Friends and Family and a Patient’s Professional Support Group

If someone important to you does not identify with the sex and gender they were designated at birth, you can help them get the professional help they need.  The first thing you can do is reassure your loved one that they are not alone and that there are many talented and dedicated professionals ready to help.

Action points to get started:

• Educate yourself on transgender issues and help your loved one to find the information necessary to understand what they are feeling and what can be done to improve it. See:
  www.transfamily.org
• Together with your loved one, become familiar with the terminology being used. Use the Internet to explore the often confusing terminology employed by professionals, the general population, and by transgender individuals themselves to describe a condition that is variously referred to as a Gender Dysphoria (formerly gender identity disorder (GID), gender distress, gender conflict, or transsexualism. Essential resources are: www.wpath.org, www.cdc.gov, www.allpsych.com/
• Research online or contact by phone national or international organizations serving the transgender community to find a branch closest to you and go with your loved one to a consultation. Ask about referrals to trained professionals in your area who specialize in transgender issues. Seewww.community.pflag.org, www.ren.org, www.ifge.org

Building a Professional Support Group

If your loved one has been in distress for a long period of time, which is very often the case, they may already be in the care of a family doctor, local clinic, psychologist, psychiatrist and/or social worker. Offer to accompany them on their next visit and find out who is treating them and what treatment has been received. You may require written permission from your loved one to be given access to medical information. Remaining neutral and non-judgmental will help you in collecting the information you need.

Your goal is to be sure that the doctor, psychiatrist, psychologist, surgeon or other professional involved in treating your loved one is competent and qualified and has the certifications to ensure responsible treatment over an extended period of time.

Once you have read the guidelines laid out in the WPATH Standards of Care and are more familiar with the medical standards and terminology, you will have a better understanding of the complexity of the treatment. In general, a 3 stage program of treatment is recommended, keeping in mind that each individual patient is unique, so treatment must be tailored to fit that individual’s goals. The usual stages of treatment are:

• Examination by the patient’s primary care physician or physician experienced in hormone treatment for transgender patients to determine or rule out a hormone imbalance, genetic cause or other medical problem that may be causing the emotional distress, and also explore whether hormone therapy could be a viable option.
• Examination by a professional psychologist or psychiatrist experienced in treating transgender patients to determine whether Gender Dyphoria is the cause of secondary problems such as an eating disorder, substance abuse, or a self-image disorder, and set up a schedule of treatment.
• The same psychologist, or, alternatively, a professional counselor who advises transgender patients, can also explore with the patient the possibility of living for a monitored period of time in the desired gender to “test the waters” for a transition to the desired gender identity.

This 3-step approach has been found to be very effective in relieving distress and helping patients to build a more comfortable lifestyle and improved quality of life. Hormone therapy and psychological counseling can be lifetime commitments but are usually a worthwhile tradeoff for gender satisfaction.

When hormone therapy is not desired or is not a viable option for health reasons, or psychological therapy and hormone therapy are not enough to reach a sufficient level of gender satisfaction, the services of a plastic surgeon are usually desired. The plastic surgeon should be a board certified plastic surgeon  with experience in treating transgender patients and aware of the special needs both in preparation for surgery and long-term follow-up after surgery.

Checking a Doctor’s Certification, Education and Experience 

If your loved one is already in the care of a physician, ask for credentials. Usually a phone call to the doctor’s office will get you this information or a referral to a website listing describing his education, doctor certification and experience. Discuss with your loved one their level of satisfaction with their current doctor.  Do they feel progress or improvement is being made? Do they feel comfortable asking intimate or personal questions? Seeking a second opinion is a natural step if progress is not being made, and most doctors are understanding and helpful in this respect. Sometimes the doctor-patient relationship is fine but the doctor does not have experience in hormone therapy for transgender patients; in that case, ask for a referral to a specialist they respect.

If your loved one is already under the care of a psychologist or psychiatrist, use the same procedure to check psychiatrist certification and specialized training, and ask your loved one what their level of satisfaction is with rate of progress and rapport with the doctor. Seek a second opinion if necessary.

Collect referrals from national organizations set up to support transgender and gender non-conforming people, and be prepared to make a lot of phone calls. See above and Helpful Links. Make a list and keep notes. Since insurance coverage is almost always an issue, the first two things to determine are whether the doctor is accepting new transgender patients and whether they accept your loved one’s insurance plan. You will usually be speaking with an office manager or administrator so ask pertinent and specific questions (“How many transgender patients does the doctor treat?”; “Do they work with transgender support organizations? “Do they follow the WPATH Standards of Care?”, “Do their patients like them?, “Are they easy to talk to?”…etc.).  Keep in mind geographical location and accessibility to public transportation.

When the time comes for plastic surgery to be considered, checking surgeon competence is much the same procedure. Often the attending physician or psychiatrist can make a recommendation, and many national support organizations maintain lists of surgeons who work with transgender patients. A plastic surgery procedure such as MTF breast augmentation or FTM chest reconstruction – or the very specialized genital sex reassignment surgery procedures—can be performed in another city or state as long as the surgeon is willing to communicate with the other medical professionals managing the patient’s treatment.

Board certified plastic surgeon  Dr. Scott Mosser, treats patients from all over the world in his downtown San Francisco clinic. He is an ideal example of what to look for in a surgeon. He has advanced training from top medical institutions and experience in MTF Breast augmentation and FTM chest reconstruction. He and his team of professionals are familiar with the transgender community and the complexities of treatment and special needs, and they can make arrangements for out of town patients.  His patients find him welcoming and non-judgmental, and very easy to communicate with. He also encourages his patients to bring a friend, partner or family member with them, and he is happy to coordinate with the medical professional on the support team.

Family members, friends, or a partner can ensure that their loved one is in the care of competent and certified medical professionals. This service can make a crucial difference in achieving a successful treatment and transition to gender satisfaction and a better quality of life.