I think this is the kind of topic worth resurrecting once in a while, because I believe the situation is common to so many of us.
I share the pain: to be honest, I'm quite unsure if I'm 'female inside' or not. All I know is that I'm most definitely not a male; never was, and very likely never will be. Because I tried so hard to act and behave as a male, and utterly failed as a result of 'overtrying' (is there such a word?), I now suffer from gender dysphoria, depression, and anxiety (the latter, fortunately, is very easy to keep in check with medication; depression, so-so).
I'm also married, for almost two decades. For some bizarre reason which I cannot understand, all my close friends and familiars are ultra-conservative — except, fortunately, for my wife. She is twice as intelligent as I am, with an IQ at the Utter Genius level, which in turn makes her a voracious reader — and that helped when I 'came out' back in 2004, telling her that I'm 'merely a crossdresser'. That was mostly a lie to myself; I did truly want to believe that's all that I was. In fact, I fervently wish, every day, to be 'just a crossdresser'. I've got a lot of crossdresser friends; those who are transgender, with perhaps one exception (she's genderfluid and oscillates between maleness and femaleness), suffer from gender dysphoria; those who are 'merely crossdressers' are mentally healthy, very happy people, enjoying themselves to the fullest, absolutely sure about their male gender but loving their occasional female presentation. And it's not as if they just occasionally crossdress — many spend more hours dressed as women (at home) than as men (at work).
Almost all of my crossdresser friends also share a common characteristic: they are divorced. Many (most?) struggle with the issue of their children; many are too young to understand, others are teenagers struggling with their own hormone-induced gender and sexuality questions, others still are young adults who would be utterly shocked for having a divorced 'dad' who walks around in women's clothes. In most cases, the divorce was
not because of their crossdressing. Most are also occasionally dating women who understand and accept them (most are also divorced themselves), although a very few are more into men, or at least bi-curious and wondering if they could establish a life as wife to a wealthy man. In fact, one of my friends did exactly that — she came out as 'homosexual male' years many ago, found out that sex with other homosexual males was not fulfilling, and finally figured out that what she really wanted was to get a heterosexual male as a partner. This, of course, would only be possible if she became a woman instead — which she did, rather quickly in fact (when I first met her, not quite two years ago, she was not even on hormones; today, she's fully recovered from her gender confirmation surgery and is 'full woman', in her own words).
So... among my circle of friends and acquaintances who self-label themselves as 'trans-something', I see those who are more similar to me being the saddest group. We all go to therapy and have to fight depression along gender dysphoria. In my country there are no jobs for transexuals (or any kind of transgender people) outside sex workers, even though there is a very high level of public tolerance and relatively low levels of open transphobia. Still, no MtF transexual — ever — who transitioned in my country managed to keep their jobs (FtM transexuals usually have no problems finding jobs, especially as teachers — they almost always pass anyway, and they're used to changing schools all the time). A few, very few, managed to get a job outside sex work; one works as a model, but she had a huge push from her daddy, a very influential person in certain circles. This currently means hundreds of jobless transexuals, some of them still depressed, or at least quite frustrated and desperate for getting a way to pay for their bills; many had no choice but to go back to their parents' home. I have asked a few doctors around — currently there are 'thousands' of transgender people in therapy, many of which in several stages of transition, but the vast majority is just trying to cope with the hopelessness of it all. And these are just those who do, indeed, seek medical help from medical specialists in clinical sexology (those are the ones in my country who are allowed to sign the papers for HRT and surgery); there are merely estimates, based on informal chats between colleagues at hospitals and clinics, which calculate that there are possibly tens of thousands of transgender people out there, suffering in silence, and not daring to seek professional help— but who confessed to their family doctors the kind of urges they had to become women, and the effort they made to suppress those urges. Now, these numbers might not impress you; but I live in a small country and we're talking about 1% of the male population suffering from some degree of gender dysphoria — and these are just the ones who talked to a doctor. How many are still silently suffering, not daring to talk to a doctor?
