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Basic Issues in Transgender Mental Health

This page contains a short outline of issues that arise for transgender individuals, particularly those effecting one’s emotional and psychological state.  I hope to expand on many of these in future posts (check the ‘categories’).

Gender Dysphoria – This is a fundamental unease and dissatisfaction with the biological sex one is born with which results in anxiety, depression, restlessness, and other symptoms.  The dysphoria often acts as a catalyst to change one’s body and gender expression (how one presents to the world) to be more in keeping with what is felt to be one’s gender identity (the gender that one feels oneself to be).

Problems associated with growing up with Gender Dysphoria – The main problem of growing up with gender Dysphoria, aside from the body dysphoria itself is the social predicament.  Essentially everyone expects the individual to be and act like a boy/girl, when they feel inside to be a girl/boy.


Early Childhood – Children get cues early on from parents about appropriate behavior, and internalize them.  For example MTF (male to female) transsexuals have reported getting the message from parents that it wasn’t ok for them to play dolls with their sisters or neighbors, and that they were expected to do “boy” things – like rough and tumble play.  Kids of this age start to get the idea that there is a part of themselves that must remain hidden.

Puberty – This is a particularly hard age, since the body begins to change and adapt gender specific features (breasts, changes in genitals, menses, etc..).  Transgender individuals have reported “I was disgusted by (hair, breasts…etc)”.   Many transgender individuals are aware of their issue by this age, but lack the means and agency to effect any change.  This has been changing in recent years where some transgender youth are more “out”, have supportive families and are able to access services.

In some cases medication is available to “delay” puberty until the individual is old enough to decide whether or not to transition.  This has the benefit of essentially avoiding the trauma of experiencing the physical effects of puberty in the unwanted gender.


Early Adulthood – With emotional and financial independence some people feel free to begin to address transgender issues at this age and look into transitioning.  However, some are not as free to do so, due to family and other obligations, or due to lack of information and access to services.

Later Adulthood – Some transgender individuals put off transitioning until later in life when they feel able to do so.  This can be satisfying, but can also have the disadvantage of  producing a less convincing outcome.   In addition there can be regret about having lived so long in an unwanted gender.  Friends and family may have a harder time understanding what is happening since they knew the person for so long in their natal gender.

In all stages – There can be isolation, hiding and secrets, which can lead to depression and anxiety.  Transgender adults are much more likely to have suicidal thoughts, with 50% of adults reporting some suicidal ideation.  There seem to be two paths that people take early on: either one tries to hide their inner feeling of being the wrong sex and “passes” for what looks like a boy or girl, or one is incapable of hiding and presents as either a tom-boyish girl or a feminine boy.  Either path is fraught with problems for one’s emotional development.  The second scenario – of presenting as gender non-conforming is known to elicit harsh responses from society.  This is true for non-transgender people as well and many gay men and women experience this early on.


Deciding what to do – This is a big part of the transgender Individuals experience.  Making decisions about transitioning, what level to transition to, or whether to attempt any transition at all are complicated decisions and require time and support.  There are fears of how one will be accepted by family (parents, partners, children, grandparents and others), friends, colleges, fellow students, church groups, etc..  There can be anxiety about ‘passing’ or how convincing one will be to others as a man or woman (i.e. whether or not one will be “read” as transgender).

There can also be the wish to not completely transition, but assume an identity as “gender queer” or “third sex”.  All are perfectly acceptable options.  Usually one doesn’t start at that place, so this requires some form of transitioning as well.   At the point of decision making, many things are unknown and it can be very stressful.  It can also be exciting and joyful to be able to act and move towards a more authentic self.

Transitioning – For those transgender individuals who decide to transition (to present and live in the other sex outwardly), these emotional/psychological issues may come up:

  • Fears about finding a partner
  • Impact on family relationships with parents, children, partners and other relatives
  • Impact of relationships at work and with friends.
  • Fears about violence and prejudice when one is read as transgender.
  • Feelings about having to experience surgeries, hormones, (and for MTF transsexuals) facial hair removal and voice changes.
  • Frustration of having to change or explain legal documents (drivers license, passport, titles to property, diplomas, etc)

Post transition issues – Some issues that may arise include:

  • Disappointment that transitioning didn’t solve all problems.
  • Level of satisfaction with appearance
  • Level of satisfaction with any surgeries
  • Emotional issues that were not addressed before.


When one decides not to transition. Not everyone is able or wants to transition. This is a perfectly valid choice for people to make.  However these individuals must learn to cope with the tension that the gender dysphoria produces.  Sometimes this can be helped by having times when one can cross-dress, interact with others who are aware of one’s status, talk about the issue, and take low-levels of hormones (that don’t effect the body outwardly).

Other mental health issues not related to being transgender. Just because some one is transgender doesn’t mean they don’t have other issues in their lives.  It can be hard for some people to let themselves seek treatment for other issues when the gender dysphoria is so prominent a concern.

The good news: It’s important not to lose sight of the  satisfaction one can have by acknowledging and (if possible) changing what can be changed and moving towards of one’s authentic self

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.

77 Comments Post a comment
  1. Thank you for your insight into transgender issues, as I finish a post about this topic.

    April 30, 2014
  2. Isle #

    great info. thank you for the insight

    May 26, 2014
  3. A comprehensive understanding of the many issues facing TG individuals prior to, during Transition, and Post-Op.

    Helen Beck Transgender Awareness Trainer/Adviser/Mentor, United Kingdom

    October 20, 2014
    • Jeniffer #

      Can you offer any reading on the effect of HRT therapy in older men transitioning

      September 7, 2015
      • Andrea #

        Hi Jeniffer,
        I am an older M2F transexual. I have taken anti-androgen, estrogen and projesterone for about 12 years. I get specialist medical support from my doctor, a psychiatrist and endocrinologist. I have a satisfying level of transition on hormones only plus a more recent orchidectomy which has reduced my need for antiandrogens! I did fly solo and stealth for a few years but the deception became intolerable. I now have B bra cups, wider hips, rounder face, less hair loss on my head and fine hairs on my body. My skin is smooth and soft.
        I am happy as I go but obviously want more but too old for surgery.
        Hope that helps!

