Stop Trans Pathologization*: Some People Are Transgender, and Some People Are Not

Just like any variation of the human condition, some people are left-handed, and some people are not. Some people have two different colored eyes, and some people don’t. Some people are allergic to dairy, and some people are not.

Some people are transgender, and some people are not.

In some of the trainings I do, I ask the question: when is gender pathological? It’s basically a trick question, because gender isn’t pathological. Gender just is. It has neither good nor bad qualities. Yes, distress can come from feeling like your exterior presentation does not match your brain gender identity, and distress can come from society not understanding your gender, but gender in and of itself isn’t distressing. It just is, and we all have a gender identity even if that gender identity means not having a gender at all.

Some people are transgender, and some people are not.

Parents come to me with various theories for why their child may be transgender, or at least “presenting” as transgender. I’ve heard many different theories over the course of my years in working with transgender children, and many similar ones. I think space needs to be held for these parents wondering “why?”, and their theories should be listened to and considered. However, sooner rather than later there needs to be a time to take the “why?” and replace that with “OK, now what?”. In the end, the “why” doesn’t really matter. What matters is the child’s happiness.

My theory?

Some people are transgender, and some people are not.

Some people wrongly believe that being transgender is some form or sign of mental illness. In fact, even some professionals will use the term “co-occurring” when they speak of someone being transgender along with having a mental illness. Being transgender is not a mental illness. There is not a certain “type” of person with a certain set of presenting problems who is transgender.

Say it with me:

Some people are transgender, and some people are not.

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*This blog post is going live on October, 24, 2015, the International Day of Action for Trans Depathologization, an annual day created by Campaign Stop Trans Pathologization. Let’s stop pathologizing gender… because simply some people are transgender, and some people are not. 🙂

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Legal Name and Gender Change: Detailed Information with SAMPLE PACKETS (California)

I have been meaning to post this for quite a while, but I have been shorter on time than I have on good intentions. 🙂 I know this is something that many people need assistance with, as filing a name and gender change (for yourself or your child) can be a daunting undertaking. Please keep in mind it typically takes 6 weeks from filing the documents to court date with a completed court order.

I want to give a huge “thank you” to Emmett for putting together a list of step-by-step instructions for filing a name and gender change and providing me with the court paperwork for an adult. Also, special thanks to Britt for providing the sample paperwork for a name/gender change for a minor.

I took the paperwork and filled out “sample” packets for each. The areas you need to fill out are highlighted. These didn’t scan well, so I apologize for the poor quality. If you have any trouble reading them, please let me know and I will either re-scan or I can answer specific questions. The files are too large to email. I know these are specific for San Diego, but I hope they will be useful to those in other parts of the state as well. If you are one of my clients and see me in my office, please ask me for a copy of the sample packets- I have several on hand!

Click here for the Transgender Law Center’s page with links to forms needed. (San Diego County link listed below.) For those of you not in San Diego, simply Google your county and “name and gender change”. PLEASE NOTE, DUE TO AB1121,  IF YOU ARE CHANGING YOUR NAME TO REFLECT YOUR GENDER IDENTITY, YOU NO LONGER HAVE TO PUBLISH ANYTHING IN THE NEWSPAPER. If the court is unaware of this, educate them.

Here is the Transgender Law Center’s awesome resource, “ID Please” that includes UPDATED information on changing name, gender, etc.  If you are interested in pursuing a name and gender change, start on page 9. If you ONLY need to change your child’s gender marker (keeping birth name), and your child was born in California: click here.

Filing the packet costs $435 (at least in San Diego), but the fee can be waived based on low income. (“In Forma Pauperis“.)

Youth (minor) name and gender change sample packet HERE.

Adult name and gender change sample packet HERE.

BEFORE YOUR COURT DATE

(Thanks again to Emmett for these detailed notes!)

Print all necessary forms and fill them out (or have them filled out, as is the case for the doctor one, NC-210). Here is the website for printing the forms for San Diego.

Forms needed for an both an adult or a minor name/gender change:

CM-010

NC-220

NC-230

NC-200

NC-210

NC-110

-Make a copy of signed/filled out paperwork for your records. Bring the original packet and a copy of the packet to 330 W. Broadway. (Downtown San Diego).

