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Surgeon for gender reassignment surgery
Oct 2015
Born a girl, our young adult child will be undergoing gender reassignment surgery within the year. Yes, all the counseling, etc., has been completed, and testosterone treatment begins this month. This will be under the UC health system, and I'm looking for advice and/or recommendations on affiliated surgeons to ask for or avoid. Information on good experiences and bad experiences equally appreciated, so this dad can help advise who to ask for. Thanks in advance for any help. Please keep negative comments (I would not expect them here, but you never know) to yourself.
My young adult stepson had his top surgery at Kaiser and they were absolutely wonderful. Unfortunately I don't think that is an option for you, but I wanted to assure you this is easier than you think. I was so scared. He has not had bottom surgery, so I can't help you there; I'd check with this guy: https://2015genderspectrumconference.sched.org/speaker/curtis_n_crane.1ty51u2v#.ViURnBCrRE4 (if the link doesn't work -- Curtis Crane, MD).
I'm so glad you are on this journey with your child. As you've probably already learned, a supportive family is one of the most important factors in your child's success, happiness, and healthiness.
As far as finding a surgeon (I think you are looking for someone to do phalloplasty or metoidoplasty if I'm getting this correct), I think there's really only one great option, and that is Curtis Crane. He has a long waiting list. He's world famous. People literally come from all over the world and we're lucky he's here in the Bay Area. There are some other options in the US that aren't as good, and there are some options in other countries that are also great but definitely best if you have insurance coverage to go with Dr. Crane.
If I got the surgery wrong and you are looking for someone to do vaginoplasty, there are more good options out there. Crane and his associates are still a great option. Marci Bowers is also great and she's local as well.
Seeking therapist for transgender issues
Jan 2009
My husband told me that he thinks he is transgender. We have a 3yo and an infant. We are staying together, but I need to find a therapist I can talk about this with. I'm looking for someone with experience dealing with the issues of transgender families, transition within relationships, and transitioning with kids. SF would be best. Thanks!
Diane Ehrensaft is a psychologist in Oakland who specializes in treatment around gender issues. Her website is http://www.dianeehrensaft.com/. She is a very supportive and nurturing woman I recommend her highly. Jessica L
Please check Gaylesta.org, which is the Bay Area's Gay, Lesbian, Bisexual, Transgender therapist association. They have a referral service and a good listing of therapists who deal with such issues. Click on Locate a Therapist, then search by location or zip code. I hope this helps. Let me know if you need further information. Guy A.
I've just discovered that my husband cross-dresses
Jan 2007
After more than 5 years of marriage, with one child and a baby on the way within a month, I discovered that my husband cross- dresses for sexual pleasure. I found a stocking package in the garbage, and (after a lot of questioning) it was all revealed: his active fantasy life as a provocatively dressed women and his secret cache of clothes, with $1300 spent on stilettos, lingerie, outfits and other paraphernalia just in the last year. Our marriage has basically been of the low-sex variety, and we have talked about it a lot (and I have cried about it a lot), but he never told me about his secret life. Looking back, I now see that he invested almost all his sexual energy into cross-dressed masturbation.
He maintains that he is heterosexual and has no desire to really be a woman. He maintains that he doesn\x92t have a name for this woman he dresses up as, and that he has no interest in going out in public as a female or in talking with other transvestites. He feels ashamed, embarrassed, and very sorry for the hurt he has caused me. He says that he wants to save our marriage, above all. He has been willing to answer almost all of my many questions, though I continue to catch him in lies about some of the details of his purchases and activities. He has also been making a good effort sexually: since the revelations a few weeks ago, we have probably had more sex than in the past two or three years combined.
