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How to become a gender and sexuality therapist

A gender therapist helps individuals and families deal with gender-related issues, including gender changes. Becoming a gender therapist requires you to spend a considerable amount of time in school. You will usually have to spend four years earning a bachelor’s degree and learning some basics about mental health and sexuality before you go on to earn a master’s or doctoral degree in preparation for this career. In many cases, the level of responsibility you will have is related to the level of education you complete. You may also need additional training to prepare, and many jurisdictions will require you to take licensing or certification exams to become a gender therapist.

The first step you’ll likely take to become a gender therapist will be enrolling in college. Typically, this career requires an advanced degree, and earning a bachelor’s degree is a necessary stepping stone toward the credential you need. Majors in science, health, or mental health may provide particularly good preparation for this career. No matter which major you choose, however, you may benefit from taking undergraduate courses in such subjects as human sexuality, gender issues, and reproduction — relationship- and counseling-related courses may also help prepare you. It is possible to gain admission to a graduate-level program without taking such courses, but they can provide knowledge you can build on later and might make you a more attractive graduate school candidate.

Most graduate schools will not have a course of study or a degree specifically for gender matters. Instead, you will usually need to earn a graduate degree in a mental health field and then take elective courses that help prepare you to become a gender therapist. A master’s degree is often the minimum you will need to pursue this type of career, but a doctoral degree will likely improve your job prospects and allow you to take on positions of greater responsibility. For example, you may need a doctoral degree to become a licensed psychologist in most jurisdictions.

If you want to offer gender therapy as a psychiatrist, you will still need an advanced degree but will typically attend a different type of institution to earn it. In most places, becoming a psychiatrist means enrolling in medical school and studying for four years. This course of study will usually include not only traditional classes, but also an internship in which you’ll have the opportunity to interact with patient’s as you learn. Upon successful completion of this type of program, you will earn the medical degree necessary for becoming a psychiatrist.

In most cases, you will also need specialized training to become a gender therapist. Before you can become a licensed or certified therapist, for example, you will often need to complete clinical training under the supervision of a licensed professional and pass a licensing or certification exam. To practice as a psychiatrist, you will usually have to complete a residency program and then take and pass your jurisdiction’s physician licensing exam. You can also seek additional training, such as through seminars, continuing-education classes, and self-study to prepare for a gender therapy career.

What Does a Gender Therapist Do?

Gender therapists are licensed mental health professionals who work with transgender, non-binary, genderqueer, and genderfluid people, as well as other people who fall under the trans umbrella. The main role of a gender therapist is to help people who are exploring their gender identities to either identify or affirm their feelings.

Gender therapists have several main responsibilities. The largest one is to help clients explore their gender identities and, when necessary, provide written gender confirmation documentation. Clients can then use that documentation to help them receive hormone replacement therapy (HRT) or to get gender-affirming surgeries such as double mastectomies (“top surgery”). Other surgery options include vaginoplasty, phalloplasty, or metoidioplasty (“bottom surgeries”).

One of the bigger challenges that people who fall under the trans umbrella often face is how to tell their loved ones, co-workers, or other people in their lives about their gender identities. A gender therapist can help them come up with a plan to do so as well as be a safe place to talk through feelings if coming out doesn’t go as well as they’d hoped. Often, this includes helping clients explore how their gender identities play into their personal feelings of self-worth, as transgender people are often more susceptible to depression, anxiety, or mood disorders.

Sometimes, gender therapists take time away from seeing clients in order to educate other people. They may meet with other therapists to educate them about what it means to be transgender, the various identities that fall under the trans umbrella, as well as teach them the best practices for working with transgender clients. It is important to keep in mind that clients will not always be teenagers or adults, so educating how to also speak to younger children who are exploring their gender identities is important.

Above all else, the gender therapist’s responsibility is to protect his or her client’s safety and mental health as much as possible.

What Are the Benefits of Becoming a Gender Therapist?

There are many benefits to becoming a gender therapist. Perhaps the biggest benefit is being a safe space for a transgender patient who otherwise may not have anyone safe in their life. You can truly change someone’s life simply by providing a listening ear and affirming that they deserve to be who they feel like they are on the inside. 

In addition to helping people, gender therapists have a wide variety of places and ways that they can work, which means plenty of flexibility. Gender therapists may work in schools, for LGBTQIA-exclusive organizations, in mental health hospitals, in private practice, or via online platforms. They can work from home or in an office, can conduct one-on-one sessions, family therapy sessions, couples’ therapy sessions, or even support group sessions. From rural school districts to metropolitan private practices, the need for gender therapists already spans a range of locations and situations and that need is projected to grow in the coming years.

How Much Do Gender Therapists Make?