-Once you pass the security check, take the escalator up to the second floor & the Civil Business area.

-It can be a little confusing, so ask someone if you are lost.

-Get in line on the far left of the room and wait to file your forms with the clerk.

-They will go over all your forms, stamp them and give you a case number.

-They may try to tell you that you need to publish your name change, REMEMBER that AB 1121 went into effect July 1, 2014 that states that a person changing their name for gender purposes is not required to publish.

-They will give you a court hearing date and time.

DURING YOUR COURT DATE

-Show up early.

-Bring both copies of all the documents and a pen.

-Give yourself time to find the court room.

-Sit down and wait outside.

-A lot of people will likely start showing up because people legally change their names for a variety of reasons (marriage, divorce, etc).

-Someone will come out and point to a list that is up on the wall. The list has everyone’s name on it and a number next to it. Find out what number you are and write it down. They call out cases by number and sometimes last name (so don’t worry about your birth name being called out!)

-They sometimes call in everyone that is getting both a name and gender change first because there are fewer people and it’s a more private matter than a marriage.

-You will get called in, you will be seated, the judge will come in, they will review your documents, and if everything is in order: declare your new legal name. (Congratulations!)

-After that they will tell you to go wait outside and they will bring you four signed copies of the court order.

-Do not worry about your physical appearance or gender presentation. If all the forms are filled out, especially the physician form, the judge does not care.

-You can leave and celebrate. 🙂

AFTER YOUR COURT DATE

Your work is not done! There are more documents to change that had your birth name on them. These documents are supposed to “match” in the system, so this is important. Here’s the order you must go in.

1) Social security

-1333 Front St, San Diego, CA 92101. (855) 820-0097

-Fill out this form for a CORRECTED social security card

You’ll need to bring your court order (form NC-230), identification (driver’s license, ID or passport) and the form above filled out.

-No need to make an appointment, just walk in and take a number.

-Allow 4-6 weeks for the card to come in the mail.

-IMPORTANT The form does not include a specific gender change. So in the “sex” section mark the gender that you legally changed to (transmasculine folks mark male, transfeminine folks mark female) and make sure to point it out on the form when they call you up. It doesn’t say your gender marker on the card, but it does in their system, and that’s how the DMV verifies your gender when you go there to change your documents. Confirm they have changed it in their system.

2) DMV

-Go to whichever DMV is closest to you. Make an appointment, or get there early.

-Fill out this form with your doctor BEFORE going to the DMV

You’ll need to bring your court order (form NC-230), identification (driver’s license or ID) and the form above filled out.

-You will also need to fill out form DL 44 (name change), but they give you that when you show up.

-They’ll call you up, review your forms, tell you everything is good and send you over to get a new photo taken.

-Allow 4-6 weeks for you Driver’s license to come in the mail. They will send you an ID card sooner than that.

3) Bank

-IMPORTANT you must have your updated ID or driver’s license BEFORE going to your bank. They use it as proof that you are who you say you are.

-Go in and ask to see a teller.

-Bring your court order (just in case), and your new ID or driver’s license.

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In the near future I will be posting more detailed information about how to change your birth certificate and password- stay tuned!

If you have any information that would be helpful to add to this blog post, please email me at tandotherapy@me.com

One more time, here are the sample packets!

MINOR PACKET

ADULT PACKET

Don’t Poke the Dysphoria Monster

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There may be a monster in your child’s closet. All of the reassuring you may have done when your child was little that there was “no such thing as monsters”, checking under beds and in closets to alleviate anxiety, may not have been exactly true. For transgender kids and adolescents, and even adults, a Dysphoria Monster may be lurking nearby.

