Transgender? Gender Non-Binary? Where to Start.

Are you questioning your expression of gender?

There’s a lot to consider. I spoke to some of our gender therapy experts at the Gay Therapy Center for their advice about navigating the process of becoming more you in your gender identity.

Here are some of their suggestions.

Begin To Trust Yourself

Katie Hauser, LCSW, a psychotherapist at our New York Gay Therapy Center, wants you to know how important it is for you to “trust yourself to be your own best expert when making decisions about gender expression.”

It’s not always easy to know who you are when it comes to gender. Exploring your childhood experience is one way you can learn more about your true gender identity. Michael Sally, LMFT, a psychotherapist in our Redwood City/Silicon Valley location helps clients “explore the messages, the images, and the play they enjoyed as children,” he says.

All of our gender therapists believe in the importance of trusting children to know themselves. Katie explains, “The message of society is that kids don’t know themselves, especially when it comes to gender identity. And yet the stories of my clients reveal that many kids know their gender at a very young age.”

“Of course there is a lot of rhetoric about acceptable ways to express gender and kids usually get boxed in quickly,” says Katie. As adults we have to relearn how to explore our identity. There’s a lot to dismantle there.”

Dan Keady, LCSW, a psychotherapist in our San Francisco office, strongly agrees. “Some kids know their gender even before they have words for it. I’ve worked with parents of three-year-olds who report that their children are adamant about expressing their gender through toys, clothes and role models.”

Get Some Community

Finding a community of people who share your gender experience is typically an essential step in the process of managing the struggle of social expectations.

“People come to therapy thinking that they are alone. That is simply false. There are many things we say to ourselves about gender that we think are only our burdens to bear. When we start to learn more we discover we have a shared experience,” says Katie.

Participating in discussion groups for people who don’t conform to society’s gender standards is crucial in the path to self-acceptance. Dan explains, “Humans need validating relationships. We all need people who appreciate us and see us for who we are. Not having a community of supportive friends is a huge stressor.”

Unfortunately, gender non-conforming people also face misunderstanding and rejection within the gay and lesbian community. “Sometimes my clients are asked by other queer people, ‘why are you this way?’ No one wants to hear that question. Would you? That question is not embracing who they are. It is much harder for transgender people to find supportive community,” says Dan.

Dan adds, “In the groups I’ve run for transgender people there is real joy. That happens when people come together to support each other. A key moment is when group members talk about when they realized they were different and had words for it.

My advice is listen to other people’s stories. It can feel isolating to be on the front end of your gender story. And the brightest and most famous story might not be your story. There are thousands of stories out there. Keep listening until something resonates.”

Anxiety, Depression, and Challenges

“Anxiety and depression are the number one issues facing the gender non-confirming community,” says Katie. “There’s the anxiety of being accepted. The fear of each step of coming out. And then depression can come in, crashing off the anxiety. They are linked.”

Katie outlines more concerns: “For transgender people can be the additional worry that they won’t ‘pass’ as their real gender. There may be fears about the legal process of changing their gender. There is often worry as they consider the risks of surgery. There may be concerns about finding partners. There may be the threat of potential violence. And there are often family struggles.”

Michael agrees “that struggle with family acceptance is typically a key topic in therapy. Often clients experience freedom when they come out, but not always. So much depends on the family itself. Rejection is still a common reality. Family counseling, when people are open to it, helps a lot.”

Dan helps clients explore complicated surgical options. “Many transgender people face difficult questions about surgery. Some clients know that there can be a loss as well as a benefit. It’s hard to prepare for that change, and to know what to expect. I make space for uncertainty. We all want answers about what to do next. We’ll all make mistakes, have moments of sadness, regret, and loss. That doesn’t mean you are on the wrong path. With any change process you leave something old behind. That doesn’t mean anything is wrong, or it’s the wrong decision.”

Michael agrees, “You don’t have to know everything. At some level all humans are lost and learning and stumbling. And that is okay.”

“Decisions around surgery can’t be rushed,” he says. “Exploration really needs to come from a deep level. Sometimes my role is to slow clients down to make sure they have fully explored the potential joys as well as the challenges.”

Michael adds, “Working with some medical providers can be difficult. Often they don’t have the same language or experience as their gender non-conforming patients. Finding the right caregivers takes patience and self-advocacy.”

Gender Non-Binary Experiences

People sometimes think that the concept of gender non-binary is a new idea or a fad. The truth is that non-binary people have lived across many cultures for centuries.

Non-binary can be defined as either having a gender that is in between or beyond the categories of “man” or “woman,” or as fluctuating between those binary categories, or as having no gender permanently or some of time.

“The acceptance of gender non-binary gender identity is often elusive,” says Katie. “The concept is newer than transgender, which means that there is a great lack of understanding. People reject what they don’t understand, and even in the queer community there can be pressure to ‘pick a side’ when it comes to gender.”

Michael adds, “Clients often can be shy about talking about their gender non-binary experiences. It is typically fraught with confusion. I make sure when I meet new clients that I am inclusive in my language so that they know this is a safe space to discuss anything.”

“My advice is to be open, explore your own assumptions, and don’t be afraid or ashamed of them,” he says.

Dan says, “At first gender non-binary folks may not have any idea that what they are experiencing is about gender. Often they just have a sense that ‘I don’t fit in.’ They may think they are just being too bold or too timid.”

“Or they may have been subject to subtle expectations and vague messages growing up. For example they may hear, ‘of course you won’t be interested in that career.'”

“There can be an ‘aha’ moment when they finally have language for what they have been through. They don’t judge themselves as harshly. Their felt experience and thoughts are aligned. This is a huge relief.”

The work in therapy is to allow what was not allowed to be expressed and to help them be who they need to be. “I help them gently consider that there is nothing wrong with them and instead explore the perspective that society or family hasn’t made a space for them.”

Michael says, “Non-binary clients brush up against society’s need to classify. People will want to fit you into a box. Some days a client may feel more female identified and some days more male identified. Friends may want them to decide because they are used to relating to different genders in different ways.”

The Future

The field of psychotherapy — and the community at large — has a long way to go to meet the needs of people with non-conforming gender expression.

As Katie says, “I think there is a lot of work left to be done. I really look forward to the growing understanding of gender identity as we move forward in the mental health community. Awareness is expanding to protect and help more people. We now get to celebrate so many forms of identity that have existed for centuries. We are finally beginning to catch up.”


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