How This All Began

I regularly get asked how I got into the gender work I do. Here’s how it all went down:

In early 2006 I was establishing my private practice while I was still working at the Naval Medical Center San Diego. As a way of getting new clients, I advertised on Craigslist. I was a little leery of doing this, for fear it would attract people not exactly looking for therapy. True, I got a couple of off-color inquiries, but thankfully these were easy to screen as not legitimate. Since I had never before worked with gender nonconforming clients, my ad said nothing about that. Here is a snippet from that ad:

“Although I specialize in working with children, I also work with adult individuals and couples. I find that my warm and empathetic approach that works so well with children also helps to create a safe, therapeutic environment for adults which promotes progress in therapy.”

Perhaps it was the way the ad was phrased that made someone struggling with their true identity reach out to me?

“Hello, I was wondering if you offer any type of therapy that deals with gender reassignment[…] If you don’t, and happen to know of someone please send me their name. Thanks.”

Unfortunately, I don’t have the response I wrote back to him, but this is the return email:

“Darlene,

Thank you so much for responding to my message. You are right it was a hard step as it will be the first talking contact for me. I appreciate your honesty in telling me that you have not worked with any transgendered [sic] patients. Doesn’t bother me one bit. In all honesty, I feel like I know where I am at as far as how I feel about the situation. Where I am having my biggest doubts and fears are when it comes to telling my family and friends about my issue/feelings. The fear of their reactions is kind of holding me back. […] For some reason I feel like we can work together, and you can help me a lot. […] I have a few other questions regarding my letter for T, and top surgery, but I’m sure we can discuss these at a later time. Which name would you like? My birth name or what I plan (at this moment) to go by? Thank you.”

I don’t have my response but I do know it included this question: “What is T?”. This always makes me smile thinking back to it. “T”, referencing Testosterone, is now a standard (almost daily!) part of my vocabulary. I also know that even though I hadn’t been “trained” yet in gender therapy, I knew to of course ask for his preferred name. That is the name I have called him ever since, and have never once called him his birth name. There are SO many things I had to learn after I started working with him and soon thereafter many more transgender individuals. However, the concept of being transgender never confused or fascinated me. It just seemed so simple, pursuing alignment to match one’s gender identity. As I’ve said before, some people “get it and some people don’t. I got it.

Our first session focused on a psychosocial assessment and discussing his goals for gender transition. He needed to educate me about some things, but I also made it clear I would be doing research and pursuing my own education about this. I knew that just because he was my first transgender client it wasn’t his job to teach me everything I needed to know in order to give him the best care. He left me with his copy of “Testosterone Files” by Max Valerio which I promptly read. After all the books I’ve read on this topic, I’m always glad that was my first. I felt it was a very informative and well-written account of someone transitioning from female to male.

Here is part of the email I received after our first session:

“Hey Darlene,

I just wanted to say thank you for taking time out to talk with me today. I admit I was really nervous before we started, but I ended up more comfortable than I thought I was going to be. I also want you to know that you are very easy to talk to, and I believe you are going to be able to help me figure out what I need to do. I actually left your place with a feeling of relief for the first time. Somehow I feel as if things are going to be all right eventually for me. Thanks. Looking forward to our next session!”

This client was traveling quite a way to see me, which was my first clue there were not a plethora of other therapists working with this population. He connected me with his case manager from the former S.T.A.R. program, “Supporting Transgender Access to Resources”. The care manager reiterated the lack of therapists for this community and was soon sending me MANY more transgender clients. I did my best to get equipped for the details of my newfound duties; writing letters for hormone treatment and surgery, helping clients access resources, assisting them in the coming out and transitioning process. I read books, attended conferences, and attended monthly FTMI (Female to Male International) meetings at the LGBT Center here in San Diego. Soon I was leading a weekly support group for FTM individuals in addition to the clients I was seeing one-on-one. I am so grateful to all the people and clients I interacted with during that time; I learned so much from them and became more committed to and invested in my work than ever.

At first my gender therapy was only with adult clients. Soon, my name was “out there” and I began seeing gender nonconforming and transgender children. Since my specialty had always been working with children and my newfound specialty was gender therapy, this was a beautiful and serendipitous melding of the two.

When I first found out about the substantial lack of gender therapists in San Diego, I didn’t understand why. Why weren’t there more if the need was so high? Was there something I was missing? Was I looking at this too simply, that these people coming to me knew their true gender and just needed some help getting there? Over 8 years later, I can answer: no, I wasn’t missing anything. This work truly is that cut and dry; the clients are the experts on their own gender identity. I am just here to help and support them along the journey.

My first client has told me many times how I “changed his life”, but I can honestly say he changed mine in much the same way. He gave me a specialty that I am deeply passionate about; I am absolutely inspired and energized by my work. In an amazing “parallel universe” kind of way, entering into this particular niche has helped someone very significant to me discover their true gender identity and therefore transition. Because of this, gender transition is a part of both my professional and personal life, and I wouldn’t have it any other way.

