The main problem with determining a course of care or treatment is in the diagnosis. Determining if someone is transgender or transsexual is based primarily on that individual’s history and feelings. There are many factors and reasons why someone would be drawn to or desire a different gender role. Some transgendered people are born that way as with those who are biologically inter-sexed or gender non-specific. This condition is more obvious than those who simply “feel” they are the opposite gender. Evidence to support an individual’s claim of being in the wrong body could be discovered by looking at or mapping the brain. However, having the brain development or thinking patterns that are more aligned with the opposite gender does not necessarily mean that person will have a gender identity disorder (GID), and desire or need any special care. Even those who are inter-sexed may not have GID, and lead “normal” lives by focusing on their personhood beyond polarized gender. All readers should be aware of the limitations of knowledge in this area and of the hope that some of the clinical uncertainties will be resolved in the future through scientific investigation.
The declaration that a person is not at peace, frustrated or unhappy with their gender remains to be the most compelling reason to pursue hormone treatment or gender reassignment. This puts the diagnosis squarely in the hands of the therapist. This is why it is key to find a therapist that is knowledgeable and neutral when it comes to diagnosis and care.
Feelings have a tendency to change, to ebb and flow over the years. Even very intense feelings and thoughts can change due to circumstances. Because so much of the diagnosis relies on emotion and self-declaration, a protracted period of time should be allowed before deciding on any course of action. Some doctors love to dole out drugs and will prescribe hormones with very little clinical evidence to support their need. So just because you can, does not mean that you should. Proceed with caution.
Part 1: Therapy and Resources
There are many causes and influences that combine to form an unhealthy gender identity. The three main factors are physical, psychological, and social. Physical or psychological trauma can be a catalyst for questioning birth gender as well. The question of gender identity could also be raised based on a person’s poorly developed or non-specific genitalia. Body type or brain construction can also contribute to an unhealthy gender identity. There are many more factors (most of them social) that contribute to poor gender self-acceptance. A therapist or trusted care giver may help in sorting out what influences and causes have contributed to your poor gender identity.
Finding the right therapist is difficult, and it may take a few attempts before you find one you are comfortable with. Finding the root causes of your gender identity disorder can help. Although the ministry Light in the Closet does not hold to the notion that we are defective, there are some conditions like chemical imbalance, chronic depression, and physical or emotional abuse that should be addressed by a trained and licensed therapist. It is best to find one who has experience in gender identity issues and concerns.
Finding a Therapist
The following resources for therapy are found on the Psychology Today web site: (Information taken from the Diagnostic and Statistical Manual of Mental Disorders National Institutes of Health – National Library of Medicine.)
Finding a Therapist*
The following five links should help you in choosing a therapist that’s right for you. Also by entering your zip code you can find therapists in your immediate area. Unfortunately, the amount of therapists listed as being knowledgeable about transgender issues is thin. Finding a therapist who can help will take some time but is very much worth it. Don’t give up! http://www.psychologytoday.com/topics/therapy.php
How to Choose a Therapist
Some helpful tips on how to choose a therapist who’s right for you from Dara Hoffman-Fox. The video is very informative.
What’s the difference between a psychologist and a psychiatrist? This is your 101 course on practicing pros.
How can a family therapist help transgender clients?
You may ask, “Most of the resources I see online are for transitioning (SRS) Sexual Reassignment Surgery. Can I find a therapist that might present more options? How is my therapist going to work with me to solve my issues? The AAMFT American Assoiciation for Marriage and Family Therapy may be able to help.
10 Tips for working with Transgender Individuals
This publication was created by the Transgender Law Center in San Francisco, CA. It is geared towards health care providers. www.lgbtagingcenter.org/resources/pdfs/Providerfactsheet.pdf
Suicide Prevention Lifeline
The National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service available to anyone in suicidal crisis. If you need help, please dial 1-800-273-TALK (8255). You will be routed to the closest possible crisis center in your area. With more than 130 crisis centers across the country, our mission is to provide immediate assistance to anyone seeking mental health services. Call for yourself, or someone you care about. Your call is free and confidential.
