By Anne Vitale Ph.D.
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T Note #6
September 6, 1997
Although seeing gender dysphoric clients who are in mid life is not new to me, the recent increase in genetic males who are in their late forties and early fifties coming in to work on their gender issues is too large to simply ignore. Why the sudden increase? Is there a special profile associated with this group? What have they been doing about their problem all these years? Is it too late to do anything about it? In this Note, I'll pass on what I have learned about this phenomenon and some of the results of my work with these individuals.
One of the first questions I ask when doing an intake interview is: "How were you referred to me"? The most common answer I get these days is they heard my name mentioned on the internet. Ahh yes... the internet. That magical place where people can either participate in, or invisibly observe the written thoughts of others. Even when someone chooses to participate, they can do so safely without revealing any information they feel might eliminate them from the discussion. Without the handicap of visual appearance, participants can be as female or as young as they like. It is an excellent outlet for individuals who have spent up to half a century in hiding. Of course, in a way they are still hiding. The difference is that at least they can now talk to others who are in a similar situation.
Apparently, talking online has at least some of the effectiveness of face-to-face conversation. At a minimum, online revelation of gender issues has a way of breaking the ice. Typically these people have never seen a therapist for any issue before. However, once the individual starts speaking out about their dilemma, apparently it is very difficult to stop. I can only assume that this factor is similar to what drives others to seek therapeutic help: the hope that the therapist will be able to provide relief from emotional pain and confusion.
Here is a closer look at eight genetic males between the age of 45 and 54 who have come to me for help since May 1, 1997 (Normally, only one or possibly two in this age group would have presented for treatment in that time period). Each has presented with gender issues. Three of the eight were very clear from the onset that they were intent on living out the rest of their lives as women. Each of them felt that they had already waited far too long and now that they had made their decision, they wanted to get on with it. In contrast, the other five varied in their hesitation. They shared a common difficulty talking about their issue and were very apprehensive as to where talking to me would lead.
A surprising constant, no matter what their thoughts were toward transition, was that all eight had done little or no research regarding gender dysphoria. When queried, four people noted that they avoided all contact with information regarding the subject for fear of being discovered. The other four had only recently felt brave enough to start research via the internet. All eight expressed surprise to learn how much clinical information there is available and how common the disorder is. Despite their earlier isolation, they were relieved to learn that they are not the only ones to experience gender dysphoria.
All eight of the clients, at the onset of our work, were either married or in a long standing relationship with a woman. In three cases the marital or partnership relationship has changed in the last several months due to the revelation of the individual's gender identity issue. One of the individuals is a retired policeman. Another recently sold a successful business and was devoting his energy to his transition. The rest are all still fully employed, holding managerial positions in various organizations. Six of the eight have grown children. A seventh has a son who is eleven years old. In all cases, their significant other either didn't know that they crossdress or had only recently found out. The average number of years they have been crossdressing is forty-two. As important and as helpful as crossdressing had been for them all these years, each reported that it was becoming an intruding obsession and that they needed more relief than crossdressing could now provide.
Fortunately, the medical mechanics of gender transition, even for individuals in mid life, are relatively straightforward. On the other hand, the emotional and psychological aspects of transition for individuals in this age group can be arduous. At root is the considerable investment in family and career that one would naturally accumulate in forty to fifty years of life as a male.
No matter what the age, timing is the key to a successful resolution to gender issues. Timing always translates down to adjusting the pace of the work to the client's ability to absorb and discover what is meaningful and workable. Each person must face the reality of their situation in digestible bites. Fortunately, expectations in all eight clients were mature. None of the eight expressed a view of themselves as a woman that was unreasonable given their age.
As I stated earlier, three of the eight were highly motivated and were eager to get on with the transition. A common report was that they had considered transition earlier but had either talked themselves out of it on practical grounds or that they found themselves investing more into their lives as males at times when gender issues were most pressing. Now determined not to falter, they are pushing very hard. That determination, if appropriate, needs to be kept alive but tempered down to a realistic pace. The other five were extremely cautious, even to the point of being overcome by fear. To prevent overexposing them to their own emotions, I slow the pace down and let them absorb the reality of their situation in very small increments.
Another important therapeutic aid is participation in a gender issues group. Groups are especially popular with my middle aged clients because it is the safest place to meet other like minded individuals in similar life circumstances. For many, the group becomes the social nucleus for what may become a new way of being in the world. As an exercise in individual responsibility, I let each participant choose the name and gender they wish to be identified as. There are no crossdressing requirements, but most people take advantage of the friendly environment to dress. I also actively encourage the members to meet outside the group sessions. It is very common for members to have a late dinner together or go out to have a drink after session. For some, these forays are among their first social experiences dressing in public. The only drawback in encouraging extra group activity is that the new friendships become too precious and the members tend to become too considerate of each other. If something comes up that is especially bothersome, it rarely gets discussed openly. Instead it gets saved for me to explain in the next private session. In turn, I routinely put it back on the client to bring it up in group as an exercise in learning healthy discourse.
So there it is. I believe that because of the internet, more individuals who have suffered privately with their gender dysphoria well into mid life will be coming forth in the near future. These individuals, whether overly eager to transition or frightened to death over the possibility, have low expectations and are very thankful just to be taken seriously. With only slight modification in hormonal delivery, medical treatment for these individuals remains about the same as for younger dysphoric individuals. Psychotherapy, on the other hand, needs to be handled with special finess. As of this writing only one of the eight individuals I have discussed above has started living full time as a woman. There may or may not be others. The important thing here is that each of them has already expressed new hope for a better life in the future no matter what form that takes.email-- Contact the author ----Please use the word INQUIRY in the Subject Line!
Copyright, 1997 by Anne Vitale, Ph.D. Dr. Vitale is a Licensed Psychologist specializing in gender related issues. Her office is located at 610 D Street, San Rafael CA 94901, (415) 456-4452. This Note may be reprinted in any non-profit organization's newsletter if Dr. Vitale's name and address appears with it. Other publications must obtain written permission from Dr. Vitale. A copy of any reprints must be sent to Dr. Vitale.