One of the things therapists need to understand is that mental health concerns and gender identity concerns are often intertwined. For example, a Transsexual who is unable to get the proper care may become suicidal. If all the professional sees is the suicidal aspect the client is likely to be misdiagnosed and even mistreated. The DSM currently lists Gender Identity Disorders (GID) and identifies normal transgender emergence as pathological, without acknowledging how cultural contexts create the pathology. Here's the actual section of the DSM that defines GID.

Transgender Emergence involves a lot of personal development and interpersonal transactions. The process of developing a gender identity is a normal process that everyone experiences, but for gender variant people the process is complicated by cultural expectations. Because others see you differently than you see yourself, there's more that must be overcome. As an emerging transgender man or woman, most of us must come to terms with our gender variance and move from denial and self-hatred to self-respect and gender congruence. The steps for getting from "here" to "there" are also impacted by other identity issues. (Many transgender people negotiate these stages without professional assistance.) We've identified these stages not as a way to "label" people or define transgender maturity, but to give clinicians an idea of what to encounter when clients come to them for help with "gender dysphoria."

Arlene Istar Lev's Developmental Model of Transgender Emergence identifies six stages in this process.

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