What Are You Going To Do About It? (Deciding About Transition)

I’d like to talk about two very important arenas of working with transgender people: one is their gender identity, and the other is what they are going to do about it.  One is who you ARE, the other is what you DO.

A woman I was speaking with recently made reference to a transgender acquaintance of hers: “He is in the process of becoming transgender.” “Transitioning”, I said. “What?” she asked. “Transitioning is the process”, I said.  “Being transgender is who he is.”

One does not “become” transgender. One is born transgender.  What one eventually does with that is an entirely different issue, and is different for every individual.

Understanding, knowing, discovering, realizing one’s gender identity is a unique process for everyone. Some people understand what gender they are from the very start, never think about it, and never have to worry about it, not even once in their entire lives. These people are usually those whose biological sex match the gender of their brains. For transgender individuals, coming to understand their personal gender can look many different ways. Some have an immediate sense of identifying as the “opposite” gender (forgive my reference to the gender dichotomy!) and depending on temperament, family influence, etc. that awareness can cause very different levels of distress in the individual. Some are vocal about it, since childhood. Some guard it like a secret. Some don’t really know exactly what’s going on, but they have a sense there is something not quite right. Some individuals don’t realize their gender doesn’t match their biological sex until they are much older, but when they do, a lot of pieces fall into place. (Having a child or family member not realize until they are much older is often more difficult for the family members, but that’s a subject for another blog!)

By the time a client makes it to my office, they are usually pretty darn sure about their gender identity. In fact, MOST transgender clients I come into contact with are completely sure of what gender they are. I have been known to facetiously say, “that’s the easy part!”.

After understanding and coming to peace with one’s gender identity, the next task is deciding what they are going to DO about it. For those of you not completely savvy with all the concepts and terms, the process of aligning one’s biological sex with one’s gender identity is called “transitioning”.  Mainly this includes changing one’s appearance, name, and pronouns to “present” as the gender with which they identify. It often includes hormones and sometimes includes surgery.

This is the hard part.

Much of the agony for my clients comes from not trying to figure out what gender they are, but what they are going to do about it. Transitioning from one gender to the other, and coping with all that entails, is a very scary thing.  Some clients will come saying they identify as “third gender” or something in the middle. (Of course, some people really feel this way, and they refer to themselves as genderqueer. In this blog I’m discussing those who ultimately identify as transgender.)  What usually causes someone who is transgender to say this is the fear of the transition. In this case it is the “what to do” wreaking havoc on the “who I am”!

In my experience with my clients, fear of transitioning mainly comes from outside sources.  They may fear the reaction of significant others, family members, co-workers, or society at large.  If the fear of this remains greater than the desire to make themselves happy by aligning their body with their mind, the transgender person may decide not to pursue transitioning. This does not make the person any less transgender. It just means too much got in the way of doing what they needed to do for themselves, to make themselves happy.  Having a transgender person decide not to transition is not cause for a sigh of relief, it is often cause for concern.  Not transitioning due to fear of reactions or to please others may be the recipe for an unhappy future.

For some, deciding to transition is easy, even if the process is still a challenging one. Once their gender identity is realized, transitioning to match their body and outer appearance is a natural next step. For many transgender individuals, transitioning is a very positive process, one that brings much relief, joy, and satisfaction.

It’s my wish that over time, with an increased understanding of what it means to be transgender and extensive de-pathologizing of the concept, the gap between who someone is and what they are going to do about it will become much, much smaller.

To my transgender friends, clients, and blog followers, I’d love to hear your feedback about this! Either comment on this blog or email me privately. Thanks as always for reading!

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Published in: on July 28, 2011 at 9:04 pm  Comments (11)  
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Helping Your Gender-Expansive Child With Teasing (Gender Spectrum Workshop)

Due to a family emergency, I was forced to cancel my presentation at Gender Spectrum this year. My workshop was titled, “Helping Your Gender-Expansive Child With Teasing”. I have been contacted by parents who had anticipated attending the workshop and who had been looking forward to gathering information on the topic. For that purpose, I’ve outlined and summarized what I was going to discuss. Please feel free to contact me if you have any questions! An important part of my workshop was going to be role playing, so if that makes you squirm, you got lucky… this time. 😉

My presentation was going to be based largely on this blog post: Your Gender Variant Child: Teasing.

Please read it before reading this blog post if you haven’t already.

One of the main points of my previous blog post was about the importance of parents avoiding warning a child about how their interests, way of dress, etc. may result in teasing. This increases anxiety and makes the child wary, rather than equipping them with coping skills.

Helping Your Gender Nonconforming Child With Teasing

Key concepts:

Gender Identity: How someone identifies in his or her brain; male or female.

Gender Expression: How a person may choose to dress or express gender; feminine or masculine.   May be in line with gender identity or may not; may be in line with assigned birth gender and may not.

Gender Nonconformity: Conform means to “behave according to socially acceptable conventions or standards”. Being gender nonconforming is not subscribing to society’s gender “rules”; what colors/dress/interests are for girls and which are for boys. These societal rules are always changing, and it’s my belief these gender rules won’t always be so rigid.

Coaching your child: It’s our job as parents to teach our kids how to behave, right? Remember, gender identity is not a behavior. It is simply a core characteristic of a person: whether they feel male or female. Gender expression, if it is a reflection of their gender identity, is not a behavior that should be molded or changed to prevent teasing. If your child has a behavior that is negatively impacting others, and is a behavior they can change, coach them about this. (Examples of this might be if they themselves are teasing peers, if they are physically aggressive, bossy in play, etc.) If it’s not a behavior they can change, teach them how to care for themselves in response to behavior from others.

Why do kids tease?

There are so many reasons why kids tease: because they themselves have been teased, they want to feel powerful, they want to impress other kids, etc.

Why does gender nonconformity elicit teasing? A gender variant child is even more susceptible to teasing given that they tend to behave or dress in a way that can be unexpected by other children or deemed by other children to be “different”. As most of us know, those that are “different” or in the minority are more likely to be teased, get teased more often, and often more severely than other children.

