Gender identity

Learn more about Gender Identity including non-binary identities.

March 2024

Raising the Alarm on Gender Identity Change Efforts Disguised as Talk Therapy

2024-03-12T21:34:50+00:00March 12th, 2024|Advocacy, Gender identity, LGBT, Thoughts From A Psychotherapist|

Below is a petition that some concerned California clinicians wrote to both educate providers and consumers and to use to send to mental health professional organizations to urge them to speak out against these practices.

I want to recognize that the American Psychological Association(APA) issued a very thorough statement February 2024 called APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science. It was a great statement and occurred while this petition was being devleoped. You can find the entire statement here. I will quote below two statements that are especially relevant to the petition ask.

WHEREAS such misinformation is widely disseminated through formal and informal networks, yet credible scientific evidence has not been widely disseminated and is not readily accessible to the public, having the potential to further stigmatize and marginalize all transgender, gender-diverse, and nonbinary individuals, hindering their access to indicated and necessary healthcare, worsening existing geographic disparities in healthcare access, and fostering an environment that may lead to discrimination (DuBois et al., 2023; Goldenberg et al., 2020; Weixel & Wildman, 2022);

THEREFORE, BE IT RESOLVED that the APA supports efforts to address and rectify the dissemination of false information to ensure the well-being and dignity of transgender, gender-diverse, and nonbinary individuals

The below petition can be viewed and signed here. I am encouraging everyone to both sign it and share it. It is important to the well being of the trans community that we get information such as this out there to counter all of the false information that exists. It is also important the reputable organizations like make strong statements like that of the one from the APA to fight the narrative that supporters of gender affirming care are extremists when the reality is that there is wide support of such care.

Thank you to all the therapists that took the time to engage in this work which is critically important right now.



We are a group of concerned therapists, psychologists, and psychiatrists writing to ask your associations to put out a statement regarding the rise in Gender Identity Change Efforts (GICE) disguised as psychoanalytic or talk therapy. The effort to delegitimize and provide an “alternative” to gender-affirming therapy and the World Professional Association for Transgender Health (WPATH) Standards of Care (Coleman et al., 2022) is being led by a small group of clinicians who start many organizations that attempt to wield power through promoting debunked research. The main organizations involved in this effort are Wider Lens Consulting, Therapy First (formally the Gender Exploratory Therapy Association), Thoughtful Therapists, Genspect and SEGM. We are asking your association to put out statements warning against these organizations for their dishonest and fraudulent advertising, as well as naming them as organizations promoting GICE.

1. Dishonesty, Fraud, and Deception:

All of these organizations are careful to sound like they promote reasonable, well-informed, evidence-based treatment for those with gender dysphoria – “a neutral ground between the ‘radical’ gender-affirmative model and ‘unethical’ conversion practices” (Ashley, 2022). The byline for Therapy First reads: “Therapy First exists because we see a great need arising from the current oversimplification and politicization of gender dysphoria in the field of mental health.” Therapy First represents itself as apolitical. However, multiple clinicians on the advisory board and clinical team have participated in political activity aimed at anti-trans legislation and related to many of the trans health bans that we are seeing today. Stephen Levine, one of the clinicians who authored the Therapy First clinical guidelines, was the sole “expert” witness for the state of Arkansas’s ban on gender-affirming care for minors. It was struck down in June of 2023 (Levine, 2020). SEGM has been the central subject of subpoenas by the state of Alabama to the American Academy of Pediatrics, WPATH and the Endocrine Society in the trans youth care ban case Boe v. Marshall (Lannin declaration).

The clinicians involved in founding these organizations are part of a large web of anti-trans organizations aimed at attacking trans rights (Anti-Trans Conversion Therapy Map of Influence), including the American College of Pediatricians, which has been labeled an anti-LGBTQ hate group by the Southern Poverty Law Center (American College of Pediatricians | Southern Poverty Law Center).

Stella O’Malley, who founded SEGM and Wider Lens Consulting, has stated that her mission is to make sure that children are stopped from medical transition (Leveille, 2022). In emails leaked in March of 2023, Lisa Marchiano, LCSW, another board member of Therapy First, SEGM, and Wider Lens Consulting, was caught trying to obtain private information about a transgender journalist with the intent of leaking information to Fox News. When the private information was leaked, it resulted in online harassment of the journalist (Doyle, 2023).

The claim that Therapy First, Thoughtful Therapists, Wider Lens Consulting, SEGM, and all affiliated organizations have no political agenda is completely dishonest and deceptive. We need reputable clinical organizations to make this known to both consumers and therapists.

2. Gender Identity Change Efforts (GICE) by these organizations:

Even though Therapy First claims to not promote so-called “conversion therapy,” further investigation into the organization and client experiences points to GICE. The Therapy First clinical guidelines promote a “psychotherapeutic approach” to gender dysphoria, stating:

“Psychotherapeutic inquiry does not simply accept that a person has the wrong body or gender, it explores why and how a young person came to have negative feelings about their sexed body or that their body or gender is “wrong.” This involves exploring relational and developmental history, the quality of relationships with parents, any traumas or losses that have affected the family, the presence of marital dysfunction, domestic violence, sexual abuse or other detrimental interpersonal dynamics. It also involves exploring social relationships with friends and peers (Ayad et al., 2022, p. 41).”

