Topic: Getting diagnosed w/ Gender Dysphoria

[ParkerTalks]

Hey all,

What sort of questions can I expect from a gender therapist when getting evaluated for gender dysphoria diagnosis? How does diagnosis 'go down'?

[Dena]

You simply answer any questions the therapist ask as honesty as you can and you express what you feel. It's not what you say or how you say it but the feelings you express. I don't know if you look at introductions but after you see enough of them, there is a common thread that we all share. That thread says we are transgender. Therapist are trained to see it. In our case we were born with it and we can recognize it in others. If you want something a little more down to earth, look at the “the transition channel” . This is very similar to what therapy was like for me 40 years ago and it's still true today.

[BlueJaye]

In my own experience, the therapist will want to speak with you and observe you for a period of time, maybe 3 months, before making a diagnosis.

During that time I just talked with the therapist about my life. My experiences, why I was seeking help, the areas of my life that were the most painful. I actually didn't set out to get diagnosed with anything. I was super deep in denial about gender dysphoria and my therapist was very good about being patient and moving at my pace, but also knew how to crack open the facade and get to the behind-the-scenes stuff that I was trying to hide and avoid.

I had been seeing the therapist for about six months when she felt confident enough about my symptoms to start talking to me about gender dysphoria and treatment.

I was scared out of my mind to open up with her about the really painful stuff, but she got me through that and we started discussing treatment options. No therapist should force any particular treatment on you, just offer the treatment options and let you decide what is best. My therapist had worked with transgender people before and looking back I think she coached me a little to pick the best choice. Maybe not the objective manner a therapist is supposed to present, but she knew what she was doing.

I gave HRT a shot. It was my last resort before giving up on life. I am actually surprised in retrospect that she gave me the support letter for HRT, since I was suicidal. That seems like it would be a huge no-no. But I am guessing she knew I was more likely to go through with ending it all if I didn't at least try HRT. It was a gamble either way for her and she chose to nudge me toward the least dangerous option.

I am glad I went through the process, but be ready to relive some painful memories and expose some wounds and scars.

Sent from my SM-A205U using Tapatalk

[randim]

Hi Parker,

Most therapists will probably not make a diagnosis for a while, I would think,.  Mine didn't. They obviously are going to want to know *why* you are seeking therapy, and if gender is on your mind that will come up in discussion pretty quickly. In my case I had a cross-dressing history and I was starting to go out in public dressed, so it came up pretty fast. I suspect diagnosing dysphoria varies greatly from therapist to therapist.  It is more art than science, unfortunately.  FWIW, this the American Psychiatric Association's summary of the DSM-5 criteria:

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.

In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:

    A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
    A strong desire to be rid of one’s primary and/or secondary sex characteristics
    A strong desire for the primary and/or secondary sex characteristics of the other gender
    A strong desire to be of the other gender
    A strong desire to be treated as the other gender
    A strong conviction that one has the typical feelings and reactions of the other gender


I don't know if this is the actual language of the DSM-5.  My therapist read the criteria to me at one point and I recall some language about a 3rd gender as well as the "other gender."  But I could be misremembering. The bit about significant distress is important. If you were fully comfortable with your gender presentation, even if it is completely trans, you technically would not have dysphoria.  And as you can see, there is significant subjectivity in the criteria. "Strong" and "typical" are not crisply defined.

I would guess any therapist would want to probe your self-perception of your gender identity, any concrete steps you might be taking to realize it, and what sort of emotions and/or problems it is causing.  I have to say I really value my therapist.  They can be wonderful relationships, in a provider/patient sort of way. I hope you can find one that's a good match for you.

[Devlyn]

Hey all,

What sort of questions can I expect from a gender therapist when getting evaluated for gender dysphoria diagnosis? How does diagnosis 'go down'?

The first question is usually "What are your goals?" or "What can I help you with today?"

So what are your goals?

