Therapist for Transgender and Gender Questioning Issues

Parent Q&A

Explorative therapist for gender dysphoria? Aug 18, 2021 (9 responses below)
ISO therapist for transgender kid Mar 10, 2021 (4 responses below)
Seeking a Therapist for Gender Questioning 7YO Jun 27, 2018 (8 responses below)
  • Explorative therapist for gender dysphoria?

    (9 replies)

    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.

    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.

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

    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.

  • ISO therapist for transgender kid

    (4 replies)

    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. 

    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!

    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. 

    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.

  • 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.

    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/

    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." 

    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. 

Parent Reviews

RE: Advice re non-binary teen ()

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

RE: Advice re non-binary teen ()

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=NjH32xMT...

Feel free to ask me questions

RE: Advice re non-binary teen ()

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. 

RE: Advice re non-binary teen ()

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.