He says he is willing to go to therapy and to stop crossdressing, though everything I have read says that it will be very difficult (or impossible) for him to stop doing it. He has done it since he was a teenager. As for my part, I do not feel willing to \x93accept\x94 what he does. I want to be with a person who is more turned on by me than by looking at himself in high heels and a miniskirt. In my view, his selfish pleasures have been the source of my pain and loneliness, and I feel strongly that it is him who should change, not me. Has anyone been in this situation, or a similar one? Can I reasonably hope that he can and will change? A cross-dresser's wife
First I want to say that I am so sorry to hear that you are going through this. My story is a bit different but involved being married to a sex addict. I found great support in 12 Step programs for this. There are two groups that I know of COSA (Co-sex addict anonymous and COSLAA (Co-sex and love addicts anonymous). Both groups are to support those affected by the actions of a sex addict in their life. The meetings are closed to the addict. I found it a very safe place for me to recover from the shock and hurt that came from the discovery of my husband's secret life. I know that they have meetings at Mandana House in Oakland, you can also google either group and find local meetings. Remember it can't hurt to go to a meeting and see if it is for you... if nothing else you will know you are not alone. Anon
My dad was a crossdresser for most of his life and would describe it himself as an addiction that eventually he had to kick. It took him about 30 yrs to do that, and on the way caused much family stress and blew a ton of money on clothes, make up etc. I also dated a man who was a crossdresser and I thought that i was okay with it.
I soon realised though that there is a self obsession tied up in crossdressing that I couldn't live with. I really felt jealousy for the ''other woman'' that he was obsessed with. On the other hand, i know lots of women manage to stay in relationships like this. I think it comes down to how the issue is communicated about and understood between teh two of you. Therapy will not change your husband's fetish but it can help with the communication between you both around the issue. Even then you may feel this is something you cannot live with. You didn't enter into the marriage knowing this about your husband; you need to reassess the situation. crossdressers daughter
I really feel for you, having seen my sister go through a similar situation. She married her husband 15 years ago -even after she found him wearing her underwear. No one in our family knew, but she was unhappy for most of her marriage. Although they were compatible in many ways, sexually they weren't. He hid his cross dressing until a year before they divorced, when she discovered his secret cache of clothing. She tried to make it work, but in therapy, he felt comfortable enough to reveal that he would prefer to make love with her in his feminine garb. She wasn't comfortable with that but to top it off, he was having an affair. Like your husband, he, too, was ashamed of his interest in crossdressing and apparently the other woman did not know and so he could ''pretend'' with her that he was ''normal''. I can only suggest to you that you talk to a professional about this. In my sister's case, they also had a very low sex life and he showed distaste for her body, only exhibiting an interest in the superficial, girly clothes and perfume she wore. She is now divorced and only regrets that she waited so long and ignored many signs. They have one child who is in the dark about this - the therapist suggested they wait until she was older. With him, it also started at a young age (as a choirboy, he loved the feeling of the cassock against his legs). My sister felt very alone but learned that there are a lot of couples handling this - it just wasn't for her. anon
Try to get into it, seriously. It's clear that the idea doesn't turn you on, but it really won't go away or do any good to try and suppress it. It's also totally ok and not that unusual for a straight guy, by the way. So my advice is for you to try and be a little open minded about it. Set a day each month, to start, where he can call the shots and play out his fetish with you in costume. With time he can work up to full regalia. And it might just awaken something in you, too. Remember that this is something special to him, and sharing it is special and hard.
You said: ''I feel strongly that it is him who should change, not me.'' In my opinion and experience, any time there is a conflict, both people in the relationship have to change, or else it's not really going to work.
Really, he will love you all the more for accepting this part of him. But do start slowly so that you really get comfortable with it all. No sense in either of you being dishonest. Kink's Not Bad
CDW, You are in a difficult place. I would imagine that this entire experience has shaken the foundations of trust of your relationship. Having this ''out'' is an important first step of change and healing. The fact that your husband has started to let you know what has been going on for the last five years, and is open to working on himself and values the marriage are all good signs. Work with a trusted therapist is essential. Ben
My husband, who passed last year at a fairly young age (59), was secretly bisexual and acted on it throughout our marriage. I found this out only after his death. If you had asked me when he was alive about his sexuality, I would have said that he was extremely sexual, because that's how he was with me. We had a great sex life. It never occurred to me that he had another large facet to his life outside of our relationship.
