Honestly, don’t feel stupid. I had dysphoria in my teens but didn’t have any interventions until I was a thirty-something doctor. A lot of medical/surgical transition is about trying to avoid pain - and that’s not something we can overcome by being ‘smart’. What’s important is that you are learning a way that is likely to help you more.

Hi, it sounds like your current level of experience/education/comfort with assessment for transgender surgery likely means that you don’t meet the WPATH recommendations for therapists performing this role. Have you read the most recent SOC? I think in your situation it would be very easy for you to tell your client that you don’t meet the requirements of the SOC to be providing the assessment for surgery readiness. I will say that my story is probably not the most common that you see on this sub (I had top surgery and took testosterone but never socially transitioned, and benefited immensely from top surgery. I was in my mid thirties and a medical practitioner when I had top surgery, and I am now in my early 40s). Therefore I’m not sure how useful my comments might be. The gender related therapy I had I didn’t find particularly helpful overall, but that was probably because my therapist had a particular view of gender ideology that didn’t align with my quite traditional Christian worldview. I think the most useful thing my general therapist did was just listen! I would personally consider framing your role with the client as someone whose responsibility is to explore the positives and negatives of surgery with them, and how to best manage these. It doesn’t sound like your role should be to assess readiness. You could explain to the client that every major surgery has risks, benefits and challenges, and that a responsible therapist would offer support in all these areas (with the choice of whether the client wants the therapy obviously being theirs- although noting that a gender specialist who does assess their readiness may well want to know from you how willing they have been to participate). I would frame this across the journey from pre-op preparation to long term health. This would start with, eg, do they have practical supports and financial resources to prepare and pay for surgery, are they in a relationship and do they want to talk about how this might affect current and future relationships, how will they cope with postoperative pain/wound care, how do they feel about the possibility of specific recognised surgery complications or unwanted outcomes and have they thought about how they will manage these complications, what long term health and well-being issues need to be considered after this surgery? I hope some of what I have said might be of use.

It sounds like you have come to some very sensible conclusions. My piece of advice would be that you don’t need to classify yourself as ‘trans’ or ‘not trans’. What’s important is that you work on your mental and physical wellbeing and consider what makes you comfortable. There are many ways to live as a woman. I personally have been jealous of women who seem comfortable wearing feminine things- but outside of social pressure and stereotypes there is no need to wear those things to be a happy, authentic woman.

Not really. The former name was Gender Identity Disorder. BDD is a different disorder. In BDD people will focus on a perceived flaw, and often have an extremely distorted perception of their body. People with gender dysphoria may perceive their body accurately, but feel distress at the sexual characteristics.

Thank you! I think the history you outline also illustrates that people who detransition are a diverse bunch. I think this subreddit is important in highlighting that diversity. There is no ‘one size fits all’. I stopped testosterone but don’t regret my mastectomies, for example. But I would never want my story to be used in isolation to support top surgery for everyone. Having said all that, I think the guidelines are appropriate. Despite being conservative in lots of ways, and never having socially transitioned to a different gender, I found the Gender Critical comments incredibly stressful, hurtful and unhelpful.

I had top surgery almost 3 years ago. I have never transitioned or detransitioned socially, only medically. The first times I wore a proper binder, it took away long term discomfort in my body that I didn’t even realise actually related to my breasts. It was light-bulb, life changing. And then I couldn’t un-have that realisation. Obviously no regrets. I had obviously managed to deeply disengage from my body. I even breastfed a baby for a year, which I am very glad I was able to do but probably shows how deeply I’d buried these things between about age 20 and age 35.

Are you receiving mental health treatment? If not, please reach out to a doctor or counsellor. This sounds like a crisis situation. There are a lot of ‘black and white’ elements to your thinking, and it sounds like therapy could help you address ‘cognitive distortions’ / unhelpful thinking styles. Your pain can pass. I have had awful emotional pain that has been treated by medication and therapy. It can get better.

You are writing on a page with a lot of people who regret their surgery. Have you looked up people’s experiences here, eg struggling to get prescribed female hormones after hysterectomy. I think a number of people here probably find your quest for surgery personally triggering.

It’s understandable to be scared, with so many unknowns. But it sounds like you have been learning lots about yourself and maybe about the healing you want for you and your partner. Try to be brave in talking about it - including with your partner. My big piece of advice would be to (thoughtfully) include your partner. I believe that lack of communication on both sides was the downfall of my marriage. Also try to think about how you would encourage a friend in your situation - I bet you would tell them that things will likely be much less catastrophic than they imagine.

You are still very early in the process. I have come off injected testosterone a couple of times now, and it takes ages for your body to change, and then ages for your brain to get used to your body. Don’t feel you have to wear makeup or work hard at a stereotypical presentation. Just try to be yourself - whoever that is! If you go back on T, you lose the opportunity to adjust, and all the hard work you’ve done.