Now let's look at some parochial statistics. Those 'happy crossdressers' (I don't wish to sound as if I envy them; in fact, I'm very glad that they have no problems!) outnumber us 'sad gender dysphorics' by at least 5:1, and very possibly more. Of course I'm just counting those in my group; and of course a few might be 'faking' that they are 'merely crossdressers' exactly for the same reasons that most of us do: to try to persuade themselves and everybody around them that they can handle gender dysphoria and suffer in silence. I don't know. Few openly admit it, that's for true.
What's my point? That the number of people desperately clinging to any other 'label'
except 'transexual' (in the sense of suffering from gender dysphoria that can only be dealt with through transition) is actually much higher than what we may imagine. The media tend to show the many success stories — and a few tragedies. Activist sites, as well as many others, tend to portray the image that going through transition is hard and tough, but always worth is — so long as what you
really want is to leave your 'old' life behind and start from scratch a 'new' life.
Unfortunately, that's not such an easy choice for everybody! My own therapist actually sided with my wife when I told them that I wanted to 'come out' to more people, including some familiars and close friends: they both told me to refrain from doing so. Why? Because it's unclear if I will ever have the courage to break up all ties with family, friends, job, a city, a way to support myself financially... and jump blindingly ahead and start living my life as woman without a real plan on how that can really be achieved (emigration is an option for a few transgender friends believing that they might get luckier in getting a job in the UK or the Netherlands) — so I should just keep a low profile. Sure, dress as much as possible, at home or in public with other crossdresser friends, but stick to that, and only that.
Mind you, there is no doubt in the minds of my therapist and psychiatrist (and even on my family doctor) that I
do suffer from gender dysphoria. It's questionable if it's a very severe case, though — I would say it's moderate-to-mild, since I do not entertain suicidal thoughts, nor do I have the courage to break all ties with everything, which is what people with severe gender dysphoria usually want to do. Nevertheless, I have seen some reports. Doctors want to help me out of depression (which currently prevents me from working), but the therapy they proposed does not meet with my wife's approval — they suggest that, since most of my work (if not all of it) can be done remotely, I ought to dress like I wish every day, stay at home for 8 hours and do my work, and eventually go out with some friends as a 'reward'. In fact, I have tried this 'therapy' for a couple of days and it certainly worked wonderfully well. But then reality stepped in: my wife said that there was no way I she would be going to the supermarket with me ridiculously dressed as a woman (or, what she says, a 'hyper-feminine stereotype of a woman that really does not exist except in my mind'), and of course we need to shop for food. And she can add a few millions of other examples when it would be completely unthinkable for me to go out (especially with her), face everybody, and so forth. For my wife, this is simply unthinkable, and, in a word, 'stupid'. She does not
believe that I have 'gender dysphoria'. Instead, she follows a line of reasoning not unlike that of Felix Conrad
<commercial links are not allowed> — that going out with crossdressing friends provokes an adrenaline rush, a sensation of well-being, which is important for someone who is depressed (that's why we shouldn't stay at home, but seek the company of others), and this leads us to imagine that we would be better off if we 'acted' as if we were 'female bimbos' and do it all the time. My wife has a sharp tongue; she is not politically correct when telling me how I should behave

But of course she forces me to think about my
real choices, and separate 'wishful thinking' from real goals in my life. In spite of going out in public quite a lot (yes, even to the supermarket... just
not with my wife, of course), the truth is that I'm unsure if I could handle living as a woman full-time — especially if that means being alone, scorned and despised by friends, family, and (former...) colleagues. My wife says that she would support me, of course, even though she is quite adamant in her conviction that it would be the most stupid decision ever. I simply don't know for sure any more. It seems to be a lose-lose situation. Felix Conrad, mentioned above, says that one of the questions we must ask ourselves very seriously is: will I be
more happy afterwards? (meaning: after transition has been completed) And how much 'more' is 'more'? If the answer is: 'I'm so miserable right now that starting life from scratch as a woman cannot make it worse', then, yes, go ahead with transition. But if the answer is that, like every other choice in life, there will be a good and a bad side to everything, well, then it's best to continue to suffer in silence and do the occasional crossdressing. This is the old adage of choosing the Hell that is already familiar than jump into Heaven, where we have no idea if it'll be better or worse...
