I am always struck when I receive phone calls and e-mails from individuals who are thinking about transitioning from Female-to-Male or Male-to-Female at how little they know about the process of gender therapy and the key role it plays in moving from one gender to the other.
Back in the 50’s and 60’s, the endocrinologist, Dr. Harry Benjamin, a clinician ahead of his time, became aware of the overwhelming obstacles that transsexuals faced in negotiating their way through transition. He became the first physician to add hormonal treatment to what had hitherto been only surgical intervention (sex reassignment surgery). In 1979 the Harry Benjamin International Gender Dysphoria Association (HBIGDA) was formed. It set up a system called the Standards of Care, still in use today, which laid out formal rules for transitioning to protect the physical and mental health of those seeking transition.
Key among the requirements HBIGDA spelled out was engagement in the process of gender therapy before referral to endocrinologists and surgeons for hormones and sex reassignment surgery. HBIGDA’s rational was to help prepare the transsexual for a process, which, by any standards, is arduous and to guide those who were not good candidates for transition towards other solutions. Note: HBIGDA is now called the World Professional Association for Transgender Health (WPATH).
As a therapist devoted to the well-being of the transgender population, I believe the clinician’s job is paramount. She or he must be highly trained and experienced in caring for those who are struggling with Gender Identity Disorder.
To illustrate the complexity of the gender therapist’s task Lev (2004) has coined the following model, which, in my view, is ideal for use by the gender therapist and is important for the transgender individual to understand.
States of Emergence
1. Awareness – In the first state, gender-variant people are often in great distress. The therapeutic task is the normalization of the experiences involved in emerging as transgender.
2. Seeking information/reaching out – In the second stage, gender-variant people seek to gain education and support about transgender. The therapeutic task is to facilitate linkages and encourage outreach.
3. Disclosure to significant others – The third stage involves the disclosure of transgender to significant others – spouses, partners, family members, and friends. The therapeutic task involves supporting the transgender person’s integration in the family system.
4. Exploration: Identity and self-labeling – The fourth stage involves the exploration of various (transgender) identities. The therapeutic task is to support the articulation and comfort with one’s gendered identity.
5. Exploration: Transition issues/possible body modification – The fifth stage involves exploring options for transition regarding identity, presentation, and body modification. The therapeutic task is the resolution of the decisions and advocacy toward their manifestation.
6. Integration: Acceptance and post-transition issues – In the sixth stage the gender-variant person is able to integrate and synthesize (transgender) identity. The therapeutic task is to support adaptation to transition-related issues.
Evaluate a therapist before hiring him or her! The following questions from The Transsexual Roadmap (2010) are important signposts:
How many TG patients do you have?
How many individuals have you referred for surgery?
How long have you been working with TGs?
What is your educational background?
What books on TG issues most influenced you?
Have you written any books or articles on the subject?
What got you interested in working with the transgendered?
What is your basic philosophy about how to treat this condition?
What is your opinion of the Harry Benjamin Standards of Care?
What is your hourly rate?
What length of session do you usually prefer?
Is it possible to do longer or shorter sessions?
How long do you usually see patients before you might OK them for hormonal therapy? SRS?
Are you affiliated with an endocrinologist or plastic surgeons?
Are you part of my insurance network?
Do you diagnose Gender Identity Disorder?
What are your hours?
Do you have weekend or evening appointments?
Do you work from your home or from an office?
Lev, A-I. (2004) Transgender Emergence: Therapeutic guidelines for working with gender-variant people and their families. New York: Haworth
Choose to work with a gender therapist on your gender “emergence” journey and choose your therapist wisely.