Whose Rights Matter Here?

I saw two news reports today involving two transwomen. In one case the question is raised about the rights of the individual vs. the rights of society, in this case, the rights of other teenage girls to be afforded a dressing room without a preoperative teenage transsexual girl sharing the locker room with them. The other case involves the rights of an adult transsexual woman to complete her transition by having gender reassignment surgery vs. her parents' desire to block her from having the surgery. In that case, a Pennsylvania judge has issued a stay preventing the woman from having her surgery until the case can be heard.

Because the transsexual girl is a minor, I have chosen to delete her name from the news report by the CBS news affiliate who did publish her name. I don't think publishing her name is the proper thing to do.

In the first case, the CBS affiliate in St. Louis, Missouri reports: " Over 150 Missouri high school students voiced their displeasure about a transgender teen using the girls’ locker room by walking out of class.

Students at Hillsboro High School staged a two-hour walkout Monday over 17-year-old  (the student), a student who has identified as a female since she was 13, using the girls’ locker room during gym class.

The school offered (the student) a gender-neutral bathroom, which she turned down. St. Louis attorney Timm Schowalter says, “All students have a right, under Title 9, to access the bathroom of their choice.”

Family members of high school students were also holding a protest.

“Boys need to have their own locker room. Girls need to have their own locker room, and if somebody has mixed feelings where they are, they need to have their own also,” protester Jeff Childs told KMOV. Childs was holding a “Girls Rights Matter” sign.

Tammy Sorden, whose son goes to Hillsboro High School, believes it’s not right to give (the student) special treatment “while the girls just have to suck it up.”

“The girls have rights, and they shouldn’t have to share a bathroom with a boy,” she told the Post-Dispatch."

As a preoperative transsexual myself, I find myself agreeing with the female students of the high school. I don't think they should have to share a locker room with a preoperative transsexual. That is an environment in which there is not the privacy afforded in a regular women's bathroom. This is an environment in which women are fully disrobed in front of each other and I do think it is important to be sensitive to their feelings about this situation. Personally, at this point in my own transition I think it would be terribly disrespectful to subject genetic women and postoperative transsexual women to my presence in the locker room. In the news report or in the protests by the high school students, I do not see any mention of the girls objecting to this preoperative transsexual girl sharing the regular restrooms. This indicates to me that this particular school's students and faculty are rather tolerant of the transsexual students presence in another intimate place, albeit not as intimate as a locker room. To me the transsexual student is being insensitive to the feelings of the very people she is trying to assimilate with. This is not the way to go about it, in my opinion.

In the second case, I will include the name of the transsexual woman because she is an adult.

The Associated Press reports " A transgender woman whose parents went to court Wednesday to block her gender-reassignment surgery in Pennsylvania said she would rather die on the operating table than continue living with male anatomy.

Christine Kitzler, 48, said during a break in the emergency hearing that the risk factors her father raised - including complications from her HIV and Hepatitis C diagnoses - were worth enduring to have her body match the gender she's identified with since growing up in suburban Cleveland, Ohio.

The surgery, temporarily halted earlier this week by a suburban Philadelphia judge as he considers a longer stay, would also save her from backsliding into alcohol and drug addiction, Kitzler said.

Her parents, Klaus and Ingrid Kitzler, contend Kitzler is not competent to make an informed decision to have the surgery because of depression and a childhood learning disorder, and want a temporary guardian named.

"I might die from this. But it's worth dying," Kitzler said. "I would rather die than live the way I was and return to my bad addictions, like alcohol, because I can't do it and I won't do it."

Kitzler's surgery had been scheduled for Tuesday in Pennsylvania, but Bucks County Judge C. Theodore Fritsch Jr. stopped it after her parents' lawyers filed for an injunction and asked for time for reflection before she goes through with what they called an irreversible surgery.

Testifying at the hearing, Klaus Kitzler underscored his concern for his daughter's health. He said he would accept her surgery if an independent psychiatrist deemed her fit to make the decision.

"I accept it, but I want to stop it," Kitzler told the judge. "I would love to have a son back who goes to church with us on Sunday mornings."

Christine Kitzler, who lives in Myrtle Beach, South Carolina, has already been through 16 months of pre-operative preparation, including a 24-hour fast before Tuesday's scheduled surgery, and has received clearances from mental health professionals that she is knowingly and willingly undergoing gender reassignment, her doctor said.

Her lawyer, Angela Giampolo, said she had never seen competency invoked to block a gender-reassignment surgery.

"This isn't a competency hearing. This isn't a guardianship hearing. It's a difference of opinion," the prominent Philadelphia gay-and-transgender-rights lawyer said.

