Gender Identity Disorder Information

THERAPY - Introduction

So, you're thinking about starting gender therapy, eh? Well, congratulations, as that is a big step toward getting things moving forward - assuming you find a competent therapist!

You may be asking just how in the heck you find a therapist? Moreover, how do you know whether they're competent or not? or Why do you need a therapist anyway? Well, those are very good questions and, hopefully, you'll find some answers here.

Editor's Note: Don't worry, there ARE actually links to a couple lists of therapists on this page. You can scroll down to the links if you like, but you should really read the other information about therapists and therapy on this page before you go contacting any of them. :-)


"Need" may be a strong word, as there are certainly many well-adjusted transgender people out there who arguably don't need psychotherapy. However, there are also many who find psychotherapy beneficial, especially if one suffers from what are often termed "peripheral problems" (such as Depression, Bipolar Disorder, OCD, etc.) that may or may not have anything to do with being Gender Dysphoric, but nonetheless adversely affect the quality of the individual's life.

The other reason to see a therapist is because, if you are transitioning "by the book" (i.e., following the Harry Benjamin Standards of Care), psychological evaluations are a requirement for professional recommendations/referrals for things like HRT and GRS/SRS.

Technically you can transition without undergoing psychotherapy, or in some cases for people who are well-adjusted and already living in role and/or on HRT, a one or two visit "evaluation" amounting to little more than a formality may suffice.

Actually it is possible to transition without even consulting a therapist, and many people do go that route. HRT drugs can often be obtained via prescriptions through a family doctor or some other medical specialty, or (more commonly) purchased from overseas with or without a prescription. Surgeons (particularly in Asia) who perform SRS/GRS or other feminization surgical procedures often do not require letters of recommendation from therapists, mostly because psychotherapy is not as common in Asia as it is in the West.

While this may be the more expedient method for those who are free of psychological issues, unfortunately it also means transition can be more expedient for people who DO have problems - including those who may not have been ideal candidates for transition, HRT, and/or GRS in the first place.

Even if a person was well-adjusted and free of psychological issues before transition, there are problems that can surface during, or because, of transition which may need to be addressed. For example, many people suffer rejection by friends and family, or relationship problems with thier children and/or a significant other. If a transitioner does not pass well there may be issues with social interactions, body image, self-esteem, depression, etc. Having a therapist to help one deal with the issues that crop up DURING transition is a possibility sometimes overlooked by those who initially avoid psychotherapy.

Another often overlooked benefit of seeing a gender therapist is the fact that they've been privy to the transition experiences of other transgender people, so they may be able to offer coping methods or points-of-view that had not occurred to you. Not to mention they likely know which doctors and businesses are trans-friendly, if not by professional reputation than by "word of mouth" from their patients.


This is the trickiest question. Ask most transgender people and they will tell you to seek the help of a QUALIFIED GENDER therapist. Many a warning has been issued to a "newbie" (i.e., someone just starting out with transition) about going to a therapist who has no prior experience treating people with Gender Identity Disorders. The consensus is that a "general" therapist is more apt to misdiagnose a gender patient, focus on the peripheral issues, and/or act as a "gatekeeper" to hamper the patient's transition.

If you look below you will see a number of "screening questions" to ask a therapist once you've hunted one down. Remember, though, that one of your GRS/SRS letter writers must, according to the Harry Benjamin Standards of Care, be from a doctorate-level clinical professional:

"If the first letter is from a person with a master's degree (M.A.), the second letter should be from a psychiatrist (M.D.) or a clinical psychologist (Ph.D.). If the first letter is from the patient's psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient."

Which leads to the question of just what in the heck do all those letters behind a therapist's name mean anyway? Well first of all, you should know that not all therapists are doctors. They may be social workers, licensed counselors, or people with an education level below that of the "doctorate" level. This does not, however, mean that these therapists are less qualified than another who holds a doctorate - especially if that doctorate is not in a clinical mental health field!

