Transgender & Gender-Diverse Care
I provide affirming, individualized psychotherapy and sexual-health care for transgender and gender-diverse adults.
Transgender & Gender-Diverse Care
My approach recognizes that gender diversity is part of the range of human experience and that seeking therapy does not mean there is something inherently pathological about a person’s gender identity or expression. People may come to therapy for many different reasons—exploring gender or sexuality, navigating relationships and intimacy, addressing sexual concerns, working through trauma or other mental health concerns, considering or navigating aspects of gender transition, or simply wanting a knowledgeable therapist with whom gender does not need to be explained or defended.
My work is informed by current professional standards, including the World Professional Association for Transgender Health (WPATH) Standards of Care Version 8, while remaining centered on each person’s individual needs, goals, autonomy, relationships, sexuality, and lived experience. The information below is intended as a resource for transgender and gender-diverse people, partners, families, healthcare professionals, and the broader community. If you are considering therapy or would like to learn more about working with me, please contact me directly.
2101 W 69th St, Suite 103
Sioux Falls, SD 57108
(605) 740-6557
Understanding Gender, Sexuality & Gender Dysphoria
Language around gender and sexuality continues to evolve, and different people may use the same words somewhat differently. The most important starting point is to respect the language people use to describe themselves. The following terms provide a useful framework for understanding gender identity, gender expression, sexual orientation, and gender-diverse experiences.
Gender, Sex & Identity
Gender identity refers to a person's internal sense and experience of gender. Someone may identify as a woman, man, nonbinary person, another gender, more than one gender, or may experience gender in ways that do not fit neatly within these categories.
Sex assigned at birth refers to the designation typically made at birth—such as female or male—based primarily on observable physical sex characteristics. This is more precise than terms such as biological male or biological female, because biological sex involves multiple characteristics, including anatomy, hormones, chromosomes, and reproductive development.
Gender expression refers to the ways a person may communicate or express gender through appearance, clothing, behavior, voice, mannerisms, or other forms of presentation. Gender expression does not necessarily tell us someone's gender identity or sexual orientation.
Cisgender generally describes a person whose gender identity corresponds with the sex they were assigned at birth.
Transgender is an umbrella term commonly used by people whose gender identity differs from the gender associated with their sex assigned at birth. Not every gender-diverse person identifies as transgender, however, and individual language should be respected.
Nonbinary describes gender identities that are not exclusively woman or man. Some people may use terms such as genderqueer, gender-fluid, agender, bigender, or other language to describe their experience. These terms are not interchangeable, and not every nonbinary person uses the same language or identifies as transgender.
Two-Spirit is a culturally specific term used by some Indigenous people and communities. It should not be treated simply as another synonym for nonbinary or transgender identity, and its meaning is grounded in particular Indigenous cultural and community contexts.
Gender Identity and Sexual Orientation Are Different
Gender identity describes who you are in relation to gender. Sexual orientation describes patterns of sexual and/or romantic attraction. One does not determine the other. Transgender and gender-diverse people, like cisgender people, may describe their sexual orientation in many different ways.
Lesbian generally refers to a woman or woman-aligned person who experiences attraction to women.
Gay commonly describes attraction to people of the same gender and is also frequently used specifically by men attracted to men.
Straight or heterosexual generally refers to attraction to people of another gender.
Bisexual generally describes attraction to more than one gender. It does not require attraction to only men and women or equal attraction to different genders.
Pansexual generally describes attraction that is not limited by gender or in which gender is not a determining factor in attraction.
Asexual describes people who experience little or no sexual attraction. Asexuality exists on a spectrum, and being asexual does not necessarily mean someone has no romantic relationships, intimacy, sexual behavior, or capacity for sexual pleasure.
Queer is an umbrella term some people use to describe a sexual orientation, gender identity, or broader experience outside heterosexual and/or cisgender norms. Because the word also has a history of being used as a slur, it is best used for people who choose it for themselves.
The acronym LGBTQIA+ generally refers to lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or aromantic identities, with the + recognizing the many identities and experiences not represented by a single letter.
Names and Pronouns
Names and pronouns are part of how people communicate who they are. Rather than referring to someone's “preferred pronouns,” I use the person's pronouns—the same way I would use the name a person tells me is theirs. People may use she/her, he/him, they/them, combinations of pronouns, neopronouns, or no pronouns. Pronouns cannot reliably be determined from someone's appearance, gender expression, anatomy, or identity label. When I do not know, I ask. Respecting a person's name and pronouns is a basic part of respectful clinical care.
