According to the most recent Diagnostic and Statistic manual of Mental Health Disorders, Gender Identity disorder(GID) is no longer classified as such. GID has now been replaced with Gender Dysphoria(GD). We now can diagnose our clients in a much more accurate and less stigmatizing way. Gender Dysphoria is an intense and persistent feeling of incongruence between one’s internalized sense of gender and our biological sex. This is represented on a spectrum ranging from mild to moderate to severe. Many individuals experiencing mild gender dysphoria find ways to express that part of their identity that do not involve gender role transition.  However, those experiencing severe GD are often only able to find peace and congruence upon addressing and living their authentic selves. Identity is not something we can (or should) change, so the treatment plans often focus on ways in which we can change the physical body to match the internalized sense of gender.

There are a few options for addressing this intense Dysphoric feeling. The first step is often Hormone Replacement Therapy(HRT).  HRT can have tremendous feminizing/masculinizing effects on the physical body(depending on age, genetics, etc.). However, one thing that we do know is that Testosterone is a very powerful substance. For those MtF (Male to Female) clients who are transitioning at a later age, the effects of Testosterone have already set in and often will be unchanged via hormone use. This is particularly evident in male/female facial structures. Hormones will often result in secondary sexual characteristics (though sometimes underdeveloped…ie: small breast size for mtf).

In Western society, there is a huge amount of emphasis put on one’s body image. We can see this every time we pick up a magazine or go to the gym. An intense and often exaggerated sense of disgust with one’s physical body is known as Body Dysmorphia. I feel that in the Trans-identified individual, this is only amplified. Besides not feeling like the body one has fits for them, there are some major safety concerns that often intensify this feeling. ‘Passing’ becomes of utmost priority. This can often lead to Trans-identified individuals seeking out more procedures than we may feel are necessary.

Long after the 2-3 year hormone replacement process, many mtf may continue to struggle with seeing the female in the mirror they have so desired for most of their lives. It is more important for us as healthcare providers to explore how changing one’s body might affect them. In our society, plastic surgery often comes with mixed reactions. Many people feel the need to let people know they do not ‘need’ any procedures. This however, can be a catch 22. By telling someone who is Trans-identified that they don’t need any procedures and that they are fine the way they are can possibly undermine or deny the individual’s core belief about their physical selves; no matter how good-intentioned it may have been.

So in conclusion, i hope that healthcare providers will take into account the effects of Body Dysmorphia on the Trans-identified individual. It is not our place to tell people they should or should not physically alter themselves.  Instead, we should be focusing more on the thoughts, concerns, and beliefs that have become so ingrained in their psyche. Many clients will pull for approval, but this is a time for staying very client-centered and not interjecting our personal biases based on our lived experiences.

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com

Nutrition has been in the center spotlight of health for many years now. What we eat can often lead to reactions in the body.  We can enhance or minimize effects of dietary plans, Athletic Achievement, Sleep, and many other areas of functioning within the human experience. One such area includes hormone levels.  Various foods we eat can have an influence on our abilities to create or suppress hormonal reactions throughout the body. As a diagnostic tool, I will often suggest young people and their parents to add small portions of certain foods to their diets and report back how they feel. Relatively little change (if any) will be achieved through specific diet changes alone, but in conjunction with Hormone Replacement Therapy, diet may act as an enhancer to the treatment.  I am NOT a licensed nutritionist and I strongly urge everyone to consult a doctor before making any major changes in one’s diet. With that being said, lets explore some foods that may raise/lower Estrogen and Testosterone levels.

Lowering Testosterone (goal of MtF)

Many foods can assist male-to-female clients in fighting off increased levels of testosterone. Since males cannot produce Estrogen in significant quantities, efforts to reduce levels of Free Testosterone will enhance the impact of estrogen supplements taken during HRT. Foods that reduce testosterone levels include:

Meats

  • Avoiding meats will lower testosterone levels in the body. According to 4-Mens Health, evidence suggests that consumption of meat boosts testosterone levels. One reason is the cholesterol meat contains, which is a “precursor” to hormones such as testosterone, according to B-Net. Vegetarian diets, on the other hand, cause a decrease in testosterone levels.

Fats

  • According to The Hormone Shop, studies prove that low-fat diets  will yield lower testosterone levels. Furthermore, The Hormone Shop states that essential fats, such as omega-3 fatty acids and saturated fats, are essential for normal testosterone production and by avoiding such fats you will decrease the natural production of testosterone.

