Transgender Support Before, During and After Transition
Supporting the LGBTQIA community is important here at Kimberly Keiser and Associates. In our ongoing Sex Plus Symposium training series, Dr. Xtine Milrod joined our team to discuss questions our team had in order to best serve our transitioning and transgender patients.
Dr. Milrod holds an M.A. in clinical psychology and a Ph.D. in human sexuality. They are a licensed Marriage and Family Therapist (LMFT) and certified WPATH Transgender Affirmative member and mentor, and a full member of the International Society for Sexual Medicine.
They specialize in sex therapy, sex and life coaching and psychotherapy with an emphasis on human sexuality, evolutionary psychology, sexual/gender identities and dealing with socially constructed gender roles. Milrod also works with transgender issues and is a member of the Gender Dysphoria Affirmative Working Group, dedicated to broad based affirmative treatment and support of gender diverse youth.
To review more of Dr. Milrod’s credentials and clinical and research interests and work, visit any of the sites below, or you can view some of their talks and appearances on YouTube.
For this Sex+ symposium speaker session, our therapists provided Xtine specific questions that come up in routine practice.
Have you ever had these questions? We hope you enjoy learning about these trans/gender/diverse (TGD) topics as much as we did!
Sexuality During Transition
Therapist Question: Have you found the need for sexual exploration to be a common experience once an individual begins to feel congruent with their self, such as after physically transitioning? How would you suggest they step toward that curiosity while also maintaining an existing relationship?
Answer: Affirming someone’s gender can be very liberating.
Before transitioning, it is extremely common for trans-persons to experience gender dysphoria and display a form of asexuality — or even identify as asexual — prior to using hormone treatment, surgery or otherwise affirming their gender.
Then, as they transition, it is also common for people to experience gender euphoria and sexual curiosity. They may even question their sexuality or want to explore what it’s like to be sexual with someone other than who they thought they were attracted to.
Some trans people who are already in a committed relationship but are questioning or want to explore their sexuality will usually consider how to bring their chosen partner along with them on their journey. They may wonder if an open relationship would be valuable or necessary.
Using an example of a trans woman: though she was assigned male at birth, she was in what she called a lesbian relationship prior to using hormone treatment to affirm her gender. After several months going through hormone replacement therapy (HRT), she is beginning to question her sexuality and consider whether she is attracted to masculine individuals — and whether or not an open relationship would be the right decision.
The pitfall of an “open relationship” is how vague the term really is. What does an open relationship mean to the trans woman and her partner? What are the boundaries? These discussions need to happen to maintain a solid relationship and support the trans woman in her exploration.
“Passing” One’s Transition
Therapist Question: How do you approach individuals experiencing difficulty with passing once transitioned?
Answer: The difficulty with the thought of “passing” as an individual’s chosen gender is that it’s not only toxic, but also very culture-specific.
For example, what we think of as feminine can be very different in Los Angeles, Georgia, or in South Dakota. The term “passing” also strictly narrows norms of who is feminine and who is masculine, and it usually affects trans women more readily than trans men.
Clients and therapists should work on strengthening the trans person from the inside to shift their way of thinking about “passing.” Instead of comparing yourself to what’s on TV or Instagram, find and explore peer communities — whether on social media, such as the International Transgender Health Facebook group, group therapy or in one-on-one sessions.
Transgender Support and the Autism Spectrum
Therapist Question: How do we best support someone who is on the spectrum and has black and white thinking in regards to the transitioning process? I am curious about how to support transgender clients on the spectrum on issues they would benefit from (e.g. improved socialization) but that they are not interested in.
Answer: Neurodivergence can be difficult to navigate in general — and if a person is both transgender and on the autism spectrum, that can make it even more of a challenge.
One of the hallmarks of being on the autism spectrum is a feeling of being consistently misunderstood. People with autism may have a difficult time in social settings and feel like they can’t connect with others.
Another part of being on the spectrum is being very literal, what some people call “black and white” thinking. Add in anxiety around being transgender, especially if they aren’t supported or don’t trust those they work with or are in their lives, and the difficulty becomes exponentially greater.
Being neurodivergent is not a liability. There is beauty and positive aspects in neurodivergence. Finding ways to emphasize and embrace your strengths is important.
One way to find those strengths and maintain more control — another important thing for people on the autism spectrum — is to find community. There is a large online community of people who are both neurodivergent and gender divergent. Finding this community can be very affirming.
Another thing to remember is that confronting an issue immediately can feel overwhelming in the moment, so it’s okay to take a step back and process the issue in their own time. It’s also okay to revisit an issue a number of times and to allow the space to react and digest it how they need to do so.
Past Trauma in Transgender Individuals
Therapist Question: Are you familiar with the literature on sexual abuse recovery in working with adult survivors of childhood sexual abuse? I currently have a case where the trauma appears to be two-fold: from the abuse and from gender dysphoria. They were abused while presenting as female, but are doing sexual abuse recovery post-transition.
Answer: If a person was abused while in the gender they were assigned at birth, they can deal with trauma both from that abuse and also from the gender dysphoria that can come before transitioning.
For example, if the abuse happened to a person assigned female at birth, the masculine identity of this person was never known or understood by the abuser. The masculine, in this instance, has an opportunity to bloom and take action.
There is incredible possibility for healing in this situation. Using an Internal Family Systems (IFS) framework, this trans man can consider how he wants to protect himself and the little girl he used to be. How can he use his masculinity in the service of resilience, strength and healing? By exercising his own power, he can heal.
The roap map to sexual abuse recovery can be complicated by many factors — not just gender identity or transition. It is important to unravel any aspects that add complexity to sexual abuse recovery when working with victims of sexual abuse.
Kimberly Keiser & Associates provides individual therapy for TDG clients, as well as TDG support group psychotherapy.
Gender Pronouns in Social Situations
Therapist Question: What is your opinion on using gender pronouns being required in some social or work settings?
Answer: Identifying your pronouns has become more normal in many situations in our country today. However, some people feel uncomfortable when they’re asked to announce their pronouns in social settings.
Look at announcing your chosen pronouns as a common courtesy. This is one of the things that people are consciously thinking about and training themselves to do. To someone who may not look like their chosen pronouns, it can be very inclusive to have someone consider it the norm to announce their pronouns.
By announcing your pronouns when requested, you are part of this social movement to educate others. And the more you do it, the more comfortable you will likely become.
Discussing these topics around trans/gender/diverse (TGD) healthcare is extremely important today. Our therapists are respectful and supportive of every patient who comes to us for help — whether in one-on-one sessions or as part of TDG support group psychotherapy.
If you are looking for more understanding, education, support or other help, contact us today.