Since I found out about his secret, it has made me realize that perhaps we never really know some people, even our mate; and do we really need to know everything? Well, if our safety from HIV is concerned, yes of course. If we find out these ''awful'' secrets, is it our right to feel utterly betrayed and to demand changes in behavior and what secrets do we have, the ''normal'' half of the relationship? Sexuality is a very complex and a very slippery slope; some people exist at many levels of sexual activity, interest, response, at the same time. For them it feels ''normal.'' Is this wrong? Susan
My understanding is that, in fact, your husband will probably not be able to ''change.'' He is a transvestite, and cannot ''change'' that, anymore than he could change being human.
I was saddened to hear that you choose to see the lack of sex in your relationship as being a result of his ''selfish'' pleasures. Is it not possible that the lack of the sex was because he was afraid to reveal himself to you? After all, transvestitism is extremely misunderstood, and usually reviled.
I do think your husband was extremely irresponsible not to have revealed this to you BEFORE you got married. He had no business entering a marriage without knowing how you would feel about his transvetitism once you found out (instead, perhaps fooling himself into believing he could hide it from you forever).
But how are *you* not being selfish right back? Are you willing to make any effort to learn to accept who and what he is and see if you cannot learn to incorporate that into your sex-life with him? How is it loving to say ''you change who you are to accomodate me, so I don't have to learn to accomodate you.''
Here of course, is the problem with his not revealing himself to you before you got married: you may be some one who is unable to accept him as he is, and cannot enjoy sex with a transvestite - he had a responsibility to find out and move on when he found out that you weren't interested in learning to understand his ''peculiarity.''
It seems to me that for your marriage to continue to grow and be happy, there needs to be MUTUAL understanding, acceptance and willingness to grow (change) and explore. I'm afraid it is simply not realistic to expect it to be all one-sided: you are responsible for doing your part, and doing your own ''work'' and soul-searching. Good luck. Anonymous
I'm sure many people will write with the information that this kind of fetish usually runs pretty deep and attempts to change or stop it will probably result in repression and deep unhappiness--which I'm sure sounds very discouraging. But perhaps there is a way to find a compromise between total acceptance and total rejection of this aspect of yor husband. I recommend the book *The other side of the closet: The coming-out crisis for straight spouses* by Amity Buxton. Although this book is geared more for hetero people with gay, lesbian, or bisexual spouses,rather than transvestites, it offers a lot of helpful models and insights about how to deal with the revelation that your spouse has a different sexuality than you thought. The first sentence of the first chapter reads ''When the initial shock subsides, straight spouses are typically devastated by what seems like a rejection of their sexuality...'', which sounds very much like what you are dealing with right now. I hope it helps. anon
This is a very difficult situation, but to me it sounds like things are already looking up and could get better because of his revelation.
You've had a longterm, seemingly unsolveable problem of not enough sex in your marriage, and finally you're having more sex, since you found out about your husband's fetish. You attribute this to his ''making a good effort''. There might be more to it though. Now that he's shared his fetish with you, he might be more able to relate to you with his whole sexual self, no longer keeping his sexuality hidden away along with his shameful secret.
You might be the first person he has ever revealed this to. Try to be gentle with him about his fetish. From everything I've experienced or read, it is not really possible for a person to change what turns them on. But anyone can try new approaches to sex without giving up the old way. He hasn't done anything really bad, like cheating or gambling away all your money. He hid his fetish partly out of fear of being judged. Now that he's told you, it will be a challenge for you not to condemn him and his fetish. But if you resist that urge and give yourself time to digest the situation, it could make your marriage and sex lives a lot better.
This is an opportunity for both of you to open up sexually, to yourselves and each other. Everyone has things that turn them on. Many (or perhaps most?)people have something a little silly or embarrassing that turns them on. It's theoretically possible for you to accept your husband's fetish and even indulge it or participate in it in some way (only he could tell you how to do that). At the same time, you can make it clear you want him to indulge your sexual proclivities too. Maybe you don't have any unusual or secret desire, but you might like something (just making this up) like more hugging, or him telling you you're beautiful, or him changing his hairstyle or wearing a tailored button-down red shirt or... anything.
