what a young transgender client needs from their therapist(s)

Emily Marie Williams, 2019-03-16
© 2019 Whole-Systems Enterprises, Inc.

Who I am: Credentials or Something?

I’m not a psychologist, not a social worker, not a medical doctor. In fact, I’m not a doctor of any kind. Just a highly intelligent and introspective citizen scientist. (Yes, I hold a baccalaureate).

Oh, and I happen to be transgender: Thirty-nine years living publicly as a man, approaching four years living publicly as a woman.

And I’ve studied the science of gender identity in exhaustive detail; I happen to be a scientist by trade.

And I’ve seen more therapists than I care to count.

First Define Therapeutic Goals

All Ages

Let’s first define therapeutic goals, appropriate for transgender clients of any age:

  • Client learns they are responsible for their own learning
  • Client learns suicide prevention and distress tolerance skills
  • Client learns how to respond emotionally and socially to harassment and bullying
  • Client learns how to respond emotionally and strategically to discrimination
  • Clients learn the correct language and choose what applies to them
    • “Transgender” vs. “transsexual” vs. “intersex” vs. “transvestite” vs. “cross-dresser” vs. “genderqueer” vs. “drag queen” vs. etc.
    • Gender identity vs. sexual orientation
    • “Trans” vs. “cis”
    • “Transwoman” vs. “transman”
      • E.g., a man who becomes a woman is a “transgender woman”, not a “transgender man”!
    • Why the “T” is included in “LGBT”
  • Existential health:
    • Client will not need a theologian or a philosopher to tell them they are right with the divine and/or the universe
      • Although I admit it helps emotionally!
    • Client will not need an evolutionary psychologist or an anthropologist to tell them they are right with society
      • Although I admit it helps emotionally!
    • Client experiences daily joy
  • Client understands that a gender transition (of any kind or degree) will not cure all their ills
    • We all still have death and taxes
  • Client knows their legal rights in their jurisdiction
  • Clients are appropriately guided toward biomedical interventions, where desired
  • Clients become aware that the transgender community exists and is networked
    • We have a history and mythology, e.g.,
      • The Stonewall Rebellion
        • This was just as much about gender variance as it was about non-heterosexuality, a fact that the “mainstream” queer movement swept under the rug until recently
      • Joan of Arc
      • The Rebecca Riots
      • Tiresias
    • We have a music community (e.g., G.L.O.S.S., Trap Girl, Axis Evil featuring Napalm Fatale, Against Me, and QTPi Xpress).
      • Disclosure: I am “Axis Evil featuring Napalm Fatale”.
    • We have legal advocacy groups and work closely with the ACLU

Youth and Their Parents

All of the above-stated goals apply to youth, but parents play a greater role in their success:

  • Parents learn they are responsible for their own learning
  • Parents learn how to affirm and validate their children
    • Including respect for desired names and pronouns
  • Parents learn suicide prevention and distress tolerance skills
    • For both themselves and all their children
  • Parents learn the correct language, and let their children choose what applies to them
    • “Transgender” vs. “transsexual” vs. “intersex” vs. “transvestite” vs. “cross-dresser” vs. “genderqueer” vs. “drag queen” vs. etc.
    • “Gender identity” vs. “sexual orientation”
    • “Trans” vs. “cis”
    • “Transwoman” vs. “transman”
      • E.g., a man who becomes a woman is a “transgender woman”, not a “transgender man”!
    • Why the “T” is included in “LGBT”
  • Parents learn how to work with schools to attenuate bullying
  • Parents learn about discrimination and systemic oppression. They must be “woken up”
  • If parents are spiritual and or religious, find a faith community that proves supportive
  • Parents must learn and model joy
  • Parents understand that gender-related care for their family will not cure all their ills
    • Again, we all still have death and taxes
  • Parents know their children’s legal rights in their jurisdiction
  • Parents understand the array of biomedical interventions available
    • And the time dependencies of these interventions with respect to the onset of puberty
  • Parents need to understand that the body of research regarding transgender youth is slim
    • Parents need to understand that an active effort within the research community regarding transgender youth is identifying the difference between “is it a phase?” and “is it clinical gender dysphoria?”

As Long as I Can Remember

For perspective:  As soon as I realized there was a difference between boys and girls, I wanted to be a girl. Maybe two or three years old?