        July 24, 2016
      • Rowena #

        One is never too old for surgery. I had my GRS at 73 having started to transisiton at 68.

        May 29, 2018
  4. Hadijah n #

    Thank you for your insight into transgender issues, the world needs this information to create a free society free from human isolation and abuse.

    November 20, 2014
  5. very informative and helpful writing on transgender. I have experienced my life of feeling different as early as age 3. I am transitioning later in life. I am a male to female transgender who struggles with suicidal thoughts and bouts with insomnia every day. I have a family and a son who needs me but I struggle every day with my transgender situation. it is a very difficult life. thank you for this well written article. emily

    November 24, 2014
  6. Carol #

    I also thank you. For every thansgender that we see there must be a thousand of us hiding. We’re your plumbers, mechanics, big 6’4″ guys with the beards, We’ve been hiding most of us since we were only 3 or 4 years old. We’re masters of the disguise to the point that it clouds our reality. As for me I’m what appears to be a masculine home renovations contractor. I live my life primarily in male mode but in the past 2 years I’ve come out to everyone that I am close to including family,siblings and children. I’ve even taken on the practice of coming out to my clients and today 70% of my clientele know the real me. My biggest problem has always been an honesty issue and hiding or mascarading is just not honest. Still have so much to deal with but at least I’m being honest and forthcoming to the people who care for me. Oh yea! Thus far there hasn’t been 1 negative reaction and I’ve received nothing but support even from the ones that I feared the most.
    Best reaction was when my cousin exclaimed “Finally!” I finally understand you now.

    December 3, 2014
    • Lana #

      This is so encouraging, Carol! I’m 30, and feminine even by the average male standards. I am so distraught – living in Asia, Catholic, with a conservative family, social and work context – I feel suffocated at the realization that I am in fact transgender. I wish I’d never realized this.

      Now I see the light, and it seems a cruel joke. Something I can desire with all my heart but only at great personal sacrifice, and at much trauma to others. I’d always known I’d liked boys, but the lack of awareness – of groups and fora as this, even the internet came to me late – always made me classify myself as gay. That didn’t quite sit right. And now that I know :) I suppose self-realization helps.

      I am SO happy for your transitioning, and the immense support and encouragement you receive from your family, friends and colleagues! As someone who quite possibly sees life as a study in solitude, I wish you ALL the very best! You deserve it! : )


      January 6, 2015
      • Andrea #

        Hi Lana,
        It is a difficult journey however it is one from the shadows into the light. It is a journey which is entirely your own. Nobody can tell you how far or how fast you should travel. Remember this is not primarily about our bodies but our ‘essence’. Society just makes it difficult because binary notions about gender are so pervasive. It was my fear and shame which kept me in long term stealth. Now, having come out to family and friends, I just have regret that it took me so long to be honest about myself. I have also been able to get the help I need from medical professionals.
        When I was a child my father and other family mrmbers all thought I should be toughened up with disastrous consequences. When I ultimately came out most folk who knew me and loved me were very accepting. Some don’t quite know where to ‘place’ me. As a believing Christian, most of my problems have been my own self-rejection although I must say, my biggest problem has been therapists who wanted to fix me. The consequences were guilt, shame, depression and when younger with a number of suicide attempts.

        What I can say have joined the conversation, that in itself is an act of bravery.

        Be strong and give yourself a big hug,


        July 26, 2016
    • Hi Carol, thanks for this. I am personally so proud of you! It totally conforms to my own experience. I tried to stay ‘hidden’ for decades because the only experience my feminine self had received was condemnation, misunderstanding and serious bullying/sexual abuse (at all ages) most especially from my father who wanted me to ‘man up’. I was a stealth female. I used every trick I could to obtain hormones. Now I realise how dangerous self-medication is and fortunatly now have proper monitoring by an endocrinologist and my doctor. The guilt mounted in me to a crescendo which had to be resolved. When I came out my wife, children, family and friends most of them ostensibly accepted me but never my really deep need to transition. I had been a little too sucessful as a male ‘actor’ and even today my transgender issues are the ‘elephant in the room’. It is really like there has been a death in the family which nobody wants to talk about. My real feminine self has to be totally hidden from my grandchildren on orders from my children. My real self is really so alone and isolated. I am so utterly depressed, I want to move on but I fear being rejected all over again.

      July 23, 2016
    • Andrea #

      Carol, just to thank you for sharing. We are both late starters and on similar journeys. As people who were forced to be in stealth mode we have our own story. Thanks again!

      July 27, 2016
  7. dss68 #

    Hello,Im a straight female,desperately in love with a transgender and the information you’ve provided was informative and if more people would be this informative i think we would live in a more accepting world.

    May 19, 2015
    • Stephen boylan in my boy name I like Stephanie #

      I hear you on that one I’m transgender my mind is girl but I have a boys body I hate it I wish I had the courage two changed when I was in elementary school now if I did read a lot harder since now I’m 25 I’ve always been an outcast shy kept to myself a lot even with my friends even with my friend and I have all the signs I wish travel to the girls section in every store and I’ve been depressed for a long time I hasn’t buyed guy outfits as long as I can remember. Thank you for being so supportive I’m transgender it’s a very hard thing to deal with people have no clue

      August 3, 2015
    • Cheryl #

      please email me at I liked what you wrote,I am a Female and wanting to transformed to male…my name is Cheryl

      August 6, 2015
    • Corey #

      I wish you would talk to my wife about how you deal with having a trans husband. She is accepting to a piint9we are now which is basically crossdress/trans mentally. We have talked about the transition and thats the part we are having a time seeing eye to eye on. More of she wants me to do whats right for me but she also thinks that her and the kids are holding me back from it. Yes they are holding me back but not in such a way as she thinks. Its a good thing. Instead of just jumping into it and transitioning I’m doing research and weighing in all the options and consequences that will happen. She just needs some support and there isn’t a lot of support for spouses when it comes when it comes to this.

