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Understanding Transgender Reality

An in-depth interview with international speaker, transgender man Ryan Sallans.

Used with permission.
Source: Used with permission.

In February, at the annual International Institute of Trauma and Addiction Professionals (IITAP) symposium, I was honored to hear Ryan Sallans, an international speaker, transgender man, and author of the book Second Son, speak. His presentation both moved and educated those of us who were present, and I wanted to share his insight with the wider public. We conducted our interview via email rather than over the phone (we live in different states) because Ryan wanted a chance to thoroughly consider his answers. I am grateful that he has done so, and I hope that his words will provide both understanding and hope for those who need it—be they transgender themselves or a loved one of a transgender person.


Do people sometimes ask you, “How did you know for sure you were transgender?” If so, how do you feel about being asked that question, and how do you typically answer?

I’ve been asked, “How do you really know?” on numerous occasions. This question is always hard for me to answer because knowing didn’t happen overnight. My awareness slowly started to build internally from the time I was a child into adulthood. In looking back, I realize there were moments when my feelings of being a man were very strong, but then a different life obstacle would move to the forefront, forcing my sense of being male into the shadows.

The day that I knew I was transgender for sure was age 25, after stumbling into an LGBT bookstore. On the shelves was a photography book called Body Alchemy by Loren Cameron. Within the pages were photos and stories of transgender men (men who were born assigned female, but transitioned to male). As I flipped through the pages and saw these men’s faces, I finally saw myself. At that moment, the lump that had sat within my stomach dissolved. I didn’t know how I would do it, but I knew that I needed to transition.

After hearing my story of when I knew, if people still don’t understand, I ask them, “How did you know you were a man or a woman?” Usually they hesitate and then reply, “I just did.”

If you were starting your transition all over again and you went to a therapist for the first time and stated, “I think I’m transgender,” what is the most important thing that therapist could say to you? Conversely, what is the worst thing that therapist could say to you?

Saying the words out loud, “I think I’m transgender,” is one of the hardest things to do, especially if it is the first time. My therapist was the second person I chose to come out to. Prior to our session, I had organized photos into a timeline that I planned to use as a prop. I stumbled to find my words, and my hands shook, but while describing my feelings I would lay a photo down on her desk to provide further evidence. I could tell she was waiting for the big reveal, so I nervously whispered, “I think I am a boy.”

She looked at me, took a deep breath, and simply responded, “OK, I know nothing about this topic, but I’m willing to learn.” Her comment had a huge impact on me because I was afraid of coming out to her for fear that she would reject me, or tell me this wasn’t real and that my feelings were just due to my past history with an eating disorder. To have her not even hesitate, and to hear her say, “I’m willing to learn,” sent me the message that she would be there for me and she would help me in my journey.

Other helpful therapist responses might include:

How does it feel for you to say this out loud to me?
Tell me more about what you mean by “I think”?
What thoughts are you currently having?
What thoughts and feelings have you had in the past?

Staying open-minded and sitting with a client who is exploring gender identity is key. Also, not assuming or putting the client in a box is extremely important.

Things not to say to a client include:

I am surprised to hear you say that.
You don’t act like a boy/girl.
I’ve worked with transgender clients in the past, and I don’t think you are transgender.
Are you sure?

Similarly, how would you want your friends and family to ideally respond to the news? And what would be the thing you’d least want to hear?

What I would most want to hear is, “I love you,” followed by, “I’ll support you no matter what.” These are the most powerful and impactful words a transgender person can hear when first coming out. There are so many unknowns in a transition that it often becomes very overwhelming. Knowing that you are loved and supported—even if you and the person you are coming out to feel scared, concerned and/or worried—makes what’s to come feel more manageable.

Sadly, this response isn’t one that is always given when a person chooses to come out, primarily due to the other person’s confusion, fears, ignorance on the topic, and feelings of shame, embarrassment and/or denial. The phrases you don’t want to hear include:

You are not transgender. You’re just confused.
You are making this up.
I don’t want to hear about it.
This is just another phase.
I’ll always love you, but as my daughter/son.

In your book, your brother at one point tells you that he always thought you were transgender. Do you wish that he’d mentioned that to you sooner, or are you glad that he let you discover things in your own time?

After my brother told me that he already thought I was transgender, I jokingly said to him, “I wish you would have told me because I didn’t know.” But in reality no one can tell you who you are; you need to discover it on your own.

In looking back at my life, I truly believe my awareness of my transgender identity came to me at age 25 because I wasn’t able to handle it prior. Through six years of therapy before that time, I was able to grow and overcome some of my other struggles, and I was also able to find comfort in forming my identity outside of my family, but I wasn’t ready to admit that I am transgender.

My heart breaks every time I think of the adolescents who have internally affirmed their transgender identity but have not received external acceptance or support from their family, friends or school. I am not sure I would have been strong enough in my teenage years to hold this knowledge about myself while trying to survive in my small Nebraska town.