The feeling didn’t stop with puberty. Didn’t stop when I registered for Selective Service. Didn’t ever stop.

Where Seeing More than One Therapists is Appropriate

Having a client see more than one therapist at the same time is controversial, but I do it. Here is why it is practical:

Therapists who specialize in transgender issues are scarce and generally clustered around major cities. Therefore, it is totally reasonable for a client to see a “regular” therapist on say a weekly basis and see a specialist on a monthly (or longer) basis. Seeing a specialist at least occasionally is vital, as they have access to the latest clinical practice information and are one of the key gatekeepers for obtaining biomedical interventions such as hormone replacement therapy.

The “regular” therapist I referred to in the above paragraph can work on matters like distress tolerance, suicide prevention, family dynamics, etc.

Suicide Prevention and Distress Tolerance

The suicide rate is extremely high in the transgender population. (I don’t know how this breaks out between youth and adults—a later edition of this text will provide those details if they exist). Therefore, it is imperative that transgender youth, their parents, and transgender adults learn suicide prevention skills. “Skills” is the correct word here; we are talking about a set of learnable behaviors that save lives.

Distress tolerance skills are also vital; saying that living transgender proves distressing is an understatement! I’ve found Dialectical Behavioral Therapy (DBT) the best approach for myself and would recommend it to anybody. DBT is all about skills development.

Family Therapy

Family therapy proves vital as well, as poor family dynamics and abuse (if it is present) will not help anybody.

Also, parents may carry undue guilt that their child expresses gender identity issues—as if they were bad parents or something. While my research shows a possible heritable element of gender dysphoria, the same research supports a hypothesis of biological origin of the condition.

Murder Prevention

The murder rate among transgender individuals is high, especially for transgender women of color. A therapist and a transgender child’s parents must ensure the client knows how to protect themselves.

I carry a hunting knife in my purse and know how to disable an attacker by hand.

Affirmation and Validation

Through various channels (social, parental, religious, etc.), transgender children can get the message that their feelings are either “not real” or “bad”. This needs to be countered by therapists, and parents must be taught by therapists how to counter these ideas as well.

What a Therapist Should Watch For

While it is perfectly possible for a client to be both schizophrenic and transgender, the schizophrenia must be treated first, as it might be a source of gender confusion. For example, and forgive my shallow understanding of schizophrenia, a schizophrenic individual might have one or more feminine-identified “insides” and one or more masculine-identified “insides”.

Additionally, there are some homosexuals who are so homophobic that they would rather change their sex than accept their sexual orientation. Here the problem is acceptance, not gender dysphoria, and gender transition is not a clinically appropriate treatment. I can see this scenario playing out in a teenager raised in a fundamentalist environment. Interestingly, Iran forces homosexual men to become woman, as it is okay with transsexuality but not homosexuality. This probably does a lot of damage to these individuals’ psyches.

Adolescent Sexuality

All adolescents struggle with sexuality, but I think it is worse for transgender individuals. Therapists must be understanding of this.

One of the most confusing issues I faced in my youth was that for me as a teenager, I became sexually aroused when I wore women’s clothing. So, I couldn’t tell if I was expressing a fetish or something more fundamental to my core identity. Now that I am an adult and wear women’s clothing full time, this arousal no longer happens. In other words, my desired to cross gender lines cannot be explained by fetish alone.

A minor psychological theory that some practitioners still refer to, though it has largely been discredited, is “auto-gynephilia”. This model defines men who express transgender thinking as simply being sexually attracted to the idea of themselves as a woman (and female)—basically a “meta-fetish”. The idea has been used by hostile parents in court cases to prevent children from receiving appropriate transgender care. The major proponent of this idea—I forget who—is still alive and working for a major research hospital (I think; I’ll check on this detail later and update this document accordingly).

The problem is not with auto-gynophilic sexual fantasies, which I’ll admit even I have from time to time, but with the idea that that model alone fully explains male-to-female transgenderism. To put it in personal terms, when sexual arousal and activity is the farthest thing from my mind, I still want to be called “Emily” and “she”, and I still want to interact socially as a woman.

Feminism and Young Adults

Most feminists support us, but there is a small and vocal subset that severely opposes transgender individuals and their demand for rights. A young woman thinking of transitioning to manhood can easily be dissuaded by these ideas. This is okay if the individual decides so; but most members of this small, vocal subset of feminism are bullies and need to be taken through that lens. (We call them TERFs, for “trans-exclusive radical feminists”). TERFs often refer to female-to-male transitioning as “testosterone poisoning”, among other things. I won’t even begin to tell you what they say about women like me, because it is out of scope for this document.

