Out On The Couch

The Courage to Care for the Transitioning Self

Posted: 5-22-23 | Karina Schneidman

How It Begins

Any life transition is hard. The human condition is a complicated one at best. It is riddled with pain, sorrow, confusion, darkness, and the unknown. However, that also comes with the gift of growth, beauty, love, happiness, peace and of course courage to live the life each of us deserves. As these words are typed and expressed right now, my mind goes to the many people who are struggling between the world they are being seen in and the world they want to show up in? We have different worlds.

Imagine being invisible in a world that can see, imagine having to wake up every single day knowing that to be seen by the world in the way you want to show yourself will take a risk, a risk that can possibly cost you your life? The result of a gender dysphoria diagnosis and treatment is a difficult and uncertain journey (Chang et al., 2019). A journey that can cost a life, a family, a future, and hope. Affirmative mental health care can offer a place to slow down these very big and real anxieties.

The Risk(s) of Self-Care

When people hear or read about self-care the first few things that come to mind are rest, sleep, eating healthy, fitness, right? However, this is not the typical self-care model for the transitioning transgender population. These concerns are typically down the list of their worries, and concerns, it’s hard enough just trying to survive in a world that can be so harsh and rigid. What most of the population doesn’t know about the risk factors transgender people are considering in their doctor’s office doctor’s office.

The topics of life and death decisions, the coping mechanisms that it takes to step into self-care by taking major risks. The scope of risk when it comes to accessing gender-affirming care, is monumental (Coleman, 2017). It is these conversations that are not shared enough. These risks are not truly understood until people are touched by it either as an ally, friend, or family member. It is a conversation that simply doesn’t get addressed enough. 

The Courage of Self-Care 

While many transgender people don’t appreciate being called courageous for transitioning, it does take courage to make difficult choices. It takes courage to understand oneself. It takes courage to risk. Humans are such creatures of habit. Gender is a habit formed in the first hours of life and deeply integrated in all our habits and routines. Now, one must take all they know and give it up for what they don’t know because they want to live in their true colors. True colors represent feelings, thoughts about the body. The focus of courage from this point of view is the risk of a better tomorrow. It takes courage to truly love the self and this courage is attached to risk, no matter how it is sliced. 

How We Can Help

The transgender transitioning population (Safer et al., 2016) is at the core some of the highest medical treatment risks in the United States. It takes community and collaborative care to provide affirmative gender health care.

Maybe you’re in the medical field, working in one of the many specialties that support transition needs. Or you’re in mental health care and you’re working with a client who is suffering from gender dysphoria and is getting ready for the next steps in their journey. 

Perhaps you know someone at work, or at school or are related to someone who is fighting their way towards their true self. 

Even if you’re still developing your affirmative practice, there are things you can do now. 

You can show care, support, and understanding  by acknowledging what you don’t know yet.

There is safety in community, and you can help a person in transition build their support system.

Through your own courage to bear the unknown, you can spark courage for a transgender person to do the same. 

You can keep learning, keep investing, and advocating for the transgender community in affirming ways. 

Maybe you will change a life, a life fighting to be here, with us. 

Learn More from Our Courses: 

The text Gender-Affirming Medical and Surgical Treatment for Therapists presented by Cadyn Cathers, PsyD, Up to 10 CEs available is printed below a photo of a person in a white doctor's coat holding a heart with the transgender pride flag colors on it. Reconceptualizing self-care for therapists presented by Teresa M. Theophano, LCSW 1.5 CE Course” under an image of a rainbow heart with two bandages on it representing how over emphasis on individual self-care negatively impacts psychotherapists non binary person joyfully waving flag


Chang, S. C., Singh, A. A., & Dickey, L. M. (2019). A clinician’s guide to gender-affirming care : working with transgender and gender-nonconforming clients. New Harbinger Publications.

Coleman, E. (2017). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People. Principles of Gender-Specific Medicine, 69–75. https://doi.org/10.1016/b978-0-12-803506-1.00058-9

Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Current Opinion in Endocrinology & Diabetes and Obesity, 23(2), 168–171. https://doi.org/10.1097/med.0000000000000227


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