What happens to those intensely dysphoric people who do not transition? How do they cope? I contemplate never transitioning and thus enabling me to make that commitment to my wife and family. How on earth can I do that and have a happy life without this persistent voice going around and around in my head?
When people wait until they are in mid life and have established a career and family before attending to their gender dysphoria the situation becomes almost impossible to resolve without disrupting the lives of loved ones. The sooner people with gender dysphoria understand that their condition is chronic, the easier the solution becomes. Gender variant people can no more change their gender variant identity then those who fit the more common male/female gender binary. I know all of that doesn't answer the question directly but there are certain truths in life that can not be denied. Being gender variant is one of them.
Of course, it is perfectly possible to be gender dysphoric and NOT transition. Gender dysphoria is not new. There is evidence of it dating all the way back to the beginning of recorded history. Since there was no treatment for it then, gender dysphoric people did the best they could to make their lives work and many societies accommodated them. (see http://www.avitale.com/historicalaccount.htm).
The only real solution is to make every effort possible to get family members to understand the seriousness of the problem. Seeing a good family therapist that is knowledgeable in these matters is a good place to start. I have also found that by referring couples to groups of other couples where there is a gender variant partner also helps.
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