Michele O'Mara is a licensed clinical social worker and therapist who specializes in gender dysphoria, including homosexual and transgender issues. O'Mara is located in Plainfield, where she works with adults and occasionally with youths. She is certified in Imago Therapy, specializing in couples counseling, and is nearing completion of her Ph.D. in clinical sexology.She is a member of the World Professional Association for Transgender Health (WPATH), as well as the American Association of Sexuality Educators, Counselors, and Therapists (AASECT). Email her at firstname.lastname@example.org for more information about her practice. She recently answered some of reporter Chloe Sell's questions on transgender support issues.
NUVO: What is the typical age people identify their gender?
O'MARA: In my practice, it's usually one of three time frames. It's either really early, like 3-5, when [in kindergarten] the division between males and females really starts. That's usually the earliest time frame. If it doesn't happen then, it usually happens during puberty. If it doesn't happen then, it happens at some point in adulthood. Sometimes even after a person gets married and has kids. The oldest person I have worked with had the realization about gender dysphoria when he was in his 60s. There isn't a solid time frame, but I would say it is most common for people to identify very early or during puberty.
NUVO: Is it normal to see transgendered teenagers?
O'MARA: I work primarily with adults in my practice. I don't have a child or adolescent practice, but it is very common for me to receive phone calls about young people. And frankly, there aren't a lot of services around for young people. I have slowly started to see more and more.
NUVO: Is it OK to put a teenager on hormone replacement therapy when they are already going through hormonal changes?
O'MARA: Typically, the earliest a doctor will put a young person on hormone replacement therapy is around 16. And it depends on something called a person's Tanner stage. The Tanner stage has to do with where a person is in their sexual development. There are two lines of treatment when it comes to medically intervening. One is to stall or stop puberty. So people that are prepubescent or in puberty will usually be treated with a substance that will stop the progression of puberty. It's as safe for an 18-year-old as it is for a 40-year; old. An 18-year-old has gone through puberty, and at that point you're just stopping either testosterone, if it's a biological male, or estrogen, if it's a biological female, and adding the opposite hormone.
NUVO: What do parents need to know if their child thinks they are transgender?
O'MARA: They need to know who to contact to get that child support. Because that's probably not going to be something that most parents are equipped to deal with. They need to know that it is usually not a phase, something they've made up or trying to do to get attention, which are all things that I have heard parents suggest. And that is a very painful experience. If their child has come to them, they've taken a huge risk, a huge leap of faith that the parent is going to be understanding.
NUVO: Could it be confusion or an emotional phase? Could they think they are transgender but they're mistaken?
O'MARA: No. There was one client that did not identify with gender dysphoria but had some gender confusion, but I've never had anyone say, "I really think I'm a girl", or "I really think I'm a guy", but [then say] "Oops, I was wrong, I was just having an emotional breakdown." I don't think it's one of those things that people experience lightly.
NUVO: What concerns should parents have?
O'MARA:Parents should be concerned about the emotional well-being of their children. The doctors are usually really good at taking care of the physical aspect of the transition. And parents need to be concerned about managing their own shame and misunderstanding, and any phobias that they have about their child's gender, and what their own friends and family will think of them so that they won't put that on their child. I think parents really need to educate themselves. A lot of people in our culture just don't understand what being a transgender person means. There's a lot of shame from that, and parents need to deal with that. Participate in therapy, doctor's appointments, that sort of thing.
NUVO: What are some of the emotions friends and family should expect from someone who has begun the transition?
O'MARA: Often transgender folks who are beginning a transition experience a combination of excitement and relief, for having honored one's truth, and moving toward realizing it.Sometimes they are impulsive in their excitement and move more quickly than those who love them are comfortable.Depending on how a person feels about their loved ones, there may also be fear of disappointing family, fear of being disowned and rejected, fear of always being alone, and unloved, fear of being viewed as a "freak," and there may be some extreme self-focus in order to see the transition through.Many of my clients also fear for their safety, and struggle with decisions we take for granted, like:"Which bathroom should I use?" There is a lot involved in transitioning one's gender.I often say it is not for the weary.Unfortunately, for many people, it is a process of trading losses.The options are, live as you have been and remain untrue to yourself and unhappy in most cases, or risk losing friends, family, and life as you've known it but gain your sense of self.It has been my observation that the younger a person is, the less there is to lose, and the more success he or she is likely to experience.
For more information on transgender resources, O'Mara suggests:
True Selves, by Mildred Brown