Also, kids are focused on rules. Since the day they begin exploring their world, they begin learning about rules. Don’t touch that, don’t do that, can’t go there, don’t eat that, etc. It’s how kids learn about the world around them and learn what works. Things fit into categories so that it makes the world make sense. The more one is able to categorize something, the less thinking one has to do about it, and the less discomfort it brings up. When something doesn’t follow the “rules” a child has been taught, there is discomfort, possible anxiety- and kids work to have their world make sense again. They have been taught specific rules, “pink is for girls, boys don’t cry, girls don’t like sports, boys can’t wear skirts, etc.” When a peer’s gender expression doesn’t fall in line with these “rules”, kids can compulsively make it their job to let them know they are not following the “rules”. Additionally, because kids are essentially being controlled much of the time, it is likely an outlet for them to try to be the one to control others occasionally.

Teasing vs. Bullying- what’s the difference?

Teasing: Can be done by friends or kids who are not friends, can be done in a friendly/fun way, or in a mean way. Typically mild by nature. Does not cause major distress on behalf of the child being teased.

Bullying: Greater intensity, more frequent, and can also be much more hurtful or damaging. Typically mean-spirited.

Important distinctions between the two: teasing is a behavior or an act that is temporary or occasional. Bullying may be ongoing, daily, etc. Most important clarification is how much distress it brings to your child. If child starts to have somatic complaints (headaches, stomachaches), wants to avoid school, etc. they may likely be getting bullied at school.

Responses by caregivers to both:

Teasing: Caregivers process incident (talk about feelings) with child and empower child to stand up for self, ignore, problem solve.

Bullying: Caregivers may need to intervene, get school (or other) authorities involve, advocate, make sure bullying is addressed.

Ways to support and empower your gender nonconforming child:

  • Stay connected. Ask the best and worst parts of day at bedtime/dinnertime. If your child seems to clam up under one-on-one questioning, as questions in the car. With your eyes on the road and not on the child, some children tend to open up more.
  • When your child reports teasing, ask questions; fight the impulse to just give “answers”. You will find out a lot more about your child’s feelings about and ability to handle the teasing if you avoid jumping in and trying to “fix”.
  • Again, don’t warn about the potential to be teased. If your child asks if you think they may be teased, be honest. “Maybe.” Ask questions. “What do you think?” Model confidence that even if you do think teasing may result, your child can handle it. (If you are nervous about the potential of your child being teased for an interest, toy, clothing choice, don’t show it. Fake it ‘till you make it! J)
  • If your child comes home and is sad or upset about teasing they encountered, ACT like it’s not upsetting to you. You can show compassion for your child without showing it is hurting you.  Your child may avoid telling you about being teased if they know it upsets you. See my first blog about teasing to read about ways to take care of your feelings.
  • Support your child’s true self at home.  Teach your child I AM AWESOME JUST THE WAY I AM, until they believe it and it is a part of their core self.  (This is important for ALL kids, not just gender nonconforming kids!)
  • Model appropriate responses to others if they question or mock your child’s gender expression or reflection of gender identity. Be it in response to a family friend or a stranger at the grocery store, don’t apologize for your child’s behavior, gender expression, etc. or act like you are sorry for how your child is making them feel.

Equipping Your Child

Work with your child on having a toolbox of responses (both verbal and behavioral) to teasing. You can write these down and put them in an actual box your child can revisit from time to time. Or, make a list you can review in the car on the way to school.

  • Verbal responses are best used in regards to children your child considers to be a friend. “That hurts my feelings”, “Please don’t say that”, “Please stop”, etc. (Saying these verbal responses to children who are not your child’s friend, or who are mean to your child on a consistent basis, may open your child up to more teasing.)
  • Practice assertiveness skills. Chin up, eye contact, shoulders back, looking strong. Facing the person they are talking to. Using a firm but kind voice.
  • First teasing is usually a “test”- help them pass. Explain the importance of “acting” like it doesn’t bother them. If a child senses the teasing has “gotten to” your child, it may fuel the fire. Teach your child to hold back emotion until they are in a safe place or speaking to an adult they trust. Also discuss the importance of not “fighting back” with their own mean words.
  • Ignore. Act as though the other child is invisible. Can’t see ‘em, can’t hear ‘em.
  • Walk away! Move to another area of the playground. Approach another group of kids or another kid who is typically friendly.
  • Stay in adult eyesight or earshot. Kids aren’t going to relentlessly tease or bully other kids who are near an adult. Talk with your child about what it might look like if they were “subtly” trying to stay near an adult.
  • Get adult help. If the teasing is getting to your child, your child is having difficulty ignoring, may act out in response to the teasing, or is in physical danger, teach your child to get adult help right away. Explain the importance of saying “I need help because ____________” rather than presenting it as “telling on” a peer.
  • Role play! I can’t stress the importance of role plays enough. If your child reports being teased, or is worried themselves about being teased, practice at home. Have your child tease you, and model appropriate responses. Then switch!

Dealing with teasing can be stressful for both the gender nonconforming child and their parent(s). I hope these tips make you and your child feel somewhat more equipped! Please feel free to comment about other specific topics you would like to see covered in this blog.

Published in: on August 1, 2013 at 5:56 pm  Comments (6)  

Cross-Sex Hormones for Transgender Youth

A topic that comes up often in my work is the question of whether or not to treat transgender youth with cross-sex hormones. (For those of you who don’t know, this would include a Male to Female preteen/teen taking Estrogen, and a Female to Male preteen/teen taking Testosterone, in order for them to go through puberty in line with their brain gender identity. Read more about it here).  I know this is a controversial topic, and there are as many opinions about this as there are professionals, if not people.

