--Shumer

Identity in adoption is a complex issue, I mean it’s complex for everybody, but there’s a whole other layer for adopted people that sort of triggers, in many of them, a deeper look within themselves about identity and maybe this is part of what they find.

--Pertman

Hunter Keith is 17 and a trans male. He has his own theory.

I've been part of my family my whole life, I've never had that feeling of not belonging," he said. It's not something I ever questioned.

Here's one possibility Keith has discussed with friends: It's based on studies that show greater rates of autism and learning disorders among transgender kids than among the general population (another Shumer study). Could the kids be inheriting those conditions from their biological moms and could those conditions be one reason the mothers give their kids up for adoption?

There's this incidence then of children who are adopted who have a genetic history coming from families where there are learning issues, ADD, ADHD. It does seem that those things overlap and correspond in greater numbers [in the transgender population].

--Roz Keith, Hunter's mother

I think it’s a stretch, frankly. People, in trying to understand what transness is and how it manifests and why some of us are this way, will elicit all kinds of conjectures.

The speculation speaks to how little we actually know. There’s much more to be learned about transness, about gender, about gender identity development in all people.

--Jamison Green, WPATH

Green was himself adopted.

With so little research, it's not clear if or how these findings should affect care for children at transgender clinics. Shumer says it may help parents contemplating adoption to learn more about gender identity as a spectrum. Doctors, nurses and counselors may want to set up support groups for adopted children and make sure they understand the psychology of adoption.

It's the transgender piece that throws everyone off, but really it's his issues from being in a poor foster home for the first 15 months of his life that really make him struggle at school, struggle with anger. The trans piece is this little piece but it over-complicates what therapists see, what schools see, and they is fixate on it.

--Judy Tasker, adoptive mother of a transgender boy

Full disclosure: The assembler of this diary was not adopted, but also thinks coincidences are suspicious.