My Book: The Conscious Parent’s Guide to Gender Identity

Many of you have probably been wondering why my blog has been so inactive lately. Well, I wrote a book! F + W Media, Inc. has a series called “The Conscious Parent’s Guide To…” about a number of different topics. They wanted to publish one on gender identity, found me through this blog, and asked me to write it! I was happy to have the opportunity to write about how to best support gender expansive kids to a more wide-reaching audience. I truly hope it helps a lot of families.

The book is ideal for parents/guardians of gender expansive kids, but could also be useful for extended family members, therapists, teachers; anyone involved in a gender expansive child’s life. Click here to order your copy: The Conscious Parent’s Guide to Gender Identity: A Mindful Approach to Embracing Your Child’s Authentic Self.

I do want to add that I did not write Chapter 1. Chapter 1 is the standard chapter for all of the Conscious Parent’s Guides. I only added in the parts related to gender. So, if you don’t love Chapter 1- keep going. 🙂 If you liked Chapter 1 best, sorry. 😉

In addition to the overview in Chapter 1 about conscious parenting, there are ways to incorporate being a mindful, conscious parent throughout the book. This is so much more than just being “present”, it’s about recognizing your little human as a separate being, with their own unique will and spirit. I write about how to best connect with your child in order to be most receptive to what they are trying to tell you.

I write about the differences between gender and sex, gender identity and sexual orientation, gender expression vs. gender identity, and what gender “expansiveness” really is. This not only helps those involved in a gender expansive child’s life understand these concepts, but helps explain them to others.

I discuss the concept of getting to know one’s child for who they are from the beginning, rather than making assumptions that later need to be shifted or undone. I write about parenting gender expansive children, and the difference between being transgender and “just” gender expansive. In the book you will find practical tips for interacting with and advocating for your gender expansive and/or transgender child, while learning how to trust yourself and appreciate life at the same time.

Later in the book there is more specific information for families who have a child in need of social or medical transition: how/when to navigate interventions, coping with outside influences/reactions, siblings, extended family, schools, etc. There is a specific chapter dedicated to “helping your gender expansive child with teasing”, based on the concepts I present at gender conferences. There is also a specific chapter dedicated to dysphoria, which is important for everyone involved in a transgender child’s life to understand.

The appendixes include some resources I hope you will find helpful, including ways of looking at natal sex/gender identity/gender expression/sexual orientation on spectrums, or on more of a fluid shape. There is a list of “Classroom Rules” to help classrooms promote diversity. There is also a worksheet for children who may need some help in understanding when a friend or loved one is going through transition. Last but not least, there is a sample letter from parents informing their loved ones about their child’s social transition.

Let me know how you like the book, and leave an honest review on Amazon! Thank you so much for your ongoing support of this blog, I promise to get back to writing regular posts soon.

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Physical Transition Options for the Transgender Individual*

In conjunction with my last blog, “What’s in YOUR Pants?”, this blog is about physical transition options for the transgender individual. As stated in the aforementioned blog, many people ask about surgery the first time they hear about a transgender individual’s plans to transition. It may surprise many people to find out the transgender individual has no plans to pursue surgery, specifically genital surgery.

I recently watched a documentary called “Diagnosing Difference” by Annalise Ophelian (excellent; I highly recommend it!).  This quote from that documentary summarizes perfectly what I was trying to say in my last blog, and leads nicely into what I’m going to explain in this blog. “There’s this huge stereotype that trans people all have genital surgery, that we know that someone’s really the new gender because they’ve had genital surgery, and that’s one of the biggest misconceptions about trans people. In reality, the vast majority of trans people will never have any surgery, and many trans people have surgeries that aren’t genital surgeries. [Italics added.]  And some people don’t have surgeries and don’t undergo medical care related to their gender because they don’t want it, it’s not appropriate to them, there’s other ways that they’re expressing their gender, and some people don’t have it because it’s not available to them, it’s not covered by their insurance…and so for both of those reasons, rules that govern are you really trans or have you really transitioned based on genital status or surgical status are very damaging to trans people’s well-being.” –Dean Spade

