Nurse Daniel Hardy, MSN, PMHNP-BC, PMGT-BC
Transgender healthcare
Transgender, nonbinary and gender diverse/nonconforming individuals seek mental healthcare for many reasons.
The stress of coming to know oneself as other-than-cis can be exceptional. Although the feeling of gender euphoria that comes with being Truly Seen as yourself is one of the best feelings in the world, it can be difficult to navigate a society that isn't always the most accepting. This difficulty, a form of minority stress, can impact you physically and mentally, leading to disease states. Having someone who understands to talk things through with can help.
Individuals who are seeking medical or surgical transition services may be required by their insurance to seek out a mental health consult for a letter of support. You can read more about my thoughts on medical gatekeeping at my blog
here.
Assessment flow
For those individuals seeking an assessment for surgery or hormones, I use the WPATH SOC v8, considered the "gold standard" for assessment worldwide, and used by most insurance companies in the USA. The SOC specifically endorse that exceptions are allowed to the guidelines, "[c]linical departures from the SOC may occur due to a TGD [trans/gender diverse] person’s unique anatomic, social, or psychological situation." This means that it's helpful to be totally honest with me; if your actual lived experience doesn't fit the "typical trans narratives," that's okay.
Because assessments always come with a lot of "unknowns" and unknowns often equal anxiety, especially in neurodivergent individuals, I'd like to take a moment to let you know how the assessment process works. It's usually completed in one 50 minute appointment. Unless otherwise required (for example, for urgent upcoming surgical cases),
I will ask you questions about:
- your relationship to your gender and how you came to understand it
- how you anticipate the treatment to improve your quality of life
- the severity and impact of other mental health conditions/neurodivergencies and impact of your gender experience on them (including how others treat/perceive you, and how you expect that may change after treatment).
- your ability to understand the treatment including any temporary or permanent effects, including potential reproductive limitations.
- your capacity to make an uninfluenced decision about treatment
- any previous gender treatments or affirming actions you may have experienced (social transition, unofficial or official name change, hormones, surgeries).
I will also determine whether or not there is a strong chance that other conditions are likely to be causing the gender incongruity/gender dysphoric feelings.
Some people believe that you have to have the right story in order to get approved for a letter- "I've always known since I was a little kid." "I want to do hormones first, then top surgery, then bottom surgery." This simply isn't true. The SOC require that the assessment is customized to the client's transition goals and needs. Just tell me YOUR story.