In practice, what this often looks like is searching for any possible reason for a youth or young adult being transgender, rather than simply being transgender (Santoro, 2023). Marchiano spoke out against the executive order against conversion therapy signed by Joe Biden in June of 2022, telling The Economist that it would have a “chilling effect” on the practices promoted by these organizations. She acknowledges the goal of gender exploratory therapy, which is for trans children and teens to resolve their dysphoria through finding the root psychological cause of their dysphoria (“The Biden administration’s confused embrace of trans rights,” 2022). Furthermore, the Therapy First Clinical Guidelines contain detailed assessment questions including intrusive inquiries about the client’s masturbation habits and sexual fantasies (Ayad et al., 2022, p.26). This type of pathologizing, gaslighting, and delaying any gender-affirming care until a talk therapist rules out every possible cause for the gender dysphoria, besides being transgender, is highly problematic and psychologically damaging (Matouk & Wald, 2022; Boerner, 2022; Bhatt et al., 2022; Tordoff et al., 2022).

Everything put forth by members of these organizations points to their belief that being transgender is undesirable and therapy should seek to explain and resolve the transgender identity so that the patient “accepts themself” as the gender they were assigned at birth. The case studies presented in the Therapy First’s clinical guidelines highlight these beliefs and intentions (see Therapy First clinical guidelines pages 57-102 for case studies) (Ayad et al, 2022).

These organizations have been able to wield extensive power in a short amount of time and are attempting to replace the WPATH Standards of Care. Gender Exploratory Therapy/Therapy First has been recommended as the treatment in many of the trans health care bans gaining traction across the country (Reed, 2023b). It has also gained notoriety in prominent problematic articles in The New York Times (Paul, 2024), which greatly inflate the statistics regarding “detransitioning” and conversion therapy (Reed, 2024; Urquhart, 2024; Urquhart, 2023).

Research continues to confirm that gender-affirming care is not only evidence-based but life-saving (American Psychological Association, 2024). The results from the national trans survey have found that 94% of people who pursued a form of medical transition report greater life satisfaction (U.S. Trans Survey, 2024).

The NASW, AAMFT, and the two APAs are signatory associations of the United States Joint Statement Against Conversion Efforts (United States Joint Statement, 2023), a statement by 28 professional associations clearly asserting that so-called “conversion therapy” is unethical and potentially harmful.

We ask that the NASW, AAMFT, and the two APAs (both psychological and psychiatric) also make a clear statement about Therapy First, Genspect, SEGM, Wider Lens Consulting, and other affiliated organizations, warning potential clients about their false and deceptive advertising.

We also want it made clear that social workers associated with these organizations are violating the NASW code of ethics, and potentially their local state laws, as they pertain to Gender Identity Change Efforts and conversion therapy.


American College of Pediatricians. Southern Poverty Law Center. (n.d.).

American Psychological Association. (2024, February 17). APA policy statement on affirming evidence-based inclusive care for transgender, gender diverse, and nonbinary individuals, addressing misinformation, and the role of psychological practice and science.

Anti-Trans Conversion Therapy Map of Influence.

Ashley, F. (2022, September 6). Interrogating gender-exploratory therapy. Sage Journals.

Ayad, S., D’Angelo, R., Kenney, D., Levine, S., Marchiano, L., & O’Malley, S. (2022). A clinical guide for therapists working with gender-questioning youth, Version 1. Clinical Advisory Network on Sex and Gender.

Bhatt, N., Cannella, J., & Gentile, J. P. (2022, Apr-Jun). Gender-affirming care for transgender patients. Innovations in Clinical Neuroscience.

The Biden administration’s confused embrace of trans rights. The Economist (2022, June 23).

Boerner, H. (2023, March 30). What the science on gender-affirming care for transgender kids really shows. Scientific American.

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., Nieder, T. O., … Arcelus, J. (2022). Standards of care for the health of transgender and gender diverse people, Version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259.

Doyle, J. E. S. (2023, March 23). Inside the Terf Harassment Machine. Medium.

Gender Exploratory Therapy Association.

James, S.E.,Herman, J. L, Durso, L. E. and Heng-Lehtinen, R. (2024, February 8). Early Insights: A Report of the 2022 U.S. Transgender Survey.

Leveille, L. (2022, April 3). Leaked audio confirms Genspect director as anti-trans conversion therapist targeting youth. Health Liberation Now!

Levine, S. B. (2020, March 12). Expert Submission of Dr. Stephen B. Levine, MD – PA General Assembly.

Matouk, K. M., & Wald, M. (2022, December 8). Gender-affirming care saves lives. Columbia University Department of Psychiatry.

Paul, P. (2024, Feb. 2). As kids, they thought they were trans. They no longer do. The New York Times.

Reed, E. (2023a, January 13). Unpacking ‘gender exploratory therapy,’ a new form of conversion therapy. Xtra Magazine.

