Saving Lives One Letter

Affirming care that is trauma-informed and anti-oppressive for trans, non binary and many more non cis people is supporting the client where the client is at and removing barriers that are within our power to grant basic access to. Using a person’s name, pronoun(s), and validating who the person is, is the bare minimum and basic. We would be doing this for a cis client as we do not question the pronoun(s) the person uses, the name that the person shares with us or invalidating the person’s understanding, knowledge and exploration of self. Trans, non binary and many more non cis community members are constantly misgendered, dead named (using a name that the person was assigned at birth or is legally the person’s name), having to prove that the person really is who the person shares the person is, having to go through assessments in order to gain access to live saving medical care that affirms who the person is. 

If a cis person wants to have surgery and/or start hormones, the person meets with a medical provider and is able to move forward with accessing care without needing a mental health provider to assess and provide a letter for approval. This is not the same equitable and accessible process that trans, non binary and many more non cis community members get to experience. The difference is the power and privilege that a cis identity holds over all other identities. Trans, non binary and many more non cis people have to endure a series of questions that question the person and the person’s identity. The person has to attend and afford therapy to access this care (the average yearly salary of a trans person is 10k a year).  

We are all familiar that therapy is not cheap and/or free and many people don’t have access to insurance. Many of those who do, understand that having low income/no income insurance can be almost impossible to gain access to me mental health provider, let alone one who is trans https://www.google.com/search?client=safari&rls=en&q=Best+restaurants+in+pasadena&ie=UTF-8&oe=UTF-8affirming. Once the person has accessed mental health therapy and proven that the person truly is who the client shares that the person is. The person then may receive a piece of paper that enable the person to gain access to starting hormones, having surgery, medical procedures, electrolysis, hair removal and/or different medical interventions to create safety and/or comfortability in the person’s body both internally and externally. 

I want to invite you to please read through all the information below which includes statistics of realities of the impact of having access to affirming care, surgery, hormones and/or medical procedures. While also holding that we have the power to create access and remove barriers to people who are just wanting to be true to oneself and to be able to experience one’s body in a way that aligns with who the person knows themselves to be. 

More often than not, therapists communicate, “Oh, I don’t work with that population” when referring to the LGBTQPIA+ or even just trans and non binary people. Their reality is we do, we have and we will. 2022, 44% of adults in the United States of America know a person who is not cis. This percentage rose in one year from 41% in 2021 (https://www.yahoo.com/lifestyle/5-percent-of-americans-under-30-transgender-nonbinary-new-research-140030354.html?guccounter=2). That means that more than 4 in 10 of our potential clients may hold identities that are not cis and we may not even know it. Which indicates that we absolutely have worked with clients who hold these identities, that we know people who are trans, non binary and many more non cis identities and that in the future we will work with people who are not cis. We then must question how safe am I, am I willing to be an ally, what will I do to make it safer for my clients share these parts of the client’s identity(ies).  

There are mental health providers who have gaslit many people in this community due to ignorance and/or naivety. People are unfamiliar with the vast amount of identities that a person can hold. Here are a few and not limited to, trans, non binary, two-spirted, A, fluid, Male Alyha And Hwame, Ninauposkitzipxpe, Ashtime, DemiGirl, Non-Conforming, MTF, FTM, Questioning, Non Binary, Variant, Inter, Hijra, Female, Mahu, Nadleehi And Dilbaa, Pan, Sekrata Poly, Winkte, Xanith, Whakawahine, Tri, Quiariwarmi, Neutrois, Lhamana, Kathoey, Guevedoche, the list of labels & identities does not stop here. 

The potential identities that exist, that we embody, that we hold that are affirming and so much more are not limited to just the list above and it is vital that we are understanding that just because we don’t recognize an identity, it does not mean that it is not valid and/or real. Our role is to trust the client, who is trusting you enough, to share with us as mental health providers in sharing who the person is with us and believing our clients. 

More than 5% of Americans under the age of 30 years old have shared that the person’s identity is trans, non binary and many more non cis identities. In 2018, that number was 1.8% (Pew Research Center 2022).( https://www.yahoo.com/lifestyle/5-percent-of-americans-under-30-transgender-nonbinary-new-research-140030354.html?guccounter=2 )(https://www.pewresearch.org/social-trends/2022/06/07/the-experiences-challenges-and-hopes-of-transgender-and-nonbinary-u-s-adults/).

This community continues to grow, not because it is a fad or because it is contagious, but because we are creating a world that is a little safer for some of us to be able to push past the societal constructs that define us and really lean into ourselves as we continue to explore and find more of who we are. This not true for many of us and it is vital that we are doing our part, as mental health providers and humans, to create accessibility and safer spaces for ourselves and our clients. I am inviting you to be part of the live saving solution. This is a moment in life where we get to decide and chose which side of history we will be on. 

The Trevor Project, is one of the leading suicide prevention organization for LGBTQ+ youth, found in a 2022 national survey of 34,000 LGBTQ+ youth ages 13-24 that over 50% of trans and non binary youth in states across the US had seriously considered or attempted suicide in the past year (2022 U.S. National Survey on LGBTQ Youth Mental Health by State | The Trevor Project). 

Research also consistently shows that when a person's identity is affirmed, via access to medical care, hormones, surgery and more, these numbers significantly are reduced. 

For instance, the largest study of this kind (Psychosocial Functioning in Transgender Youth after 2 Years of Hormones | NEJM, New England Journal of Medicine, January 2023), which tracked over 300 trans and non binary youth across the country for over two years as they took testosterone or estradiol, found that depression and anxiety symptoms decreased and life satisfaction increased after starting and continuing affirming hormone therapy. 

