Therapist for Trans & Gender Questioning Issues

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4 parent reviews ▼

Parent Q&A

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  • Seeking Current Recommendations for Therapist for Teen

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    Mar 14, 2024

    Hi, lots in the archives but as we know, therapists are pretty impacted these days. Can anyone recommend an East Bay therapist with openings for new patients in person, who is experienced at working with teens with a lot of issues to sort through, including neurodiversity, social anxiety, gender dysphoria, and college worries? Thx!

    Mar 14, 2024

    I highly recommend Catherine Metzger at Still Waters Psychotherapy.  She is very intelligent, intuitive, insightful and an expert in adolescents with a specialty in gender dysphoria.  The fact that she has in person openings will not last long - she just started her private practice.  She has been working with my family for over 5 years while she was gathering her clinical hours.  Her website is: https://stillwaterspsychotherapy.com/catherine-metzger%2C-amft

    Mar 18, 2024

    Please go to "therapy first" if gender dysphoria is involved. Or a therapist who knows what exploratory therapy is and will consider it.  A gender clinic in the US tends to follow, especially here in the bay area,  the "affirmation only" model, which affirms rather than trying to understand the gender dysphoria. Affirmation tends to provide medical intervention as requested (see Reuters' Youth in Transition as well), but these interventions have not been shown to be safe, effective or even necessary. No one can show they know what is likely if a young person is given medical intervention or if they aren't. (whether it will help or harm their mental health, gender dysphoria, or quality of life....long term...short term there is a placebo effect, "honeymoon," that has been reported).

    The US affirmative model is being discarded by countries which are looking at the evidence behind medical intervention.  There is a great medical article reviewing it by Jennifer Block (Gender dysphoria is rising in young people and so is professional disagreement), peer reviewed, in the British Medical Journal. She also wrote an information packed op ed for the Boston Globe last fall on the "hall of mirrors" aspect of treating gender dysphoria in this country. Pamela Paul also wrote two articles in the NYT last month, which highlighted one of the therapists leading "therapy first."

    In particular, a lot of people in the US don't realize that it is unknown for whom gender distress/trans identification will not go away without any medical intervention (social transition seems to make gender distress persist). That is, it can be transient and there is a huge ethical problem in trying to know what to do. This is made worse because the medical interventions also haven't been demonstrated to help (anyone who tells you it will affect suicide risk is misinformed, point them to Ruuska et al., 2024, or the systematic review by Baker et al., 2021). Anyone who doesn't know the expected outcomes are not well determined is not giving informed consent. There's information about gender dysphoria for instance in the Cass Review's interim report, a thorough overview involving systematic reviews of the evidence, and discussions with clinicians, patients, families, stakeholders, etc. 

    A lot of US "major medical associations" follow "WPATH", a group which just had a lot of its internal documents put out there for the public, so that you can see how much is (not) understood by this group.  I think Ben Ryan had a really good summary in the NY Sun? The peer reviewed investigative article by Block in BMJ talks about the evidence base (needed to understand risks, benefits, alternatives and what happens if you do nothing) behind different treatment recommendations, including WPATH's. 

    Mar 18, 2024

    Chloe Jhangiani (https://www.psychologytoday.com/us/therapists/chloe-jhangiani-berkeley-ca/865080 ) is an excellent local therapist, is well versed with queer and questioning youth of many backgrounds, and has been in practice for about 15 years. She was a therapist for our middle child for two years and was incredibly helpful to understanding and guiding her through questions of gender and sexuality. Good luck!!

    Mar 20, 2024

    Hello - We had similar issues with our academically gifted, artistic and neurodiverse teen, whose depression and anxiety skyrocketed over the course of remote learning (preceded by a case of sexual assault and some pretty awful bullying). Our kid announced a trans identity literally overnight (with no history of gender incongruence) a year or so into the isolation, accompanied by a deep, deep dive online as required by online school. Though we were (and are!) supportive of our kid and used the new name and pronouns, it felt like exploration rather than a a truly authentic identity. It is these kids jobs to explore identity at this time, and also to individuate. 