Of course, the first step in treating a transgender child about to enter puberty is usually hormone blockers. While incredibly expensive, I think most parents and doctors are more willing to allow the child/pre-teen to go on these because a) it buys them time, b) it prevents physical changes from happening during puberty that have to be “undone” later, and c) the changes are reversible. Remove the hormone blocker, and the individual goes through the puberty of their natal sex. Not so with cross-sex hormones. Many changes are irreversible, and can have life-long impact on one’s reproductive system. I understand the anxiety parents and doctors feel about transgender pre-teens starting hormones. I’m still a proponent of it, on a case by case basis.

I recently learned that the Endocrine Society guidelines recommend that endocrinologists wait to put pre-teens/teens on cross-sex hormones until the age of 16. In my opinion, this is too late. Most of their peers will be going through or will have gone through puberty by that age. One argument I’ve heard about this is that there are “late bloomers”. Sure, there are “late bloomers”, but these teens need not be.  Being late to enter puberty means something entirely different to a non-transgender teen and a transgender teen. The former may be anxiously awaiting puberty. The latter may be close to suicide.

For those youth who do receive hormone blockers, this is a life-changer: their body is not going to go through the “wrong” puberty. However, even these pre-teens and teens struggle with gaining those important “gender markers” in order to help them pass in society; a deeper voice and facial hair for male teenagers, a more curvaceous figure for female teenagers. Without the needed physical help from hormones, passing can be very difficult. And being read as the wrong gender every day is an agony no teen should have to go through.

In my opinion, treatment before the age of 16 is medically necessary to support the mental health of transgender youth. I suppose if more people sat across from transgender pre-teens and teenagers the way I do, more people would agree. I see a sadness and a desperation in their eyes I simply do not think has to be a part of this process. I don’t have all the answers; I don’t have a medical degree that would help me understand exactly the process of cross-sex hormones in an adolescent’s body. I’m coming from a therapist’s standpoint who understands how crucial it is for teens to feel as though they fit in with their peers -as well as the need to be seen for who they really are- and the depression and suicidality that results when they don’t.

In the words of Karen, the mother of an FTM individual and author of the blog  Trans*forming Family, “When a child is as sure as my son is, I think it is senseless and really torturous to make them wait until they reach some arbitrary age guideline. I realize this is anecdotal, but every trans teen I’ve known of who has been suicidal, depressed, or has self-harmed has been in that age range where they cannot get cross-gender hormones and/or surgery and are miserable due to dysphoria[…] the negative symptoms lift after medical transition, so why prolong their suffering unnecessarily?”.

Monica Nuñez-Cham leads the family support group for families with gender nonconforming and transgender children in San Diego. She is also the mother of Isaac (now 18), an FTM individual who started medical transition (cross-sex hormones soon followed by surgery) at the age of 13. “He wanted so badly to appear male and experience the same changes his friends were having (lower voice, facial hair, etc). He was very uncomfortable in his body and hated every feminine form (hips, butt, chest). I knew that the physical changes of T would help others who knew him as a “girl” to perceive him as male. The risks (that nobody could explain with certainty to me because there is not much research) were much lower than the 100% reality of seeing my dearest child in emotional pain every day and withdrawing himself from life. […] I always tried to listen to my heart and do what I thought was the best for him, with the tools I had at the time.  

Hormones and surgery were the best decision we could have made. Isaac as a little boy was a happy one, always singing, talking, making friends and very easily expressed his feelings by kissing, hugging and verbally. Close to puberty he stopped being happy, to the point of not allowing me to touch him. After the T, he came back, not little by little, suddenly he was the same happy kid. After the surgery I was very surprised to see him just BLOSSOM in a spectacular manner.

I attribute his success as a person (academically, socially, emotionally) to the fact that we acted as soon as we knew how.”

 The Harry Benjamin (now WPATH) Standards of Care were revised 7 times. In my opinion, the first version was hopelessly damaging to transgender individuals seeking treatment. By the 7th version, it is finally coming around to the way it should be: professionals supporting and making life easier for transgender individuals, not harder. Additionally, the Standards of Care were only created to be general guidelines to give those who are inexperienced some semblance of a plan. They are not laws that govern how a professional chooses to treat a transgender individual. Such is the same as the guidelines for the Endocrine Society, in fact it says so in their disclaimer statement: “Clinical Practice Guidelines are developed to be of assistance to endocrinologists by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient’s individual circumstances.”

Wondering what the latest version of the Standards of Care say (in part) regarding prescribing hormones to transgender adolescents? “Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence (Nuttbrock et al., 2010), withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents.”

I know of two gender clinics in all of Southern California who medically treat transgender youth.* These clinics, as you can imagine, have long waiting times due to the high demand and sheer number of patients in need. 

I’ve said it before, and I’ll say it again. I see my role as helping individuals live their lives as the gender they are in their brains. Most of the time this is not about helping them figure out their gender identity, but figuring out what they are going to do about it. For those children/pre-teens/teens who know who they are, and what they want to do, let’s help them do it.

Most people will doubt your judgment because of your age. It may take a lot more talking to convince the ‘adults’ that you really know who you are.  -Chris, 19 (From the Advocates for Youth pamphlet, “I Think I Might Be Transgender, Now What Do I Do?”.)

*If anyone reading this has more information on endocrinologists who treat transgender youth in California, please private message me or include in the comments.

Your Gender-Expansive Child: Teasing

Most children get teased at one point or another in school. Sadly, teasing has become part of the social culture at schools and often goes on away from adult supervision. A gender variant child is even more susceptible to teasing given that they tend to behave or dress in a way that can be unexpected by other children or deemed by other children to be “different”. As most of us know, those that are “different” or in the minority are more likely to be teased, get teased more often, and often more severely than other children.

You know that one tone of voice children use when tattling? “MOO-ooomm, Johnny HIT Meeee!”. It’s universal. I’m convinced kids are born knowing how to use this voice, without ever having it modeled for them. Parents have a similar standard tone/cadence when warning their child about natural and logical consequences to choices. “Okaaayy, you can go on that water ride, but you’ll probably get soaked and feel cold the rest of the day!”. It just comes with the parenting territory. Letting your child choose behaviors while warning possible ramifications is a parenting basic.