Hormone Therapy

OK, so before I get to surgery, let me talk a little bit about hormone therapy, or hormone treatment. Hormones are often a huge part of the physical transition process. Female-to-male (FTM) transgender individuals take Testosterone or “T” (by patch, cream, or injection, most commonly injection). Doses vary depending on the individual and his desire for physical outcomes. Often the first changes that occur from taking Testosterone are the deepening of the voice and facial hair. These are also two irreversible changes that occur from taking T. Other changes include changes in facial features, head shape, clitoral enlargement, and fat redistribution (less on hips/butt/thighs, more to stomach). For more information regarding FTM hormone therapy, visit http://transhealth.vch.ca/resources/library/tcpdocs/consumer/hormones-FTM.pdf or http://www.ohio.edu/lgbt/resources/transoptions.cfm.

Male-to-Female (MTF) individuals often take Estrogen, which can be administered orally or by injection, most commonly in a pill form taken orally. Hormone therapy for MTF individuals also often includes an anti-androgen, which blocks the effects of testosterone.  Results from taking Estrogen include but are not limited to: breast growth, softening of the skin and facial features, lessening of body hair, and changes in fat distribution (less on abdomen, more to hips and bottom). For more information about MTF hormone therapy, visit http://transhealth.vch.ca/resources/library/tcpdocs/consumer/hormones-MTF.pdf, http://www.transgendercare.com/medical/resources/tmf_program/tmf_program_6.asp, or http://www.ohio.edu/lgbt/resources/transoptions.cfm.

Female-to-Male Surgical Options

FTM individuals have the option of two types of surgery, commonly referred to as “top surgery” and “bottom surgery”. Top surgery refers to the removal of breasts, the shaping of a male chest, and re-sizing the nipples. In my experience, this is the most commonly pursued and desired surgery for the FTM individual. A main reason for this is that the removal of breasts eliminates the need to bind (http://www.ftmguide.org/binding.html) and also helps the individual “pass” as male. Many (if not most) FTM individuals pursue this surgery, and those who don’t often cite the obstacle of not having the finances for it. Top surgery commonly costs between $6-10k, out of pocket.  For more information re: FTM “top surgery”, please visit: http://www.ftmguide.org/chest.html.

As for “bottom surgery” (surgery to construct a penis), most FTM individuals do not pursue any genital reconstruction surgery (GRS). You read that right, most DON’T.  Finances are often a major obstacle; GRS costs anywhere from $20k to $70k, depending on the procedure.  Additionally, many FTM individuals are not happy with the options/projected results; techniques have not been perfected enough to deliver optimal results. Additionally, some FTM individuals don’t have a problem with their genitalia or see the need to have it changed. (Remember, one’s genitalia has more to do with one’s anatomy than gender. For a refresher on the difference between Gender and Sex, visit my blog Gender Vs. Sex.)

For those who do pursue “bottom surgery”, there are a few options. These include but are not limited to: a metoidioplasty, which involves cutting the ligament connecting the (now enlarged, thanks to T) clitoris and removing extra skin, resulting in a small phallus. The urinary tract can also be lengthened if the individual wants to be able to urinate while standing. Another surgery called a “phalloplasty” is basically the creation of a penis using skin from a donor site on the individual’s body, most commonly the forearm.  If the trans man desires testicles, the skin from the labia can be used to create a scrotum. At least six months after a phalloplasty, testicular and penile implants can be inserted.  To quote Hudson’s FTM Resource Guide, “Phalloplasty usually involves a urethral lengthening procedure so that the patient can urinate through the penis. Erections are usually achieved with either a malleable rod implanted permanently or inserted temporarily in the penis, or with an implanted pump device.”   For more information regarding GRS for FTM individuals, please visit http://www.ftmguide.org/grs.html or http://www.savaperovic.com/ftm-srs-metoidioplasty-total-phalloplasty.htm.

