Our therapists work closely with the LGBTQIA community in the Sioux Falls area. We seek to aid understanding and provide support for those seeking transgender therapy.
The information provided below serves as a resource for you and our community. If you should need further support, please contact our office directly.
Defining Important Terms
Let’s get started by defining some important terms:
Gender identity: The inner sense of being male or female, both or neither
Sex: Physical characteristics of our body at birth (biological)
Gender: Related to our social interactions and roles we take
Cisgender: Sex and gender identity match; preferable to biological or natural male/female
Transgender: Affirmed gender doesn’t match assigned gender
One of the most frequent questions we hear is whether a transgender person is gay or straight. Many people don’t understand that gender and sexuality are not the same things.
Sexual orientation describes the gender or genders we are attracted to:
Gay: Attracted to the same gender
Straight: Attracted to the opposite gender
Bisexual: Attracted to both genders (male and female)
Pansexual: Attracted to all genders
Asexual: Not attracted to anyone
Queer: Umbrella term of anyone who is not cisgender and heterosexual
And just to clear up any confusion around the alphabet soup, here is what LGBTQIA stands for:
LGBT: Lesbian, gay, bisexual, and transgender
LGBTQ: Lesbian, gay, bisexual, transgender, and questioning
LGBTQIA: Lesbian, gay, bisexual, transgender, intersex, and allies
It is important to let each individual define his or her gender identity. Some gender identities are nonbinary, meaning not male or female. This can also be known as: gender variant, gender queer, pangender, gender fluid, androgynous (having both male and female characteristics), non-gendered, gender-neutral, and two-spirit (Native American).
Most transgender or gender variant people find the use of pronouns to be critical to the integration of their gender identity in a social context. It is important to use each person’s preferred gender pronouns: “he,” “she,” “him,” or “her.” For individuals who are gender neutral, they may have a preferred pronoun of “they.”
People who are transgender or gender variant may experience anxiety and/or depression as a result of the disparity between who they are on the inside and who they are on the outside. This is referred to as gender dysphoria.
The Diagnostic and Statistical Manual of Mental Disorders (5th Edition) defines gender dysphoria as “a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months duration.”
The Transgender Transition Process
A transition process, done alone or with the help of medical professionals, can treat gender dysphoria. When someone starts to identify with a particular gender, they come out. Coming out is an important process in a transgender transition.
When someone starts to physically alter their body and behaviors to align with their gender identity, they transition. The transition process can vary depending on the person and what relieves gender dysphoria and creates congruence for them. Many times transition involves hormone therapy and sex reassignment surgery (SRS) or gender-affirming surgery (GAS).
Top surgery is the changing of one’s chest. This can be a mastectomy or removal of the breasts on a female-to-male transgender person or hormone therapy to develop breast tissue or breast implants on a male-to-female transgender person.
Bottom surgery is the changing of one’s genitals. This can be a vaginoplasty in male-to-female transgender people or a phalloplasty in female-to-male transgender people.
After a transgender transition, someone can choose to live as trans, some who pass may live as stealth. In the transgender community, pass is defined as the degree to which a transgender person will be seen as their gender. Stealth is defined as someone passing completely in their preferred gender in the public sphere.
Creating a Coming Out Plan
The first step in the transgender transition process is when someone comes out to themselves. Coming out can be euphoric, or it can cause one to live in denial.
Transgender people decide to come out in different ways. Some make major changes, and some continue to live as their assigned gender due to family or economic barriers.
Coming out to yourself involves a deepening process of self-understanding. Many transgender people change the course of the transition as they develop a better understanding of who they are. It is important to practice a lot of self-care during this time.
Coming out to others is the process by which a transgender person knows who they are and they start to tell others. Everyone who goes through this has different circumstances to consider. Difficulties can range from fear of job loss or family security to shame and guilt. Many people are scared to come out to others, but it is an important step in the transition process.
It is useful to create a coming out plan in which you decide who to tell first and how you will tell them. It is important to share feelings and set expectations about what you need, including what name you’d like to be called and which pronouns to use.
To learn more about creating a safe coming out plan, read our article on gender dysphoria and coming out.
Changing Your Appearance
One of the first things that many transgender people do is start to change their appearance in ways that are more gender congruent with how they identify.
Many people start first with changing the clothing they wear, whether in public or private, wearing clothing that aligns with their gender identity. There are an increasing number of websites and stores that create clothing for the transgender market, e.g. shoes that are sized larger. Transgender people start to change their hair and makeup in ways that lessen gender dysphoria and allow them to feel more like themselves.
Non-medical Body Modifications
There are a number of non-medical body modifications that can be done to relieve gender dysphoria:
Packing: Putting something in your pants for the look of a penis and testicles, e.g. folded-up socks, a condom with hair gel, or specialty products like packers made of silicone. There are both hard and soft packers; hard packers can be used for intercourse. There are also a number of dual-use packers.