Some of the common letters you will find behind the names of therapists include:

M.D. - Most people know this one, it means "Medical Doctor." While medical doctors are required to learn some basic Psychology, this does not usually qualify a medical doctor to practice therapy in a mental health setting, and certainly not to treat as complex an issue as GID. Psychiatrists are usually medical doctors who have specialized in the field of mental health, in much the same way that a "Cardiologist" specializes in heart health. A Doctor of Psychiatry may also be "Board Certified" or "Board Eligible" in Psychiatry or even Child Psychiatry.

D.O. - Doctor of Osteopathy. This is very similar to an M.D. Osteopaths generally get the same residency training as medical doctors. Their medical schools include additional training in physical manipulation techniques somewhat similar to chiropractic. Editor's Note: A reader sent this in, "Well, for all practical AND legal purposes the M.D. and D.O. degrees conferred in the United States are equivalent in what concerns the practice of medicine, and that includes Psychiatry. As such, a D.O. who is board certified in Psychiatry (and there are many who are) is just as qualified in providing Gender Therapy as a M.D. with the same qualifications, with the provision for both types of practitioner, that they have an interest and some training in the area (the same provision applies to any other type of licensed therapist, of course)."

Ph.D. - This means "Doctor of Philosophy." You should ask your potential therapist if his or her doctorate degree is in Clinical Psychology (with a focus on research and practice), Counseling Psychology (with a focus on practice in less pathological populations), School Psychology (although many school psychologists do not get a doctorate), or just Psychology (many experimental and social psychologists at colleges have this), or the more recent psychological field known as "Sexology" (see below under ones to avoid). Just because a therapist has a Ph.D after his or her name and a"Dr." in front of it, doesn't mean they are an expert in a mental health field - that doctorate might be in "Art" or "Literature." Which is why it is important to know what concentration was in which the doctor earned his or her degree.

Psy.D. - Doctor of Psychology. A clinical psychology degree which places more emphasis on practice than research. Psy.D. programs developed to train practitioners who would keep up with research but might never do much research of their own.

Ph.D.(c) or Psy.D.(c) - The "(c)" means "candidate." It indicates that the individual is a "doctoral candidate" but has not yet actually earned their Ph.D. If you see this after a therapist's name make sure to look for some other legitimate therapy credentials - for they may be practicing under a Masters Degree they are in the process of "upgrading" to a Doctorate Degree, or have experience as a licensed therapist or counselor under some other credentials (because a Masters or Doctorate degree are not prerequisites for obtaining a license to practice counselling others). If the Ph.D.(c) stands all by itself, though, you may have to question whether they are actually qualified to treat your gender problem, either because he or she has insufficient education and/or experience.

One thing of interest to many gender patients is how much difficulty and expense they may have in obtaining hormones for HRT. A Psychiatrist, being an M.D., can usually write prescriptions for drugs - including hormones - while a Psychologist, being a Ph.D. or Psy.D., cannot. While this may save some money and time by not having to deal with a referral and added expenses of seeing an Endocrinologist, it may also mean substandard or absent monitoring (i.e., limited or no lab testing). Also one consideration is the major criticism of Psychiatrists (especially in the United States) that they over-prescribe medications which only address the symptoms of a problem (such as depression), rather than doing the probing to discover the cause of the problem. If you are only looking for letters of recommendation and prescriptions you'll probably be satisfied with a Psychiatrist. If you actually want to explore, understand, and deal with the root cause of your psychological issues (especially if you are against medicating psychological problems), you may find a Psychologist more to your liking.

D.S.W. - Doctor of Social Work. An advanced social work degree, often held by educators in social work.

Ed.D. - Doctor of Education. Many Schools of Education confer this degree. A recipient can be a psychologist, an educational administrator, or someone in another education-related field. Definitely ask any practicing therapist what their field of study was!

D.Sc. - Doctor of Science. More common in Canada than in the U.S. I'm not entirely clear on the distinction between this and a Ph.D. It is a legitimate degree though.

Masters Degree - Many therapists have masters degrees in a mental health field. There are generally three forms:

MSW - Masters of Social Work. This is conferred on someone who completed a master’s degree in social work by the university they attended. It is the same as the PhD, which is awarded by an educational institution. Not everyone with a master’s degree in social work alone or other fields is sufficiently trained to conduct psychotherapy independently.