For more information contact: http:http://www.suicidepreventionlifeline.org
Perhaps you have felt suicidal in the past. Maybe you are feeling suicidal now? If you are on this web site, hopefully it is to find support and comfort for how you are feeling. Although I am not a trained therapist, I do understand what it is like to feel frustrated, angry and trapped. If you have considered ending your life, please know that your feelings are not uncommon. Many who have dealt with gender identity issues have felt there is no way out. Please beleive me when I say that there is hope. You are not alone. If you feel that you need immediate medical attention, please call 911. There is some good advice listed on this link: http://www.metanoia.org/suicide/
The Basics About Suicide*
Suicide is a serious problem in the transgender community. The attempt rate is 20% or more, and for those closeted it could be as high as 50%. Most of those who view their gender issues as a struggle or a sin often consider suicide at one time. Suicide is never a good solution. Many transgender people believe they are alone with no good options. This is simply not true. You are not alone for there are many people, over 14 milion just in the United States, who do know how you feel. Please reach out for support and fellowship. You are beloved and precious to God, and very important to us as well.
There are many resources that can help. The web site TransFaith, headed by Chris Paige, is a good resource for Transgender Christians. For more information about suicide contact: http://www.transfaithonline.org/intersections/suicide
Are you in college and not only balancing your gender identity, but also classes, personal relationships and so much more? This website is sensitive to the specific needs of college students trying to cope with the every day challenges of life. Contact: www.affordablecollegesonline.org/college-resource-center/college-suicide-prevention/
The Basics About Depression*
Often a transgendered person (especially young people and those who are closeted) will suffer from depression. This can be temporary depression, or long-term depression caused by a chemical imbalance that should be treated medically.
Many individuals try to hide their feelings of depression from family, friends and co-workers. They do not want to be a burden and so just try and make it through the day. They look for ways to distract themselves from feelings of depression and, for a time, may get some relief. However, this never addresses the root cause, and they end up once again entertaining the same thoughts and feelings of depression. For a transgendered Christian, this depression is often intensified by the incorrect notion their transgender nature is especially sinful and beyond the grace of God. THIS IS NOT TRUE! You may have dealt with depression most of your life and even tried to make peace with it as unavoidable. Although it is impossible to remove every negative thought, feeling or circumstance in your life, it is very possible to improve your quality of life and move past depression.
Light in the Closet urges you to consider the resources and teachings offered here and begin the process of “right thinking.” For some, their depression is a result of years of emotional wounds. For others it is a result of chemical imbalance. For most it is a combination of the two.
Don’t give up, there is hope! Depression is a treatable condition. A trained therapist or professional medical practitioner can greatly help in determining the cause of your depression and recommending treatments. The web site TransFaith has more information about depression and other resource links as well. Contact: http://www.transfaithonline.org/intersections/depression
Many transgender persons put off treatment for depression because they are used to hiding their feelings and issues. They also can assume that their depression is wholly linked to their gender identity issue. This may not be the case. Most transgender persons do not suffer from chronic depression, and gender identity and chroinc depression are not always connected. Dealing with gender confusion does often lead to anxiety and a depressed mood. However, these are temporary conditions and not the same as chronic depression and may not require anti-depressants or similar medical intervention. There are lots of reasons for depression, and any resaonable treatment scenario will include a combination of medical (anti-depressants and hormones if needed), psychological, and life-style options (foods, vitamins and exercise). Below are links that discuss the effects of diet and vitamins on depression.
“Vitamin for Depression?”
“Diet for Depression”
Part 2: Medical Resources*
Although the study of treatment and care for those who are transgendered is still in its infancy, some decent information is becoming available. Below are some links that may be helpful in understanding the brain development and chemistry.
Information about Brain Chemistry and Development
What makes us male and female? This is one fairly clinical resource that attempts to discuss the relatively new field of brain mapping. It looks at gender-typical behavior patterns, sexual orientation and gender identity.