Gender Dysphoria
Being transgender, nonbinary, or otherwise gender diverse is not in itself a mental disorder. Gender dysphoria refers instead to clinically significant distress or impairment that can occur when there is incongruence between a person's experienced or expressed gender and their assigned gender and/or sex characteristics.
The DSM-5-TR retains Gender Dysphoria as a diagnosis, with separate diagnostic criteria for children and for adolescents and adults. For adolescents and adults, the diagnosis involves a marked incongruence between experienced or expressed gender and assigned gender that persists for at least six months, together with clinically significant distress or impairment in social, occupational, or other important areas of functioning. Importantly, a transgender or gender-diverse person does not need to experience gender dysphoria simply because their gender differs from their sex assigned at birth. Experiences vary considerably. Some people experience substantial dysphoria; others experience little or none.
Current language also recognizes gender incongruence and gender diversity without automatically equating either with psychological distress. The World Professional Association for Transgender Health (WPATH) Standards of Care Version 8 similarly emphasizes individualized care for transgender and gender-diverse people. The goal of care is not to establish whether someone's gender identity is valid, but to understand the person's individual experience, health needs, goals, relationships, sexuality, and—when relevant—the forms of gender affirmation they may wish to pursue. Mental health care can address gender dysphoria when it is present, but it may also address concerns that have little or nothing to do with gender: relationships, sexuality, trauma, anxiety, depression, family experiences, intimacy, or the ordinary complexities of being a person.
Gender Affirmation & Transition
There is no single way to be transgender or gender diverse, and there is no single transition process. Some people make social, medical, legal, or physical changes to bring different parts of their lives into greater alignment with their gender. Others pursue only some of these changes, pursue them at different times, or do not experience a need to transition at all. Gender affirmation is highly individual, and what feels important or affirming to one person may not be important to another. Current standards of care emphasize an individualized approach that respects each person's identity, autonomy, health, relationships, circumstances, and goals. Gender-affirming care may include psychotherapy or other mental health services, social changes, hormone therapy, voice and communication services, reproductive counseling and fertility preservation, primary care, hair removal, or gender-affirming surgery. Not every transgender or gender-diverse person experiences gender dysphoria, and medical transition is not required for a person's gender to be valid.
Social Affirmation
For some people, gender affirmation begins with changes in how they express themselves or how they are known by other people. This may include:
using a different name or pronouns
changing clothing, hairstyle, grooming, or other aspects of gender expression
changing how one presents in different social settings
using facilities or spaces that correspond with one's gender
sharing one's gender with partners, family members, friends, coworkers, or others
changing identity documents or other records when desired and legally available
These changes are sometimes described as social transition, although not everyone uses that term. Coming out is also not a required stage of transition. Some people share their gender identity widely; others are selective about whom they tell; and some choose not to disclose it in particular relationships or settings. Decisions about disclosure may be influenced by privacy, safety, relationships, employment, culture, finances, housing, community, or simply personal preference.
Coming Out—or Choosing Whether to Disclose
Coming to understand your own gender can be an important process in itself. For some people that understanding develops gradually; for others it feels immediate and clear. Gender identity and the language used to describe it may also evolve over time. If you are considering sharing your gender identity with other people, therapy can provide a place to think through what you want, what you need from others, and what circumstances may affect your decision. A thoughtful disclosure or coming-out plan might consider whom you want to tell, what you want to share, how you would like your name and pronouns to be used, what questions you are willing—or unwilling—to answer, what support is available to you, and whether there are practical or safety concerns to consider first. There is no obligation to disclose your transgender or gender-diverse identity simply to demonstrate that you are certain about who you are.
Gender Expression & Nonmedical Forms of Affirmation
Gender affirmation can also involve changing aspects of appearance or the body without medical treatment. Clothing, hair, cosmetics, facial or body hair, voice, movement, and other forms of gender expression can all be meaningful. Some people also use garments, prostheses, or other strategies to change body contour or reduce discomfort with particular sex characteristics.
Chest binding uses a garment designed to create a flatter chest contour. Because prolonged or overly restrictive compression can cause pain, skin problems, or difficulty breathing, appropriately designed binders and safer binding practices are preferable to improvised methods that may excessively restrict the chest.
