Transgender identity issues are commonly assumed to be about sex. Occasionally this is the case, but far more often they are about identity itself.

Now and then, the sex of a person’s physical body and the gender identity of a person’s mind do not match. No one knows for certain why this happens, but evidence increasingly implicates genetic or other biological factors. However the discrepancy comes about, when the mind cannot be brought into alignment with the body through any ordinary efforts, including psychotherapy, the person may seek relief by altering the body to match the mind, as closely as medical science will allow.

I do not share the general assumption that feeling such variance – feeling oneself to be male when one has a female body, or feeling oneself to be female when one has a male body – is, by itself, a mental disorder. I have known too many transgendered people to believe that the problems they face necessarily began with their own delusions, and I know too well the painful costs of being transgendered to imagine that anybody chooses this path who can equally well choose another. For those reasons, among others, I generally support the rights of transgendered people to do what they find appropriate with their own bodies and lives where hormones, surgery, and self-identification are concerned.

I also think, however, that if a person is told she is not who she feels herself to be, perhaps starting from a very young age, and hears that message repeated over and over again in every possible way by family, friends, schools, places of employment, and society at large, then it is very difficult to grow up without some sorrow, anger, grief, resentment, shame, guilt, anxiety, depression, identity confusion, or other form of psychological wound. Suffering in those ways would seem so justified and appropriate to some people’s circumstances that in many instances not feeling some sort of unhappiness would more likely signal an emotional problem than feeling it.

Those kinds of sufferings, moreover, have the potential to compromise anyone’s ability to engage in intimate relationships, receive and accept acknowledgment from peers, set and achieve goals, or attain a sense of satisfaction with life. And even though such sufferings are not the individual’s fault, they can still compromise her or his ability to be happy, satisfied, and fulfilled in life, and to know her- or himself thoroughly.

However these kinds of psychic distresses were engendered, people do not have to live with them forever. Often the strains can be eased or relieved by examining them with a trained and sympathetic witness or guide, without demeaning an individual’s gender identity. Such considered examination can assist people who feel they are transgendered to make their own decisions as clearly as possible, informed by self-awareness, regarding the treatments they choose to access. For that reason, among others, I support the Standards of Care promulgated by the World Professional Association for Transgender Health (http://www.wpath.org), and encourage anyone questioning or examining his or her gender identity to consult those Standards and to work with an experienced specialist.