The Practicalities of Mental Health and Gender Affirming Care for Trans Youth: An Interview with Jordan Held, LCSW
Curt and Katie interview Jordan Held, LCSW, about gender affirming care, trans mental health, the practicalities of transition (as well as the different types of transition), specifics when working with trans youth, and the politicization of trans folks. We also explore culture and privilege related to transition.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
An Interview with Jordan Held, LCSW
Jordan Held (he/him/his), LCSW is a Primary Therapist and Gender Specialist at Visions Adolescent Treatment Center. Prior to Visions, Jordan was a Therapist and Intake Coordinator at Children’s Hospital Los Angeles in the Center for Trans Youth Health and Development, the largest trans youth health clinic in the USA.
Jordan’s mental health practice centers around creating a trauma-informed and healing-centered space for both adolescents and their families. Jordan’s expertise is working with gender and sexual minority youth with complex histories of PTSD and trauma. Jordan speaks internationally about creating and supporting affirmative LGBTQ+ environments with an emphasis on informed consent and enhanced family communication. As a queer-identified, transgender man, Jordan brings an important dual perspective to his work as a mental health provider.
Prior to social work, Jordan worked extensively in secondary school education, with a decade of experience teaching, coaching, and developing health and wellness curricula. Jordan’s work focuses on gender violence prevention, diversity, equity, inclusion, and cultivating strength and belonging for teens. Jordan is on the Board of Directors of the Los Angeles LGBT Center, the Laurel Foundation, JQ International, and Mental Health America of Los Angeles. Jordan is also a long-time facilitator at Transforming Family, a support group for gender-diverse youth and their family.
Jordan holds a Master of Social Welfare degree from UCLA, a Master of Sports Leadership degree from Northeastern University, and a Bachelor of Science in Kinesiology from the University of Connecticut. Jordan is an avid sneakerhead who self-cares by lifting heavy weights, going to the beach, loving his rescue dog, and embracing his gender euphoria!
In this podcast episode, we talk about trans mental health
For Pride Month, we wanted to deepen our conversation on trans mental health and what therapists should know when working with trans individuals.
What is gender-affirmative care?
“Trans people are being used as political pawns.” – Jordan Held, LCSW
- The way that “gender affirming care” is being taken out of context
- What is actually happening, how it has been politicized
- The misinformation related to what is available to children who are exploring their gender (i.e., parental consent and youth care)
- The role of therapists versus the role of medical providers
- Discussion of gender norms
Different types of transition for trans individuals
- Social transition (name, pronouns, clothes, haircut)
- Medical interventions that may start during puberty (i.e., puberty blockers, progesterone only birth control)
- Cross sex hormones and surgeries (which actually require a long process)
- States are very specific for what they require for gender care (as do insurance companies)
Conversations in therapy for trans youth
- Gender journey
- Meeting the kids where they’re at
- Lying to get what they need
- Letters and recommendations for surgery
- The gender dysphoria diagnosis and sorting that out from depression, anxiety, etc.
- Supporting trans youth with social transition and getting the support they need
- The concerns with maladaptive coping skills available online
- Positive resources for trans youth (scroll down to resources)
- Identity and impacts
The Politicization of Trans Individuals
“Shame on us as adults that we are so scared, we have so much fear over – let’s be honest – what’s in someone’s pants, right? All of this has to do with the fear of something that we don’t know. This fear… that somebody’s genitals do not align what we think is in their pants. And as an adult talking to another adult, that’s kind of gross, right? Like, why as adults do we care so much about what is in a kid’s pants?” – Jordan Held, LCSW
- Jordan grew in privilege when he transitioned
- Schools removing conversations related to gender and sexuality
- Play and sports being withheld from trans kids
- Bias and how being trans is perceived
- The actual numbers of trans folks who want to play sports or want to use the bathroom that aligns with their gender identity
- Advice for trans kids and families where gender care is illegal, advice for therapists
- Age limits and laws that don’t align with logic
Culture, privilege, and being trans
- Increasing or decreasing privilege when one transitions
- Getting used to the changed dynamic within society based on external experience
- The complexity of the experience and the changing of the experience
- The concept of “passing” and how it taps into bias
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Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Online support and communities for trans youth:
The Trevor Project (helpline, suicidality)
Google local universities in state – they often have support groups
Relevant Episodes of MTSG Podcast:
Additional episodes for Pride Month:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Curt Widhalm 0:01
This episode is brought to you by GreenOak Accounting.
Katie Vernoy 0:04
At GreenOak Accounting they believe that every practice should be profitable. They work with therapists all around the country and they give practice owners the financial confidence and information to make data driven decisions. They want their clients businesses to be profitable, so they can focus on fulfilling their mission.
Curt Widhalm 0:21
If you’re interested in speaking with a member of their team, visit their website at greenoakaccounting.com today, and listen at the end of the episode for more information.