There are MANY different options for FTM individuals who don’t choose to or who can’t afford bottom surgery. There are all sorts of accoutrements available for purchase that allow the trans man to stand to urinate, wear a penis, and/or to have intercourse. In order to stand to urinate, there are “stand to pee” (STP) devices. (http://www.ftmguide.org/packing.html#stp)  If the trans man prefers to wear a penis, full-time if desired, this is called “packing”. (http://www.ftmguide.org/packing.html) There are a variety of different packers available for purchase.  (http://www.tranzwear.net/store.php?seller=TranZwear&navt1=101317&navt2=101323. For a 15% discount on purchases from tranzwear.com, use discount code “TRANZ” when checking out.)  For sexual intercourse, there are also a variety of options to choose from (http://www.ftmguide.org/packinghard.html).  I should add here that not all trans men choose to pack or wear any kind of prosthesis. As with any group of individuals, there is a spectrum of preferences about this!

Male-to-Female Surgical Options

Facial feminization is a common surgery pursued by MTF individuals. This can include changing the hairline, frontal bone contouring, mandible contouring, chin augmentation or reduction, rhinoplasty, lip augmentation, etc. I don’t know the exact numbers on this, but the cost of this surgery can be upwards of $30k. For more information on facial feminization, visit: http://en.wikipedia.org/wiki/Facial_feminization_surgery. Some trans women opt to undergo breast augmentation surgery. (Estrogen often does not enlarge one’s breasts to more than a “B” cup.) http://marcibowers.com/grs/breastaug.html

As for MTF “bottom surgery”, often referred to as Sexual Reassignment Surgery (SRS) or Genital Reconstruction Surgery (GRS), many transgender women opt to undergo a vaginoplasty, using skin and tissue from the penis to create a vagina, clitoris, clitoral hood and labia.  This is another expensive surgery not covered by insurance; I don’t know the exact figures but what I could find implied a ballpark figure of $20k. Sue Boyd, LCSW, a trusted colleague of mine who works with more MTF individuals than I do, estimates that about half of her MTF clients opt to pursue this surgery “expense and all”. My guess is because the results are more satisfactory to the consumer than the current results of FTM bottom surgery. For more information on MTF GRS, please visit: http://www.thetransgendercenter.com/transgendersurgerymaletofemaleMTF.html or http://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male-to-female)#Genital_surgery.

I should say again that all of the above depends on personal preference. Some individuals believe opting to get any or all of the above surgeries is a way of buying into the gender stereotypes prescribed by society, particularly about how a man or woman “should” look. To quote the film “Diagnosing Difference” again, “I think ‘passing’ is a word to discriminate us immensely. Not everybody can pass. And passing is something that the doctors will tell you to do, you try to pass. Well, no matter how much I pass, I will never be a biological woman. How about empowering me as the transgender woman that I am?” -Adela Vazquez

A moment on my soap box:

After reading all these extensive options a transgender individual confronts, don’t you wish things could be a little bit easier? They can be. By intervening EARLY with a child or pre-adolescent who has yet to start puberty, their future does not have to hold as many medical interventions! For the MTF individual, staring on hormone blockers pre-puberty would prevent facial hair from growing in, thereby preventing HOURS of painful and expensive electrolysis. Hormone blockers would also prevent one’s Adam’s apple from growing and the voice from deepening, which would eliminate the need for a “trach shave”… ouch! Similarly, staring hormone blockers pre-puberty for the FTM individual would prevent breast growth and ultimately prevent an expensive and painful “top surgery”. Additionally, for the transgender individual who desires to “pass” as their true gender, intervening early gives them the best chance at doing exactly that. For more information about hormone blockers and intervening early for transgender children, please visit http://transhealth.ucsf.edu/trans?page=protocol-youth.