    The suffering our kid was feeling was very real, whatever its source (and there were so many things that clearly contributed). We had an extremely hard time finding a therapist who would help gently guide our teen through the issues of trauma and not focus solely on the gender dysphoria. What was helpful (also for me as a parent as the class is attended by both the teen and a caregiver), was Dialectical Behavior Therapy. We only did one of the modules, which, rather being individual talk therapy focused instead on recognizing patterns of behaviors and thinking and figuring our helpful ways to shift these. We went to Clearwater Clinic (in both Oakland and Orinda clearwaterclinic.com). It is pricey, but did offer a pathway to become more self aware and help with the constant anxiety and worry. 

    It is not anti trans to question an overnight identity shift that is often swiftly accompanied by medicalization with risky and has irreversible consequences, and we are in an era where this is being applied to a young cohort that the CDC itself recognizes is in the middle of a mental health crisis. It is not anti trans to be concerned about the physical, mental, sexual and reproductive health of one's child. There has to be room for thoughtful, nuanced, balanced care. We are being told as parents that our kids are in danger of committing suicide if we even question the medicalization, and current "hide any identity change from the parents" laws are creating a triangulated situation with schools and other institutions and the kids who are told that the parents are the enemies. (While there are inevitably exceptions, in 16 years of experience of shepherding my kid from preschool - high school I have yet to meet a parent who did not love and prioritize their children, and none who would kick them out for being gay or identifying as trans.) 

    It is possible to support a trans identity and not support medicalization. It is possible to be trans, and not to immediately medicalize. That medical and surgical gender affirmative care is available is vital (especially for those who have been on the hormones long enough that their bodies no longer produce their birth hormones, so they need the other hormones to function), but the idea that they are absolutely required for every 15 year old who announces overnight that they are trans is absurd. 

    The trans community is vulnerable, and needs support, especially in states where the dangerous bans are being enacted. Kids with mental and other health issues are also vulnerable, and caution should be taken before irreversible medical steps. Both are true. It is not anti trans to seek and exercise nuanced care. What does your gut say as a parent? You know your kid. 

    I wish you and your teen all the best. It's a tough time, but also can be wonderful. 

     

    Apr 1, 2024

  • Therapist or other parenting help for gender-questioning teen

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    Dec 26, 2023

    Hi all.  
     

    I'm struggling on how to parent one of my teens. They have a lot going on and I'm really not sure how to support and help them. They were just diagnosed a few months ago with inattentive ADHD, dyslexia and dysgraphia. None of which was a surprise. They are also exploring their gender identity. My teen was not able to go to school where most of their friends from middle school did which has been hard but it was a private school and they didn't get in. We found a school that is doing a great job of supporting them academically but socially they are struggling. I can't seem to find much of anything that will get them out of the house. They only want to be in their room on screens. I've tried to have the psychologist that diagnosed them convey that being active will help with the ADHD and sleep but it falls on deaf ears. I limit screens but it almost always involves a battle. They are reluctant to contact their old friends and make plans even though I've told them I will do whatever I can to help them keep those connections. And new friendships are slow to happen. Obviously, there's some depression happening but finding an available therapist that my teen also likes has been extremely difficult. I feel like maybe if we treat the ADHD that will help but we have Kaiser and I'm not even sure where to start.  Given all the issues I'm not exactly sure which boundaries to hold, what to force and what not to. Does anyone have a parenting therapist they like for complicated teens? TIA

    Dec 26, 2023

    There is a group called therapyfirst.org that helps young people who have gender identity questions in the mix. There is a tendency to view gender distress as the root cause of issues in the US "affirmative model", not accepted in many places in the world which have looked at the systematic reviews of the evidence. Please be aware it is a very controversial issue and that what is being pushed in the US to support young people with gender issues is by no means either evidence based or generally accepted by professionals, especially those who have looked at the evidence reviews.

