It is not a therapist's job to figure out whether you're really trans. We should not be auditing your story to ensure you had the “right” childhood, the “right” type of distress, or the “right” kind of certainty. The therapist’s role is to help you become more aware of what’s happening inside you, no matter what that internal conversation looks like. I'm a gender therapist practicing online across Washington state, I work from lived trans experience, and I don't have a test for you to pass. Certainty counts. Questioning counts. "I don't know what this is yet, and I need somewhere to think out loud" counts.

The heavy screening built into older models of gender care was supposed to prevent regret, and it turns out there was never much regret to prevent. The largest analysis to date, pooling 27 studies and nearly 8,000 patients, found a regret rate of about 1% after gender-affirming surgery — one of the lowest figures documented for any elective procedure. And in the rare cases where regret does occur, the reasons people report are frequently related to social factors, such as family acceptance.

And if what you need right now is paperwork rather than therapy (a letter for surgery or hormones, or a gender dysphoria assessment) I also offer gender-affirming letters and assessments.

Gender exploration without a required destination

Some people come to gender therapy already knowing who they are, and what they need from me is support, not evaluation. Others come with a question that has been circling for years. Exploration here doesn't obligate you to anything. Starting therapy is not a first step down a conveyor belt toward transition, and it's also not a place where anyone talks you out of it. Every honest outcome is a good outcome: trans, nonbinary, cis, or "still figuring it out and no longer panicked about that."

Some people who are holding a gender question have spent years arguing with themselves before they ever say it out loud. Therapy can be a space to get the argument out of your head and into a room, where nobody has a stake in the answer except you.

Support through transition — social, medical, or both

If you are transitioning, or deciding whether to, there's a lot of terrain to cover: names and pronouns, coming out to family or at work, navigating medical systems that range from wonderful to exhausting, changes in your body, changes in how strangers treat you, dating, documents, timing. I've walked terrain like this too, which mostly means you spend less session time explaining and more time on what's actually yours to work through.

Our feelings about transition are often complicated. You can be certain about what you're doing and still grieve what it costs. You can feel joy in your body for the first time and be frightened of what that joy makes visible. None of that is a warning sign, and none of it means you're doing it wrong. There are often different parts of you holding each of those feelings at once, and parts work gives every one of them somewhere to be.

Transition support also means dealing with the world as it is. Family who may not come along, workplaces that require strategy, a political climate that adds real weight. We plan for real conditions, not ideal ones.

Trauma work, when you want it

Gender and trauma get tangled together badly in a lot of clinical settings. Being trans or nonbinary is not a disorder, not a symptom, and not something that needs a traumatic origin story to explain it. I will never treat your gender as the wound.

But many trans and questioning people are carrying actual wounds: family rejection, religious shame, harassment, bullying, medical mistreatment, or trauma that has nothing to do with gender at all. When you want to process that, we can. I'm an EMDR and complex trauma therapist, and I pace that work carefully, in doses small enough to stay tolerable. When you don't want to, we don't. You set the agenda. Plenty of gender-affirming therapy never touches trauma processing, but it can if you want it to.

Intersecting identities

In a study of transgender adults, people who delayed health care because they feared discrimination had roughly three times the odds of current depression and nearly four times the odds of a past-year suicide attempt, compared with people who didn't delay. Bracing for mistreatment keeps people out of care, and staying out of care can be harmful.

That's one of many reasons clinician fit matters: we need to be able to trust that we won’t be discriminated against in the therapy space. I'm a trans therapist who is also kink-aware and non-monogamy affirming, neurodivergent-affirming, and trained in EMDR and parts work for complex trauma. Trans lives don't sort themselves into specialty silos. If you're trans and kinky, or nonbinary and autistic, or questioning your gender while untangling religious trauma, you shouldn't need a different therapist for each thread, or a therapist who affirms one part of you and quietly pathologizes another. None of that makes you a complicated case. It's the ordinary shape of the lives my practice is built around.