Katie Vernoy 0:30
This episode is also brought to you by Thrizer.
Curt Widhalm 0:33
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is, you don’t have to give up your rates. They charge a standard 3% processing fee.
Katie Vernoy 0:56
Listen at the end of the episode for more information on a special offer from Thrizer.
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 1:17
Welcome back modern therapists, this is Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for all things therapists and the clients that we see. And wanting to recognize pride month here a little bit, we wanted to circle back to some conversations, maybe fill out our catalog a little bit in talking about trans mental health, and some of the ongoing issues going on in the world with some of our clients that are faced with just about every single news controversy that could be going on and helping us navigate this conversation is Jordan Held, LCSW. And thank you for joining the show.
Jordan Held 1:59
Thanks for having me.
Katie Vernoy 2:01
So excited to have you here. I was lucky to have a preview conversation. And I’m excited for the information that we’re going to be talking about and sharing with our audience. But to get started, the first question we ask all of our guests is Who are you? And what are you putting out into the world?
Jordan Held 2:17
All right, I love that. And Happy Pride. I love pride month. Actually, it’s like pride year for me. I’m like, what do you mean, it’s just in June? It’s all the time. So who am I? I am a very proud social worker, I say I’m a proud social worker, sometimes instead of a therapist, because I just really love the values that you know, that encompasses for me. I love young people, I love teenagers, I identify as a queer, transgender male. The work that I do really involves creating a healing centered space for gender diversity on people and families. As a therapist, I do a lot of work pertaining to trauma, family systems, and all the other myriad of things that young people are facing in today’s society. And I also am a guy who’s just really obsessed with sneakers. That’s really I just love sneakers. And I’m a therapist who loves sneakers and teens. That’s me.
Curt Widhalm 2:17
We asked this question at the top of a lot of our episodes as well. And this is for a place of learning that we’re not out here to shame anybody but to help prevent therapists from making the same mistakes that other people have. But what do therapists usually get wrong when working with trans folks?
Jordan Held 3:33
That’s such a good question. I think to start out, you know, it’s more, I want to frame it more as what therapists don’t know, versus what they think they should know. I think one of the things that’s so challenging is that there’s no education in schools really pertaining to gender and sexual minority individuals. If there is it’s probably one class that somebody took along the way. And so I think there’s a lot of fear of saying the wrong things. There’s a lot of risk of saying something where a client will get activated, or triggered, or be angry and upset. And so I think what happens then is that a lot of therapists don’t feel comfortable asking tough questions. We see that in a lot of different realms of the therapy world, whether it’s about non suicidal self injury or about suicidality. The same holds true with talking to trans people in general, there’s a fear of messing up. And so one of the things that’s so important for me, not only as a therapist who does a lot of family work and talking to parents about this, but also in the trainings and workshops that I give to clinicians, like take a deep breath and realize that if you’re here right now, then you’re willing to learn. And so that’s the number one thing is be willing to learn. And with that the great news about gender in particular is that you don’t actually need to know everything because that’s impossible. You know, and I’m sure we’ll touch on that a lot today like especially for your working with trans youth, we’re always going to be behind, like always. So all you need to be willing to do is sit in a space and listen and then ask questions.
Katie Vernoy 5:10
So I think that leads to the next question which I’ve heard a lot about gender affirming care. And so what does that actually mean? Because it sounds like you’re saying, Have a comforting space, be present. But it seems a little bit more specific than that.
Jordan Held 5:25
It’s such an important question, because I think this concept of gender affirmative care has been taken so out of context in the last year or so, and is starting to mean something that it really does not mean. When we’re hearing this concept of, you know, gender affirming care, especially when it comes to youth care, there’s this automatic assumption that we’re talking about medical interventions pertaining to gender identity. The reality is that we’re when we’re talking about gender affirmative care, we’re talking about, you know, being a nice person. We’re talking about. So like, if really, if this was the title of my podcast, it would be how to not be an asshole. Right? Because, like, gender affirming care is really that, right? It’s like, how can you look like be with someone sit in a space with someone and know that you have a different experience than them. We’re not talking about hormones, we’re not talking about surgeries, we’re not talking about anything that’s irreversible. We’re talking about, sometimes we’re talking about pre pubertal children, who, maybe they are assigned female at birth, and they don’t want to wear a dress, and they want to play with a GI Joe. We’re talking about going against gender norms in society. That’s being an affirmative clinician. And affirmative clinician is about somebody saying that they want to try out they/them pronouns, where they want to try out a different name and saying, cool, that’s awesome. What name are you using now? Right. None of that is permanent in nature. But that is what it means to be an affirmative clinician. But over the last few months, really, it’s turned into this assumption that there are people and therapists who are pushing this concept of a trans agenda on to other people. The reality is, I wish that I got a commission for every kid that I saw that was trans. I don’t, you know, I, I see hundreds of people and whether or not they turn out to continue to align as their sex assigned at birth, or, you know, if they transition medically, socially, I have no stake in that game, right? My only stake is like, is this person going to live a happy, healthy life? And what can I contribute to them in that moment?