    There's a recent Boston Globe op ed:  Youth gender medicine has become a hall of mirrors, Block, 2023: “What if it’s possible that there are kids who identify as trans who indeed know who they are at very early ages — younger versions of the adult patients who haunted Spack — and there are also kids who identify as trans for a finite period of time? And what if there’s no sure way to tell them apart?”

    Reuters had a great investigative series as well ("Youth in Transition") and Block also wrote a peer reviewed journal article in the British Medical Journal (Gender dysphoria in young people is rising—and so is professional disagreement, Block, 2023)--see also the editor's intro (Caring for young people with gender dysphoria, Abbasi, 2023). The Block article describes what many other countries are doing, but since then more countries have called for caution..

    And another article: Current Concerns by Levine and Abbruzzese (2023), as well as "The Myth of Reliable Research in Pediatric Gender Medicine..." (Abbruzzese et al., 2023).

    Good luck, I bet you're right that more physical activity would likely help, kids are so dissociated from their bodies nowadays...woodworking, metalworking, swimming, ropes courses, bicycling...

     

    Jan 1, 2024

    Hi,

    As the parent of a now-adult trans person who is neurodivergent, I can relate. It often felt like a giant pile of different pieces of string that you’re trying to help become a single ball. And teens absolutely don’t want parental interference, even when they want support.

     I’m not with Kaiser, but I found this on their website: https://thrive.kaiserpermanente.org/care-near-you/northern-california/e… which might be a place to start. The Pacific Center has both programming and mental health services for LGBTQ+ teens. Most of these still happen on line, so your teen can check them out from the safe space of their own room. Meeting other kids like themselves may help with their self confidence, and being part of a community may offer potential friendships and a greater sense of belonging. Another gathering place with LGBTQ+ teen programs is the Oakland LGBTQ Community Center, which offers counseling, support groups, and social activities.

    If there are non-screen activities they enjoy(ed), see if there are offerings for queer kids. You might also meet other parents who share your challenges. Also look for summer camps that are for, or have a large number of, queer kids.

    While they doubtless miss their friends from “before,” I’d be cautious about encouraging them to connect. At that age shared context is often the linchpin for group identity and friendships. If most of their friends are going to school together, they might find it isolating to spend time with their old friends since they aren’t navigating the stresses of adolescence in the same school. Things change very quickly at that age.

    I’m not a psychologist, but my gut says it would be prudent to find resources for supporting your child’s learning challenges that are entirely separate from their other struggles. We were always concerned that our kid might feel that their neurodivergence would make them feel ‘less than’ in school and other settings, and we didn’t want them to see their gender identity as just more proof that they were different, which at that age can easily be conflated with ‘wrong.’ Our kid has executive function challenges, and we hired a coach who helped them manage their schoolwork and scheduling. They were initially resistant, but I lined up a couple of potential coaches and then left my kid to conduct the interviews without me in the room. They agreed to “try out” one of them, and he was a godsend. My kid bonded with him- it turned out he was queer, and he also spoke Mandarin which was our kid’s biggest academic challenge. The coach also helped us understand that our kid’s executive challenges were not spaciness or a lack of attention, which rid us of many of the areas of conflict between them and us parents. We four (coach & family) felt they wouldn’t gain much from an IEP, but your kid is different, so you’ll make choices that are right for them. I think what was most important was our commitment to making our kid an equal partner in the decision-making process about moving forward. We can’t see past the walls adolescents put up, so we must have faith that they know what is in their head and heart. Make sure your kid knows you are there for them, that you love them no matter what, and that your goal is to support - not direct - their journey.

    You CAN do this, and well!