A good therapist needs to be aware of TERF thinking and influence, especially when working with young adults attending a university.

I’ll Add More Later…

I’m sure I’ll think of more to add to this document as time passes.

evolutionary psychology and toxic masculinity

A well-known tension exists between evolutionary psychology theorists and feminist theorists. Feminists reasonably complain that evolutionary psychologists are simply reinforcing sexist paradigms—particularly the sexism that still pervades scientific inquiry—while evolutionary psychologists reasonably argue that their findings simply derive from examining our species’ mental adaptations necessary to ensure survival.

I’m not here to argue about which viewpoint is right. Truth probably lies in both modes of inquiry.

However, I’ve been thinking about “toxic masculinity”, a concept that wouldn’t exist without the feminists having identified it.

Let’s assume that “toxic masculinity” exists as the feminists define it.

Let’s also assume that toxic masculinity is a phenomenon we want to rid society of, that it is a bad thing.

Is it enough to simply think our way out of this mess? My experience suggests no. We need to examine the deep psychological pull of toxic masculinity, particularly in woman’s lives. (I’m assuming here without rigor that women are complacent in its social realization—part of the problem).

I propose that evolutionary psychology might explain some of this.

Assume that the patriarchy has dominated human relationships and individual humans’ self-realization since at least the time we settled down to start growing our food (about 10k years ago). Assume further that toxic masculinity evolved in men’s psyche as a way to maneuver within this patriarchy—that men who exhibited toxic masculinity prospered while men who didn’t exhibit it did not. Then it follows that natural selection favored the men who carried toxic behavior.

Women relied on men’s successes, and therefore it is possible that women who found toxic masculinity initially attractive (in terms of sexual/emotional arousal) would have more success finding a mate. Over millennia, natural selection might have favored this behavior.

Thus we may have a deep attraction to toxic masculinity written deep into our DNA.

Okay, so how does this help? If this hypothesis holds water, we know what we are up against and can adjust our cognitive reframing work and cultural change efforts accordingly.

fighting psychosis with psychosis

This method isn’t for the weak-minded:

But I’m not a bit weak-minded and the strategy described below suggested potential when I tested it on myself. (That makes this an n=1 study—hardly scientific—but exploratory research has to start somewhere!).

Background: I carry a long and well-documented case of bipolar disorder, and have become skilled at handling the “lows”. However, the manic “highs” still catch me by surprise. They come fast and full-blown, and I’ve often (until recently) acted recklessly when they occur. The resulting social damage proves costly.

Moreover, a full-blown mania often brings with it some degree of psychosis; realize of course that psychosis lies on a spectrum, it is not binary (sane vs. insane). For my part, I become grandiose and make decisions based on information filtered through that grandiosity, i.e., at some level disconnected from reality.

Now this state is basically a “drug high”, in that it is a chemical situation in my brain causing the mania. As a youth I tried cocaine and the feeling compares.

The psychiatric medicine I take controls the worst of the disease, especially the “lows”, but fails to inoculate me completely against mania. So I still have to learn how to effectively handle these “drug highs” as I don’t expect them to ever go away completely.

It becomes a management game:

So I got to thinking: “Why not intentionally induce manic psychosis in a safe, controlled environment so I learn how to pilot the condition?”. In doing so I’ll develop skill at managing unexpected manic episodes when I experience them in the real world–I’ll strengthen my mental power over them.

This is kind of like becoming well-practiced at meditation when you are relaxed, so that the skill proves easily accessible during an anxiety attack. (For me, the manic episodes impact me far more than anxiety, which also affects me; I’m just trying to draw a useful analogy here. In other words, I’ve ruled out meditation and mindfulness as short-term solutions to my mania challenge, though I’m certainly developing these tools for my long-term repertoire).

So I took a hit of LSD to induce grandiosity, euphoria, and delusional thinking; and then worked diligently and intently through the resulting altered state to learn how to handle the condition effectively, to learn how to take control.

The strategy worked! My recent subsequent manic episode came on quickly and intense, but I was able to recognize the state immediately and take appropriate countermeasures before making any reckless decisions.

