For those of us who do not identify as transgender, we infrequently have a moment in our lives where we have to prove to others the gender in which we live. In cisgender males and females, there are millions of stories of breast augmentation or reduction, hormones used to increase testosterone and estrogen, and a long list of medications that reinforce one’s ability to perform certain acts associated with one’s lived gender. By the way, that’s all gender-affirming care. 

However, most cisgender people are forced to answer the question, when did you know you were male or female. It was always just that way, and when cisgender people want to fully express their gender, there is a plethora of care available to them without question or reservation among their healthcare providers or the insurance companies that approve it. 

Honoring Identity through Affirmative Care

Gender is a social construct that we tend to articulate in the binary of male and female. Sex assigned at birth results from identifying one’s reproductive organs, male, female, or intersex. So, when talking about transgender-affirming healthcare, we are talking about the care providers can deliver to support an individual to live in their experienced gender per the society in which they exist. 

Here’s the stark reality about transgender-affirming healthcare, and it applies to you, me, and everyone we have ever met. We know ourselves better than anyone else can or ever will know us. We can honor one’s identity by acknowledging and embracing it, providing supportive services that enable our patients to achieve their healthcare goals, and overcoming limitations in ourselves and within the systems we work to deliver quality healthcare. 

Mindful Mental Health Support

Transgender healthcare here is not solely about prescriptions and procedures but about understanding and compassionately addressing the unique challenges faced by this community. The biggest challenges are prejudice and discrimination in the form of transphobia and violence, which are often embedded in the healthcare systems all of us are required to use. As we are seeing across the United States, vast numbers of legislatures are attempting to enshrine discrimination into the legal system meant to protect our rights to life, liberty, and the pursuit of happiness. 

In the mental health realm, counselors are frequently asked for a letter that confirms their client’s experienced gender before medical practitioners agree to provide treatment or insurance companies will approve care. 

Informed Consent in a Gatekeeping System

Counselors face increasing challenges when attempting to provide transgender-affirming care. Not all counselors can provide this care due to a lack of training or experience. Worse yet, stories abound about counselors who reject clients due to their “sincerely held religious beliefs” or who attempt conversion therapy. None of this is helpful to the person simply trying to live in a way that feels right for them, which we all have a right to do.

What often goes unidentified in the counselor’s office are the models through which transgender-affirming care can be delivered. On the one hand, we have the informed consent model. Simply put, we offer transgender clients information and resources to make the best decision for them.

On the other hand, when asked for clinical documentation, we are put in the position of treatment gatekeeper. In such situations, your counselor can still apply the informed consent model to enable you to achieve your healthcare goals. It’s just a bit more complicated. 

In the case where a transgender client must comply with the gatekeeping model due to medical or insurance requirements, your counselor can help you to develop the “evidence” that this model requires. Here are a few ways that can be done:

• Assessment: Your counselor can provide a clinical evaluation (think of it like a survey) to put a number to your gender identity. Even writing it sounds strange, but this data point is just one of many ways to articulate the incongruence between one’s sex assigned at birth and one's experienced gender. 

• Observation: Your counselor can track their observations of your gender identity as you move through the social transition, which can provide further evidence of readiness for any medical transition you seek. 

• Timeline: One of the ways to “prove” to the powers that one’s gender identity is persistent is to create a gender timeline that articulates your thoughts, feelings, and bodily sensations associated with one’s gender identity. 

• Narrative: The narrative is literally like writing the story of your gender identity. Each of the above items can be used to inform the narrative. What’s great about this tool is that it allows you to form thoughts and language specific to your experience and prepares you to manage obstacles in the process should they be placed before you. 

Remove Discrimination from Practice

At Indigo Path Collective, we practice informed consent. Even when you need a letter to clinically document your gender experience, we will work with you to do what is required to achieve your healthcare goals legally and ethically. In all cases, our goal is to support your healthcare journey in a way that is void of discriminatory practices and to help you enlist a supportive healthcare team committed to doing the same. We do our best to help you navigate the system in the most gender-affirming way possible, which we all know is a pretty tough thing to do in our current environment. But we do so because all of us deserve the opportunity to live a fulfilling life.