In this article, the author examines Louise Erdrich's representation of Father Damien in "The Last Report on the Miracles at Little No Horse" in the context of mainstream attitudes about transgender identities and Native American gender systems. In this context, Erdrich's novel provides a theory and practice of gender identity formation that challenges mainstream concepts and the intolerance that rises from those concepts. Among other things, the author discusses the pan-Native American term, "Two Spirit," established by Native Americans. "Two Spirit" determines "the qualities that define a person's social role and spiritual gifts." According to Beverly Little Thunder (Standing Rock Lakota), "Two Spirit" is a term of honor that resists the Western "label of designated other." It also represents variant gender traditions that include third and fourth, and perhaps fifth and sixth, gender categories. (Contains 90 notes.)