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Frequently Asked Questions? FAQs

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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Statistics on the percentage of men who are dealing with gender issues range from 1% to 10%. No one knows for sure, of course. How about women? Reading between the lines it appears that a much smaller number have similar issues. Why is this? I suspect it's because they don't carry the same amounts of shame and guilt that men do about expressing themselves and being themselves however they please. Society seems to give a wide latitude to girls and women. Maybe that's enough?

I have worked with about 50 genetic females (vs 400 genetic males) who were dealing with gender issues over the last 21 years. In many ways the pressures they face by their families to remain female despite a strong desire to transition are similar to those of genetic males who are considering transition. The big difference, and your suspicions are correct, is that many gender dysphoric women can and usually do live primarily as men anyhow. That is, they avoid female dress styles and couple with straight female partners who in turn pretty much relate to them as if they were male. That goes a long way to ease their gender expression deprivation anxiety. The problem, as you have surmised, is that it is often not enough. Knowing that there is a way to permanently masculinize their bodies and function more fully in the male gender role is more then many can resist. That is when they search out for help.

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Do you think society is becoming more accepting of transgender?

Yes. That is apparent in several different ways. For example, only twenty years ago, in most cities in America, it was illegal for a man to crossdress in public. Now even the California DMV has a form that allows an individual to change, with a doctor's approval, not only their name but their gender identity on their driver's license. From there it is only a simple step to change all other forms of ID and go on with life.

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What should the society know and understand of the transgender community? What is something most people do not know about them?

First of all society must come to understand that gender identity is not simply binary. Because one's gender identity and sex form at different times while the child is still in the womb and that process is subject to potential problems, there is a very real chance that the process could be upset, leaving the child gender variant. This happens often enough for there to be, in reality, a gender spectrum. Transgendered people are born gender variant and as such are simply trying to find a space in life to exist comfortably. Also it is important not to confuse gender issues with homosexuality. Even though we hear the term LGBT used, it is a marriage of political convenience, not a biological one.

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Is there a way of dealing with Gender Identity Disorder without gender reassignment? My daughter has told me repeatedly that she prays each night that she wakes up in a man's body. Because she is a Christian, she faces a moral dilemma each day regarding the depth of our relationship.

Gender dysphoria is a very persistent disorder. It can't be cured in the normal sense of the word. When I treat someone, my only objective is to help them live with their gender variant condition. That can range from encouraging them to introduce some minimal form of cross gender behavior in their daily life to giving serious thought to complete gender role transition. There are no other known alternatives other then to suffer the anguish of inaction. There should be no more a moral dilemma involved with gender identity issues than with any other medical condition.

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Nothing on this site should be viewed as providing therapeutic advice. No formation of a client/therapist
relationship with Dr. Vitale is intended or to be implied or inferred. The information provided in this site is for educational
purposes only. I attempt to keep the information current but make no representation or warranties in that regard. You should
not rely upon this information as a substitute for consul with a qualified mental health professional.