Curt Widhalm 7:46
So not pumping kids full of hormones. Not, you know, pinning them down and forcing surgeries on them. Like, this seems like a pretty low bar to not be an asshole to trans kids.
Jordan Held 8:00
Yeah, it’s kind of a low bar. Right? Like, and I think I love that we can kind of make light of it. And I’m talking about it. Because when I hear some of the things that gets said, to me, I mean, the amount of times that I work with parents who don’t necessarily understand anything about, you know, their, their trans kids, you know, they assume that I have some bias as a therapist, when the reality is, I work with most of so much of my practice are cisgender straight kids, right. I’m just a therapist. But when I put out into the universe, that I’m also trans, it’s this automatic red flag of, oh, my gosh, Jordan’s gonna convert my child. Right. And it’s really problematic, because it’s creating a system where the stigma that was kind of gone away for a little bit is now back. And trans people are being used as political pawns, and being politicized and rights are being taken away, which I know we’ll talk about in a little bit, because it’s really important to talk about. But no, we’re not pumping anyone full of hormones. I mean, the amount of times that people talk to me about is my kid going to do this? I don’t know. The reality is I’m a therapist, right? My ethical duty is to sit in a space with someone and listen to their experience. I don’t lead anyone on any path, right? I listen, I affirm, right. I can offer feedback. And then that’s where medical providers come in. That’s a whole different, you know, scope. But there for some reason, gender care has really meshed together. And on some hands, that’s that’s a good thing. Comes to making sure that people in general are set up for success. But we don’t need to get ahead of ourselves. Nobody is like coming into an office as a 16 year old and getting on hormones and having a surgery the next week. That’s just not the reality. But this landscape of gender care is completely filled with myths and propaganda right now.
Katie Vernoy 10:00
Well, I want to get back to that. But I think the thing that I think maybe we should start with is what is the reality? Like, what does, what does it actually look like? What’s the process and it sounds like it makes sense to start with trans youth. And then we can move forward into like, what it’s like for adults that are going through the transition or affirming care process. But to me, it seems like, there are so many myths, and I don’t know that I know all the steps and details on how something happens, or even what choices there are, it seems like there’s a lot of logistics that most of the public are just not aware of, and are very afraid of.
Jordan Held 10:37
I love that let’s myth bust. And I think talking about youth first is good, because youth are, obviously, there’s the most heat around this topic. So let’s talk about it. First of all, anywhere in our country, if you are under 18 years old, you cannot make any kind of medical decision trans-wise, gender-wise without parental consent. So that’s a really important first marker, nothing medical is happening to anyone without parental consent under the age of 18. Now, if we’re talking about youth care, this is a process. Let’s start and back up and talk about different ways of transitioning. Social transition is literally that. When we’re talking about a social transition, we’re talking about things like maybe changing your name, maybe changing pronouns, changing the clothes you wear, getting a haircut, essentially like trying out gender, this is something that we as a society should embrace. This is something that if we weren’t so focused on boys play with GI Joes, and girls play with Barbies, we wouldn’t really have to worry about in the same way. But because as a society, we’re so obsessed with gender starting very young at like a gender reveal party, which, you know, here in California, they just cause fires anyway, so you should be wary. But like, you know, we’re obsessed, right? We just were obsessed with boys wear blue, and girls wear pink. And that is how it is. So we’re talking about social transition, nothing is medical, right. And this can happen as young as two-three years old. Right. And oftentimes, you know, when young people present to, let’s say, a gender clinic in a hospital, usually that focuses on gender care. What’s happening to anyone, when they’re young is just a conversation about gender norms. That’s precisely what it is. I worked for a few years at the largest trans youth health clinic in the country. And those were the conversations if someone hasn’t gone through puberty yet. We’re not even talking about medicalization of anything. We’re talking about how can your young person have access to the bathroom that aligns with their gender identity? We’re talking about how can they make sure that you know they’re not getting mis-pronouned or mis-named in class. They’re not getting bullied, that they’re not getting made fun of, that they can wear the school uniform that aligns with their identity. That’s what we’re talking about. But that has now gotten conflated with medical interventions, there are no medical interventions that are occurring before somebody starts puberty. And that’s so important to know. Because there are all these myths that are you know, people are getting these surgeries and starting hormones at age nine. Nobody is doing that. There’s nothing to change at that point. Medical interventions can start, you know, when somebody starts puberty. Hear a lot about puberty blockers, hormone blockers, which have been used for years for things