*Disclaimer(s):

  • I am a Licensed Clinical Social Worker, not a medical doctor. The information contained in this blog should not be considered a replacement for medical advice or consultation.
  • The websites used in this blog should not be considered as endorsements but rather sources of information.

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, he or she is usually pretty darn sure about his or her 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 he or she is 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 he or she identifies. 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 he or she is 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!

Published in: on July 28, 2011 at 9:04 pm  Comments (10)  
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Important Medical Info for Trans Men

I finally watched the documentary “Southern Comfort”; it’s one I’ve been meaning to watch for years. I wouldn’t recommend it to someone trying to find out more about the trans community, but it addresses a VERY important topic. It’s the story of a Female to Male transgender individual named Robert Eads, who died from ovarian/cervical cancer after being refused medical treatment. It shocks and saddens me that anyone in the medical field would refuse to treat someone in need of help, regardless of their race, gender identity, social status, anything… and as recently as 1999!

The main reason the doctors cited not wanting to treat him was that it might make the other patients in the waiting room uncomfortable or that treating him would damage their reputation. As a result, over the course of the movie you see a very vibrant and loving person diminish and then pass away.

However, I’m not necessarily writing this blog about the outrage of refusing to treat a trans individual medically. The main reason I chose to write this is to remind trans men: if you still have a cervix, ovaries, or a uterus, you are at risk for cancer in these areas! I know reading this, thinking about this, or talking about this is just about the last thing you want to do, and many trans men avoid the tests for these cancers like the PLAGUE. Having a pap smear is an uncomfortable experience at best for most women. For trans men, I can only begin to imagine how awkward/humiliating/discouraging having to go to one of these appointments must be. PLEASE GO ANYWAY. It’s better to feel like you’re going to die of embarrassment then to actually die of cancer. Yes, I am trying to scare you into going. To quote Mr. Eads himself, “The last part of me that is female is killing me.”

I have a couple of practitioners in San Diego to whom some of my trans male clients have gone for these types of exams, and have had nothing but nice things to say about the doctors. In addition to this, I have called both of these doctors’ offices and asked if they are open to having their names on my resource list for my trans male clients. They both said yes! Please see the bottom of this post for their names and contact information.

If you don’t have medical insurance and can’t afford to pay out of pocket for these providers, there are some low-cost clinics in San Diego that could perform these tests. If you don’t live in San Diego and you need help finding a place to go, email me and I will help you research this. Or, if you are too shy or scared to call a doctor’s office to find out if they would be trans-friendly, let me know! I will call for you. Client or not…even if I’ve never met you.

Once you have an appointment, one thing you can do to make the experience more comfortable is call the doctor’s office or clinic the morning of your appointment. If you are too nervous to do so, have a partner, family member, or trusted friend do it for you. You or they can let the front desk staff know who you are, what you will be seen for, and how you present so there is no confusion when you arrive. You may need to gently remind them they are to use male pronouns and your chosen name (if not yet legally changed).

One important point made in the documentary is that since Robert transitioned later in life, he was close to menopause. Because of this, he was advised he did not need to have his uterus and other female reproductive organs taken out. I believe the loose guideline for getting a hysterectomy after taking Testosterone is 5 years. If you are an existing client of mine and need a letter to have the hysterectomy performed, let me know.

The most important thing is that you don’t ignore this.

Come on, be a man… go get a pelvic exam!

For more information go to:

http://www.ftmguide.org/tandhealth.html#pap

http://www.checkitoutguys.ca/

http://www.ftmguide.org/hysto.html#why

San Diego Providers:

Dr. Alisa Williams*

619-299-3111

4060 Fourth Ave Ste 640

San Diego, CA 92103

*Dr. Williams also does hysterectomies

Dr. Laura Norton Petrovich

(619) 435-2234

1224 10th St Ste 200

Coronado, CA 92118