Warning about being teased for being gender nonconforming gets tricky, however. Being gender nonconforming is not a behavior; it is a way a person is. Warning about teasing that may come from displaying a core characteristic/something the child cannot change is dangerous territory. Yes, the child can choose to act on or express their way of being, or choose to inhibit it. But they cannot change being gender nonconforming or transgender.  While I can appreciate and recognize a parent’s urge to warn and possibly prevent teasing that may come from a way of dress, behavior, or interest, this can quickly be translated to shame and self doubt. The problem is, in these scenarios we’re not talking about nose-picking or some other minor social infractions that a child can learn how to avoid. We’re talking about children being who they are, and who are doing absolutely nothing wrong. “Warning” the child  by saying something like “If you choose to play with ‘boy things’, you might get teased at school”, “Girls don’t usually have really short hair, so you might get teased,  but you can cut it if you want”, “Boys don’t usually walk or talk like that, but if you want to go ahead. Just know you might get teased” may not have the protective nature parents are going for.  In fact, it may teach the child to prescribe to what others say is the best way for them to be. Remember my Oxygen blog? Much like you wouldn’t “warn” a child about being teased for wearing an oxygen tank to combat oxygen deprivation, try not to warn your gender nonconforming child to avoid their natural gender expression.

I want to again acknowledge that most parents are coming from a very loving place when they explain what may lay ahead. My worry is that this can instill fear and dread in the place of blissful innocence. It may make the child LESS equipped to deal with the teasing that may come with being gender nonconforming.  If my parents had sat me down as a child and said, “Just so you know, little girls with hazel eyes sometimes get teased. Some people think hazel eyes are wrong and some people just don’t like kids with hazel eyes.  You can go ahead and wear those hazel eyes to school, but just know you might get teased”, I would have experienced childhood differently. I may have been fearful to let my true eye color show, even though I couldn’t change it. I may have looked at (or looked away from) everyone I met with just a little bit of suspicion or mistrust. I may have thought, “Is this one of the people who hate kids with hazel eyes?”. I may have chosen to grow up wearing sunglasses, even indoors. Many parents warn their children about being gender nonconforming much in the same way, even though it’s not something the child can change. Yes, the child could change their behavior to HIDE who they really are, but that’s not what we want for our children, is it?  Children become inhibited based on the response of others soon enough.

So, what’s a parent to do? Parents can help their child by unconditionally supporting who they are on the inside so they know without a doubt I AM AWESOME JUST THE WAY I AM.  This won’t prevent the pain associated with teasing, but it will help build the ego strength in the child so that they understand their basic worth doesn’t change based on what others say.

If your child asks you if you think they may be teased for wearing something, doing something, etc., be honest. Say “maybe”, and then discuss how the child might best handle it.  Communicate (even if you have to “fake it”) that you know your child will be ok even if they are teased. This energy is something they will absorb from you.

If your child comes home and reports being teased, ASK QUESTIONS; you don’t have to be the one with all the answers. This will help you get a feel for how much understanding your child has about the reasons behind the teasing. “Why do you think they teased you about wearing a skirt?” “Why do you think they said that?” (Not what they are used to, they don’t understand, they feel differently, etc.)

At dinnertime, bedtime, etc. ask your child about the best and worst parts of their day. If they report teasing, process it with them. Talk with them about how it made them feel, and how they can take care of themselves when they have that feeling. Discuss and practice possible responses based on the teasing so they feel more equipped should it happen again.

Last but not least, take care of yourself and your own feelings! Listening about your child being teased can be a very hard thing for a parent to take. Talk to your friends, talk to other parents, talk to a therapist. Remind yourself this is not something you can “fix” or prevent, but you are doing right by your child by nurturing his or her true self.

Choosing/Evaluating a Gender Therapist for Your Child

The Hunt

Finding a good gender therapist for your child can be a daunting task. If you are in the process of looking for a gender therapist, this means there is already a lot going on in your family! Gender dysphoria or gender nonconformity can at times cause distress for parents and the child who is experiencing it.

There doesn’t seem to be many of us out there (gender therapists who work with gender nonconforming youth), and I wish there were more. So once you’ve found one in your area (or relatively close to you), how do you know if the therapist is a “good” one? As with every profession and specialty, there are the good, the bad, and the ugly.

If someone claims to be a gender “expert”, don’t just assume your hunt is over. Ask questions (see below for a sample list) and go with your gut instincts.  Ultimately, YOU are the expert on your child.

After you have met with the therapist for 1-3 times, re-evaluate how the sessions are going for both you and your child. Is your child comfortable? Are you? If not, address your concerns with the therapist.  The therapist should be open to your feedback and be able to explain their reasoning behind the treatment methods. If things don’t change, begin your search again!

Let the Client (Child) Lead

As with any therapy, or reason for seeking therapy, the gender therapist should not enter into therapeutic work with you and your family with an agenda. If you get the sense on the phone that they have their mind on accomplishing something (such as getting your child to transition or not transition), consider that a red flag. Every child and family is different, with a different story and different needs. Some of the interventions and suggestions will be similar to those used with other families, but most will be tailor-made to your family.

Your child will be the best source of information re: their gender identity. Children of a very young age are aware of what gender they are, and/or what gender expression they are comfortable with. You, the parent(s), will be excellent historians for how your child has expressed their gender from an early age, current significant behaviors, etc. Of course, part of the gender therapist’s job will be working with the parents in regards to their feelings about their child’s gender nonconformity, and feelings about potential options for their child.

Red Herrings

Many parents see their child’s gender nonconformity AND a lot of other emotions and behaviors. Some of these emotions and behaviors will be related to their child’s gender identity; others may not. Those that seem unrelated to the gender identity but may actually be symptoms of the distress the gender nonconformity is causing are what I call “red herrings”. The gender therapist can help you sift through some of these factors to find out what needs to be addressed first. It is common for some emotions and behaviors to be resolved once the gender identity is validated. One good way to narrow down what is really going on for your child is to focus on what seems to be causing the most distress. For example, if your child is having social skills problems, academic problems, gender nonconformity/expressions of gender identity that does not match their body, anger outbursts, and anxiety, what seems to bring them the most mental distress? What do they talk about the most? What do they shed the most tears over? This is what needs to be addressed first.