Your medical provider should be following the WPATH Standards of Care, for your viewing convenience we have a copy of them here: https://www.susans.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual,_Transgender,_and_Gender_Nonconforming_People

I hope this helps. 

Hugs, Devlyn

[Sarah-Red]

There's no gender therapist around here. But for the one that had the training, I really went all out right out the gate. I'm transgender. I have dysphoria, I'm looking to transition. Bam. (well, there was a bit more stuff, and feelings, too) She did ask me details about how i felt in my life and all that, and how I did now. I was in it both to be honest about how strongly I felt about my gender, and also on a mission to get to the hormones as soon as I could. She went along my plans, so it went smoothly from there.

[Sarah-Red]

A lot of people I talked to about gender didn't even have any sense of gender for them, but they still identify with their gender. So I would say cis people do identify with their assigned one, but don't necessarily actively get a sense for it.

But since this is about dysphoria, I think anyone who feels like their body doesn't match their gender are on that spectrum. From how little to how high it gets to you, whether it's uncomfortable or in some of our cases here, a type of agony. I dont know what they base themselves on exactly for the diagnosis, but I would just be honest about how you feel on your body compared to the gender you identify with.

[Allie Jayne]

My gender psychologist explained to me that it would take a minimum of 3 sessions (@AUD$210 per session) for her to make a diagnosis, then she asked me to tell her my life story. 40 minutes later she stopped me and said she had never encountered a more classic trans woman, and she was happy to refer me for hormones after asking 5 standard questions from the WPATH guidelines. I was desperately ill from dysphoria, and pre suicidal from depression, so she saw some urgency in getting me treated.

Allie

[Lexxi]

Hi Parker,

My experience mimicked Allie's. My therapist thought it would probably take 3 sessions before she'd know anything for sure...it took her less than an hour to diagnose me. I mean the guidelines are pretty clear in the DSM. I clicked off just about every single one of the markers for gender dysphoria. So even though she officially gave me my diagnoses before our first appointment was over, she wouldn't give me my letter of recommendation for HRT until she saw me a couple more times.

I couldn't have been more happy after that first appointment though. I mean I knew in my soul that I was trans, but to have a diagnoses from someone who's experienced just made me feel better. I wish everyone's process could go as well as mine did.

xoxo
Lexxi

[BlueJaye]

My gender psychologist explained to me that it would take a minimum of 3 sessions (@AUD$210 per session) for her to make a diagnosis, then she asked me to tell her my life story. 40 minutes later she stopped me and said she had never encountered a more classic trans woman, and she was happy to refer me for hormones after asking 5 standard questions from the WPATH guidelines. I was desperately ill from dysphoria, and pre suicidal from depression, so she saw some urgency in getting me treated.

Allie

My therapist also told me I had one of the most textbook cases of gender dysphoria a therapist could hope for. But since I was in denial about it, she delayed giving the diagnosis until I was ready to accept it. I'm just glad I have super awesome insurance and it probably cost me less than $150 USD for all of my sessions up to that point combined. I don't know how people without good insurance can jump through all the hoops. It would be incredibly costly!

Sent from my SM-A205U using Tapatalk

[ChrissyRyan]

My therapist also told me I had one of the most textbook cases of gender dysphoria a therapist could hope for. But since I was in denial about it, she delayed giving the diagnosis until I was ready to accept it. I'm just glad I have super awesome insurance and it probably cost me less than $150 USD for all of my sessions up to that point combined. I don't know how people without good insurance can jump through all the hoops. It would be incredibly costly!

Sent from my SM-A205U using Tapatalk

I have been through denial.  After I finally learned that I was masquerading as gender fluid, although having both male and female traits if you will, I finally accepted that I am a woman. Not so much outside as a cis-woman - yet; but, I cannot deny that I am a woman.

It is good to work with a trained gender specialist as you are well aware.

It is very cool that medical personnel thought you were female at first contact, yet you presented as male.  I get that at times when presenting as female or androgynous.  Not as male.  But as male, I do not expect to.