      August 15, 2016
  8. Very useful information about transgender persons which removes ill-formed opinions about. them

    July 5, 2015
  9. Helo my dear thankq for this short and sweet summarry about Transgenderand thier mentall health iam having some doubt TG…. CAN U EXPLAIN???

    August 4, 2015
  10. TSis #

    Hi, I have a question. I found out that my cousin might be transgender. He seems to trust me enough to add me on his gaming social network and up until now I sort of had suspicions that he was feeling that way but after reading his profile and his posts I am now concerned. I don’t know how much of what he says is true or not but he mentions he’s depressed and that he is also asexual. I can feel he’s afraid his family from his mom’s side might not me as tolerant as his dad’s (my uncle) side. I know there’s a lot of ignorance and I myself don’t know how to deal with the situation. I’m by no means going to out him to the family but I want to make sure he’s going to be fine in the future and armed with the tools to take the best decisions for himself.

    December 28, 2015
    • Just love and accept him/her and let open discussion follow. Look beyond the facade he/she shows you and accept the real sould trapped inside.

      July 23, 2016
  11. Tanya #

    I have a young family member who is gender dysphoria who is given a lot of support from his mother and brothers, born female and is now living as a boy and changed his name and came out at school. He has suffered from some bullying at school from a few of his peers but most seem to have accepted him now. However I am concerned as his behaviour towards his mother , who has given him the most support, has been terrible and he has attacked one of his brothers and hurt their family pet. His mother makes excuses for his behaviour but to be honest I am frightened that he may actually seriously physically harm someone. I just wondered if any adult transgender people went through a stage of disruptive behaviour and physically attacking the people who loved and supported them, is this just a phase or should we be concerned and seek professional help? Thank you

    March 31, 2016
    • Zazzirah Kohan #

      I would seek professional help as soon as possible. If he’s on testosterone it could have something to do with the destructive behavior. I’m trans but was born with excess testosterone, I’m female with a male body and my emotions and stress at one time went out of control and my dad had to withold me so I wouldn’t hurt anyone. My trans therapist said that since my brain is hormonally female and I have a lot if testosterone it could be a dangerous thing since females are more emotional. If he’s not on testosterone then it’s spiritual and he needs spiritual counseling.

      June 20, 2016
  12. Raven. #

    Always seek help when it comes to gender dysphoria. Never take it for granted. What we go through as children is brutal. We need help with sorting out our thoughts and feelings. Understanding why we behave the way we do. At such a young age it is so crucial. Our brains and bodies are changing. We are beginning the stages of the rest of our life.

    Never take any act of violence for granted from any child. Never think it will just go away. It is an act of frustration or inner conflict. Seek professional help.

    This does not mean your child is bad or the gender dysphoria is wrong. It just means they are struggling and need to get the right help. Such help can be beneficial to every one. Family can learn what the motivating factors are behind the aggression. Know how to deal with it.

    Psychiatric medications are not always the answer. However, they can help. But be mindful they should never be used to fix a problem. Just help with symptoms.

    If medications are suggested, they should only be considered a temporary means to help with treatment. I think over the long period they could cause more problems than good.

    Proper therapy and support along with a good support network, is helpful, Never expect a fix over night. This is a complex human being with a major conflict in their mind and body. This doesn’t sort itself out right away. It takes time and lots of hard work. Your child is really smart. More than you may know. Think about that. What if you could not relate to the world?

    Some how your child will find a way. They just need to know they are loved, even when they are angry or frustrated with their body. After all how would you feel if you were born into a prison?

    I am trans. I am gender dysphoric. I will always be this way. I had no support as a child. I grew up with alcoholics. I was raped and abused. I am still here! Your child has his family! He has way more support than I did! I envy him for having support. I think that you reached out here is wonderful and reflects your qualities as a parent. Good job!

    April 5, 2016
    • Hi Raven, thanks so very much for this. Your experience so aligns with my own. I had a hectic childhood, abused, miserable and lonely. My father and family wanted me to ‘man up’ and did everything they could including sending me to an all male boarding school, forced me into the army. I was seriously abused by my elder brother. I attempted suicide a few times. I was more than scared to come out, I was terrified. When I did muster the courage my wife, family and friends did their best to accept me but honestly the conversation just died then. Now I transition but only with support from my doctor, psychiatrist and endocrinologist. The emotional scars of my childhood still haunt me and make me so frightened of abuse. When I was young there was no understanding or acceptance of transgender people but happily it is coming out in the open now.

      July 23, 2016
  13. Chris #

    I liked how you described the current issues with transgendered people. I have this issue and was born in 1969. I would like to see more information about the emotional effects of those who did not benefit from the awareness and treatments trans people have today. I am transitioning now but wonder what long term emotional issues may stem from the lack of information and treatments when I was struggling as a child/teen.

    April 21, 2016
  14. Juliet #

    Dear ones with our gender difficulties. This seems more like an opinion than a reply. I hope my position has not hurt anyone’s feelings.
    We may consider this from both ends of one’s evolution.
    Gender identity dysphoria results in so many individuals that have no common physical abuse or common verbal abuse and no common family disfunction yet they relate same extremely strong gender feelings. So we may evaluate the condition ( 1 out of every 100 individuals) where the environment in which we all begin our lives has absoltely no impact in our gender preference. A small number of exceptions may occur which turn out to be not to be Gender identity dysphoria.
    From a more scientific position we find many items. We find many items that are specific to our primitive portion of our brain located at the base of our skull. Some (not all) of these are: breathing, sexual orientation, initial response to external stimuli (One’s fear, fright, danger,threats, and safety), and gender identify.
    I would like to list two issues here: First in comparing the brain of a transgender MTF with a female’s brain. Many physical simiarities exist here between the female brain and the brain of the MTF transgender person. But these similarities are not similar when a female’s brain is compared to a gay man or heterosexual male. Second the development of this portion of the brain is asynchhronous with conception and occurring four to six weeks after conception. With no known dependance upon one another there indicates a high probability a possible different outcome.
    Gender identity dysphoria is certainly becoming more thoroughly understood with the most recent opinions point more and more to a purely biological influence.
    Gender identity is permanant. It is who we are. From my perspective your only choice is what you do with it.