In the article, Long-Term Regret and Satisfaction with Decision Following Gender-Affirming Mastectomy, published on August 9^, 2023, the question was asked “What is the rate of regret and satisfaction with decision after 2 years or more following gender-affirming mastectomy?” The findings indicated a significantly low rate, almost no rate of regret and/or dissatisfaction. This means that the rhetoric we have been receiving and potentially regurgitating is not based on facts and evidence. Studies are continuously showing that this is lifesaving care, so why are we exposed to apposing content and information? 

The reality is, we live in a transphobic world that wants this community eradicated since colonialism. The media, religious institutions and so much more would rather us die because it goes against the systems that currently exist. The same systems that were created to keep privileged identities in positions of power because people are scared of what people do not know. 

Transphobia is deeply connected to transphobia and what I mean by this is that people hold so much internalized transphobia that a person would rather blame and/or harm a trans person for “tricking them” versus holding that you can be a man, attracted to a woman who has a penis and not be labeled as gay. Yet our fragility prevents us from holding that being attracted to a trans, non binary and/or another non cis person does not change our sexuality nor is it ever okay to equate a trans woman as a man or a trans woman as someone who was “born a man” “biological male” “was a man” as all these are so deeply rooted in transphobia. 

Biology is chromosomes, hormones, cells, receptors, and so much more. When a baby is a born, the doctor looks between the baby’s legs and determines the gender marker based on genitalia that is observed. Biology is not taken into account. Equating a person’s gender marker that was labeled on a person to a who a person is and/or was transphobic. 

Forcing people to live based on who we were told we were as a baby is harmful and oppressive. We were born a certain weight, does that mean we can’t buy clothing that would fit us at the weight we are now because a document that a person recorded information on however many years ago dictated that, this is now our weight forever? 

We grow, we change, we gain access to information, and we learn more about who we are, so if it doesn’t match who others told us to be, it doesn’t mean we are mentally ill/unstable or that we need to be assessed. It just means that the world is scared of us because history has shown us, we are scared of what we don’t know and our history in the United States of America shows us that we are scared of who can take power from us and change what we are comfortable with. 

One of the largest studies was released in the New England Journal of Medicine that showed a decrease in anxiety & depression in trans youth after tracking over 300 trans and non-binary youth across the country for 2 years who were on hormones. The study’s conclusion was that the trans and non binary youth who received hormones that lead to the youth feeling a congruence between who the person is and who the person saw directly improved the psychosocial functioning of the youth (https://www.nejm.org/doi/full/10.1056/NEJMoa2206297). 

Another study did a systematic review and meta-analysis of regret after having surgery to affirm oneself in one’s identity and the conclusion was that the prevalence is extremely low of regret with trans patience who had surgery.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/). 

Mental health providers are often afraid of being sued for providing an assessment and a letter to a trans, non binary and/or another non cis identity. To date, there hasn’t been one case that a trans, non binary and/or another non cis person has won a law suit against a mental heath provider for providing a letter after an assessment for affirming surgery, procedures and/or hormones. 

Studies continue to show an increase in livelihood, functionality, sense of self and so much more. 

How you can be part of the solution 

I am asking you to be part of this life saving care where we prioritize people’s livelihoods over our own fears and discomfort. I am asking you to please hold that engaging in assessments and writing letters for LGBTQPIA+ people to get access to medical care is vital and life saving. It could literally mean life or death for another person. It is up to us to choose to be on the right side of history and work towards ending gatekeeping. 

I hold and understand that many mental and medical care providers often feel insecure in their ability to engage in an assessment and write a letter. This is why I developed an easy-to-use application called No More GateKeeping (https://nomoregatekeeping.org) that can be used on your phone, computer, tablet and/or many more smart devices. Following this app provides both the training to understand what is needed to write a letter, as well as an easy-to-follow process for writing them. 

How the app works 

The app provides the trauma-informed questions to ask the client. The provider types in the responses of the client. Once all questions have been answered, the app populates a ready to go letter that just needs the providers signature and date. The letters and information store locally to the device you are using to continue the protection of our clients. 

A little about me 

A little bit about me: I am a trans, non binary, autistic, person of color, who is a dually licensed mental health therapist. To date, I have trained 3,000+ providers across the country on how to write affirming letters for clients. My life’s work has been dedicated to creating safer and accessible ways for my community and many more communities to have access to life saving care, affirming spaces, and safer engagements. I spend at least 10-20 hours a day, 7 days a week trying to find a way to make this world a little safer for all of us. 

I am inviting you all to help me in this work, aligning ourselves with anti-oppressive and trauma-informed engagements so that we truly are meeting our clients where they are at, and supporting them in trusting themselves. I am asking you to affirm that our clients are the experts of their realities, so that we can do all we can within our power and scope to affirm and protect our clients.

Van Ethan Levy, MA, LMFT, LPCC, (they) (elle), a trans and non binary therapist, is a queer, non binary, trans, socialized as female, nBPOC (not Black Person of Color), who is autistic, and has dynamic disabilities amongst many more historically excluded identities. Van provides consultations and trainings on trans and non binary identities, is the organizer of the upcoming 2022 Virtual International Do Something: Identity(ies) Conference, authored the interactive book, Exploring My Identity(ies), and produced the Documentary, Do Something: Trans & Non Binary Identities, Website: VanEthanLevy.com.