When I worked in a residential treatment facility for children, I used the “Addiction Monster” metaphor to explain addiction to children. Many children who resided there had parents who were addicted to substances, and this resulted in inconsistent visits, broken promises, and time away in jail. I would explain that when someone is struggling with addiction, they have an addiction monster that is sometimes small and manageable, sometimes huge and overpowering, but never nonexistent. When it’s huge, it has them in their grip, throwing them around, banging them up, holding them hostage. When the addiction becomes more under control, the individual may have more power over the monster, like walking it on a leash. After some time of sobriety when urges have decreased dramatically and the individual is in recovery, the monster may get small enough to tuck away in their pocket. But remember: it’s always there, and they would need to take care to keep it small.

Now that I work with transgender individuals, I have met the Dysphoria Monster. For those of you who don’t know, dysphoria is the discomfort and depression that can come with having a body that does not line up with one’s gender identity, or come from not being read as/treated as the gender one is in their brain. Dysphoria can range from unpleasant to life-threatening; it’s a force to be reckoned with.

Most transgender people experience and relate to dysphoria differently. Some have very little (tiny dysphoria monster tucked in their pocket), some have debilitating dysphoria (picture the gender dysphoria equivalent of Godzilla). Dysphoria can fluctuate on an hourly, daily, weekly basis. How much dysphoria is present on a day-to-day basis can be dependent on temperament, life experience, support, stage of transition, relationship status, triggers, and much more.

Here is an example of how the Dysphoria Monster can work: picture a female-to-male individual walking down the street with a female friend. He’s feeling good; confident, content, enjoying the day. His monster is quiet; he doesn’t really notice it. Suddenly he and his friend enter a restaurant and they are greeted with, “Hello, Ladies!”. His monster is awakened! Growling, breathing down his neck. The monster sits with them at the table for the rest of the meal as he agonizes over being misgendered.

Ever heard of the expression “don’t poke the bear”? It’s important as the loved one of a transgender person that you don’t “poke the Dysphoria Monster”. Be aware of the fact that this monster is lurking nearby and that it is in your loved one’s best interest that the monster stays docile. Unfortunately, parents and partners (and other loved ones) can fairly easily poke the monster because they are usually the ones who are around the individual the most. This can happen in any number of ways: misgendering (using wrong pronouns), using birth name, commenting on body parts, commenting on appearance, giving tips on how to be masculine/feminine, the list goes on.

Do you want to know how big and unruly your loved one’s Dysphoria Monster currently is, and how to avoid inadvertently awakening it? Here are some tips:

  • Educate yourself on dysphoria. Don’t expect your loved one to do it all for you. Understand what can be the most distressing parts of being transgender. Use compassion to fill in the blanks you don’t understand.
  • Check in. Don’t be afraid to ask, “How’s your dysphoria?” (or whatever word they would like you to use). Usually they will know exactly what you mean, and you will get the most direct answer that way.
  • Ask them what triggers their dysphoria the most. This will help you not only learn to avoid causing these triggers yourself, but will be alerted to check in after you witness one of these triggers happening.
  • Ask what helps lower their dysphoria. Ask when they feel the least dysphoric, and then try to increase or replicate these experiences/situations.

How big is your or your loved one’s Dysphoria Monster? Would you describe it differently?

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.

Overthinking: Saboteur of Transition?

dsa-overthinking-3

Picture source here.

There’s something happening, folks, in the teenage and adult minds across America. It’s an epidemic. It can cause anxiety, distress, and indecision. What is it? It’s overthinking.

“We are dying from overthinking. We are slowly killing ourselves by thinking about everything. Think. Think. Think. You can never trust the human mind anyway. It’s a death trap.” ―Anthony Hopkins

Sometimes a client will ask me a question that causes me to pause and wonder how in the world they ever ended up at that question in the first place. My friends, some of these questions have to be the result of overthinking, because they seem to transform a somewhat simple concept into something very complicated and convoluted. If you are my client, you may have heard me ask the following question a time or two during our sessions together: “Is it possible you’re overthinking things?”.

“Some thoughts should never be conceived. Some questions should never be asked, because they have no answer, and the questions themselves serve only to haunt with grinding guilt and second guessing.” ―Bobby Adair, Slow Burn: Dead Fire

So, how does this concept relate to gender and gender transition? My argument is that overthinking can be a transgender person contemplating transition’s worst nightmare. All steps, stages, and possible outcomes are analyzed to death, creating fear and hesitation. This is the beauty of a transgender child being allowed to transition: overthinking is not part of the process. They just are, and therefore they just do. Adults seem to have the impression that the more they think about something, the surer they become. In my experience, both personally and vicariously, the opposite is often times true.