    April 25, 2016
  15. Alicia Remauro #

    Im 52 year old male trapped in this dreaded body and having serious depression issues right now,Dont know what to do and the feeling of transitioning right now is stronger then ever was ,confused ,depressed,anxiety Im lost right now the thought for some reason does not leave my brain Help

    May 5, 2016
  16. Jerry #

    I understand your pain my friend. I am 64 years old and have carried this secret all my life until last fall. I find myself now, alone, divorced, afraid to go out in public dressed, in therapy and not much interest in anything. What I am learning over and over is that sometimes honesty is not always the best policy.

    May 6, 2016
    • Andrea #

      Dear Alicia and Jerry,

      I want you to know that there are thousands who understand and many others who try to understand. Just remind yourself that the battle to be true to who we are is really the only fight worth fighting. The other is to be able to share our love, care and freedom with the world around us. We have a great struggle with self-acceptance but it gives us the capacity to understand people who are non-conforming or social outcasts.

      Remind yourself also, again and again, that you are your essence even if it does not align with your body. You are that person you wish to be already – in your heart.

      For me the choice to end my dishonest (and manipulative) life meant I could get the help I needed most especially from medical people who had the capacity to understand and give me the therapy, hormones etc I sorely needed.

      I now try to stick with those who have or can achieve understanding. Others I quietly avoid.

      With love,

      July 26, 2016
  17. powerking14 #

    I am 15. I am A boy. when i was little i would play with dolls. My parents would say that i am not a girl. and that boys don’t play with dolls. I have always wanted to be a girl when i was in elementary school. but i just don’t know if i want to be a penitently a girl. I don’t know what my family to treat me different because i decide to be a girl. I don’t want to have to hide from what i want to be.

    Please help me!!

    Please email me to help me make my choice

    May 14, 2016
    • Andrea #

      Hi Poworking..(your handle I guess.)
      You are right to be hesitant to decide at 15. There are big decisions with so many issues to consider. My advice would be, if at all possible, get some professional help. Letting people have your email could get you into some trouble with someone who could be ignorant or bad. You could just say you are depressed and need to have some counselling. Just take it one step at a time.
      Playing with dolls and wanting to be a girl does not mean you are necessarily transgender but it could be that you are. In any event, in most countries, you do need to have counselling and come out (to a certain extent) to start on the quite long road to your real gender. My view is you should not leave it for too long as what can be done is, in the meantime, you are given anti-androgens to slow your development down a bit.
      Try not to get anxious or depressed, your life journey can be really happy even if it is challenging. More than anything give yourself lots of hugs!

      July 27, 2016
  18. Felix #

    1. Has anyone ever connected the transgender idea to elements of autism? I am looking into connections specifically in the newer area of “female autism” as it relates to disparity between mental and emotional/physical development. Any lead is helpful…
    2. Also, it seems that the conversation of “transgender” has replaced the idea of gender liberty by forming another category to assign. The blending of personal identity into an antidote for implied social norms and queues serves to confuse an origin of non-conformance to birth gender norms with an escape clause (transgender labeling). It is a curious abdication of the gender discussion. Why not instead return to the individual a need to conform to their birth gender so that within existing genders (male and female) they provide an updated narrative to what the social norm should be? In other words, the transgender community seems to be like the pilgrims escaping religious persecution on the Mayflower wanting to have freedom when the actual mechanics result in establishing another colony attached yet apart from society. The label of “transgender” doesn’t solve the issue of acceptance just as the transformation option doesn’t make all the changes expected nor remove all the elements of the Gender Dysphoria. That is not to say there is no “transgender” dissatisfaction… that is not my point. The point is the response to the tension internally in each person is still to choose between being boy or girl. Why not remain within the birth gender and remove social norms rather than adopting the narrative of the opposite gender and participate in reinforcing the social norms that opposite birth gender folks find so abhorrent? To clarify: a boy wanting to be a girl adopts the societal norms for how he perceives girls portrayed. A girl wanting to be a boy does the same inside of male norms. Each participate in social norms that they reject for themselves yet turn around and celebrate each other as “transgender”, escaping the social norms they started with only to reinforce the social norms that the other found so limiting and oppressive. Nothing changes for others who feel “trapped” by their birth gender so the issues remain and continue. Gender liberty ( defined as freedom from societal gender constructs) is not gained. Instead, “transgender” labeling serves as a way for society to allow for people who have identified a problem within themselves, placing them into a holding pattern until they decide to participate as a girl or boy within society. The “acceptance” from people serves as an acknowledgment that the “transgender” person is making a choice to be either girl or boy. My confusion about the whole conversation comes back to determining that the individual, rejecting their birth gender with all of the associated expectations, training and social queues, should be the one to choose to be the opposite gender. The choice itself is only informed by observation not experience. Transformation becomes a test of the assumption that transforming to the opposite gender is a solution and we leave it to the individual to “know”. Surgeries, hormone supplements and chemical alterations through medications have lasting consequences. Isn’t the issue more about how we understand the scope of each gender to be rather than assuming that falling outside those boundaries means falling into the boundaries of the opposite gender?