like precocious puberty. So a cisgender person who started going through puberty too early, puberty blockers have been used to kind of put a halt on that puberty because nobody likes a hairy fifth grader. Right? So some people might, I mean, I’m not here to yuck anyone’s young. But you know, you don’t see that many fifth graders with full beards, right? These are interventions that have been used for really long time. And then when you’re talking about some other options, a lot of let’s say trans masculine people, if they have menstrual dysphoria, so distress with getting their cycle every month, there are really safe, non trans specific things such as progesterone only birth controls, things that sis people use as well. Right. So there are these medical interventions that have been used not only for trans people, but now because we’re like talking about trans people everything is coming from like this negative deficit space. When we get into the landscape of things like cross sex hormones and surgeries we’re now talking about things that are really lengthy processes. Right? And I think that that’s an important thing contextually. So, talking about myths. There’s a lot of myths that you just kind of, that a young person in particular, somebody who’s under 18, walks into a gender clinic and gets a prescription for estrogen or testosterone or whatnot. And that’s not the case, though, it’s important too, you know, for the audience, states are very specific when it comes to what they require for gender care. And even more than state specific, there’s insurance specific, there’s what is your state insurance. So here in California, we have really great protections for trans people, medical, or our state insurance covers all trans specific care, which is amazing. But that really depends state by state. How does it work? Well, let’s take a gender clinic at a big, well known hospital, for example, typically, what would happen, let’s say for a 16 year old if a parent brought their kid in, and that’s important, right, the parents have to bring the kid in. I think sometimes there’s this weird thing of like, the kids magically go to these clinics by themselves and like get access to things. Somebody had to bring their kid to the gender clinic, you know, this was coming for a reason, you’re going to be meeting with a therapist, you’re going to be meeting with somebody who’s going to talk about your gender journey. Talk about what has this looked like for you? Really delve deep into, I like to call it the gender journey. And what I mean by that is, tell me your earliest memories of when you felt incongruence in your identity versus your body, right. And it’s important to frame it as a conversation. Because teenagers are smart. Teenagers are very crafty. Teenagers have access, they do, they have access to the internet. And teenagers will do things based on the knee when it comes from a therapists perspective, what I want everyone to get out of this is you need to meet your kids where they’re at. And what I mean by that is we want to make therapy something that kids want to go to. If we make kids and if we set up a system where kids or adults need to lie to get what they need, they will lie, right. And when we talk in a little bit about access to things like letters of recommendation for surgery, it’s so important to know that we actually want people to be able to talk about what’s going on with them and not feel forced to say something because they need access to a resource so badly that they’re willing to kind of manipulate the truth because no one has listened to them. And that is something that has plagued trans people for a really long time, which is different now than it was when say I was accessing my medical interventions for my transition. So it’s a process for youth care, you’ll then meet with a doctor, right, who specializes in gender care. Sometimes this might be an endocrinologist in if you’re in a state that doesn’t necessarily have a dedicated gender clinic. There are other places that are really amazing, like Planned Parenthoods offer really great resources for trans people. But then you’re looking at quite a long process of dialogue, of communication, of looking through the consent forms, like what are the changes? What is going to happen? What are the risks and benefits? Gender care, like everything else in medicine, when it comes from that perspective is about the risks and benefits? Right? Nobody is just kind of saying here? This is what’s for you, you should do this. It’s more along the lines of like, let’s talk about it. Let’s do assessments. How is this impacting your life? How is this impacting your activities of daily living? How is this impacting your mental health? Let’s separate the gender dysphoria from the depression, the anxiety, the suicidality, let’s see what they have together and what they have apart. Because trans people can have depression, trans people can have anxiety, trans people can be on the autism spectrum. And they can have things to do with each other. And sometimes they don’t. I mean, God, I could talk about this for just days. So I don’t know if there’s any specific questions because we could just go on.
Curt Widhalm 18:54
So beyond kind of the steps that somebody would go through, as far as everything that you just described, I’m curious about how therapists support some of the social changes that teens go through in this process as well, because one day they’re hiding who they really are, who they’re dealing with, they are from their peers, and the next day, they’re showing up trying on some of these things. Can you talk about that support that gets provided for teens in these situations?
