It’s normal to question

Whether it’s not fitting into the role assigned to you, feeling uncomfortable with stereotypes, or struggling with parts of your body, many people grapple with some aspect of their gender.

And when I first began to wonder about mine, I had more questions than answers.

In the 2 years I spent exploring my gender, I cut my long, curly hair, started shopping in both the men’s and women’s clothing sections, and began binding my chest so it would appear flatter.

Each step affirmed an important part of who I am. But how I identified and the labels that most accurately described my gender and body were still mysteries to me.

All I knew for certain was that I didn’t solely identify with the sex I was assigned at birth. There was more to my gender than that.

It’s OK to be scared

The thought of disclosing my questions and feelings to friends and family without yet having a clear understanding of my own felt incredibly scary.

Up until that point, I’d tried hard to identify with and perform the gender that people associated with my assigned gender and designated sex at birth.

And although I wasn’t always happy or comfortable in that category, I made it work in the ways I knew how.

The years I spent living successfully as a female person and the praise I received in moments when I performed that role well caused me to doubt aspects of my authentic gender identity.

I often wondered if I should settle for the gender that was assigned to me instead of continuing to discover and affirm my own.

The more time that passed, and the more comfortable I felt in my gender presentation, the more certain aspects of my body seemed to stand out as a major source of discomfort.

My chest binder, for example, once felt affirming of the non-female parts of myself I needed to embody and have witnessed by others.

But it became a daily reminder of the pain and distress I experienced; the appearance of my chest was in conflict with who I am.

Where to find support

Over time, I noticed my preoccupation with my gender and chest had a negative impact on my mood, physical health, and overall well-being.

Feeling at a loss of where to begin — but knowing I didn’t want to continue feeling this way — I began to look for help.

But I didn’t just need general support around my mental health. I needed to talk to someone with training and expertise in gender.

I needed gender therapy.

What gender therapy is

Gender therapy focuses on the social, mental, emotional, and physical needs of those who:

• are questioning gender
• are uncomfortable with aspects of their gender or body
• are experiencing gender dysphoria
• are seeking gender-affirming interventions
• don’t exclusively identify with their designated sex at birth

You don’t have to identify as something other than cisgender to benefit from gender therapy.

It can be helpful for anyone who:

• feels confined by traditional gender roles or stereotypes
• wants to develop a deeper understanding of who they are
• wants to develop a deeper connection to their body

Although some general therapists may receive basic gender diversity education and training, it may not be enough to provide adequate support.

Gender therapists seek out continuing education, training, and professional consultation to learn more about:

• gender identity
• gender diversity, including nonbinary identities
• gender dysphoria
• medical and nonmedical gender-affirming interventions
• transgender rights
• navigating gender in all aspects of life
• relevant research and news on these topics

Everyone’s needs are different, so gender therapy is tailored to each individual. It may include elements of:

• psychotherapy
• case management
• education
• advocacy
• consultation with other providers

Gender therapists who use a gender-affirming approach recognize that gender diversity is a naturally occurring part of being human and not an indication of mental illness.

Having a nonconforming gender presentation or a non-cisgender identity does not, unto itself, necessitate diagnosis, a structured mental health evaluation, or ongoing psychotherapy.

What gender therapy isn’t

A gender therapist shouldn’t attempt to diagnose you because of your identity or try to change your mind.

You don’t need a therapist’s permission or approval to be who you are.

A gender therapist should provide information and support that can help you better understand and connect with core aspects of yourself.

Gender therapists don’t subscribe to the idea that there’s a “right way” to experience, embody, or express gender.

They shouldn’t limit or presume treatment options or goals based on the labels or language used to describe yourself.

Gender therapy should focus on supporting your personal experience of self and relationship with your body.

A gender therapist should never presume your gender, force you into a gender, or attempt to convince you that you’re not a particular gender.

Understanding gender dysphoria

Gender dysphoria is both a medical diagnosis and term used more informally, similar to depression or anxiety.

It’s possible for someone to experience dysphoric feelings without meeting criteria for a diagnosis, in the same way someone can experience depressive feelings without meeting the clinical criteria for depression.

As a medical diagnosis, it refers to incongruence or distress that can result from conflict between a person’s designated sex at birth and gender.

When used informally, it can describe interactions, assumptions, or physical traits that don’t feel affirming or inclusive of a person’s expressed or experienced gender.

As a diagnosis

In 2013, the American Psychiatric AssociationTrusted Source changed the medical diagnosis from gender identity disorder to gender dysphoria.

This change has helped combat the stigma, misunderstanding, and discrimination caused by mislabeling as a mental illness what we now know to be a natural and healthy aspect of identity.

The revised label shifts the focus of the diagnosis from the gender identity to the distress, discomfort, and problems functioning in daily life that are connected to gender.

As an experience

How dysphoria looks and manifests can change from person to person, body part to body part, and over time.

It can be experienced in relation to your appearance, body, and the way other people perceive and interact with your gender.

Gender therapy can help you understand, manage, and minimize dysphoria or other feelings of discomfort related to identity and expression.

Gender exploration, expression, and affirmation

It’s important to remember that people seek out gender therapy for a variety of reasons.

This includes:

• exploring your own understanding of gender identity
• supporting a loved one who is navigating gender
• accessing gender-affirming interventions
• addressing gender dysphoria
• managing mental health concerns more generally

The steps taken to explore, self-determine, and affirm your or someone else’s gender are often referred to as gender-affirming interventions or actions.

Oftentimes, mass media and other outlets focus on the ways people affirm their gender or address dysphoria using medicine and surgery.

However, there are many other strategies to help people explore, express, and affirm this part of who they are.

