Q:   What are some of the challenges people face when transitioning?
A:   It is pretty major. Getting your name changed legally is a set of court documents and costs a small amount of money and takes some time. Getting a new driver's license is more paperwork and requires going through more bureaucracy. Probably the biggest piece is dealing with people's responses and not knowing how hostile or shocked they will be. I have clients of all ages and in all stages of life. I have one client who is a college student and who started college as a male but plans to arrive at school next year as a female. She has been having electrolysis and working on her makeup and clothing, and she has even contacted a sperm bank to save sperm so that later in life she can have a child that is biologically hers. I have another client who has male pattern baldness and is very embarrassed about it. So he gets Propecia (a hair-loss treatment) from one pharmacy and then goes to another pharmacy to get his hormone-therapy prescription filled. So these are some of the things that you might never think of that people go through. You have to be willing to cope with it, and you never know how hostile the reaction will be.

In addition, in relation to the hormones, when you add estrogen into a body that wasn't meant to have it, there can be an increased risk of breast cancer. Likewise, when you add testosterone into a body that wasn't intended to have it in that amount, you get facial and body hair developing, but you can also add an increased risk of cardiovascular problems, especially if you're overweight.

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Q:   And explaining it to your friends and family must be extremely difficult, right?
A:   Probably the hardest thing for transgender individuals is dealing with the people in their day-to-day lives. It's very hard. Parents have an awfully hard time moving from having a son to having a daughter and from daughter to son. Children have a hard time, too, as do siblings and grandparents. A number of people end up really distancing themselves from their family. Sometimes some members can deal with it and others can't. Coming out to your employer is a pretty awkward thing, too. I see people who really have lost everything — financial, family support, their job. So the number of and the kinds of problems people encounter in transitioning is huge, and it is very hard. Even the little things are difficult, like getting people to refer to you as he if they have known you as a she. Or finding clothes and shoes that fit you. I have one client who was big as a male, and when she transitioned to a female, she found it hard to find clothes and shoes that were big enough. I have another client who had a very heavy 5 o'clock shadow and who, before she was in transition, covered it with makeup. She got caught in a rainstorm and by the time she got home from work she looked pretty bedraggled. And it felt bad to her. It doesn't feel good for anyone, but when your makeup is running and your beard is showing through, it is really hard. It is not an easy thing to go through. The clients I have who have done the best are female to male clients who have partners who were with them when they were female. They've already broken the gender stereotypes, so they tend to do well. It really runs the gamut, though. I've seen people who have had fairly easy transitions, and I've seen people who have lost everything.

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