 Soy

  • The “Journal of Endocrinology” has determined that soy (which contains phytoestrogens) will decrease testosterone levels. Phytoestrogens, a word closely related to estrogen, has been the basis for many men avoiding soy milk and other soy products.

The fear that consuming soy products, and therefore the consumption of phytoestrogens, would cause a change in testosterone was proven in a study done by Gifu University School  of Medicine located in Japan. According to the U.S. National Library of Medicine, the study revealed that testosterone concentrations were inversely related with the intake of soy products, after controlling all other factors.

Carbohydrates and Simple Sugars

  • According to The Hormone Shop, diets which are high in complex carbohydrates, simple sugars and fiber will result in lower testosterone levels. Consuming an excessive amount of carbohydrates will cause blood sugar to elevate and therefore release elevated levels of insulin and cortisol. According to The Hormone Shop, once these two hormones are in the body, they work to decrease production of testosterone and oppose the action of the testosterone which is released into the body.

Additional Tips and Warnings

  • Remember to avoid consumption of too much protein. Protein stimulates hormones in the body which regulate the release of proper levels of testosterone, according to The Hormone Shop.

Remember…Attempting to decrease hormone levels without a doctor can be dangerous. Please consult a doctor before beginning any large dietary changes.

Read more: Types of Food That Lower Testosterone | eHow.com http://www.ehow.com/about_5611234_types-food-lower-testosterone.html#ixzz2KGyNpyIr

Foods That Decrease Estrogen levels (part of goal for FtM )

Estrogen dominance occurs when estrogen is in the body at a much higher level than other sex hormones, mainly progesterone. The increased level can be the result of excess estrogen production or storage, or a drop in the level of progesterone. Symptoms of estrogen dominance are obesity (with fat accumulating in the mid-section), fibrocystic breasts and ovaries, menstrual irregularity, headaches and often breast cancer. With these unwanted side effects of estrogen dominance, many look for natural ways to combat it. One way to help control the level of estrogen in the body is through the diet.

FIBER

One of the first nutritional changes you should make to fight estrogen dominance is to up your fiber intake. Dr. Ronald Hoffman of New York states that a high fiber diet will decrease blood estrogen levels. Since excess estrogen leaves the body by way of the bowel, if stool remains in the colon the estrogen will be reabsorbed. Some foods  that are high in fiber and make great additions to the diet are celery, apples, berries, oatmeal, nuts and seeds and any kind of bean.

FLAX SEED

Add flax seed to your diet. Flax seeds contain compounds called “lignans.” According to the Linus Pauling Institute, a health research center at Oregon State University, lignans have an “anti-estrogenic” effect, in which they interfere with the enzymes that are involved with the production of estrogen. While flax seeds have anti-estrogenic properties, they are also very high in phyto-estrogens, which are estrogens from a plant source, so you want to consume them from a food  source no more than once a day. The highest food source of lignans is flax seed. Flax seed can be added to baked goods such as breads and muffins, or sprinkled on top of salads or lean stir-fry dishes. It can also be purchased already ground.

SULFUR FOODS

The liver works as a filter that cleans harmful substances from the blood stream and sends them for elimination, including excess estrogen. When the liver works too hard and can not function properly, toxins build up in the system, including estrogen says Dr. Hoffman. Eating foods that keep the liver healthy can help the liver reduce the estrogen dominance within the body. Foods such as onions, garlic and egg yolks are good for the liver because they contain sulfur. The George Metaljan Foundation, (“World’s Healthiest Foods”), states that it is sulfur compounds that give the liver the ability to get rid of toxins such as pesticides and liver damaging medications. Other foods that aid in liver detox are lemons, limes, spinach, leafy greens and Brussel sprouts. While the cruciferous vegetables such as Brussels sprouts and broccoli help with liver function, they also contain higher amounts of phyto-estrogens, so vary your vegetable intake and have cruciferous vegetables every other day.

CHOOSE ORGANIC

When selecting fruits, vegetables and even lean meats, seek out organic sources. Organic foods are not grown or raised with pesticides or added hormones, so they give the liver a break by not adding extra toxins or estrogens into the system. Xenoestrogens, estrogens from environmental sources, are found in pesticides, plastics, detergents and even perfumes. If you purchase food that you are not certain is organic, be sure to wash it first to rinse any pesticide residue from it. When purchasing meat or milk, make sure it states that it is organic and “hormone free.”