    Jan 1, 2024

    I do not have a specific therapist to recommend, but just want to let you know you are not alone, as what you are describing is much like my own teen.   We also have Kaiser and it is a mountain to climb to get help, but help should be a available to your family.  I would contact their pediatrician (start with email, then request phone appointment if that doesn't work) and let them know you want a referral to psychiatry.  My daughter has been able to get services that way, including a middle-school girls group that runs online.  You are doing the right thing by trying to be proactive about getting help.  A number of people told me that the only way to access Kaiser MH services for them was via an emergency room visit in an acute situation.   We have also gotten help from East Bay Art Therapy, and sessions with friendly available clinicians along the way, that maybe weren't the perfect fit, but got us through low points.  We are definitely considering changing out insurance to access better MH care. Kaiser does have some good clinicians and programs, but getting to them is very hard. 

    Jan 1, 2024

    I'm so sorry for what your child and your family are going through.  It is really tough to pry these kids out of their rooms.  My trans ADHD kid is very similar, and I can empathize.

    I would recommend Joanna Wise Bradman as a therapist, either for your kid or for you.  She has a lot of experience with teens and exactly this type of struggle, and has helped me so much.    https://www.joannawise-bradmanlcsw.com/

    I can also highly recommend my kid's "Neurodivergence coach" Rew Berry who works with them over zoom and has supported and mentored them through so many challenges.  She has a creative and supportive approach and meets my kid where they are at.  https://rewberry.com/

    Best of luck to you.  The teens are the hardest part of parenting.

    Jan 1, 2024

  • Therapist for non-binary 13 year old

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    Nov 3, 2021

    I am looking for therapist recommendations for my non-binary child. (Assigned female at birth) They have had a therapist but would like someone with a great knowledge of the non-binary experience. Anywhere in the East Bay is fine. Preference for in-person sessions. Female or non-binary therapist preferred.  My child has selective mutism with adults and social anxiety. So a therapist that can relate to this is a big plus. Or even would take someone who specializes in these issues if I can’t find non-binary therapist. My child has so much to offer and very talented but they are dealing with a lot right now. 

    Nov 3, 2021

    I highly recommend connecting with Gender Spectrum (genderspectrum.org) and attending their caregiver support group for parents of non-binary youth.  They also have groups for teens.  It really helpful our family.

    Nov 9, 2021

  • Explorative therapist for gender dysphoria?

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    Aug 18, 2021

    I’m looking for a therapist who uses the exploratory model, to help support my child with gender dysphoria (transgender identification). That is, someone using supportive psychotherapeutic exploration (of the kind used in this book and this  short summary article).  Their model notes: “We have observed that the desire to transition is often connected to an attempt to distance the person from the psychic pain related to internal and/or external traumatic experiences.” It seems relevant for my young person, as it has occurred when there are mental health issues like being on the spectrum, not “fitting in”, being depressed, anxious, having trauma.  It has been seen to help people recover from gender dysphoria (examples are in this study, these cases, these cases).  

    I’m only finding Bay Area therapists who use the affirmation model (e.g., Ehrensaft) which is based on assuming most mental health issues come from cultural reactions to gender dysphoria, rather than sometimes causing it. It doesn’t seem to include exploring and treating first the mental health issues which sometimes cause gender dysphoria. (I’m also leery of having my young mentally distressed person castrated by medical transition, especially if transition is not what is needed.) 

    Again, given the mental issues present and the possibility they are causing my young person's gender dysphoria, I’d be grateful for pointers to therapists who use an approach which explores for and then treats, if appropriate, this possibility.  Thank you.

    Aug 18, 2021

    Following this. Also interested in finding a similar therapist. I don't see responses, but there must be someone out there. Not interested in having my child sterilized when he's so young (<16) and too mentally unstable to give anything near informed consent, but he needs help with his distress and he needs to be in a better place in order to prepare for the changes he'll go through if he transitions.

