Did we want a living son or dead daughter?
It's a shocking question, but one which a Christian family in the heart of conservative America felt they faced.
When Jeff and Hillary Whittington were told that their first child would be a girl, they were thrilled. They excitedly decided on a name - Ryland - and painted the nursery pastel pink. Ryland was born in November 2007 and friends and family arrived with polka-dot booties, frilly beanie hats and bows for her hair. She was a healthy, happy baby, but when she was one year old, the Whittingtons received a devastating blow: Ryland was deaf.
"We were heartbroken," says Hillary, who was 25 when Ryland was born. "At that stage we really thought Ryland might never be able to talk or hear."
Jeff, a firefighter, took on a second job to pay for cochlear implants and speech therapy, and the hard work paid off as Ryland made good progress, and eventually moved out of a special-needs pre-school.
But soon after, they received another shock. Ryland's first words, after "Mama" and "Dada", were: "I'm a boy."
From the age of two, Ryland cried whenever she was dressed in feminine clothes and ignored dolls in favour of boys' toys.
When she was asked to draw herself at school, she depicted herself with boyish short hair.
Friends and family told Jeff and Hillary it was "just a phase", and Ryland was labelled a "tomboy".
"The trouble is, phases end," says Hillary. Ryland's discomfort about being a girl, however, only became stronger. She tearfully asked: "Why didn't God make me a boy?"
The turning point came when Ryland was five, and despondently said to her mother: "When the family dies, can I cut my hair so I can be a boy?"
Hillary Googled the word "transgender" and came across a horrifying statistic: 41pc of transgender Americans attempt suicide.
"This made things very clear to me," says Hillary. "Did I want a living son or a dead daughter? I wasn't going to take the risk by waiting around and doing nothing."
So Hillary and Jeff spoke to psychologists, psychiatrists and gender therapists, who all reached the same conclusion: Ryland is transgender. As Hillary describes it, "Although Ryland was born with the anatomy of a girl, her brain identifies with that of a boy."
That day, Hillary and Jeff - both churchgoing Christians who were raised in conservative families - made a vow: to bring up Ryland as a boy, without any strings attached.
They made a video about their journey, which attracted more than 7.5 million views on YouTube. A book called Raising Ryland is also coming out this month.
Today, I meet the family at their comfortable bungalow in San Diego, California. Both Hillary and Jeff are there to greet me, along with their impeccably polite little boy, Ryland, now eight, and his three-year-old sister, Brynley.
This is their first interview with a European newspaper and they're braced for criticism (something they have already had to contend with by the bucketload). In particular, they are concerned about the impact on Ryland: he is now old enough to Google himself, Hillary tells me with a shudder.
Much of the criticism to date arises from confusion about the term "transgender" itself, with people incorrectly assuming that Ryland has undergone an operation or started taking hormones.
But the label simply applies to a mismatch between a person's gender identity and their assigned sex, so Ryland's transition required nothing more invasive or irreversible than a haircut, a wardrobe change and a grammatical switch from female to male pronouns.
However, the criticism also comes in the form of personal, vicious and petty remarks: Jeff recalls one particular online commentator who blamed Ryland's "confusion'" on his "funny-looking dad".
Then there are the accusations that they are shamelessly capitalising on a little girl's "phase" or "confusion" to secure a lucrative Kardashian-style reality TV show. For the record, they have politely declined several offers of further publicity.
But the most wounding criticism is when people attack their parenting abilities. "The hardest thing for me to read is that we're liberal, agenda-pushing parents, or pushovers who'd let our kids do anything," says Jeff. "Our household has a lot of rules, the kids know they can't get away with whatever they want."
When the mother of one of Ryland's schoolmates gave Hillary a lecture that began: "God created Adam and Eve," Hillary's response was: "I don't have all the answers, but I have exhausted all of the resources, and this is my only option to save my child's life."
She points to the sobering statistics that at least four trans teens in the San Diego area took their own lives last year.
Jeff adds: "We deliberated over this more than anything else in our lives. It was a long and uphill battle."
In 2014, when it was clear that Ryland was on the brink of serious psychological trauma as a result of distress and shame about his gender, Hillary and Jeff sent a carefully worded letter to friends and family. In it, they announced that, in accordance with his wishes, Ryland would now be known as a boy.
They knew not everyone would understand their decision, but the response was overwhelmingly positive. Both sets of grandparents were immediately on board. Even Hillary's Mormon uncle wrote: "We are all God's children made in his image, and we'll love Ryland for who he is, unconditionally."
Those who muttered "he's awfully young to make such a big decision" were at odds with virtually every expert in the field. According to psychiatrists, children start strongly identifying as a particular gender between the ages of three and five - and the sooner a transgender child is accepted as such, the less shame they feel and the sooner they can adjust to a life comfortable in their own skin.
"There are huge benefits to doing this earlier in life," says Darlene Tando, a gender therapist who works with the family.
Hillary and Jeff are still amazed at the immediate effect of the transition on Ryland's behaviour and confidence. "He became happier and more confident overnight," says Jeff.
At six, Ryland spoke at the Harvey Milk Foundation's annual diversity breakfast. "My name is Ryland Michael Whittington," he read, from a self-penned script he steadfastly refused to let Hillary edit. "I'm a transgender kid. I am six. I am a cool kid. And I am the happiest I have ever been in my whole life."
He is still thriving, yet Hillary and Jeff predict challenging times ahead.
"One day soon, Ryland is going to come home from school in tears," says Jeff. "We don't know when, and we don't know what form it will take, but right now everyone has been so accepting - and we know that sadly this can't continue forever."
Hillary squirms as Jeff speaks. "I'm so nervous," she admits. "I just want to keep Ryland in our little bubble, to protect him from everything, but I know that I can't. I guess this is motherhood."
© The Daily Telegraph