Frequently Asked Questions about Assessments

What is the purpose of an assessment session?

The purpose of an assessment session is to provide support to the individual in establishing a diagnosis and delineating appropriate treatment for that diagnosis. In this case, an assessment session is scheduled to determine if you have Gender Dysphoria, a recognized diagnosis in the DSM-V (the handbook of disorders and diagnoses for mental health providers in the United States) as well as the ICD-11 (the international handbook of disorders and diagnoses). I will investigate that diagnosis by asking you questions about your life, history, and possible symptoms of Gender Dysphoria. If, through that process, I am able to establish a diagnosis of Gender Dysphoria, I can then write a letter of support, which compels your insurance or healthcare providers to provide you with treatment appropriate to the diagnosis of Gender Dysphoria, including surgery. The assessment session is also to determine if you have any other mental health diagnoses that explain your symptoms better than Gender Dysphoria, or which might interfere in your ability to make sound, well reasoned medical decisions on your own behalf.

Will the assessment help me determine if I want surgery?

No. The purpose of this assessment is to establish a diagnosis, and advocate for the care that can provide relief and affirmation for many individuals with that diagnosis. Whether you believe you will be one of those individuals in an important question, and one you should take time to explore and address on your own, and with people whom you trust, including friends, family, or a therapist whom you see regularly. While not required for transition, getting connected to and talking with a therapist regularly about your feelings about gender, identity, sexuality, and your own experience is highly recommended, and can be a tremendous benefit in helping you determine your transition goals and what feels best for you, as well as in dealing with some of the associated difficulties of transitioning and living in an often transphobic or trans hostile world.

Gender variant and transgender people are a highly diverse group, and your relationship to your body, your identity, and your gender is personal and unique. While I can provide more information to you about surgical procedures and recovery, as well as information from research on surgical satisfaction, the assessment session is NOT a substitute for a robust and personal decision making process.  The reasons that individuals choose to pursue or not pursue medical transition and/or specific procedures are complex, and it is highly recommended that you take time discussing and exploring this choice, including how it fits to your own understanding of your gender and goals. If you are interested in therapy with me or someone else to examine these questions more, please reach out – I’d be happy to connect with you if I have space for new clients, or provide referrals to trans competent providers who can help you explore more.

As a provider, do you agree with this process?

No, I fundamentally do not. Trans people, like all people, have the right to bodily autonomy, and to decide what to do with their bodies and how willing and able they are to live with the consequences of their choices, bodily or otherwise.

It is important to note that these criteria – getting letters and evaluations from mental health professionals – were initially adopted to help folks access care, not to prevent them from getting it. The standards of care (SOC) set in place by the World Professional Association for Transgender Health (WPATH) (which require individuals to get letters of support) first existed as a way to demonstrate that trans people could get medical treatments and that they could be effective in reducing distress, during a time when it was thought trans identity was just pathological itself and should be eradicated (i.e. that trans people should be forced to be cis, and that cross-gender identification is delusional). The SOC were developed in order to demonstrate that gender dysphoria is real, and logical, and able to be diminished with medical interventions: that trans people actually get better, and happier, not by denying their gender identities, but by expressing them, and being empowered medically to do so.

However, in our current and different era, this process can serve to keep people from pursuing surgery who otherwise would, invade people’s privacy, or otherwise add unnecessary steps, costs, and burdens to often already quite burdened people. As a provider, I operate from an informed consent perspective and believe that the same criteria of mental fitness that empowers you to be able to sign legal documents, work, and make other binding decisions (including medical ones) should also empower you to make medical decisions related to transition.

In my practice and in my life, I hope and work for a world in which I never have to write you a letter.