Image from https://en.wikipedia.org/wiki/Lysergic_acid_diethylamide.

curvilinear optimism

Consider the following exponential growth curve:

This shows how the possible consequences of a decision do not just vary over time; the magnitude of that variance itself increases with time. For example, suppose you do something reckless like join the circus, start a business, or express love. You not only do not know the short- and long-term consequences, but the variance in the possible consequences widens as time moves forward.

So where is the optimism in this you might ask?  With uncertainty lies the opportunity to create exceptional outcomes!

Now consider the exact same curve, with completely different annotation:

When we make bold decisions, consequences follow. Then we must decide how to proceed as those consequences roll in. But the number of available good responses increases with time, because wisdom increases, data flows in, and time settles disruption.

Optimism is a skill.

a corset and an LSD trip

I’ve dropped acid trice in my life, both times for religious reasons. The first time was on New Year’s Eve in 1993, and the second last Saturday.

During the latter experience I took detailed notes, which I may publish on this blog in the future. What can I say? I’m a scientist!

I respect the drug, so before each trip, I took prudent steps to ensure physical and psychological safety. So this last time I tripped while wearing an extremely tight-laced corset. You see, corsets make me feel cozy—like being constantly hugged. I wear them whenever I’m experiencing psychological distress, which is often. They comfort me. (Please don’t ask me to explain this right now—I know why, but I’ll save that matter for a later article).

I believed this decision helped keep me remain positively “grounded” during the trip; i.e., it limited the risk of a “bad” trip. I would have embraced a “bad” trip as educational, but I’m happy to report my experience went fabulously. Took advantage of LSD-driven thought processes to gain clarity regarding my love life and my frequent suicidal ideation.

More generally, I made sure to dress extremely feminine before proceeding. I expect this helped as well. Note the lace socks in the picture below. (Also note that I wore lace gloves during the trip which are not pictured below):

toward a gene panel for psychiatric violence

I recently developed a method for specifying a comprehensive gene list for investigating genes related to psychiatric violence, which I describe below. First though, here’s a cool picture from the analysis:


I started by extracting a list of diseases involving violence from [1], removing epilepsy, dementia, mental retardation (is there a better word for this?), and Alzheimer’s disease. Also removed sexual sadism from the list as one might debate whether or not this qualifies as “disease”. I then matched those diseases by name–more accurately by components within each name–to diseases contained in DisGeNET [2] to determine genes associated with those diseases. Next, I built a network graph of the genes where an edge between two genes indicates one or more diseases in common. A tractable subset of this graph is pictured above for demonstration. Finally, I computed the size of the ego graph for each gene (node) and ranked them, as listed below. Greater ego network size indicates greater probable biological importance vis-a-vis psychiatric diseases having violence as a symptom.

I posted my code used for this analysis at [3].


  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686644/
  2. http://www.disgenet.org
  3. https://github.com/whole-systems-enterprises/blog/tree/master/adoption_study/genetics


Here is a portion of the gene list I put together:

Ego Network Size NCBI Gene Symbol NCBI Gene ID
1729008 NR3C1 2908
1723895 GRN 2896
1723751 PBRM1 55193
1721624 DAOA-AS1 282706
1721482 OPRM1 4988
1721103 LINC00273 649159
1720930 TDO2 6999
1720404 MTHFR 4524
. . . . . . . . .

how to validate someone who won’t talk with you (text version)

(A video version of this content is available here).

In my post “on love“, I describe active validation of one’s beloved as a key tactic for transmitting constructive love. I further discuss how that validation must express in terms of things eternal, rather than in terms of the one sending the validation. In other words, while stating your beloved’s value to you proves important, I encourage the communication of your beloved’s value in terms of the universe or the divine.

But how do you do this when your beloved won’t talk to you (or let you write, etc.)? The mandate remains, the vitality of this action remains, and you will feel pain at the disconnect. And this scenario occurs all too frequently in our lives, so prudence dictates the formation of a plan for dealing with it.

Here I offer six strategies for successfully delivering that validation when the receiver will not communicate with you. Granted these fail to match the satisfaction of a requited in-person transmission, but they help nonetheless. By help, I mean these tactics salve your pain a bit—provide a bit of meaning and purpose. But more importantly they actually validate and uplift the other person in very real social and spiritual terms.