To my “OG” client: THANK YOU. Thank you for giving me a chance. For trusting me with such a huge undertaking in your life even though I had no “experience”. Thank you for blessing me with this amazing work I get to do. And, thank you for letting me share part of your emails here.  🙂

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Published in: on August 19, 2014 at 7:04 pm  Comments (2)  
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Viral Video: Ryland’s Story

A very important video has gone viral with over 4.5 million hits in one week. It’s the story of young Ryland, a transgender boy who was allowed to socially transition at the age of 5. To see the video, click here. As a gender therapist, and a gender therapist who also works with transgender children, I’m thrilled to see this video in mainstream media: Huffington Post, People.com, Upworthy.com. It’s bringing awareness to an extremely important issue: not just that transgender children can transition, but it drives home the point that transgender people are born transgender. The age that one is consciously aware of being transgender or transitions can vary widely, but an individual does not become transgender over the course of their lifetime.

I had the honor of speaking about this issue on Good Morning America. To see the clip, click here. I said a lot more than what was aired, but there’s only so much they could fit into a 4-minute news segment. I’d like to take this opportunity to address some of those things now. These points are in direct response to the questions I was asked by Good Morning America about the video. Regular readers of this blog are probably well-versed in the answers below, but in case this post is read by someone seeking more education or to understand young transgender children, I wanted to be thorough.

Many people were surprised to read that 41% of transgender individuals have attempted suicide, while the rate of the general population is 4.6%. That staggering statistic, I believe, applies to transgender individuals who transition later in life and meet with familial/societal resistance, rejection, or shame. “New analysis of responses to the National Transgender Discrimination Survey (NTDS) shows that transgender respondents who experienced rejection by family and friends, discrimination, victimization, or violence have a higher risk of attempting suicide.” I strongly believe that number will plummet in the coming years with increased awareness, education, and accepting, responsive families like Ryland’s. To read the full report from the Williams Institute, click here.

I was asked questions about what interventions are recommended for transgender children. For a transgender child as young as 5 or 6, the first step is social transition. This means changing pronouns, sometimes name, and some societal markers of gender such as haircut or dress. No medical interventions happen at this stage, contrary to some sensationalistic beliefs. The first medical interventions would be just before the onset of puberty, at which time hormone blockers would be introduced to prevent the body from going through the “wrong” puberty. As the teen ages, cross-sex hormones would be administered to initiate puberty of the preferred sex, which would produce some much-desired “gender markers”.

When a child has been clear about their gender identity and not transitioning causes distress, transitioning young can be incredibly beneficial to the individual. While not all transgender people are focused on “passing”, it is hugely important to many. “Passing” means being read in society as the gender with which you identify in your brain. Going to the grocery store and having the cashier address them with the correct gender pronouns… that is “passing”. Transitioning early and intervening before puberty takes over will allow that individual to pass as his or her “true” gender without question.

One thing I want to say is that I know many people worry that a very young child is too young to make such a big “decision”. I want to remind you that gender identity is not a decision. We all know very early on what gender we are. A transgender child of Ryland’s age is not making a “huge decision” to be a boy. He IS a boy. His parents were faced with a huge decision about allowing him to transition, and they made it based on Ryland’s asserted gender identity.

I thought Good Morning America did a good job of covering this video. I was pleased about the input from ABC’s Chief Health and Medical Editor, Dr. Richard Besser. “The more we’re learning about gender, the more we’re learning that this is really hard-wired. It’s hard-wired in the brain. And from very early, from the first couple years of life, children will recognize gender and then start to identify with gender.” My only feedback would be that he should have used male pronouns when referring to a transgender boy.

One thing that didn’t sit right with me was the way they worded the “teaser” for the upcoming segment on the video. “True Identity: The incredible story being shared coast to coast of one little girl who just wanted to be a boy. Why her parents encouraged her to change gender.”

This statement is misleading at best. First of all, this child is not a little girl. This child did not “want to be a boy”, this child has the brain gender identity of a boy. As the video said, this child did not say “I want to be a boy”, he said “I AM a boy”. Now, I understand those snippets are meant to be short and can’t cover it all, and they are geared to having people tune in to watch the segment. The part that got me the most was the last sentence: “Why her parents encouraged her to change gender.” If you are the parent of a transgender child, you probably understand why that sounds a little silly. Do these parents have some sort of ulterior motive to have a transgender child? Doubt it. Was this in their master plan? Likely not. Many of the parents of young transgender children I work with struggle extensively during the process of understanding their child’s true gender identity. It takes time to accept their child is transgender, and naturally, parents tend to agonize over allowing their child to transition. Supporting and responding appropriately to their child’s gender identity is not encouraging something that wasn’t there; you can’t make a child transgender. However, supporting and encouraging the child to live life as their true selves, that is selfless, unconditional love. For more reflections on how difficult and intense this journey can be for parents, see my blog post “Feelin’ The Love: Watching the Journey of Parents”.

In the video, the song fades from “Hallelujah” by Jeff Buckley to “Good Life” by One Republic as it shows Ryland transitioning. I think it was the perfect song choice. So many parents worry whether or not their transgender child can have a good life. The answer is: ABSOLUTELY. Thank you to Ryland and his family for being selfless and strong enough to share your story so that many more transgender children can have good lives, just like you.

Clip from “The Doctors” Show

Recently I had the opportunity to appear on the show “The Doctors” on an episode about a gender nonconforming child, subject of the blog and book “Raising My Rainbow” by Lori Duron. Here is a 3 minute clip in which I discuss the terms “gender nonconforming” and “transgender”. Click here to see the clip.