Therapist for Trans & Gender Questioning Issues
Parent Q&A
Hello my assigned female at birth child also expressed the same things. It started around age 15 at first as non-binary and then as trans male. Also, he had bullying at school and a molestation at age 10, a trauma that I don't feel was properly addressed at the time. Up until age 15 he had long, long hair and dressed and acted like a girl never expressing that he didn't feel comfortable with his gender or that he didn't want to be a girl.
At 16, he wanted to take testosterone and also talked of having top surgery. Many of his online friends were non-binary. We let him start the testosterone. He took it for about a year and then decided on his own to stop. He still has facial and body hair from that. We were torn about the top surgery since we didn't feel that at 16 he had the maturity to make that decision and although we didn't want to make him sad, we kept putting it off. When we finally began talking with a Dr. and setting up appointments, it turned out that my insurance company wouldn't cover it until the age of 18. (BUT the doctor WOULD have)
Thank God because his 18th birthday came and went (he's 19 now) with no mention of it and he told us he changed his mind and doesn't want to ever do that.
At one point last summer he expressed wanting to be referred to as 'she' again but that didn't last long. He seems to want to be feminine a lot of the time but at the same time wants to be referred to as 'he'. This is with no pressure from me at all. He wears dresses sometimes, and makeup, earrings and nail polish daily.
For me as a mother, i see a confusion of self, anxiety with the world and an underlying mental illness (diagnosed with dissociative disorder) caused by childhood trauma.
I would urge you to be supportive of your child and allow them to express their identity but without taking any non-reversible steps. It was so easy to get the testosterone at 16 that it's frightening. My son was born and raised outside the U.S. where it would not have been possible at all. We didn't move back here till a few years ago, so I was not used to what to expect.
I would also urge you to keep trying therapists, psychologist and psychiatrists until you find the right one. I can recommend Zara Drapkin but she doesn't take insurance. It has only been in the last 5 months that I've finally decided to pay out of pocket and it is expensive but I think worth it.
First and foremost, you know and love your child better than any therapist or doctor. Be very assured of that. Find someone you can explain your questions and apprehensions to.
Another place that was very very good is Alta Bates (on Dwight) that has an outpatient program (but is hard to get in) and also might not be meeting because of the coronavirus.
I'm sorry for you and your child because I know it's very difficult for both of you. Try to take things one by one and get through little milestones.
I hope they get better soon.
Take care
My transgender child sees Jay Williams at:
https://spectrumpractice.com/
He has been an incredible therapist that has helped my child through really difficult times. My 15 year old also anxiety, depression, sensory issues, been bullied, & had disordered eating/ARVID.
To gain deeper understanding of all the terms and identity labels prior to conducting the activity, read Sam’s “Breaking through the Binary: Gender Explained Using Continuums” article (szp.guide/bttb) or book A Guide to Gender (szp.guide/g2g).
Check out this great website:
https://thesafezoneproject.com/activities/genderbread-person/
https://thesafezoneproject.com/resources/
Read books:
Beyond the Gender Binary (Pocket Change Collective)
by Alok Vaid-Menon, Ashley Lukashevsky (Illustrations)
https://www.goodreads.com/book/show/48190203-beyond-the-gender-binary
My Gender Workbook: How to Become a Real Man, a Real Woman, the Real You, Or Something Else Entirely
https://books.google.com/books/about/My_Gender_Workbook.html?id=NjH32xM…
Feel free to ask me questions
My AFAB child also told us they identify as non-binary and prefer a different name and the pronouns "they/them" last year when they were 15. It was also somewhat of a surprise to us, and I will admit it took us too long to start using their preferred pronouns consistently. So first of all I commend you for doing that. Our child had never been bullied or had disordered eating, but they have suffered from depression and anxiety and were unable to attend school through much of middle school. We also didn't see huge improvements in their anxiety and depression with medication and regular talk therapy. In their case, they developed very large breasts after puberty and we were already looking into breast reduction even before they came out as non-binary. It turned out that regular breast reduction could only get them down to a "C" cup, which still felt too big to them. We ended up deciding on "top" surgery which they went through last December, at age 16. I am very confident that was the right decision for them. In fact almost the first thing they said when they came out of the anesthesia was "I'm so happy!" They haven't expressed any interest in any other procedures or interventions like hormones.
We have Kaiser and had some sessions at the Gender clinic in Oakland. Overall we've found Kaiser to be very good on this (although their mental health care in general is not great.) I think it's important for you to be able to separate your child's gender identity from their mental health issues. The bullying, anxiety etc. did not *cause* their non-binary gender identity, and their gender identity will not be affected by antidepressants. Similarly, any surgeries or other interventions will not solve "the problem" of their depression and anxiety. It will only address the problem of their body dysphoria, which may be contributing to their depression but is not the only factor.
Now, 3 months after their surgery, our child is still 100% happy with the surgery. However they still struggle with depression and anxiety to some extent (although they are happier and less anxious now overall.) We found the doctors at Kaiser to be very aware of the mental health issues involved in these decisions, and I imagine the doctors who perform this surgery outside of Kaiser are too. They don't just do irreversible procedures on teens without a fair amount of discussion and counseling. I know this is difficult for you, but your child really needs you to accept them as they are. They are telling you that they are not female or male. If you love them, you have to believe them. Sending love, peace, and understanding to your family.
If you are a Kaiser member, Oakland and SF have multi specialty transitions departments. They have therapists. Your teen may need some therapy and to try hormone blockers if they have not completed puberty. That will give them time to delve into these issues before moving forward irreversibly.