ACSW, DCSW, BCD (and a number of others) These credentials are conferred on someone by a professional organization. They are an attempt to certify that the person who attains such credentials has some level of competence usually by taking an exam of some kind. Those listed above mean "Academy of Certified Social Workers," "Diplomate of Clinical Social Workers," "Board Certified Diplomate in Clinical Social Work" respectively.

LICSW, LCSW, CSW (and others) – These are usually credentials issued by the State Government signifying the individual is in possession of a license or certification (hence the "L" and/or "C" in the alphabet soup). In many (but not all) states, in order to practice legally or to call oneself a particular title, a license is required. The “I” in the clinical social worker’s license is important as it signifies they are licensed at the highest level and can practice independently. This means they do not need to be supervised by another clinician and also means that is one less person who would routinely know your business and private communications. The ones above mean "Licensed Independent Clinical Social Worker," "Licensed Clinical Social Worker," and "Certified Social Worker" respectively.

M.S.W. - Masters in Social Work. This is the traditional degree for Social Workers. In some states, the title LCSW is used for a Licensed Clinical Social Worker (or one of the variations listed above).

M.Ed. - Masters in Education. Many counselors have this degree or the similar M.S.Ed. It is given by schools of education in almost any field of Education.

Some states also license Counselors, who may or may not have an advanced degree, be sure to ASK if your goal is to obtain the necessary letters of recommendation for GRS/SRS:

L.P.C. identifies a Licensed Professional Counselor.

M.F.C.C. is used in some states to identify a Marriage, Family, and Child Counselor. A therapist with such credentials may be beneficial to parents with a transgender child, or a transgender person with a spouse.

M.S. or M.A. - Masters of Science or Masters of Arts. These are the traditional degrees given by "Colleges of Arts and Sciences" In the United States a Masters degree in Psychology has not been considered a "terminal degree." A psychologist (other than a School Psychologist) generally needs a doctorate to be licensed. Some Canadian provinces license psychologists with a Masters degree. A few states are also beginning to do this.

Ed.S. - Educational Specialist. This is a degree which involves more training than a Masters degree and less than a doctorate. Some School Psychologists have this degree, as do some counselors.

Physicians generally pass "specialty boards" to become "board certified in Psychiatry" or other specialties.

A.B.P.P - Psychologists can also become board certified, but this is an extra credential which many psychologist do not get. The "American Board of Professional Psychology" allows psychologists who pass their test to use these initials.

F.A.C.P. - is a "Fellow of the American College of Physicians" Fellows in the ACP are doctors who are dedicated to continuing education in medical practice, teaching, or research. Fellowship is an honorary designation given to recognize their ongoing individual service and contributions to the practice of medicine. Nice to see after a name, since it means your doctor is less likely to be working with outdated information or techniques, but it's only of value if they are staying current in a field of medicine relevant to your gender therapy.

In most states there is no license requirement to simply call oneself a therapist or psychotherapist. Just about anyone can hang up a shingle. It is important that whom ever you chose as a therapist that they be licensed. It is no guarantee of good treatment but at least you have some minimum safeguards.

Ones You May Wish To Avoid for Therapy:

The following degrees are either inappropriate, insufficient, or just plain questionable for anyone practicing as a therapist.

M.D. - Medical Doctors who are not Psychiatrists or who do not have psychological training or certifications.

D.O. - just like with an M.D., check for some other qualifications to treat your gender disorder.

Ph.D.(c) - [ see above why you may want to ask some credential questions of any therapist displaying this after his or her name - since it means they are only a "doctoral candidate" that has not yet obtained their degree]

J.D. - Doctor of Jurisprudence - An attorney. Some mental health professionals also have law degrees, so look for OTHER certifications besides this doctorate!