Packing involves wearing a prosthesis or other device to create a genital contour. Some products may also serve additional functions, such as standing to urinate or sexual activity.
Tucking involves positioning the penis and, for some people, the testes to create a flatter genital contour. Because prolonged or restrictive tucking can contribute to skin irritation, pain, urinary problems, or other complications, comfort and physical safety are important considerations.
Breast forms, padding, shapewear, and other prostheses or garments may be used to alter chest or body contour without medical intervention.
Hair removal or hair growth may also be an important part of gender affirmation. Options can include shaving and other temporary methods as well as professional laser hair reduction or electrolysis.
These practices are not trivial or merely cosmetic. For some people, they can meaningfully affect comfort with the body, gender expression, sexual experience, and the experience of moving through the world.
Medical Gender-Affirming Care
Some transgender and gender-diverse people pursue medical care as part of gender affirmation. Depending on the person, this may include gender-affirming hormone therapy, puberty-related care for appropriately assessed adolescents, reproductive and fertility care, voice and communication services, hair removal, or surgical care. The appropriate pathway depends on the individual's goals, health, age, reproductive considerations, informed consent, and the specific treatment being considered. Medical decisions should be made with appropriately qualified healthcare professionals rather than according to a predetermined sequence of steps. Hormone therapy and surgery are not required parts of transition, and one intervention does not necessarily imply that another will follow.
Gender-Affirming Surgery
The broad term gender-affirming surgery encompasses a number of different procedures. Rather than referring to surgery as “sex reassignment surgery,” current language recognizes that surgical care may affirm particular aspects of a person's body without defining or creating the person's gender.
Chest or breast surgery may include chest masculinization surgery, breast augmentation, or other procedures intended to create a chest contour that is more congruent with the person's goals.
Genital and reproductive surgeries may include procedures such as vaginoplasty, vulvoplasty, phalloplasty, metoidioplasty, orchiectomy, hysterectomy, oophorectomy, or other individualized procedures.
Other gender-affirming procedures may involve the face, neck, voice, hairline, or body contour.
People may pursue one procedure, several procedures, or none. Decisions about surgery are individual and should be made through informed discussion with clinicians experienced in the specific care being considered.
Gender Affirmation Is Not About “Passing”
Older discussions of transition often focused heavily on whether someone could “pass” as a cisgender man or woman or live “stealth” without others knowing that they were transgender. Some people still use these terms to describe their own experiences, and being perceived in a particular way can have important implications for safety, privacy, comfort, and dysphoria. But being perceived as cisgender is not the measure of a successful transition, nor is disclosure of transgender identity an obligation. The more useful question is not whether someone successfully conforms to other people's expectations of gender. It is whether the choices they make allow them to live with greater congruence, comfort, authenticity, safety, and well-being.
Therapy During Gender Exploration or Transition
Psychotherapy is not intended to determine whether your gender is valid or to direct you toward a particular outcome. Instead, therapy can provide a place to explore gender, relationships, sexuality, body experience, intimacy, disclosure, family dynamics, trauma, anxiety, depression, sexual functioning, or the psychological and relational dimensions of medical decision-making. For people pursuing medical or surgical gender affirmation, therapy may also provide support before, during, and after changes in the body or social environment. Gender affirmation can affect relationships, sexuality, body image, sexual response, partnership dynamics, and the way a person experiences themselves in intimate relationships—all areas that may deserve thoughtful attention. The goal is not to follow a prescribed transition pathway. It is to help you understand what is meaningful for you and make informed decisions about your body, relationships, sexuality, and life.
Medical Gender Affirmation: Hormone Therapy
Gender-affirming hormone therapy is one option some transgender and gender-diverse people choose to bring aspects of their bodies into greater alignment with their gender. Hormone therapy is highly individualized: not every transgender or gender-diverse person wants hormones, and there is no single hormone regimen or physical outcome that defines a successful transition. Depending on a person's goals and health needs, gender-affirming hormone therapy may include estrogen, testosterone, and medications that modify or suppress the effects of endogenous hormones. Specific medications, doses, routes of administration, and treatment goals should be determined with a qualified medical professional experienced in gender-affirming care.