The amount of money that a gender therapist can earn varies greatly depending on education, experience, whether they work for a non-profit or private practice, and which city they practice in. According to the Bureau of Labor Statistics, gender therapists earned an average of about $89,000. However, the information focuses on those who are psychologists, which typically requires more education. Another source says that licensed clinical social workers earn about $67,000 annually in metro areas and about $56,000 annually in rural areas. Typically, more education, bigger cities, and private practices will pay more.

How Long Do You Have To See a Gender Therapist?

There is no set amount of time that a person has to see a gender therapist before they can begin to transition, but that doesn’t mean that they can (or should) skip seeing one altogether. There are still several reasons to see someone before beginning medical transition. For one thing, many medical professionals and insurance providers do require documentation from a professional stating that someone has gender dysphoria and will benefit from beginning hormone replacement therapy or undergoing surgical procedures.

Additionally, the World Professional Association for Transgender Health (WPATH) recommends that people experiencing gender dysphoria undergo thorough mental health screenings and psychotherapy before, during, and after the transitioning process. This is for several reasons. Hormone therapy can cause extreme emotions of all types, which are often much easier to talk through with ongoing therapy sessions. The same can be said for surgeries. Even the most excited patient is bound to have some nerves and need to talk with people who understand. Furthermore, HRT may affect how antidepressants, anti-anxiety medications, and other mental health medications work in the body. Ongoing therapy ensures a client’s medication continues to help and provides an opportunity to make adjustments as needed. 

What Does a Gender Therapist Do?

If your goal is to help people who struggle to understand their gender identity or have family issues stemming from a gender-related topic, you may be considering becoming a gender therapist. Gender-affirming therapists are in high demand as there are not enough trained clinicians who understand the nuances between biological sex and gender, the mental health effects of gender dysphoria, and the struggles during a gender transition that a transgender person may face. Aspiring therapists who wish to help this population should focus on getting a high-quality education from an accredited college or university and then pursuing specialized training in gender therapy.

What Is the Role of Gender in Therapy?

There are many ways in which a clinician could work with gender-related issues in his or her clinic. Clinicians who wish to work specifically with transgender patients as they undergo a gender transition should be prepared to support this client for the long and arduous process of transitioning. Concerns raised in appointments may cover body image, voice changes, and how others perceive your client as he or she transitions. You may also work with people who do not fall into one category of gender: Many people who do not feel either male or female may use one of over 50 labels to describe their gender identity. For example, a client may wish to understand their nonbinary gender identity and develop a plan with you for coming out to their family and friends.

What Is a Gender-Affirming Therapist?

Simply put, a gender-affirming therapist is a clinician who understands the role of gender in a person’s life. While cisgender people — or those whose gender identity matches their biological sex — may deal with issues related to their gender, transgender and nonbinary individuals have unique issues as compared to this majority population. Most therapists are happy to take on clients experiencing gender dysphoria, but not all are trained to know how to help these clients.

Who May Need To Visit a Gender Therapist?

There is no hard and fast rule for knowing when it’s time to visit a therapist, but in the complicated scenario of a gender transition that includes surgery, therapy or a behavioral evaluation may be suggested as part of the process. Below are two examples of people who may become the clients of a gender-affirming therapist.

Anyone In the Process of a Transition

Though transitioning clients are not typically mandated to have therapy, a behavioral evaluation before starting hormone therapy or having surgery is strongly recommended. This ensures that the client is in the right place mentally and emotionally before taking such an important step.

Anyone Questioning Their Gender

Despite what the media may lead you to believe, gender issues aren’t always easy to understand. Instead, clients who question their gender may struggle with a lifetime of conflicting thoughts, feelings, and societal expectations — even those who are in the process of transitioning! Anyone who feels like they need a qualified, compassionate clinician to help them name their feelings and sort through their thoughts should visit a gender therapist.

Anyone Struggling To Understand a Friend or Family Member

Even family members and close friends with the best intentions may not understand how to react to their loved one’s transition or sudden announcement that they do not fit into a certain gender category despite their physical appearance. People who need help processing someone else’s transition are more than welcome to visit a gender therapist (with or without that loved one present).

How Long Do You Have To See a Gender Therapist?

There is no predetermined time or number of set appointments that clients have to adhere to. Instead, clients should focus on scheduling an appointment with a gender therapist in two situations: When they feel like they need help, and when their doctor asks them to schedule an appointment before medical intervention.

How Do I Become a Gender Therapist?

If you wish to become a gender therapist, you must first possess a strong desire to help those who need help with gender identity issues and the ability to listen without judgment. Education-wise, you should complete a bachelor’s degree and then a master’s degree in counseling, social work, psychology, or medical school with a subsequent psychiatry residency (though psychiatrists often do not practice therapy). Spend your time studying about gender, speaking to people who do not subscribe to the idea that gender is binary, and learning all you can about the subject.

You may wish to also pursue specialized training or certification in the area of gender-affirming therapy. If you have been through a transition or are in the process of answering your own gender identity questions, choosing to become a therapist who helps others is a worthy goal.