FOODS TO AVOID

To reduce estrogen levels, certain foods should be limited or omitted altogether. Foods and drinks that contain caffeine should be removed from the diet. Dr. Michael Lam, who specializes in natural healing, reports on a study that involved measuring caffeine consumption and estrogen levels. The result of the study was that even only one cup of coffee per day could increase estrogen levels, and more than four cups of coffee  raised the level 70 percent higher than the one cup level. Dr. Lam also states a study that showed a reduction in estrogen levels of women who gave up a diet full of high carb and high fat foods in exchange for a plant centered diet that was low in fat. Avoiding sugars, fatty and processed foods and opting for fresh, whole fruits and vegetables and nuts is one way to reduce estrogen dominance.

Read more: http://www.livestrong.com/article/16099-foods-reduce-estrogen-dominance/#ixzz2KGkHwvFw

These are just some suggestions to discuss with your doctor or nutritionist. Diet alone will not lead to a miraculous feminine or masculine figure, but when paired with exercise and hormone replacement therapy, one might see enhanced effects.  Again…Consult your doctor first!

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com

So I was asked recently to blog about the transition process for males to females (MTF). So while transition is different for everyone, there are certain timelines many of us follow as set forth by the World Professional Association for Transgender Health (WPATH) Standards of Care. These include: Psychotherapy, Hormonal treatments, Surgeries, etc.  I am going to discuss these major concepts and my thoughts on them, including benefits/hassles of the “real life experience”.

Psychotherapy – There is still a lot of stigma in the world regarding psychotherapy within the general population.  If one goes to see a therapist, it is often concluded there must be something wrong or pathological occurring. When we combine this with the pathological stigmas surrounding gender dysphoria, a good deal of resistance may come up for the prospective client.  However, within the therapeutic process it is important to identify particular mental health areas that may be a challenge or affect the client moving forward; An example of this may include depression or anxiety.  While these health issues are often very treatable, they can and are often exasperated during the transition process for many.  As a therapist, it is not my responsibility to challenge one’s Transgender identity, but to explore it and find ways to relieve distress and help my clients attain a personal authenticity that is safe, comfortable, and conducive to growth and happiness.  If I can assist them in identifying pitfalls that we can treat before any transition occurs, chances of that transition going smoothly are greatly increased.  This treatment phase generally lasts for 12 weekly sessions. However, while it is important to note that not all clients may need or benefit from this timeline, therapists must act in an ethical and professional manner as determined by their professions guidelines. My experience shows the Standards of care to be appropriate guidelines for Therapists to consider.

Hormones – Once a client has attended the required 12 weekly sessions of therapy, they may be eligible for a hormone referral letter to a local Endocrinologist.  Regardless of determination made by a therapist, the endocrinologist will ultimately have the final say regarding hormone distribution.  So clients should be prepared for a series of tests which include blood work and other means of measuring physical aptness to hormone replacement therapy(HRT).  In the MTF client, the goal of hormones is to lower Testosterone levels to that of a ‘normal female’ range, while increasing Estrogen levels. In most cases, Gender Dysphoric individuals should experience some relief to symptoms before any permanent effects occur. This is often used as a diagnostic tool for many endocrinologists. While regimens may vary, the standard time-cycle for HRT is anywhere from 18-24 months from when Testosterone levels reach female norms. This is often described by many as a second puberty.  However, while the average genetic female pubertal cycle lasts 4-5 years, an MtF’s cycle is roughly two years.  Needless to say, a lot of changes happen in a very short amount of time.  It is important to note and discuss with clients that the closer they are to their fist puberty cycle, the more physical effects they will achieve with HRT.  Drastic physical changes tend to taper off after about the age of 35.

Surgical procedures – There are a large variety of surgical procedures available to MtF individuals including: Facial Feminization Surguries (FFS), Breast Augmentation, and GenderAffirmation Surgery (also known as Gender Reassignment Surgery-GRS) to name a few.  I feel it is important to discuss an important concept here.  Roughly 60% of Trans individuals never undergo surgical procedures.  There are many reasons that may affect this number, but many Trans-identified people live perfectly happy lives with only hormonal interventions (or no interventions whatsoever for some). It is also important to never question someones surgical status as a representation of gender.  To do so, would be to dismiss one’s internal gender identity.  Often the first question that is asked of a Trans person upon coming out is, “Have you had surgery?” Regardless of the fact that it is no one’s business, it is a question that could easily undermine the work people go through to discover their authentic self.