These six strategies, plus a bonus strategy and then two examples, follow:

Give Them Space

Learned this lesson the hard way: If a person expresses a clear wish for no communication with you, they generally mean it. Therefore the only direct way to validate them requires validation of their request by complying with it.

Again I stress that I learned this lesson the most difficult way possible, by repeatedly failing to respect my beloved’s request. This only made the situation worse—it further accentuated the distance between us. Counterproductive when working to validate.

So leave them alone!

An exception to this injunction exists, which I discuss below in the “Keep the Door Open” section of this article.

Validate and Uplift Those Around Them

If you regularly interact with folks in your beloved’s sphere of influence, work to validate them too. This accomplishes two things: First, it sets an example that those in the sphere might follow to transmit their own validation of your beloved, thereby contributing to your goal. Second, it enriches the climate your beloved lives and/or works among, as experiencing validation generally improves happiness, and happiness moves socially.

Build a Better World

Taking the last strategy to its logical next step, work to make the world a better place. Not just for your beloved, but for everyone. This validates your beloved by producing slightly better world for their children to inherit, thereby contributing to their ease and peace. One person makes a difference when they choose to.

Of course we talk about “validation” as an abstract action in this case; I argue that indirectly improving someone’s life demonstrates valuation of their life. They will likely never know. But you will know. And the divine will know. And this will aid your sleep at night.

Pray for Their Well-Being

For spiritual readers, I highly recommend regular prayer for your beloved’s and their family’s well-being. I regard this as the most powerful thing one can do for a person, provided you back it up with action if provided a chance to deliver.

Prayer for someone’s well-being declares to the divine their value to you. And (at least in my faith) the divine values the person as well, so you stand in alignment. You form a team. The divine may never employ you as a vehicle for further transmission of love for that person, but prayer sets in motion action on the part of the divine to validate and enrich your beloved’s life. (See my post “the currency of love” for further discussion of this concept).

Keep the Door Open

If you can, keep the door open for reconciliation on the transmission of radical forgiveness. Smile at your beloved. Say “hi” or wave to them if permitted. Basically, acknowledge their existence in a friendly, welcoming way.

I don’t have these option with someone I particularly love and cannot talk to right now. So I’m simply going to send her a Christmas card next December (it’s now February). I’ll address it to “Jane Doe, Attn: Peace on Earth and Goodwill Department, 123 X Street, etc.” and I’ll say little other than what comes written on the card. Hopefully that will shatter a portion of the wall between us.

Yes, by doing this I will violate her request that I not contact her, but almost a year will have passed and Christmas cards are kind. In my book a nice way to promote validation. So I’ll risk her wrath to deliver this message.

Produce Art

If inclined, produce art inspired by your beloved, or inspired by the pain of not connecting with them. Furthermore, I recommend making this art public. I write and publish songs for this purpose. I write and publish prose for this purpose.

Keep your beloved’s identity anonymous when you do this! Respect demands it!

Public delivery of such art declares to the world that someone touched your life. The individual will likely know who they are. Validation!

And whether kept public or private, I think of my process of producing art as prayer in action, as per the strategy discussed above.

Bonus Strategy: Know Your Purpose and Intent

It occurs to me that I need to write an article explaining the meaning of validation, as this article simply assumes you know. But I digress…

To validate effectively, you must know and trust your intent. If you merely desire your beloved’s attention and affection, you miss the point and will fail. One must not confuse desire with validation, though I find it “validating” to some degree when others desire me. But here I mean something far more outreaching and spiritual than romantic desire.

Intend to validate them for their value in the universe, for their value to themselves, to the divine. Only then should you validate your beloved with respect to you. Know your purpose. Know your heart!


To walk the talk I now offer two examples from my own life.

In the first example, my beloved worked for the same company as myself, though in different departments. So I built relationships with individuals in her department and threw myself into projects that interacted with her department—usually offering them novel ideas on how to build their business (this was an R&D environment). By building up the individuals around her I hoped they would in turn validate her. More importantly though, I worked so hard on the projects and the business proposals to strengthen her job security. This activity served as prayer in motion. Served as indirect validation of her importance because I didn’t want her to suffer job loss.

As another example, I wrote the following song about two women at once:

While it includes expression of romantic longing, it mostly states my commitment to them as a friend, in spite of the fact that they won’t have anything to do with me. When I published this song I basically declared this commitment to the world! As I work to deliver integrity at all times, this public declaration means something to me. To others. To the divine. Expressed validation. Prayer.


