Welcome to Debbie Ballard's Transgender Information Site.

 Deborah Ballard aka Debbie Lawrence is a transgender woman with nearly 40 years of IT experience, nearly 40 years of transformational programs including 12 step programs, leadership training programs, open source support groups, transgender support groups and websites.  Debbie has written 6 books on transgender issues, so far.

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Keep in mind that most transgender people know they are transgender at a very young age that they are transgender, that their REAL selves are not the gender they were ASSIGNED at birth.

 

Unfortunately, most of us had to keep the real person hidden.  Transgender girls often experience a great deal of harassment and ridicule from parents, from adults, and from kids their own age.  

 

By the time they are in first grade, forced segregation of boys and girls begins, and transgender kids hate being put in the wrong group.  The tomboy wants to roughhouse and tumble and mix it up with the boys, and the sissy lives in fear of being severely physically assaulted, sometimes so badly they end up in the hospital.  These are a DAILY experience, with the most dangerous places being bathrooms, playgrounds, and outside school.

 

By the time they reach high school, most transgender kids who haven’t come out are terrified to do so.  They are acutely and painfully aware of the “girl inside” or the “boy inside”, but often they are terrified to let anyone know.  They begin to develop the mask that lets them pass as the gender they were assigned at birth, but it’s very unnatural for them.

 

Puberty has done a lot of damage, and they often struggle to SURVIVE those changes, hoping somehow that they will be able to find some way to live with those changes caused by puberty.  Puberty through early twenties is often a time where they are at VERY high risk of suicide or self destruction.  

 

Drugs, alcoholism, and suicide attempts are common.  Transgender men often get into fights, street racing, and other ways to prove their man-hood by doing dangerous things.  Transgender women often struggle to find themselves, trying to date women or men and having difficulty with both as the mask.  Love is very elusive because their partners are aware that something is being hidden.  Many end up being loners romantically, finding ways to fit in socially, within a niche crowd, but few real friends.

 

Coming out is incredibly difficult for both Transgender women and transgender men.  

 

For transgender men, the most difficult is going from “toe in the water”, wearing men’s clothes and hair style, but still being perceived as a woman, learning that they have to conform to the same strict norms that men aren’t even aware of, or settle for a more gender fluid identity with confusion of others.

 

For Transgender women, the biggest challenge is overcoming their own fear.  The fear is based on some intense reality, lots of PTSD, living with nightmares fueled by real memories of real violence, verbal abuse, bullying, and ridicule.  They have grown up knowing that their parents would reject them, throwing them out on the street if they were to come out, they have been unable to communicate with doctors or therapists who refuse to accept that they are transgender, and coaches and church leaders act like a boy who is a girl is the lowest form of life on earth, an abomination.

 

For the transgender woman, there is often a point where they try to “settle” for being a cross-dresser, dressing up in private, often keeping their secret from friends, family, even spouses and children for years or decades.  The cross-dressing gives them minimal relief, enough so they don’t just give up on life entirely.

 

At some point, many transgender women finally get the courage to get fully dressed, learn to put together a good presentation that will allow them to go “public”, often dressing up to go to gay bars or other “safe” places, usually on Friday or Saturday night, but only 1 or 2 nights a week, sometimes on the road.  If they haven’t done so earlier, this is when they give “the girl inside” a name.  This is necessary for social reasons, but also so that they can talk about their true selves with people who have met the girl, without drawing attention to themselves.

 

Initially, during the early public cross-dressing stage, there is often the perception that this new person, with the new name, is the costume, the mask, the identity.  Often this is because during this early “transgender puberty”, they tend to dress very sexy for clubs, with little or no wardrobe for normal activities like shopping on the week-end or going to the grocery store.  In this “Cinderella” stage, they even enjoy being the center of attention, being admired by others, and a personality that had been so hidden and repressed for so long comes bursting out.

 

Soon, especially if they start seeing a therapist who knows ANYTHING about treating transgender people, the transgender person begins to realize that this other person they thought was an act, a mask, is who they REALLY ARE!  They start to realize that the person they were assigned at birth is actually the mask.  The boy is a mask they have learned to wear, no matter how painful or uncomfortable, because they have to wear the mask to survive.

