Research has shown that living authentically improves mental health outcomes for transgender and gender-nonconforming (TGNC) individuals (Fredriksen-Goldsen et al., 2011; Riggle, Rostosky, McCants, & Pascale-Hague, 2011). We see helping TGNC people live authentically as part of fulfilling the American Psychological Association’s mission to use psychological knowledge to improve people’s lives.
TGNC individuals have the opportunity to transcend the socially defined gender binary, developing a unique perspective of what it means to be male and female. Those who come out report feelings of freedom, enhanced personal relationships, a greater connection to the LGBT&Q communities, a higher level of political activism, and an enhanced sense of self. Being transgender or gender-nonconforming represents a unique experience that may bring benefits not experienced by others (Riggle et al., 2011).
Most health insurance policies require TGNC individuals to obtain referral letters from mental health professionals in order to receive coverage for hormone replacement therapy (HRT) and gender-affirming medical procedures (Grant et al., 2010). The World Professional Association for Transgender Health (WPATH) requires that letters include the results of a mental health screening. Our staff will be available to work with you through your process. At our clinic, the collaborative development of a letter for medical providers entails the following steps:
- Schedule an initial one-hour consultation with a clinician to discuss your needs and goals.
- Complete a two-hour assessment, which includes a structured clinical interview and a mental health evaluation. Information gathered during the consultation and evaluation can be incorporated into the letter.
- Meet individually with the therapist to write the letter together. This usually takes about two additional hour-long sessions, but may require more.
Living out an authentic gender expression can pose practical and psychological challenges due to social and systemic factors, which can contribute to distress. Though not a requirement for obtaining a letter, WPATH strongly recommends participation in psychotherapy. Studies have found that TGNC individuals have a number of increased risks:
- Family rejection (Gay and Lesbian Medical Association, 2010; Grant, Koskovich, Frazer, & Bjerk, 2010)
- Stress (Riggle et al., 2011)
- Depression (Cook-Daniels & Munson, 2010; Fredriksen-Goldsen et al., 2011; Nuttbrock et al., 2015)
- Suicidality (Fredriksen-Goldsen et al., 2011; Hatzenbuehler, Phelan, & Link, 2013)
- Substance use disorders (Fredriksen-Goldsen et al., 2011; Mayer et al., 2008)
- Sexual trauma (Grant et al., 2011)
- Discrimination (Grant et al., 2011; Reed, Franks, & Scherr, 2015)
- Hate crime victimization (Fredriksen-Goldsen et al., 2011; FBI, 2015).
In addition to providing gender-affirming psychological care, we can address other mental health concerns you might have, including depression, anxiety, eating disorders, and OCD. Whether you’re seeking a letter for medical providers or need help with a mental health concern, our staff has the training and expertise to address your needs.
- Cook-Daniels, L. & Munson, M. (2010). Sexual violence, elder abuse, and sexuality of transgender adults, age 50+: Results of three surveys. Journal of GLBT Family Studies, 6(2), 142-177. doi: 10.1080/15504281003705238
- Federal Bureau of Investigation. (2015). Hate crime statistics, 2014. Retrieved from https://www.fbi.gov/about-us/cjis/ucr/hate-crime/2014
- Fredriksen-Goldsen, K. I., Kim, H. J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., . . . Petry, H. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health.
- Gay and Lesbian Medical Association. (2010). Healthy living 2010: Companion document for lesbian, gay, bisexual, and transgender (LGBT) health. Retrieved from http://www.glma.org/_data/n_0001/resources/live/HealthyCompanionDoc3.pdf
- Grant, J. M., Koskovich, G., Frazer, M. S., & Bjerk, S. (2010). Outing age 2010: Public policy issues affecting lesbian, gay, bisexual and transgender elders. Washington, DC: National Gay and Lesbian Task Force Policy Institute.
- Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force. Retrieved from http://www.thetaskforce.org/static_html/downloads/reports/reports/ntds_full.pdf
- Hatzenbuehler, M. G., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813-821.
- Mayer, K., Bradford, J., Makadon, H., Stall, R., Goldhammer, H., & Landers, S. (2008). Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98(6), 989-995. doi: 10.2105/AJPH.2007.127811
- Nuttbrock, L., Bockting, W., Rosenblum, A., Hwahng, S., Mason, M., Macri, M., & Becker, J. (2015). Transgender community involvement and the psychological impact of abuse among transgender women. Psychology of Sexual Orientation and Gender Diversity, 2(4), 386-390. doi:10.1037/sgd0000126
- Reed, O. K., Franks, A. S., & Scherr, K. C. (2015). Are perceptions of transgender individuals affected by mental illness stigma? A moderated mediation analysis of anti-transgender prejudice in hiring recommendations. Psychology of Sexual Orientation and Gender Diversity, 2(4), 463-469. doi: 10.1037/sgd0000138
- Riggle, E. B., Rostosky, S. S., McCants, L. E., & Pascale-Hague, D. (2011). The positive aspects of a transgender self-identification. Psychology & Sexuality, 2(2), 147-158. doi:10.1080/19419899.2010.534490
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