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Frequently Asked Questions? FAQs

When breasts grow, how do genetic males handle the look?

One of two ways, either you let them show or you hide them with loose clothes. That is not a glib answer. It is what people do. It depends on your state of mind. Incidentally, it is not unlike what many self conscious 12 year old girls go through as their breast begin to develop.

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I am 50 and disabled. I've read were TS people have been injured by people that see us as less than human. So I have some concerns.

Many hate crimes against the transgendered are reported but in fact they are relatively rare. Of the 650 + clients I have worked with since 1978, I have never had anyone report being mistreated by a stranger. Although there are some notable exceptions, most of the incidence where people have been seriously hurt or even killed have had some thing to do with sexual encounters. Simply follow the same rules of safe conduct that most genetic women follow and you should be all right. (see http://www.avitale.com/actsafely.htm)

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Besides some of the social problems that come with transitioning, what are some of the moral or spiritual issues that come up.

Rarely do I see anyone with religious concerns who has not already worked out their spiritual issues regarding transition with their spiritual leader. However, if the individual has strong religious ties and is associated with a particular church, mosque or synagogue then there could be a problem. That is where a good therapist can help all parties to come to a workable solution.

Familial concerns are much more common. Most people who come to see me are in mid-life with familial obligations. The idea of altering the family structure or even destroying it to save their life can lead to overwhelming feelings of guilt and shame and are much more common and problematical than spiritual issues.

In such a circumstance the therapist should go to great lengths to educate family members about the gender variant condition and make an effort to keep the family together. I am happy to report that success in keeping the family together has increased dramatically in the last several years.

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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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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.