Often times things such as the anger outbursts/academic problems are what bring the parents the most distress, and therefore this is what the parents want addressed first. This may be like putting a Band-Aid on something without treating the cause. In some cases, it will be the therapist’s job to gently prevent you, the parents/guardians, from following the red herrings. If your gender therapist seems determined to only focus on these other things, and not address the gender issues, this should also be a red flag for you. While you may feel some relief that the gender therapist is recommending holding off on making any major decisions or is wanting to address everything else other than the gender identity, pay attention to what your gut is telling you. You know your child. If the therapist’s recommendations seem to bring your child more distress, something has gone awry!

Hormone Suppression/Therapy

Your gender therapist may help you (and your child) explore whether or not your child is gender nonconforming or transgender. If the consensus is your child is the latter, your gender therapist can help you navigate the next steps in your child’s journey. Your gender therapist can be your ally in deciding if hormone blockers/therapy is the right decision for your child, and if so, when to start. Sometimes, making this move can help ease some of the other symptoms that may have arisen for your child. Many times the child may express being ready for hormone blockers or hormones before the parents feel ready. The gender therapist can help parents walk through many of the anxious and difficult feelings that may arise during this significant decision-making time.

Structure of Sessions

There is no exact science to how a gender therapist might structure their sessions with you, but in general there should be a good balance of meeting with you and meeting with your child. The therapist should meet alone with you as part of the assessment process and at other times as needed throughout treatment. This is because you need to have free reign to say what you want to say about your child’s gender expression and your feelings about it. Your child should not hear all of your thoughts, opinions, and feelings about their gender expression or possible transgender identity. Children tend to try to take care of their parents and avoid causing their parents distress; therefore hearing statements made my parents (particularly those expressing resistance) can impact their ability to say what they want and need in regards to gender expression, transitioning, etc. This can have serious ramifications on their mental health and futures.

Similarly, your child should have the opportunity to speak alone with the gender therapist and speak their mind without censoring things out of regard for their parents. The gender therapist will not tell you exactly what your child has said while in private, but should help your child communicate better with you when you are all together. For this reason, joint sessions are also called for when it comes to working with youth. It is important for family members to learn how to talk to one another about the gender identity issues, and to become more comfortable with the topic. Additionally, parents tend to be better historians and reporters of behaviors, which can be extremely beneficial to the treatment course.

Sample Questions to Ask a Potential Gender Therapist

  1. What is your opinion about how young a child can understand their gender identity?
  2. What is your general opinion on letting a child express their own gender identity?
  3. What are your thoughts on hormone blockers/therapy for youth?
  4. How long have you worked with children?
  5. Are you experienced in building rapport with children?
  6. Have you been trained in how to talk to and interview children in a non-leading manner?
  7. How involved are the parent(s) in the therapy with the child?

If you are struggling to find a gender therapist that is right for your family, reach out for help. TransYouth Family Allies is a great resource. If you join TYFA Talk, you can chat with other families and get information about what resources are out there. Wishing you all the best on YOUR journeys!

*Special thanks to Kim Pearson of TYFA who requested this piece to present at this year’s Gender Odyssey Family Conference.

**While this post was written specifically for parents finding a gender therapist for their child, many elements can be applied to the gender nonconforming or transgender adult. Go with your gut! Find a therapist who will support you in your journey and help you access resources. If it doesn’t feel right to you, keep looking.

Published in: on August 3, 2012 at 2:52 pm  Comments (3)  

What’s In YOUR Pants?? (They’re called “privates” for a reason)

When a person reveals their transgender identity and plans to transition, one of the first questions they are often faced with has to do with their anatomy, or genitalia. If you have been one of those people asking such a question, don’t feel bad. It’s normal to be curious about this, and it’s something concrete I think people tend to ask about as a way of understanding the transition process. However, I’d like to take this opportunity to explain why questions about a transgender person’s genitalia might be a little off the mark.

When you ask about anatomy/private parts/genitalia, you are referring to one’s sex, not gender. When a person reveals their gender identity to you and it is different than how you have always thought, they are explaining how they would like to be seen by friends, family, and society at large. They are talking about which pronouns they would like you to use (“he/him/his”, “they/them/theirs” “she/her/hers”, etc.), which name they would like you to use, and whether they would like to be seen as a man, woman, both, or neither. If you think about it, our genitalia do very little for us in explaining our gender identification! Simply put, no one sees these parts of us except perhaps medical professionals or those with whom we plan to be sexually intimate. If the one of first questions you ask is about one’s genitalia, I would say you’re concerned with the “wrong end”. Bring your attention up… way up. One’s gender identity exists in one’s brain. If you really want to know about how a transgender person feels, identifies, or wants to be seen, ask about what goes on for them in their brain.

If someone says they are “transsexual”, this translates to “changing sexes”. So the more outdated “sex change operation” applies here. (Now called Sexual Reassignment Surgery.)  However, your loved one will probably not refer to themselves as transsexual. You will likely hear the term “transgender” which yes, means “changing genders”. Stay with them in this revelation and focus on their gender, not their sex.  (For a more detailed explanation of these two concepts, please check out my Gender Vs. Sex blog.)

They’re called private parts for a reason.  A complaint I often hear from transgender individuals is that as soon as they reveal their plans to transition, others feel they have the right to know about what’s in their pants, or what’s going to be in their pants post transition. A good rule of thumb: if you wouldn’t normally ask this person about their genitalia, don’t do it after they’ve come out as transgender to you.

If the transgender individual is a VERY close friend or family member, and you think it’s ok to ask, ask eventually.  Don’t have it be one of your initial questions. Show you understand their gender FIRST. Do research on what options are out there for transgender individuals and then lovingly ask  your loved one what they are considering.

