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This paper presents a composite case based on a group of female-to-male transitioners with a history of trauma due to early separation or family illness. These early traumas may interfere with the process of integrating the mind and body. Symptoms of gender dysphoria often arise from, or increase in response to, subsequent separations later in life, as individuals transition from childhood to adulthood. Increased referrals to gender clinics are noted at puberty or the point of separation from the family, as individuals face the prospect of leaving home to go to university. Affected by anxieties associated with the onset of puberty or separation anxieties, these individuals sometimes seek a medical transition to gain control over their bodies. Exploring underlying psychoanalytic issues can help clinicians assess various conscious and unconscious influences, and help patients make more informed decisions on whether to pursue a medical transition. A focus on defence mechanisms and forms of thinking can help clinicians find ways of working with individuals who may be highly defensive and concrete in their thinking and feel threatened by the functioning of their minds.