Since you are so upset, and since he kept this a secret for so long, it might help if you talked to a sex therapist, or did some reading about things like this. Good places to start are Good Vibrations for books, or San Francisco Sex Information for free telephone couseling. Both have websites. I don't know how to find a good sex therapist, but no doubt other people will respond with that info. Good luck!
I am sorry you and your husband are having this issue. I think both of you should be in therapy together with a therapist that understands this issue. Also, come on, this is the BAY AREA, there has to be a support group for couples that are going through this! Please try to be creative about this. Please don't expect your husband to change. He obviously loves you and is heterosexual. Give yourself some time to live with the issue and to discuss the closeted aspect of it with your husband so that he is not driving all of his feelings inside (and hiding spending from you too). If you don't want to go to counseling with him then find him a good counselor (Not to CHANGE HIM, but to help him cope with this issue that causes him so much conflict). I don't believe you can make this go away, but rather for the sake of your marriage and your FAMILY see if you can get some support from professionals to learn to live with it.
Sorry to be so abrupt, but thinking you can ''fix'' or ''change'' him is in my opinion rather selfish and wrongheaded. My grandfather committed suicide because he struggled with this and of course had no support because it was the 1950s and he lived in New Jersey. He hung himself in the basement and my grandmother found him there. My mother was absolutely devistated by this loss. The suicide has forever altered our family, even though I never got to meet my grandfather.
I am only sharing this because I think people with ''different'' sexual preferences can really struggle with this and somehow when you are ready he needs your support. Both of you need counseling and hopefully a support group. Ask a trained therapist to see if there is a support group available.
You can get through this together and save your marriage and family. M
Your husband has a fairly common problem. I know of other women whose husbands have this fetish. I don't think you should take it personally, especially since your husband is trying to help things. (I'm sure it's hard not to, but it's not about you, it's about him.) I suggest you join a support group or an online community where those with experience can help you work through this. Lynne
I understand why you feel confused. Your husband has not been sharing a part of his life with you. You feel like you don't know him anymore. But from your response, I can see why he didn't share this information with you sooner. He might have sensed that you would be judgemental and feel threatened by it.
Fetishes are normal. Many straight men like to dress up as women. You are only making your husband feel worse about it by treating it like it is something horrible. He's not going to stop wanting to dress up like a woman because you don't want him to. If he stops doing it because you asked him to, he's going to feel resentful of you. If he continues but hides it from you, he's going to feel guilty and ashamed. The only emotionally healthy thing for him is to be with someone who accepts him for who he is. So you need to decide if you can get used to the fact that he enjoys dressing up like a woman or if you need to leave the relationship.
You correlate his dressing up like a woman and masturbating with the two of you not having sex together, but I don't think those are necessarily related. I think that open communication and honesty leads to feelings of intimacy between partners. If you don't have the feelings of intimacy, you don't want to have sex as much. He was hiding his fetish from you, so he was blocking the lines of communication. But I think you need to forgive him for not telling you sooner, especially considering your initial reaction when you found out. Focus on understanding. Have some heart-to-heart conversations about it. Read about it. Go to therapy (both of you). Don't make a hasty decision.
This whole thing may seem overwhelming now, but I think it's an opportunity to make your relationship richer. The man you married is still in front of you. You made a lifetime commiment to him. Try your hardest to embrace him for who he is. Good Luck!
I read all the responses you received about your husband's transvestism and I was warmed by how even-keeled all of the responses were. I am so proud of the Bay Area!! You have a right to have your feelings--whatever they are--about your husband's crossdressing, just as his desire for crossdressing is valid. You are involved with someone who enjoys things you didn't know about before you married him, so it makes sense that you feel shocked and betrayed. He feels a great deal of shame around this issue, so it is hard for him too.
I was thinking about this, and I realized that we never really know what we are in for when we enter relationships. People do change, and we do learn new things about each other. The beauty of this is that much of this involves growth for both parties. A friend of mine and I have a saying: ''I HATE learning experiences!'' And it's true--they are always painful and awkward.