    Aug 23, 2021

    Omg very much following this. My own teen sounds very much like yours. Hugs to you 

    Aug 23, 2021

    Also interested in seeing responses to this. My former son just came out to us today as a trans girl. We want to be completely supportive and are using preferred pronouns and name, but I’m worried about moving too quickly into puberty blockers, which I understand do have serious side effects. I want her to be sure this is what she really needs rather than her not addressing other problems—she is going to be tested for ADD and learning differences but she’s been struggling with anxiety for a long time. In many ways, her coming out is a huge relief—last year was a nightmare for us as she was clearly going through something but couldn’t communicate what it was. I just want to be sure, since she showed no signs through eighth grade that she was unhappy being a boy. She came to this conclusion over the course of the past year, which was disastrous and traumatic in so many ways for so many kids. Thanks for any help and take care, parents who are going through similar times! It’s been incredibly difficult for everyone.

    Aug 23, 2021

    Following and plus one on all your comments!

    Aug 24, 2021

    Here's a link to a new organization which may eventually have links to therapists--https://genderexploratory.com/

    There may be some other useful resources at genspect.org (an organization for parents of gender -questioning kids)

    I have also been seeking a local therapist who can help my trans-identified teen who also has some other mental health concerns-- I have stopped seeking a 'gender therapist' though, as I came to realize that moniker usually indicates an enthusiastic and unquestioning embrace of the gender affirmative approach, regardless of individual circumstances. I have decided instead to look for a therapist who might be skilled with treating my child's other issues and screen the person ahead of time to see what their thoughts on gender are-- many therapists I have talked to don't even seem to realize there IS an alternative approach to automatic gender affirmation. I don't necessarily want someone to talk my child out of their feelings, just someone with an open mind and a warm heart to hold the space and ask good questions while my teen struggles with these existential questions over time (as opposed to rapid referral for hormone therapy). I kinda thought that is what therapy is about, but this has been surprisingly hard to find. So for now, I'm just trying to find a reasonable person to teach my child some useful skills to deal with emotional regulation, etc. 

    Good luck to you and your child. 

    Aug 24, 2021

    Find out all you can about blockers and focus on the other other mental health conditions. Blockers really increased the distress for my kid, not the opposite. I have huge regret about agreeing to them. Line up a good therapist first so your kid can get a good handle on what’s going on before going down what is ALWAYS a one-way path, but not necessarily the only one or the right one for all kids. Sweden and Finland have already stopped these treatments for most teens for good reason.

    Aug 30, 2021

    I do have several referrals of therapist who works with gender exploration and will support many young people who are now detransitioning. Please PM me for referrals. 

    Also check out this group focused on appropriate gender care. https://www.gccan.org/

    https://www.gccan.org/blog/interview-with-a-detransition-obsessive-thou…

    Sep 5, 2021

    Original poster here, thank you for the leads. 

    I went to Genspect.org and found they have guidelines for therapists at https://genspect.org/guidance/
    although they don't have a list of names.  As I didn't receive names, and several of us seem to be asking,  I wanted to mention that I am now going to try instead to share these guidelines with a therapist who "holds the space" and who "asks good questions", as one of you suggested.

    Thank you.
     

    Sep 10, 2021

  • ISO therapist for transgender kid

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    Mar 10, 2021

    My 20 year old kid recently came out to me as transgender. I honestly did not see it coming. This is a challenging time for our family, but we will get through it. I'm just trying to be as loving and supportive as possible. We both feel strongly that she should start seeing a therapist to help as she transitions from man to woman. She has been trying to find a therapist, but it seems that many are fully booked. I am looking for recommendations. She is away at college, but location is not a concern since therapy sessions can be done by phone or zoom. I already have my own therapist, and those sessions have been extremely helpful. Thank you. 

    Mar 10, 2021

    I'm glad you are helping your daughter with this. Gender identity is not yet well understood and it isn’t known how it develops and changes, especially for people who have a strong mismatch with their body kick at this age (way past early childhood).   But people are still trying to figure out if it “settles” perhaps later on, after, say age 25, when other things in the brain mature.  Exploring it and learning more about oneself is wonderful.  She’ll have lots of company, apparently about 2% of college students are now identifying as transgender, and another 2% as non-binary (you can  look at how many people answer “yes” to these questions).


