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Is Therapy Necessary?

So, one of the first things I am asked when someone inquires of my hormone services is whether or not I require them to be seen first by a mental health professional before I will start them on hormone therapy.

The short answer is no.

Now, after extensive amounts of education, training, immersion, and experience with trans individuals, I feel I am more than qualified to make the call as to whether or not an individual is "ready" for hormone therapy. Let one thing be clear here, though: I in NO way question someone when they tell me they are Trans/NBY/etc. Not at all. I do not look for ways they could be "wrong." I do not look for "proof of trans-ness." I simply ensure that the individual is well educated regarding the process and is realistic in their expectations. No one has ever questioned ME whether I am a female when I asked for birth control or pap smears. And I am not about to question your assertion that you know your own gender identity. That's ridiculous.

Now, having said that... What I do recommend is....therapy. Ha! Gotcha! But not really. What I mean by this is that, in general, everyone can benefit from a good therapist now and again. Trans folks undergoing a transitioning process, whether it be social, hormonal, or surgical, are going to be under an awful lot of stress and adjustments. In addition, there will almost certainly be some accompanying changes in their social structure during this time, which is usually the most stressful external source of badness. Even the most well-supported trans individual will undergo significant adjustments mentally, physically, and spiritually during the transition process. And these can be mitigated to a high degree through a good therapy relationship.

Now I'm not talking about going to some boring person who says, "Tell me about yourself," and then you drone on and wonder if they are even listening. No. We are talking about a true relationship of trust. You need to first find a therapist with a good reputation, hopefully with training or experience in LGBTQ issues, that you actually get along with. One size does not fit all. Sometimes personalities just don't fit. As healthcare professionals, therapists get that. They really do. If you don't mesh well, resulting in inhibited communication, they will have absolutely no issue with referring you on to another colleague. No hard feelings. It is a common practice even! They are trained to recognize communication barriers, and if the barrier is insurmountable, then they find someone who can get around it for you. No probs.

I find that many folks who come to see me are so excited by the prospect of beginning their transition that they do not fully grasp the stressors that will arise. Oh, they're not naive about it by any means, but there are just sooooo many aspects to a single person's existence that I think it may be quite impossible to anticipate everything. No fault of yours, we are just multifaceted beings. And the stressors come in many forms: People who were previously supportive can suddenly "switch sides" when the trans person gets access to hormones (I guess it just makes it more "real" for them?). Family may become estranged. Religious worship may be hindered. Work may become a bit more stressful due to the scrutiny others may apply to the transitioning person. Established romantic relationships may become strained for many reasons. And on and on. But while none of these are rocket science to figure out, just knowing about them doesn't make them go away. Minority stress is a VERY real thing. Look it up sometime.

So anyway, do I think you need someone else to tell me that you are trans before I will prescribe hormones? Nope. You know who you are. I trust you. Therapy is only an excellent option that I put forth to you, nothing more.

But, I do want the best experience possible for my patients. And I want their transition to be the happy time it deserves to be. And I believe that for the vast majority of people, a good therapist is worth their weight in gold.

Hell, I could use one right now, to be honest! ;)

Stacie, NP

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