Giampolo said Kitzler's parents are trying to prevent her from living an authentic life. They said they fear Klaus and Ingrid Kitzler want to bring her back to Ohio, win a court action there and permanently block the surgery.

"They have a daughter. They don't have a son," Kitzler said. "I'll have the parts. I am a woman." "

Ms. Kitzler is an adult and she has made a carefully informed decision that having gender reassignment surgery is necessary for her to have a quality of life that makes life itself worth living.

In my opinion, the arguments that she has suffered from depression, has a history of addiction and has a learning disorder are all specious arguments. And here is one reason why the WPATH standards of care exist. 

Let's take this point by point: 1. Ms. Kitzler is an adult and as an adult it is her right to pursue gender reassignment. 2. Show me a person who is transsexual and never suffered from depression to one degree or another. I don't believe there are enough of individuals who have not been depressed in people who are transsexual to be considered statistically significant. 2. Transsexual individuals experience higher rates of addiction and substance abuse than the general population. 3. Having a learning disability in no way impacts the decision to make a gender transition. 4. Having HIV and Hepatitis C infections does not necessarily preclude one from having surgical procedures. 5. None of the above factors generally diminish legal competency.

Because of the guidance of WPATH standards of care, Ms. Kitzler was screened by mental health professionals and found that her mental health and substance abuse issues at this time are not a barrier to treatment and that she is making a well informed and competent decision to pursue gender reassignment surgery. Her physicians have assessed her and found her to be a good surgical risk and are willing to perform the procedure. This should be the end of the story, but it isn't. Her father's sole reason for seeking the court's intervention is that " I just want to have a son who goes to church with us on Sunday mornings." 

If the truth be told, he never had a son, though I do believe he didn't know that for many years. Transsexuals become skilled at living a life and acting out a life that is not authentic. Wouldn't if be more loving and affirming if her father had said, "I'll be looking forward to having my daughter to go to church with us on Sunday morning." 

When this sad episode is over, I'm guessing he will neither have a son or a daughter. My guess is that Ms. Kitzler will never wish to speak to her parents again, or at least for so long a period of time that there will not be much time left in life for them to share. Really, how sad is that? What a terrible thing to happen.

Prequel: Gathering information for an article I am writing on Transsexual Regretters

This discussion will tie into something I've recently taken an interest in and am writing an article about; transsexual regretters. What role, if any, does the  informed consent model contribute to the rate of transsexual regretters? I am looking at statistical outcomes for my article. If 5% of people who have come to regret their decision to transition and have grs, that becomes significant and can become an argument against informed consent, or even providing the means to have access to HRT and GRS via WPATH SOC.
Do you believe this is a significant issue? To be honest, and in the interest of full disclosure, I advocate for the WPATH SOC and am a member of WPATH.  I am a psychotherapist who is post transition and pre op. I have chosen to adhere to the SOC despite having the means to circumvent the process because I believe that WPATH's SOC is a reasonable and thoughtful approach for people coping with our issues. I am, however very open to other points of view. I don't believe I have the lock on what is "correct" or "right".
When I look at the recent study by NCTE and their statistics on substance abuse, poverty, victimization and attempted suicide rates (> 30%) which are magnitudes above the general population, then read what those who regret transitioning and their perspectives, I recognize that something significant has occurred and there seem to be far too many who think they made a terrible mistake.

Many of those who regret their decision to transition do not take much personal responsibility for their tragic regrets. They indict a system that allows almost no review in the process they undertake and see tragedy as a result.

Others rail against any kind of system that compels a person to engage in a process of examining their motives and potential for poor or disastrous outcomes in the hopes that system will provide better outcomes for those who transition from a biopsychosocial perspective.

I am exploring why those who regret their choices are so vocal in opposition to allowing others to proceed in this process and why whatever decisions they made to transition ended in such tragic results.

There are no clear compelling arguments for the extremes of each position here. What is your opinion?

Do It Yourself Hormones: Is this a good idea?

I had a nice discussion with a lovely woman from Florida who came to my workshop at Southern Comfort two weeks ago. She had been on do it yourself hormones for awhile, stopped taking them and went back on them, but after she heard my comments, she changed her mind and was going to look into getting prescriptions and medical monitoring of her hormones.

I am someone who is not an advocate of doing it yourself, also sometimes known as D-I-Y. But I am also someone who has tried do it yourself, albeit a long time ago and it was only for about 3 or 4 months. I hope that this article will help people to reconsider the D-I-Y route and seek medical supervision.

My personal adventure with D-I-Y does not contain a horror story and I am not going to paint dire pictures of certain doom, illness or death, but there are potentially serious health complication that the D-I-Y person should be aware of and at least take some reasonable steps to minimize the potential for harm that exists with D-I-Y.