Reed, E. (2023b, May 29). Ohio rep. pushes conversion therapy; Bill mandates it for trans kids. Los Angeles Blade.

Reed, E. (2024, February 2). Debunked: Misleading NYT Anti-Trans article by Pamela Paul relies on pseudoscience.

Santoro, H. (2023, May 2). How therapists are trying to convince children that they’re not actually trans. Slate Magazine.

Tordoff, D. M., Wanta, J. W., & Collin, A. (2022, February 25). Mental health outcomes in transgender and nonbinary youths receiving gender-affirming care. JAMA Network Open.

United States Joint Statement (2023, October 11).

Urquhart, E. (2024, February 6). Pamela Paul shows NYT Opinion’s lack of accountability to the truth. Assigned Media.

Urquhart, E. (2023, December 1). What it actually means to listen to detransitioners. Slate Magazine.

February 2024

Gender Exploratory Therapy has a new name and it is still dangerous

2024-02-09T20:12:14+00:00February 5th, 2024|Gender identity, Thoughts From A Psychotherapist|

A few months ago I wrote about the dangers of Gender Exploratory Therapy. The organization promoting this therapy, previously known as The Gender Exploration Therapy Association (GETA) has undergone a name change to Therapy First. Upon examining their revised website, one might find the content appealing, especially in the context of allowing children time and support to explore their gender identity through therapy, which on the surface appears commendable. Notably, a guidebook designed for therapists working with gender-diverse youth has garnered attention for its articulate and seemingly rational content. However, a closer examination of the authors reveals Lisa Marciano’s involvement, who has been advocating for the concept of Rapid Onset Gender Dysphoria since 2017, a purported condition often invoked by conversion therapists to justify their practices.

Upon, reviewing the case studies featured in the aforementioned guidebook, several concerning observations emerged. The first case study involving a teenager named Alina showcased the therapist’s pursuit of various explanations for the teen’s gender identity, none of which acknowledge the possibility of Alina being transgender. The study lacks any clear outcomes apart from a reduction in family conflict and a diagnosis of ADHD for the client. The language employed within Alina’s case study exhibits transphobic undertones, with Alina’s efforts to express their identity dismissed as “antics.” Moreover, the report mentions instances where Alina’s parents intervened by isolating them from perceived negative influences and confiscating their binders, leading Alina to resort to potentially harmful alternatives such as using multiple sports bras, exacerbating their asthma. Rather than recognizing potential signs of transgender identity, the therapist attributes Alina’s behavior to a “hatred of the sexed body and fear of adulthood.” 

I would argue that there was no harm in letting Alina use another name and wear a binder. If they later decide that the name or binders do not work for them they can change their name and stop using their binder. These are social transition steps that are fully reversible. Allowing the client to be where they are at and accepting that is the supportive intervention. Telling an adolescent that they do not know themselves never has a good result. It only invalidates them and makes them feel unheard and unaccepted, which certainly can lead to depression. 

It is imperative to clarify that therapists engaging in gender-affirming therapy do not presuppose that all clients are necessarily transgender or non-binary. Instead, the aim is to facilitate clients in exploring and establishing their identities, acknowledging that identities may evolve. Medical interventions, particularly in youth, are typically limited to reversible measures such as puberty blockers, which afford individuals the opportunity to explore their gender identity without undergoing irreversible physical changes. Social transition steps, such as adopting a different name or using binders, are reversible and serve as avenues for self-expression and exploration. Respect for the client’s journey and acceptance of their current state are central tenets of supportive intervention. Conversely, dismissing or invalidating an adolescent’s self-perceived identity risks exacerbating feelings of alienation and may contribute to mental health challenges such as depression.

Regrettably, prominent news outlets like the New York Times have perpetuated misinformation by featuring articles that promote conversion therapies, citing discredited studies to bolster their arguments. Erin Reed’s comprehensive rebuttal of a recent New York Times article on detransitioning offers a valuable counterpoint to such narratives. A link to the article is provided below. 

As therapists, it is incumbent upon us to speak out against practices that may cause harm to individuals under our care. The alarmingly high suicide rate among transgender youth underscores the urgent need for approaches that affirm and support their identities. A therapist’s role is to provide a nonjudgmental space for clients to navigate their identity journey, recognizing that it is a dynamic and evolving process.

Contrary to these principles, Therapy First adopts an adversarial stance, refusing to acknowledge the possibility that a client may be transgender. Instead, they attribute clients’ identities to external factors such as autism, trauma, or social influences. An affirming therapist approaches trauma with sensitivity and does not discount the self-awareness of neurodivergent clients. The notion of social contagion, proposed by Therapy First, is unfounded and has been debunked by reputable sources.

I would encourage all therapists to stay educated and make sure if any of your clients need information that you direct them to reputable resources.

Please note that I have intentionally not linked to any of the resources provided by Therapy First in this article as I do not want to do anything to validate their website.

