My discussion of Diane Ehrensaft's paper begins with some comments that extend her ideas. I suggest that the interaction of nature and nurture in the creation of gender begins before birth and perhaps even before conception. I argue that there are practical limits to the degree to which we can expect sociocultural forces to yield to Ehrensaft's call for a broadened narrative of gender. I then go on to pose some questions: Should children have complete autonomy regarding their bodily development, as Ehrensaft seems to suggest? Does such autonomy extend to areas beyond gender, such as issues of racial identity? And I close with some criticisms, chiefly that gender identity should not be conceptualized as something that is clearly or immutably defined in childhood, but as a component of one's self that constantly interacts with one's biology, psychology, and sociocultural milieu from conception until death. Child and adult psychoanalysts are only beginning to accumulate the data necessary to respond to Ehrensaft's challenging hypotheses.