Hormone therapy can produce changes in secondary sex characteristics over time. Some changes may begin within months, while others develop gradually over several years. The extent and timing of these changes vary considerably from person to person. For some people, hormone therapy can also affect sexual experience—including desire, arousal, genital response, orgasm, body comfort, and the experience of intimacy. Fertility and reproductive capacity may also be affected. These possibilities are important parts of informed decision-making and should be discussed before treatment when they are relevant to the individual. The goal is not to achieve a standardized masculine or feminine body. It is to help each person make informed decisions about which changes, if any, are meaningful to them.
Psychotherapy & Gender-Affirming Care
Psychotherapy is not inherently required simply because someone is transgender or gender diverse, nor is therapy intended to determine whether a person's gender identity is valid. The World Professional Association for Transgender Health's Standards of Care Version 8 (SOC8) describes a broader, individualized approach to gender-affirming healthcare. Mental health professionals may be involved in many different ways depending on what a person wants, what services they are seeking, and what requirements apply to a particular medical intervention or healthcare setting. My role may include helping someone explore gender and identity; addressing gender dysphoria when present; supporting decisions about social, medical, or surgical affirmation; exploring relationships, sexuality, body experience, or reproductive concerns; treating co-occurring mental health concerns; or providing an assessment when clinically or administratively required.
Assessment Without Gatekeeping
When an assessment related to gender-affirming medical care is appropriate, its purpose is not to prove that someone is “trans enough” or to persuade them toward—or away from—a particular treatment. A thoughtful assessment considers the person's experience of gender, treatment goals, capacity to provide informed consent, understanding of the potential benefits and risks of the intervention, relevant physical and mental health considerations, and any psychosocial circumstances that may meaningfully affect care. The presence of anxiety, depression, trauma, neurodivergence, substance use, or another mental health condition does not automatically preclude gender-affirming treatment. When another concern could meaningfully affect decision-making, treatment, recovery, or safety, it should be understood and addressed as part of comprehensive care rather than used reflexively as a barrier to it.
Mental Health Beyond Gender
Transgender and gender-diverse people seek psychotherapy for the same broad range of reasons as anyone else. Sometimes gender is central to the work. Sometimes it is one part of a much larger clinical picture. And sometimes it is barely relevant to the reason someone comes to therapy. My work may include anxiety, depression, trauma and posttraumatic stress, childhood maltreatment, relationships, intimacy, sexual functioning, sexual pain, body image, major life transitions, or other psychological and interpersonal concerns. When distress is related to gender, it is also important to distinguish between distress arising from incongruence or dysphoria and distress arising from the environment in which someone is living. Rejection, discrimination, harassment, violence, social isolation, barriers to healthcare, and other experiences of stigma can contribute significantly to psychological distress. Good clinical care requires understanding that context rather than locating every difficulty within the individual.
Sexuality, Relationships & the Body
Gender-affirming care is also sexual healthcare. Hormonal and surgical interventions can influence body experience, sexual response, desire, arousal, orgasm, genital sensation, fertility, relationships, and how people experience themselves sexually. Changes that are affirming can still require adjustment, exploration, and communication with partners. This is an area where my background as a psychotherapist and AASECT Certified Sex Therapist is particularly relevant. Therapy can provide a place to explore not only gender, but what changes in gender expression or the body mean for sexuality, intimacy, pleasure, relationships, and one's evolving sense of self.
Collaboration with Medical Providers
Gender-affirming healthcare is often interdisciplinary. When appropriate and with your permission, I can collaborate with physicians, prescribing clinicians, surgeons, sexual-health professionals, or other members of your healthcare team. My role as a mental health professional is distinct from the role of the clinician prescribing hormones or performing a medical procedure. I do not prescribe hormone therapy. When I participate in assessment, consultation, or coordination of care, my goal is to contribute psychological, relational, sexual-health, and behavioral-health expertise while respecting the individual's autonomy and the scope of each professional involved.
Support Through Gender Affirmation
There is no required psychological pathway through gender affirmation. You do not need to complete a predetermined number of therapy sessions, follow a particular sequence of social and medical changes, or adopt a particular transgender narrative for therapy to be useful. I approach this work with the same principles that guide the rest of my practice: curiosity, careful assessment, respect for autonomy, attention to the whole person, and an understanding that sexuality, relationships, psychological experience, and the body are deeply interconnected. Whether you are exploring gender, considering gender-affirming medical care, adjusting to physical changes, navigating relationships or sexuality, or seeking therapy for concerns unrelated to gender, the work begins with understanding your experience and what you want for your life.