Having just found this thread via the 'Sexual/gender identity thread I need to add a few comments.
Re gender dysphoria when a family is involved. we have to bear in mind that, for the older contributors here, marriage and family was an almost inevitably unavoidable concept when we were growing up. It was more or less hammered into us on a daily basis- this was our fate and compliance was expected of us. Add to that the almost petrified concepts of 'man', 'woman' and their roles back then and it doesn't surprise me that many of us reached 'The point of no return' much later in life and with the problems of family on our plates.(Luckily (hindsight), fate has seen to it that the various chalices of relationship, family etc. have passed me by.) Interestingly, when I finally came out, various friends said that they weren't surprised(!) which puzzled me a bit. How did I blow my cover?
Imagine you've got to hold a large beach ball or a green physiotherapy ball under water. At the start, and for a good while it's easy but...then you start to tire and the ball starts to come up. So.you redouble your efforts and push it down again....and again you begin to tire. This goes on and on with ever shorter intervals until you eventually reach a point where you have to realise and accept that things can't go on like this and the problem has to be faced. Some of us bite on the bullet and adjust our lives, others will unfortunately choose suicide.
There are quite a few transgender musicians in jazz and rock and there musical proficiency seems to be decisive although, in contrast to the 'folk scene' as members in bands they're less noticeable and there's usually a good few metres between the band and the audience anyway. In any case, at a rock gig the punters are too busy leaping about to question the gender of, say, the bassist. In the folk scene we're predominantly soloists and almost on top of the first row of the audience.
And the folk club/ open mike evenings? Well, I'll have to bite on that bullet despite having to use 'his' voice. It's possible to adapt the speaking voice but the singing voice is another matter, as is anything involving being loud.
It's a pity that Louisa Jo Killen is no longer with us as, if she'd been a Mudcatter, she could have reported 'from the front line' on her experiences as TG in the UK folk scene.