I have written numerous articles over the years, many of which discuss important issues such as coming out, however this particular piece addresses issues which affect the transsexual who generally recognizes his or her gender identity but is uncertain how to proceed with transition. Some of the topics focused on are also important to transgenderists or others who believe living in a new gender role may be the next step in their lives.

In many instances the information contained here is designed to promote questions. Good, focused question asking is how people arrive at answers, even if those answers are temporary and will be modified in the future. If you do not agree with everything you read here that is a good thing. After all, in writing this I am condensing insights gained after working with 1,600 clients. I have never found any two clients to be exactly the same because everyone's journey differs although the various themes that people encounter often can be similar.

To begin, relax for a moment. Imagine that you are in a private consultation with me. Like many of my clients you will find that I am relatively non-judgmental. You also might wish to consider approaching the start of your transition from a non-judgmental standpoint. In doing so, strive to rid yourself of any guilty feelings regarding gender transition or being transgendered. I have found that far too many people indict themselves for not having been able to disclose to family and friends. I ask you, how are people supposed to reveal their transgender identity when in fact they are just starting to learn about their situation? Finally, after setting aside judgments, I encourage you to discount rumors you may have read on the Internet, heard in the media, or from people who are not gender specialists. In doing so, you minimize fears that would be stimulated by such exposure.

In starting a transition, either full or part-time, it is important to gauge the extent that your current relationships, responsibilities, employment, and emotional stability will be interrupted by making important personal changes. Generally, the more impact a transition is going to have on the preceding variables, the more prudent it will be to move forward with careful investigation and planning.

Be forewarned that serious damage can be suffered by people who do not closely adhere to the preceding advice. Do you want to be caught like poor little Bambi in the headlights, because you aren't ready to answer very important questions? People make the most mistakes by either thinking they know everything or allowing their emotions to control their behavior. Then, they find themselves spending a lot of time on damage control because they disclosed unwisely with regard to time, place or person. Are you supposed to have all the answers when you disclose your situation to your closest loved ones, co-workers or friends? No way! What you need to have behind you is experience coming out to non-essential persons or support group members. You also definitely should have an established relationship with a gender specializing therapist and/or a support group at the point of disclosing to loved ones. Having an understanding of how a number of other people handled disclosure and dealt with conflicts is essential.

When embarking on transition a great many people fall prey to the misconception that starting hormones early is always better. These individuals believe that years of thinking about and wanting hormones is a sure sign they are immediately ready to start. As well, some persons with a propensity toward self-medicating feel indignant that gatekeepers might try to prevent their starting hormones. Typically starting hormones is clinically appropriate once a person has committed to seriously exploring gender issues or beginning transition. However, hormones do have serious side effects, which often catch an ill-informed person by surprise. In addition to medical contradictions, hormones can accelerate social, emotional and physical changes much more rapidly than one expects.

Much of the information you read about hormones does not accurately describe the small but significant changes that happen with hormone administration. Even on lower dosages, when a person is not aware of changes, others typically may perceive that something has changed. People may do double-takes trying to figure out what is different about you. Your body may change to the point that your significant other notices, and surely he or she may not be amused to hear you started hormones without discussing the matter. Even pets with highly acute chemical sensory perception will react to you differently.

The most important step in securing hormone administration or any other medical procedure, such as facial or Genital Reassignment Surgery, is to find out as much information as possible about what choices exist. Do you want to start at higher dosages, or are more gradual changes right for your situation? Which hormones and what hormonal blood laboratory testing values match your goals? If you have researched several clinically recognized references, such as my book, Transgender Care, then you are likely prepared to approach your physician as a well-informed transgender consumer. When starting transition far too many people also immediately begin their quest by seeking out genital reassignment procedures. This is not necessarily a bad thing; after all you will wish once again to have properly researched what procedures are available. However, the best of your efforts in starting transition should be spent on creating a life that fills your needs as a person living in a new gender.

I receive a lot of inquiries about the right time to start electrolysis. This question leads me into the crucial subject of cosmetic technologies and the pursuit of fashion. I advise MTF clients to start electrolysis as soon as possible and be close to completion before transitioning at the workplace. Additionally, all transsexual persons should explore wardrobe choices before starting a full-time transition. There are many choices an individual can make about personal presentation, and it is wise to note what others are wearing in your appropriate gender so that you may pick and choose what works for you.

In starting transition, people often also feel as if they must make up for lost time or meet others' expectations. If you use a reasonable amount of caution so others and you and others don't get hurt by your choices, as well as focusing on optimistic thinking, building a life which fills your needs can be rather fun. Of all the advice I have given about transition, the one people have most appreciated is my suggestion that they make every effort to enjoy the process of transition. Therefore, slow down and enjoy the adventure. After all the process of transitioning gender can present many fascinating opportunities on which to build your life.

Commentary on "StartingTransition" By Barbara F. Anderson, Ph.D., LCSW

Not to quibble, but I feel Ms. Israel has not stressed sufficiently the importance of starting transition in a stable emotional state. In the spirit of the adage "Well begun is half done," I'd emphasize the importance of laying a solid foundation for this many-layered process. Therefore, psychological readiness must precede an approach to the areas she has so ably described - the search for accurate medical information, decision-making around disclosure, and weighing cosmetic and fashion options.

My experience leads me to conclude that without adequate self-knowledge or insight; the conviction that one is transgendered; and a readiness or confidence to take the necessary risks of disclosure; this difficult process may be undermined and ultimately fail. A necessary element of arriving at this psychological state of well-being is as Ms. Israel advises, the adoption of a non-judgmental, guilt-free attitude; but I would add freedom from unmanageable psychiatric symptoms and addictions as well as a neutral if not supportive immediate environment.

Once these conditions, which provide the foundation of transition, are met then one has the psychic energy to devote to research, exploration of resources and as Ms Israel says, enjoying the experience.

Barbara F. Anderson, Ph.D., LCSW is the Coordinator of Gender Identity Treatment Services at San Francisco's Center for Special Problems, in private practice and a faculty member at San Francisco City College.