Many youth who come out in adolescence report not having a strong sense of gender during preschool, kindergarten, or elementary school. Young children are physically fairly gender neutral. If a six-year-old wears girls' cloths and grows long hair, she will be seen as a girl. If the same child cuts their hair and wears boys' people will assume he is a boy. Its only with secondary sex characteristics such as breast, facial hair, and a deeper voice that clothed bodies become more clearly male or female. As a result, gender may not have seemed particularly important for some trans children. It is the onset of puberty and the increased ways they are sexed/gendered in the world that typically precipitate the emergence of adolescent onset gender dysphoria. [page 90]