Jordan Held 19:24
Such a good question. I mean, one thing that COVID has done for us as a positive is that it’s made a lot of support groups accessible online. So even people who live in more remote rural areas are able to access support groups, and this goes for parents, caregivers, young people, siblings, online. So that’s huge. You know, schools need to be doing a better job at normalizing diversity in general. Right, normalizing gender diversity, normalizing sexuality, right. We’re seeing that this is getting attacked in states like Florida. It’s a huge problem. Racial diversity, ethnic diversity, religious diversity, right. We need to just all be better at, hey, people are people, and people are all very different. Kids, because of the access of the internet and social media, kids will find things that they need. Right. Now we as adults can either help them to cultivate really healthy coping skills and resources and groups. Or if we don’t get involved, that’s where some of these more maladaptive resources come into play. A lot of social media sites that are talking about whether it’s things related to myths about gender or self harm, we as therapists, we first of all need to be aware of what’s out there, right. I think we all as clinicians need to know what our young people are accessing. It’s so vital, I sometimes get made fun of because it’ll be late at night and I’ll be like, looking on these sites and obsessively being like, oh, my gosh, I didn’t realize that there were 500,000 members of this one particular group. Young people are accessing so many things. And to be honest, a lot of them are life saving. A lot of trans youth are finding communities online. Some of them are potentially detrimental, but others are life saving. Let’s say somebody is in a state that has a lot of restrictions and bans on trans people, if they are able to go online and find people that are like them. That is a life saving intervention. So as therapists we can know, what are those safe sites? And what are those sites that those people could should stay away from? And we can also work to educate parents, caregivers, schools, other clinicians, etc.
Katie Vernoy 21:34
Do you have some recommended more national resources that we could put on the show notes?
Jordan Held 21:39
GLSEN, G L S E N is really great for trans kids in schools. I think that you know, Trevor Project is really amazing for resources are like helplines, suicidality. HRC has amazing human rights campaign has great resources. PFLAG is awesome for parents, Flamingo Rampant books has awesome books about gender and diversity. I think that everyone should watch the documentary Disclosure, because it’s just fantastic. Other, other websites for people, Google some of the local universities that are in your state, because you can often find a lot of LGBTQ, like rainbow groups for the university, and then they will know more local resources. That’s often…
Katie Vernoy 22:25
Jordan Held 22:08
what I sometimes say to do because some of the bigger especially research universities, like let’s say, even in Texas, or in Alabama, or in Florida will be able to point people to things that they can use in there specifically.
Curt Widhalm 22:34
We’ll put that in the show notes. That’s really helpful.
Jordan Held 22:40
Curt Widhalm 22:40
You’re bringing up the news blog here. Let’s talk about being in 2022. Yeah, as a trans person in 2022, with a lot of laws moving backwards. What is this experience? Like? What are you hearing from clients, even in a state that’s very protective of a lot of gender affirming care policies?
Jordan Held 23:03
It’s hard, right? It is hard to navigate this as somebody who is both personally and professionally invested in this work and in the community. And I’ll tell you why it’s hard. And I hold a lot of privileges, right, I walk through the world as a white guy, right? I’m a boring white guy who doesn’t have to worry about anything, right? When I transitioned from somebody who was assigned female at birth to a guy, I kind of grew in my privileged status, right? When I walk through the world, nobody knows, quote, unquote, that I’m trans. And that is something that has taken a long time to, for me to understand, and I honestly still understand, have trouble understanding my privilege in different spaces. But you know, when it comes to the legislations, they really are impactful on a grandiose state, and kids know about it. So things that are happening now, schools are taking away rights of trans people, or even LGBTQ people from talking about their gender or sexuality. There’s nothing that’s being brought up in health classes. There’s no dialogues about sex education. And this is really important when we’re talking about the trans youth population, because there’s a lot of preventative care that is not being discussed with young people, especially middle school and high schoolers, but that also goes into adulthood. Young people are losing out on one of the fundamental aspects of childhood and that is play. So many of these laws and legislations have nothing to do with trans people. And it has everything to do with people’s discomfort with things that they don’t know about. Right. When people don’t know that you are trans. They’ll talk to you, right, like I’ve had conversations with plenty of people like at the gym, say, and you know, it’ll come out that I’m trans. I’ll say it about something. And they’re like Wait, what? And then we’ll go into that whole, like shame spiral of you don’t look trans and how would I have known that and could go on and on, which is really this realization of a lot of people think that they have never met a trans person in their life. And that shows that bias that exists within people, like people are expecting trans people to be aliens and mutants in that there’s something wrong with you. And that gets internalized. And I’m a fully grown adult who does this for a living, and it still impacts me. And I can’t imagine how it impacts somebody who’s already struggling in early or middle adolescence, it’s really toxic. And when you talk about losing access to something like play, I’m talking about, if somebody who is under 12 years old, wants to play on the baseball team, instead of the softball team. If we are making it such a big deal that they then don’t want to play anything. That’s a problem. And it’s a problem in terms of like, shame on us as adults that we are so scared, we have so much fear over, let’s be honest, what’s in someone’s pants, right? All of this has to do with the fear of something that we don’t know. This fear of genitals, right, and that somebody’s genitals do not align what we think is in their pants. And as an adult talking to another adult, that’s kind of gross, right? Like, why is adults do we care so much about what is in a kid’s pants? Right, we should care about the fact that they want to play baseball, and that they don’t want to play softball, right? Because boys are directed into little league baseball, and girls are directed into little league softball, right. And that’s just an example. And transports, I mean, this is something that I spent years working as a coach and in schools, and this is what we should be wanting our kids to do. Right? We should be wanting to get people outside and do activities. And we wonder why trans kids are isolating. We wonder why trans kids have high rates of suicidality and depression, it’s because they want to have access to things that their peers, their cisgender peers have access to, and they’re being denied. And then we have to look a step further from the discomfort and go really into how many people are we actually talking?