 

This is when the therapist follows WPATH standards of care and recommends that they start spending more time as their true selves.  The lucky ones have wives who love them enough to want their happiness, and will support them.  Too many find that they have to confront the fact that their spouse fell in love with the mask, and will leave them rather than get to know the real person underneath.  Others find that their wife becomes a friend, but the intimacy and romance they once shared has been gone for a long time, and won’t be coming back.

 

The “Real Life Experience” phase is probably the hardest part of the entire transition.  They have to learn how to BLEND in with other women, dressing appropriate to age, size, and situation.  The club wear was great for the clubs, but now they have to learn to dress less sexy, more like most of the other women in the rooms they are in.  Jeans or leggings instead of dresses or short skirts, a C-cup bra instead of a Double-D breast form, and bare legs with shorts or skirts rather than sheer energy panty hose.  Fortunately this is a relatively short period, a few weeks to a couple months.

 

Then comes the transition process in earnest.  Having a   5 o’clock shadow removed with laser or electrolysis, having arms, legs, and other body hair waxed off, having eyebrows shaped, and growing out hair.  Many therapists want to see these processes started before recommending hormone therapy.

 

Hormone Therapy (HRT) is often a three phase process.  First, the doctor needs to get natural blood levels of testosterone and estrogen before starting anything.  Many transgender women already have low testosterone levels, either part of the same biology that made their brains feminine, or attempts at self-castration during early puberty.

 

Then the doctor will start the “Blockers”, these are medications like Spirinolactone or Finistride, also used as diuretics and for prostate reduction.  These blocker lower the amount of testosterone in the system.  Doctors use blockers on younger trans-girls if they are near age of puberty, but often wait until 14 or 15 to start the estrogen.  

 

One of the important things about blockers is that they also function as chemical castration.  In fact, these same medications are given to sex offenders to prevent them from being able to be sexually active.  

 

For adults, the doctor will start the estrogen within a month or two, as soon as he can determine how much the estrogen levels increase.  Estrogen levels have to be very carefully monitored.  Too much can cause blood clots, heart attacks, and strokes.  Too little can result in stunted feminization.  In most cases, the doctor will try to monitor testosterone, estrogen, and prolactin to make sure that they are the same levels as a muenstrating woman, often a girl going through puberty.

 

By this point, the trans-girl is living at least half-time as a woman, pretty much only living as a man during work hours.  She has already planned her transition at work, often making sure she understands the companies diversity policy, especially their policies toward LGBT issues.  Often, they have already contacted the LGBT community contact, as well as LGBT centers in their area.

 

Female coworkers are often the first to notice the subtle changes.  The thinning eye-brows, improving complexion, and the budding breasts.  This is a period when trying to continue as a man gets awkward, wearing compression shirts or binders to protect the breasts and keep them from showing at work.

 

Often, the transition at work and the name change process are closely coordinated.  It’s best to tell your employer LGBT contact that you are planning to transition so they can plan the transition with you.  The legal name change requires that you publish your name change in the local paper, but it has to be a major paper.  Many of us by this time have already established e-mail accounts and other accounts in our planned name, and when the name change is approved by a judge, we begin the process of getting our name and gender legally changed on all our documentation, including driver’s license, passport, credit cards, bank accounts, and credit agencies.

 

The day we transition to full-time, is often a very happy day for us.  We finally get to live authentically.  We can finally stop pretending to be something we never wanted to be, and start being who we really are.  We may have to learn new rules and codes of conduct, for example, when to start speaking in business meetings, how to guide a man to the right decision or action without direct confrontation, and so on.  Ironically, for many of us, it actually comes quite naturally.  In fact, it was a struggle to do it the “man’s way” and we only did it because we would be perceived as “wimps” if we did it as men.

 

The final stage, which is often optional, is getting the Gender Confirmation Surgery (GCS).  Keep in mind that GCS very expensive, as much as $30,000 including everything, and often it’s a challenge to get it covered by insurance.  Many insurance companies only cover half because it’s “out of network”.

 

GCS is not “chopping it off”, it’s actually turning the tip into a clitoris and turning the shaft inside out.  Bringing up a second problem.  Many transgender girls are not well endowed to begin with, so the simple surgery may involve grafts of skin, colon, or paratineal tissue that is used to provide functional depth.  After the surgery, it is necessary to dilate regularly, at least once a day for the rest of our lives.

