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Transgender, Gender Nonconforming, and Nonbinary Folx

One important aspect of my practice is providing therapy for people of all genders. Of course, I also work with cisgender people (those whose personal identity and gender corresponds with the sex they were assigned at birth). Sometimes I work with cisgender people about other issues, and I see a lot of cisgender folx who have transgender and/or nonbinary partners, friends, and family members. My interest in serving people of all genders developed in the 1990’s when I first had personal relationships with transgender friends and partners.

The first time I worked clinically with transgender clients was in 2006 at the Counseling Center at Stanford University and that was when I first sought out professional consultation for writing letters for a transgender client seeking hormones (letters were then a requirement for hormones) and other gender affirming interventions.

Some of my compassion, interest, sensitivity, and sense of connection made more sense to me when I embraced my own nonbinary identity. I came out to friends and colleagues and started using they/them pronouns in 2014. I continue to deal with the challenges of being misgendered (and feeling unseen) at times in my personal and professional life.

In the fall of 2018, I deepened my education and training by completing 19 hours of Continuing Education in Transgender Medical and Mental Health Care offered by WPATH. While I have not opted to continue the path to call myself a Gender Specialist, I do regularly consult with colleagues on my cases to deepen and continue my learning. I commit myself to providing affirming care to people of all genders and I commit myself to ongoing learning.

I also write letters for people who need them for their gender affirming procedures. My preference is to be part of an ongoing treatment team and to offer ongoing psychotherapy to my clients. But, when needed, I sometimes provide a two session assessment for folx who have another trusted therapist who may not have a doctoral degree, and so they need a second letter.

Caution: Avoid any therapist using the term “Gender Exploratory Therapy.”

Sadly, the old “Conversion Therapy,” which which referred to services that attempted to “cure,” “fix,” or “repair,” a person’s gender identity to cisgender is now being re-packaged and named Gender Exploratory Therapy.” People who offer this may claim that they want to help to support you in understanding your gender journey. But this is NOT Gender Affirming Care. All mental health organizations have condemned the use of Conversion Therapy as harmful and ineffective. Sadly, some clinicians are attempting to deceive those in need of gender affirming services by offering “Gender Exploratory Therapy.” My advice is to steer clear of anyone using this language on their website. You can learn more here

I greatly dislike the gatekeeping aspect of this work, and I do my best to frame it as a collaborative and supportive process. Ultimately, my role in doing these assessments is to make sure that any psychological issues you are dealing with (or have dealt with in the past) are well-managed. My job is also to assure that you are aware of the risks and benefits of any procedure you are seeking (which is also the job of the doctor you are working with: providing informed consent). I also am looking to make sure that you have a good support team in place for aftercare if you are getting gender-affirming procedures that require aftercare. Please understand that at this time, a diagnosis of Gender Dysphoria is necessary for coding and to justify medical necessity if you intend for your insurance to pay for these services.

I adhere to the WPATH Standards of Care (Version 8). I will ask about your mental health history and your ability to follow aftercare instructions for any gender affirming procedures. We just want to be sure we can answer the questions your doctor will want to know. If you have met with other providers to discuss gender issues in the past, I will want to consult with them if you are comfortable giving me permission to do so. If you have questions about the questions I am asking you, please feel free to interrupt and ask why this is relevant. I want to be transparent with you. What we will also do together is go through the specific risks and benefits of any of the procedures you are seeking, thinking through what that might mean for you in terms of your emotional, social, occupational, and sexual functioning. 

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Do you need a free letter?

At this time, I am unable to offer this as a pro bono service, but if you need a free letter, you should be made aware of The Gender Affirming Letter Access Project, and please do seek a clinician from that site in which people commit to providing free letters.