I met privately for an hour yesterday with a therapist who has forty years experience working with gender dysphoric clients; she runs the monthly TG Support group I've been attending. She was wonderful, knowledgeable, and so resourceful. I feel very fortunate for being able to meet with her and felt others here might appreciate my sharing some of the details (that I can recall!) of our meeting.

I broke up the points into three sections to make it a little more readable. There is no particular order within each section.

General Information

• There is a biological based theory of gender dysphoria that has had some confirmation with animal testing. It goes like this: there are pulses of hormones in the womb that occur in the second trimester (after sexual organs are defined in the first half of pregnancy) whose timing, intensities and/or durations create the fetus's gender identity in its brain. If those signals are distorted for whatever reason gender dysphoria may result. At this time there is no way to measure these pulses or otherwise test the theory on humans.
  

• It’s quite common for men to feel intense shame about these feelings and find themselves unable to ignore them in mid-life as they more fully grasp that their life is unsettled and/or incomplete and they have limited time to address/explore their gender issues.
  

• She doesn’t like to use labels and says that the terms “transgender” and “transsexual” may be going out of favor due the baggage that anything “trans” may carry. She prefers to use “gender concern.”
  

• Some men find that while they don’t need to or cannot live dressed as a female (at home, work, or both) that they must wear some female clothing underneath their male clothing or otherwise not be able to remain focused on their work. Examples include: panties, bra, stockings, camisole, etc. Or, they may dress at night and then drive around in their car.
  

• Men with a gender issue often experience intense erotic feelings with feminine clothing when younger (teenage) that with time tends to decrease.
  

• She had told me previously that contrary to earlier belief that the number of cisgender males and cisgender females having gender issues is heavily weighted toward males, she strongly believes that the ratio of males/females who have gender issues is identical. That said, she acknowledged that women (at least in the US) have much greater latitude of socially acceptable dressing and thus may be able to contend with their masculine desires (such as wearing masculine clothing) without attracting undo attention.
  

• I pointed out that a source of uncertainty and frustration for me was that it seems that one's “transgender diagnosis” and location under the umbrella is largely self-determined and that all a therapist like her can do is mentor, consult, provide guidance and so forth. She agreed completely; she cannot tell anyone exactly what’s going on for them nor can she predict the future of where they will end up.
  

Given all of the above I think the intensity of my feelings, need to be accepted for who I am, and emotional reactions to feeling rejected (real or imagined) are very understandable.

Specific to Me

• My struggle with verbally explaining or describing my inner feelings is very understandable; she didn’t have suggestions of other words I might use. (I had thought she might have words that she’d heard from other clients.) She confirmed that my description of being more “emotional” and “sensitive” than a more typical male made sense to her.
  

• I described that when I dress in the clothing that I have (e.g., a dress, nightgown, leotard, tights, panties, bra) that it “just feels good” (like when my skirt brushes across my legs when walking) and that I simply go about my otherwise normal existence at home, working at my desk, dealing with our pets, etc. She said this is entirely consistent with her experience.
  

• I told her that although the outcome of make-up is appealing the thought of applying it, going through all that, is not. She said let’s face it, most women don’t particularly like doing it either, and women have varying styles. For example, she had a transwoman visit from Las Vegas, wearing alluring clothing and high heels that were appropriate for there but quite unusual for Palo Alto. Likewise, a transwoman from Idaho came wearing a plaid shirt, jeans, and work boots – “right off the farm.” Appropriate for Idaho but equally unusual for Palo Alto!
  

• I told her that I don’t have dysphoria with my body; I’ve never felt compelled to chop off my penis for example. Here again, she said that physical dysphoria is also largely a myth; surgery is more for alignment with one’s inherent gender than with revulsion of ones cisgender sexual characteristics.
  

• I had printed out the “Sex Orientation Scale” that Karen posted on her blog and highlighted the characteristics that feel most in alignment with me. She immediately recognized the chart from Harry Benjamin’s book “The Transsexual Phenomenon” and showed it to me. All of my highlights are in the in Group 1 “Transvestite” and mostly in the Type I and Type II columns.
  

• Prior to my current therapist I’d partially come out to two others whom I told that I occasionally crossdressed. They both told me that in and of itself it’s no big deal (sorry, that phrase again). This therapist agreed 100%. And in fact, here’s what’s kind of weird: when I dress at home, like just wearing a dress and underwear, it feels “right,” “good,” but not much more than that. I like it. But when I return (as I must) to Levi’s and a T-shirt, that’s no big deal either.
  

Regarding My Wife/Marriage

• I need to recognize and appreciate that my wife has only become more fully aware of this in the past 2-3 months and that is a very short time; I need to be patient and allow her to come to terms with her own and very valid fears and anxieties.
  

• Contrary to an assumption my wife had, I don’t pose/prance in front of the mirror when dressed, admiring myself. In fact, I prefer not to see myself at all although it’s not particularly bothersome if I do. Again, quite a common experience.
  

• With my engineer’s mentality I tend to perform thorough analysis, prepare reports, and anticipate that the recipients will appreciate my being so forthcoming and transparent. But as I saw with my wife when I enthusiastically gave her a report a couple of months ago, this was simply too much information too fast. Again, a common enough occurrence.
  

Conclusions: Wow.

P.S. For those interested, the therapist’s name is: Judy Van Maasdam, and she can be reached at: jvanmaasdam@gmail.com. Her office is in Palo Alto, California. She gave me permission to publish her name and suggested that those interested email her; you/she can follow up later via the phone as needed.