Be different. Because many transgender people have told me this is one of the first questions they get, it will be refreshing for them to come across someone who doesn’t ask about their anatomy. Ask about what you can expect with their upcoming changes and how you can support them during this major transition. More importantly, ask them how they are doing with such an important change.

Because changing genders is largely about how someone is seen and perceived, transgender individuals are often most interested in those changes that will help them “pass” as the gender which matches their brain gender identity. One’s genitalia is not proudly displayed while one is shopping at the grocery store. Therefore, genitalia is not one of the first considerations of a transgender individual when focusing their efforts on trying to pass. The main things that help individuals pass for a particular gender include but are not limited to: hair length and/or style, presence or absence of facial hair, pitch of voice, clothing, and presence or absence of breasts. When someone is trying to assess another’s gender, these factors are usually used the most when trying to make a decision. Hormone supplements (Testosterone or Estrogen) can assist with many of these changes.

Shay O’Reilly explained it well in the article “Shunning Medical Hoops, Transgender Patients Turn to ‘Informed Consent’ Model”: “While much media attention is paid to gender confirmation surgery, it’s hormone replacement therapy that often makes the largest difference in the lives of transpeople. Patients frequently report that hormone therapy makes their body feel more comfortable or more like home—more importantly to many, hormones masculinize or feminize the body, helping trans people be read correctly as their gender.”

Referencing one’s genitalia immediately following a revelation about their gender can enforce stereotypes and insecurities. When the questions and conversation goes immediately to one’s genitalia, you are reinforcing the misconception that one’s gender is based on and entirely connected to one’s anatomy. When one immediately “goes there”, the interpretation may be something like this, “You say you want to be a man, well, men have penises” or “So if you say you’re a woman, you’re going to have a vagina, right?”.  If the transperson cannot afford or does not wish to pursue “bottom surgery”, the implication could then be that they will not “really” be the gender they are saying they identify as.

Additionally, it is likely the trans person is acutely aware of how their anatomy (sex) does not match up with the gender identity of their brains. Calling attention to this and asking them to explain it (often over and over to many different people) can be exhausting. Not only because it’s private and could make the transperson uncomfortable, but because it may bring up feelings of inadequacy, sadness, or wishing their anatomy were different.

For the transperson reading this blog who does not like discussing this with others, here are a few tips to deal with “the” dreaded question.

  • Have a response ready, or an arsenal of responses ready. Be a broken record if you need to.  Examples:  “I’m not comfortable answering that”, “That’s a little too personal”, “I don’t feel comfortable telling you about me specifically, but I can tell you that some transgender people choose to … and some choose to….”. “That’s private”.
  • If the question brings up feelings of frustration or exasperation, take a deep breath. Give yourself space for a response. As I said before, I don’t believe others are trying to be invasive or inappropriate; they are merely curious and trying to understand.
  • Re-direct the person to a more appropriate means of getting their curiosity satisfied. “I appreciate your interest. Let me suggest some websites… books… blogs, etc.”
  • A great way to re-direct a question like this is to briefly clarify the difference between gender and sex. You could say, “Actually, that question is more about my sex, and I’m trying to tell you about my gender.”
  • Use humor. Laughing it off will make the other person more comfortable, and it will probably be good for you, too. Kim Pearson, co-founder of Trans Youth Family Allies and mother of a Female to Male transgender individual, uses a great response when fielding questions about her son. When asked if he’s had “the” surgery, she states, “No, he still has his appendix”. When the person then clarifies they were referring to genital surgery, she asks them to please go first and describe their child’s genitals in detail. 🙂

Stay tuned for my next blog which will include descriptions of bottom surgery and other options for transgender individuals. My hope is that this will help satisfy some curiosity so the questions don’t need to be asked as often, and for transpeople to use as a resource to give those who are curious.

Reactions of Others Part 3: Your Alignment; Their Transition

I’ve talked a lot in this blog about the process of discovery transgender people go through and how there are often two major parts: realizing one is transgender (has the gender identity of something other than their sex at birth) and deciding what they are going to do about it, normally described as “transition”.  For the sake of this specific blog’s concept, I’ll be describing the process a transgender person goes through as alignment and the process the loved ones go through as transition.

If the transgender person chooses to go through the process of changing their gender, they are aligning themselves with their “real” gender. There are several definitions of align; the one I choose for this topic is “to move or be adjusted into proper relationship or orientation”. It’s critical people understand the choice to transition is a way of making things right, not deciding to change something that is already perfect. Deciding to align oneself is typically the result of many years of contemplation, possible ambivalence, agonizing, the weighing of options, and considering all outcomes.  Finally making the “big decision” can bring on feelings of relief, gratitude, and excitement, mainly because they have decided to ALIGN themselves, and that is a positive thing. Yet these feelings are not usually shared by the loved ones of the transgender individual. They are the ones who have to fully transition from an idea they have about who their loved one is to something different.

Transition: “change or passage from one state or stage to another”. When you reveal your gender identity and/or plans to align yourself, you are asking your loved one to adjust to the idea that you are about to change, when they like you just the way you are. 😉  (Additionally, the change loved ones anticipate tends to be more dramatic than what happens in reality, so there is fear involved here, too.)  They are often presented with years of your contemplation delivered in one single revelation; in a moment they are forced to adjust to an entirely different idea of you than they had in the moment before. Hundreds of things likely go through their heads in that moment; things that you have been contemplating for some time now. Whatever their initial reaction, remind yourself they are playing “catch up” and will likely need some time.

Although all of you are involved in this big change, these two perspectives can make this experience very different for each of you. This depends on whether you are aligning yourself with something that feels better to you, or having to transition to an idea that feels altogether foreign.

