How long each of these stages last is variable and there may be some overlap. Certainly this is true of the childhood and the adolescent stage. As the transsexual begins to develop a sense of being an individual who is entering the role of a member of the opposite sex, she begins to explore what it means to be a woman (man) as defined by society and by her own perception.She enters on a personal search for identity. This may be compared to the developmental stage of adolescence. Just as a young person going through adolescence may seem like a five year old going on thirty, so the transsexual swings between childishness and extremely mature behavior. One day, she may come into your office bubbling over about a new doll or Teddy bear she added to her collection (yes, we do such things), and the next appointment she may appear wearing a severe business suit expressing worry about her career. At this stage the transsexual begins asking questions related to who they are and who they will be after transition. It's a time of exploration, questioning and discovery. At this stage you begin to face up to the fact that there will be a life after SRS and you begin to prepare for that life. Just as a physical adolescent may be a bit scared about the future, so the transsexual going through this adolescent phase is worried about a future which will be so different from her past. She may begin questioning her career goals. Although thirty-five with ten years seniority with a single company, she may consider quitting the job to work as a cocktail waitress because it seems more feminine. There is, however, some value to this questioning. I hate to say it, but some transsexuals are fired as soon as they disclose their intentions to their employers. Others may find opposition from fellow workers so intense that it would be difficult to remain in that position. Some MTF's find that the female form is not conducive to certain types of heavy labor. So, some evaluation of career goals is not out of order as long as it remains realistic. At this stage, you will see a great variety in the types of clothes the client wears in her quest to develop her own image. I think this will be more evident in MTF's than in FTM's. Many of the clothes she will buy may be inappropriate for her biological age. I remember buying a simulated leopard-skin mini-skirt. I don't think I wore it over three times out in public, but somehow it looked great in the store. Needless to say at 38, leopard-skin miniskirts were not exactly my style. But at the time I bought it, I was about 14 in my mind. But by buying it, I discovered that it wasn't my style and I was able to refine that style further. The transsexual at this stage may present some challenges in therapy since they often see you, the counselor, as the adult standing in the way of their needs. The impatience and independence of youth begins to express itself here. The client may begin to challenge you and become demanding. Your job during this time is to make sure that any changes in behavior which are necessary be seen as precedes from within the client. In other words, make her believe it is her idea. This should be a time when the transsexual begins to leave the safety of home and venture out into the world as a member of her new gender if she has not done so already. She needs to begin to develop friendships and social contacts, preferably among people who are unaware of her situation. Whether that is possible or not may depend on many practical issues such as job security, presence of family members in the community, current friendships, and the ability to pass effectively at this stage of transition. However, even if the only social contacts the person has in the new role is a gender group, it is important for her to begin relating to others as a female. A lot of fear goes with stepping out the door of your home or apartment "dressed." A multitude of questions flood your mind. What if I meet someone I know? What if someonereads me? What if they make a crude remark? What if they attack me? What if I can't pass? Would that mean that I can never pass? You will have to deal with these cognitions. You will also have to help the client move beyond the cognitions to action. A program of gradual exposure will help reduce the anxiety. First, the person goes to another town and goes to a movie theatre or dark restaurant at night, or she goes for a walk around the block in the evening. These are relatively safe activities. Then she goes shopping during the evening in another town. Then she goes shopping during the daytime. Then she chooses one social or educational activity like a class, church meeting, street fair, lecture, concert, play, etc. to attend once. Then as she gains more confidence she might get involved with some group on a regular basis. I joined a Christian women's club and worked with the YWCA during this time. I made friends, gained confidence in my femininity, and I learned more about being a woman than any counselor or book could have told me. Graduated task assignments might be necessary to encourage this process. You provide a level of accountability for the client. By reporting to you on the completion of the task, she has the motivation to take the risks one at a time. Adolescence is a time of risk taking. You want to assure that the risks the client takes are reasonable and productive. When the client begins hormone therapy, the transsexual's adolescence takes on a physical as well as a symbolic meaning. In many ways the client relives puberty, but this time on the other side of the fence. We'll deal with specific hormonal effects in another chapter. However, certain effects are especially significant from a developmental perspective. For MTF's the most significant of these effects is the development of breasts. From the time you feel the first tingling in the nipple until you see the swelling of the full breast, you are flooded with a type of wonder at the transformation occurring. Not totally unlike the emotions of a young girl whose breast development is a visible sign of her passing from childhood into adulthood. Some MTF's also experience a cycling of mood which roughly approximates a woman's menstrual period. I know that there is one week during the month that I will be irritable, given to dysphoria and mood swings. One week shortly after beginning hormone therapy, I found myself crying for no discernible reason. Reading some writings by other transsexuals I began to realize what was happening. For FTM's the most visible change will be the increase of body hair and especially facial hair. Again, the correlation to adolescent males is obvious.
