If you’re in crisis because you think you’re trans, contact The Trever Project at 866-488-7386 (they also have text and online chat support,) or Trans Lifeline in the US at 877-565-8860 or in Canada at 877-330-6366. Besides being a sympathetic ear, they can direct you to local trans support resources.
Gender counseling is not required for a succesful transition but is often one of the hoops you have to jump through to access other care you need, like hormones and surgery. It can also be a lifeline during a very hard part of life when it can seem like no one else is willing to support you. It can fuck you up or help you figure out what to do next, depending on the person you see, so selecting the right person is critical.
I’ve seen five gender counselors, five or six ‘general’ counselors for other life shit, three marriage counselors across two marriages, and have sourced two and counting counselors for one of my kids over the years. The first gender counselor I saw dismissively told me I was ‘just a crossdresser’ when I said I thought I might be trans. This set me back years. I’d like to save you time and emotional energy so that you won’t have the same experience.
For full disclosure, my being white and living in an urban area means that I’m unable to fully address specific issues relating to access for people of color or those in rural areas. I’ve both paid out of pocket and had insurance for counseling, and while I touch on billing issues, how to pay for or get someone else to pay for counseling is not covered in this post. This information is also US-focused.
How to find a gender counselor
The best way to find a qualified pool of counselors to evaluate is to ask other trans people. Trans people will generally be happy to refer you and tell you the pros and cons of each. Since much of successful counseling can rely on personal chemistry, take recommendations and criticisms with grains of salt.
Asking people in a local gender support group has the added advantage that you might make a friend or two. Google is your friend here to find a group. If you’re in an area that doesn’t seem to have any gender support groups, PFLAG has a support group locator and Laura’s Playground also has a group locator, though it skews towards crossdressing resources. (Note: Don’t count out crossdressing resources. Many in that community can also provide referrals and there tend to be more crossdressing groups than gender groups due to historical reasons.)
Psychology Today has an online counselor listing for the US and Canada and has a specific Transgender filter, (look under the ‘Issues’ list). A cursory glance at listings in states that aren’t considered trans-friendly turned up several providers.
If you live in Chicago, Dallas, Miami, New York City, San Francisco, or Seattle, MyTransHealth is a great listing for mental health, medical, crisis, and legal services that have been vetted to be trans-friendly and supportive.
If you’re in or near a college town, many colleges have LGBT groups who might be abe to refer you. Other college resources are women’s/gender/sexuality programs, usually located in the Psychology or Sociology departments. Skimming their web pages or dialing down the faculty list can usually provide some other leads to follow up on.
Another option is to ask your doctor, at a local clinic, or your school’s clinic. The medical community can be hit-or-miss, usually leaning towards the clueless side the further from urban areas they are, but it can be worth asking, especially if you’re expecting to coordinate transgender medical care.
If you have insurance plan or an employment benefit with mental health benefits, calling them and asking for referrals will usually turn up a few names. This way also helps sort out part of a billing point before you even contact a counselor.
Eleven questions for evaluating a gender counselor
Once you have a list of people to contact you’ll need to make some phone calls to interview them. When dealing with counselors and health providers in the Gender Industrial Complex, remember that these people are service providers – you have choices and options, and if they aren’t meeting your needs, find someone else.
Remember that you are interviewing them for fit. If the phone conversation feels awkward, it’ll probably be awkward in person. This is someone you’ll be telling most of your deep thoughts and secrets to. Their job is to listen sympathetically and be supportive while getting you pointed in the right direction. If they come across as distracted, argumentative, or lacking empathy on the phone, it’ll only be downhill in person.
Most importantly, you should never be charged for an initial call to evaluate if they are a good fit for you. If they want to charge you for that first call, run.
These initial calls usually won’t go past 15 minutes. It helps to be in a quiet place where you won’t be interrupted, to have your questions written down, and to take notes. Notes are important so you can compare counselors easily and so you can focus on the conversation instead of trying to remember everything. I tend to use email on my phone or laptop so I can jot down the answers and them mail them to myself so I can find and refer to them later.
Once you’ve talked to everyone, compare your notes. Ask yourself how you feel about each and if there are deal-breakers. Sometimes seeing someone who isn’t a perfect fit is the best you can do for the time being. I had one counselor that was very helpful and practical up to a point and then the appointments turned into gossip so I stopped seeing her and found someone else.
Here are some of the questions I’ve asked. You should consider what’s important to you and adjust accordingly.
- Do you consider the WPATH (World Professional Association for Transgender Health) Standards of Care (SOC) guidelines or rules? If they don’t know what the WPATH SOC are and they put themselves out as a gender counselor, that’s a big red flag. While the SOC are guidelines, many counselors do treat them as rules. Depending on where you live and the choices you have, you may or may not be able to use their stance as a screening criteria. Knowing where they stand on this tells you right up front if you’ll have to jump through hoops, (wait three months for hormones, for example,) to get what you want.
- Where is your office and what are your office hours? Even if the counseling was free, if it’s hard to get there and be there during the available time windows, that’s going to be challenging.
- Do you support phone or video appointments? The counselor I see now does this and it has been helpful when my schedule made it impossible to see her in person.
- What is your billing process? This is going to vary from ‘I bill insurance and then follow up with you for anything they don’t cover’ to ‘payment is due before the appointment’ and everything in between. If you have insurance, it’s good to know what they cover so you can determine if you have to pay out of pocket and get reimbursed or if there are co-pays. If you don’t have insurance and are paying out of pocket, you should ask…
- Do you have a sliding scale? A sliding scale is them adjusting how much they charge depending on your financial ability to pay. Some do, some don’t, and the scale can vary wildly. If this is an issue for you and you can’t afford them, ask them for a referral to someone who does sliding scale.
- How do you code the bill for insurance? For every service, there is a corresponding billing code a provider submits to insurance. For privacy reasons, especially if you’re on someone else’s insurance, you might not want your insurance company to have a record that you’re seeing someone for gender counseling because sometimes the code shows up on the bill or statement. If this is a concern, ask if they are willing to code you for something more generalized like depression or something else.
- What is your missed appointment policy? Some give a free pass. Others don’t. It’s good to know what it is before it happens.
- What is your gender counseling experience? This starts to get into if it’s a core focus of their practice or not and how long they’ve been doing it. A good followup question here is if they attend any gender conferences for continuing education.
- What percentage of clients do you see for gender issues and do you have a ‘typical’ client? This helps determine if gender is something they do to supplement their practice and who they are used to seeing. If you’re a student and the counselor mostly sees older people with families, it’s not that they won’t be able to help but more that it may be harder for them to provide guidance and resources for your specific situation. Given your physical location, gender as a component of a practice might be the best you can get.
- What is your treatment methodology or philosophy? Gender counseling is a specialization on top of general counseling and while gender will be the main area of focus, it also intersects with family and personal behaviors. If they have a family of origin (how your family influences/has influenced your behavior) background, expect to spend time talking about your family. If they have a cognitive behavioral therapy (CBT) background, you’ll focus on immediate issues and how to address them. There are also spiritual and other methodologies. Philosophies can be grounded in feminism, scientific rationalism, or the Flying Spaghetti Monster. There is no ‘best’ methodology or philosophy, but knowing what they are can help frame what you’re likely to encounter and help you determine fit.
- Do you have any areas of specialization? Some focus on family relations, others on workplace issues, still others on sexuality. Again, this is more of a fit thing given your needs.
Not sure if you should transition? I think You should start transition.