The Cold Lake Analogy

Picture this: you want to go swimming in a very cold lake. You first stick your toe in, shiver a bit, but forge ahead. Slowly, inch by inch, you submerge your body in the lake. It’s uncomfortable, but you’re determined to take a swim. Once you have been treading water for about 5-10 minutes, the water seems to feel much warmer. Eventually it’s hard to remember you thought the water was cold at all. You see your friend and yell, “Come on in, the water’s fine!”. They stick their toe in. Their response? “Are you serious?? It’s FREEZING!”.  Looking at you submerged in the water, smiling, your friend just can’t understand what it is you are doing, or how it feels good to you. This tends to be the way a loved one looks upon the transition; by the time the transgender individual “comes out”, they have been adjusting to the “water” for much longer.

One thing to keep in mind from this analogy is that the water both people are feeling is the exact same water; the same temperature. The difference in their interpretations of the feeling of the water largely comes from how long each has been getting used to it. The positive spin on this is that given more time, the other person may be treading water before you know it. 🙂

To the loved ones of transgender individuals: when your loved one reveals their plans to align themselves with their brain gender identity, please keep in mind they are revealing a way to make themselves right. They are not doing something to you, or trying to disrupt something you like just the way it is. They are trying to be whole; they are trying to be happy.

To the transgender individuals, this is my gentle reminder that you are asking your loved ones to jump into a very cold lake! Be patient, be kind (to them and yourselves) and keep your eye on the prize… YOU, aligned.

The Catalyst: When Being Transgender is Brought Into Conscious Awareness

Say you’re visiting a foreign city and you’ve been sightseeing all day. So many things to do and see, you’ve been going nonstop. Suddenly you see a menu hanging outside the door of a restaurant with a picture of the most delicious looking pasta you’ve ever seen. Suddenly aware of how hungry you are, you exclaim to your companion, “I’m STARVING!!” The two of you quickly agree to go inside the restaurant for a meal and begin pouring over the menu to see what other options are available.

Despite the common phrase, “Stop talking about that! You’re making me hungry!”, nothing but time and lack of food can actually make someone hungry. Did the picture on the menu actually create the existence of hunger? No, of course not. You were hungry because you had been active and had not eaten in a while. The menu simply made you aware of your hunger; it was the catalyst.

Such is the same with anything that sparks a transgender person’s “AHA” moment. Unless the person is someone who was insistent about their gender identity from early childhood, many individuals can name what it was that brought their being transgender into conscious awareness. For some, this is a person; either the person understands about gender identity and could explain it to them in a way that made sense, or the person had experience themselves with gender nonconformity. Often times this person will be significant to the transgender individual’s journey because of the help they provided in coming to understand themselves. Sadly, for some loved ones the person who was the catalyst becomes the person who is blamed for influencing the transgender individual. However, no one becomes transgender just because their friend is or because someone explains the notion of being transgender. One is either transgender or not; nothing another person can say or do can change it.

I will say that another person can influence the journey, or the transition, of the transgender individual. Influences by other people can either speed up or slow down the transition process. However, the transition is more an intervention to the state of being transgender and is not necessarily a good thing to be avoided. Read more about the separation of these two concepts in my blog post “What Are You Going to Do About it?

Other means by which someone may be triggered into understanding themselves and their true gender identity are often mainstream media, books, and of course, the internet. I’ve heard some parents lament the existence of the internet, feeling certain if it did not exist their child would never have learned about this and would therefore not be transgender. I have to gently remind them that their child would still be transgender, but they may not be consciously aware of it or know what options are available for it until much later. (Again, this is not necessarily a good thing. For those who feel the need to transition, early medical intervention can be very beneficial. For those who identify as nonbinary or under the trans* umbrella, they may come to understand their gender identity and how to ask others to respect it much earlier than they might otherwise have.) A catalyst is not causal; it does not cause the existence of something. It simply allows for awareness that something exists. In many ways, the catalyst has an extremely important job and is an essential part of the process. Just as that menu was the catalyst to help you recognize (and do something about) your hunger before you were collapsing from low blood sugar in the middle of a foreign town square, such is the case with something triggering awareness of being transgender. Transgender people may be grateful to the person or thing that brought this into their conscious awareness; maybe someday their loved ones will be too.

Do you think a catalyst can be causal?

If you are transgender, do you remember your catalyst? What was it?

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Transition is an INTERVENTION, Not a Decision

In my post “What are you going to do about it?”, I discuss two very separate concepts: one’s gender identity and one’s “decision” about what to do about it. However, I made it clear that “deciding” not to transition is not usually a positive choice for a transgender individual. Today let’s break it down one step further and clarify what this “decision” means. Deciding to transition often means acting upon something that already is. That is, someone can be transgender in that they feel the brain gender identity they have is different than their assigned gender based on their natal sex. Is being transgender a decision? Absolutely not. You cannot decide to be transgender, just as much as anyone cannot “decide” on their gender before birth. I think talking too much about the “decision” to transition undermines what just simply exists; one’s brain gender identity. I want to acknowledge that there are some people who are transgender and who choose not to transition. This is a valid choice and one that is completely within their right. Let’s just say, for argument’s sake and the sake of this blog post, that transitioning is the natural response to one being transgender. If that is true, let’s stop thinking about transition as a decision and more as an intervention. I suppose this distinction has become more and more clear in my work with transgender youth and how different their process can be. Adults have the tendency to overthink everything, and so sometimes my work involves sitting with a client while they agonize over the “decision” to transition. Some of this includes not just IF they are going to transition but when, how, etc. It is somewhat different with transgender children. Because of their luxury of not yet having a brain trained to overthink things, they typically know just what they want to do about it. It is their parents/guardians, those in charge of their care, who typically stall the transition. They want their child to be SURE. They want their child to know all aspects of transition prior to “deciding to do so”. I have heard this statement so many times: “I just want him to be sure he knows what he’s getting into if he decides to transition” or “I just want to be sure she is mature enough to make a decision like this”, and “I told her if you’re going to make this decision I just want you to know what the consequences could be”. (If you have made a statement like this in my office, please know it is not about you specifically. I have heard these things too many times to count or to connect to one person or family. 🙂 ) Because children don’t overthink things, being transgender and transitioning* are fluidly, easily connected. Let’s try not to infringe our overthinking brains upon them. Let’s start looking at transitioning as an intervention, not a decision. If your child had a medical condition, and a doctor recommended an intervention that could make their lives a whole lot better, or potentially save your child’s life, would you put the decision on the child? Would you present the options to your child but then warn them to consider the financial implications, social implications, family implications on said intervention? Of course not. (For a similar concept covered in a different blog post, see “Oxygen”.) We are so used to warning our children of possible outcomes that we forget some are natural consequences to a circumstance, not something to avoid at all costs. Will there possibly be difficult times ahead for the transgender child who opts to transition? Yes. Will you be there to help them through it? Yes. Given how debilitating and dangerous dysphoria can be, I can assure you any stumbling blocks post-transition will likely be easier to overcome by the distress of not transitioning at all. Adults reading this who identify as transgender, what if you were to think of transitioning as an intervention instead of a decision? Would you give yourself more permission to act on how you feel and what you know you need? Would you be more willing to assert what you need from others, knowing this is something that is necessary for you?

