On April 18, 2015, Pam Balentine arrived in Philadelphia with her husband of 15 years, Ken. Two weeks later, she returned to her South Dakota home with her wife, Kendall.
Just before the multiple surgical procedures that changed her spouse's sex and both partners' lives, Pam was blunt with Ken.
"If you go through with this, one of us will be very unhappy," she said. " That will be me."
The scenario for Yoel and Matthew Solis was dramatically different. Fifteen years ago, Yoel, then called Yolanda, wore a bridal gown to marry Matthew in a traditional Long Island wedding. Unlike Pam, Matthew was not startled by his spouse's wish to transition. It was a decision they made together. Today, both men, who live in Philadelphia with their three children, say they are happy with their relationship.
Even their 14-year-old daughter, Erica, insists, "It's no big deal. If someone asks, I say, 'I have two dads; one of them is transgender.' No one bats an eyelash."
There are no reliable statistics on what happens to marriages and families after a spouse declares that he or she is transgender. A limited survey of 6,450 trans men and women, recently published by the Center for Transgender Equality, indicates that more than half of younger couples stay together after a gender transition, but only about a third of those over age 50 do so.
If anything, that survey sounds generous, experts say.
"Most marriages are not able to handle this sort of thing," says Kyle Schultz, a psychologist in private practice in Philadelphia. "The partner has changed the nature of the contract. But some say, 'I've committed to being with him or her for better or for worse.' If you ask them what they love about the partner, it is not that they are male or female … it is that they are kind, gentle, fun, good parents."
J. Jody Janetta, who teaches behavioral sciences and psychology at Wilmington University, Rowan College at Gloucester County, and Cumberland County College, trains social work and psychology students in how to work with transgender clients and their families. He sums up the attitude of spouses who can cope with gender change this way: "They get it that the packaging may be different, but the content is the same."
Financial considerations, the effect on young children, or the willingness to be more fluid about sex may also influence the decision not to divorce.
Still, "to no longer be the woman in a relationship can be devastating," says Helen Boyd, author of My Husband Betty and She's Not the Man I Married, both based on her own marriage to a trans woman. "In a marriage, you know the rules. You know who brings the chocolates on Valentine's Day. It's all scripted."
Boyd, a professor of gender studies at Lawrence University in Appleton, Wisc., says she adjusted. "I love my wife, who is an amazing and incredibly creative woman, naturally more feminine than I am. But I still miss the man I married. I have three brothers, and I like men."
"Being heterosexual is just easier," she said.
In the year after Ken Balentine delivered the stunning news of his plans, Pam had been alternately angry and depressed.
"I had no clue, not an inkling," says Pam, now 62. "We were just an ordinary couple who enjoyed being together, holding hands as we walked down the street, going to see action movies, watching reality TV, eating spaghetti at our favorite restaurant."
Now that Pam knows the full story, she feels less betrayed, and is committed to the marriage. Yet she still is on edge about her new status as a woman with a wife.
Kendall, now 50, never felt like a boy.
At age 3, young Ken pointed to his penis and asked his mother, "When is my thing going to fall off?"
When he was 13, his father, a career Army man, told Ken he was embarrassed by him. "You're walking like a girl," he scolded his son, who had already endured years of teasing at school for being feminine.
Ken reacted like many men with gender dysphoria, and modeled himself after the manliest guy he could think of. In his case, that was Bruce Jenner. "Little did I know I was walking in her shoes," Kendall says of the Olympic athlete who is now Caitlin Jenner.
Ken buried his feelings, even from himself. He dated girls, but found sex with them "completely gross." He was not attracted to men, either. At 17, he joined the Marines. He worked to become a "mean person," never smiling or laughing. "I didn't just do man," he says. "I did uber man."
By the time he met Pam, he had convinced himself that he was male. At 12 years his senior, she found him an "old soul" and loved their long talks. "She wasn't big into sex," says Kendall, "and I liked that. We were a perfect match."
But within a few years, he no longer could deny his relentless pain and anxiety. When Pam spent two weeks away from home to be with her grown children, Ken used the time to think and explore. On a Google search, he typed in, "My body doesn't match me. I want to be a girl."
He read about transgender people in the search results and recognized himself.
"I became giddy and excited, and I felt relief and terror at the same time," he says.
His next thought, though, was of Pam. " 'Now,' he recalls thinking, 'I'm going to lose the person I love.' "
Pam said she "was going to leave" when Ken delivered the news. "But I couldn't stop crying. We're very close, and I couldn't imagine Ken not being in my life."
The days stretched into months as Ken prepared for surgery, swallowing the feminizing hormone estrogen and spironolactone, which reduces testosterone. He dieted and exercised off 120 pounds, let his hair grow, and bought new clothes.