Recommended further reading

Why Ethical Therapists Everywhere, Should Be Alarmed by Gender Exploratory Therapy, now dubbed “Therapy First” by Addie Kogan 

Debunked: Misleading NYT Anti-Trans Article By Pamela Paul Relies On Pseudoscience by Erin Reed

May 2023

Why Gender Exploratory Therapy is a BAD thing

2023-05-05T15:53:48+00:00May 3rd, 2023|Gender identity, Thoughts From A Psychotherapist|

Recently the California Association of Marriage and Family Therapists printed a letter to the Editor promoting Gender Exploratory Therapy. For those of us in the community we saw the language and knew this was a bad thing. But if you go to their website they state things in a gentle way that does not show their true agenda. Their agenda is clearly to not allow children to transition at all. That is conversion therapy which is illegal in CA. Many of us let CAMFT know what we thought about them publishing such a horrific letter. I am grateful to be a social worker our professional organizations would never publish something like that.

However, for a parent seeking out therapy for their gender-curious kid, this therapy might look like a good thing. It plays up all the reasons that a parent might be thinking about. A parent might worry it is a trend or their kid was influenced by others (there is no scientific evidence to back this claim). A parent will of course want there to be a thoughtful process with their child and they want to make sure that their child is not influenced. And although that is what good gender therapists do the right-wing extremists claim otherwise. A parent worries about what transition would be like for their child and fears that they will change their minds (again the rate of de-transitioning is very low and has not been studied alongside family support). So a parent can easily be sold on this group of therapists. 

Questions a parent might ask a gender therapist for their child

  1. How many clients have you supported through transition?
  2. What are the main obstacles you see for a child struggling with gender?
  3. How do you feel about puberty blockers?
  4. What is your training in working with gender-diverse children?
  5. How do you collaborate with parents, medical providers, and the schools?

A good therapist will collaborate with other providers. A good therapist will be open to puberty blockers at the right time. A good therapist will cite that family support is the main protective factor for transgender children. A good therapist will work with the child and family where they are at and let the child show the way on their journey. They will let your kid be your kid in ways that are authentic for them. A good therapist never has an agenda for the outcome of therapy. 

Gender Exploratory Therapy is a repacking of therapy known as conversion therapy. This therapy started with therapists trying to treat the gay out of clients and now expanded to doing the same to gender-diverse clients. This therapy is dangerous. Suicide rates for people that have experienced this therapy are high. It is important to get the word out to laypeople so that they understand how to best support their loved ones that are struggling with their gender identity. 

Here is a great handout from the American Psychological Association with a more comprehensive list of questions

Below is a simple infographic I created about why Gender Exploratory Therapy is bad. Feel free to download the pdf and share yourself.

Why Gender Exploratory Therapy is BAD

Want to download the pdf to share? Do so below!

Why Gender Exploratory Therapy is BAD PDF LINK

This is a video I made describing why Gender Exploratory Therapy is Bad.

This is a video I made explaining why the letter to CAMFT was Bad

April 2023

Have I Become a Gay Elder?

2023-04-04T16:58:17+00:00April 4th, 2023|Gender identity, LGBT|

Yesterday I saw a post on social media where a 38-year-old person talked about how they had become an elder in the community. As someone a bit older than that I immediately thought then what am I?

I was asked last week by a younger person if the current environment towards LGBTQ+ people was the worst I had ever experienced. My answer was yes. As I reflected more I feel like the time before I came of age was most likely worse since clubs and even homes were raided and people’s lives were ruined by being outed. But in my Gen X lifetime, this is the unsafest I have ever felt.

Why now? Back in the late ’80s and early 90’s there was a lot of being closeted. You were not out if you had any job working with youth. My first job out of graduate school was at a residential program for youth and you better believe I was deeply closeted. On the other side of the equation, though there was so much community. Yes, much of it was at bars but when you felt like it was all too much, there was always a place to go and just be with people that looked like you and had similar experiences. When I moved to San Francisco in the early 90’s it was right before AIDS medication became what it was today. The local gay paper had pages and pages of obituaries every week. Until the week they did not and that was a celebration. Living in the Castro, I felt safe. We may have been invisible to the general population but we were okay in our safe space (for those of us lucky enough to find them-other people’s experiences were different). We looked out for each other. I know many straight people do Friendsgiving now but back in the day it was survival. If you were celebrating you made sure your people had a place to go or you invited them over. Even people that you may not have known that well. When you left your safe space you were alert. You watched out for yourself and stayed closeted in most spaces. But since media attention was not on us, people were not paying attention so it felt safer.

Social media and its use by anti-gay and anti-trans groups has made most of us feel unsafe. Now we are a political pawn everywhere. Yesterday in a Facebook group the admin twice deleted posts asking for LGBTQ book referrals because the hate crowd could not skim by and instead had to post hateful remarks. IT WAS a group about BOOKS. But the people with the hate feel emboldened now they feel like they can post their hate anywhere and not have repercussions. And for the most part, they are correct. Now it feels like there is no safe place. Social media and news are in most of our homes, even if we try and restrict it. There are very few if any gay bars or gay spaces anymore. People have said to me well isn’t that better? You can go anywhere now. Yea but if I do and it is full of straight people it is a different experience. And sometimes I just want to be with people like me or at minimum people that really get me.