*I want to clarify that for the sake of this blog post I am speaking of transition in fairly binary terms, that is someone transitioning from male to female, or female to male. However, plenty of people do not identify within this binary; some are gender fluid, some are genderqueer, some are bi-gender, some are agender, some are gender nonconforming. For these individuals, the “transition” and “intervention” may be somewhat different. It could just include having those around them understand them better, possibly change pronouns, and advocate for the use of proper treatment and pronouns. Those in charge of their care/their loved ones should also look at their stated preferences as interventions to how they feel, not “decisions” they are making to be a certain way gender-wise.

“Blank Slate” Parenting

A big part of what I do is helping individuals explore their gender, assert their true gender identity, and help family members adjust to transitions that occur. In addition to this, I’m a big believer in changing our society’s understanding of gender so that we can pave an easier path for LGBT youth (and adults, for that matter!). In my presentations, I talk about Blank Slate Parenting as a way to point out parents really don’t know the gender and sexual orientation of their child until the child/teen is able to share it with them.  I also included this concept in my book, The Conscious Parent’s Guide to Gender IdentityHere is the excerpt:

“Blank slate” parenting is the ability for a parent to enter into parenthood without too many assumptions and expectations. This may sound difficult, but it is possible. Most parents enter into parenthood with some basic assumptions: their child is going to be cisgender (their gender identity “matches” their birth sex), gender conforming (their interests and expressions are in line with what most expect from their birth gender), and heterosexual. Considering that many children are not these things, these assumptions may be inaccurate and possibly detrimental for both the parent and the child. Unless a parent is having an intersex baby, the parent will likely find out they are having a natal male or a natal female, either during the pregnancy or when the baby is born. Once this is revealed, all sorts of associations are created! If the child is a natal male (born with male anatomy), the parents will likely assume the child will always identify as a boy and will engage in the “typical” interests and affinities of most boys. If the child is a natal female (born with female anatomy), the parents will assume that she will always identify as a girl and will engage in the “typical” interests and affinities of what society expects girls to be interested in. If the child is a natal female, parents often assume they will one day be interested in males. If the child is a natal male, parents often assume they will one day be interested in females.

Even if these assumptions are not explicitly stated, they will implicitly become the foundation of what your child understands is expected of them. Children have an inherent need to please their parents, so feeling “other than” what their parents expect can range from uncomfortable to downright scary. Anything other than what has been envisioned and assumed results in the parents needing to make a “shift” in what they had expected. The nature of the shift will depend on how tied the parents are to their expectations, and what this difference means to them personally, socially, and culturally.

What if, instead of adopting these basic assumptions, parents remained open to who or what their child is or will become? What if parents provided a blank canvas for their child to paint, rather than providing a paint-by-numbers template? What if society evolved to the extent that people understood the difference between sex and gender, and the knowledge that some people are simply born transgender? Imagine how much easier it would be if parents understood not to get too attached to the sex of their child at birth! What if parents learned to ask “Do you feel like a boy or a girl? Both? Or neither?” instead of telling the child who they are based on anatomy?

What if society at large acknowledged being gay/lesbian/bisexual as a natural way to be, a way of being that is just as valid and recognized as heterosexual? What if parents learned to say, “Do you like boys or girls? Both? Or neither?” instead of making assumptions of a heteronormative nature?

Parenting from a blank slate standpoint would essentially eliminate the “coming out” process. Children would be able to evolve and share as their identities developed. They would not have to hide parts of who they are for fear they might be disappointing their parents. They would not have to overcome the expectations/assumptions that were placed on them at birth. They would simply be their authentic selves, and parents would know these selves sooner rather than later.

Rather than making assumptions, ask questions, often and early, to help learn who your child is. The questions will serve two purposes: you will learn about your child, and your child will learn that there is a beautiful spectrum of human diversity, not just boxes in which one has to fit. In order to provide a blank slate for your child so that they can be free to display their authentic self, you must be mindful of your own projections and assumptions. Such things impede the ability of your child have an actual blank slate on which to create. Recognize your child is their own individual being, and that you are lucky to witness their true self unfold. Remain curious about how this little individual will turn out. Your message to your child, both implicitly and explicitly should always be: “Any way you are is OK.”

More tips for “blank slate” parenting:

  • Instead of assuming and then waiting for them to correct you, ask about who your child is.
  • Expose them to and talk about diversity: different family structures, identities, and communities.
  • Be aware of language. Avoid using the gender dichotomy like “boys and girls”. Try not to use strongly gendered language to refer to your child and others. Incorporate many gender-neutral phrases and expressions to allow more space for your child to decide how they relate to gender.

Excerpted from The Conscious Parent’s Guide to Gender Identity: A Mindful Approach to Embracing Your Child’s Authentic Self by Darlene Tando. Copyright © 2016 F+W Media, Inc.  Used by permission of the publisher. All rights reserved

This excerpt was also recently featured on the Mother.ly website here

Published in: on September 2, 2016 at 2:32 pm  Comments (14)