Gender Affirming Care

I’m really grateful to be a gender affirming therapist. I think of loved ones who are gender expansive and am grateful they too have had therapists who saw them, even if they were cisgender (like myself) and may not have felt what it was like to be them. Without this lived experience, and sometimes maybe even with the lived experience, therapists sometimes really miss the mark with gender affirming care. It reminds me of when I went from region to region getting training in serving a variety of folks and heard nonsensical things like to give patients a survey to see if they played with “girl” or “boy” toys. It didn’t make sense to me and felt like I time traveled to times when colonialism had an even tighter chokehold on binaries of gender than now possibly, well at least in the US. I remember a higher up asking me if a patient’s gender was how the patient saw themself simply because they did something outside of the binary understanding. This makes no sense and really hurts people. I can even remember when a lawyer called to ask if parents were forcing their child to be a particular gender. I used evidence from interviews and observations as well as a number of other doctor’s experts perspectives (mine included) that indicated the parents were not forcing their child to do anything regarding their gender. I won’t go into detail here because I want to be mindful of the smallness of communities and folks’ identities, but wow it makes me chuckle to think of dumb we are when it comes to gender.

It’s not just within the field. I, as a cisgender gender therapist should have said something more, but when a neighbor said that times are hard for young people today because they “don’t know what gender they are with all this gender stuff” I literally froze. It is absolutely no excuse. My lizard brain took over and I froze. I look forward to having a channel, an open discussion with this man one day. There were a few other things at play here too, but for now I’ll focus on how we can serve and support gender affirming care.

As states decide to revokes people’s medically necessary care such as by limiting and taking away gender expansive folks access to care, we can support our loved ones who are trans or don’t fit in a box they were assigned at birth. If we’re therapists we can learn how to write gender affirming surgery/hormones letters. Hey, call me! I’ll teach you. Well email me, don’t call me since calls take so long to catch each other on. I’ve shared my experience with folks so they too can get people the letter evals they need as soon as possible to access gender affirming services. Call people by their name and pronouns. No it’s not preferred. Call them how they say to call them and do it consistently because it can be heartbreaking if we don’t. If someone was assigned male at birth and she is a woman, don’t bother calling her a transwoman unless she says to, she’s just a woman and use her name and her pronouns.

I’m no expert, but I love to think of what San Fransisco State University said about when we call people by their name and pronouns, accept them and their partners, invite them to family things without asking them to be different, love on them when they come out, and just be regular with them then they have less chances of harm. Folks, they actually have less rates of suicidal thoughts, suicide in general, and substance abuse! This research says that when we see young gender expansive people as they are we reduce addiction and death. I’ve seen patients tear up as I share this data with them. It’s powerful knowing how much love can heal and repair.

I also want folks to know that they can learn the basics about gender and then dive into the traumas gender expansive folks survive from our podcast Breaking The Couch where we demystify what happens in and behind the therapy scenes and explain various traumas. There’s so much more to this topic, but for now just let me know if you’d like more in a sepcific direction via email or the comments below.

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