I hope you find these strategies useful in your own life! But please do not limit these strategies’ underlying spirit to those who won’t communicate to you. Please apply them to everyone you value! Also, please let me know how it goes, or send comments and questions, by commenting on this post below or through Twitter or Facebook. I look forward to hearing from you!

See Also

radical forgiveness (video)

the currency of love

the pedagogy of love

on love

make an intent board

Optimism is a skill.

A simple exercise that strengthens your focus and direction involves creating an “intent board”, also called a “dream board” or a “vision board”. These serve me well in life!

Basically, you make a poster, or in my case a Pinterest board, called “Intent” and fill it with images that speak to your goals, values, and dreams. Then you review it every day for inspiration! The images you select may include photos, clippings from magazines, drawings, or anything else you can imagine.

For example, my intent board (below) shows everything from vaginas to fiber optic dresses to cyberfeminist propaganda to geodesic domes.

What you believe and what you focus on creates your reality. (I won’t back this statement up with psychological or spiritual arguments today, just run with me here…). Intent boards clarify goal-oriented beliefs, convincing you of possibilities. They help focus you.

While I don’t expect to—or want to because it would be too much to healthily manage—gain everything I put on my intent board, it helps to review the full scope of what I like as I work to target my actions. An intent board not only helps you enact conscious goal-seeking activities, but it teaches and pilots your subconscious such that you diminish the likelihood of sabotaging yourself in the process.

If you create your intent board using poster paper, I recommend updating it at least yearly as your values and goals evolve. Pinterest provides the advantage of unlimited space and an easy way to search for images. If you use Pinterest, I recommend altering the descriptions of any pins you add to describe your intent, rather than keep the expressed intent of the original image source. In other words, make the image “yours”. (Note that some Pinterest pins do not seem to let you alter the description).

And remember there exists no wrong or right way to do this!

Setting An Example

To demonstrate, feel free to check out my personal intent board below. You’ll identify many concepts (e.g. spirituality and music) expressed among the images that I touch upon with this blog. (Only a portion is shown below; click here to see the full board):

hypothesis #1

Hypothesis: Women generally excel at mindfulness over men because living in a patriarchy forces us to.

I can envision an experiment to test the first part of this hypothesis:  Put statistically representative samples of men and women through a battery of psychological tests to measure mindfulness, and then compare the sample medians.

However, establishing the proposed causality would prove tremendously difficult.

repairing jewelry as metaphor

Lately I repaired several pieces of jewelry that have been laying around, cluttering my limited storage space. Not only did that action reduce the clutter but it turned out to be a metaphor for reconstructing my life out of my recent psychiatric crisis.

I own an excessive amount of jewelry, which I cling to psychologically as a symbol of my successful transition and femininity. You see, I quickly discovered that one of the best ways to not get called “sir” early in my transition was to wear bright and flashy jewelry, because that image enters viewers’ minds as “female”. (This is also one of the reasons I never wear pants—more on that in a future post).

Occasionally, pieces break. I decided to fix the several that had piled up. Spent hours on the task, and multiple trips to the craft store to purchase the correct supplies. The act gave me semi-mindful time to muse; not wholly mindful because my mind drifted into problem areas I’m working through (which I permitted), but partially mindful because I kept part of my mind busy concentrating on surgically manipulating small components.

Repairing this jewelry, one of the few material items I value intensely, gave me a feeling I was repairing my integrity and my life. I was repairing a symbol of who I am.

Two Other Takes on My Attachment to Jewelry

I treasure the jewelry given to me by men. Makes me feel special as a woman.

My last post explores the meaning I attach to a necklace I purchased for a woman I love but am not able to give her, culminating in my decision to stop hoping and start wearing the necklace myself.

Update 21 September 2017

I have one piece left that I’m still working on. Not a repair, its just that I’m waiting for thicker beading string to come in the mail so that I can remake a necklace–one I made myself–in a stronger form than previous. (From an engineering view, the beads are too heavy for the original string I used. These beads were expensive, so I didn’t wan’t the string to break!).