Before this time there weren’t laws allowing us to marry and transition (in some states) and have employment protection. We never got a full victory on those things. And now the victories we did get are slowly being torn to pieces. We are constantly being bombarded wtih messages that we are sick and that our existence is an issue. We can’t talk about our families or have our kids read books that represent what we look like. I do not know an LGBTQ+ person right now that is not totally freaking exhausted. We want to live our lives and it’s very very hard to do that right now.

I worry about all of this a lot. When I look back on those pictures from my days in SF in the 90s many of those men are no longer with us. I fear with the culture that is being created now those in their 20s and 30s are going to be facing the same thing when looking at their photos in the future. Except more of those people will die at their own hands when they just can’t take it anymore.

This is my personal experience from a place of white and economic privilege. Others may feel differently. However, I doubt anyone would say it’s not very very hard. And the answer to my original question is yes I am now an elder and a grumpy one at that.


May 2022

Filled with Rage Today

2022-08-29T19:04:23+00:00May 4th, 2022|feminism, Gender identity, LGBT, Thoughts From A Psychotherapist|

I had a list of topics to write this month’s blog. Then yesterday happened. There is one topic. The attacks on marginalized people. Right now, it is women. This means that it will affect women of color and women without resources the most. We also see attacks on LGB people, massive attacks on transgender people, and ongoing attacks on people of color. If Roe V Wade is overturned we know the next issues on the agenda are birth control, gay marriage, interracial marriage, and medical privacy. There will be no such thing as an established court precedent anymore.

Many of us have seen this coming for years. We have been gaslighted and told we were overreacting. Roe V Wade was a settled law. It would never be overturned. The right has been laser-focused on this issue since Roe in 1973 and have finally begun to reach its goal. Many of us have been feeling this rage for a long time, it gets amplified every time we face another loss. I am rageful at everyone who denied this was happening, who chose not to vote because it didn’t matter anyway, and to politicians who have failed on their promises. I am less rageful at people who support the overturn because they have been honest about their intentions for years. This should not be a surprise.

Why am I as a therapist being so vocal about this issue? Shouldn’t I be a blank slate for a client to work through their pain? No. That is not what I as a social worker believe. I believe in social justice. I am part of marginalized communities as are my clients. For me to be silent in the face of this is to be complicit in it. I don’t raise the issue in therapy but if/when my client does I am there with them validating their rage and the parts underneath the rage that are filled with sadness and feelings of powerless and everything else that is there. My clients need to be safe with me and part of that is knowing that I understand how marginalized people are treated in this country. My experiences are different from theirs but I get how painful it can be.

In an online therapist group, the question was asked Would you tell your client your feelings about this issue if they asked? And some of us said our clients do not need to ask. They already know where I stand. Especially, since 2016 when politics became a constant topic in therapy. Then COVID when therapists were experiencing the same trauma as clients. One of the most effective interventions I had during the shutdown was to say it’s not just you to my clients. At the time many of us felt like our feelings were just ours as a result of not being exposed to many other people to check in about this.

I have to be honest with my clients about my parts that are activated with what is going on in this country. I don’t ask them to take care of me. I don’t tell them how I deal with it because that is mine to manage. I do model that I am activated also. That is who I am as a therapist and as a person. I am angry. I am sad. I am scared. I am figuring out how I will move forward and what actions I need and must take. Probably a combination of self-care and activism. A combination that may shift back and forth over these next months until the next election. What I won’t do as a therapist or as a person is be silent. I will scream and yell with every bit of energy I have. And I will tell my clients that when they ask.


October 2019

Traveling while trans

2021-07-27T17:38:02+00:00October 31st, 2019|Gender identity, LGBT, Thoughts From A Psychotherapist|

The other day this article caught my eye. CNN was covering the trauma of TSA for transgender people. Essentially the problems boil down to two main issues.

  1. The scanner used by TSA must have someone manually enter a perceived gender of the person entering it. If that person does not have a body that the scanner feels like is in accordance with that gender the person is then subject to a pat-down.
  2.  Many transgender people have then be abused by TSA officers when going through TSA. If you want specific examples read the CNN article.

While the abuse of transgender people is bad enough my experience is that those scanners also hate those of us that are gender non-conforming. I always get pulled aside for a pat-down. Sometimes gently which is my general experience at SFO and some times rather invasively which is my experience at Newark airport. Needless to say after my last trip through Newark airport I was personally pretty traumatized. I have family in NJ so it is not an airport that I can avoid. I cannot even imagine the trauma of trans and non-binary people.

Shannon Minter legal director of the National Center for Lesbian Rights (NCLR) was quoted as saying this in the CNN article

“For many transgender, nonbinary and gender-nonconforming people, going through airport security is a grueling and often humiliating and traumatizing ordeal” “Some of the worst stories we hear are from gender-nonconforming women who are subjected to intentionally assaultive pat-downs from TSA agents. In effect, these women are being asked to accept being sexually assaulted as the price of traveling by air.”

