Q:   What guidance do you give those people who are considering living their life as the opposite sex? What types of questions do you ask them to make sure they are ready for this new lifestyle?
A:   I'm not one who believes that we need to identify this as a problem. Usually people who are considering this are willing to make adjustments because the adjustments are exactly what they need to feel better. So I think it is pretty arrogant for the medical community to think we have to make sure they are ready. But some of the things that I might ask them are: How are things going at work? How are they going at home? How do you feel? How does it feel when people are rude or harassing? My experience is that, especially with the advent of the Internet, most people have already addressed these questions and gotten answers to their questions from communities on the Internet. But, generally, I want to make sure they have the support they need to come out.

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Q:   As you mention, family members can have a hard time accepting this change. What advice would you give parents of teens who are considering living as transgender individuals?
A:   First, it makes sense that dealing with this type of issue with your child would be a difficult thing. Gender is such a significant part of what and how we understand another person — any other person — to be, and everything about our child we experience more intensely than with others. So the first thing I say to parents is to be gentle with themselves. Next, I remind them that their process of coming to grips with this issue is separate from their child's — and usually a few paces behind. I recommend learning about transgenderism in general — it helps to know that others have gone through this. I also suggest they find a support group of other parents, through an organization like PFLAG. Even the parents of a gay, lesbian or bisexual child can be of help, in terms of nonjudgmental acceptance of a child who breaks societal gender norms. A therapist experienced with this issue can also provide support through this process.

There are several specific things I would share with parents, too. One is that in general it is easier on a person to be dealing with such issues earlier in life rather than later. When a person goes through childhood, adolescence and some part of adulthood feeling unhappy and uncomfortable, that has a lasting effect. Even worse are the effects of trying to fit in when one has to hide who one is to do so. It is a part of the development of our ability to have relationships that are genuine, to be genuine in our dealings with others as we come to know ourselves. When one is trying to hide one's self from others, that works against this process. And it also takes up a significant amount of cognitive and emotional energy.

This is also not a decision that many people are likely to come to lightly. It is a path that is clearly difficult — which is not lost on those considering it — and it is usually embraced by someone when it is the only answer that they can see to ease the discomfort they feel. This is difficult, because it is very hard to recognize the level of pain and discomfort that someone else is experiencing — especially when they may have worked actively for a long time to hide it. It is useful for parents to try to parse out their concerns and separate those that have to do with their child's well-being from those that have to do with their own personal discomfort. While this process is something a transgendered person does to alleviate their discomfort, it often causes us discomfort. Then again, it is OK and even useful to get support for their process of dealing with it.

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