He chose Bala Cynwyd surgeon Sherman Leis, nationally recognized for his expertise in gender reassignment procedures. As apprehensive as she was, Pam felt reassured by meeting Leis. He marked Ken's body to show the couple where he would do breast implants and explained the face and neck lift, lowering the hairline, shortening the upper lip, eliminating under-eye bags, augmenting the chin, replacing male genitalia with a vagina.
Pam has continued to struggle since the surgery and left Kendall twice but returned when living without her was too painful. Pam is especially heartbroken that her three adult daughters will not accept Kendall.
Her anger has melted. But she still misses Ken and the big, muscular body that gave her such a sense of protection. Kendall keeps reminding Pam that she's the same person on the inside, but a better version — softer and kinder. Sex was never a priority for either of them before Kendall's surgery. Yet they are now more interested in romance and intimacy.
"In spite of how our lives have changed, the friends we have lost, the bitterness of my children, there is no one I'd rather be with, laugh with, and spend my life with," Pam says. "I keep hoping that as transgender people become more visible, others, including my children, will be more accepting."
Yoel and Matthew Solis were both theater majors in college. Gender identity issues were acknowledged and discussed freely.
Matthew, now 42, knew that his then-girlfriend identified as somewhere on the spectrum between male and female, but was sexually attracted to men, and appeared feminine with her thick mane of dark hair.
A year after they married, the couple had a daughter, Erica, then twin sons, Colin and Phillip, all nursed by their mother.
Meanwhile, Yoeli, as friends called her, was shadowed by depression. She confided to Matthew and others close to her "that I felt more male than female." Six years ago, Matthew urged his wife to explore the possibility of becoming his husband.
In May 2011, Yoel, now 49, began injecting himself weekly with testosterone, which he must continue for the rest of his life. He had his breasts removed in December of that year.
Yoel hopes to have his genitals altered in what is generally called "bottom surgery" in two years, depending on finances and his work schedule. Meanwhile, he and Matthew continue to enjoy sex. "It is even better than before," says Matthew, "because Yoel feels so much more at home in his body."
According to Gary J. Gates, director of research at Gallup and former research director of the Williams Institute at UCLA's School of Law, there are now 1.4 million transgender people over age 13, a number that has doubled since 2011. More often, gender is seen as an identity that can change through a lifetime rather than being unequivocally determined at birth.
But when the transition happens after marriage, and especially after childbirth, there is more at stake. How will the families, and especially the children, react? How will the world receive us?
"In some ways, already having had children made it easier," Yoel says. "I didn't need my breasts anymore."
The couple's experience is perhaps unusual, but not unique, says Kenneth M. Maguire, senior staff psychologist at Philadelphia's nonprofit Council for Relationships.
"In younger generations, there is more flexibility in the way relationships go," he says. "They are communicating about it, which opens up support and allows more room to transition. In those cases, it is more likely the relationship will survive."
Matthew and Yoel encountered no resistance from anyone who mattered to them. Yoel's aunt and uncle, who raised him, were supportive. "When you are transitioning in your 40s, you get taken more seriously than when you are 17," Yoel says. "They knew I was constantly getting sick, was exhausted by the end of the week, and had no energy. I never identified it as depression, but I think they recognized it before I did ."
Yoel and Matthew chose to live in a particularly liberal part of Philadelphia, Mount Airy, and joined Germantown Jewish Center, where they found people who fully accepted their family.
Erica, who remembers when Yoel was "Mama," not "Abba" (Hebrew for father), was 9 when he transitioned. She was embarrassed, and didn't want anyone at school to know. Today, at 14 and a freshman at Central High School, she insists that nothing about the way her family lives has changed: "They are your parents, and within a year or so you just get used to it."
Yoel, she says, is "still the same person he was when he was my mom. He's just less depressed and much happier now."
Now age 8, twins Colin and Phillip don't remember Yoel as "Mama." Transgender is a familiar word to them, good for a gentle joke, not shame. Phillip points to their cat and says mischievously, "His name is Winston. Did you know he is a transgender cat?"
Danna Bodenheimer, who founded the Walnut Psychotherapy Center in Philadelphia to specialize in treating the LGBTQ community, says no one should find it odd when a couple stays together after a gender change.
"When you love someone and they transition, you see them come to life, and you can love them more," she says. "It is anxiety-provoking to live in the wrong gender. So someone who is less anxious and depressed makes a marriage healthier."
"Thinking that gender is biologically derived is an old-fashioned idea," says Helen Boyd. "Gender is malleable … you can change your gender, the way you express it … and be happy."