“The more you overthink the less you will understand.”  ―Habeeb Akande

Children, and adults, know their gender identity. The difference is that knowing what to do about it is either subject to overthinking or not. Given a child’s pure mind, you can rest assured they will have more simple answers than we do, and sometimes simple is exactly what you need. For adults contemplating transition, what would the child inside you say to do?

d789ed3bbcb2614fb6d80d3845924f18

Other interesting articles related to overthinking:

http://lifehacker.com/how-to-stop-overthinking-everything-and-find-peace-of-m-1609850688

http://themindunleashed.org/2014/09/8-ways-stop-thinking-find-peace.html

Random side note: I did a fair amount of overthinking about whether or not the word overthink should be hyphenated. In the end I just went with the majority on the internet and how my iphone auto-corrected. If you think the word should be hyphenated, sorry. Don’t think about it too much. 😉

Name and Gender Documentation in Schools

It’s that time of year… school is starting or is about to start! If you have a transgender child or teen, it’s time to be discussing with the school what name and gender marker is going to be on the rosters, computer system, and “Power School” fields if the school uses it. Only those close to transgender children and teens realize the distress that having their birth name and/or gender marker on school paperwork can cause. I’ve seen the panic in their eyes firsthand. They are often petrified of having their peers learn their birth name. They are worried about being “outed”. Every time they log into the computer system at school, every time attendance is called (especially in the beginning of school or by every single substitute teacher), every time a schedule or report card is passed out, even sometimes buying lunch and having their birth name and gender pop up on the computer letting them into the cafeteria… I can only imagine the tension and anxiety every single one of these instances brings up for them. This is an unnecessary stressor for these kids and we all need to do our part to be educated and speak up about this issue. The following is an excerpt from Guidance for Massachusetts Public Schools: Creating a Safe and Supportive School Environment; Nondiscrimination on the Basis of Gender Identity: “The 2011 National School Climate Survey by the Gay, Lesbian & Straight Education Network (GLSEN), found that 75.4% of transgender students had been verbally harassed in the previous year, 32.1% had been physically harassed, and 16.8% had been physically assaulted. Educators play an essential role in advocating for the well-being of these students and creating a school culture that supports them.” I believe changing the documentation that circulates around school and on attendance rosters is a crucial part of creating a school culture that supports transgender and gender nonconforming youth. I recently learned at the Gender Spectrum conference that the school is only legally required to keep the legal birth name and gender marker somewhere in the permanent file, but they can change EVERYTHING ELSE to the preferred name and gender before a legal change. Before spreading the word, I did a little research on this topic to back up this claim. The following quote is from the California Safe Schools Coalition Model School District Policy Regarding Transgender and Gender Nonconforming Students: “Official Records The District is required to maintain a mandatory permanent pupil record (“official record”) that includes a student’s legal name and legal gender. However, the District is not required to use a student’s legal name and gender on other school records or documents. The District will change a student’s official record to reflect a change in legal name or legal gender upon receipt of documentation that such change has been made pursuant to a court order. In situations where school staff or administrators are required by law to use or to report a transgender student’s legal name or gender, such as for purposes of standardized testing, school staff and administrators shall adopt practices to avoid the inadvertent disclosure of such confidential information. Names/Pronouns A student has the right to be addressed by a name and pronoun that corresponds to the student’s gender identity. A court-ordered name or gender change is not required, and the student need not change his or her official records. The intentional or persistent refusal to respect a student’s gender identity (for example, intentionally referring to the student by a name or pronoun that does not correspond to the student’s gender identity) is a violation of this policy.” The following are excerpts from California School Boards Association (CSBA)’s “Final Guidance: AB1266, Transgender and Gender Nonconforming Students, Privacy, Programs, Activities and Facilities“: “Upon request, districts should prepare data systems to list a transgender or gender nonconforming student by his or her preferred name and gender.” “Privacy Rights of Transgender or Gender Nonconforming Student A student’s decision to inform the district that his or her gender identity differs from his or her biological gender is extremely personal and private. In addition, transgender and gender nonconforming students may face bullying and harassment as a result of other students or staff not understanding or tolerating the public representations of their gender identity. At the same time, the decision may potentially involve very public components if, for example, the student starts to go by a different name. Despite this potential for public awareness, districts are still legally responsible to maintain the students privacy according to the students wishes.” The following is an excerpt from Know Your Rights – Transgender People and the Law; Name Change and Identity Documents “Can a person change his or her name to reflect his or her gender identity? Yes. In some states [and California is one of those states], through what is called “common law name change,” people may change their name simply by using the new name in everyday interactions. It is free and easy, but does not create the kind of solid paper trail needed to change identity documents.” If you are interested in pursuing the legal name and gender change, know it takes at least 6 weeks to go through. Those of you who reside in San Diego can find the packet here.  Click here for the Transgender Law Center’s comprehensive page with links to all forms needed. For those of you not in San Diego, simply Google your county and “name and gender change”. PLEASE NOTE, DUE TO AB1121, YOU NO LONGER HAVE TO PUBLISH ANYTHING IN THE NEWSPAPER. If the court is unaware of this, educate them. Filing the packet costs $435 (at least in San Diego), but the fee can be waived based on low income. (Ask for the “In Forma Pauperis“.) Here is the Transgender Law Center’s awesome resource that includes UPDATED information on changing name, gender, etc. If you are interested in pursuing a name and gender change, start on page 9. If you ONLY need to change your child’s gender marker (keeping birth name), and your child was born in California: click here. Any other tips from those who have been down this road greatly appreciated!

