Questions I Am Often Asked As A Gender-Affirming Therapist - cut outs of female and men

Questions I Am Often Asked As A Gender-Affirming Therapist

Sabrina Lyn Surovec
June 1, 2023
May 30, 2023

This blog post was written by Sabrina Lyn Surovec, Counselor at Nivati. You can see more of their content on the Nivati platform and on the Nivati blog. If you want to learn more about Nivati, click here.

Working as a gender/sexuality-affirmative, kink- and sex-positive therapist during this politically trying time means that clients, or their parents, often ask hard (and sometimes heartbreaking) questions. LGBTQ+ people are currently facing an unprecedented amount of violence and discrimination, and I believe that part of the problem stems from people simply not understanding the queer experience. Sometimes, a gender-affirming therapist is the only positive, stable relationship clients experience, so I take my position as seriously, and humbly, as I can while offering support, validation, and an ever-evolving base of knowledge. That said, there are many different theoretical approaches to gender and sexuality, and as it is a personal topic, others' experiences may differ from what I offer here.

What Is the Difference Between Gender and Sex?

Gender is often viewed as a psychological and sociocultural construct, whereas sex is considered a biological construct. Although many Western cultures view gender and sex as occurring on a binary, even from a purely scientific point of view, there are many more sexes than only male or female. However, gender and sex are interlinked via society's interpretations of how we should behave, and what roles we should take, according to cultural assumptions about what our bodies say about us. When one's gender is felt as congruent with one's body, a person is considered cisgender; when it is not congruent, a person is considered transgender.

What Is the Difference Between Gender and Sexuality (Affectional Orientation)?

This might seem like a basic question, but the answer can be quite complex. Roughly, gender is a facet of how you relate to your own identity, whereas sexuality is thought of as your affectional relation to others. Both gender and sexuality occur across a spectrum, and both of these can fluctuate throughout an individual's life. Although gender is separate from sexuality, the two can intersect in various ways depending on one's relationships with others and how one chooses to define oneself within those relationships. 

What Does It Mean to Say That “Gender Is a Social Construct”?

When people say that gender is a social construct, what they are referring to is the set of cultural norms, roles, and behaviors to which people are exposed throughout their lives. In addition to our gender identities (how we view ourselves), we also internalize messages about who we are based on society's interpretations of the ways in which we present ourselves. The social concept of gender is as vast and unique as the many cultures in the world, and to add to its complexity, these constructs can also shift over time. When we say that gender is "assigned at birth," it means that one's gender is interpreted (often as binary) as male or female by society's prevailing views on what gender "matches" one's genitalia. 

Do I Have to Choose a Gender, a Sexuality, or a Label?

No. While labels often serve to help us understand and categorize, they are not necessarily something that all people need or even desire. There are many words used to describe static, changing, or even absent genders and sexualities, and there are more being created to define further nuances every day. The labels people choose can reflect anything from deep, personal insights, to their identity, to a need to connect with and feel part of a community. Bear in mind that language is subjective, and just because a label may be difficult to understand does not mean that it is invalid. Also, if you do choose a label (or set of labels) for yourself, you are not bound by that label forever; the more we understand gender and sexuality, the more we discover that both of these can be fluid and change over time.    

Am I Really Trans (or Cis/Straight/Gay/Bi/etc.)?

Although a therapist can provide guidance by asking thoughtful questions, the only person who can decide this for you is you. Exploring gender and sexuality is a natural part of the identity development of every human being on the planet. Unfortunately, there are always people who will try to define others' existence for them, but no one has the right to decide your gender or sexuality but you. It is also a common occurrence for people to decide on a certain set of labels at one point in their lives, only to find that their feelings change later. This does not invalidate who you are, or were, at the time! 

Can I Still Be a Straight, Cisgender Male if I Sometimes Find Other Men Attractive, or Have Sexually-Charged Dreams About Men?

Yes. It may come as a surprise, but having dreams or fantasies about genders and sexualities counter to your own is a common, natural occurrence. There are many men who define themselves as cisgender and who are in (or are interested in having) exclusively heterosexual relationships who enjoy a range of behaviors and desires that are not typically thought of as "straight." These identity conflicts often arise when the dominant culture has established a set of criteria to define masculinity that can be counter to many people's personal experiences. 

Can I Still Be Trans if I Don’t Transition?

Of course! Transitioning can be a physically, mentally, emotionally, and financially taxing process. While it is usually rewarding for those who wish to undergo it, not every trans person chooses to do so. Transitioning at all, or to what degree, is an entirely personal decision. The trans umbrella encompasses not only those who wish to surgically change their bodies to match their gender identity, but also those who consider themselves non-binary, genderfluid, genderqueer, agender, and other gender variations that aren't a static point on the gender spectrum. 

What Goes Into the Process of Transitioning? Am I Too Old to Transition?

People have transitioned, socially and physically, as late as their 80s. The process of transitioning is unique to everyone, but the general path for those who decide they want to undergo gender-affirming surgery (formerly called "sex reassignment surgery" or "gender reassignment surgery") is to socially transition (express their gender both privately and publicly), then begin a course of cross-sex hormones (testosterone or estrogen), then proceed with "top" and/or "bottom" surgery. This process can take a short or long time, depending on a variety of factors such as the person's individual needs, the availability of gender-affirming treatment, cost, insurance coverage, physical health, support networks, safety, and more. The minimum amount of time usually required (depending on the laws or regulations of the area in which they live) is two years. 

Will I Be Safe if I Come Out?

Although I am frequently asked this question, this is something that can only be answered by each person for themselves. There are so many factors that intersect in a person's life that determine safety that it would be impossible to answer, but some things that I ask clients to consider are their relationships with family and friends, their office/school environment, and the overall social climate where they live, as well as their stress tolerance for living "in the closet," which is known to cause both mental and physical health problems. Ultimately, no one has a right to know or define your identity but you.


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Sabrina Lyn Surovec
Sabrina Lyn Surovec
Sabrina has over seven years of experience as a crisis counselor and is setting out to create a private practice specializing in LGBTQIA+ issues and historical trauma. The foundations of their counseling style rests on a philosophical background of existentialism and intersectional feminist thought. Person-centered, solution-focused therapy informs their therapeutic practice. Sabrina is also fandom-friendly and knowledgeable about issues surrounding online harassment. Holistic wellness is important to them and they are open to discussions of sexuality. In their free time, Sabrina enjoys karaoke, tabletop role playing games, writing, drawing, photography, sci-fi/horror movies, long distance running, and weight lifting.