 

Other trans-girls opt for an orchiectomy.  This is necessary because at some point, the blockers become less effective, and there is the risk of going through male puberty again.  This is a MUCH less expensive procedure, costing about 10% of the cost of GCS.  The orchiectomy essentially makes us eunuchs.  The chemical castration has eliminated the ability to have erections or ejaculations, but not orgasms, in fact, the orgasms are more like female orgasms and possible in a number of different ways.  The orchiectomy just makes this permanent.

 

Some transgender girls, a small minority, like to become she-males.  They often get breast enlargement surgically and discontinue or reduce blockers and maintain lower doses of estrogen.  They are often gay and enjoy being “tops”.  Even so, these women are very careful not to put their junk on display for anyone other than their lover.  As a transgender woman, she wants to be accepted as a woman in her regular life.

 

This was probably more than you ever wanted to know, and it’s long.  I have written several books on the topic and my web site debbieballard.org has a bibliography of transgender fiction and non-fiction to give you a sense of what is involved and the thinking and feelings we experience as we are going through the various stages.  I strongly suggest you look at a few of them.

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I originally posted this on Facebook Jan 13, 2018

 

There are many dimensions of transgender. I created the transgender matrix to help identify the different needs. Different people have different needs, and are at different places in terms of where they are currently, and where they want to be.

The cross-dresser still in hiding, the tom-boy fighting for acceptance, the drag queen who cries when she takes off her makeup, the girl taking hormones on the internet, and the transsexual getting her GRS all have one thing in common. The gender they were ASSIGNED AT BIRTH, based solely on what the doctor or midwife saw between the legs seconds after we were born, does NOT match the GENDER we actually are inside.
Many of us could prove that the doctor got it wrong. DNA tests, CT brain scans, and even body chemistry and internal MRI scans may show that the soft tissue between the legs doesn't match the brain or the genetics, or the overall biology.
In some cases, we were even surgically modified at birth, and all records destroyed. A "boy" whose penis was to short was turned into a girl, a girl with a penis had her vulva sewn shut because daddy wanted a boy. Often the surgery was followed by high doses of hormones, testosterone to masculinize the ovaries into testes, or estrogen to shrink the clitoris. About one in 100 births exhibit one of about 30 forms of "gender ambiguity", one in 50 people have gender ambiguity biologically. 1 in 15 exhibit gender ambiguity behaviorally before they are 7 years old.

In elementary school, there is often a "forced normalization", boys are kept together, and separated from the girls. Ambiguity results in teasing, verbal abuse, rejection, bullying, violent assaults, even group assaults by large groups of boys. Much harder to suspend, expel, or arrest 15 boys when only one sissy was attacked, even if they ended up in the hospital.
Often the bullies are encouraged by parents, preachers, Sunday school teachers, and athletic coaches, to even escalate the abuse. Since many principals and school administrators started out as coaches, they often side with the bullies, saying "boys will be boys".
Years of daily cruel and unusual punishment, without knowing anything other than that they called you a "sissy" while beating you, can lead to a LOT of emotional problems. PTSD, depression, isolation, distrust of others, and general anxiety are common.

Then comes puberty, slamming the door on any hopes of escape. Trapped in bodies we hate, terrified to let anyone know how upset we are, we act out. Many of us turn to booze, drugs, sex, and self mutilation to escape the pain, even if only for a few hours. For many of us, suicide seems like the only permanent solution to a permanent problem.
If we survive, we begin to build a mask. We create an image that is "accepted". We might be funny, or tough, a tom-boy might dress more sexy, whatever it takes to survive.

Our mask helps us win. We succeed at school, date, make friends, and even succeed at work.

The problem is that the more we win, the more uncomfortable the mask gets, each win is like another jagged edge, a spike, a nail. Meanwhile, others are perfecting the mask. Putting a pretty smile on it, decorating it with praise and awards, making it tighter, and worst of all, those close enough to see the real person underneath, add locks, to make sure we can't ever take it off. Children, property, house, career, all locks to make sure the painful mask can never come off without losing everything.

 

Only 1 on 10 transgender people are able to take the mask off. For the great majority of those still locked in their iron masks, seeing us transition, and blossom into our true selves, is just another nail in the mask.

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Too often, society and even therapists tend to focus on only one dimension of the transgender person, I came up with this matrix to help people understand the broader dimensions of transgender people.

