Dear Annalisa

There’s something I’m finding increasingly hard to cope with: I’m not my parents’ daughter – I am their son. I’ve always been very tomboyish and relished being perceived as a boy; while my parents were never entirely pleased with that, they let me be. I’ve been pretty vocal about LGBT issues ever since I was 14 and came out as gay when I was 17. My parents, who used to think that gay people were “abnormal” have both come a long way since this first announcement. But there’s more to it than that.

For the past two years, the thought that I would, one day, be able to move on and be who I am, has kept me going. My friends, I think, would understand and accept me for what I am – I’ve been binding my chest for a year and have just completed a project on transgender rights, so I suspect my being trans wouldn’t come as a complete surprise. But my parents are already highly distressed, and I don’t want to add to their worries. They just wouldn’t understand; my being their daughter is a structural part of the way they relate to me.

Having said that, I am not as strong as I hoped, and the constant lying, the female pronouns, the terms of endearments – I can’t really cope with these any more. Next year will be my last year at university and I’m not sure I can (or want to) carry on being someone else. But, apart from the emotional implications, I’m funded by my parents and while I don’t think they’d ever disown me, our family situation is complex enough without my adding to it.

I don’t know what to do, but feel that unless I do something I’ll crumble and be no help at all to anyone.

Your longer letter was all about everyone else in the family. You’ll see I edited all that to get to the nub of the matter: you. I’m not surprised you feel like crumbling. You have a lot on your plate, and feeling you are living in the wrong gender can be incredibly stressful. Now you feel like you can’t have the life you want as the person you want to be without your family collapsing. And that’s not fair or healthy. I think you may have reached a point where you have to let your family take responsibility for themselves while you attend to your needs. You have to look after your mental health, too.

I went to Dr Polly Carmichael, director of the Tavistock Clinic’s gender identity development service, and a consultant clinical psychologist, with your letter. She felt you were being incredibly brave to ask for help and thoughtful to think about the impact this will have on your family.

“It’s clear,” Dr Carmichael said, “that you want to be accepted for who you are. And there isn’t a right or a wrong way of approaching this, but planning [how you’re going to talk to your parents] and thinking things through will make it easier.”

Dr Carmichael thought it would be helpful to think about how you’d like your family to support you (this could be, as a starting point, that they call you by the male pronoun). She felt it might help you if you thought of it as more “about wanting them [your family] to share how you feel, not for them to pick up the problem”. To be clear: we don’t think you want your family to pick up the problem; quite the opposite. But if you tried to see it differently – that it would be less of a problem and more of an opportunity – it might help you to feel less like you’re going to tip the already delicate family dynamic.

“At the moment,” Dr Carmichael said, “what feels unmanageable is that you’re putting your feelings aside.”

I wonder if you know about genderedintelligence.co.uk? Not only is there lots of information, it also offers support groups and groups where families can meet up.

You parents may have doubts, fears and even feel upset when you tell them. It may be worth rehearsing how you will do this. They will have a reaction, but I think it’s very important that you talk to them. Tell them how you feel, what you’d like to happen next. I think the more confident you can be, the more confident they will feel. Remember that although you’ve known about this for a while, for them, it’s all new. They may have some gauche questions.

Dr Carmichael was keen to stress that there are many variations in gender identity/expression); male, female as well as people who don’t identify fully with either. Working towards the gender you feel comfortable in and that allows you to be you, takes time. People follow different paths and may or may not decide that hormone drugs and surgery are right for them and this can change over time. It is important to give yourself space to explore what feels right for you. The acceptance and support of family and friends in this can help enormously.

This article first appeared in The Guardian on 1 August 2014.