I am a longtime reader of your column. I'm writing to ask a question about my son, as I'm concerned about his ability to be sexual with others.

He was born female, but from a young age he was able to express that he was actually male. When he was six, after some therapy sessions and some long conversations, he simply started living as a boy. Two years later, my husband's job took us across the country. After some conversations, my son decided to take advantage of this fresh start and only was known as a boy, deciding to keep what he now considers to be his "birth defect" private.

My son is now 18, a senior in high school. He never went through female puberty and has been on testosterone injections for almost four years. He does not see himself as transgender; he doesn't think that that identity fits him. Watching him develop into an adult, it's hard to imagine that he doesn't have a Y chromosome; he's six inches taller than his father, plays varsity lacrosse and soccer, and has just generally grown into a very handsome and mature young man. However, he has never had a girlfriend (and yes, he does like girls). The fact that we can't afford for him to have reconstructive genital surgery probably has a good deal to do with this. From conversations we've had on the topic, he has a lot of shame and anger surrounding the way that he is. I feel sad that he can't have the typical teenage experience complete with sexual experimentation. It makes me worry that his life will be missing a major component to it. I know that he feels very out of touch with his friends and everyone else in his age group.

Is it possible for my son to have romantic or sexual relationships in the future? He seriously believes that his past will not allow him to do so. I feel like the fact that he does not have a typical transgender identity and has always seen this as being a medical problem will make this a lot harder for him.

Majorly Overwrought Mother

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I shared your letter with Ryan Blackhawke, a trans man who lives in Seattle, where he serves on the board of the Ingersoll Gender Center. What follows is Ryan's response.

Can I just start out by saying how awesome MOM is for supporting her kid? Some are not as lucky as her son is. It is heartening to see more parents reaching out for support over the past few years.

I'm finding that many guys who are fortunate enough to have figured all of this out before puberty don't feel that "transgender" fits them because they have always felt like guys. Some refer to themselves as MTM (male to male) as opposed to FTM for obvious reasons. The important thing to remember is that no matter how we choose to identify, we can and do lead fully realized, productive and sexual lives. And one does not have to identify as transgender in order to seek support from our community. He deserves just as much support as the people who do come in and ID as trans.

What MOM is referring to when she states that her son feels shame and anger for the way he is (I'm assuming female-bodied is what has him upset) is what is known as gender dysphoria. I won't go into the politics of the DSM-V controversy here but this is the diagnosis that healthcare providers use. Gender dysphoria occurs when one feels anxiety or just plain doesn't like what they see when they look in the mirror because their body is not aligned with their gender. Not every person experiences dysphoria the same way. I had very little dysphoria until I was getting closer to my surgery date, when suddenly I could not wait for surgery. Other guys really struggle with it.

For me, I realized that it isn't my body that makes me a man. It is how I think and feel, how I carry myself in the world. Which is a good thing because we will never have the junk we want. The surgical techniques are still quite primitive and there is no erotic sensation. We wouldn't be able to get hard without a rod and we won't be able to ejaculate. Not to mention it is prohibitively expensive and usually not covered by insurance. (Most policies have boilerplate language denying any coverage for transition-related expenses.) So once again, this is about learning to love what you got, even if it ain't exactly what you want.

Is it possible for him to have romantic or just plain sexual relationships in the future? Of course it is. Like any dating scenario, the trick is finding someone who complements you and can love you for you. I don't think this is an issue that is exclusive to people who cross gender boundaries. There are plenty of women (and men) out there who are interested in the person he is, not the junk he's got. Besides, there's nothing like letting your partner pick which cock she'd like you to use on her.

I don't know where MOM is but I suggest to reaching out to a support group in her area. In Seattle, Children's Hospital has some great support groups for kids and their families. In addition, Gender Spectrum is a conference held concurrently with Gender Odyssey with a focus on families and their trans kids.

And of course, anyone is welcome to attend Ingersoll Gender Center's support group.