Stand-to-pee device: A tube with an upturned curve that can be placed against or underneath the urethra. This allows the wearer to use them while standing to urinate. This is important for some transmen who want to use the male bathroom for passing and to relieve gender dysphoria.
Tucking: Placing the penis between the legs toward the anus and pushing the testicles up. Some transwomen use medical tape to keep their genitals in place; it is useful to shave before doing this. There are special undergarments known as gaffs and dance belts, which can also be used to keep male genitals in place. These can be found in theater or dance shops.
Nonsurgical breast enhancement: Wearing a bra and stuffing the cups.
Binding: A method of compressing the breast tissue to achieve a flatter chest profile for transmen. Sports bras or compression shirts, ACE bandages, and binders can be used. It is important to not bind to the point of cutting off circulation.
Facial and body hair removal: Can be done with shaving, electrolysis, or laser hair reduction. Facial hair growth will slow or increase with hormone use, depending on which hormone being used. Most creams and other methods of hair removal designed for cisgender women will not work for transwomen. Most transwomen seek electrolysis, laser hair removal, or both:
Electrolysis: Involves inserting a needle-shaped probe into the hair follicle and using electricity or heat to permanently kill the hair root. This is slow and painful, but permanent.
Laser reduction: Not permanent; it involves using a focused beam of high energy light whose frequency is tuned to the color of the pigments of the hair. This requires ongoing treatments.
With any procedure, it is important to find a provider who is experienced with transgender patients.
Medical Body Modifications: Hormone Therapy
Hormone therapy, cross-sex hormone therapy, or hormone replacement therapy involves taking medications (hormones) to allow secondary sex characteristics to develop. This will result in a second puberty, which will take several years for the full effects to be achieved.
It is important that transgender people are educated on this process and have realistic expectations for the changes over time.
Hormones that transgender people take are estrogen, testosterone, and progesterone. These are considered sex hormones because they affect our sexual and reproductive capacity and drives.
To learn more about the different types of hormone therapy regimens, including the physical, emotional, sexual, and reproductive changes that occur, read our article on transmasculine and transfeminine hormone therapy.
Psychotherapy and Counseling for Transgender Health
The WPATH standards of care (SOC) outline the protocol and guidelines for working with transgender patients in a mental healthcare setting. They focus on the role of mental health professionals in the care of adults seeking help for gender dysphoria and related concerns. There are several tasks of a mental health professional:
To assess the degree of gender dysphoria via an assessment of gender identity, history, and development of gender dysphoric feelings, impact of stigma attached to gender nonconformity, and availability of support from family and friends. The evaluation may result in no diagnosis or multiple diagnoses.
To provide information regarding options for gender identity and expression, including possible medical interventions. The important task is to educate clients regarding the diversity of gender identities, expression, and the options possible to alleviate gender dysphoria. The professional should make referrals as appropriate and discuss long-term changes and implications for the person’s life.
To diagnose and treat other disorders. Mental health concerns beyond gender dysphoria are common in this population, whether related or related to what is often a long history of gender dysphoria. Concerns include anxiety, depression, history of abuse or neglect, substance abuse, sexual concerns, personality disorder, and psychotic disorder. Disorders should be diagnosed and treated because they can facilitate the resolution of gender dysphoria.
To use the criteria provided by WPATH SOC to guide decisions regarding hormone therapy. Clients should be both psychological and practically prepared and, if of childbearing age, should explore reproductive options.
To educate, advocate, and assist clients with making changes in identity documents. The professional should educate members of the public on behalf of their clients.
At Kimberly Keiser and Associates, we take our roles as mental health professionals very seriously. We encourage you to contact us about our transgender counseling services in Sioux Falls.
Why Do We Treat Gender Dysphoria?
Having an oppressed identity is not healthy for anyone. There are a number of mental health issues known or suspected to affect transgender people more than cisgender people. There is limited research in this area, but in general, people who live in societies that stigmatize them are under more stress.
Many trans people face discrimination. They are at greater risk of experiencing family rejection, peer rejection, bullying, threats of violence, abuse, assault, homelessness, job prejudice, lower socioeconomic status, negative media attention, lack of governmental and legal protections, and religious bigotry.
This causes them to be at higher levels of emotional distress. Trans and gender-nonconforming populations have a self-injury rate twice as high as the general population. Suicidal thoughts for trans people in various studies have ranged from 48% to 79%. Between 21% and 41% of trans people report a history of suicide attempts. Many transgender people are at increased risk of developing a substance use disorder, a body image or eating disorder, or a personality disorder.
Treating gender dysphoria through the coming-out process utilizing non-medical or medical interventions is ethical and effective care.
Our team of Sioux Falls therapists works closely with our LGBTQIA community. We specialize in supporting individuals with a host of specialties including evaluations for hormone therapy and gender confirmation surgeries, transition plans, advocacy, and support.