Transgender info & Process

Transgender info and process

WPATH has released their new Standard of Care (SOC Version 7) which includes major new initiatives emphasizing depathologizing the experience of being transgendered and insisting medical professionals take  a more collaborative approach with clients who approach them for assistance.

Here's a link to V7 of WPATH's SOC


This page is a work in progress. I invite you to email me websites you think are appropriate. Email me at [email protected]

I will use this space to describe the process I generally use to help people deal with gender identity issues and for passing on links to other sites.


Generic Process:

Awareness of history and potential

We begin by exploring the individual’s own sense of who they are, when and how they came to understand that they were somehow different, and their awareness of how others have proceeded. We then discuss how they would like to move forward and any problems that need to be resolved to accomplish their goals. It is important early on to provide realistic hope that peace is possible, that they are not the only one to have felt the way they do, and while their path is unique, together we will find their best way to deal with it.
Analyze strengths and weaknesses. What resources are important and need to be preserved? What time-line opportunities are there? What immediate problems are there? Are there current mental health issues?
Identify and understand living/working/social problems and opportunities. Complete bio-psycho-social history.
For therapists, helping someone achieve self-acceptance is often the Holy Grail. To transition from one gender to another raises the question of ‘Who am I, and do I have a right to be here?’ Early awareness of being seen as the wrong gender and society’s insistence that you play the role your birth doctor assigned you can wreak havoc with self-acceptance. While this struggle is not always part of one’s journey it presents often enough that it is worth discussing.
Many struggle with whether or not they have the right to be their ‘true-selves’ while  others try mightily to deny them that right. People in early transition (however they come to define that for themselves) often struggle with passing as their correct gender. They have difficult tasks to perform as they learn to move through the world as their correct gender. A lack of self-acceptance gets in the way of being accepted by others. People read that as tentative behavior and that often makes people look twice. When they do that they may see incongruences. The resulting finger wagging further decimates self acceptance and can cause a downward spiral that is very painful. Perhaps Desiderata says it best, “you are a child of the universe, you have a right to be here” We work on this together and it is often one of the largest hurdles we encounter.


Tentative Decisions

When a client is unable to make a decision about how to proceed they may decide to make a tentative decision. Tentative in the sense that it is a trial or experiment, just something to try on and imagine what it would be like. We do this sometimes by simply using the desired names and pronouns, talking about how they might tell others, how they might appear in public as their true self, trying on different looks in the office, etc. There are times where we might use MtF hormones as a diagnostic tool and as such it too is a tentative decision.

Experimentation to verify

Clients who are considering living as a different gender, or perhaps to live agender/gender fluid/gender queer or however they may feel more authentic, will often begin by experimenting. Challenging society’s rigid binary system often brings up feelings of fear and inadequacy. First forays into their new world may be here in my office or with a group of loosely similar people. Supportive but real conversations and interactions may solidify or modify one’s belief about exactly what their path to feeling whole will look like. They may begin to venture into safe places in the world. Shopping, dining, and the theater are frequent first destinations. Later in their work, when they are ready to come to the office as their true self I may ask them to come in as though they were going to an office or out to a social event or a sporting event. We ALWAYS go at the client’s pace.


The quality of many finished products depends mostly on the preparation. Whether you are preparing to paint an aircraft or preparing to live as your true self, much more than half of the work is preparation.

Frequently the older the person is the more time needs to be devoted to getting ready to live the life you have dreamed.


Together we will figure out which tasks need to be accomplished and in what order. Some of the common issues involve:

How will loved ones, friends, family, employers, peers, and organizations be informed?  Does any one even need to be informed? In what order should they be told? When shouldn’t they be told?


What will the new you look like? Will there be a need for medications or surgery? When? How will you arrange finances? How will your life be different?

Are there other psychological conditions that need to be addresed? Before dealing with your gender issues? After? During?

How will you support yourself and those dependent on you as you move forward? Will you find new employment? Stay where you are? Who should you tell first? How will you present yourself at interviews? Who and when, if ever, will you reveal your history to?

What do you want to do about future reproductive possibilities? Are you aware that even though you MAY be able to have biological children by stopping contra-hormone therapy it is probably safest to assume you will not. How important is this to you? What can you do to preserve the ability to have your own biological, children in the future?

How will you begin the process of moving through the world as your true self? How will you learn what it will really be like? Where will you get the things you need? Where will you first begin experimenting? Where will you learn the reality about living as your true self? How will you handle potential losses? All of these issues and many more, unique to each individual, should be thought through in some detail. You have to make all of these decisions. My job is to help you figure out how (and if) you can get to your goal. I will always be supportive of what you want to accomplish, and empathetic about the obstacles you face but I will also never lie to you or ignore problems that I think are important to address.


Links to other sites:

Suicide Prevention:

National Suicide Prevention Helpline:  1-800-273-TALK

Hopeline Depression is treatable, Suicide is preventable

Suicide info from the National Center for Transgender Equality




The Wig Lady in Fleetwood, PA

The Hair Pair in Roxborough, PA





Vision of Hope Metropolitan Community Church

Transfaith on line



Endocrine treatment of transsexual persons: An endocrine society clinical practice guideline

Lynn's Place
Supporting our transgender, transexual and intersexed brothers and sisters with all the resources they need for a sucessful transition. Our goal is to strive for social justice, equality, support and resources for our transgender and intersexed individules and their significant others.


Virginia Surgeon






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