Youth (minor) name and gender change sample packet HERE: minornamegenderchange

Adult name and gender change sample packet HERE: adultnamegenderchange

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.  🙂

Published in: on August 19, 2014 at 7:04 pm  Comments (2)  
Tags: , , ,

A Parent’s Post: Anti-Loss

Many parents of transgender children (youth and adults) express sadness about feeling like they’re going to lose their child in some way when their child transitions. I’ve heard several parents say this impending loss feels like a death, and they prepare to grieve accordingly. It’s never really that they are feeling that way; usually they are scared they are going to feel that way when their child transitions.

I tell them most parents end up not feeling that way, as their child will still be here, but they won’t know this until they go through it themselves. Really, the parent is not losing their child. The child (again, I’m talking about “adult children”, too) is going to be the same person they always were. The parent is only now beginning to understand what pronouns and gender identity go along with who their child really is. The main loss is that of pronouns and a mental image of who the parent thought they were.

Recently, a father made it clear he had not experienced loss as a result of his child’s transition. I wanted desperately to bottle up his words and give them to each parent I see who is struggling with a sense of impending loss in regards to their transgender child. So, I did the next best thing; I asked him to write a blog post about it! Without further ado, please read these words from a father who has gained so much.

“Anti-Loss – By Peter T.

Emma was our second child, born from the love her mother and I shared and wanted to manifest in the world.  In the days after we learned she was pregnant, my wife and I had no idea if she would give birth to a boy or a girl – and to both of us, it made no difference, whatsoever. Whether our baby, our child, our young adult was a boy or a girl was pretty much irrelevant, as long as they grew up happy, strong, knowing they were deeply loved and accepted for their unique and beautiful self.

Our baby was born in the body of a girl… but in this baby, nature decided to do an interesting thing. Somehow, the heart and mind and spirit of a son was inserted into the body of a girl.  We as parents, being such literal and visual creatures, took the visual presentation of our baby to be all we needed to know about gender.  The doctor said “It’s a girl!” and we believed.  We went about dressing our baby and our child as a girl… giving “her” girl activities… and investing in our expectations about what “she” would grow up to be.