Severity

Social

Personality

Expressions

Sexuality

Dysphoria

0-Cisgender homosocial, alpha, popular Aggressive, violent, bullying, Extreme cases become criminals. Sexist, Elitist,views opposite sex as inferior. Excessively masculine or feminine, conforming to birth gender. Views opposite sex as playthings, objects, or alien creatures. Very comfortable with birth gender, threatened by those who aren't
1 – Stealthy beta, friendly, heterosocial, mix of friends, boys and girls. Friendly but withdrawn around alphas of their gender. plays games with both genders, enjoys both. may dress in a few items of the opposite sex, privately. Mild, mostly normal, bullying usually limited and infrequent.
2 – Masked beta, mostly heterosocial, most friends are opposite sex, close friends of same sex. Isolated, socializes when needed, but avid reader, games, private activities. Intelligent, prefers company of opposite gender, enjoys company of same gender. limited sexuality, confused, occasional cross-dressing, limited in scope, usually private or descreet. Mild dysphoria, frequently bullied, puts on “Act” to prevent abuse (clown, smart, goofy)
3 – Emerging Most friends are opposite sex, only a few friends of same sex. Isolated, avoids recreational activities and sports, avoids, same-sex activities most. Isolated, avoids social interaction with same sex peers, avid reader, often trying to figure out EVERYTHING because nothing makes sense. Isolated sexuality, may even avoid sex with partners, cross-dressing for both sexual and nonsexual satisfaction. May dress for extended periods privately. Severe, struggles with attempts to emulate birth gender, chameleon, evasive, deceptive. Dislikes birth gender but struggling with the idea of transition.
4 – Public Nearly all friends are opposite sex, same sex relationships may be romantic. Isolated, mood swings, unusual wisdom, avid reader, researcher, seeks to understand people. Refuses to participate in same-sex athletics, especially team sports. Everything seems unreal, isolated even in a crowd, focused, studies same sex & opposite sex. May act or dress more like opposite gender.
May be gender fluid, doing both masculine and feminine things in behavior and appearance.
Avoids sexual and romantic encounters with partners. Dislikes being recipient, dislikes genitalia. Masturbation fantasies are as the opposite sex. Self-abusive, genital mutilation, binding, tucking, drugs, alcohol, suicidal, dare-devil, doesn't care about dying, but not actively persuing.
5 – Transsexual Very few friends, nearly all friends are opposite sex. Avoids contact with same sex, except maybe romantically. Until transition, isolated, alone, socially “retarded”, rude, intellectual bully, lonely. Until transition, almost autistic, depressed, lethargic, argumentitive, drives people away. Pre-transition – sexually giving, but derives little or no satisfaction as receiver. Avoids sex. Critical – suicidal and secretive, drug addiction, alcoholism, overeating, high risk behaviors, often without telling anyone about the pain they feel has been ignored.
6 – During Transition After starting transition, more social, more friendly, more fun to be around, more friends. Very social, especially with other opposite sex people. Enjoys flirting, socialization, and cares about people. Friendly, outgoing, caring, compassionate, kind, loving, able to experience love. Sexually generous and enjoys receiving, often adventurous and creative, may enjoy sex with more kinds of partners, bisexuals may start gravitating toward opposite sex of their target gender. Much happier, enjoys life, enjoys people, service oriented, helps others. More interested in health, fitness, and staying healthy and happy.
6 – Post Transition homosocial with target gender, popular, friendly with both genders. Outgoing, pleasant, polite, happy, supportive, kind, enjoys a happy life more like a cisgender person of the target gender. Consider themselves their target gender, more like cisgender member of the opposite sex. A bit stealthy about previous life. Genuinely cares about both genders, treats partners as special gifts, generously return love when given. May struggle with PTSD, fear that they will have to go back, grieving lost youth in wrong gender.. Generally much happier and healthier, may even look and act younger.

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Paul McHugh has a long history of opposing transsexuality, claiming that gender identity and gender preference is malliable.

McHugh makes valid assumptions, because about two-thirds of the population is bisexual and two-thirds are gender-fluid. 

1/6 are inflexibly heterosexual.  Men who would prefer Kellyanne conway to Tatum Channing.  And women who would prefer Donald Trump over Emma Watson.

1/6th are exclusively homosexual and would prefer almost any guy over almost any woman.

The folks in the middle will usually be conformant to cisgender-heterosexual norms if the social pressure is intense enough. 