I have said before and I will say again, hormones are not playthings. Misuse of hormones can lead to heart, kidney and liver damage. They have the potential to raise blood pressure and cause heart attacks and strokes or fatal embolisms. Some people are not candidates for HRT because of other pre existing serious heart problems.

One of the most serious problems is that the pharmacies that one can obtain these hormones from do not require prescriptions. There is no guarantee that the drug you have purchased was manufactured with adequate standards to insure that the two milligram estradiol tablet actually contains 2 mg of estrogen. It may contain 2.5 mg or it might not even contain 1 full mg if estradiol. You just don't know what you are really getting. When you get a perscription filled, you are buying hormones that have been manufactured under rigorous standards and can feel safe that you are actually getting what you expect to be getting.

Many people who do it themselves ignore the need for regular blood testing every 6 months. This is important for many reasons. One reason is this is how physicians determine that your organs are not being negatively impacted by what you are taking. It confirms that you are getting proper amounts of hormones so that you can get the most benefit from taking them. You just might not be getting the serum levels of hormones up to where they should be in order to be most effective! It allows you to be aware of your cholesterol levels which can affect your heart and arteries and your liver. Adjustments can be made with other drugs, you don't necessarily have to cut back or eliminate HRT with this information if things aren't in balance.

One of the many reasons people don't go to their personal physician is because they continue to experience guilt and shame over experiencing gender dysphoria. That is something that occurs frequently and needs to be addressed, I've been there. I had literally had an old country doctor who was getting near retirement. My own guilt and shame at the time prevented me from going to him and telling him about myself. My solution was to ask my gynecologist to refer me to a female doctor as I'm not keen on having men seeing my body. So now I have a female primary care doctor who I can go to and talk to without feeling ashamed of myself. Whatever you have to do to get rid of the guilt and shame to have a health care provider you trust, please do it. You deserve nothing less than quality health care!

Another thing to consider is that you may be paying way over what you should for those black market hormones. Did you know that a prescription for 90 days of the maximum therapeutic dose of estradiol is $36.00 (U.S.) at Walmart, Kmart, Kroger or Martins for example of stores in my area? That's $12 dollars a month! That's dirt cheap. Most insurance companies' co pays would be higher than that. So isn't it worth dealing with your fears to find a competent practitioner you can trust? Then you know you are getting what you are supposed to be getting. How much is Spironolactone? $18.00 for 90 days at the recommended highest dose. Some of us take progesterone and there is some debate whether it is at all helpful or not in breast development. Generic progesterone is also inexpensive. My gynecologist prefers Prometrium because it is bioidentical to women's natural progesterone. It is expensive though. The maximum dose runs me a bit over $100.00 a month. In 6 more months I'll make a decision whether this is benefitting me or not in terms of breast development. If after 18 months on it and the results aren't that much, I'll likely discontinue it.

"Sherri, you don't get it, do you? I live in BFE (that is a remote place in Egypt). There is no doctor where I live who I can trust to go to or is willing  to prescribe HRT. I know this for a fact because I have called around."

Ok fair enough, not all health care professionals are as enlightened as I am or as enlightened as the ones who take care of me. I'll grant you that.

At least, go get your blood work done every six months, Please, please, PLEASE! get your liver and kidney functions tested and cholesterol too, even if you choose not to tell the doctor you are doing it on your own. We have a term for that. It's called HARM REDUCTION.

Speaking of harm reduction, being a member of WPATH, we strongly advocate harm reduction. What does that mean? It means that anyone who comes to see me on DIY hormones goes to the head of the class. I issue a letter of referral and give my patient the names of two, soon to be three doctors in my area who are willing to prescribe HRT for trans people. I give this letter on the second visit.  Harm reduction is the overriding principle and it is a principle supported by the WPATH standards of care. I want my patients to be safe!

Please consider these thoughts when you decide whether you decide to go see a doctor or do it yourself. You only get one shot at HRT and it has to be done right so that all we have to endure pays off on our journey to be who we truly are! What good is it, if one ruins her health on the journey?

I'm Back From Southern Comfort Conference: Reflections and Observations

I'm home again from the Southern Comfort Conference. Well, actually I came home a week ago last week on Sunday. I was quite tired, had to work the next day and I've gone to bed fairly early each night until last night night when the Gods of Football television decreed that the University of Alabama begin their game at 9:15 P.M. local time, so I find myself tired again this morning and did not participate in my intentional community's service. Perhaps I will get back on track with that next week. I hope so, as I always feel better for having attended.

As always, I truly enjoyed my time at the conference. The Crowne Plaza Ravinia in the Perimeter area of Atlanta is simply a gorgeous venue and conveniently located across from a very nice mall and several very fine restaurants. Other shopping is convenient as well in the area and you won't get lost.