Katie Vernoy 27:19
Jordan Held 27:20
Right. Like, there just aren’t that many trans kids who want to participate in sports, because they’re all bloody scared of it, because they’re really scared. It’s the same narrative with bathrooms, you talk to any trans person, most of them don’t go to the bathroom as much as they should during the day. And all the rest of them run in, run out as quickly as they can. No one is predatory in the bathroom. Right? It’s fear based. And all of this is fear based. And it’s impacting our young people a lot.
Katie Vernoy 27:47
So when we’re looking at the news, I mean, there’s the transports thing, which sounds like that’s a pretty long conversation. But I like what you’ve said so far, just about letting kids play. I think it shifts a little bit for folks when they start getting into adulthood, which I don’t know that that’s relevant to this conversation. But I think the thing that I keep coming back to, especially for whether it’s the don’t say gay, or the it becoming illegal for gender affirming care for trans kids, I think it’s in Texas, it’s something where, to me, when you kept saying there’s not an allowance for time for play, or that kind of stuff. I’m thinking about what you had said earlier about kids kind of playing around with gender and being able to experiment with things and doing the social transition that we were talking about, to really understand themselves. And if we don’t allow that, then it seems like there’s a chance that that kids are not going to truly understand themselves, and maybe make decisions that aren’t aligned much later. In looking at families who are affirming, and are looking toward supporting their trans kid, if there is legislation that makes it illegal for them to do it, and I’m even thinking as a provider, if it becomes illegal for me to provide gender affirming care, like what is what advice do you have, because this is this seems like a really dangerous time, and a very important time for people to stand up and support these trans kids.
Jordan Held 29:15
It’s a really dangerous time.
Katie Vernoy 29:17
Jordan Held 29:17
I mean, it’s not we’re not trying to be like doomsday about it. But it is, I mean, I have people who I work with, and I have a pretty large network of providers, both medical and mental health across the country. And it is scary. And I have to really name that parents who are affirming and these are the kids who have the families that really understand the journey. Some of them are moving. I’ve worked with numerous families who are literally, and once again, privilege comes into play here the privilege and access to resources, who are moving from some of these states because they want their kid to have a better life. Right? It’s crazy in 2022 that I’m having this to name this idea of like having a better life in America. Right and I think a lot of marginalized populations are actually feeling this way in different ways. But yes, families who are moving from places like Florida and Texas coming to places where there is access to gender affirming care, access to schools where their young person won’t get bullied or harassed, it’s really real. I think what we can do as providers is once again, tap into our networks. I think it’s important to know people in different states, I think it’s important to know your laws and legislations, it’s also really important to know if there are any kind of loopholes or I think sometimes politicians like to play these games and put fear in people, what is real, what is a myth? What can somebody have access to? You know, when it comes to medical interventions, this is scary, right? And we don’t have a lot of the answers right now. In a state like Alabama, where they’re banning gender health care under the age of, you know, 19, I’m confused by this, right? This goes into the whole argument about like, legality of guns, right? You can, you know, go fight overseas, but you can’t get hormones, none of this really quite makes sense. And it goes deeper into, we don’t fully understand, people who are saying these things don’t understand that being trans is not a choice, I do not choose to be trans, I am trans. And I can be happy in this, I can be happy in this body, I can be happy in this life. Who are the people that have a problem with it, right? It’s those people in society who are making the mental health of so many trans people really hard, my gender and my identity. And what I do with my body has no impact on other people. And when it comes to youth, that’s where families and education and support groups and time and really the deep conversation and understanding about somebody’s journey really comes into play.
Curt Widhalm 31:56
One last question here before we wrap up, or at least from my end, but you were talking with Katie about status and privilege changing during the transition process. And I’m curious on this, Katie, let me know a little bit about this. But I’m very interested in what this conversation means.
