Be Supportive – Avoid questioning their plans to transition

If you think they are making a bad or rushed decision about transitioning itself you are in a tight bind. Their therapist is looking out for them. That’s the person who safeguards both their welfare and their information. Even for a minor child (to the best of my knowledge) you can’t just ask  for private information from therapy sessions unless it involves harm to the patient or someone else.

Transition includes several aspects although what most are aware of is the “social” transition, the person changing their gender presentation. Their internal gender does not change, and it is not necessarily the case that their body will ever change. This is between them and their caregivers.

Transition also includes a mental aspect that starts some time before someone starts changing their public presentation and ends (typically) a few years after they have finished going full time. This doesn’t mean they don’t stop changing, just that the bulk of the mental process is complete. For myself, I found it notable that when I joined an online gaming guild several months after starting hormones I came across as male despite identifying as female, but now, several years later, am not seen as anything but female. I’ve seen reflections of this in my day to day life as well. This is the work of mental transition and self acceptance.

Physical transition for those who are taking hormones and who may also seek reassignment surgery can go on for many years. The bulk will complete after about two years, but it continues as a more subtle level for more. 

[Requirements are from the WPATH standards of care]

The therapist will not agree to start cross sex hormones for the patient until:

  • At least three months have passed since therapy started (an absolute minimum). There are exceptions made, but they involve patients who’ve already been living as their target gender or have typically been taking hormones without medical supervision. The last is not a good idea.
  • Other psychiatric disorders like schizophrenia have been ruled out that might mimic gender dysphoria
  • Psychiatric problems like depression are under control
  • They have decided that cross sex hormones are the best treatment for the patient

For surgery:

  • At least one year on cross sex hormones
  • At least one year living in the target gender
  • A medical doctor’s evaluation recommending the patient for surgery
  • A therapist’s evaluation recommending the patient for surgery

Most surgeons and most insurance plans will insist on a second therapist’s note or even a PhD Psychologist’s evaluation. This is not a minor barrier to surgery. Most patients understand that there is a significant recovery time as well, and some life long maintenance required because of the surgery.

If you still wish to talk about their transition, just keep the above in mind and include that many consider the entire process a bit of an endurance race. I’m a bit mixed about it, but not entirely unsympathetic. However, for myself I actually sought a second opinion before starting hormones, so I was better safe than sorry for my own health.


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