Outdated Research

Paul McHugh bases his conclusions on surgeries performed by Johns Hopkins university by doctors who based their methods on hand-drawn notes.  From the late 60s to 1972.

There were no WPATH screening, no Standards of care, no therapist before and after surgery.

As a result cross-dressers who were still in the closet were getting "the sex change operation" with zero real life experience. 

Botched Operations

Hopkins operations were notable because the vagina was too far forward, there wasn't enough dilation, and depth was minimal.

There was minimal follow-up so when people DID come back to John's Hopkins for follow-up support, it was usually because they didn't have a support network,  lost jobs, families, and homes.  They also had difficulty in relationships with men because their plumbing was so unnatural. 

New Standards of Care

Today we have WPATH Guidelines and Standards of Care,  candidates for surgery have already been on hormones at least a year and living full time as women for at least two.  Most do therapy or support groups or both.  They have built up an environment that supports them as women even before the operation. There are books about the whole process.

Better research on more subjects

Unlike McHugh, who bases his conclusions on a small group of "dissatisfied customers", the last two decades have provided empirical research on thousands of respondents to over dozen surveys of transgender people ranging from cross-dressers to post-op transsexuals.  Furthermore research on suicide lines, including lines dedicated to serving the transgender community,  have provided insights into those who actually end their lives.

As a result, the diagnosis,  treatment,  and effectiveness of treatment for transgender people has been vastly improved since McHugh retired.

McHugh was treating people with a hammer and punch, modern treatment and diagnosis includes blood tests, CT scans, online training and support, thousands of books and online articles, and better legal protections in many states.

What we do know now is that 2 to 3 million people struggle with gender dysphoria.  Of those, roughly a third are seeking transition in some form.  The most common being hormones and breast modification.  Of those, about a third actually undergo "bottom surgery".  Most MTF transsexuals want the surgery but have obstacles that may take years to overcome.  These include lack of insurance coverage,  shortage of surgeons, medical issues such as weight, and lack of "raw material" needed for penile inversion.

As a result,  those who succeed in completing the surgery are always happy to have the completed operation.

We know that half of all transgender people attempt suicide prior to transition.   Those with unsupportive families and friends are at the highest risk, over 80%.  Of those who attempt suicide, over a third will eventually succeed.   Again,  the highest risk are the most repressed.

Transgender people have higher intelligence and are very good at keeping secrets,  especially their Gender Dysphoria,  if they experience rejection, condemnation,  or lack of support.

90% or more experience harassment, assaults, sexual assaults, and threats BEFORE THEY TRANSITION, most before even telling their own families.

Many have been in traditional therapy and were shut down if they talk about wanting to be the opposite sex.  The result is that the dysphoria gets worse and they stop trusting their therapist. 

McHugh bases his observations on a passive view of a few hundred subjects in clinical summaries.

The findings I'm citing are based on 30 years of active interaction with thousands of transgender people over extended periods.

Right wing groups cite McHugh and the American College of Pediatricians, because both offer outdated studies that support the notion that gays and transsexuals should be subjected to conversion therapy.  A combination of various brainwashing techniques that is marginally effective on bisexual and gender fluid subjects.   The remainder usually end up dead or institutionalized.   The only reason practitioners aren't arrested is because the torture and abuse is done in the name of "Religious Counseling".  Most have no medical credentials at all.

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Most, but not all transgender children are fully aware that they are not like others of their own gender by the time they are old enough to talk. Often, their parents can see the indicators by the time the child learns to walk.
 
What complicates things is when adults try to repress a transgender child. Sometimes the parents don't even realize the child is being repressed. For example, a father may make homophobic statements or call the boy a "sissy faggot" when mom's not around.
 
By first or second grade, transgender kids are already struggling with their forced gender. Transgender girls forced to live as boys are often severely bullied, suffering frequent violent attacks. Transgender boys forced to live as girls also find themselves frustrated, often getting into fights with other girls and even other boys.
 
Many non-transitioning children begin to isolate. Sometimes this is mistaken for some form of autism such as autism. They may become avid readers, spend hours at the computer, or bury themselves in music. Ways to avoid people and still put their excess time to some productive use.
 
Spotting the transgender girls is pretty easy, look for multiple visits to the nurse's office, especially after gym, lunch, or recess. Watch for who leaves the school an hour or more after the other kids have left (staying after class means less risk of being attacked on the way home).
 
