I came to this work when a loved one came out in the early 1990s and began the long transition before most therapists understood gender dysphoria and Internet access to solid information did not yet exist. For her, the risk of career loss was high, the emphasis on “passing” and neatly disappearing anonymously into a binary, strict male or female world was deemed essential to avoid stigma, and no insurance plans paid for any of the huge medical costs or transgender care that could attain this.
My loved one was able to grasp the brass ring, affording medical costs by cashing in her retirement savings, while enduring a stressful ‘proving ground’ environment at work that seemed to rest on her complete ability to remain undetected, also called “stealth.” She has the good fortune of ‘passing’. Today she thrives, proving that gender dysphoria is not indicative of a character, psychotic, or sexual disorder, and that a civilized society can be taught to have compassion for those it has not understood.
Today more insurance plans cover the costs of genital surgery, and most cover hormone therapy and psychotherapy. In Colorado, the law forbids transphobic actions by employers and landlords. Two carriers, Kaiser Permanente and the new Colorado Health Co-Op, offer surgery, though with differing options as to choice of surgeon (KP has only one so far, Dr. Toby Meltzer, who is quite highly regarded).
Many gender dysphoric people need to make the transition but know they will never ‘pass’ even with expensive facial feminization surgery (FFS), state-of-the-art masculinizing genital surgery and decades of hormone therapy. They face the dilemma of living authentically and carrying themselves with dignity in the face of social stigma. But Western society is maturing in its ability to accept and understand transgender and transsexual people–aided by the coming-out stories of celebrities like actor Laverne Cox, film director Lana Wachowski (The Matrix) and others. My philosophy of transgender care includes helping clients see their presentation accurately, and “toughen their emotional skins” adequately while experimenting with taking their privately-lived gender expression out into safe venues, such as in therapy groups I lead and out into public life. The Standard of Care of WPATH advises this gradual adjustment to living publicly in one’s true gender, before genital sex surgery is recommended.
My role is to assess, offer counseling, and recommend my clients for hormone therapy and surgery, helping them know the risks and benefits and without unrealistic ideas about how their lives will and will not change after transitioning. I help clients to thrive in the world, with good self-esteem and coping skills when ‘read’. Transsexual people must become realistic, but need not become passable: only strong enough and wise enough to live in society proudly and successfully. They have ultimate decision making power about living ‘out’. I have worked with over 500 transsexual clients, for as little as a few months for those who come to me already successfully living full-time, to as long as several years in many cases, until we have reached this goal. It is not a fast process: it takes as long as it takes.
Meanwhile, I advocate for society’s acceptance of people who do not look like the gender-normative presentation. My dissertation work in developing interfaith pastoral responses to transgender people of faith aims to update religious clergy’s pastoral theology to accommodate biological facts about gender diversity and dysphoria. Religious leadership shapes public perspective and politics of even secular society’s treatment of human beings, also made in God’s image: for the Bible says, “male and female God made them,” not “or.” Clergy and theologians must become responsible to understand the science and the proven treatments for gender dysphoria. Religious authorities should feel morally bound to update doctrine about human beings with accurate knowledge from the human sciences. Pastoral teachings must catch up with spiritual wisdom about the sanctity of the person, including those who may require alterations of the body in order to live in peace.
I have worked with over hundreds of transgender/transsexual adults (and lately, teens 16 and older) and their families and spouses as needed. I understand the needs for expert assessment and support when medical and social transition is the best route to psychological (and when clients ask, spiritual wholeness as well: I am also a trained pastoral/spiritual therapist). I provide consultation to therapists, psychologists and psychiatrists with transsexual clients, and supervise graduate student therapists according to the Standards of Care of WPATH, of which I am an active member. Please visit About Dr. Thor for more information.