What is the supportive cis person to do? Pay attention to the treatment of transgender, nonbinary and gender-nonconforming people in your community and nationally. Right now there is an epidemic (as identified by the AMA) of violence against transgender women. As of the date of this blog post 18 women, mostly of color, have been murdered this year. These are only the deaths that have been classified as such the real number is much more. Last year 26 women were murdered. While I get that we are in a time where there is so much to fight for it is important that we do not forget these women and that we all do we can to fight against the attack against trans people. And since the majority of these women are of color we need to be aware of the intersection between transphobia and racism in this country.

When you see injustice speak up and help the person. Vote for candidates who include transgender people in their policies. Donate to organizations that support transgender rights. Just be aware of the daily struggle of transgender, nonbinary and gender-nonconforming people. It is easy for any of us to get stuck in our own day to day life and not be paying attention to what is happening to various groups. I get it. I sometimes have to stop watching the news myself. But now more than ever we need to be paying attention. Lives are literally being lost every day to violence and suicide. It may not seem like much to be harassed when you travel but it is having to live with the constant threat of something like that happening in any environment that creates sustained trauma that needs support and treatment and won’t get better until society does.





Photo Copyright: sevenozz / 123RF Stock Photo

Rage and sadness at knowing LGBT rights are once again under serious attack

2021-08-11T00:14:14+00:00October 8th, 2019|Gender identity, LGBT, Thoughts From A Psychotherapist, trauma|

I am filled with rage today. I suspect underneath it all is a deep sadness and grief but right now I am experiencing rage. Full on. I am rageful that I live in a country where the court is going to decide if it is legal to fire LGBT people just for being who they are. I am rageful at all of the straight well-meaning people that just don’t get that in 22 states you can be fired for being LGBT and that winning the federal right to marry did not end the battle for LGBT civil rights. I am rageful at the people that think that their personal or religious beliefs should be more important than the civil rights of an entire group of people.

One of the happiest days of my life was my first wedding on February 13th, 2004 (both weddings are to the same spouse). Gavin Newsom said he thought LGB people should be able to marry on Feb 12. That day my now wife and I talked on the phone and said let’s do it! She had always said we would never get married until it was legal. With no planning, we got up at an obscene time of the morning and were waiting outside of City Hall with many others as it opened. It was beautiful. It was a time of triumph. We saw mostly older couples that first morning. All of us were both excited but also afraid that the marriages could be stopped at any time. The city staff was almost as excited as we were. As each couple came out with their license the entire line erupted in cheers. I am getting goosebumps on my arms as I write this. Then the community started to bring food and other celebratory items to support those in the lines that were now getting longer and longer.

It was a bit bizarre because after we got married, we each went to work. We were in a bit of shock, I think. At the time I worked at an LGBT counseling center. When I got there I told everyone that I got married. People cheered and cried and many raced to their phones to call their partners and propose. It was amazing.

Of course, eventually the courts both stopped and invalidated the 2004 marriages. Court cases continued until in 2008 the CA Supreme Court ruled in favor of marriage equality. Marriage became legal in CA. So, in July 2008 we did it again. Another of my happiest days! This time it was planned and we took a brief weekend honeymoon. There was little time to enjoy being married because shortly Proposition 8 was approved to go on the CA ballot. This meant people got to vote on whether it should be legal for gay people to marry in CA. It passed 52% to 48%. That day and the days to follow were some of the most challenging in my life. For a long time after Prop 8 passed I would look at everyone I saw and wonder how they voted.

Our marriage was then in limbo for years. In hindsight, I am not sure we would have gotten married in 2008 because it led to years of us being married in CA but not being married federally. Taxes were a nightmare.

We had to wait until 2013 when Prop 8 hit the Supreme Court along with the famous Windsor Case. Prop 8 was vacated on a technicality but Windsor case finally gave us the full federal right to marriage. It was an amazing victory.

Post Windsor, it felt like things changed a lot. When we traveled, we didn’t feel the need to be as cautious as before (granted we don’t travel to places like the south where we still wouldn’t feel safe). We told restaurants it was our anniversary and got free cakes. I must admit that on one vacation I told several restaurants that and got a few free desserts. I figured after all the years of not getting anything I could milk it for a bit

Things felt safer for us personally and I imagine for others who are LGB in blue states. I don’t think trans people have ever felt safe nor should they. Then came the 2016 election and it all went to shit. None of us felt safe. Our rights and the rights of other minority groups like Muslims, immigrants, Jewish people, and POC were being assaulted daily. November 6, 2016, was another on the list of very terrible days.

Now in 2019, I will say that in some ways there is a greater awareness of the issues. I see straight cis friends advocate some for trans and gay rights online. At the same time, I don’t think most of them get what it feels like today. It feels like shit. I am super privileged. I recognize that. I am white, I am middle class, and I live in CA. So, I have legal and other protections that others do not have. I cannot even imagine how they feel if I feel this bad.