But we move through them. If you can let just a little bit of light into your current ''learning experience,'' you may be surprised at how good about yourself you will feel when you allow yourself to heal from it all.
I got involved with a man who was ravenous for me before we settled down, but now has practically no interest in sex with me at all. It certainly wasn't what I bargained for when I moved in with him! But I am trying to learn about myself in this situation, to understand all the different ways of responding. I know, ''crossdressing'' sounds much more scary than ''no sexual interest,'' but we are in similar situations: You and I both have partners whose sexuality is not the same as it was when we settled down (or at least what we ''thought'' it was). You are grappling with a lot right now--when you feel really angry at him, try to realize that he didn't choose to have this fetish--he was just made that way. It might help you feel more patient. Take good care of yourself. anonymous
I think that it's pretty evident that now that your husbands'fetish' is out in the open and you guys are actually having sex, that his disclosure has already helped your relationship! I hope that you can not only be comfortable with the idea, but embrace it! I mean, what fun you can have if you try to ...get into the idea! Good luck!
Feeling very alone about my transgendered husband
March 2006
I am looking for help and support as a wife of a trangendered husband. Early in our relationship he revealed that he liked wearing women\x92s shoes, etc. (especially in private) and I was totally fine with that. As we have evolved as individuals and as a couple, he has gradually become more androgynous and goes out sometimes as a man and sometimes as a woman, though at this point he does not plan to transition fully. We also have a new baby and this is playing into the dynamic as well. I love him very much but am feeling very alone about the issue and would love to find support or suggestions from others who have been through something similar. Anon.
My sister discovered that her husband liked to wear women's clothes early in their marriage. Coming from a conservative, sheltered background, I have to give her credit;she tried to make it work, but eventually the combination of issues related to the cross-dressing (he liked to wear lingerie for sex and padded his bra) as well as other problems in general in the marriage, led her to seek a divorce. You don't say how comfortable your husband is with his orientation - my brother in law was very secretive and projected out a lot of insecurity and hostility. At the time, I found that there are numerous websites and support groups you can sign up for. You're not alone. anon
Your husband and you may benefit from joining in the discussions on Our Family Coalition, based here in the Bay Area. See: http:www.ourfamily.org and sign up for the listserv and/or view the resources list. There are many similar families in this organization and your questions will meet with many experienced responses. Gender identity consists of a wide continuum of feelings and practices, so don't be marginalized or feel like you're the only ones out there with this situation. Seek information and contact with others who are living similarly. You are fortunate to be in this area, take advantage of all there is to offer. Walking in the Middle
Please call the Pacific Center for Human Growth in Berkeley, and/or the San Francisco Lesbian, Gay Bisexual Transgender Community Center. Theses organizations may be able to provifde resources for you and your husband. A Transgender family fair write up was just featured in the SF Bay Area Reporter and The Our Family Coalition Newsletter, which I would also encourage you to visit on the web. You can look these up on the Web and/or phone book. The best of everything to you all. Peace v.
No great advice, just the hope that you are able to find support and fellowship with others going through a similarly difficult time. I salute your compassion and remarkable tolerance during a painful and lonely situation. Lots of good wishes to you, your husband, and new baby.
Try PFLAG (Parents and Friends of Lesbians and Gays). They have some books that they recommend plus some information that you can download. www.pflag.org They have a link to a support group for Straight spouses of LGBT persons called www.ssnetwk.org I think that there is a group that meets in the Bay Area. This will put you in touch with people who understand and can relate to your situation. Peace, Queer friend of straight people
My dad is transgendered and my parents are happily married going on 32 years. Until the late 80s my dad was a closet cross-dresser, and in his late 30s began to feel he needed to take it further (hormones, electrolosys) - Although my mom knew my dad cross-dressed she was initially against his taking it further, but they made it through that period and are happy and in love now. There's obviously a lot more depth to the story, but it's too much to write here - I'd need a lot of space. Anyway, if the woman with the transgendered husband is interesting in contacting me to learn more, she's welcome to e-mail me. anon
I don't have any experience with Kaiser, but I have a trans daughter that came out to us a few months ago. She hasn't started hormones yet, but it being seen at Stanford. If you are interested in chatting, please contact me through BPN.
