FAQs for Transgender Clients

I do a number of consultations for transgender clients who have questions about changing documents, getting medical services, etc. Here are my answers to some of the most frequently asked questions.

How do I get started with hormone therapy?

There are several doctors here in the St. Louis area who are knowledgeable and experienced at providing hormone therapy for transgender clients.  Many doctors require a referral letter from a therapist, stating that you qualify for a diagnosis of Gender Dysphoria, and that any other mental health concerns are being effectively addressed. In order to write a referral letter, a therapist will need to do a psychosocial evaluation. This is pretty routine and does not require a great deal of time.

There are also a couple of options that do not require you to get a letter from a therapist first. This is called the Informed Consent model, and it means that the doctor or healthcare facility prescribing the hormones is able to document Gender Dysphoria and talk with you about any other concerns as well. You can still see a therapist if you choose to, but it’s not required.

I am happy to help clients who need assessments and referral letters for hormone therapy or referrals. Contact me for a consultation to talk through the process, and I can answer any additional questions you may have.

If you are interested in informed consent options, check out Washington University’s Clinic,  and Plume, a telehealth subscription-based service specifically for gender-affirming hormone therapy.

Can you recommend a doctor?

Yes! If you have health insurance, I may be able to suggest someone who is in-network. If you don’t, there are options for you too. Give me a call, and let’s discuss.

What if I am interested in surgical procedures?

I always suggest finding a surgeon and having a consultation with them first. While all reputable physicians work to the same standards of care, different providers have different requirements for documentation. Some merely require the same letter I would write for a referral for hormone therapy. Others have a specific form they want filled out.

Why do I need to be diagnosed with something in order to get hormones or surgery?

Good question. The inclusion of Gender Dysphoria as a diagnosis is controversial, and the clinicians who worked on the latest version of the Diagnostic and Statistical Manual had serious concerns about it. The previous revision of the manual used the term “Gender Identity Disorder.” The term “disorder” was clearly inaccurate. Gender variance and gender fluidity are not disorders. The revised term at least acknowledges that. Many clinicians, including some of the authors of the manual, would like to see Gender Dysphoria removed from the DSM completely, as it is not a mental health condition. However, they also understood that having some sort of diagnosis is necessary for many people simply so that they can get the services they need.  Many insurance companies only cover procedures and therapies they deem “medically necessary,” and in order to meet that requirement, documentation is required. We can expect the landscape to continue to evolve, hopefully in a better, more progressive direction.

How do I change my name, get my gender marker on my driver’s license changed, or update my passport?

It depends on where you live. Transequality.org/documents has a good rundown of the specifics on a state by state basis.

For Missouri residents, changing your gender marker on your driver’s license is now fairly simple: http://dor.mo.gov/forms/5532.pdf.

I live in an outlying area and can’t easily get to St. Louis. 

I do have the ability to work with clients remotely, through a secure online platform. Contact me if you would like to discuss in more detail how that would work.

What other questions do you have that are not on this list?