At this point as I write this, I feel sick to my stomach and am so so sad. I knew there was a lot under that rage. I do not know how to cope with this. I also know that I will be holding this for many of my clients. One already brought it up in session. But more in the manner of a minority saying “yup, we are getting screwed again what can you do”. I am not sure what we can do. This decision won’t come down until June 2020. There is nothing we can do to influence the decision. Most legal experts expect the decisions to be against LGBT people (there are three cases two for gay men that were fired and one for a trans woman who was fired).

I can work towards getting legislators in office in 2021 that will finally pass an LGBT employment non-discrimination act. Once again LGBT people will have to just suck it up. We may be allowed a day or two of feeling awful but then what? We will all just move on until June when the decision comes out. And if I feel this bad now, I cannot imagine what I will feel like then.

What I will say is if you are straight and cis reach out to your trans and gay friends and check-in. Let them know you see what is going on and you care. Advocate in the ways you can for legislators and judges that will protect all of our citizens. After Prop 8 I had a friend send me a stuffed animal with rainbow clothes on it. That meant so much to me. It meant she saw the pain I was feeling. At the end of the day really what we need when we are struggling is to be acknowledged and not feel so alone.

August 2019

On Being Gender Non-Conforming

2021-07-27T17:57:29+00:00August 7th, 2019|Gender identity|

I am gender non-conforming (GNC). Until recent years I did not have language for this. It was just who I was. In my younger years, I was called a butch but in many ways, that label did not fit me. I was also called a Dyke both in friendly and not so friendly ways. Not a word that is used very much anymore. That seemed to fit better. But when language evolved to include gender identity and I heard of GNC I was thrilled. That was me. I don’t know why a label helped me but it did. Perhaps because from about age 9 when I got a Knotts Berry Farm Ball Cap and wore it everywhere I began to be treated differently because of that. While the more rural area where I lived had some room for “tomboys” I was often reminded that my appearance was not feminine enough. I got read as a boy often and I internalized my parent’s embarrassment at that. At the same time, my father was supportive of my ideas to do things that were “boy” things. While little league or being an “altar boy” never happened my dad was supportive of those ideas.

In high school, one of the jobs I had was at a ladies fashion store Fashion Bug. I got clothes at a discount and began presenting in a more feminine manner. Interestingly enough at the same time, I had some feelings about my sexuality and I bought Our Body Ourselves (not so easy in the days before Amazon). When I saw the pictures of lesbians in that book there were all very masculine women. So I knew that of course, I was not a lesbian because that was not what I looked like. When I was applying to Rutgers University there were different colleges there to apply to including a women’s college. I refused to apply to that school because that is where the lesbians went. So homophobia is often related to our struggles with our sexuality. Nonetheless, in my junior year, I worked at a women’s shelter and met lesbians and got an enormous crush (on a straight woman of course!). At age 21 I came out as a lesbian. I became part of a community and I increased the masculine nature of my appearance.

As part of this journey, I learned that bathrooms were an unsafe place for me. To this day I am one of the fastest people in and out of a bathroom. If I enter the restroom with someone else I don’t wait for them I get outside as soon as possible. I have fortunately never been threatened with physical violence but I have been told the restroom was a woman’s room and given many many dirty looks. Those looks always make me feel unsafe. In recent years it has happened less. I live in the Bay Area and now I am middle-aged and a middle-aged woman is fairly invisible in today’s world. In this case, it is of benefit to me. However just this weekend I was out of town. I was washing my hands when I heard the door to the restroom open and heard a gasp. I knew immediately what had happened. I finished washing and then opened the door to an elderly woman. I stepped back and held the door for her to enter. She slinked past me thinking angry thoughts the entire way (you can tell). I went back to my table and reported back the incident to my companion. It was not as upsetting as it can be sometimes. Maybe because this woman did not feel like a threat to me. I was concerned she would go get a staff person and make a scene which thankfully did not happen.

So why am I telling this fairly personal story? I just want people to understand the effect of the microaggressions on GNC people. And I know for trans and non-binary people it is way worse and often they are in great physical danger. I fully recognize that I have the privilege of being able to say I am a woman and most people will accept that when a transgender woman will not get that same acceptance. I hear stories often from my trans and non-binary clients about the different abuses they face in their daily life. I know the effect on me of the dirty looks. The effect that has been cumulative since I was a young child and given so many messages that I was not normal. They add up and they have taken years of working through and can still get triggered sometimes. I suspect many of my friends may not understand these burdens though I know they empathize. We are coming to a time where there is greater acceptance for the LGBT community but still, there is discrimination against the community especially around gender identity and presentation. I want people to continue to understand this so that they can make sure they are both being accepting, and affirming, and better yet learning to be an ally. Because I know most of my people that are not white cis men are afraid right now. We are in a country that is actively perpetuating hate against Transgender people, Muslim people, Jewish people, People of Color, Women and other groups too numerous to list here but all very important. I think it is each of our obligation to try and protect those with fewer protections than we have.

