We begin by imagining a world where children are separated by sex at birth and raised without exposure to traditional gender norms. We debate whether gender incongruence is a result of nature or social conditioning. We discuss gender affirming care for children, highlighting the complexity of diagnosing gender dysphoria amidst co-occurring psychiatric conditions and the potential influence of social contagion. Key insights include questioning the lack of robust evidence for the efficacy of puberty blockers and cross-sex hormones, and the need for comprehensive psychosocial care before considering medical transition. The Cass Review was released after we recorded our conversation, but we address similar concerns.