    May 17, 2016
    • Hi Felix, anybody who has gender disporia will try to relate to what you are saying here and almost every individual would probably wish for a different life but I do honestly regret that as a transgendered person an intellectual debate on how society could help us and how constructive that would be is so far from being practical it is not true.

      Being transgendered is really not an external social reality it is a broken internal reality in which the person sees their physical body as non-aligned to their own identity. It is a rift in the mind/body connection. My personal experience, after hours and hours of very expensive psychotherapy, fasting, prayer and even spiritual deliverancesessions is that these interventions only increase our inner turmoil and can also be positively dangerous resulting in chronic depression and suicide.

      I can see you are trying to be helpful but I cannot believe you are transgendered or you would not propose that this really has to do with acceptance by society. No doubt it would really help if we were accepted by those dearest to us and possibly also by society. The reality is we need to find self-acceptance and often make some really difficult decisions on the extent to which we will transition.

      July 23, 2016
      • Felix #

        Andy, you are correct, I am not TG. However, I do have relatives who declare so the conversation is very personal. Hopefully not identifying as TG doesn’t disqualify me from a continued discussion. It is helpful to have the dialogue.

        In response to your comments: thank you. Having this discussion is not intended to change anyone. Rather, the importance of diverse points of view is to clarify bias, challenge assumptions and provide a means to dig into the questions that remain silent otherwise.

        Here is my response to the points in your reply:
        I understand your point about the difference between an external and internal reality. My post was a starting point in that discussing the external struggle vis-à-vis social acceptance serves to relieve, at least in part, the internal burden. So they are not exclusive. The reported experience, as I continue to read stories of TG declaration, suggests that those who have a support network have an easier time with their own acceptance. Again, the external experience impacts the internal so including discussion of social acceptance is important for the internal conflict although it is not the only factor of the struggle to accept the self. Within this context my question remains: how does adopting a male to female or female to male change, switching gender physically, serve to relieve the internal struggle when the adoption of an observed other gender (not an experienced one as those who live out their gender from birth) is not fully informed? Committed action such as surgery and hormone supplement, where someone commits to physical changes, have consequences potentially adding to the internal struggle. The need to physically change seems driven by the need to participate within an understanding of the other gender that is observed not experienced. Without the experience of being the other gender, how does someone who is one gender physically know when they have fully transitioned unless there is a baseline to measure it against? Not all TG want to change their sex organs so a physical change that is not based on an anatomical measure suggests there is no baseline apart from common observed differences between the genders in both perceived norms physical attributes. Binding for instance doesn’t remove breast tissue, it disguises it to look like male pectoral muscles, changing social perception not gender. Yet some men have “man boobs” within the spectrum of male body types so flattening the chest suggests a desire to participate inside a narrower definition of a male body type. Without making all the changes to ones body that are possible there seems to be a spectrum along which a transitioning person finds their place to be rather than simply becoming either a man or a woman. Instead of participating on this spectrum of perceived gender differences, why not fall into the spectrum of each gender, expanding what it means to be male and female rather than transitioning between them? Pursuing a physical (external) change as a means to accept an internal identity suggests that the physical change is about claiming an identity of “transgender” as a new identity never fully participating in being either male or female even though it is a declared preference to claim “male” or “female” as the new identity based on how an individually perceives themselves internally.

        The journey of self-acceptance is not an LGBT journey, it is a human one. There is tension for boys becoming men, girls becoming women and adults with aging over time and the changes for each individual internally in each of these transitions. We are all in a process of acceptance between how we want to be perceived and our reality physically. Age removes youth and youth is celebrated in our culture. Wrinkles and gray hair are earned and valuable as signs of wisdom and experience but the cosmetics industry sells a “cure” for them. A cure is not needed when we expand acceptance for people as they are instead of trying to change them.

        It is curious that the TG community posits change as the remedy for an identity struggle when acceptance is the goal. There is no one change that a person reporting TG can make to conclude their Dysphoria. Rather the landscape of solutions for TG identity is an offering of ongoing changes to commit to. It continues until the individual becomes satisfied or else remains in pursuit of a satisfying outcome that may or may not present itself and seems only available when the individual decides to stop on the spectrum of change. Might a solution regarding self-acceptance be found in acceptance of physical birth gender that is also relieved of the burden to participate in gender norms observed by the individual and expressed in society? We are all finding our own way and those who find their voice in the TG construct may, through an acceptance of themselves as they are physically, emotionally, and mentally, lend that voice to the broader discussion regarding how we understand femininity and masculinity.

        I understand that these ideas are not going to be popular within this forum. As folks who celebrate acts of courage it is my hope that the discussion can be embraced as both a courageous presentation and a means to expand understanding as we share ideas.

        July 26, 2016
    • Roxie R. #

      Felix, imagine if one morning you awoke to find your right leg was starting to grow these little irritated plates. You don’t know what they are but as time goes by more and more of them start appearing on your body. Soon you are covered in these dark, chitinous scales and when you look into a mirror the face that looks back at you is horrible and Alien, a disgusting perversion of the person you knew you were before all these scales starting appearing on you and changing your appearance. Somehwere, under all those scales you know Felix is still in there, but your body is being morphed into something even you can’t recognize as yourself.

      That’s how dysphoria feels, and it has absolutely jack shit to do with how other people treat me. Does it intersect with that? Yes, of course it does, but correlation is not causation. If I was alone on an Island, I would still be disturbed and offput by my own psychical appearance. For a very long time, I tried to accept my body as it is, but as I got older my appearance moved further and further away from what I can even recognize as myself. I.E, the scales are spreading and I know how to stop them from forming, so why wouldn’t I?

      Nobody told me to feel that way. It’s how I feel. You can tell me I don’t feel that way, but like, you’re wrong so. Have a nice day.

      July 8, 2018
  19. Zazzirah Kohan #

    Informative, thank you.

    June 20, 2016
  20. I’m unclear. This article seems to indicate that psychological pathology leads one to “transition” but the transition does not resolve the mental pathology? Isn’t this just harming a healthy body as a futile “treatment” for an unhealthy mind?

