Why therapy for the Transgendered should still be recommended – An Opinion Piece
By LeeAnn Potter

The views and opinions expressed in this article are those of the writer and do not necessarily reflect the views or policies of Ammonoosuc Community Health or their providers. If you have questions or concerns related to this article and your personal health care, please consult with your primary care or behavioral health provider.

Recently, the Diagnostic and Statistical Manual of Mental Disorders (DSM) standards eliminated Gender Dysphoria from its document (DSM-5). It did so to try to reduce the stigma regarding Gender Dysphoria being considered a mental health issue. As a result, some see this as a reason to no longer recommend behavioral health therapy for those transitioning.

From my perspective as a transgendered patient, I see this as unfortunate. Changing your gender assigned at birth, one of the things that identify you to most people, is a complex and difficult endeavor, and is not something that should be engaged in without significant thought.  It also requires that professionals in the Medical, Psychology, or Sociology fields help ensure that you are ready, and have the necessary support to ensure success.

It seems as I’m not alone in this thought…

WPATH (Worldwide Professional Association for Transgender Health) still recommends therapy, and indeed still requires the signatures of 2 therapists in order to qualify for surgery (one must hold a Ph.D.). Some doctors follow these guidelines, some do not (both of my surgeons required letters, in 2010/2011).  I went to a therapist weekly for almost a year prior to surgery but know others who saw a therapist only twice before getting letters. Since WPATH are only guidelines, doctors are free to choose what parts they choose to follow.  

We know that Transgender people are more susceptible to behavioral health concerns including, anxiety, depression and post-traumatic stress disorder, due in part to prolonged discrimination and lack of family or community support. Suicide is still a major factor with Transgender people, particularly youth.  According to a recent survey over 50% of transgender male teens, nearly 30% of transgender female teens, and 42% of non-binary youth (gender identities that are not exclusively masculine or feminine‍) respondents stated that they had attempted suicide at some point in their lives.

Integrated care which includes behavioral health therapy
could be the key to long-term success

Integrated health care which includes primary care and behavioral health services can set a course for success with transgender patients. It can help ensure adequate coping mechanisms are in place to deal with the physical and emotional issues that are sure to arise. It can also provide a network of people to turn to when you have questions and need somebody to talk to.

Transgender patients should also be counseled to reach out to additional support networks at the state and local level. Online support groups do exist; in NH, Facebook has several groups. Transgender New Hampshire, North Country Equality Alliance, Parents of Transgender Children NH and Rural Outright,  are all active groups. If therapy is not an option, due to cost, lack of appropriate therapists or trust issues, perhaps peer discussion can provide some degree of assistance, on a confidential basis.

Therapy, while possibly difficult, is an important part of the gender transition process; it is there to make sure that you are ready for the transition and that you have the help needed during this major life change.

Additional Resources:

• What Is Gender Dysphoria? – American Psychiatric Association
• Management of the Transgender Adolescent – Journal of the American Medical Association (JAMA)
• Standards of Care for the health of Transsexual, Transgender, and Gender Non-Conforming People – WPATH

About the Author – Lee Ann Potter retired as a civilian engineer from the U.S. Army, after holding the position of Senior Engineer/Analyst in Research and Development.  She worked much of her career with a wide variety of communications and computer systems. She began her gender transition just prior to retirement, completing it in April of 2011. Today, she serves as the president of a national non-profit, and in her free time enjoys working around the house. She has been happily married to her wife since October 1989 and has 5 children.