Here are some of the more common medical and nonmedical interventions and actions that gender therapists are familiar with.

Medical interventions

• hormone treatment, including puberty blockers, testosterone blockers, estrogen injections, and testosterone injections
• chest surgery, also referred to as top surgery, including chest masculinization, chest feminization, and breast augmentation
• lower surgeries, also referred to as bottom surgery, including vaginoplasty, phalloplasty, and metoidioplasty
• vocal cord surgeries
• facial surgeries, including facial feminization and facial masculinization
• chondrolaryngoplasty, also known as tracheal shave
• body contouring
• hair removal

Nonmedical interventions

• language or identity label changes
• social name change
• legal name change
• legal gender marker change
• pronoun changes
• chest binding or taping
• tucking
• hairstyle changes
• clothing and style changes
• accessorizing
• makeup changes
• body shape changes, including breast forms and shapewear
• voice and communication changes or therapy
• hair removal
• tattooing
• exercise and weightlifting

The difference between gatekeeping and informed consent

Gender therapists and mental health professionals are often tasked with guiding individuals to self-determine the steps and strategies that will help them feel more connected to their gender and body.

Current medical guidelines and insurance policies often (but not always) require a letter from a licensed mental health professional in order to access puberty blockers, hormones, or surgery.

This restrictive power structure — set up by the medical establishment and supported by some professional associations — is referred to as gatekeeping.

Gatekeeping occurs when a mental health professional, medical provider, or institution creates unnecessary obstacles for someone to overcome before they can access medically necessary gender-affirming care.

Gatekeeping is heavily criticized by much of the trans community and in academic literature. It’s cited as a major source of stigmatization and discrimination for many transgender, nonbinary, and gender nonconforming people.

Gatekeeping can also interfere with the gender therapy process by creating conditions that might discourage people from being forthcoming with gender questions.

This can put unnecessary pressure on the individual to say the “right thing” in order to be granted access to the care they need.

The informed consent model of care was created in an effort to move the field of gender health forward.

It recognizes that people of all gender identities should have the right to make their own decisions about their gender-related healthcare needs.

Informed consent models of gender therapy and transgender healthcare are centered around an individual’s agency and autonomy as opposed to readiness and appropriateness.

Gender therapists who use this model educate clients about their full range of options so they can make fully informed decisions about their care.

More and more gender clinics, medical providers, and health insurance policies are beginning to support informed consent models of care for puberty blockers and hormones.

However, most practices still require an evaluation or letter from at least one licensed mental health professional for gender-affirming surgeries.

How to find a gender therapist

Finding a gender therapist can be challenging, both practically and emotionally.

It’s normal to have fears and concerns about finding a therapist who acts as a gatekeeper, has limited knowledge, or is transphobic.

To make this process a bit easier, some therapy directories (like this one from Psychology Today) allow you to filter by specialty.

This can be extremely helpful in finding professionals who have experience or are open to working with LGBTQ+ clients.

However, it doesn’t guarantee that a therapist has advanced training or experience in gender therapy and gender-affirming healthcare.

The World Professional Association for Transgender Health is an interdisciplinary professional and educational organization devoted to transgender health.

You can use their directory to find a gender-affirming provider.

You may find it helpful to reach out to your closest LGBT Center, PFLAG chapter, or gender clinic and ask about gender therapy in your area.

You can also ask non-cisgender people in your life if they know of any local resources, or if they can refer you to a gender therapist.

If you have health insurance, you can call your carrier to find out whether there are any in-network mental health providers who specialize in transgender care.

If you don’t live near LGBTQ+ services, have challenges accessing transportation, or would prefer to see a therapist from the comfort of home, telehealth may be an option.

What to ask a potential therapist

Always ask about their professional training and experience working with clients who are trans, nonbinary, gender nonconforming, and gender questioning.

This helps ensure that your would-be therapist has actually completed the necessary training.

It also rules out anyone who may be advertising themselves as a gender-affirming therapist or a gender specialist simply because they’re accepting of LGBTQ+ or trans people.

Here are a few sample questions you can ask to help determine whether a potential gender therapist will be a good fit:

• How often do you work with transgender, nonbinary, and gender-questioning clients?
• Where did you receive education and training about gender, transgender health, and providing gender therapy?
• What’s your process and approach for providing letters of support for gender-affirming interventions?
• Do you require a certain number of sessions before writing a letter of support for gender-affirming medical interventions?
• Do you charge extra for a letter of support, or is it included in the hourly fee?
• Am I required to commit to ongoing weekly sessions?
• Do you offer remote sessions using telehealth?
• How familiar are you with trans and LGBTQ+ resources and medical providers in my area?

If they don’t have any training or struggle to answer your questions about their gender-specific training, it might be a sign that you should explore other options or shift your expectations.

The bottom line

Although it can be daunting to find a gender therapist and begin gender therapy, many people find that it’s helpful and rewarding in the long run.

If you’re curious about gender but not necessarily ready to reach out to a therapist, you can always start by finding peers and communities online or in real life.

Having people who make you feel safe and accepted to call on can be incredibly valuable — no matter where you are in the gender exploration or therapy process.

Every person deserves to feel a sense of understanding and comfort in their gender and body.

Mere Abrams is a researcher, writer, educator, consultant, and licensed clinical social worker who reaches a worldwide audience through public speaking, publications, social media (@meretheir), and gender therapy and support services practice onlinegendercare.com. Mere uses their personal experience and diverse professional background to support individuals exploring gender and help institutions, organizations, and businesses to increase gender literacy and identify opportunities to demonstrate gender inclusion in products, services, programs, projects, and content.