i cannot speak to healthcare on this for you. i’m just weighing to applaud you for your kind, loving and level headed approach. and offer a cautionary tale. my teen niece went thru all this over the last three years. she was in the drivers seat with divorced parents who could not agree (mom against, dad didn’t like it but caves to kid on any/every topic) and a therapist who was not only not neutral but who actively championed this. as it wasn’t our kid we kept our mouths shut and watched from afar. the minute kiddo clicked eighteen it was off to florida for top surgery (he spend every waking minute not in school working to save money surgery for two years). the surgery was performed after only a single psychological evaluation. this kid has (and had a history) of significant mood disregulation, issues with executive functioning issues and possible personality disorder. is whip smart and extremely adept at splitting and manipulation. basically a highly pissed off kid unable to sustain relationships even with supportive friends and family. now kiddo has irreparably changed his body with surgery and hormones. is still miserable and feeling victimized by everything and everyone… including the transition. my heart is broken for him. i worked in an industry i loved with queer and a trans oeople for decades so i’m not some prude or backward thinker. but what has unfolded in my own family is nothing short of a greek tragedy. i have zero doubt there might be pushback on my opinion here, but it needs to be said. some kids insisting on medical solutions for problems that are not medical are a train wreck in the making. again my heart is broken for this kid and i’m angry at a system and all the ‘adults’ who allowed it to unfold. you are asking the right questions. refuse to get bullied into silence. either way this goes, your kid needs to you do your best for her especially the thankless job of asking hard questions and demanding answers. the chips are down. i hope is for the very best outcome for your family.
I would go to genspect and get information, especially genspect.org/guidance.
Segm.org has info in all the countries which have been doing evidence reviews and finding it's insufficient to justify these serious interventions without being much more careful than the Wpath or us models. And much more.
A lot of places follow the affirmative model which does not include careful evaluation.
Drs. Edwards Leeper and Anderson wrote a great op ed about this in the Washington Post last fall. (Note that studies behind these interventions are low quality so that even people who do evaluations are not basing their evaluations on moderate or high quality studies.)
Dr. Anderson has had a few more in the sf examiner early this year and an interview in the uk daily mail last week.
There is a recent medical article by Stephen Levine and others, https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221 - "Reconsidering informed consent for trans identified...".
That might give you the best up to date information.
There's also a Medscape article by Will Malone from 2021 (about puberty blockers in the title).
Lots of parent stories at the Pitt substack.
A trans identification can be temporary and related to many things but many clinicians and schools are misinformed and think they have to affirm. That's not true. There's no reliable test to say when it's not temporary (very tough situation), but temporary versions have occurred when trauma, ASD, OCD, wing gay, anorexia, separation anxiety, depression, etc. are involved. Many bay area practitioners don't know this. Some even think that a young person is more at risk of suicide if they are not immediately transitioned. This is false. You can also Google Sinead Watson or Keira Bell or Tullipr (substack) to hear from some of the many detransitioners out there. No one knows how many detransition, there are inaccurate tiny numbers being thrown around,the studies are unreliable.
Some people find their conflict between mind and body resolves with exploratory therapy. Dont let anyone tell you trans is the new gay, one is self perception and one is sexual orientation (sexual orientation seems much less fluid).
It's very important to listen and understand where she is getting her information, too. Some people online will tell a young person that their distress is due to being trans and sometimes a young person stops exploring at that point. A lot of people giving diagnoses online.
Some kids also got exposed to porn and were so traumatized it led to a temporary trans identification.
It's not bigoted to explore and ask questions.be aware that se people will think he ser dysphoria is understood and that you should affitm and will treat you with condescension and pretend you are being a helicopter parent. And will get your kid all excited about being independent and rebelling. Buy this is a serious and not well understood condition and anyone who tells you otherwise is likely misinformed.
Also be aware that social transition is not neutral.
Ask questions, this is medical care for your child and the misinformation out there is terrible!