My workshop was well received and I'm always both flattered and humbled that people enjoy my presentation and I always give an historical context for the present state of the WPATH standards of care, as well as what the standards actually do state. There is a lot of myth about the standards of care that continues to abound. It confuses both people who are wanting to approach a transition and be healthy, and puts so many people off who resort to illegal sources to obtain hormones for a number of reasons. I'll be writing more on this topic next time.

Chloe Prince had a reception for Pink Essence members which was well attended and very lovely. She announced that she is launching a new web enterprise called TrueEssence.org. It's purpose is to be a one stop website to help people find the various resources we all need on our gender journey. This is a much needed service to our community and I wish her all the success in the world with this venture!

I didn't attend many workshops myself this time. Many of the topics I've heard on a number of occasions. This is not to say I am above it all or that there isn't more to learn, because there is always more to learn and I need to stay current so that I can help others better and for my own needs at this late time in my transition. I attended a workshop on transitioning in the workplace that was excellent and got a few ideas about better ways to go about taking this up with the workplace administration. The other workshops I attended were on sexuality for the male to female transsexual taking hormones and one on coping with and resolving internalized transphobia. That is a very important topic as even those of us have dealt mostly with coming to terms about who we are and coming to terms with the people in our lives, can sometimes feel a degree of doubt or guilt and shame creep into the back of our minds. Resolving internalized transphobia isn't like completing a contest, or arriving at a destination, just like the process of transitioning, it is a journey.

My purpose this time, besides the main purpose of presenting my workshop, was to get some time to destress from my practice of psychotherapy which has been very busy and undergoing a lot of changes with the changes coming with the new health care systems. I wanted to get a massage for a back problem and for the holistic health benefits from a therapeutic massage. So the good news is that I got my back straightened out after almost a month and I was able to return to playing golf this week. I played twice in fact! On Thursday I played 9 holes with a friend after work and then yesterday I played 18 holes by myself. I played well for my level of skill on both occasions. I'm playing on a course I've never played before this Wednesday afternoon that is rated #36  in difficulty in the United States. I'm pretty sure I will stink it up, but I never take the game seriously, don't get angry when I don't play well and generally have a fun time and get rid of my stress.

Another purpose was to network with other psychotherapists, gender surgeons, and other allied health care professionals who I know. I took the opportunity to meet some other professionals I hadn't met before.

Then of course one of the biggest reasons is to see old friends I don't to see more than a few times a year and some I only see once a year. Wonderful people and I wish I could see them more often. I have friends like them all over now because of the opportunity to give the workshops in various places.

One of the things I enjoy a great deal is the opportunity to make new friends and each time I go to give a workshop, I meet new friends and look forward to seeing them the next time I'm in their city. That's always a lot of fun for me!

One of the things I reflected on is the debate on gender identities and I recently wrote on that topic here. The article is called The Dialectic of the Gender Continuum. One of the things I wrote mentioned that various gender identities are all valid, though not necessarily having anything in common with each other. Before I went to the conference, I wrote another article about the important role conventions such as Southern Comfort play for our communities. Some people I know expressed that they no longer go to these conferences because they feel they have nothing in common with others who have different gender identities. They feel clearly different from people with other gender identities and don't wish to socialize with them. I find that attitude disappointing. While I personally don't feel as if my identity has common elements as a woman of transsexual experience, I don't like the idea that I shouldn't socialize with others because they are different. I think if those who segregate themselves from others with different gender identities were to reflect on this attitude, they might be shocked to realize that that notion is no different from segregation due to racism and that they would not find those attitudes to be attractive within themselves. I'm not going to like every person who identifies as a cross dresser, fetishistic transvestite, transgender, or whichever identity someone may claim, but I am going to like some of them and I would not wish to not have the opportunity to make a new friendship. I've found that I never have enough friends and that all my friends, close or not, have something to offer me or teach me. I'm pretty shy, people wouldn't guess that, but I do like people.

Along this same theme, I heard the attitude shared that many younger people at the conference philosophically don't like the idea of having a gender identity at all. They identify as gender queer or other similar labels and they would deny everyone their own right to a gender identity as male or female in a society of their own design. I find it interesting that they would segregate themselves and impose a societal code that denies others of their own gender identity. You see this theme in much of feminist academic writing and in the presentations these individuals give at workshops. They want to impose the use of new language in the use of pronouns that deny the existence of gender identity. Ironically, these folks seem to be a small proportion of those in the gender community. I can never see myself identifying as anything than "female" or "woman" and would feel oppressed by a society that denies me my own identity, much as these individuals feel oppressed by a society that expects them to have a gender identity of either male or female. I find that rather ironic that they would choose to subject others to the same oppression they seek to be freed from.

