With the past two posts being fairly heavy and delving into difficult topics, I’m taking a break and taking on some easier topics for the next few posts.
One of the bigger surprises since I’ve realized my gender non-conformity has been the number of professionals I’ve come into contact with because of it. In my first post, I mentioned that I’m only out to my spouse; well, that’s not exactly true, because I’m also out to a number of medical and mental health professionals. Here’s a breakdown of my experience so far:
This was the first professional resource I reached out for – someone who could help me navigate these confusing feelings I’m suddenly hyper-aware of. I’ve actually seen a few therapists since the beginning. I started with one who just helped me calm down and realize that these feelings aren’t going away and I can deal with them. After a few sessions, I realized that she was not very experienced with gender issues, and sought out another therapist who was. The therapist I found has helped for the past 4-5 months as I unpacked my emotional baggage and began to piece together the memories and experiences which brought me to my revelation. For those who are just starting on their gender journey, I’d recommend starting with a gender therapist.
How do you find one? Well, that was a daunting task when I first realized I needed help. I started with Google, and searched for “transgender mental health [my city]”. It gave me a variety of results, including the local LGBT center and a few organizations set up to support LGBTQ+ people. But the single most useful result was the top result – the Psychology Today therapist search engine. When you plug in your city, you’ll get a list of therapists in your area. You can narrow the list down by expanding the Issues list and selecting Transgender. You can further narrow the list down with additional filters, if you’d like. With this list, I began to carefully research each of the therapists, visiting their website, seeking out reviews (search for their name and the word “review”), and narrowed my potential list down to about 4-5 therapists. At this point, because I was so new to the idea that my gender might not match my body, I was very nervous about calling anyone, so I agonized over who I should call. Here’s my advice – it matters less who you call, and more that you call. Your first choice might not be the right fit for you, but making that first step is the important part. Many therapists offer a 15-minute free phone consultation where you can just quickly outline what you’re dealing with and what you feel like you need. Don’t worry about how they are going to react – they’re professionals, and have heard way worse than anything you’re going to share. If you do happen to get a bad reaction, simply let them know that you don’t think it’s a good fit and move on to the next therapist. Assuming you have a good conversation with the therapist, you’ll next set an appointment with them for a full session.
Again, what you do at this first session is probably less important than just getting yourself through the door and seeing the therapist. It’s natural to be nervous about this session, but again, trust yourself and your own instincts. If you feel like the therapist is giving you good feedback and is receptive to your needs, then you’ve probably found a good match. If not, don’t worry – just move on and try again. At my very first session, I read a long essay I had written during that night when I finally realized what I was dealing with. It was probably as good as any other approach – it informed the therapist where I was and what I was working with, and it gave me a “script”, so I didn’t have to think too much about what to say. By the time I moved on to my second therapist, I was comfortable enough talking about it that I didn’t need the script and we just talked.
After my first session, I was exhilarated! I had just spoken out loud, to a stranger, what I’ve been dealing with, and the stranger was receptive and accepting of what I told her. And then I crashed! My emotions were so high from that relief, that when I realized that I was still just as confused as before, my emotions swung to a low place. I had this experience (feeling great immediately after a session, then crashing emotionally) for the first few sessions, but it got better. If this happens to you, just remember that you’re not alone, this is normal, and your feelings are valid and you are worthy. And it will get better.
By the time I started seeing my second therapist, I was a few months into my journey and it felt like my emotions were out of control and my dysphoria would alternately crush me and then disappear. The focus of my sessions became “how to deal with the dysphoria”, since for me, that felt like the one thing that if I could get it under control, everything else would fall into place. We tried a few things – a few mental exercises, trying to change my way of thinking about the dysphoria; trying to identify potential triggers; even pharmaceuticals – none of them worked. As you’ve probably figured out, I deal with things by learning more about them, and this was no different, so I scoured the internet for how other people deal with dysphoria. To me, one theme became apparent: for a few people, they have been able to find ways to cope with dysphoria, but for the majority of people, the only solution that worked was Hormone Replacement Therapy (HRT). This led to the…
Again, Google is your friend. But now I also had a few more tools. I’d found a few online communities (among which, Reddit’s asktransgender and genderfluid subreddits were particularly useful for me), so I searched for “endocrinologist transgender (my city)”, which brought up many useful results. For me, it quickly became obvious that for my city, while many doctors provide endocrinology services for trans people, there was one doctor who was very respected in the trans community. My therapist gave me a letter recommending HRT and I set up an appointment. This was another scary call to make, since this doctor’s primary business isn’t endocrinology (though she has many certifications in it), so I was concerned about how my call would be received by the office staff. I shouldn’t have worried – the appointment person handled my call professionally and respectfully. This continued with my first appointment – the office staff all handled things wonderfully and without any judgement. I left with orders for lab work and to have an unrelated medical condition investigated by my…