The point is, I’m taking my time to do this project right, just like I’m taking an appropriate time to heal by not rushing things.

vision quest, punishment, and burning desire

I’m on a conscious mission to rid all my remaining masculinity from my subconscious, and I’m constantly looking for tools to help me do it. — From my post “corset training

Smoking weed puts me in touch with my base sexuality like nothing else, and femininity consumes my base sexuality. And my base sexuality demands complete femininity.

So should I follow Timothy Leary’s approach and smoke pot to engineer my subconscious?

If so, how would I do it? Marijuana delivers two major challenges: Inaction and likely distortion of the memory-forming process. So I’d need a robust plan for successfully enacting an “engineering” activity while high. Then it might be a crap-shoot regarding what I retain.

We are not talking about surgical precision here.

Timothy Leary preferred LSD anyway. I’ve taken it once, and remember the key life lessons learned from the trip (even after over 20 years). Perhaps a vision quest now that I’m a woman is the ticket?

I’m likely going to pass on the LSD approach for two reasons: First, I don’t want to do anything that will jeopardize my forthcoming gender-affirmation surgery and its long term success. Second, it probably won’t help my struggles with bipolar disorder.

I’ll also pass on using marijuana as a tool for engineering my subconscious. There are just too many variables for a controlled process.

I don’t think behavior modification as a psychological practice survived long in psychology after B. F. Skinner. The exceptions I’ve seen are the highly related cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).

CBT and DBT work by developing conscious skills for managing subconscious responses to stimuli. This is simply training and practice.

This points to the core: I think the only behavioral modification strategy that really works is training and practice.

In sissy games, the dominant partner often employs punishment in attempt to drive out masculine behavior and masculine thinking. I suspect this ultimately fails, as it probably just breeds resentment and frustration—even if the person being subjugated “wants” it. And there really is no incentive for the sissy to change if both partners “like” the punishment cycle.

This points to an even deeper core: I think the only behavioral modification strategy that really works is burning internal desire for change.

estrogen deficit disorder

Potential correlation: I’ve recently upped my estrogen dose, and have recently been happier than I’ve been at anytime in the last two years. What if the two are related? What if my brain expects a certain baseline level of estrogen to function best that it never received until now?

There is evidence that hormone administration improves psychological functioning in transgender people (see my post “the science of gender identity (part 3: psychology)” for a discussion of this evidence.

Perhaps I finally hit a (psychiatrically) clinical dose.

the science of gender identity (part 4: summary)

To prepare for a book I intend to write on the science of gender identity, I drafted the following three blog posts to collect my thoughts. They are highly technical; I need to recast the content for the layperson. I also assembled some of my own biological data to analyze.

The first post covers the very little we know about the genetics involved. It specifically examines polymorphisms in particular genes and tests their correlation to transsexualism.

The second post I think is the most compelling. And it has the best pictures! It investigates brain anatomy in transsexuals and how it differs from that of cisgendered individuals.

Finally, the third post covers some of the most recent psychological information I could get my hands on. There were two problems here: Since I’m not a psychologist I only understood the statistical arguments in the papers, and have very little access to psychological literature. Nonetheless I did my best. The most notable discussion in this post is the description of a study examining the stability of gender identity in very young children.

My Own Data


While no correlation between testosterone level and the male-to-female transgender experience has ever been established, it is interesting that my natural testosterone level is extremely low. (This was measured before I started blocking my testosterone with Spironolactone). Here is where I sit on the curve for natal males my age:

The “normal boundaries” are those that my HMO says are healthy. To produce the curve I extracted the mean and standard deviation from [1]. I asked this source for the raw data so I could produce the actual data distribution, rather than the normal approximation, but they did not respond.

Brain Anatomy

I have a brain MRI recorded before I started taking hormones. This is important because hormones can alter brain anatomy. I’m attempting to use the 3DSlicer program [2] to measure the sizes of my various brain regions using image recognition. My intent is to compare the measurements to a body of (sort of) age-matched female and male brain MRIs I downloaded from [3].

Right now I’m struggling with the image recognition for my particular MRI, but I’ll figure it out and report the results on this blog.

An example of what this effort looks like in 3DSlicer is:

Related Posts

the science of gender identity (part 1: genetics)

the science of gender identity (part 2: brain anatomy)

the science of gender identity (part 3: psychology)


  1. http://www.ncbi.nlm.nih.gov/pubmed/21697255 (supplemental data)
  2. http://www.slicer.org
  3. http://www.loni.usc.edu