As our child grew up and was able to begin to make choices in clothing, friends and activities, it was gradually apparent that our ideas about “being a girl” weren’t really fitting this small person.  Still, we took our child to ballet lessons and set up tea parties with classmates, bought cute dresses and imagined the life-ahead for “her” – and our child seemed to participate in these things happily… up to a point, but beneath the seemingly-accepting exterior of this small person, inner turmoil was brewing.

We, as parents of transgender teens, all have our stories of how our child made their truth known to us and how we initially – and then eventually – reacted to their needs.  I won’t lengthen this writing by sharing mine in detail, but I will acknowledge that I definitely had to go through my own reprogramming… adjusting in some fundamental ways, how I perceived my child.  The child I had known for 13 years as Emma now was to be called Andrew… “she” was to be “he” and a whole new world of concerns for his welfare appeared – in addition to the ones that come standard with every teen.

I have been so very fortunate to be included in my son Andrew’s counseling sessions.  All sorts of truths rise to the surface there that “real life” often doesn’t allow time or space for.  A few weeks ago, I said something to Andrew in counseling that I’d said several times before – but this time, he finally made it clear that what I’d said was hurting him.  What I’d said was that he was at something of a disadvantage in passing as male, because, as a girl, he was quite pretty – and that gave him an obstacle to overcome in looking masculine.  Andrew shared with me that when I said things like that, he felt as though I was saying I had lost something – that I had lost my “pretty daughter”… and clearly, it hurt him to feel that who he truly was inside – and now, outside was something “less” to me.

I was very sad to know that my observation about “what he used to be” caused him to feel I had lost something along the way.  The truth is so entirely opposite – for me it has been “anti-loss” – ONLY gain – as I have seen my child stand up and speak his truth and claim his real life – against all odds, despite peer pressure, despite fear of ridicule, in the face of the certainty that his road ahead would be so very hard.  I told him then… and I will remind him often… that he is so very much *more* than I ever could have hoped for in a child, in a son, in a young man who I am so entirely proud to have in my life.

What was it again?  What did I wish for… back in those days before his mother and I knew his eye color or his name?  What was it that we had hoped for, above all?  I had wished for a child who would be able to grow up happy and strong… who would face difficult challenges with integrity and intelligence… who would know himself deeply  – and from that knowledge, live a life filled with love and joy and passions-abounding.  In my lovely son, I have found examples of all those things that I, myself, can only hope to aspire to.  His process of becoming himself is such an incredible honor to participate in and I hope, as he grows into the amazing man I know he will be, that he always knows that his parents accept him and love him deeply and completely.

There is nothing here but gain.”

Thank you, Peter, for your beautiful words and sharing your perspective. Thank you also to Andrew for letting me share part of your story. ❤

But What If They Change Their Mind?!

Consider this post a close cousin to my last post, “On Being ‘Sure”. Related to loved ones’ fears about a transgender person being “sure” about transitioning are the fears that they may one day regret the transition or “change their mind” about being transgender. Yes, I hear this a lot. From doctors, from parents. It’s a valid concern, although I’m not sure the frequency with which it happens is correlated with the amount of concern about it.

It seems that at first parents hope their child (either a youth or their adult child) will change their minds when a transgender identity is first revealed. Later, this thought turns into a fear as transition nears or progresses.

In my opinion, some of the fear and anxiety comes from good intentions, trying to use their own perspective to understand. If they put themselves in the transgender person’s shoes, they would imagine not only would they “change their minds”, but they would want to “switch back” immediately. It’s really important to try to not use your own perspective in this situation if you have never once struggled with your gender identity. For as sure as you are about your gender identity, your transgender loved one is likely just as sure about their gender identity.

But what about the studies?? Oh, the studies. The studies that scare everyone. There are plenty of studies that show gender nonconformity in childhood doesn’t persist. That even those who insist they are the “other” gender do not go on to transition. Keep in mind some of these studies were written by doctors who were actively trying to get the child to conform to their birth gender. Additionally, all the dynamics at play with the child’s gender identity are not known in those studies.

Not everyone follows the same path. Not everyone has the same personality, confidence, support system, encouragement, discrimination, access to resources, parents, communities, ego strength, temperament, role models etc. All of these factors, and many more, can affect whether or not someone chooses to transition.