I hope that the gender communities will come to accept others with different identities than their own and not feel threatened by those identities that are different than their own, just as we expect the dominant culture to accept us and respect our place in an open and free society. Sometimes I think the dominant culture is way beyond us in acceptance of us when we can't be tolerant of others with different identities in our own community. What do you think?

Do the Gender Police Confront You?

Sheri Berenbaum led a thought-provoking discussion about the often-debated topic of gender differences. An inquisitive crowd kept Berenbaum on her toes as she answered questions concerning whether gender differences are innate or learned. Drawing on over 15 years of research on congenital gender disorders—and using props such as Legos and make-up kits to illustrate her points—Berenbaum challenged the audience to "think outside the box" about the mix of social and biological factors that make us male or female. Sheri can be found on the web and also at her University, Penn State.

The Gender Police have drawn hard lines on people of my experience. We have the extreme Right who would say our very existence is an abomination and we have the extreme left who insist that we must identify as some blend of gender that is neither wholly male or wholly female. I find one as constraining as the other.

I wonder where it came from that if we were free and perfectly healthy individuals that if we identify as women, we are not respected as women or if we identify as men, we are not respected as men. This is the problem of the extreme Right. We simply want to live our lives and be left alone to the right of privacy as any other American Citizen.

The other side of the equation exists from the extreme fringes of Feminism and is solely an extension of Womens' Studies professor Janice Raymond's ideology. Even today as she rewrote a foreward to her book The Transsexual Empire: The Making of the SheMale.  Even with her new forward, which is a rather shallow apology to transsexual women, she still sees us as victims of a patriarchy. She was unable to and continues to fail to recognize that we are woman who for many different reasons ended up at odds with our assigned gender. The majority of these do not involve obvious anatomical variations. For this reason being politically coerced into a continuum known as "Gender Spectrum" includes vastly different presentations because of vastly different etiologies, makes us pawns in a political struggle between Left and Right.

Interestingly, the most negative people about the realities of our lives both as individuals and in varying collectives include the extreme Right and the Extreme Left.

For one group, our very existence on the earth is anathamema. For the other group, our very right to a unified gender identity is sacriledge. I find both extremes both nullifying simultaneously.

At this time in our culture, very few who wish to fall under the umbrella  of transgender identify as gender queer. They have every right to that identity. It's not my identity. I do not consider them to have the same orientation of gender or have much in common with me other than a political desire to be left alone and become the best me I can be.

Similiarly people who feel a mix of their genders but have no burning urge to match their physical being to their identity, may be known as transgenders, crossdressers or by other labels that they define themselves by, have every right to be left alone and become the best people they can be.

Simply put, I am a woman. This is not a sociological statement, nor is it a political statement. It is who I am. There are more women who were correctly assigned at birth and individuals such as myself who were not, but sought to correct that error. I do not identify as a third gender or a fourth or a fifth. I'm just a woman.

This is a dual journey that I travel. I am the gender therapist and the gender patient, I bring my experience, professional and personal to the therapeutic alliance. All therapists do that. It is somewhat more unique for my patients as I am also someone who has been going through a legitimate process per the standards of care established by the World Professional Association of Transgender Health, a body of which I am proud to me a member.

As many of you know, I have been developing a comprehensive health care system for transgender people in the Shenandoah Valley of Virginia. I have been instrumental in initiating the Speech and Language Department of my health care system to offer voice and communication therapy for transsexuals in order to be able to communicate in a gendered manner that is congruent with our identity.

In announcement to a health care online network, this program was rebuked with a harsh and in my opinion, unwarrented attack. The author of this attack who is a faculty member of a large institution of higher learning, stated that she found it highly offensive that such a program would state that the therapy offered would improve the ability to communicate in a more masculine or feminine style, depending on the preference of the patient. She stated that because of this, she would not wish to refer anyone there for voice therapy.

Personal disclaimer: I was involved in the initiative to develop these services, provided a number of training resources and linked them with other Speech and Language therapy professionals who are members of the World Professional Association of Transgender Health in their field who could be of further help in developing the program that we offer. In my opinion, they have developed a quality program that I myself have participated in and am so more than just comfortable in referring my patients who are interested in these types of services.

What I find to be most outrageous of this experience is the lack of forethought in the reckless condemnation of a service that person has no personal knowlege of, just a blind conviction of an ideology leading to  the same type of rigid results that the extreme right can be accused of (and rightfully so at times).

This is why I always say that I have found as much as bigotry, prejudice and hatred on the far right and the far left.

The issue at hand that I object to is that this person made a judgement that this person knows better for you than you do, therefore would not even grant you the opportunity to decide if this service would be helpful to you or not. Considering the philosophical orientation of this person, I find as much patriarchy in the Third Wave Feminist theory as they railed against in the Second Wave of Feminism. Each wants to control you, just to a different end, but neither will be the one of your own determination.

