Various Issues That Transgender Clients came up  with In Their Counselling

A  personal perspective

By Alice Purnell OBE

These days many trans people self identify as being transgendered, then the problems can start.

Most can benefit from professionally trained counsellors and therapists.

The problems may not actually be about being transgendered, but can be related to a feeling of being “outsiders,” or very many other issues.

Medicalisation of Trans There has been a move away from medicalisation in treating trans matters, to demedicalise trans.

But when medical interventions are needed, like irreversible gender confirmation surgery, in the cases of transgender where surgery is needed, the surgeons must be certain that there is no mental illness or confusion, so a psychiatric assessment was, and is, required, thus the psychiatrist was placed in the position of gatekeeper prior to surgery.

Taking hormones has medical implications and constraints, so, from a position of the general health of a person, a doctor /physician must be involved. Unfortunately, there are many suspect fake substances sold on the internet that those in a hurry will buy suspect or fake hormones, sometimes with tragic consequences.


You should only take genuine hormones and they need to be prescribed and monitored by a physician / GP.    

One must be certain of being trans to avoid becoming one who regrets having any surgery or taking hormones.      

Many transgendered people feel some confusion, even shame, great psychological pain and isolation.

The role of counselling and some other therapies is to help the client to decide on a rational, reasonable way ahead and ways to cope. With an holistic person-centred approach these issues can be resolved. The aim of good counselling is to facilitate, to help the person to cope emotionally and with good sense and information.

The person (client) can benefit by getting qualified accredited Counselling / Therapeutic help to overcome these and other difficulties. Often there is poor self-esteem, unrealistic ideals and perceptions.

Many were bullied at school and most have experienced abuse, or trans hate crimes.

All have suffered some discrimination in employment.

Relationships are often very complex, both in the family and in keeping & finding lasting partners.

There are issues regarding children of trans people and the effect on children of having two parents of the same gender, or one parent in the process of transitioning.

There can be problems of body image resulting in multiple surgeries to try to attain a reasonable physical outcome.

Problems of ageing, isolation and loneliness are common.

There is a lack of research on the effects of long-term medications and being agonadal.

Furthermore, although there now is much information on the internet, not all of it accurate.

Although the UK Law and Society have become less anti GLBTQI people, and there is now theoretical equality, there is discrimination in employment, housing, and funding for research.

The Beaumont Trust is a small Charity so is not in a position to offer funding on any significant scale, but we still maintain our aims and objectives.

Legal Matters  Although the legal situation has improved (new amended Birth Certificates = gender identity legally recognised) and there is progress in surgical and hormonal treatment & the medical implications of Gender Reassignment / Confirmation Surgery = the medical aspects, there is still some way to go.

Now GLBTQI can marry or have a Civil Partnership.

Now hate crimes  are illegal and Society is hopefully less transphobic.

It is important that appropriate therapy be available, as the rate of suicides were very high among trans people and still seem to be higher than for the average person.

Different therapies suit different individuals, few are adequately available on the NHS

Counselling methods and Therapy can be:

Person Centred Therapy
Behavioural Therapy
Cognitive Therapy
Interpersonal Therapy
Jungian Therapy
Guided Self-help

Also helpful is Mindfulness and Yoga and exercise – and good company helps! 

The point of therapy is to help the person to develop effective strategies towards coping, to be the best version of themselves they can be, working towards the best outcome. Helping a person to make the right decisions for themselves, to take responsibility for these and to move forward without regrets as far as possible.

But there is no magic wand.

Below is a selection from the range of problems and psychological pain trans people and those close to them have said in counselling with me….

(Some were very ill-informed, confused and unhappy – others were even suicidal. )

These headings are some of the issues that my clients had said troubled them –

They came for Counselling saying they had strong feelings of:


I can’t cope I often feel I hate living like this – I want to die

Why me?

I have wasted my entire life living a lie

Life is hell if you’re not normal

My whole family has rejected me, am I as evil as they seem to believe?

I will never pass as a real woman but I can’t go on pretending to be a man

Why does everyone hate me?

Sorting this out takes too long I want surgery now, but can’t wait or afford going private

I’m too old to become myself, I will lose my family, my job and my friends – My life’s a joke.

