Given the absence of reliable predictor variables that differentiate between children whose gender dysphoria will desist versus those in whom it will persist into adolescence, child analysis, with its unique capacity to search beyond the manifest content of a patient's desire, potentially offers a venue from which to assess the developmental achievements that might impact a decision to support or question the utilization of puberty blockers to forestall the physical manifestations of gender. An examination of Ehrensaft's True Gender Self Therapy notes an inherent contradiction between her stated view of gender as “an aspect of self that can be altered over the course of a lifetime” and the notion of an unchanging gender self that only needs to be uncovered. The latter position veers toward an essentialist position that neglects the exploration of gender fantasies and defines gender in a manner that necessitates an environmental or medical response.