D.Min, Th.D, D.Div.. - A "Doctor of Ministry," "Doctor of Theology," or "Doctor of Divinity." Or more basically put, they are a minister - possibly a doctoral level pastoral counselor, but not always. Note that MANY of these degrees are bestowed by Bible Colleges that are not even accredited institutions of higher learning. While many ministers these days do have some training in psychology they are certainly not knowledgeable enough to counsel people in the same way a Psychologist can. Furthermore, many of these "Pastoral Counselors" provide counsel that his highly biased toward their own religious beliefs. Given that most mainstream religions have very negative views of transgenderism, it is strongly recommended that such "therapists" be avoided.

M.Div. - Masters of Divinity - another degree that ministers get - some of whom are pastoral counselors. Again, it is the opinion of the author of this web site that transgender patients should avoid "faith-based" counseling due to the negative views most mainstream religions hold concerning transgenderism.

D.C.H. - Doctorate of Clinical Hypnotherapy. Certainly not a standard doctorate. It is offered by the American Institute of Hypnotherapy which is located at This degree should not be equated with the above degrees. In fact, I read of a story where one person - as a joke - got a dog (yes, a dog) "Board Certified" as a Doctor of Clinical Hypnotherapy. Even if you believe in hypnotherapy, there's no evidence it is effective in treating GID.

N.D. - Naturopathic Doctor. They are trained (but to what extent varies greatly) in subjects such as anatomy, physiology, counseling, dietary evaluations, nutrition, herbology, acupressure, muscle relaxation and structural normalization, homeopathy, iridology, exercise therapy, hydrotherapy, oxygen therapy and thermal therapy. Some practitioners are also trained in additional specialties such as acupuncture or natural childbirth. This "doctorate" also should not be equated with M.D. or Ph.D. given the un-accredited institutions that award (or outright sell) Naturopathic Medicine credentials. While some may act as counselors (usually "mind/spiritual" or "whole body health" type counselors), they would not be an appropriate or qualified choice for gender therapy.

Other initials stand for "certifications" in certain areas. A certification is similar to a license, but with a more limited scope of practice. Some common certifications are:

CSAC - Certified Substance Abuse Counselor. This is someone with extra training in substance abuse. They generally have at least a Bachelors degree (the basic four year college degree). In most states they cannot practice independently.

CAC - Certified Alcoholism Counselor. Similar to a CSAC, but with an emphasis in alcohol.

While the above certifications may be of value to transgender patients who also have substance abuse problems in addition to (or becuase of) a Gender Identity Disorder, a substance abuse or alcoholism counselor certification would not be enough qualification to treat a GID as well.

B.C.F.E. - Some specialty boards are suspect because they allow almost anyone to pay a hefty fee and get the credential. Until recently many professionals could use these initials with modest training and without passing any test. This board (the American Board of Forensic Examiners) has plans to "certify" professionals in psychology and other disciplines. The main advantage of this certification seems to be the extra letters after a professional's name.

Sexologist - may be a "Masters" or "Ph.D." This is a (some say "dubious"), sub-field of Psychology. Part of the reason it is contraversial is due to the fact some non-accredited schools award degrees in this subject (link: read about one of them), but also because some researchers in this field have allegedly employed questionable (or overtly non-scientific) methods or adhere to theories widely regarded as "fringe science," "junk science," or "pseudo-science." This does not mean, however, that all therapists who hold a degree in Sexology are bogus. But the fact that some in this field have conducted themselves in a manner that is questionable or hold highly suspect credentials should be cause by any gender patient to exercise caution if dealing with a Sexologist, especially one who obtained his or her degree from a non-accredited school. Take the time to question a Sexologist about which gender theory or theories to which he or she subscribes.

Just "Doctor": If you read an article which is written by a "doctor," and the author does not specify what type of doctor they are, then be skeptical. One prominent example is the popular radio personality and advice columnist "Doctor Laura." She is not a psychologist nor a psychiatrist. Her doctorate is acutally in "Physiology" and she is licensed as an M.F.C.C. (Marriage, Family, and Child Counselor). This doesn't mean she cannot dispense advice (anyone can offer advice, after all), but it means that, technically speaking, her doctorate doesn't qualify her to do the job she is doing.