Doctors often see patients with bruises on arms or face, but bruises on the torso and thighs a a good indication of an attack by a large group of boys, going after targets where the bruises won't show.
 
Unfortunately, all this violence, almost ALWAYS unreported, tends to make it even harder for a transgender girl to admit that they are transgender. They may deny it because they are afraid of being a target for more violence. They may say to someone they trust "I WANT to be a girl" rather than I AM a girl, because they have been told they are not a girl so many times that they no longer know how to describe the struggle between their girl brain and their (barely) boy body.
 
A child who has been battered and abused daily, with no intervention by teachers will find it nearly impossible to to ANYONE, because they are so traumatized.
 
All this only makes the dysphoria worse. The isolation becomes more consistent and persistent. During puberty, they are often moody, even suicidal. Too many are misdiagnosed with clinical depression when the real problem is situational depression. Their bodies are changing in ways they don't want. Transgender girls see hair growing and they see themselves as monsters, like werewolves. Transgender boys see their breasts developing and see themselves becoming street whores.
 
Those who actually kill themselves are only 1/3 of the gender dysphoria population. Others turn to alcohol, drugs, sex, and overeating, suicide on the installment plan, often in a self-destructive spiral.
 
Ironically, at any stage, there is a simple treatment that is about 90% effective. Transition. Transition is a process that takes two to four years to complete. Step one is living full time at home, usually evenings and weekends at first, then through the summer, if the desire to transition persists, then going to school full time as a girl is recommended. Many children change schools for this process, or they have made friends with other girls their age who will help and support them.
 
Keep in mind, if a transgender girl decides she wants to go back to being a boy, that's it! Contrary to myths perpetuated by Conservative Christian Right Wing groups, the school programs to support transgender kids to not permit "commuting".
 
They don't get to be a girl for a week, then a boy for a week, and back and forth anytime they choose. Their behavior has to be persistent and consistent. They have to look, act, dress, sit, walk, and talk like a girl all day every day for the entire school year.
 
If someone is just a cross-dresser, the clothes will lose their power to thrill, and they will decide for themselves not to transition, at least not at that time. Many transgender girls get very confused about clothes vs social and behavioral patterns. It's only when they can accept themselves fully as girls that they are ready to transition. In the meantime, the clothes give them an outlet that can ease some of the pain and suffering of their dysphoria.
 
I know that no cis-gender person can possibly imagine what it is like to be transgender. I wouldn't wish that on my worst enemy (if I had any enemies), but I also know that I will never know what it is like to be cis-gender.
 
We know that there are real biological and physiological causes for gender ambiguity and gender dysphoria. Gender ambiguity is more common than cleft palate. When you combine all forms of gender ambiguity, the odds of having a dysphoric child are greater than 1 in 100.
 
Remember, most statistics only identify the most severe forms of dysphoria, those who seek HRT and GCS, which is currently estimate at 3 million in the United States. We know that this is only about 5-10% of the entire transgender population. Gender dysphoria in more mild forms may occur in as many as one in 15 children.
 
They may be hiding their dysphoria from an unsupporting parent, trying to avoid persecution by the peers they are forced to play with, or just have fears that once they do share their secret, they will be denied help, or denied help, love, and caring.
 
This is what makes Gender Dysphoria different from being transgender. There are millions of children with Gender Dysphoria who masquerade as cisgender children until they kill themselves. It's only when the police investigate the suicide that they discover the child's true nature, and the bullying related to it.
 
If your child had a deadly disease that killed 80% of it's victims, but could be treated with simple medications and a relatively inexpensive surgery when they reach the appropriate age, would you tell the doctor not to give your child the medication? Would you tell him not to do the surgery?
 
Acute Gender Dysphoria is a deadly disease that kills 80% of those who suffer from it. Those with the condition are not able to accept their birth designated gender and are not able to transition to their preferred gender. This may be due to parental non-support, peer pressure and persecution, or religious persecution.
 
Being transgender isn't the problem. Transgender kids who transition are generally quite happy and healthy and have suicide rates slightly lower than the general population.
 
If anything, the problem is not that kids are transitioning too soon, but rather they are forced to wait for the life-saving surgery. To have a normal sexual and social life, they need surgery when they are 16, but are forced to wait until they are at least 18 years old.