Someone may decide that having their body be different from their affirmed gender identity is more distressing than having their birth gender identity be different from their affirmed gender identity. Everyone is different. People experience distress in different ways and because of different things. Just because someone chooses not to transition, or later “de-transitions” does not mean they are not transgender. It means that they (or others in their life) decided transitioning was ultimately not the best choice for them.

I believe that most of the children/teens/adults who say they are “sure” and then transition do not live to regret this decision. I have anecdotal evidence with my own clients. Don’t believe me? In 2011, a man named Colin Close conducted a survey about how medically-assisted transition
affects the lives of transgender people. The study examined the
experiences of 448 individuals to identify the impacts transition on
gender dysphoria, quality of life, emotional well-being, personality
traits, and sexuality.

The outcome?

  • 94% of trans* people reported an improvement in their quality of life due to transitioning
  • 96% answered that their sense of well-being improved
  • 9 out of 10 responded that their overall personality improved due to transition
  • 85% described their emotional stability as “improved” (11% reported no change)
  • 96% reported an overall satisfaction with transition
  • 97% reported a satisfaction with hormone therapy
  • 96% reported satisfaction with chest surgery
  • 90% reported satisfaction with genital surgery

You can download the full report here.

Are there those that do change their minds and regret transitioning? Yes, there are. I can’t speak to exactly what dynamics led to this, as only they know everything that went into all of their decisions. However, I believe they deserve just as much support “de-transitioning” as they did transitioning. It is their gender. It is their life. It is their journey.

We as humans (probably as self-protective measure) tend to look at the “worst case scenarios” and feel scared by risks associated with choices, no matter how small. It’s natural. However, those small percentages of things often scare us from taking the leap to do something we want to do.

Let me use this as an example: what if the ratio of successful airplane flights to the number of airplane crashes was roughly equivalent to the ratio of people who are satisfied about transitioning to those who regret it?

If we all based our sense of safety on thinking about the small percentage of airplane crashes, none of us would want to fly again. There a risk to much everything we do, and there are no guarantees. Yet with risk often comes adventure, new possibilities, fulfillment, joy! Think of transitioning as your loved one spreading their wings to fly. 🙂

What about the kids, you say? They are not adults. How can they POSSIBLY make such a huge decision as this? Well, gender identity is not a decision. It is a way one is. For children who have shown a persistent and consistent cross-gender identification during childhood and express a strong desire to be seen as the gender with which their brain identifies, they should be allowed to do so. Transitioning is something one does about one’s gender identity if it doesn’t match one’s body. Parents and professionals need to help youth access the resources they need to do so; that is the vehicle for supporting one’s true identity, not just a “big decision”.

Bear with me for a moment while I expand upon the decision about marriage as a metaphor of sorts for gender transition as I did in my last blog post. I don’t know what the current percentage is, but last I heard 50% of marriages end in divorce. 50%! That’s HALF of the people who decide to commit themselves to someone for the rest of their lives, and essentially “change their minds”. I can tell you that is FAR higher than the number of individuals who will regret their gender transition! Now, does this mean we should increase the hoops one should jump through in order to get married? Should one’s mental health be evaluated before entering into marriage and signed off by a licensed therapist?Does the person who is performing the marriage have to have some sort of guarantee that this marriage will last forever before conducting the ceremony? Of course not. If both parties are entering into the marriage willingly and are able to make sound decisions for themselves, they should have every right to do so. Informed consent is the name of the game when it comes to getting married, as it should be with gender transition.

Is there a chance your loved one may regret the decision? Yes. Is there a chance you may die the next time you get in your car or the next time you take an airplane flight? Yes. There are no guarantees. But I can say this: there are more risks associated with not transitioning or allowing your child to transition that there is with transition. Acknowledge your fear but don’t let it hold you (or your loved one) back. Soon you’ll all be ready for takeoff.

On Being “Sure”

One of the first things that comes to most loved ones’ minds when told about someone’s transgender identity or plans to transition is “Are you sure??” In fact, this is often a question many of my pre-transition clients are asking themselves; “Am I sure??”. The question is worth asking, but the answer may not be a simple “yes” or “no”.