A pity, isn't it? I've seen absolutely no growth since Janice Raymond. 

Choosing the Right Therapist For You (It's Not As Hard As You Might Think)

Finding the right therapist for someone who is transgendered is not an easy task, as most of you know already. Many trans people would prefer that their therapist not only be well versed in providing transgender care, but also be transgender themselves. As difficult as it is to find a therapist who is well experienced in this area to begin with, the therapist who is transsexual, such as myself, is an even more rare thing to find. As many of you know, my practice is in a rural health care system in the heart of the Shenandoah Valley. I am the only therapist for over a three hour's drive radius who practices transgender care and there are no other therapists who do practice in this area who are transgendered themselves to the best of my knowledge. I do know most of the therapists in Virginia who provide this type of therapy. So when I went searching for my own therapist, I had to find someone who although had no experience specifically in transgender care and wasn't transgendered, yet would be able to provide me with competent care to the best of her abilities.

I did a quick survey of the top 40 graduate programs in my own discipline of Social Work. Of the handful I surveyed, only two had practice course work that had the keyword transgender in the course title. The program I attended at the School of Social Work at the University of Alabama had no courses in this area when I attended (NO! I will NOT tell you the year I graduated!! A lady NEVER reveals her age!!!!).

A therapist who has herself as a patient is a fool. Someone asked me me why I don't do my own therapy in all seriousness and it was a fair question to ask. It's because I lack the objectivity that one would get from a therapist when it comes to myself. The decision to transition is one of the most important ones of my life and I have only one chance to do it right). This might seem like it would be impossible to find someone who could get the job done, but that isn't true. My own therapist has never worked with a transgendered person before me and she has done an excellent job. At this point I would recommend her to anyone seeking transgender care. She has some characteristics that ensured that she would be competent to do the job, and I knew this when I selected her to be my therapist at the beginning of my own care. I want to share with you how I was able to find someone to help me. It isn't that hard when you know how to go about it.

The secret in finding the right therapist for you is really simple: You are hiring someone to do a job for you and you need to do your homework up front, just as you would if you were hiring an electrician or a plumber. There are things you can do to make sure the person you hire is competent to do the job, just as hiring anyone else. Remember, the therapist works for you and you are interviewing candidates to fill the position, just like any other job. This can be an intimidating prospect for most people because they don't have the same knowlege base as the therapist and they don't feel like they can pick someone who will be competent, so they make appointments with someone and see if it works. That can get expensive, especially if you see two or three before finding THE ONE. Plan on interviewing three or four, if at all possible. It's nice to have a number of options.
If a therapist isn't willing to spend 15 to 30 minutes speaking with you on the phone about what your needs are, then he or she will not be a good candidate for you to contract with. When you are interviewing, it isn't so important that you completely understand the answers to some of the questions you ask, just write them down. You can look up some things afterward on the internet which will help you make an informed decision on who to pick for your therapist.

The first thing you will want to do is look in the yellow pages and see if anyone uses the term "gender and sexuality" in their advertisement. That one key phrase brought me tremendous numbers of trans patients when I had my private practice. The other resource was people who found information about me on the internet. A number of websites provide lists of therapists who are competent in gender therapy.

More and more insurance companies are paying for transgender therapy. The easiest way to find out if you will be covered is to call your insurance company or the mental health managed care entity who handles this for your insurance and ask them if the the  DSM IV- TR diagnostic code 302.85 is covered under you insurance policy. Almost every insurance company I am a provider for, with the notable exception of Coventry administered by Southern Health and their mental health managed care company MhNet cover this therapy and that includes Virginia Medicaid and Medicare.

When you are speaking on the phone interview you will want to ask the following questions:

1. Do you accept my insurance plan and what are your rates? If my plan doesn't cover this service, what is your fee for service? (If there are valid reasons that you can't pay the full rate) Do you have a sliding scale?

2. What is your theoretical orientation? There are many theoretical schools of psychotherapy. Some of the major ones are:  Behaviorism and it's derivitives, Cognitive Behavioral Therapy and Rational Emotive Therapy; Humanism; Gestalt; Transactional Analysis; Psychoanalysis and it's derivitive, Object Relations and Feminist Therapy.

My undergraduate education was strongly rooted in Behaviorism and I practice mostly Cognitive Behavioral therapy and Rational Emotive Therapy. I am well versed Humanistic therapy, Gestalt and Transactional Analysis and have a working knowlege of Psychoanalysis and Object Relations, though I only use them to conceptualize therapeutic issues when I find it useful and do not practice their techniques as I have not been supervised to practice in that area.