I do wonder though how cool it would be, at the same time maybe not good at this moment professionally, to be presenting as male but almost everyone addresses me and treats me as female. 

The answer seems to be that at that point I would have arrived or am close to it, and that it may be then the time to go full-time.  I still need to prepare for that.

I wish you the best and thank you for serving as a moderator.  I am unsure what a moderator does here but you are involved and helpful, so again, thank you.

I am glad that Matthew is okay.

Chrissy

[Linde]

Again, no story is identical, and mine is really different again.  I was on my second batch of estrogen patches before I ever saw a therapist! I had a blood test done by my internist, and he found that I was extremely low in hormones (because of that funny body of mine), and in danger of getting osteoporosis, and he prescribed estrogen for me. 
My internist wanted tome to see and endo, and I ran in the biggest gate keeper in the world!  Luckily I am in care of the Mayo Clinic now!
Later I found out that I needed to be in care of a therapist, if I ever wanted to get surgery.  That was when I decided to find a therapist.  I had two different ones, before I found my current therapist, who I love a lot!

i think it is really difficult to make absolute statements about anything for transgender people!

[ChrissyRyan]

Again, no story is identical, and mine is really different again.  I was on my second batch of estrogen patches before I ever saw a therapist! I had a blood test done by my internist, and he found that I was extremely low in hormones (because of that funny body of mine), and in danger of getting osteoporosis, and he prescribed estrogen for me. 
My internist wanted tome to see and endo, and I ran in the biggest gate keeper in the world!  Luckily I am in care of the Mayo Clinic now!
Later I found out that I needed to be in care of a therapist, if I ever wanted to get surgery.  That was when I decided to find a therapist.  I had two different ones, before I found my current therapist, who I love a lot!

i think it is really difficult to make absolute statements about anything for transgender people!

Were you a medical researcher doctor or also a MD PhD, a MudPhud? 

[Allie Jayne]

I have been through denial.  After I finally learned that it was masquerading as gender fluid, although having both male and female traits if you will, I finally accepted that I am a woman. Not so much outside as a cis-woman - yet; but, I cannot deny that I am a woman.

It is good to work with a trained gender specialist as you are well aware.

It is very cool that medical personnel thought you were female at first contact, yet you presented as male.  I get that at times when presenting as female or androgynous.  Not as male.  But as male, I do not expect to.

I do wonder though how cool it would be, at the same time maybe not good at this moment professionally, to be presenting as male but almost everyone addresses me and treats me as female. 

The answer seems to be that at that point I would have arrived or am close to it, and that it may be then the time to go full-time.  I still need to prepare for that.

I wish you the best and thank you for serving as a moderator.  I am unsure what a moderator does here but you are involved and helpful, so again, thank you.

I am glad that Matthew is okay.

Chrissy

Chissy, at work, I am still presenting as male, albeit with a long ponytail, and small breasts, and my colleagues all treat me as female. Nobody uses my male name, even though I tell them they can until I start presenting as female!


Allie

[ChrissyRyan]

Chissy, at work, I am still presenting as male, albeit with a long ponytail, and small breasts, and my colleagues all treat me as female. Nobody uses my male name, even though I tell them they can until I start presenting as female!


Allie

That is nice.

Congratulations.   

Sometimes I think I am a gender imposter if I do not simply present myself as a woman to all of my clients and everybody.  I’m know I am not an imposter but... I am conflicted still in ways, not ready in ways.

I know my time will arrive!  I am happy for you.  You go girl!

Chrissy

[Linde]

Were you a medical researcher doctor or also a MD PhD, a MudPhud?

PhD in Biomedical Sciences, specialized in pre & postoperative infection control & prevention.  No MD and not a licensed physician, but present with critical surgical cases in some teaching hospitals to help prevent a negative outcome of surgeries.  Also investigating and consulting concerning the reason and source of nosocomial infections in hospitals.