Jordan Held 32:17
Yeah, I mean, so am I, I mean, you know, it’s something, it’s something that every day of my life, I think about in one way or another. You know, whenever I talk about gender and privilege, it’s really, I always start by saying, Look, if you’ve never thought about gender in your entire life, and that’s a privilege, right? Like, if you’ve never thought about which bathroom you go into, and am I gonna get beat up, if I go into this bathroom? Am I gonna get made fun of if I go into this bathroom, you know, that’s a privilege in and of itself. For me personally, and I can only speak for myself, you know, the privileges that I hold, or that nobody really bothers me with anything, right? I walk through the world, and nobody knows that there’s anything quote unquote, different or other than me, I’m just a guy. And what I mean by that is, that also comes with some weird stuff for me. I mean, I remember the first time where I was walking at night, and there was a somebody in front of me, and they kept looking back and then walking faster, and, you know, keep going, and they were with their friends, and they were talking to each other. And then they both were looking back. And I realized after a while that I was perceived as a threat. And that’s happened multiple times. I mean, I’ve always been kind of a gym rat. Even before my transition, I was a college athlete, and sports have been a life saving thing for me in my life. And I noticed even the change, you know, when I was probably when identified as female, and I was in the gym, even if I was had the best form in the place, guys would always come up to me and want to like critique my form and, you know, say something, shouldn’t I lift this? Or why am I not getting on this cardio machine. And now, nothing has changed in terms of my lifting behaviors, but what has changed is my presentation, my beard, things like that. And now no one says anything to me. Right? No one ever says anything in the gym. In fact, they’ll come up to me guys will come up to me and ask me for pointers, and asked me for tips. And it’s such an interesting dynamic that I’ve had to get used to, that nothing for me has changed but for society, everything has changed based purely on my external appearance. And that automatic split second assumption of Is this person a man? Is this person a woman? Which also leaves out you know, an entire community of you know, gender diverse, non binary, non conforming people who struggle with kind of that in between space, and a lot of hate that can come to a lot of people. So, you know, it’s a really interesting, dynamic, and it’s important as providers to know because as a white person, you know, this works in my favor in terms of an added stacked level of privilege and intersectionality. But I’d be remiss to not talk about the amount of trans women of color black trans women, trans guys who now are getting more targeted by police and never had to grow up with that. It’s really a complex system. And so as so many people like legislations, and politicians are focused on this stuff, actual trans people are focused on how to navigate these really complex things. And I think what therapists and clinicians are missing is when we spend time focusing on the extra noise that we’re seeing in the media, we’re losing sight of the actual work that needs to be done to support our clients. Which is how can we help you actually navigate your life and live your life in an authentic way, while actually helping you tackle the issues that you do contend with everyday: dating, relationships, sex, work, you know, the list goes on. So that’s a really important thing for clinicians to take out of this.
Katie Vernoy 35:47
Well, and to me, and this is you don’t have to confirm or deny this. But for me, if I’m thinking about, you know, clinicians in areas where there’s very limited rights, and even things that have become illegal, what you’re talking about is identity. And so my progress notes would say, working with client on their identity and identity issues, because if we’re looking at it, gender is only a piece of that. And gender plays a role in all of us. And we actually did in an episode with colleague of yours and a friend of ours, Beck and we’ll, we’ll link to that in the show notes. But there is so much that all of us have to explore around gender and how we relate to the gender that we were assigned at birth, as well as all the other pieces. But when you’re talking about the intersectionality, when you’re talking about how you present in the world, I mean, one of the things that you didn’t mention that I think it probably plays a role is how well you pass versus how well you know it just as a sis person. And so to me, it seems like there’s so many elements of identity, that speak to privilege, but also speak to just how we navigate the world. And so I’m just going to throw it all under identity work and call it a day so that I’m going to provide gender affirming care, I just may not call it that if I’m practicing in a state that has made that illegal.
Jordan Held 37:17
Totally. And I would be even remiss to say like, I want to question and put back to everyone like this notion of what does it mean to quote unquote, pass? Right? Even the concept of passing is rooted in this idea that cisgender people look and present a certain way. Therefore, trans people look and present a different way, which is the other way, which is the wrong way, right? And so that is a societal shift in terms of this idea of what does it mean to look a certain way? Right? And how as people in a split-second, do we try and make this assumption of who are you? What genitals do you have? What pronouns do you use? What name do you use? Is that a boy’s name? Is that a girl’s name? Right? Are you allowed to play with Barbies? Are you allowed to play with a hacksaw? You know what I mean. Like, no one should be playing with a hacksaw. I don’t know why that came to my mind. It’s just one of those days. But you know, you’re right. But these are these more, these are the conversations that actually get into the weeds because we’re so focused on the extra noise that doesn’t actually matter. Right? Whether or not a six year old plays on like, with the boys or the girls, it doesn’t matter. They’re just kids, and they’re just playing.
Katie Vernoy 38:28
Yeah, or what they’re wearing, or what colors they like, or those types of things. So before we finish up, I think one of the steps that therapists hear a lot about and that we don’t necessarily, you know, I think that there’s a whole training that probably folks need to go to, and we can link to some of those in the show notes. But what should therapists know about these letters that therapists get asked to write?
