“What are they doing to themselves?
What’s the difference?” he said.
“I don’t want to talk about it, because it’s such a taboo subject.”
“What do you do?
What do you say?
What are you doing?” he added.
It’s a question many transgender people, as well as those with a gender identity that differs from the one they were born with, may not have been asking.
In the last year, researchers have begun to investigate what may be behind the apparent gender difference.
And it could have something to do with a genetic predisposition.
A genetic theory that explains the gender difference is called transsexualism.
It is based on the idea that there are two sexes, a male and a female, and that some people are born with one sex and others with the other.
The idea that a person is born with a specific gender or gender identity is known as a sex-determining mutation.
“The theory is that the body has a way of determining if someone is male or female,” said Dr. Julie DeBenedictis, a psychiatrist at the University of Chicago who specializes in gender identity disorders.
In some cases, it can be based on genetic testing.
For example, if a person’s father is transgender, he could have had his genetic makeup altered during childhood, which could lead to the female-to of the body.
It’s not clear how many people have undergone sex-changing surgeries, or whether the surgeries are necessary, or how often they occur.
But a 2012 study found that among 1,902 transgender men who had been diagnosed with gender dysphoria, the majority had undergone sex change operations.
According to the Centers for Disease Control and Prevention, there have been nearly 800,000 gender reassignment surgeries in the United States since 2007.
But the gender-dissatisfaction associated with gender reassignments may not be as widespread as people think.
“People are not aware of the extent to which gender dysphoric patients are actually suffering from gender dysphorias, or they are not reporting their gender dysphorians to the health care system,” said Deborah Nesbit, a psychologist who studies gender and sexuality at the UCLA School of Medicine.
For transgender people who have transitioned but have been living as the opposite gender, it’s often hard to recognize their gender.
They may not use gender-neutral pronouns or dress like the opposite sex, or sometimes even have gender-related body hair.
“It’s hard to tell people what they feel,” said Nesbits, who has worked with transgender people and their families for nearly 20 years.
“Gender dysphoria is often a way for people to hide their identities, so it’s hard for them to see their own gender as different from what they are.”
Many transgender people also have severe social and psychological issues that can make it hard to come out.
“When people feel trapped, it doesn’t make it easier to come to terms with their gender identity,” said DeBensit.
For those people, DeBenits said, there’s often not enough support, and “they feel like they’re never going to be seen as normal.”
“When you’re in a world where you’re expected to live your life like a man, it really makes a huge difference to be able to be yourself,” she said.
Nesbits is part of a team at UCLA studying the prevalence of gender dysphorian disorder in transgender people.
“I know I have to be careful in speaking up, because I don’t feel like my voice has anything to do on the spectrum,” said Kaitlyn, who asked that her last name not be used.
“But I’ve experienced so many things that I wouldn’t have known about if I hadn’t transitioned.
I’ve seen how things get twisted, and I’m terrified of what’s going to happen to me.”
A woman who wished to remain anonymous said the hardest part of coming out was not knowing who she was.
“As soon as I came out, I was immediately ostracized, treated badly, and treated like I was crazy,” she recalled.
“And it’s like a giant kick in the gut.”
But there are signs that it’s starting to change.
In recent years, researchers are starting to track the prevalence and consequences of gender identity disorder among transgender people as well.
Last month, a study published in the American Journal of Psychiatry tracked the social and medical support transgender people received in the last five years, including counseling, referrals to mental health services, and support groups.
In one case, a transgender man from California who had transitioned and had undergone a genital reassignment surgery was placed in a gender-affirming group.
But he said he felt like he was treated like a woman, and had to make a lot of adjustments to get along in his new gender.
“My therapist didn’t want me to tell anyone, and it made me feel like it was a betrayal,”