    One thing she might not know (a lot of gender therapists, even at colleges, don’t, there is no training to become a gender therapist, so it's fantastic that you are looking carefully) is that the medications are all off-label with the FDA for treating gender dysphoria (“low quality” evidence). One misguided doctor told me that the famous study by deVries supported medical transitioning for my adolescent, but deVries' work was for kids who had this wish early and strongly in childhood, and other things, it doesn't apply to teens coming late to it. de Vries actually wrote about it .  There isn't much known, especially 5, 10 years or longer after starting on treatments. Yale tried to do a retrospective survey (https://segm.org/ajp_correction_2020) and found no benefit to hormones (and the surgery results are controversial, one problem is that the only really long term study, which is almost all older people, showed a very bad death rate starting about 10 years after surgery).  They don't know how many people start the drugs and then find they don't work, some, like Keira Bell, report great harm done before getting to age 25.  Since you take the drugs for the rest of your life, the doctors working on it really want to know more about the long term dangers, besides the ones they already know about. She can't check the dangers easily herself because it's all off label use.  So it’s research in action.

    It'll be a discovery in many ways!  

    Best of luck to you and your daughter!

    Mar 16, 2021

    I'm glad you are getting support for yourself. It is hard on a parent for sure! I would check with Diane Ehrensaft or the UCSF gender clinic to see if they have a list of practitioners. There is a group here in the Bay Area that has a listserve and they can put out a call for someone with openings but not sure how you access that as a parent. I talked to a therapist that didn't have openings and she put me in touch with others who did. Look for someone with training and experience. Also, is your child neurodiverse? After my son came out as transgender we also realized that he is autistic. There is a much higher level of neurodiversity and transgender overlap than one would expect. Understanding that profile really helped me understand him better and helped him understand himself better too. Good luck. It's a lot to process but love wins out. 

    Mar 22, 2021

    Our transgender kid has been really happy seeing Amy Walthall ((510) 269-2917) in Albany.  Not sure if she currently has availability, but she has been great for our kid and for us as parents. I also talked to Jessie Rose Cohen ((510) 454-8851) in Berkeley and was very impressed.  

    Also, there are great online support groups available through Gender Spectrum https://genderspectrum.org/articles/gender-spectrum-groups

    Best of luck to your daughter as she walks this path, and to you parents as you walk it with her.  It is challenging for the whole family.  I have learned that there is grieving I need to do, and that is fine.

    Mar 29, 2021

    I found Ehrensaft surprisingly unaware of the research when I asked her for information,  she in fact misinformed me.   Also, any therapist who doesn't understand that the suicide risks have not been shown to improve with medical transition or who doesn't know that there's insufficient evidence to show that hormones are safe or effective (according to a massive recent evidence review) may not know enough. 

    Mar 29, 2021

  • Seeking a Therapist for Gender Questioning 7YO

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    Jun 27, 2018

    My 7-year old daughter wants to be a boy. She dresses like a boy and recently we cut her hair off. I want to support her on this journey and my husband and I, and my daughter all need professional help. She has extreme rage and is very confused. We are going through all the emotions and feel unsure of how to best support her, and ourselves.

    Any family therapists or play based therapists with expertise in gender issues would be very much appreciated.

    Thank you.

    Jun 27, 2018

    An organization called Gender Spectrum has a monthly support group for parents and other caregivers of gender-expansive children. You will find a great community there who can help you on your journey and give you therapist leads. More info here: https://www.genderspectrum.org/we-can-help/support-groups/

    Jul 1, 2018

    We have one of the country's experts on transgender children right here in Oakland. Diane Ehrensaft (510) 547-4147. She wrote the book "The Gender Creative Child." 