Over the years I have been concerned when I hear that a therapist describes their therapy as "eclectic". Too often that means that a therapist has not mastered any particular school of psychotherapy and just draws techniques to use in their practice because they feel right to them for the situation. They often can't articulate why the selected a particular intervention and the theory base behind it. Not all therapists who say they are "eclectic" though don't operate without a philosophical underpinning it is just important to know they understand why they select their interventions.

After you have interviewed the therapists you have selected, it's time to hit the internet and look up the information they provided you. You can then decide which therapists' theoretical orientation seem to be in tune with your own belief system and make a wiser choice in your decision.

3. If they have no transgender treatment experience, then enquire if they have worked to any extent with gay and lesbian individuals. If they have experience with them, they are more likely able to be helpful to you. While our issues are not identical to their's, they do overlap to some degree. This was the deciding factor in my choice for my own therapist.

If they do have transgender experience, ask them if they are a member of the World Professional Association of Transgender Health. If they are a member of WPATH, that is the gold standard for transgender care. If they are not, ask them if they are familiar with the new seventh version of the WPATH standards of care. If they are knowlegable of them or the prior version, then you know they are at least well enough acquainted with transgender care that they are likely to be able to provide you with quality treatment.

If they don't, but have other experiences that place them into serious consideration to become your therapist, then ask them to what degree they are willing to educate themselves to be able to help you. Are they willing to dig up resources and learn on their own? If so, you will most likely find a good therapist to help you, though they might be inclined to follow the standards of care more to the letter of the law. That can be frustrating. We all want what we want when we want it in terms of our gender issues and transition and I am no different in that respect, but someone who is going to be careful before signing off on your hormones and surgery rather than just going along with what you want may just be what is best. At least you will be sure they erred on the side of caution, if they erred at all.

Too many of us have rushed into decisions they knew were right for them without consideration how they will support themselves, who will be supportive of them and who will abandon them merely because they are differently gendered. Too many times thre have been disasterous outcomes. Our community has about an 800% higher rate of attempted suicide than the general population and an astronomically higher rate of substance abuse and addiction as well.

I hope that these thoughts and strategies will help those of you who are looking for a therapist. If anyone has any other ideas that will help my viewers, please do contribute your thoughts to the discussion.

She Gave Me Hope a Long Time Ago

As I had mentioned previously, When I was 12, I went to the library and started reading about people like me. That started a life long search in the literature to learn more about myself. I'd go to the library quite often and read the books about Transsexualism. I'd re-read the books that I had read before and read the new ones when they came in. I was too afraid to check them out so I could only read them for an hour or so at a time. This went on all through junior high and then high school. I was very fortunate that the Charlottesville Public Library had these books. In high school, I worked at U.Va. Hospital and then had access to the medical school library. Jackpot!! That gave me access to medical and other allied health care journals as well. The thing that struck me most (aside from THIS IS WHO I AM!!) was that there were so few of us that I felt so alone and so different in the world. I also thought that this is such a shameful thing that no matter what, I must let NO ONE know the truth about who I was. It continued into college, after college and then through grad school at the University of Alabama. Every time I went to the library, I'd almost inevitably get side tracked and go read the books about people like me. Even today, if I go to Barnes & Noble or online to look at books I still get sidetracked by looking for books on transgender themes and I have quite an extensive library that even includes all those old books long out of print that I read at the beginning when I was 12 and up.

A year after I graduated from the School of Social Work, I got married for the first time. The only thing I will always hold myself accountable for in the failure of my marriage was I didn't tell her the truth about myself before we married. No matter what her transgressions were, that is something that I was totally responsible for. She didn't deserve that. In my defense, I, like many of us who marry, thought it would go away. It didn't take long, maybe 6 months or so, to figure out that being transsexual wasn't nor will it ever go away. It wasn't until after my ex left that I came to the conclusion that I better make friends with this or it was going to kill me. Literally.

About a year after I was married, I made a decision that seemed inconsequential, but really gave me that first hope, just a glimmer of hope, that maybe there was a way for me to become the person I truly as I continue in the process of self-actualization today.

I had been working at the state hospital as director of the forensic unit, a unit whose mission is to care for those who were adjudicated Not Guilty By Reason of Insanity, or had not been able to be restored to competency to stand trial. This is a particularly political position for a mental health professional, and my assessments potentially had a controversial impact on communities and courts across the state of Alabama, as well as United States Federal Court in some instances as Bryce Hospital was still under Federal receivership due to the Wyatt vs Stickney landmark legal decision. That case resulted in nationally set standards for the care of institutionalized mentally ill people and is considered the "Bill of Rights" for institutionalized mentally ill people. While it was a very good job with the potential for rapid professional growth, it was also very stressful, and here is where I made a decision that changed the course of my life a bit. I decided that I needed to have a mental health day ( I called in sick). I really didn't do much of anything, I just really wanted to have a day to myself alone.

