So many red flags here. Note the references to church going. I assume this is a conservative religious family that imposes strict gender roles on their kids.

When Maddie was two years old, she loved nothing more than to parade around in the teacher’s high heel shoes at Sunday School. Maddie played with her older sister’s toys and dressed up in her clothes. At the playground, Maddie’s mother, Katie, watched her child run right past the boys for the huddle of little girls. All of Maddie’s friends were girls.

When I was Maddie's age, I never wore high heels. I hated dolls, and I wasn't fond of dresses. All my friends were boys.

“Why can’t I wear a dress to church like Grace?” she asked at age four.

This would have been the time to say "Sure, you can!" I wonder if 'Maddie' saw his female sibling getting preferential treatment and pathologized the idea of being a boy.

With her husband still skeptical, Katie found a therapist who evaluated Maddie and noted that the five-year-old never wavered in her beliefs. This wasn’t a phase.

It's always the mothers driving this, dammit. FFS 'this wasn't a phase'? The kid was five! Wait a year or five, maybe? You're nowhere near puberty.