Transgender Issues: A Guide for Therapists Working with Clients in Transition

EW: How long have you been married?

We were married as husband and wife for 5 years and as wife and wife for 3 ½ years for a grand total of 8 ½ years.

EW: How long did it take from start to finish initial consult to completed Gender Confirmation surgery?

Initial Phone Call to Schedule Consultation for GCS: May 6, 2013

Initial Consultation for GCS: March 3, 2014

Gender Confirmation Surgery: August 19, 2014

This is the timeline specifically for Gender Confirmation Surgery. Note the difference in time between initial phone call and scheduled consultation. This demonstrates how booked up my surgeon is. In fact, most GCS surgeons are booked out one to two years in advance. Furthermore, from consultation to surgery, my surgeon’s first available surgery date was 5 ½ months later!

EW: What are the various steps along the way? How did therapy play into the process?

NB: I entered therapy for two reasons. The first reason was that my gender dysphoria was pretty severe to the point that it was interfering with my life. It was important that I start talking to somebody about what I was experiencing before the dysphoria became uncontrollable.

The second reason that I entered into therapy revolved around the criteria from the World Professional Association for Transgender Health (WPATH) since most surgeons and hormone providers follow WPATH.

WPATH requires that you obtain a letter from your therapist in order to obtain hormones and to undergo Gender Confirmation Surgery. I wanted to make sure I was compliant with the criteria of WPATH and initiated counseling to begin the process.

This is just one of the many steps involved in transition—acquiring a competent gender therapist who follows WPATH Standards of Care. Some of the criteria required to undergo GCS include: well-documented gender dysphoria, medical and mental health concerns are well-controlled, 12 continuous months of hormone therapy, and 12 months living in the gender role that matches one’s gender identity. These are areas that must be documented by the therapist.


The following is a timeline of the steps that took place in my journey of transition from male-to-female. Keep in mind that not every Transgender person finds it necessary to follow all of the steps that I took.

The coming out process is generally a long one for most people and for me it was no different. The process began with coming out to my wife, Lori, followed several months later by coming out to my parents and Lori’s parents.

After talking with both sets of parents over the next few weeks, answering questions and providing resources, I moved on to coming out to my siblings and Lori’s siblings. Extended family came shortly after that. I started coming out to friends after all family was notified.

Sperm banking was another part of the process. Lori and I knew we wanted to have children in the future, but that Hormone Replacement Therapy would render me sterile. The prospect of having children was important to both of us, so we invested in sperm banking in order to make certain we could have our own biological children when the time was right.

Full facial electrolysis is the option I chose for facial hair removal versus laser treatments. I was interested in permanent hair removal as is the case with electrolysis compared to permanent hair reduction as is the case with laser treatment. I travel out of state for electrolysis in order to receive twilight sedation to reduce the severity of pain that comes with electrolysis.

Many Transgender individuals will initiate Hormone Replacement Therapy (HRT) as part of their transition. WPATH requires that you obtain a letter from your therapist to begin HRT. HRT is a lifelong process. My hormones are prescribed through an endocrinologist who specializes in working with Transgender individuals.

I chose to undergo Voice Therapy not only to learn how to raise the pitch of my voice, but also to practice other areas such as intonation, resonance, inflection, and linguistic style. My voice triggered my gender dysphoria. For Voice Therapy, I traveled across the state since there were not any services that were local.

Facial Feminization Surgery was one of the major surgeries that was part of my transition process. There are distinct differences between male faces and female faces that the mind can detect within the blink of an eye.

My surgeon and I decided together the changes that were necessary for my surgery. These included: hairline advancement, brow bone and orbital rim contouring, brow lift, rhinoplasty, cheek augmentation, chin augmentation, and tracheal shave. I traveled out of state to obtain this surgery.

Transgender Issues: A Guide for Therapists Working with Clients in Transition

Edie Weinstein Moser, MSW, LSW

Edie Weinstein, MSW, LSW is a journalist and interviewer, licensed social worker, interfaith minister, radio host and best-selling author. A free-lance journalist, her writing has been printed in publications and on sites such as The Huffington Post, Elephant Journal, Beliefnet, Identity, Inner Child Magazine, New Visions, Holistic Living, Conversations, Bellesprit, The Whirling Blog, The Doylestown Intelligencer, The Philadelphia Inquirer, YogaLiving, Wisdom, Mystic Pop, In Your Prime, the “What The Bleep Do We Know?” website and The Bucks County Writer. She has been interviewed by the Philadelphia Inquirer, Fox 29 news, CBS 3 news, WWDB 96.5 and National Public Radio as well as numerous blog talk stations. Check out her website at:


APA Reference
Weinstein Moser, E. (2016). Transgender Issues: A Guide for Therapists Working with Clients in Transition. Psych Central. Retrieved on August 10, 2020, from


Scientifically Reviewed
Last updated: 12 Apr 2016
Last reviewed: By John M. Grohol, Psy.D. on 12 Apr 2016
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