Gender Spectrum is also a good online resource. It's complicated. Your teen needs to know they are loved and accepted even if they grow in unanticipated directions. " I think I would be supportive." doesn't cut it. Others are bullying, you need to be a safe haven. Hugs.
I highly recommend Catherine Metzger at Still Waters Psychotherapy. She is very intelligent, intuitive, insightful and an expert in adolescents with a specialty in gender dysphoria. The fact that she has in person openings will not last long - she just started her private practice. She has been working with my family for over 5 years while she was gathering her clinical hours. Her website is: https://stillwaterspsychotherapy.com/catherine-metzger%2C-amft
Please go to "therapy first" if gender dysphoria is involved. Or a therapist who knows what exploratory therapy is and will consider it. A gender clinic in the US tends to follow, especially here in the bay area, the "affirmation only" model, which affirms rather than trying to understand the gender dysphoria. Affirmation tends to provide medical intervention as requested (see Reuters' Youth in Transition as well), but these interventions have not been shown to be safe, effective or even necessary. No one can show they know what is likely if a young person is given medical intervention or if they aren't. (whether it will help or harm their mental health, gender dysphoria, or quality of life....long term...short term there is a placebo effect, "honeymoon," that has been reported).
The US affirmative model is being discarded by countries which are looking at the evidence behind medical intervention. There is a great medical article reviewing it by Jennifer Block (Gender dysphoria is rising in young people and so is professional disagreement), peer reviewed, in the British Medical Journal. She also wrote an information packed op ed for the Boston Globe last fall on the "hall of mirrors" aspect of treating gender dysphoria in this country. Pamela Paul also wrote two articles in the NYT last month, which highlighted one of the therapists leading "therapy first."
In particular, a lot of people in the US don't realize that it is unknown for whom gender distress/trans identification will not go away without any medical intervention (social transition seems to make gender distress persist). That is, it can be transient and there is a huge ethical problem in trying to know what to do. This is made worse because the medical interventions also haven't been demonstrated to help (anyone who tells you it will affect suicide risk is misinformed, point them to Ruuska et al., 2024, or the systematic review by Baker et al., 2021). Anyone who doesn't know the expected outcomes are not well determined is not giving informed consent. There's information about gender dysphoria for instance in the Cass Review's interim report, a thorough overview involving systematic reviews of the evidence, and discussions with clinicians, patients, families, stakeholders, etc.
A lot of US "major medical associations" follow "WPATH", a group which just had a lot of its internal documents put out there for the public, so that you can see how much is (not) understood by this group. I think Ben Ryan had a really good summary in the NY Sun? The peer reviewed investigative article by Block in BMJ talks about the evidence base (needed to understand risks, benefits, alternatives and what happens if you do nothing) behind different treatment recommendations, including WPATH's.
Chloe Jhangiani (https://www.psychologytoday.com/us/therapists/chloe-jhangiani-berkeley-ca/865080 ) is an excellent local therapist, is well versed with queer and questioning youth of many backgrounds, and has been in practice for about 15 years. She was a therapist for our middle child for two years and was incredibly helpful to understanding and guiding her through questions of gender and sexuality. Good luck!!
Hello - We had similar issues with our academically gifted, artistic and neurodiverse teen, whose depression and anxiety skyrocketed over the course of remote learning (preceded by a case of sexual assault and some pretty awful bullying). Our kid announced a trans identity literally overnight (with no history of gender incongruence) a year or so into the isolation, accompanied by a deep, deep dive online as required by online school. Though we were (and are!) supportive of our kid and used the new name and pronouns, it felt like exploration rather than a a truly authentic identity. It is these kids jobs to explore identity at this time, and also to individuate.
The suffering our kid was feeling was very real, whatever its source (and there were so many things that clearly contributed). We had an extremely hard time finding a therapist who would help gently guide our teen through the issues of trauma and not focus solely on the gender dysphoria. What was helpful (also for me as a parent as the class is attended by both the teen and a caregiver), was Dialectical Behavior Therapy. We only did one of the modules, which, rather being individual talk therapy focused instead on recognizing patterns of behaviors and thinking and figuring our helpful ways to shift these. We went to Clearwater Clinic (in both Oakland and Orinda clearwaterclinic.com). It is pricey, but did offer a pathway to become more self aware and help with the constant anxiety and worry.
It is not anti trans to question an overnight identity shift that is often swiftly accompanied by medicalization with risky and has irreversible consequences, and we are in an era where this is being applied to a young cohort that the CDC itself recognizes is in the middle of a mental health crisis. It is not anti trans to be concerned about the physical, mental, sexual and reproductive health of one's child. There has to be room for thoughtful, nuanced, balanced care. We are being told as parents that our kids are in danger of committing suicide if we even question the medicalization, and current "hide any identity change from the parents" laws are creating a triangulated situation with schools and other institutions and the kids who are told that the parents are the enemies. (While there are inevitably exceptions, in 16 years of experience of shepherding my kid from preschool - high school I have yet to meet a parent who did not love and prioritize their children, and none who would kick them out for being gay or identifying as trans.)
It is possible to support a trans identity and not support medicalization. It is possible to be trans, and not to immediately medicalize. That medical and surgical gender affirmative care is available is vital (especially for those who have been on the hormones long enough that their bodies no longer produce their birth hormones, so they need the other hormones to function), but the idea that they are absolutely required for every 15 year old who announces overnight that they are trans is absurd.
The trans community is vulnerable, and needs support, especially in states where the dangerous bans are being enacted. Kids with mental and other health issues are also vulnerable, and caution should be taken before irreversible medical steps. Both are true. It is not anti trans to seek and exercise nuanced care. What does your gut say as a parent? You know your kid.
I wish you and your teen all the best. It's a tough time, but also can be wonderful.