Recently, my wife has also suggested that by listing most of my symptoms, she concluded that it's all part of a midlife crisis. Many doctors are reluctant to diagnose a condition merely as 'midlife crisis', because so many of the symptoms overlap classic depression. It's true, however, that an alleged midlife crisis might have a strong effect on someone who also suffers from gender dysphoria. In other words: twenty years ago, gender dysphoria was 'sufferable', especially because we lived in the roaring 1990s, when money flowed like water and there were no worries — I envisioned a bright future where I could live as a woman simply from the interest on my accumulated earnings. Then the whole economy collapsed — first with the dot-com bubble, then with the subprime crisis — and I could kiss all my earnings bye-bye. And, of course, now I'm twenty years older — and possibly at that time of life where I pretty much know that I have simply waited too long, I have wasted too many decades, and now I'm simply too old and a coward and unwilling to 'start from scratch' again — it was so much easier when I was younger and believed much more in my dreams than I do today.
Still, I keep telling myself that Caitlyn Jenner transitioned when she was 64. Sure, I cannot compare my circumstances with hers; the only thing we share is the same supplier of hip pads

But she's most definitely my role model, more than anyone else. She stifled her urges and desires of wanting to be who she is for decades upon decades, struggled along, fought gender dysphoria all the way, and once she had her whole life settled and could simply look ahead to a comfortable retirement, then she took the Big Step and went ahead with all that she ever wanted — and made a great job of it.
My own life will be by no means as 'comfortable' as Caitlyn's, of course, but I can draw some strength from the notion that she did, after so much time, fulfill her dreams. We cannot predict the future, even though we can do some planning ahead. And the only thing that my wife persuaded me to think about is to look beyond the 'trap' of transition. It
seems to be the solution for everything, short-term. But I have to honestly think about what will come
next. And that also scares me a lot: I'm not so sure that I would enjoy living the remaining decades of my life, alone, as a trans woman, lost and abandoned by everybody, and most likely having to beg for food in the streets — because, even if I could swallow my pride and offer my body for sale on the streets, the truth is that I'm far too old to be interesting to potential customers anyway. One might think that this is a worst-case scenario, and things will not be that grim. Maybe. But I prefer to prepare mentally for the worst. If I can handle
that, then anything which is 'better than the worst' will just look rosy and peachy and, well, wonderful. But right now I can only say that between suffering from gender dysphoria but keeping along with my current life, and starting from scratch a new life, alone, without real hopes of even managing to survive, well... for now, at least, my choice is clear. And the same, of course, applies to most people I know who label themselves trans* — they go through the same reasoning. It's just those who are really desperate, or have at least strong support (usually from parents who can financially help them; sometimes, from a well-off 'boyfriend'), who go for transition. The rest of us just bite the bullet and go ahead with their lives.
Note: apparently, in my country, although all therapy and surgeries are paid by the welfare state, there is a condition for getting hormones (and eventual therapy): you need to commit yourself to live full-time in the gender you identify with. This is different from many other countries where hormone therapy is an acceptable therapy to deal with the worst effects of gender dysphoria, even if the person going through HRT wants to keep their assigned gender role for the sake of appearances. Allegedly, if you go via private doctors instead of through the National Health Service, you might be able to get a nice endocrinologist who will prescribe you some hormones — but, of course, it means paying a lot. My own insurance seems to cover at least the sessions with a medical doctor with the clinical sexology specialisation. So I'll see what will come out of that and pay for a few sessions...
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