05/19/2011 03:15 pm ET Updated Jul 19, 2011

Straight Talk: When a Daughter Changes Her Gender, Does She Become a Son?

Q: My friend's daughter now says she's transgender and had surgery to remove her breasts last week. I guess I should have written my friend's "son." Anyway, "he" seems thrilled with his results, but he is still a girl where it counts, so it is very confusing. And does this make him gay, or what?

A: With all the news about Chaz Bono being transgender, your question provides a timely reminder of how complex the whole topic of gender identity can be -- and how easily gender identity can be confused with questions of sexual orientation. They are in fact quite different; so let me see what I can do to help you understand what's going on with your friend's son.

And he is indeed her son -- no need for quotation marks around the word. One of the basic concepts of gender identity is that you are the gender you think and say you are. The external genitalia that make a doctor proclaim, "It's a girl!" in the delivery room are not the sum total of that individual's gender identity. Chaz, who is the new face of FTM (female to male) transgender, summed it up by saying recently that gender identity is "between your ears, not between your legs."

Many transgender people have described the feeling -- often starting in very early childhood --that they were not what the world believed them to be, that their internal sense of self didn't match what their sex organs suggested they were. That's why many a little boy has grown up wondering why he felt so much like a girl; a little girl can have similar feelings about really being a boy. These feelings of confusion can be exacerbated at puberty, when a rush of hormones strengthens the evidence supporting that "wrong" identity.

Someone who makes the decision to transition from one gender to another is choosing to live as the gender that feels right to that person. For some that may simply mean changing their name and the way they dress; for others, it means taking hormones that produce physical characteristics that feel right. Others have sex-reassignment surgery, and, as you note, there are "upper" and "lower" elements to that. Most transgender people go through years of therapy and counseling as they try to determine which options are best for them, and they may take different transitional steps as time goes by. But when it comes to figuring out what to call your friend's son, the truth is that all this matters little. Wherever your friend's son falls along the continuum of transition, since he now calls himself a man, he is a man.

Whether or not he's gay is a question of who he's attracted to -- a question of sexual orientation, not gender identity. Now that he's male, if he's attracted to men, you could surmise that he's gay, and if he's attracted to women, he's not. But, it's really not up to me (or any of us) to make that determination for him; that's for your friend's son to decide and share as he chooses.

One of the reasons that issues of gender identity and sexual orientation are intertwined is that many transgender people go through a period in their lives when they identify as gay. You can see why: a young man struggling with the feeling that he's really a young woman might model himself on other women and explore relationships with men. As he comes to realize that his feelings are more about gender identity than sexual orientation, he may move beyond gay exploration and begin to transition to another gender. After he completes his gender transition, he may need time to explore his orientation once again. Again, Chaz spoke to this very issue on "Good Morning America":

A lot of female-to-male transgender people end up doing a stint in the lesbian community because it just kind of makes sense. At 13, 14, I was real clear at that point that I was attracted to women. So I was like, 'I'm attracted to women, I am a woman, I guess I'm a lesbian.' [But w]ho you're attracted to has nothing to do with gender identity. A lot of people find that really confusing, but they're two completely different things. One is how you view yourself and how you feel, and the other one is who you're attracted to.

The important thing to remember is that individuals who are transitioning can experience tremendous pain and confusion. By some estimates, 20 to 30 percent of transgender people have attempted or committed suicide. The support of those who love them can mean the world to them; it can, in fact, literally be the difference between life and death. Thanks for asking about this. I hope you use this information to provide some of the support your friend's son needs.

Steven Petrow is the author of the new book, "Steven Petrow's Complete Gay & Lesbian Manners" and can be found online at