A Sex Difference in the Human Brain and Its Relation to Transsexuality
Transsexuals have the strong feeling, often from childhood onwards, of having been born the wrong sex. Many have put forth the idea that this condition may be the result of natural development of the fetus. The possible psychogenic or biological etiology of transsexuality has been the subject of debate for many years. This debate has been clouded however by the difficultly many have in separating their culturally preconceived notion of normal from an impartial clinical review of prenatal factors.
The natural processes of gender evolution in the womb that determines male and female traits does so with little regard to cultural acceptance.
We all start off in the womb with feminine traits. A few weeks into development fetuses have a pair of “urogenital folds” with a small protuberance in the middle, and the urethra behind the protuberance. After sexual differentiation occurs we become distinctly male or female. However, some fetuses develop both sets of organs or have neither well defined. The end result of this process is what’s known as the birth gender.
Female and male brains are different. The determination of whether a fetus develops a typically female or male brain is influenced by a combination of factors. These are separate from those factors influencing the fetus’ physiological biology. The brain can develop a distinctively different “gender” from what is evidenced by the genitalia
This process is natural and usually without health risks.
Standards of Medical Care
The “Harry Benjamin Standards of Care” was the bible when it came to the treatment of Gender Identity Disorder (GID). It had reflected the current thinking within the medical community concerning the transgendered and their treatment and care. Now, new information has become available and more treatment options and resources as well. The “one size fits all” approach is giving way to individualized support and treatment. It is up to the individual to determine what is best. Personally I think calling the transgender conditon a disorder is inaccurate. I prefer (as stated on this website) the terms “gender-congruency, and gender-incongruency.”
Not everyone who cross dresses is a transsexual. Sometimes the desire to cross dress comes from emotional or physical abuse as a child or young adult (this usually results in more of a fetish expression). Sometimes a person feels isolated or unaccepted and attempts to alter who they are in a fundamental way by changing their gender. Often gender dysphoria is linked to chronic depression. Then again, some cross dress just for the fun of it and explore out of curiosity. Others may be going through a mid-life crisis, and rather than a red sports car, they opt for red pumps. I list these politically (dubious) incorrect reasons to raise a point. If you find the need to defend your gender-path choices by adopting someone else’s journey (reason to cross dress or transition), you may not be looking at your situation honestly. All of our gender concerns are real to us, but it takes a thoughtful, guilt-free, honest exporation to sift through all the information. The statement, “I do not have a choice” is dis-empowering. It is far better to make a choice you feel is right, weighing the good available information and moving forward with a plan that you can feel proud of, than to say you are a victim. A therapist that is knowledgeable about all of these conditions is better able to offer real help, even at times, more than a medical doctor can. I encourge you to make a choice and own it as “your choice.” (Matthew 19:11-12… “and there are those who CHOOSE to live as eunuchs (living outside of gender norms) for the sake of the kingdom of heaven. The one who can accept this should accept it.”)
As you may know, medical treatment varies and changes as information becomes more available. For example, we no longer employ leaches as a cure for fever. History teaches us that our dogma is usually faulty. Any information, or course of treatment you find, is not necessarily supported or endorsed by Light in the Closet. This information is here to help you decide which course is best for you, if indeed any needs to be taken.
WPATH Standards of Care for Transgender and Gender Nonconforming People (published 2011)
The World Professional Association for Transgender Health promotes the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus.
The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population.
The LGBT Health Channel / Transgender Health
Overview of healthcare guidelines for GID:
This web site is primarily for those who are transitioning. The information is relevant to those who have identified with their medical doctor and therapist as transexual, or transgender and taking hormones. For most, a general practitioner has the resources you will need for normal health. However, if you find that they are uninformed, looking through this web site may help. In addition to getting good health care from an experienced, sensitive primary care provider, transgender people have two main medical concerns: Care of the initial anatomical sex. – and – Care of anatomical changes, resulting from hormone therapy or from surgery. http://www.lgbthealthchannel.com/transgender/index.shtml