Sexuality, veterans, and first responders?
Yes, I know what you’re thinking—you can see an obvious connection between the veteran and first responder groups, but how did sexual identity development get in there?
Believe it or not, there is a logical explanation.
We live just south of the California-Oregon border in a rural mountain community desperately lacking in mental health services. Just out of grad school, I had not developed a niche, yet, so I was pretty much willing to see anyone within my scope of competence to acquire the hours needed for licensing. Figuring I can always refer a client out if needed, I checked almost all of the diagnostic boxes on my new PsychologyToday.com profile, including those related to sexuality. Within days, I was shocked to begin receiving calls from individuals experiencing gender dysphoria. “You realize I’m still an intern, right?” I asked, replied by, “But you’re the only one between Portland and San Francisco who checked those boxes!”
Knowing a few of my favorite grad professors had private practices, I went straight to them to ask why they had not checked the boxes for this already marginalized population. “It’s not that we are discriminating against this group,” they said, “the problem is we are not professionally competent to treat them,” explaining a therapist must be trained in evidence-based models to treat gender identity development while staying abreast of standards of care and available medical interventions to provide accurate diagnostics, treatment, and medical referrals. Therapists must also develop working relationships with local medical providers (i.e., physicians, electrologists, endocrinologists, surgeons, urologists, and gynecologists) who provide these interventions.
Given the narrow breadth and deep complexity of this population’s needs (combined with the already limited census of our rural community), who would blame me for joining my professors in shying away from this group? But after talking with just a few of these individuals, I was amazed how refreshing it was to meet them, to hear their stories with such unusual clarity of purpose in seeing me. And even if they were previously uncomfortable even thinking about it, I really appreciated their willingness to trust me with their most intimate thoughts, feelings, fantasies, and fears concerning their bodies. Most of all, I was struck by their level of self-motivation to engage in therapy and do their work, making my job a breeze.
I could also see these were not sick people, they were tortured and conflicted, suffering from the incongruence of internalized environmental expectations (the shame and guilt that keeps all of us trapped when living for others rather than ourselves). Once we’ve teased out all of that, what remains is typically their actual identity, and I observe a synergistic change occur. Taking the ball and running quickly with it, they become exponentially happier day by day, and my role transforms to providing psychoeducation, coordinating any necessary medical interventions, and helping orchestrate a life (and relationships) to nurture that identity.
My revelation summer 2020
No transgender identity?
I’d like to point out here that despite the fact I once had a sign outside my office stating "Transgender Therapy," I no longer consider myself to be a “transgender therapist.”
It was while seeing a precious preadolescent kiddo last summer that I had the revelation I was not comfortable saddling him the rest of his life with such a destabilizing, incongruent, politically-charged identity as "transgender."
Why would I not, instead, wish for this child to walk out my door on a mission to live the remainder of his life a normal member of society?
That got me thinking… I am not treating "transgender people"—I am treating people suffering the debilitating incongruence of gender dysphoria, by definition, a sadness caused by incongruent neurologically/physiologically developed sex traits.
I have also come to believe not everyone with gender dysphoria needs to medically transition their bodies, and hope that, ideally, someday in the future, our society will just accept themselves and others the way God made them, even if it includes such physical anomolies.
Summer of 2020, I also came to the realization I can no longer accept the word "transgender" as an identity, and any clinician who encourages a client to adopt it is acting out of both ignorance and clinical recklessness.
I will not get into the history of the word transgender here, but it would be a fantastic topic to explore in a future podcast. However, I will say it was poorly articulated and introduced by way of scholarly journals as an “umbrella term” to include non-binary, gender fluid, and other ambiguous expressions.
Medical model—Not LGBTQIQ+?
Because it reflects the way I think, let me also say I approach gender dysphoria through the medical lens, as opposed to the political LGBTQIQ+ nonprofit political lens inadvertently used by almost every one of my colleagues in the mental health field. In fact, the sooner my clients get away from these political identities, with social strings attached, the sooner they can integrate their identities to a single sex and get on with their lives as a normal, self-actualizing member of society in all their endeavors.
I have come to believe very strongly much of the internalized torture and discrimination my clients complain about is the result of the political polarities created by the LGBTQIQ+ groups. In fact, when the topic of what I do for a living comes up with my conservative friends, I validate their frustration with the political polarities separating our society and then I explain how the baby develops, the consequence of incongruent brain/body sexual development, and the personal experience of people with gender dysphoria simply wanting to fit into society. At this point, they are curious and even a little compassionate. Asking me one question after another, what was meant to be a 5-minute explanation of what I do for a living turns out to be a two-hour enlightenment for which they express deep appreciation.
What is the medical model?
Thanks to technological advances, research in this area is improving our understanding of neurological sexual identity every day. For example, brain scans show us there is a visible difference in the size and shape of significant nerve bundles between male and female brains. We also know all embryos start out as female until genes are activated to drop the ovaries to become testes, sending the physical body on its journey to develop male traits. In the case of the majority of my clients, who are feminizing their bodies from male to female, we now know it is possible they were genetically meant to be female, their brains already hardwiring into female brains when something happened, such as the adrenals creating too much DHEA (an androgen) or their mother’s hormones fluctuating during a critical window of fetal development, erroneously triggering the drop of their ovaries, thereby dooming their bodies to part from their already-hardwired "female brain" to develop masculine traits.
Unfortunately, we do not scan babies’ brains at birth to identify the hardwired sex between their ears, we simply look at the more easily identifiable physiological sex between their legs.
The mental health field learned the hard way that while it is possible to change the sex between the legs, it is not possible to change the hardwired sex between the ears.
So, in conclusion, the main construct of my revelation is this: if a person is born with a female brain and will live and eventually die of old age with a female brain, where is the transition? If anything, in my opinion, there is a medical intervention to correct the incongruence created during fetal development.
It is a medical procedure meant to be private and allow people to enjoy happy, productive lives as the sex hardwired between their ears.
Believe it or not, most of my clients eventually identify as heterosexual females, and they get angry when people confuse them with being gender fluid, nonbinary, hedonistic, or politically-motivated to shove their personal medical problem down the throats of others.
Contrary to common belief, my clients do not necessarily enjoy talking about their private parts nor did they ask to be a part of the LGBTQIQ+ rainbow campaign.
Needless to say, I’ve sunk my roots deeply into sexual development and gender dysphoria. Surprisingly, it was not long before I had a full case load, including clients contacting me from hundreds of miles away in all directions via telehealth.
Psych Armor for Veterans…
Upon licensure, I was contacted by the VA with referrals for veterans through what was previously called the CHOICE Program, now Community Care Network (CCN). Although these referrals were not meant to be gender-related, I have family members who served in the military, and the idea of supporting them is dear to my heart.
So, I chose to go ahead and accept the referrals and participated in Psych Armor clinical training to learn more about the military culture.
I was prepared to see VA referrals for anxiety, depression, PTSD, relationship troubles, and substance dependency, but I was not expecting to see 70% of my VA referrals present with symptoms of gender dysphoria! (Upon meeting my new VA clients, I have discovered that joining the military happens to be a common strategy for people with gender dysphoria to placate their loved ones and temporarily suppress their symptoms.)
It has been a true honor supporting my veteran clients; it makes me feel good to know I can be there for them and help them improve the quality of their lives and relationships.