When I was a first-year psychiatry resident in Boston, one of my very first patients was a male-to-female transsexual. Being naive to psychiatry in general, I was hardly prepared for what was then a rather "unusual case." This led me to the literature on transsexualism, particularly to first-person accounts by transsexuals (1,2,3,4,5,6,7,8). She's Not There: A Life in Two Genders stands out as a book by a writer who tells the story of a life, one component of which is changing her gender.

As a man, James Boylan was an English professor at Colby College, cochair of the English department, and an author; as a woman, Jennifer Boylan is the same. As a man, James was the husband of Grace and the daddy of two sons; as a woman, Jenny is the partner of Grace and the "maddy" of these two boys. It is perhaps simultaneously the transformation of a life and the capacity of Boylan and those around her to sustain support, affection, and respect as a constant through this change that is the most dramatic aspect of She's Not There.

Although this autobiography is about a "quite unusual case," transsexualism itself is certainly not as infrequent as previously reported, and probably much more frequent than many of us believe. Equally as important as the subject of transsexualism is the fact that She's Not There is really the story of making self-affirming choices in life. In this way Boylan, a Mainer, tells a story that is far more mainstream than fringe. For the point of self-affirmation alone, She's Not There is well worth the read.

Boylan has a central problem in her life as a man: she lives her life as a lie. Boylan writes, "As I walked through the woods, sometimes, I wondered on the 'being alive' problem. I'm still transgendered, I thought. Even though my life has been transformed by love. I still feel like a woman inside. At every waking moment now, I was plagued by the thought that I was living a lie. It was there on the tip of my tongue as I taught my classes; it was there as I made meatballs for the woman I loved; it was there as I took the car through the car wash and shoveled the snow and built the fires and played piano and flipped pancakes. It was fair to say that I was never not thinking about it." Boylan points out that throughout her life, before crossing from male to female, "for much of the year I felt like a chalk painting dissolving in rain."

Boylan's story is told with both feeling and humor. The humor often comes with a twang of insight. For example, "I saw a therapist not far from my home who claimed to specialize in gender issues. He had an office in a building that more than anything else resembled the Island of Misfit Toys. Beneath this single roof was a Massage Therapist, an Aroma Therapist, a Polarity Therapist, and a Numerologist."

Boylan's surgery, the final phase of the change from man to woman, occurred on June 6, 2002—that is, not that long ago, which gives immediacy to Boylan's account. You can feel the impact of Grace's call to the man who was her spouse after surgery when she says, "Whatever else you say about my husband, she's a remarkable woman." You can feel Boylan's discovery of orgasmic sensation as a woman. You can feel her seek out the feminine and masculine aspects of herself as a woman just like she did as a man. And you can gyrate with the ribaldness of Boylan's letter in May 2002 to NASA, when she volunteered to be the first transsexual in space. At the same time, the story's profound message comes through: "I believe that God made us all a certain way, and that the adventure of life is largely the challenge to find the courage to become ourselves. For many of us, the challenge that is given us is to find that courage, to be brave, and to stand up for the truth."

Anyone who gets up in the morning and doesn't think, "I'm a man today" or "I'm a woman today" should read She's Not There. Yet such individuals are a tiny subset of the potential beneficiaries of Boylan's wisdom. Although She's Not There raises many questions about gender, at the end of the book I found myself reminded of John Pentland Mahaffy's response, around the turn of the century, on being asked by an advocate of women's rights, "What is the difference between a man and a woman?" His response: "I can't conceive."

Dr. Geller is professor of psychiatry and director of public-sector psychiatry at the University of Massachusetts Medical School in Worcester.