    July 1, 2016
    • Andrea #

      Hi Tengu,
      Why are you making the assumption that gender variance is a pathology? Is being gay also a mental pathology?
      We have moved far beyond believing that.

      July 23, 2016
      • Whether psychiatrists remove gender dysphoria from the pathology listing or nor, isn’t gender dysphoria associated with ; high tastes of suicide, depression, and other mental malaise? My question is this, does any sound study show improved mental outcomes from transition surgery? For instance, does transition surgery reduce the high incidence of suicide?

        August 13, 2016
      • ‘transition surgery’ is not the same thing as a social transition. I reference 2 studies here (scroll down to the bottom of the page).

        There are new studies, which i’ll put up in a post – hopefully soon.

        August 14, 2016
  21. Andrea #

    Hi, I really appreciated the blog and almost all of the postings. This is a well moderated blog. There are just a couple of postings which attempt to pose questions which imply that being transgender is a choice and that a more accepting society may overcome the need for transition. The intention may be helpful but, as a M2F trans person I can say the questions show a lack of understanding for a person born in the wrong body. The process of being reconciled with oneself, coming out and transitioning (if those choices are made) is really very difficult. Social acceptance and support do help but they don’t resolve the very painfull dissonance we ourselves must resolve.

    July 23, 2016
    • I’m not sure if you are talking about the posts or the comments.

      I do leave a very few of the more challenging (poorly informed) and perhaps hurtful comments through because I think its important for people to see the comment and more informed answers. See this thread on my facebook professional page: under the post about ‘The Psychology of Stigma…’
      as an example.
      There’s so much lack of knowledge and misconceptions out there, that I think it does educate and inform to see a dialogue. I’d be interested in your thoughts on this.

      I don’t think I imply in any of the articles that being Transgender is a choice, however, there is a lot of choice now in options of what to do and there are people, who for various reasons choose not to do a social transition. I’m against judging anyone for this or any choice, everyone’s situation is different.

      July 23, 2016
      • Andrea #

        Hi Ami,

        I so totally agree that all of the choices are our own as well as the implications (positive, neutral or negative) of those choices. In any event personally I was victimised and profoundly (beyond description here) abused as a child and young person as being too gentle, girly and unassertive. I was a perfect target for severe bullying (and worse). I had tried to talk to my parents and others but was ‘shut down’ immediately even though I had attempted suicide twice before i was 13. For me coming out was loaded with terror and shame but the deception (which becomes so pervasive) just had to end.

        What I was trying to say, in my own way, was that being transgendered was never a choice for me but an ever increasing pressure within me which had to explode and ultimately be resolved. The relief, even with the difficulties and rejection by some, (very few actually) was huge.

        Nowadays, I find fullfillment in expressing and living out just as much femininity as I like and being available to help others who are considering transition or more often parents who have concerns about their children.

        My desire is to try to make sure nobody (especially an innocent child) has to go through so much anguish and pain as I did.
        I am also very concious of how dangerous it is to get the wrong advise or ill informed therapy and/or ministry which serves to prolong the agony and compound the shame.

        I always have to skirt around my story because I am still struggling to see or recount it positively and in a way which will be readable.

        Thanks again for the opportunity to express my views.

        July 26, 2016
  22. Andrea #

    Hi Ami, I went to your website and I must say it was refreshing.
    I guess you are right, if views are expressed we, as trangender folk should reply. I did do so without undue emotion and do hope it helped.
    Somehow many people don’t appreciate that we do not have an easy time sorting through our own issues, fears, hurts, guilt and shame let alone negotiating our way through affected relationships and the society around us. I guess we should all find our voice!

    July 23, 2016
  23. Andrea #

    Hi Ami, just to say I have read and been touched by many of your writings. I have faced years of profound rejection from childhood. My suicide attempts started at puberty and continued intermittently. I lived in stealth mode for decades until the lies dishonesty, self-harming, illegal hormone use and conflict became far too overwhelming. I am a M2F transexual but only attracted to woman. I have a wife, family and friends who do try to be understanding. My trans issues are often like the elephant in the room, barely talked about.
    I am confirmed in my gender status but I do live with deep regrets that I was not courageous enough to come out a lot sooner. My Christian faith was but no longer is an obstacle thanks to new thinkers who have helped.

    Anyway thanks again, be blessed,


    July 23, 2016
  24. Andrea #

    Hi Felix, given that being transgendered, gay or different in some other way, was optional a lot of your thoughts would be valid. Where we agree would be that each individual must ultimately make their own decisions based on what they want. These are often involve really practical, relationship and financial concerns as well as the very real risks involved or results which can be achieved which differ greatly. The whole world is almost structured around the gender binary so, while it would be nice to have a continuum, the reality is that for a transgendered person it is not the way it works or how the identity has been shaped. I must go to sleep now but will write tomorrow.

    I want to also try to help you get inside a transgendered persons skin but in another post. Be happy, be kind, be free but most importantly be authentic/yourself! Good night..

