They believed that many of the learned negotiation strategies, tactics and skills were inconsistent with who they believed they were as women, and specifically in conflict with their identity and how they saw themselves.

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Dr Bockting says a more appropriate standard for new identity documents would be evidence the role change is permanent and medically necessary to relieve the stress would-be transgender people experience from the conflict between their gender identity and their birth sex.

BBC: Transgender Americans take on New York

Solomon is in many ways the perfect writer for the subject nuanced, thorough, humane, and a gifted stylist and, trying to get to the root of this conflict, he pushes horizontal identity as far as it will go.

NEWYORKER: Little Strangers