Being transgender can be a wonderful, freeing, exciting experience. But sometimes, it can be really hard. Especially for those of us who are not out of the closet, who cannot afford to medically transition, who don’t want to medically transition, and who are constantly misgendered and invalidated simply for living as our true selves.  It shouldn’t be a surprise that a large portion of the trans community face significant mental health issues as well as barriers to adequate healthcare.

According to the 2021 Trevor Project National Survey, more than half of transgender youth surveyed had seriously considered attempting suicide within the past year; 3 out of 4 trans youth reported symptoms of Generalized Anxiety Disorder, and 2 out of 3 reported symptoms of Major Depressive Disorder within the previous two weeks. These statistics were even higher for LGBTQ youth of color. This doesn’t indicate that being transgender is a mental illness; it’s a sign that society is not built to include us. These barriers can even start at the first step of filling out an intake form, where you’re not sure if you should put your assigned gender at birth or your true gender, or which name to use. It’s scary not knowing if a provider will be accepting of your identity or even try to get your name and pronouns right. Fortunately, a lot of providers are beginning to understand that they should, at least on paper, be inclusive of LGBTQ individuals. Unfortunately, that’s just it– their policies are inclusive on paper, but clinicians may be oblivious on how to interact with LGBTQ individuals in a competent and affirming manner.

As someone who has been both a trans patient and provider, I’ve been through more than my fair share of doctors and therapists, which ranged from disappointingly ignorant to surprisingly knowledgeable. I also grew up in Texas, which is not notorious for progressive policies focusing on transgender people. I was fortunate enough to grow up within a large metropolitan area where I could find gender affirming care in the “gayborhood” of Dallas once I came out. But as for the other providers I saw, I was always weighing the risks and benefits of being out – whether I felt brave enough to tell doctors I am trans, or if it was safer to just deal with being deadnamed and misgendered. Wouldn’t it be great if we didn’t constantly have to make these decisions between potentially putting ourselves in harm’s way, and staying silent when we have to masquerade as someone we are not? Staying in the closet sometimes keeps us safe, but the effect of having our identities invalidated and denied over and over again takes a toll on our mental health over time.

It can feel really frustrating not knowing if a provider will treat us with respect and understanding. After working with several agencies over my time as a social work student, I’ve collaborated with staff and offered suggestions and feedback on language and etiquette for serving trans clients. Here’s a list of some things you can do to make sure your clinician will be gender affirming, and advocate for yourself if you find that they are not.

Their practice is listed on a local LGBTQ resource center or website with agencies that have been endorsed by members of the community.

If you live in the Columbia area, The Center Project is a great resource for finding gender affirming healthcare providers. The list is not exhaustive, and many of them may have a wait list, but it can relieve some anxiety if you already know other LGBTQ people who have had good experiences with them. If you are not in Columbia, a Google search of some variant of the phrase “LGBTQ affirming therapists in ____” should yield some results in your area. This will at least narrow things down before you start to inquire about services. However, this does not include every person in the field that works with this population. 

Their practice states that they work with LGBTQ individuals on their website, and/or they have at least one clinician that says they do.

If a practice or agency is truly an ally, they will most likely at least have a page on their website acknowledging that they work with LGBTQ individuals to support their mental health needs. As social workers, we are now trained to be acutely aware of social justice, inequality, and health disparities, and the effects that being a member of an oppressed group can have on every aspect of a person’s life. It is even included in our code of ethics – social justice is one of the six core values of social work. It’s also worth it to see if their website has a list of providers that specialize in LGBTQ issues. If possible, when contacting the agency you could request a clinician that says they have experience and passion working with LGBTQ individuals.

They have fields for your pronouns and chosen name on their intake form.

Unfortunately, if you haven’t legally changed your name, providers will need your legal name on record, especially if they deal with insurance. Some will have a space for your “preferred name” on their forms. Although this is not the ideal language (our names are not preferred, they are mandatory) it’s a step in the right direction, and they should be calling you this at all times. Rarer still are spaces for you to check a box for your pronouns or fill them in. If they use the wrong pronouns, you can gently remind them what they are and that you put that information on your paperwork. This can be nerve-wracking, and that’s totally understandable. But there is a good chance they will apologize and correct their mistake if they asked for your pronouns in the first place. At Aspire, since we do not go through insurance, you can put whatever name you’d like to be referred to as on our intake paperwork, although we may have to take note of your legal name if that is the name on your debit/credit card on file or if you need a superbill.

Your clinician asks questions about your identity in a respectful and non-judgmental way.

When doing an intake, clinicians may ask you questions about your gender and sexuality, just to get to know you better. This often includes how long you have been out or identifying as your gender, what your experience has been living as your gender, how it impacts your daily life, and if you’d like to address any struggles with being transgender in therapy. They should avoid unnecessary, intrusive questions such as why you identify a certain way or making you justify your choices. Even though they may be well-intentioned, this may signal that they have not had much training on how to be culturally sensitive.

If you are a minor, they ask you how you’d like to be referred to when speaking with your parents.

In Missouri, if you are under 18, your legal guardian has the right to choose whether you continue therapy. This is required by state law. Unfortunately, especially for LGBTQ minors, parents are not always supportive, to say the least. If a therapist refers to you by your chosen name/pronouns to an unsupportive parent that is not aware of your identity, it could cause devastating consequences. A therapist that is aware of this and is committed to keeping you safe will ask you the safest way to refer to you until you are ready to come out. The safety of our clients is our top priority above all else, and doing this is honestly good practice for anyone in your life who may interact with your parents if they know you’re not out to them.

I hope this list is of some help to you as you start your journey to healing, and that you are able to find a clinician that meets all of these criteria. I hope this will also be helpful to clinicians who are looking for ways to help their clients feel safe and accepted, but aren’t sure what concrete steps they can take to do so. Aspire Counseling is more than happy to help LGBTQ individuals and to provide a gender-affirming environment where you feel like you can be yourself. We also work with individuals dealing with PTSD, trauma, depression, anxiety, grief, and so much more.

Affirming Care in Missouri

Aspire Counseling prides itself on being an affirming facility. Along with working with those in the LGBTQ+ community, we also provide Affirming Letters, along with working with individuals experiencing trauma, anxiety, PTSD, depression, grief, and so much more. We offer in person services at our Columbia Missouri office, and now at our Lee’s Summit Missouri office, or online to anyone in the State of Missouri. We encourage you to reach out to our client care coordinator at 573-328-2288 ext. 1, or go online and fill out our form to start your journey with therapy today!

About the Author

Ozzie Dinwiddie is an intern at Aspire Counseling. Ozzie specializes in working with those in the LGBTQ+ community, along with those experiencing trauma, anxiety, depression, and domestic violence survivors, and relationships. When Ozzie isn’t working at Aspire Counseling you can find him hanging out with his cat, Momo, or enjoying some creative writing!