Good luck!
My kid did not get a careful evaluation at UCSF, don't go there.
Please stay clear of Kaiser's gender clinics. They are about as far from "evidence-based medicine" as you can imagine. Our kid was put on blockers after a 1-hour zoom call with a social worker (we've taken our kid off after learning about the harm and because there was no decent mental health support provided — so much for that "pause button" to "explore" their gender). The clinical director wanted to put my kid on hormones despite NEVER MEETING HIM, which would sterilize him within 4 months. When I asked what criteria they use to determine who will and won't benefit from them, she said they have no criteria but get "kind of a sense of" who will benefit. She's since "retired" and the social worker didn't return from maternity leave. The rest are just as bad or worse. Sloppy and dangerous. If you find someone who does a comprehensive evaluation (Dr. Laura Edwards-Leeper's wait list is long, but thinning because people are backing away from this), ask them how long they follow-up with their patients. If it's under 6 years (some say 10 years is a typical time for regret), then they have no idea whether their evaluation is at all meaningful.
You also might want to listen to this podcast. The whole series is really helpful: https://gender-a-wider-lens.captivate.fm/episode/40-social-transition-a…. Someone mentioned the PITT substack (https://pitt.substack.com/). I would read some of those parent stories to get a better picture of things.
You are right to be concerned. I do not have any personal experience with the Kaiser clinic, but as a pediatrician, I have learned a lot about the gender affirming model which is what Kaiser and most other medical institutions embrace these days and I find it problematic, simplistic, and harmful.
What this model says, among other things, is that what the child says about their gender should be believed-- i.e. taken at face value, regardless of the child's age, history, context, or any co-existing mental health concerns (which are typically attributed to 'interpersonal and cultural reactions to a child, not internal pathology')-- this despite the fact that many kids with gender dysphoria also have anxiety, depression, eating disorders, and/or autism. Another tenet of this model is that "cisgender is only one of many positive pathways-- no one pathway is privileged over another". As a parent and physician, it seems common sense to me that the pathway which allows the child to keep all their original body parts and avoid irrevocable consequences (like possible sterility) and a lifetime of mandatory medication should definitely be privileged. I believe nonurgent decisions with such irrevocable consequences can only be ethically made by fully matured adult brains, which usually happens around age 25. Especially when another tenet of this model is that "gender is not fixed at a moment in time, but a lifelong process". If that's the case (unlike, for example, sexual orientation-- which typically does NOT change over time), doesn't it make sense to explore ways to help kids make peace with the body they were born into?
If you want a 'comprehensive mental health assessment" of your child prior to medicalizing their distress, a gender clinic is definitely not the place to go-- since the affirming model does not view gender dysphoria as pathological, evaluations of mental health are viewed as unnecessary 'gatekeeping' and tend to be more of a rubber stamp (https://www.nytimes.com/2022/01/13/health/transgender-teens-hormones.ht…).
It sounds like you are looking for more of an open exploration of the bigger picture, which makes sense-- unfortunately this can be hard to find but here are a couple good places to start-- The Gender Exploratory Therapy Association ( https://genderexploratory.com/), https://inspiredteentherapy.com/.
Best wishes to you; this is not an easy journey for child or parent.
Run away from Kaiser for this issue. Not only do they not offer comprehensive assessment with their "affirmation only" model of treatment, we had to struggle with them NOT to send our teen to the MST (after a 10 minute Zoom session with them), eventually having to call on a therapist who had known our kid since elementary school to get them to back off before a more exploratory approach not immediately requiring hormones and surgery could be found. The MST clinic seems like a chute - especially if the child is simply in the beginning stages of exploring their gender. I got a distinct sense that Kaiser actively WANTED them to transition medically - despite the lack of evidence based, peer-reviewed research demonstrating long-term positive outcomes for this age group. These are kids who will often be dependent on hormones for life. I am not transphobic, and do believe that hormones and surgery can be the right path - and life saving - for some who truly are trans, but believe that especially for an age group who are by definition trying lots of things to figure out who they are (and many of who have other mental health concerns) that thorough exploration is the best course. My trans friends transitioned as adults, after their pre-frontal cortexes had developed. I echo others here in urging you to look at the Gender Exploratory Therapy Association (https://genderexploratory.com/) and other resources. It has been hard to find resources that are not on opposite ends of the spectrum (either transphobic or "affirmation only") as the issue is so politicized, especially with the horrorshow of Texan politics. What has resulted, though, especially in the more progressive areas or our country, seems like a backlash resulting in well-intentioned professionals throwing a lot of kids under the train before thoughtful exploration. The GETA seeks to take the politics out.