Primary Care Physician (PCP)
Ok, hopefully you already have one. I didn’t. Well, I kind of did. I wasn’t too happy with the one I had; they were alright, but I really wanted a PCP who didn’t treat me like a widget on a factory line. So I made an appointment with a PCP whom my endo recommended, and was blown away by how good he is! He took a good 60 minutes with me on my first visit to go through all the records I had brought, and thoroughly went through my history. Since I was seeing him to obtain clearance to proceed with HRT, he knew from the start about my gender, and has become an active part in my HRT care since. He reviewed the endo’s concerns and cleared me to begin HRT. Since then, we’ve met regularly to monitor my general health, and he includes hormone level checks on all my labs, so I don’t have to get multiple labs done from different doctors. After addressing my problems getting enough sleep (can’t shut my brain off!), he recommended that I consider being treated for depression. His recommendation came at an opportune time, because I had an appointment the next day with the…
The timing was very good – because back when I started seeing my second therapist, she had recommended seeing a psychiatrist as a potential way to access meds to help with my dysphoria. I got a list of the psychiatrists in the area from my insurance company and showed it to my therapist. She recommended one of them. So I set up an appointment at their first-available slot – 4 months later! As it worked out, that appointment came right after my visit with my PCP, so when I went in to see the psychiatrist, I had a potential diagnosis to discuss. When I arrived for my appointment, I was greeted by a gentleman in the waiting room (another patient) cheerfully telling me “good luck!”. I came to discover what he meant – that the psychiatrist I was seeing chronically runs behind and it can take hours before you will see him. But from the conversations in the waiting room, all his patients adamantly agreed “he’s worth it!” So I stuck it out and waited. Three hours later, I saw him, and found that their assessment of him was true. My appointment was supposed to be 60 minutes (as a first time appointment), and he took 75. I never felt rushed, and he seemed to genuinely care about what was going on with me. He took the time to hear my history, discuss the factors that might be affecting me, and, once he made his diagnosis and decided on a treatment, sat with me and went over any possible interactions with the other medications I’m on, including the HRT. I left with another lab order and prescription for an anti-depressant.
One more sign that this doctor is “worth it”: he called me on a Sunday to share the lab results of that blood test. He – the doctor – called, on a Sunday, to share test results.
With all the medications I’m prescribed (including HRT), it’s not a stretch to assume my pharmacists (who are both awesome!) know what I’m dealing with. And the pharmacists aren’t alone – our pharmacy has a handful of pharmacy techs – all of which I’ve interacted with when filling these prescriptions.
You know who that is, right? That’s the person who takes your blood when you have lab work done. Normally this is an arms-distance kind of visit – they are trying to get your blood drawn quickly so they can move on to the next person as quickly as possible. But in my case, I had a feeling that something wasn’t quite right on my last visit. So I checked the paperwork and identified a mistake the receptionist had made – she’d coded the wrong test, and I would have missed checking my hormone levels if I hadn’t caught it. So I notified the phlebotomist and he corrected the paperwork. That was a relief!
We recently increased our life insurance coverage, and so the life insurance company required an exam to ensure we are in good health. The nurse who came out went over all our histories and medications lists, and when she got to the HRT meds, asked what they were for. I answered matter-of-factly, and she wrote it down and moved on like nothing was out of the ordinary (because it wasn’t!). FYI, I was approved for the increase, even though I’m on HRT and an anti-depressant. More signs the world is learning to not be afraid of gender non-conforming people!
Our marriage is darn close to perfect. We love each other, have been happily married for a long time and work well together. People ask us if we’re newlyweds even after our 10th anniversary! But my realization about my gender has added a lot of stress to our relationship. We know that marriage isn’t easy and takes active work and participation, so we see a therapist to strengthen our marriage and help us navigate this new territory. The therapist we see is experienced with gender issues, so is able to work with the unique stresses we face. (She was one of the therapists who made my short list when I was looking for a gender therapist for myself.)
All these people know about my gender – and I’ve been lucky that all have handled this information respectfully and appropriately. I know others in the trans community haven’t been so fortunate. One report revealed that 28% of trans people have faced discrimination and/or harassment in a medical setting, and 50% of trans people report having to educate their medical professionals on how to care for trans individuals. Perhaps most disturbing is that 19% of trans people surveyed reported being denied care outright!
This list will grows as time goes on – for instance, our insurance company now knows of my gender issues because I choose to use insurance to help pay for my care. Some insurance companies still exclude cross-gender services, though thankfully, this practice is declining. Insurance companies are figuring out that it costs less to treat gender issues than to ignore them and then treat the complications caused from not treating them, and, it actually doesn’t add much cost to cover these treatments. Plus, the more we learn about gender, the more we find that the causes of these issues come from physiological sources, not mental.
The next time you visit a doctor, consider the number of people who, one way or another, become aware of your medical status, either by direct knowledge, or by inference or even happenstance. As I’ve found out, it’s a lot more people than you might expect!
Until next time,