May 2017

Affirmative Counseling with Transgender Clients

2022-08-26T14:40:20+00:00May 2nd, 2017|Gender identity, Thoughts From A Psychotherapist|

Affirmative Counseling with Transgender Clients

One of my specialties is working with people that are exploring their gender identity. In my other work world, I teach classes on marketing and have online CEU classes for therapists to take (not psychologists). I have been long working on a class as an introduction to working with transgender and gender non–conforming clients. I have heard many horror stories from my clients that brought gender issues into the therapy room and had a bad outcome. So I am putting together the introduction I wish I had when I started my work with transgender clients. As I say in my affirmative counseling presentation I firmly below advocacy and fighting for social justice is part of the therapist’s job.

As a part of that class I put together a slide show on affirmative counseling. I thought by sharing it here it would give my clients and those checking me out as a potential therapist insight into how I work as a therapist. The video of the slide show is below. Please let me know if you think there are more concepts that that need to be added.

November 2016

Transgender Rights and Resources

2021-08-16T22:52:33+00:00November 17th, 2016|Gender identity, LGBT, Thoughts From A Psychotherapist|

Transgender Rights and Resources

Since the election, a lot of concerns have been coming up for the transgender people. I have put together some resources and information below so that you can have the best possible information when you make any decisions. Obviously right now we do not know anything for sure. I don’t want to perpetuate panic but at the same time, people need information on the best ways to protect themselves. Everyone needs to make the decision that is best for them in their own circumstances.

I am going to focus on the practical concerns of documents and health insurance.

Please feel free to comment or email me if you have anything to add to this post.



In California, the go to for information on legal documents is The Transgender Law Center. Here is the link to their page with detailed information about this topic. Here is their extensive guide.

Here is my quick summary:

California State-Documents

In 2013 Governor Jerry Brown signed AB 1121 which made it easier to get documents changed in CA. Full implementation occurred in July 2014. So with the same Governor in office and statements issued both from him and the Legislature that assert that they will protect Californians, at this time there is no indication that this law will change and you should still be able to change your name and gender in CA fairly easily.

It is important to note that you do not currently need a court ordered gender change to change your California driver’s license, social security card, or U.S. passport. You also no longer need a court order to have a new California birth certificate issued reflecting a change of gender.

You DO need a court order for a change of name.


Documents-Other States

For information on other states and their rules, The National Center For Transgender Equality has an awesome site here. You can click on any state to get additional information including some local advocacy partners.

In states with Republican Governors, there may be a backlash against gains for transgender people and those laws may be at risk so please check in with your local transgender advocacy projects.


Federal Documents

Social security cards and passports are Federal documents and as such may have more risk for change.


Social Security Cards

National Center For Transgender Equality also has a great fact sheet on changing your gender for Social Security. Right now it is considered a relatively easy process but we have no idea at this time if this might change and become more challenging in the future so if this is an important change for you, it should be done as soon as possible.



In 2010 the State Department updated its policy to make it easy for transgender people to obtain a passport that has their correct name and gender identity. This may be an area that is targeted and changed moving forward.

If you believe you may want to leave the country at some point this is a very important process to complete as soon as possible.

Here is information from the National Center for Transgender Equality on passports.


Health Insurance-California

The California Department of Managed Health Care (DMHC) has ordered California’s health plans to remove blanket exclusions of coverage based on gender identity or gender expression. This was done to comply with the California Insurance Gender Nondiscrimination Act, passed in 2005. These rules did not apply to self-insured plans. Many larger businesses have “self-insured” plans governed by ERISA, a federal law that preempts state nondiscrimination protections.

Essentially what this means is that those who got transgender health coverage added because of the Affordable Care Act (ACA) risk losing it if the ACA is repealed.

However, many in California will continue to have transgender health care coverage under private insurance plans.

With Medi-Cal is more complicated. Many people got on Medi-Cal through the Medicaid expansion in the ACA. Many others also got private health insurance because of the ACA subsidies to buy private insurance. Those aspects are at risk if the ACA is repealed. So people will lose their entire health care plans not just transgender-specific aspects.

CA law does still require coverage of transgender health but it could get more challenging if cities lose funding for public health.


Health Insurance-Other States

If the Affordable Care Act is repealed then Rule 1557, which removed trans health exclusions federally, will be gone. If you live in a state that did not protect transgender health care prior to the ACA there is every reason to believe that coverage can be gone by the beginning of 2018. Also, those who got coverage through the Medicaid expansion will also most likely lose their healthcare coverage if/when ACA is repealed. And we know repeal of the ACA is the top of the list of legislative goals for the Republicans. The other scenario I have heard is that Medicaid expansion may stay but become much more restrictive depending on the state. Vice President Elect Pence did do a Medicaid expansion in his state so we just don’t know how this will play out.



Resources for Further information

Transgender Legal Services Network

Transgender Law Center-CA Specific

Southern Poverty Law Center is collecting reports of incidents of violence and intimidation. They advise reporting to local police first but they are tracking the violence. The link to that is here

Trans Lifeline

US: (877) 565-8860 Canada: (877) 330-6366

Trans Lifeline is a non-profit dedicated to the well-being of transgender people. It is a hotline staffed by transgender people for transgender people.

CA Courts Site Reference for further CA legal document questions.

Go to Top