I am glad to see that - following the path of other countries who are ahead of the US in this arena (Sweden, Finland, the Netherlands) and who have changed their protocol for treatment for this age group - the US may be heading in this direction as well. (See Levine https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221 ) Unfortunately it will be too late for many of these kids for whom the medicalized route is not appropriate.
I don’t have any experience with Kaiser but you’ve gotten a lot of responses about the scary side of transition and just wanted to let you and anyone else reading know that my trans 19 yo is so much happier since medically transitioning. He did get a lot of therapy before starting the medical parts but he feels good about being himself now. Gender Spectrum has some good support groups for parents. I had many doubts and worries which still resurface sometimes but seeing him more comfortable in himself is so reassuring and incredible. It’s a lot to navigate and the current culture wars don’t make it any easier. Take care.
Hi - My family and I have had an ultimately positive experience at the Kaiser gender clinic. (Our experience may or may not be relevant since our child began to want to explore questions about gender at a younger age (12).) Others have mentioned that things moved too quickly and casually, and I was worried about this too, but I shared my concerns with the gender therapist and she listened, and engaged with me in nuanced conversations. My child talked to her many times on his own and I wasn't part of those conversations, but it seemed to me that if anything she helped him relax and slow down about it all. (My child was initially sure of wanting to make a change, and in a hurry to do it, so that might be different from your situation too.) The doctors were also especially helpful for him and us in that regard. When I'd try to talk to my child on my own about my concerns about medical intervention, the conversations were painful and I could tell he just heard it as "I don't support you." But he was able to listen to his doctors, so we made appointments to talk to them together and I'd ask my questions and voice my concerns. They talked with him with gravity about what medical changes would mean, and he could hear them and ended up asking lots of good questions on his own. In fact he often emails them himself, even though I'm on the emails too. We did end up using an outside therapist as well, both for my child and for me and my husband, because I wanted to make sure we all got frequent, regular appointments and I wasn't sure that would be possible at Kaiser. One thing that I've really liked at Kaiser is the parent support groups. They're on Zoom, which isn't my favorite, but it's really convenient, and it feels like a big relief to be in the company of other parents who are facing these questions with their kids, and just be able to talk and voice what we're going through. In general I find the online/social media conversation about gender transition too polarizing and not nuanced enough. The live conversation with real people who are navigating their way through similar territory has been a real support to me.
My family had a good experience with Kaiser's youth gender clinic and I have had good experiences collaborating with them as an external healthcare provider on the adult side of things. I think their providers are providing evidence based care and are taking good care of their patients. I'm sorry to hear other BPN families have not had that experience. As a family, I never felt like they were pushing us or rushing us/our child and I do feel like we got an appropriate evaluation. Our experience is recent, within the last 12 months, and we were evaluated promptly upon reaching out.
Every healthcare system is struggling to retain enough mental health providers so if you have the financial means and you aren't primarily pursuing hormone treatment (even if you are doing so in parallel), it may be worth pursuing a skilled therapist outside of the Kaiser system for some support and clarity. I can strongly recommend the mental health providers working in the UCSF Mind the Gap program. My family and child has had a wonderful experience with the therapist we have been working with through this program and the clinicians are located throughout the Bay Area: https://www.genderyouthproviders.com/
I personally would not recommend The Gender Exploratory Therapy Association that others here have directed you to. Its organization name sounds like it's fully exploring gender and that includes gender affirmation but the providers do not affirm transgender/gender expansive individuals.