For providers and families who have a gender creative or transgender child, I just ask that you remain open and allow the child the space that he or she needs to further explore his or her identity. The stories we see on the news about suicide, bullying, and harassment should be enough to make us understand that this isn’t a phase and these kids are suffering. Furthermore, research shows that accepting families create happy and healthy kids. If a clinical provider is working with someone that is transgender, then it is that therapist’s professional responsibility to seek training, join resource networks, find qualified referrals, and recognize his or her limitations.

Your support network in the book is pretty much all FTMs. Do you also interact with the MTF community? Or are the support networks pretty separate?

The two trans men that are prominent focuses in my book are like brothers and sons to me, and each has had a huge impact in my life. That said, everyone’s support network is different. I found refuge with other trans men, both online and in a few friendships, but I also had (and have) trans women as good friends. In looking at the community as a whole, where people find support depends on who they are and what they are seeking. Some people limit their interactions to certain groups, while others are very mingled. Not every transgender person is the same, and recognizing that is beneficial.

You’ve dealt with a lot of secondary issues (on top of being transgender), such as an eating disorder, possible struggles with alcohol, etc. Is this common among transgender people?

If you look at national surveys conducted by organizations like the National Center for Transgender Equality and the National LGBTQ Task Force, you’ll see that mental and physical health issues impact people in the transgender community much more often than in the general population. Discrimination, stigma, rejection by friends, family, partners, and spouses, racism, mistreatment by health care and mental health providers, and lack of financial resources all have a dramatic impact on people in the transgender community. Because of this, substance abuse, intimate partner violence, eating disorders, depression, anxiety, suicidal ideation, and self-injurious behaviors are all common in the transgender community. For example, in the 2010 survey by the National Center for Transgender Equality it was found that out of the 6,450 respondents, 26 percent reported abusing alcohol just to cope with the discrimination they were experiencing.

When your book ends, your relationship with Lily is fairly new. Now, of course, you and Lily are married. (Congratulations!) Can you talk a little about what this step has meant for you as a transgender man?

There are some unique questions and potential barriers when looking at marriage as a transgender person. Since the state of marriage equality is still in limbo across the nation there is the question of: Will my marriage be legally recognized? Next, you have to ask: Will my partner’s family be accepting? Will they see me as a man? Will they support our relationship and treat us like everyone else?

Prior to proposing to my wife, I went to several members of her family to ask for their approval. (I know this might be viewed as very traditional, but there are some things that I am a little old-school about.) They all were open, welcoming, and excited for us. I’ve been very lucky in my relationship and the people I now call family.

For a longer answer to this question, I encourage readers to check out an interview that I did with Dr. Robi Ludwig, published on the Huffington Post. In this interview, I discuss my perspective of marriage as a transgender man, including my fantasies around marriage from childhood to adulthood, my concerns about coming out to my wife’s family, and how I deal with what I perceive as my own limitations in life—specifically reproduction and the inability to produce sperm.

In your book you talk about how Larry King asked you, on air, “When will you be complete?” and how that was a very difficult question for you. Is that a simpler question now? Either way, how would you answer that question today?

Larry’s question still stirs complex emotions and thoughts for me. Back then, when thinking about physical rather than emotional completeness, I believed that having a lower surgery would be an endpoint for me. It has now been seven years since my lower surgery, and I can say that I still don’t feel physically complete. I believe the reasons for this are related to the limitations I experience regarding reproduction and certain sexual behaviors. The concept of “completeness” is a topic that I am exploring in the second book I am writing. I find that so much of what we focus on is the beginning of a person’s transition, but what happens after they have transitioned? How do people feel about themselves, their lives, and their bodies?

If I had the chance to answer Larry King’s question again I would say, “Life is always in transition. When will any of us ever be complete?”

Other than your own book, what resources (other books, websites, research studies, support groups, etc.) do you recommend for transgender people, their loved ones, and their therapists?

Doing an internet search will pull up hundreds of different resources and books that may be helpful. In order to not get overwhelmed, first think about a specific area that you are interested in exploring. Are you interested in personal stories, medical and mental health care, media coverage, family and friend support, politics and legalities, or movies and documentaries?

If you want to begin with professional organizations, some helpful resources include:

World Professional Association for Transgender Healthcare
National Center for Transgender Equality
National LGBTQ Task Force

Los Angeles Gender Center
Lambda Legal
Center of Excellence for Transgender Health

TransLine - Project
Trans Youth Family Allies
Gender Spectrum

People might also want to read another interview I did with Dr. Robi Ludwig on Huffington Post. I encourage readers to check out this particular interview because what I have spoken about here is focused entirely on people in the transgender community who are either seeking to or have already transitioned—and that is not the case for every person who identifies as transgender.


I am Senior Vice President of Clinical Development with Elements Behavioral Health. I have developed clinical programs for The Ranch outside Nashville, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. Visit my website at