Telling your parents you're gay is one of the toughest things many of us have to tackle in life. After years of parental expectations that we will marry someone of the opposite sex, and have two kids and a house with a couple dogs, we worry that their hopes and dreams for us will be dashed by coming out to them.
That dynamic is particularly powerful in China, where family is central to the culture.
China has an unofficial "don't ask, don't tell" policy. As long as no one talks about being gay, as long a gay son doesn't have a long sit-down coming-out conversation with his parents, everyone is accepting of his "roommate" as, well, a very good roommate. A very, very good roommate.
Gay couples often go along with the charade to please their parents. While complete acceptance from their family would be wonderful, culture and traditions dictate a tough road for those gay men looking for long conversations about nontraditional love and marriage.
On top of that, China has no legalized recognition for any same-sex couples.
Yet after talking to various patients of mine in China, I've learned there's one thing that breaks through all of that, something that when included in that long sit-down coming-out conversation breaks down barriers and smooths a path toward more understanding: having children.
Family life in China is cherished, and having children -- and ultimately grandchildren -- is held as the greatest joy in life.
A large part of the disappointment felt by Chinese parents of gay sons is the idea of not being able to have grandchildren. Having a gay child ends the possibility of growing the family and bringing more children's laughter into the fold.
Of course, those assumptions about gay couples not having children are remnants of a bygone era in the United States, where gay men have access to modern reproductive technologies and less-conservative views on surrogacy. In China, where assisted reproduction is not accessible for gay couples, the assumption that a same-sex couple will not have children isn't far off.
Thankfully, that's changing. While it's mostly accessible to only wealthier people in China, many are finding fertility and surrogacy options overseas, including here in the United States. I've been proud to visit China several times, bringing information and hope about family-building to the LGBT community there.
Several of my patients in China have coupled their "coming-out" conversation with their parents with the announcement that they are having a child. They have said the impending arrival of a grandchild smooths over the sometimes uncomfortable conversation about being gay. As long as the family blossoms into a new generation, having a gay child is easier for older generations to accept.
"I put off coming out to my parents for years," one patient told me. "But when my partner and I had a child on the way, I couldn't hold back the joy of our new family member. That turned it into a celebration for my whole family."
If nothing else, when family friends ask how Johnny is doing or if there are wedding bells on the horizon, they can tell their friends that they have a grandchild on the way. That's always cause for celebration.
No doubt this same dynamic could play out here in America. Many parents' biggest concern about their child being gay is the idea that a gay child will not have children and raise a family, an experience the parents have already held so dear to their own lives. Talking to parents about the family-building treatment options that are available to gay men today may help ease the coming out process for many young gay men both here and abroad.
Of course, in the United States we generally end up coming out much sooner in life. While most gay Americans will come out to their parents years in advance of expecting a child, offering parents the hope and possibility of a growing family can help, just as it seems to smooth over family concerns in China.
GUY RINGLER is a board-certified physician in both obstetrics and gynecology and reproductive endocrinology and infertility. He is a partner with California Fertility Partners and has been helping LGBTQ people have children for over 20 years.