    Jul 4, 2018

    Gender Spectrum is having their big annual conference this coming weekend 7/7-8. You might want to go with your child. Also, Diane Ehrensaft, PhD in Oakland is a developmental psychologist who specializes in this area. If she doesn’t have openings, she may have referrals. There is a local camp for kids called Kickin’ It. 

    Jul 4, 2018

    I would encourage you to contact John Luna Sparks who I worked with for many years at Children's Hospital.  John is an LCSW with great experience and familiarity regarding these issues , certainly worth talking with him about your daughter.  He also is an Acupuncturist.  This is his website.  I believe his Psychotherapy practice may be in Albany.

    https://lunasparksacupuncture.com/john-luna-sparks-lac-lcsw/

    Jul 4, 2018

    Dr. Diane Ehrensaft is a long time expert in the area of child treatment and gender questions.

    Jul 4, 2018

    I think Jessie Rose Cohen (who is great) works more with gender-questioning teens, but she'd know whom to refer you to.  Make sure you get a specialist in gender identity.

    Best of luck.

    Jul 4, 2018

    Sorry I don't have a therapist recommendation, but as an adjunct, I can recommend the novel "This is how it always is" http://www.lauriefrankel.net/this-is-how-it-always-is.html by Laurie Frankel. It tells the story of a family and their M to F transgender child from a smart, fun, well written and well researched perspective.

    Jul 4, 2018

    If you have Kaiser, I wholeheartedly recommend Rebecca Patridge. She is based out of Kaiser MH in Walnut Creek. 

    A trans friend of mine wholeheartedly recommends Erik Grabow MFT. He is based near Ashby BART. His number is 510-549-3797. 

    If you need additional resources, you are welcome to message me. 

    Another place for resources would be the Trans Lifeline. 

    Much love to you and your child. 

    Jul 4, 2018
RE:
Advice re non-binary teen (Mar 16, 2020)

Hello my assigned female at birth child also expressed the same things.  It started around age 15 at first as non-binary and then as trans male.  Also, he had bullying at school and a molestation at age 10, a trauma that I don't feel was properly addressed at the time. Up until age 15 he had long, long hair and dressed and acted like a girl never expressing that he didn't feel comfortable with his gender or that he didn't want to be a girl.

At 16, he wanted to take testosterone and also talked of having top surgery.   Many of his online friends were non-binary.  We let him start the testosterone.  He took it for about a year and then decided on his own to stop.  He still has facial and body hair from that.  We were torn about the top surgery since we didn't feel that at 16 he had the maturity to make that decision and although we didn't want to make him sad, we kept putting it off.  When we finally began talking with a Dr. and setting up appointments, it turned out that my insurance company wouldn't cover it until the age of 18. (BUT the doctor WOULD have)

Thank God because his 18th birthday came and went (he's 19 now) with no mention of it and he told us he changed his mind and doesn't want to ever do that.  

At one point last summer he expressed wanting to be referred to as 'she' again but that didn't last long.  He seems to want to be feminine a lot of the time but at the same time wants to be referred to as 'he'.  This is with no pressure from me at all.  He wears dresses sometimes, and makeup, earrings and nail polish daily. 

For me as a mother, i see a confusion of self,  anxiety with the world and an underlying mental illness (diagnosed with dissociative disorder) caused by childhood trauma.  

I would urge you to be supportive of your child and allow them to express their identity but without taking any non-reversible steps.  It was so easy to get the testosterone at 16 that it's frightening.  My son was born and raised outside the U.S. where it would not have been possible at all.  We didn't move back here till a few years ago, so I was not used to what to expect.

I would also urge you to keep trying therapists, psychologist and psychiatrists until you find the right one.  I can recommend Zara Drapkin but she doesn't take insurance.  It has only been in the last 5 months that I've finally decided to pay out of pocket and it is expensive but I think worth it.

First and foremost, you know and love your child better than any therapist or doctor.  Be very assured of that.  Find someone you can explain your questions and apprehensions to.

Another place that was very very good is Alta Bates (on Dwight) that has an outpatient program (but is hard to get in) and also might not be meeting because of the coronavirus.