I hate myself – so many secrets

Mum says Dad will kill me if he finds out I dress up – he hates queers – I’m not a queer -just odd

The anti depression pills don’t help – I might as well take the lot and end it.


There is nobody to talk to

Am I the only trans person in the village?


What am I?

Why am I like this?

Am I transgendered or just effeminate?

Am I wicked for wanting to be myself?

I feel I am not a man, but as a woman should I fancy men? I do not fancy men.

I was born in the wrong body, must I live like this?

It is easier in this male dominated world being a man than a woman, so I want to be a man.

A woman’s life is better than a man’s, so I want to be a woman

I hate the curse and my breasts, so am I a transman?

Dad wanted a son in keeping the family name – should I have the change to please him?

I was always a tomboy and I fancy other girls, does that mean I am trans?

I like to dress in women’s clothes so am I gay?

Do I need a phalloplasty to be a real man? 


I can’t decide what to do but I can’t go on getting no help – It’s all impossible

I was ridiculed in the street I’ve lost my self confidence- I am a monster

I don’t know who to turn to- death is my only option


Will anyone like/ love me?

I feel I was lied to because he never told me

I always knew he was weird but he is my weirdo, if only he could trust me

It’s cost me my marriage, I couldn’t carry on living a lie

My parents pretend I was dead after I told them.

He now says he is a woman but we’ve been married twenty years and I knew nothing

Effect on children if a parent is Trans

Will my children become trans because I am?

Will my children be gay?

Will my kids be bullied because I’m trans?

I don’t know which is the least damaging age to tell the kids

Effect on a partner if their loved one is Transgendered

I have stayed her wife, does that make me a lesbian?

Will she be like a sister and no longer my man?

I thought she was a dyke, but now she is on male hormones she smells  and acts like a man

After the surgery how can we have children?

So will she now help with the washing up?

I don’t mind him dressing up, but not if he goes outside, what will the neighbours think?

I thought there was another  woman, but it turns out it was his lipstick? Is he queer? 

Telling parents, partners and others

How do I tell my wife / partner/ new boyfriend/ children/ friends?

Should I tell him I was born a boy?

I daren’t tell my parents, it will hurt them, they won’t understand and I won’t inherit anything

I can’t keep it secret any longer, but it will kill my Mum

Having children

Is Adoption the only way I’ll ever have children?

How can I go about storing sperm or eggs so that I can have genetic links with my children?

Costs emotional, financial and friendships

I’ve lost all my family and friends and I’ve no job or money

My wife has left me, she can’t be married to me – she sees me as a stranger and mad.

Body Image  &  Dysmorphophobia

I hate my body, especially my tiny breasts, so I want more bigger breast enlargement surgery

I found he has been taking hormones, is that why he has lost interest in sex with me?

My male voice gives me away always, what can I do?

I tried to cut off my penis  I hate this thing

Addiction to Cosmetic Surgery

I had Silica injected into my breasts and it has moved and made me ill

This will be my third nose job, I had a cheap surgery and it went wrong- now I’ve no money left

Addiction to drugs or drink

All the money I get I spend on drugs to relieve my misery

The doctor told me to stop the booze but I can’t

I’m so alone, all the doctor does is give me depression pills so I see my dealer for“happy pills.“


I thought life as a woman would be better, but it is twice as hard if you look like me

I’m an athlete, but as a trans woman they say I have unnatural physical advantages

I still like engineering, but women can’t be engineers

More than anything I want to be beautiful

Unrealistic expectations

I keep getting my face injected to look more female, but my bones are too male looking

I want to look like a super model but I’m too tall

When the doctors say I’m too unwell for surgery I will go private, I have the money

Whatever the consequences I want to be a girl , I’m married with kids, they’ll just have to get used to it

Will I get erections after my phalloplasty and satisfy another woman in bed at last? 


How should I tell my employer, will I lose my job, will pay or promotion be effected?,

I’m a builder, women aren’t builders, but I’m a woman. 


11% of GLBTQI people in UK suffered in abusive relationships  (2019 figures)

The figures for Transphobic Hate Crime are also too high.

Bullying at school of GLBTQI and other children is still a disgrace



There are support groups for addicts, alcoholics, victims of abuse , hate crimes etc.