You don’t have to be a therapist for transgender folks to know that our binary gender system is simply not working. As a gender dysphoria therapist, I have heard the stories of 1,000+ people  that do not feel comfortable with the expectations of families, their friends, their workplace, or society at large.  Unfortunately, it is often viewed as a problem for the person who doesn’t fit into the binary gender system.


It is clear to me, however, that who you are, and how you wish to express your gender is naturally occurring – which, by the way, is one definition of “normal,” according to Webster.


So there’s that.


Whether you identify as Male-to-Female, Female-to-Male, Gender Non-Binary, Gender Fluid, or perhaps something else, you have been raised in a culture that has not made adequate space for your true self-expression. As a gender dysphoria therapist, I have heard many stories – both involving acceptance and intolerance.



Gender assessment and letter of referral


In order to get HRT from a medical doctor, or vaginoplasty (bottom surgery for MTF women), or phalloplasty (bottom surgery for FTM men), or a double mastectomy with chest reconstruction (top surgery for FTM men), the majority of surgeons will require one or two letters of referral from a mental health professional like me.


My job as a therapist for transgender folks wishing to start HRT or have surgery is to provide what’s called an assessment and letter of referral.  To do this I need to verify that you meet the criteria outlined in the DSM-V (a manual of diagnoses created by and for the mental health community) for Gender Dysphoria. Once that is established, I need to verify that you meet what is called “readiness factors.”  These are things that need to be in place to ensure that you are in a life space that supports you being responsible in your transition – like having enough income to pay for your doctor’s visits and hormone supply; making sure that you are not at risk of being kicked out of your home, or losing your job or other things that might result in your successful transition.

Roughly 99.9% of the people I work with meet these criteria and factors with flying colors.  I am on your side – and I want to see you feel at peace in your skin and in your life.


gender therapist


  • A strong and persistent cross-gender identification. This means the person wants to be or is insistent they already belong to, the opposite sex.

  • A person must be persistently uncomfortable in their current gender and feel that it’s not congruent with their physical self.

  • GD does not fit if a person is motivated to transition for the purposes of experiencing a cultural advantage of the other sex.

  • There has to be evidence of clinically significant distress, or damage to important aspects of the person’s life to label someone with Gender Dysphoria


The current Standards of Care (SOC’s) outline the responsibilities of the gender therapist when providing assessment and referral for HRT letters, as well as letters of referral for top surgery for trans males and bottom surgery for trans-females and trans-males. Gender dysphoria is an overwhelming and widely misunderstood condition that causes significant distress.


Common steps involved in a gender transition


 * Seeing a gender therapist for assistance in gender identity clarification and guidance

  • * Coming out as transgender to friends, family members, co-workers and bosses, and others

  • * Finding new supports local LGBT friendly support groups, churches, social groups and online communities

  • * Coming out to medical providers or finding new LGBT friendly ones


* Laser Hair removal or electrolysis for transgender females

  • * A regimen of Hormone Replacement Therapy (HRT) for both mtf and ftm transgender persons

  • * New wardrobe and accessories that more accurately express one’s true gender

  • * Legal name change to align with preferred gender and sense of self


  • * Gender marker change on driver’s license, birth certificate, passports, and other key documents

  • * Voice therapy

  • * Breast enhancement or implants for transgender females

  • * Real life experience or real life test – living one year in your ideal gender as your true self, often required as a condition of gender validating surgery


 * Sexual Reassignment Surgery (SRS) / Gender Reassignment Surgery (GRS) / Gender Affirming Surgery (GAS) depending on how a person defines their own gender (phalloplasty for transgender males and vaginoplasty or orchiectomy for transgender females)

  • * Double mastectomy and chest reconstruction for trans-males, most commonly known as “top surgery”

  • * Facial Feminization surgery for trans-females

  • * Voice box surgery