Early in the afternoon, after playing Ms Pacman for the 100th time or some of the other computer game I had (we're talking 1989 and the IBM XT. I was 32 years old), and talking to people on Compuserve, I decided to watch some TV. During those years, Geraldo Rivera had a day time talk show. That particular day, Geraldo has a guest whose name was Marsha Botzer. I didn't know who she was, but it turned out that she was a transsexual woman who had founded the Ingersoll Center in Seattle, Washington in 1977 (To put it into historical perspective, in 1977 I was finishing up my Freshman year at Bridgewater College).

I was rivited; never before had I ever seen or heard another person who was like me. I remember how nice and respectful he was in that interview towards her. I wanted to talk to her badly, but I knew I couldn't call her from home because my wife would question the phone call. I had no idea how to tell her about my most carefully guarded secret. Until this television show, I never talked to or heard another person like myself. I had thought that people like me were so rare that it would be nearly impossible to find or even to talk to someone like myself who could understand the depth of the emotional pain with that I lived.

The next day, back at work, I knew I had to take a risk. I used the work phone to call directory assistance in Seattle, got the number for the Ingersoll Center and after a few minutes of anxiety, called the Ingersoll Center and asked to speak to Marsha. I remember being really shy and telling her how I had seen her on TV the day before the day before. I told her about myself and that I had never known anyone else like me and it meant a lot to me that she would take a few minutes to spend on the phone talking with me. I told her that I was a clinical social worker and about my life growing up. She asked me if I would like some information about the Ingersoll Center and sent me a couple of brochures that I still have to this day. I've always remembered this experience and from time to time have shared that story with others.

As some of you know, this past September, I attended the Southern Comfort Conference where for the past three years I have presented my workshop and The World Professional Association of Transgender Health International Symposium. What a once in a lifetime experience that was for me! I met so many wonderful people, many I have only read about and never dreamed I would have the opportunity to meet.

After the morning workshop on Saturday, I was walking around feeling a bit alone and shy as I often do in new situations and found myself within speaking distance with Marsha. She now sits on the WPATH Board of Directors. Now, this was one of this OMG!! experiences for me! I just had to meet her and tell her what that experience so many years ago meant to me and thank her for that!

In talking to her, I became emotional and I could see that what I had said had touched her as well, just as I had been touched by her generosity with a few minutes of her time so long time ago. Then, the highlight of the conference for me and one of the highlights of my life was that she invited me to have lunch with her! WOW! That was such a wonderful experience. I'll never forget that.

You know, life is pretty short. We never know what little act of kindness, something we wouldn't think twice about doing, will have a profound impact on someone else's life. I think it's really important to let those people who touched your life in a meaningful way know what they have meant to you when that opportunity comes. You never know if you might ever have that opportunity again. It's always gratifying to be able to make someone else aware that they are appreciated for the things they do that makes things just a little bit better for others when the opportunity presents itself.

Hello, I'm Sherri Lynne

Hi! I'm Sherri Lynne. I'm a psychotherapist and I am a transsexual. I am a Clinical Social Worker and hold the Diplomate, the highest credential in my field. Although I do many other kinds of therapy, I am a gender specialist, scholar and educator. I am engaged in one of the largest gender programs in Virginia which I created. I've developed a comprehensive program that includes my services as a psychotherapist, a psychiatrist who writes my second opinion letters, aesthetic dermatology, primary care, hormonal reassignment specialists and in January we will be offering voice therapy. All but the services I have offered and HRT (Hormonal Reassignment Therapy) have been initiated in the last two years, so my program is extremely dynamic and represents the state of the art of transgender care. I maintain relationships with a number of surgeons who perform surgical gender reassignment around the country and in Canada.

Over the past three years I have been giving workshops all over the eastern U.S. at transgender conferences and at Universities, some for continuing education credits for mental health professionals. Recently I founded a consulting business, E.I.T.C. (Excellence in Transgender Care), whose mission is to help build comprehensive health care systems that will provide competent and compassionate care. E.I.T.C. also is involved in providing professional education opportunities. I am a member of the World Professional Association of Transgender Health.

I do stay busy! I am also writing a professional text from the perspective of a transgender person who is also a psychotherapist. My goal is to write a book that is accessible to the general public but is informative for mental health professionals as well as practical. I hope it will also lend insights to professionals on what it is like to live at odds in the mind-body continuum and how to apply the WPATH standards of care in the spirit to which they are intended, not as a rigid set of rules that must be followed by rote, as explicitly stated in the SOC.

So, I hope that you will find my blog interesting, informative and thought provoking. I look forward to getting to know my readers and learn from you all as well!

Sherri Lynne