Real Life Experience – Before Gender Affirmation Surgery can occur, the Standards of Care suggest a period of at least one year wherein the individual can live in the opposite gender role full time.  For many Trans people, this period of time is unnecessary as simply getting this far in the transition process seems test enough.  However, in a patriarchal society, there are many experiences  of male privilege that may have gone unseen or even unexperienced that can potentially cause distress for some. It is also important to note that depending on the area one lives in, Trans-phobia may still be quite alive and well. This often makes it difficult to attain and maintain employment, romantic relationships, and handle certain legal aspects of life in the United States. While surgery is improving almost daily, once GRS has been completed, it is not so easy to go back to a premature physical status.  Thus it is important for clients to be absolutely sure surgery is right for them. It is also ethically responsible for a physician to make sure there client has explored all aspects before performing an extensive and expensive surgical procedure. Ultimately, I know MtF’s who could simply go through these steps quickly without any Real Life Experience and be perfectly happy and content.  However, as professionals, we need to maintain appropriate ethical standards and practices in order to give our clients optimal treatment…regardless of its controversial nature within the Trans community.

There is so much more to the transition process than I could have explained here.  I hope this has at least given you an outlook into the general phases of a male to female transition.  Should you desire consultation on any of these areas, please contact me at the information below.

 

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com

One of the more challenging aspects of understanding the Transgender experience comes to the question of sexuality.  It can be quite confusing for anyone, but when we add gender identity on top of that…it seems more challenging to comprehend.  So let me try to help you separate the two.

Gender Identity comes from a combination of factors which I believe are made of from three primary areas.  Some say more some less, but three seems to be pretty easy to work with, so we’ll go with that.  The three areas include:

Biological Gender – This is the physical gender we are born as.  Our chromosomal makeup: XX,  XY, etc. and is greatly affected by sex hormones.  This of course is not so clear when it comes to our Intersex brothers and sisters, but I am choosing to stay focused on the Transgender experience in this article.

Internalized Gender – This would be the innate sense of belonging to one gender, both genders, or neither genders.  This can manifest itself in how we experience the world in relation to ourselves.  This innate sense often goes very deep to our core.

Gender Presentation – This idea has to do with how we choose to present ourselves to our community and world around us.  I feel this is where gender roles have the most impact in our lives.  This could include clothing, accessories, the car we drive, games we play, etc.

Depending on one’s unique blend of these three factors, they will come up with a sense of where they fit along the Gender Spectrum.  This can of course change throughout our lives in an ebb and flow manner.  So now that you have a general idea of how gender is viewed in the Trans community, lets talk about sexual orientation and how that plays in with gender.

Sexual orientation describes an enduring pattern of attraction—emotional, romantic, sexual, or some combination of these—to persons of the opposite sex, the same sex, or to both sexes, as well as the genders that accompany them. (wikipedia.org)

Like in any other area of society, Trans-identified people can and do identify across the board. Gay, Straight, Lesbian, Queer, Bi-sexual, Pansexual, etc.  When it gets confusing is when people Transition to another gender and maintain their sexual orientation.  If a male transitions to female (MTF) and is attracted to women, that person is moving from a heterosexual male into the world of a lesbian female.  and so on and so forth.  While the Trans-identified person usually has some idea about this, it can seem quite shocking for the unsuspecting family member or even the therapist that does not fully understand how Gender and sexuality are differentiated.  While interconnected, they are quite different journeys our clients must explore.  It is also not uncommon for a Transsexual who has been on a hormone regimen to find themselves shift sexuality post-transition.  As with gender, sexuality and sexual orientation can change…especially when one takes cross-gender hormones.  This could be attributed to society’s acceptance of them exploring this avenue however.