I'm sorry for you and your child because I know it's very difficult for both of you.  Try to take things one by one and get through little milestones. 

I hope they get better soon.

Take care

Mar 24, 2020
RE:
Advice re non-binary teen (Mar 16, 2020)

My transgender child sees Jay Williams at:
https://spectrumpractice.com/
He has been an incredible therapist that has helped my child through really difficult times. My 15 year old also anxiety, depression, sensory issues, been bullied, & had disordered eating/ARVID.
To gain deeper understanding of all the terms and identity labels prior to conducting the activity, read Sam’s “Breaking through the Binary: Gender Explained Using Continuums” article (szp.guide/bttb) or book A Guide to Gender (szp.guide/g2g).
Check out this great website:
https://thesafezoneproject.com/activities/genderbread-person/
https://thesafezoneproject.com/resources/
Read books:
Beyond the Gender Binary (Pocket Change Collective)
by Alok Vaid-Menon, Ashley Lukashevsky (Illustrations)
https://www.goodreads.com/book/show/48190203-beyond-the-gender-binary

My Gender Workbook: How to Become a Real Man, a Real Woman, the Real You, Or Something Else Entirely
https://books.google.com/books/about/My_Gender_Workbook.html?id=NjH32xM…

Feel free to ask me questions

Mar 24, 2020
RE:
Advice re non-binary teen (Mar 16, 2020)

My AFAB child also told us they identify as non-binary and prefer a different name and the pronouns "they/them" last year when they were 15. It was also somewhat of a surprise to us, and I will admit it took us too long to start using their preferred pronouns consistently. So first of all I commend you for doing that. Our child had never been bullied or had disordered eating, but they have suffered from depression and anxiety and were unable to attend school through much of middle school. We also didn't see huge improvements in their anxiety and depression with medication and regular talk therapy. In their case, they developed very large breasts after puberty and we were already looking into breast reduction even before they came out as non-binary. It turned out that regular breast reduction could only get them down to a "C" cup, which still felt too big to them. We ended up deciding on "top" surgery which they went through last December, at age 16. I am very confident that was the right decision for them. In fact almost the first thing they said when they came out of the anesthesia was "I'm so happy!" They haven't expressed any interest in any other procedures or interventions like hormones.

We have Kaiser and had some sessions at the Gender clinic in Oakland. Overall we've found Kaiser to be very good on this (although their mental health care in general is not great.) I think it's important for you to be able to separate your child's gender identity from their mental health issues. The bullying, anxiety etc. did not *cause* their non-binary gender identity, and their gender identity will not be affected by antidepressants. Similarly, any surgeries or other interventions will not solve "the problem" of their depression and anxiety. It will only address the problem of their body dysphoria, which may be contributing to their depression but is not the only factor.

Now, 3 months after their surgery, our child is still 100% happy with the surgery. However they still struggle with depression and anxiety to some extent (although they are happier and less anxious now overall.) We found the doctors at Kaiser to be very aware of the mental health issues involved in these decisions, and I imagine the doctors who perform this surgery outside of Kaiser are too. They don't just do irreversible procedures on teens without a fair amount of discussion and counseling. I know this is difficult for you, but your child really needs you to accept them as they are. They are telling you that they are not female or male. If you love them, you have to believe them. Sending love, peace, and understanding to your family. 

Mar 23, 2020
RE:
Advice re non-binary teen (Mar 16, 2020)

If you are a Kaiser member, Oakland and SF have multi specialty transitions departments. They have therapists. Your teen may need some therapy and to try hormone blockers if they have not completed puberty. That will give them time to delve into these issues before moving forward irreversibly. 

Gender Spectrum is also a good online resource. It's complicated. Your teen needs to know they are loved and accepted even if they grow in unanticipated directions.  " I think I would be supportive." doesn't cut it. Others are bullying, you need to be a safe haven. Hugs. 

Mar 17, 2020