Most people are pretty darn sure of their gender identity. Cisgender and transgender alike, most are pretty darn sure. What confounds things is that only transgender people have to navigate through having a brain gender identity that differs from their birth sex, and having to first understand and then explain this to others. Still, most are pretty darn sure. Remember, gender identity is different than making the decision to transition. Often times, knowing one’s gender identity is the “easy” part. Pursuing a life to align one’s gender presentation with one’s brain gender identity? Now that’s the more challenging part.

So, “Are you sure?”. If you are a loved one who finds yourself asking this question, try to clarify what you are asking about. Are you asking about your loved one’s gender identity or plans to transition? If you separate the two, you may find more confidence in the first than the latter. If your loved one is sure of their (trans)gender identity, asking if they are sure about their transition may contribute to fears and anxieties surrounding this “decision”. Instead, ask “How can I help? What’s the first step?”.

Many clients I’ve met with who are contemplating transition have said to me, “I want to be 100% sure”.  My clients tend to be intelligent, high-functioning individuals who are used to doing things well, and they want this to be no exception. They research, they inquire, they ruminate, they agonize, they weigh the risks and benefits ad nauseum. After all this, they are still “not sure”. Why? Because there ARE risks, and because the process isn’t easy. Therefore, anxiety about this huge undertaking can be interpreted as not being “sure”. Again, not so much about the gender identity- if I can bring them back to that aspect of themselves instead of just the “decision” to transition, they are much more sure about their gender identity. A good example might be left-handedness. People are born left-handed, no? It used to be lefties were encouraged to use their right hands until it became habit. Gender identity is similar in that it is inborn.  It can be stifled to present differently, but that doesn’t mean it’s good for the person. And what gender one presents as is far more pervasive than which hand is dominant!

One of my clients, a happy and insightful trans man, made mention to not feeling completely sure until AFTER he had transitioned. I later contacted him to write a little blurb for this blog post, and he delivered beautifully. Here is what he had to say:

“To be honest I wasn’t 100% sure about transitioning until I was already pretty far into it. One day about 4 years in I looked in the mirror and for the first time in my life I recognized myself. I don’t think you can ever be 100% sure about anything in life, any decision, any path…it’s all educated guesses wrapped up in a hope for happiness.”

Isn’t this the case for most things? We make huge decisions all the time that will affect the rest of our lives: where to live, where to go to school, the career path to follow, to marry or not to marry, if yes who to marry, to have kids or not have kids, if yes how many, etc. Yet these decisions typically aren’t as agonized over as much or as misunderstood as gender transition.

I’m reluctant to compare gender transition to getting married, but the analogy really sticks in my mind. How many people are “sure” when they get married that they will be with the other person “forever”? Of the couples who eventually divorce, if you could ask them “but were you SURE when you got married?”, most of them would unequivocally say “yes”. Some may argue that gender transition is a more “serious” decision than getting married, but is it? Marriages often result in children, who are thereby affected by a divorce if it were to occur. If a capable individual decides to get married, they get married. However, if a capable individual decides to go through gender transition, the issue of being “sure” is one they will have to answer over and over again. I guess it’s because other people can understand marriage, but have a harder time wrapping their brains around gender transition. However, this should not matter when it comes to others and their decisions about their own lives. Not to mention the rate of transgender individuals later “changing their minds” about transition is FAR, FAR less than the current rate of successful vs. unsuccessful marriages!

I suppose feeling more at ease with one’s decision comes down to trust. If your loved one is telling you who they are what they have decided to do, trust them. If you are transgender and have decided to transition, trust yourself. If the person making this decision is of sound judgment and mind, there is no real reason to think this is an irrational decision that will ever be regretted. Additionally, if one has come to the decision to transition, it has not come lightly. Many transgender people agonize about the decision to transition long after one’s true gender identity has become consciously aware.

Perhaps being “sure” is an evolutionary process, and one that can only happen after the first step. I do know that trusting yourself is a good idea… of that I am sure. 😉

For those of you how have transitioned, how “sure” did you feel before? After?