As you begin discussing gender concerns with your psychologist, you will cover a ton of topics. However, with the rapport you build in your initial evaluations, you should feel slightly more comfortable.
Up until 2013, Gender Dysphoria meant a lot to the Psychological community. Considered a mental disorder, it allowed the medical community a large variance in how they treated patients. In ICD-11, the World Health Organization reclassified it again, making the language more political than medical. However, to keep the treatment criteria congruent with the WPATH, most psychologists continue to diagnose Gender Dysphoria the same way. They look at six criteria, and how it affects your quality of life.
- A marked incongruence between one’s experienced/expressed gender and primary and secondary sex characteristics.
- A strong desire to be rid of one’s primary and secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender.
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender.
- A strong desire to be treated as the other gender.
- A strong conviction that one has the typical feelings and reactions of the other gender.
Sample Questions Asked When Discussing Gender Concerns
- How would you describe your gender identity?
- How did you come to recognize that your experience of gender is different than most individuals?
- Were there any life events that you feel were significant in influencing your gender identity?
- Have there been changes to your gender identity over time?
- What do you remember feeling about your gender as a child? What was puberty/adolescence like?
- How do you feel about your gender now? Do you have any questions/concerns about your gender?
- How does your gender identity impact how you feel about work, relationships, family, or other aspects of your life?
- Are there any activities you did as a child or that you do now as an adult that you think of as being cross-gendered? If so, how have these been viewed by your family and others in your life?
- Did you prefer to be around individuals of any particular gender as a child? Is this different than your preferences now?
- Have you ever cross-dressed? If so, what was that experience like for you? If not, what do you imagine it would be like?
- If you could change your external appearance in any way you wanted to more closely match your sense of who you are, what would this look like in terms of your gender?
- Have you ever taken feminizing hormones or had feminizing surgery? What was that like for you?
Perceptions of Others
- How do you think others perceived your gender when you were a child? How do you think others perceive your gender now?
- How do you want to be perceived in terms of your gender?
- How important is it to you that there be a fit between how you feel about your gender and how others perceive you?
- How does gender play out in your sexual desires or fantasies? Does it impact the kinds of sexual activities you do (on your own or with others) or wish you could do?
- What is a typical sexual fantasy for you?
- Do your sexual fantasies involve other men, women, or trans people, or do you mainly fantasize about yourself? If you are in your fantasies, do you imagine yourself to be female, male, or transgender?
- What are your feelings about the parts of your body that are often associated with sexuality (e.g., genitals, chest/breasts)?
- Do the people in your life know that you are transgender? If so, what was it like to tell them? If not, how do you feel about them not knowing?
- Have you had any contact with other transgender individuals? What was that like for you?
- How do you see your relationship being with the transgender community now? What would you like it to be in the future?
- Have you used the internet to access support and information about being transgender? What have you learned? In what ways was it helpful or not helpful for you?
My Experience Discussing Gender Concerns
At this point, I feel that sharing my personal experience might help. In 2017, I met with my first psychologist to begin receiving help for my Gender Dysphoria. He spent three sessions conducting the initial evaluation before sluffing me off to another psychologist. The second psychologist spent one hour with me, before completely dismissing me to a Traumatic Brain Injury (TBI) specialist. At the TBI clinic, I underwent a specific therapy where the therapist asked me to draw several pictures as she evaluated what I made. Then, when I finally began to feel at ease, the TBI specialist sent me to a gender therapist specifically.
Tired of the seemingly endless game of pass-the-patient, I began studying and researching everything I could on the treatment of transgender mental health patients. Then, I wrote an eleven-page letter specifically focused on answering every single question I could find in the form of a story. I printed it out and brought it with me to my intake interview at the gender clinic. My nurse was surprised and a little caught off guard when I handed her the letter. At the conclusion of the intake, she scheduled me for a three-hour interview with the specialist.
On the day of my interview, I walked in and sat down, ready to start all over. The specialist showed me my letter and asked me point blank if everything in it was true. I confirmed that it was, and she dismissed me just like that. No counseling, no rapport, no other mental concerns. However, she did write me a referral to an entire care team, changing my life forever.
- Barbara, Angela M., et al. Asking the Right Questions, 2 Talking with Clients about Sexual Orientation and Gender Identity in Mental Health, Counselling and Addiction Settings. Centre for Addiction and Mental Health = Centre de toxicomanie et de santé mentale, 2007. Open WorldCat, http://www.deslibris.ca/ID/427458.
- Bockting, Walter O., et al. “Counseling and Mental Health Care for Transgender Adults and Loved Ones.” International Journal of Transgenderism, vol. 9, no. 3–4, Sept. 2006, pp. 35–82. DOI.org (Crossref), doi:10.1300/J485v09n03_03.
- Standards of Care – WPATH World Professional Association for Transgender Health. https://www.wpath.org/publications/soc. Accessed 25 Mar. 2021.