Whether your child has masculine traits or feminine traits, what ever their sexual orientation - those things have no bearing on their gender identity. Men, women, genderqueer individuals and others alternative gender identities can all be masculine or feminine, gay/straight/bi/pansexual.

Transgender issues aren't easy for most people to come to terms when they realize they have them - sometimes even in families in which those topics are openly accepted. It's very difficult to explain to someone who doesn't have the same feelings how you just *know* that what you're feeling is real. Very difficult and extremely frustrating. I didn't make this self-realization until I was in college and didn't come out until my mid-20s. The confusion and desperation that trans teenagers feel must be immense, especially with so many other life transitions happening at that time. How else could most of them cope - becoming withdrawn and depressed, trying to "fake" their way through "normal" expected behaviors or overcompensating and trying to be overly masculine or feminine in hopes of convincing themselves and others that there's nothing different about themselves.

When I came out, I told everyone I didn't want all of the surgeries available to me, just the ones that would help the general public identify me the way I wanted them to. I think that's pretty common. Over time I've been slowly changing my mind. I don't really know if I felt the other way at the beginning because I subconciously felt like it would make the process easier for the people around me, or because surgery of any type is pretty scary, or because I didn't think it would ever financially be possible for me so cultivating the attitude that I didn't need it was easier than dealing with the fact that I did need it but could never have it, or truly because at the time I didn't need it. Surgical status doesn't change identity though, so please don't use that to question your child's realization of his gender identity.

Definitely find a good counselor that can help sort through all the feelings. Also, my mother found good support at her local PFLAG group.