One Man's Story of Being Transgender in Nebraska

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Looking at these pictures, you may not see Ryan Sallans.

But he sees himself as he started life - a daughter and a sister, now a son and a brother.

It's an identity that started to form when he was very young.

Described as a tomboy when he was little, Ryan was teased as a teen and struggled to develop in a gender he couldn't connect with.

Body image issues led to severe battles with anorexia and bulimia but it was during his recovery, in therapy that Ryan first started to find who he was.

When he was 24, while browsing in the transgender section of a bookstore, the pieces of Ryan's puzzle fell into place.

He says, "I saw all these pictures and I knew that was me. I just knew it. Everything that I struggled with clicked into place and five months later I began my transition."

He describes that time as exhilarating, but scary, with his full transition taking three years.

Psychotherapist Megan Smith says many of her trans patients focus on others' reactions.

She says, "Usually a lot of our sessions are around how other people are going to cope and then in relation how are they going to cope with other people's reactions."

Ryan describes his family's reaction, saying, "My dad refused to talk to me. That's his way to deal with things that are really hard that he doesn't understand, that he's scared of. He just kind of shuts it out. So for six months I didn't talk to him at all and he removed all my pictures off the walls and all my stuff out of the house."

It took four years for Ryan's parents to start using his new name and the male pronoun.

The suicide and depression rates in the trans community are very high.

Smith says that's because there's still such a stigma attached to being transgender.

There's also a lot of fear.

Nebraska doesn't have non-discrimination laws protecting gender identity or sexual orientation.

And depending on where they live, some transgender Nebraskans may struggle with access to both physical and mental health care.

Ryan says in the future, he'd like to see more resources for transgender residents and their families, so others can become the person they feel on the inside - just like he did.

"I feel like my struggles with depression, I feel like my struggles with the eating disorder were all outward signs of me trying to deny who I was. It's pretty amazing what happens when you honor what's real inside of you that you're scared of."