    July 26, 2016
  25. Andrea #

    Hi Felix,
    I woke to consider what I could communicate to you on a public forum. So, rather than being graphic I will be abstract and let you read between the lines.
    From the age of 3 onwards I wanted to wear girls clothes, play with dolls and only be with girl. My father was so alarmed that from then onwards I was rejected, forced to stop playing with dolls etc. He even enlisted my elder brother, my mother and to a lesser extent my sister in a scheme to ‘man’ me up. I am sure he cared but when the bullying and abuse(very severe) started he always blamed me and told me I had to fight. I did not want to fight!! I lost myself at home spending even more time with my mother and sister and avoiding him.
    I have clear memories back to 3 yrs old but in an attempt to find out what was ‘wrong’ with me, I have uncovered the fact that my mother took a synthetic estrogen – stilbestrol during her pregnancy in order to avoid the loss of her child. Personally I hate the thought I was a product of an error!
    To show you my father’s desperation, he even resorted to blocking my way to take up a RADA busary to study drama and enlisted me in the army all behind my back!
    The non-accepting environment and my own fear, shame and deep desires remained but at the onset of puberty I reached a crisis point and a number of suicide attempts followed. I was at an all boys boarding school and the consequence was a redoubled effort to ‘man’ me up.
    My essential being went into hiding and I was walking around in a shell which I detested. From then on I was stealth for about 45 years. I lied and deceived to get hormones, cut myself, wore woman’s underwear, dressed up in private. I sneeked into woman’s rest rooms.
    Please note I am heterosexual (you could say lesbian) as I am only attracted to women. In my confusion I had a couple of physical/sexual encounters mainly because some me thought I was gay and I was confused!
    Anyway only a few years ago a few events helped to break the shell:
    I put myself into a mental hospital as I was teetering on the brink of suicide.
    I experienced an encounter/sensitivity training course with my staff who spoke catagorically about my feminine nature.
    I became infatuated with a woman who indicated she loved my feminine part.
    I received psychotherapy from the first person who validated my essential being.
    I came out as transgender to all of my family and almost all of my friends.
    From then on I got all the help (physical and mental) I had needed all those decades! I was happy for the 1st time in my life and all the stealth and self-abuse stopped dead.
    How far will I go to achieve congruity…a long way! Probably not all the way because testerone has poisoned my body and at my age complex surgery is risky and expensive.
    In terms of what you have written, where we agree is in the need for greater society acceptance of gender diversity (all fundamental diversity actually!). I do believe the current climate may cause people who have other problems or are unhappy with themselves to consider the are transgender. That would be a dangerous and expensive mustake! Where we differ is that somehow gender disporia can be resolved by accepting gender as this continuum you mention. For children, parents, friends and most importantly, for a real transgender person, male or female, this will exacerbate the problem as the potential to help the person become who they are will be subverted.
    I know your thoughts and opinions arise from some genuine, inclusive and compassionate concerns. They are real but in the wrong hands they are dangerous. Take it from someone who family, psychologists, clergy and so many others has attempted to ‘fix’. I was never broken, I was not mentally ill or rebellious, I was just trying to find my way!
    Take care, be happy and be blessed!

    July 27, 2016
  26. Andrea #

    Hi Tengu,
    I believe issues need to be carefully separated. All transgendered folk suffer from depression and may, attempt or commit suicide at some time. In my case I attempted twice in my puberty period. We are also subjected to a lot of bullying, abuse and social rejection. This is also a common factor in most instances of drug and alcohol addiction(in general). Surgical procedures and hormonal interventions only help reduce dysphoria they never eliminate it. We transgendered have the burden that we can never actually be changed to the extent we would like.
    There is no evidence to support lower or higher rates of suicide for those who have transitioned.
    Where you are right is in stating that rates of suicide are higher for transgendered folk. Where you are wrong is when you try to dismantle the problem by linking it to attempts to transition which have greatly varied success rates anyway.
    Personally, while I reject the idea that social acceptance will be a solution, I completely endorse the idea that it would be great! It would be even greater if violence directed against transgender (and gay) folk was to be confronted.
    Telling gender variant that they must just live with it or even worse that it can be cured is both unsympathetic and dangerous. Helping individuals on whatever journey they are on is commendable. That requires courage from everybody. Let me state quite forcefully that transgendered folk who accept and deal with their issues while helping others to understand is supremely courageous. We transgendered folk are some of the bravest people alive!

    August 14, 2016
  27. Andrea #

    Hi Ami,
    I am looking forward to your reference material!
    The problem, as I see it, is the preoccupation not only with gender as binary and not as a spectrum. In addition it is overlayed with the modern preoccupation with image over substance. As you have pointed out (I hope I’ve got you right) this transformational journey is an intensely personal one whether it is primarily mental, social, spiritual or physical. The nature, extent and speed is also an important consideration related to the possible success, risks and costs of transformation. I personally believe that there have been forces at work which have glamorised being transgendered while the reality is it would hardly ever be a choice if choice was involved. Personally, I believe male and female are seldom if ever actualised as pure types.

    August 15, 2016
  28. Andrea #

    For me, except for coming out as transgendered initially, navigating my own path from then on is fraught with decisions many of which are irreversable. Buying new clothes, dressing in gender appropriate outfits. Lazer hair removal, eyebrow shaping etc do give us urgent interim relief. It is the finality (and implied rejection) of hormonal, surgical and public engagement with the gender fluid community that is a real challenge for our partners and spouses to accept. In my case, and many others who succeed, the only time things when wrong was when in desperation I would press on with my transition alone. I must also point out how vital the various medical and mental practitioners have been for me.
    So, in summary:
    Seek out psychologists, psychiatrists, marriage counsellors, doctors, endocrinologists, urologists, pharmacists etc with an opening statement that you are transgendered and you will not be judged.
    My biggest and most painful diversions came from those who wanted to “fix” me. Conversion therapists, Christian deliverance practioners, Jungian/Freudian Psychologists etc etc always took me for a ride and then into huge suicidal depression.
    Now I work together with professional people who aren’t locked into a limited world-view.
    As backgroud, I am a committed Christian who has given God the authority over my life.
    I also reject all binary notions of gender, sexuality, race, religion, fat-thin, old-young. Actually anything which gets in the way of God’s infinite and unconditional love for all of humankind and all of their amazing creation. An in the way of our ability to love and serve each other.
    Sorry about the little rave but it somehow linked to the challenges you and your wife have been facing. I pray you will soon see a breakthrough…be happy and be blessed.
    With love,

    August 27, 2016
  29. Kai #

    The hardest part of being transgender for me is that I’m nonbinary and therefor, am stuck not knowing what to do about my obviously female body. I look like a teenage little girl (27 yoa) and it sickens me… no matter what I do, wear, etc I always look like a little girl playing dress up in my dads clothes and people always treat me and talk to me like I’m a girl and every time that happens a piece of me dies.

