I've been working with trans* people for many years, and I know there are considerations that are particularly important to you when you select a therapist.  One of those has to do with the historical function of therapists as "gatekeepers" for accessing needed services like hormone therapy or gender affirming procedures and surgeries.

I want to be very clear about my mission as a therapist to trans* people:

What I Won't Do

I will not stand in your way.  I will not ask you to undergo an extensive therapeutic process to prove to me that you are making "the right choice" about your sex and/or gender.

What I Will Do

I will function as your advocate.  I will teach you what I know about how to better advocate for yourself.  I will provide you with support in making informed decisions about your body, your mind, your emotions, and your spirit.

WPATH and Informed Consent for Access to Medical Care

I encourage all my clients to be aware of and review in detail the WPATH (World Professional Association for Transgender Health) Standards of Care, 7th Edition (2011).  It's online in PDF format, and can be accessed here: 


I follow these standards of care in my practice, using an informed consent model.  Informed consent means that you have the intellectual capacity to make an independent and informed decision about your healthcare, that you understand the potential risks and benefits of the decision you are making, and that no one is coercing you into making that decision.  I believe that while therapy can be a very important and helpful part of your gender transition, you do not necessarily need to be in therapy in order to request that a mental health professional confirm your ability to make decisions about what you would like to do with your health and your body.  You should be able to access healthcare in the same ways that anyone else would access healthcare -- by calling your medical provider of choice and requesting an appointment.  And a therapist should be able to serve as an advocate, not as a gatekeeper.  For that reason, I offer a service that I call a gender consult.

Gender Consults

If you are interested in medical transition and/or seeking recommendation for trans* healthcare, I will meet with you to discuss your history, present experience, and plans for the future of your transition.  This is generally a one-time meeting, and will take about 90 minutes.  In almost all situations, after we talk I will be able to provide you with an assessment and recommendation for hormones or surgery, depending upon where you are in your process.  My fees for doing so are a flat rate of $150 for hormone therapy, and $250 for surgery (it's more expensive because the assessment is more complex, and typically our consult will take more time).  Please be aware that if you are looking to start hormone therapy, there are doctors in the Seattle area who also use an informed consent model, and do not require a letter of recommendation.  I encourage you to explore your options, and choose the medical provider who is the best fit for you.

After we meet for your consult and documentation has been provided if necessary, it is completely up to you to decide whether you would like to establish an ongoing therapeutic relationship with me.  I understand that some people are just seeking access to needed medical services, and are not interested in therapy at this time.  I've found, however, that it's not just about "writing the letter."  The gender consult provides a great opportunity to offer you information and resources about which you may not currently be aware -- and to establish a relationship with you which leaves the door open to the possibility of working together in the future.

I share all this information with you so that you can choose to come to me knowing that I don't think you NEED therapy because you are trans*.  You may WANT to come to therapy because challenges can arise around the process of negotiating your transition and your gender expression -- and it's also equally likely that you might need support in something that has nothing to do with your gender at all.


I know that the first time you meet a therapist can be really anxiety-provoking.  Who is this person?  How can I know it's okay to trust them?  What do they want to see when they meet me?  What do they expect? 

Please, come as you are without reservation.  Don't dress up, or down, or alter your presentation in any way that makes you the least bit uncomfortable.  Speak with your voice, however it might sound today.  Use whatever name makes you smile -- I don't need to call you by your legal name.  Just be yourself.  I want to meet YOU!