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Local gender therapists see hope in health care for transgender individuals 

Queer & There

Despite increased visibility for transgender, nonbinary and other gender non-conforming folks, many still believe they have to fly solo through the process of discovering their gender identity. Not everyone can afford therapy, hormone replacement therapy or surgery, and many don’t even know where to access resources to help them explore that tangled mess of identity and cultural programming that comprises one’s perception of gender.

In the 11 years that gender therapist Dara Hoffman-Fox has been practicing, they have seen a shift in the gender landscape of Colorado Springs and the surrounding region, but the relative isolation of people questioning their gender identity remains. That’s one reason Hoffman-Fox published their book in 2017, You and Your Gender Identity: A Guide to Discovery, a way to make accessible the kind of support a therapist might give someone questioning their gender.

The book has helped those who want to better understand their gender identity and the therapists meant to care for them. A growing number of trans and gender non-conforming people now have the vocabulary and the knowledge to define their identities, but locally we lack enough informed therapists to care for them. Many therapists need to educate themselves, and most don’t even know it.

Before Hoffman-Fox opened their private practice in 2008, transgender issues were largely ignored in the mental health community, and indeed in the LGBTQ community. Even Hoffman-Fox, who identifies as nonbinary and worked at the now-defunct Pride Center, says: “I don’t know if I’m the poster child for where exactly everyone was in the Springs at that time, but me being very progressive and open-minded and liberal, I didn’t have a clue.”

And while things are changing, it’s by degrees. Hoffman-Fox’s former intern and current practicing therapist Paul Gross (who also co-facilitates BRIDGE, a support group for trans people) says that when he was completing his master’s degree at Phoenix University in 2014, courses on gender identity and expression were available to students of mental health, but were not part of the required curriculum.

In five or 10 years, the region may see a rise in therapists who know how to appropriately support their gender non-conforming clients. “But right now,” Hoffman-Fox says, “we’re in this middle stage where trans is becoming way more well known, and all the resources aren’t in place yet.”

This support deficit extends from mental health into physical health, where access and options are equally limited.
In order to begin hormone replacement therapy, a critical step if one wishes to medically transition, many patients have to give their physician a letter from a therapist, and some medical professionals use outdated standards that suggest someone must “live as their preferred gender” for a year before medically transitioning — an unnecessary burden that Hoffman-Fox says can prove unsafe, as someone who cannot “pass” as their gender may become the target of hateful violence. The few physicians in the area who operate on an informed consent model (meaning they don’t require a therapist’s go-ahead to fill a hormone prescription) fill up fast. So without a therapist, and more importantly, an informed therapist, HRT could be outside a patient’s reach.

Gender confirmation surgeries, too, are hard to come by. According to Hoffman-Fox and Gross, one’s best bet to find an appropriately qualified surgeon is to travel out of state — Pennsylvania or California — not exactly inexpensive. And while Marci Bowers, the surgeon who revolutionized gender confirmation surgery in Trinidad, Colorado, in the early aughts, will soon train surgeons at Denver Health, this is just one section of a larger puzzle, and we’re still missing some key pieces.

“This year I am focusing a lot more on educating therapists,” Hoffman-Fox says, “because it’s like my army. The more therapists who [know how to do this] ... That many more trans people are getting the appropriate attention and awareness.”

But the need for education doesn’t stop at the mental health level. More physicians, psychologists, surgeons and, yes, friends and family members, need to educate themselves about the evolving language and nuance of gender identity.

“Be affirmative,” Gross says. “That involves a lot of things. Advocating, educating, learning more. ... You’ve just got to understand that things are going to change, and there’s no way to stop it. And we shouldn’t. There’s no reason to stop it. Be open.”

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