Jordan Held 38:51
I mean, I think the number one thing is to get rid of some of the fear we as therapists who have worked so hard and tirelessly for our licenses, and live, we live in a world where we are afraid of legality issues, right. And I think we need to kind of put that off to the side, because letters are just one component to somebody getting access to, let’s say, a an affirming surgery, let’s say top surgery, for example. And letters are come from another element of privilege letters are usually for insurance companies only. Surgeons who do cash pay surgery, so if somebody can pay for cash out of pocket for their surgery, most of the time, they don’t even require a letter from a mental health provider. It’s purely so that you can code it as gender dysphoria, and it can get billed to insurance. So that’s a privilege dynamic as it is. The second thing is, you’re not the one stop shop for making this decision. Right. You are all you’re signing off on is essentially that you have met with this person and that they would benefit and you have discussed the risks and benefits as has the person who’s part of their probably interdisciplinary team. You’re one of that group of people talked about the pros and cons, we’ve talked about recovery, you’ve talked about who’s going to take care of you, you’re not signing off on, do you know 110%, that this client is making the one and only decision of their life? Right? You are working with them on this journey, the way that I do letters for people. First of all, I never charged for letters, that’s just my personal way of doing things. Because I know how hard it was, for me personally, to get a letter, it was really hard, it can be cost prohibitive. I think that it’s something that as providers, we can offer our trans patients, you know, there’s not a required amount of time that you need to sit with a client, there’s no longer need to have 12 months of consecutive therapy before you have access to certain medical interventions, do your bullet pointing things, and it’s all laid out in WPATH. The World Professional Association of Trans Health outlines everything that needs to be in these letters, as does certain insurance companies. So that’s a Blue Cross/Blue Shield. You’ll be able to look all that up, you don’t need to over disclose. So you don’t need to talk about history of medication use and anxiety and depression you’re talking about in the hear and now. And the important thing is too these letters are good for 12 months, they’re usually good for one year, a lot can change in a year, right? It’s not on the therapist, to know every little thing about what’s going on for the client, you need to know where they’re at right then, and make sure that they have everything that they need in order to make an informed consent decision for their care, just like we would for anything else. No other identity requires a letter or two for bottom surgeries it’s two in order to sign off on a procedure. Note, no other identity. So the fact that we even need to ask for a letter in order to prove somebody’s identity shows how much work we still need to do. But my final thing that I’ll say about letters is that you don’t need to know how to write a letter, you can ask for help. Nobody, no therapist is ever taught in grad school or usually at their, you know, job, how to write a letter. It’s something that you need to learn, right. And that’s one of those things I love teaching clinicians about letters. I love helping clinicians write letters, because it really is something that is so helpful for members of trans community. And you don’t need to have fear about how to do it, you can just ask the questions. And then people who are comfortable writing letters can assist you so that you can add that skill to your repertoire, just like you would write a letter for a service animal.
Curt Widhalm 42:33
Where can people find out more about you and your practice?
Jordan Held 42:38
I work at Visions Adolescent Treatment Center out in California. I work at a primary residential mental health facility, working with a lot of gender and sexual minority young people and their families. I also have a private practice out of Visions. So you can just, you know, Google Visions teen or look me up on Instagram @jordanilan, and reach out to me. I mean, we’ll have my contact information available. And literally, if you have questions ask I love teaching people about gender work, because my goal as a trans person and as a provider, is that we can educate every therapist so that it doesn’t need to be a niche specialty. Right now working with trans and queer youth and adults for that matter is really a niche. And my goal is that everyone who’s listening to this podcast can be an affirmative therapist, right? Because once again, circling back to how we started this, being an affirmative clinician just means being in a space with someone, listening to them, hearing something that might be different than you knew growing up, that you that was different than how you were raised by your family, different from your religion. And once again, like try not to be an asshole about it and you’ll do your job really well.
Curt Widhalm 43:52
We will, we will include links to Jordan’s stuff in our show notes. You can find those over at mtsgpodcast.com. And follow us on our social media. Let us know about your work in what you’re doing as far as being a gender affirming therapist and about you not being a asshole until next time, I’m Curt Widhalm with Katie Vernoy and Jordan health.
Katie Vernoy 44:17
Thanks again to our sponsor GreenOak Accounting
Curt Widhalm 44:21
GreenOak Accounting specializes in working with therapists in private practice and they’ve helped hundreds of therapists across the country reach their financial goals. They offer a number of monthly packages to fit a growing practices needs from bookkeeping to CFO services. Other specialized services include Profit First supports compensation planning and customized KPI dashboards. They help therapists achieve their clinical goals by making sure they have a profitable practice and offer unsurpassed support along the way.
Katie Vernoy 44:51
If you’re interested in scheduling a complimentary consultation, please visit their website at greenoakaccounting.com/consultation to learn more.
Curt Widhalm 45:01
This episode is also brought to you by Thrizer.
Katie Vernoy 45:04
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Curt Widhalm 45:43
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Katie Vernoy 46:20
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