 

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com

 

So as many of you may know, the terminology used in the LGBT community is constantly morphing and changing.  While Lesbian, Gay, and Bisexual are terms that have become more concrete over time, Transgender (like Intersex) is a term that was coined only 25-30 years ago.  It is only now that the label of Transgender is beginning to get recognition within common everyday circles.  Transgender is an umbrella term used to describe (according to Wikipedia.org):

  • Transsexualism describes the condition in which an individual identifies with a gender inconsistent or not culturally associated with their assigned sex, i.e. in which a person’s assigned sex at birth conflicts with their psychological gender. A medical diagnosis can be made if a person experiences discomfort as a result of a desire to be a member of the opposite sex, or if a person experiences impaired functioning or distress as a result of that gender identification.
  • Cross-dressing refers to the act of wearing clothing and other accoutrements commonly associated with the opposite sex within a particular society. Cross-dressing has been used for purposes of disguise, comfort and as a literary trope in modern times and throughout history.
  • Transvestism (also called transvestitism) is the practice of cross-dressing, which is wearing clothing traditionally associated with the opposite sex or gender.  This is often done in search of sexual gratification or pleasure arousal.
  • Drag queen is a man who dresses, and often acts, like a caricature woman often for the purpose of entertaining.

Many other terms may be thrown in under the Transgender umbrella, but these are the primary categories associated with the label of Transgender.

As a Trans-identified individual working in the therapeutic field, I prefer to focus on labels that empower us as opposed to clump or dismiss us.  A few years back the term Gender Variant was being used to help distinguish Transsexuals from the group.  It seemed to just end up as another umbrella term though and many people had negative reactions to it as it has an isolating connotation.  Sometime last year, I heard the term morph into Gender non-conforming.  This term also struck a nerve with many in our community as it set a precedent that one should conform to the binary gender system.  However, I recently heard a term that, while still somewhat umbrella, I am liking the more I sit with it.  The term to which I refer is Gender Independent.  Within western society, Independence equates to freedom and ability to stand on one’s own.  Independence is highly sought after and valued.  So if someone is Gender Independent, it is implied that they are free and capable of living the gender that best suits them. Another bonus to this term is that with all the pathology surrounding the Transgender term/concept, Gender Independent implies the opposite of pathology(or dependence) and I find it to be somewhat empowering as a Trans-Identified woman.

What are your thoughts on the term Gender Independent?

~Cammie

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com

Is A Trans-identified Therapist Really important When Navigating Transgender Emergence?

 

I have read many studies and documents that promote the LGBT community seeking out an LGBT therapist.  I have seen a few reports stating that a Trans-Identified therapist is ideal for those exploring a Trans Identity.  Personally, I think there are benefits to both sides of the conversation and wanted to share some tips for those who Identify as members of the LGBT community (particularly those exploring a Transgender Identity) when seeking a Therapist:

 

1)  Find A Therapist That is Knowledgeable – One of the primary benefits of seeking a Trans-identified therapist is that if they themselves have transitioned, they will most likely have an understanding of the process based on personal experience.  They will likely have unique perspectives into some of the benefits and challenges that may come up throughout your counseling experience.  Trans-Identified therapists may also have a stronger sense of compassion for the torment of not feeling whole.  Personally, I feel this is ideal if you are able to locate a Trans-identified therapist that you are able to connect and feel comfortable with.

 

2)  Watch out for Hidden Agendas – Many therapists (LGBTQ identified or not) may have specific expectations or agendas that may drive your therapeutic process.  An example of this would be the Trans-Identified therapist that insists SRS should be a final goal( when we know that roughly 60% of Trans-identified people do not choose that route).  A good therapist will have no agenda other than to help you relieve the pain and/or confusion you bring into the room. The goals you work towards in your therapy should be YOUR goals; Not the therapist’s.

 

3)  The Relationship Is the Most Important Aspect – Should you meet with a therapist that has all of the degrees and certificates on their wall, but no real connection with you… then I suggest you continue to shop around.  Therapy is an extremely personal process and you owe it to yourself to meet with someone that can help you honor that in a way that provides some relief.  You should be able to freely explore every aspect of your experience without worry of shame or judgment.  This should be a rule of thumb when seeking out a therapist, regardless of LGBT status or presenting challenge.

 

Exploring a Transgender Identity is one of the most exciting, liberating, and scary times in our lives.  It is important to not only do it in a safe environment, but to do it with someone compassionate and knowledgeable of the Transgender experience.

 

~Cammie

 

Cameron Duvall, MS
MFT registered intern (IMF#65656)
30 N. San Pedro Rd, Suite 160
San Rafael, California 94903
(415) 968-9591
www.live-authentically.com