    I don’t know what gender even is or feels like, I could never understand it… what does that mean? What am I?

    Obviously I can’t transition to male (though I am more “masculine” by societies standards in terms of demeanor, style, interests) and I’m most certainly NOT female so what the heck do I do now? What can I do? I can barely look in the mirror without wanting to disappear and therapy isn’t helping. Can someone PLEASE give me resources for nonbinary transgender people with severe dysphoria?

    There’s hardly any information on nonbinary / agender.

    Thanks in advance,

    October 23, 2016
  30. Gwen #

    I’d like to suggest that extreme stress leads to being transgender, just to see if anyone agrees with me. There is the idea that I was transgender all along and that led to my dealing with stress in a different way, and eventually not actually being me just was not worth it? I don’t know which.

    November 6, 2016
  31. Gwen #

    After living as a woman for 13 years; had surgery in 2007, it is clear to me that I was not transgender. As it comes out I am XXY, non-kleinfelter’s, but feel I could have lived as a very mild man. I was so put off by the males in my family that I hated them and as soon as I could I became female as much as I could. Life is much easier now, though my whole family will not talk to me and I lost my job, church and everything else. In a way I think our rigid binary culture makes people feel off. We need to simply lighten up and let people be who they are.

    November 7, 2016
  32. Amber #

    I started hormones 19 month ago , I am 40 and have been pleasantly surprised by changes in my appearance and a lot of the dysphoria has gone but it isn’t an easy path to take, my family are slowly accepting me but it has been a hard battle.
    If it was just a quick and easy change it would be simple but it is a long journey and i am great full to be on the path

    November 30, 2016
  33. Gwen #

    I started hormones on a limited basis around 1995 and went to them full time in 2003; the pills being 2mg Estradial. Around 2008, I got on .1 patches and that is when the changes really set in because the hormone was going right into the blood stream. Breast development is adequate, so I never had implants. I got a legal castration in early 2005 and SRS in 2007.

    It does not feel like I transitioned, rather it was a relief to stop pretending to be a man. The Christian fundamentalist family has not spoken to me since 2005, and it does not seem like that will change.

    My faith was the most important thing in life and now that is very difficult.

    November 30, 2016
  34. As someone writing a dissertation on the transgender community, this was a very good read! :)

    January 14, 2017
  35. Ladylove #

    What can a person do when they have made the choice of wanting to transition but because of financial circumstances can’t. Any advice on how to deal with the anxiety that comes with reality. Has anyone experienced these feelings of frustration?

    July 17, 2017
  36. I had no idea that transgenders were more prone to develop depression because of isolation and the lack of acceptance. It makes sense that taking the time to consult with a professional counselor can help anyone in this situation improve their mental health and learn to accept themselves. As I see it, taking the time to assess your feelings and needs can help you know what type of mental health professional can help you the best.

    July 21, 2017
  37. D #

    I am a 14 year old trans boy who has been struggling with many of these issues for the past two years. I always thought of myself as a tom-boy, which was fine with my parents. Instead of playing with dolls, they’d find me out in the yard looking for bugs. This, of course, wasn’t an issue until I wanted to get my hair cut shorter. It took nearly a year of convincing, but they made me get the most feminine short haircut. After some time of them getting used to it, I eventually got it cut a bit shorter and I’m happy with what it looks like now. But then there’s the issue of binding my chest. For some reason, genetics decided to be an unforgiving jerk and left me with my aunt’s boobs which are way larger than my own mother’s, and are extremely hard to hide. Even when I layer the tightest sports bras I have, there’s still an ugly, out of place bump. After getting so frustrated that I couldn’t look at myself in the mirror without crying, I eventually worked up the courage to try to explain to my dad, and asked if he could possibly buy me a binder, since I had no way of getting one myself. He said he would talk to my mom. He never did. Weeks went by and every time I asked him, he either ignored me, or said something along the lines of, “You can’t make that decision for yourself.” I know my mom wouldn’t react much better if the way she reacted to me refusing to wear a dress to the school dance was any indication. It isn’t easy, and it is painful sometimes, but I’m glad to have friends who love and support me. Thanks for reading, if you made it this far. :)

    July 24, 2017
  38. peri #

    I’ve always had the desire of being treated like a man, but I’m not comfortable with male pronouns. At the same time, I’m not comfortable with female pronouns either. I’m not comfortable with anything, and it’s starting to take a toll on my way of thinking. What is this feeling called??

    August 3, 2017
  39. Anonymous #

    My 26yr old was born a girl but at age 23 she starting taking shots. I had a hard time accepting it because that wasn’t my faith. I never bullied her but I never recognized her as a male. On 6/13/2017 she committed suicide. I wish I could go back. I love and miss her.

    August 11, 2017
  40. patience #

    I am busy doing my psychatry nursing science and I’ve learnt a lot about this subject is my first time hearing about Dysphoria

    August 17, 2017
  41. Christina lane #

    Great information i didn’t know

    November 21, 2017
  42. Paula pearce #

    Thank you for addressing this. It is so often difficult to explain this to people who have mot experianced it.. and it makes it easier to do
    Thank you. Paul/ paula .

    April 12, 2018
  43. Mike #

    Educational and enjoyed the read on multiple levels: long overdue

    December 9, 2018
  44. Sandra #

    I actually am at the point mentioned about early adulthood. I’m on my late 20s (MtF). I didn’t explore the topic for years, and now I just felt an intense urge to do it. To me transition feels a no go option since I know I would not pass and I have medical concerns about it. But each person is different. In my case, I am thinking about managing gender dysphoria by having some space to express myself in my desired gender and other options.

    Do you know of any resources regarding this other life option? (Readings/videos)

    July 14, 2021

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