Garramoni, who started changing female bodies into male bodies three years ago and has seen more than 100 patients, put it succinctly: "The kids understand. They just know that -- they say, these are my parents."
In a first-person article for The Advocate, a leading gay, lesbian, transgender magazine, Beatie said that his wife, Nancy was unable to bear children following a hysterectomy, so they made the decision that he would be artificially inseminated and carry the child.
Having children after sexual reassignment is not as unusual a decision as one might think, Garramoni said.
"It's certainly not unprecedented. Many people want to have their own child, or at least keep that option open," he said.
In many states, he added, adopting a child as a transgender person can be difficult or even unlawful.
"So when patients say they want to do that, I say 'great,'" Garramoni said. "People think trangendered are mixed-up, unstable people, but in my office we know that they are usually the most stable, grounded patients we have. They follow instructions, and the outcomes are usually positive."
Despite the possible risks, stable, grounded people -- in most expert opinion -- make good parents.
"The first five years of life sets the tone for the rest of the child's life," said Carol L.Clark, a licensed counselor and sexologist who practices in Florida
"When the first years are spent with a stable loving family the kid will probably be mentally healthy. And will probably later be able to deal with societies' conflicting values or mores."
Psychologist Rachlin agrees. "When a child has loving parents in many ways she has it all," she said. "In many ways this child will be a privileged child."