Okay, so all of that will help you determine whether or not they are a "qualified" therapist or a quack. But what about the GENDER part of being a "Gender Therapist?" That's where having a little "insider information" can be helpful. Read on. . .


Well, you can call the therapists in your area and ASK them if they've ever treated people for Gender Identity Disorders before. You may just stumble across someone who has the experience and credentials, but doesn't advertise the fact that they conduct gender therapy.

The Harry Benjamin International Gender Dysphoria Association will provide anyone a copy of their Membership Directory for $10 (order form), which will undoubtedly list some of the mental health professionals who belong to the HBIGDA. However, it is important to remember that many many therapists follow the Harry Benjamin Standards of Care for treating GID, but do not actually belong to HBIGDA. It should also be noted that membership in the HBIGDA does not require one be a psychologist! They welcome membership applications from professionals in fields such as medicine, psychology, sexology, social work, counseling, law, as well as other interested persons who wish to be involved. Since the HBIGDA doesn't require members (especially "supporting members") to even have professional credentials, those who have illigitimate or questionable credentials are also allowed to join. So membership in the HBIGDA only tells you the prospective therapist is familiar with gender disorders and their treatment guideline, it's still up to you (the consumer) to practice due-diligence in checking a therapist's professional credentials.

Then there's the "tried-and-true" method which is to seek out the local Transgender Community and ask other transsexual people who they are seeing for psychological service - and who they believe you should avoid! Of course, what do you do if you don't have (or at least don't know where) your "Transgender Community" is? Thankfully we live in the "Information Age" and you can likely find other transgender people in your area via the Internet.

There are plenty of places on the Internet where lists of therapists reported to (or claiming to) treat gender patients may be found. None of these lists is by any means comprehensive, but if you're lucky you may find a qualified therapist in your area. This site has two such lists (which I put in a box for the convenience of those lazy people that just scrolled down without reading my pearls of wisdom):




If you simply cannot locate a qualified GENDER therapist, then consider looking for a very well qualified general therapist. Most therapists with experience treating gender patients, at one time, had never treated one before. Just be extra careful to avoid the pitfalls of seeking a therapist (discussed below).

Another option, especially if you are geographically isolated, may be to seek out a therapist who will provide counseling by phone and/or Internet. Just be careful to make sure they are legitimate before paying for session time (for example, the therapist should also have a "brick and mortar" practice as well).


The Call is Coming from Inside Your House!
First step is to contact a therapist you think may be able to help you. This step can often be frightening and more than one transgender person has had an anxiety attack while trying to work up the nerve to dial the telephone, or immediately disconnected the phone call when someone actually answered on the other end. The important thing to remember is that the person you are calling is not only a professional, but one bound by a code of ethics. They simply CANNOT talk about your issues with anyone else without your permission. Just try not to gush about your gender issues to the receptionist - ask to be transferred to the therapist or his or her voicemail and leave a confidential message. You don't have to give your life story, just say you are seeking "psychological services for transgender therapy" and make sure to leave information on how to contact you! Most therapists take great care to be discreet when returning such a call, but if you are concerned about someone else intercepting the message you should consider leaving some alternative contact information.

E-Mail = The Fastest Way to Never Get a Reply
Incidently, I do not recommend you initiate contact via e-mail even if a therapist provides an address for doing so. There are a number of reasons I advise against this. First of all, e-mails aren't the most secure form of communication. Even if you sent an encrypted message, there may still be a copy of it somewhere on your computer that could be found and read by others with access to your system (this can be a lot of people you don't even know if you try to send your message from a company workstation). The main reasons for not sending a therapist an e-mail message, though, are that many of them don't read their e-mail or rarely check it. It might be a long time (maybe never) before you hear back from them. Furthermore, you never know if your message got filtered by spam-blockers or virus software either - the therapist may never have even received your message. While e-mail contact may feel "safer" because of the feeling of anonymity surrounding it, the telephone is still the best way to make initial contact with a therapist.

Let's Play 20 Questions!
Once you get to speak with a prospective therapist in person, ask them:

    1. How many gender patients do you have?
    2. How many TS people have you recommended for surgery?
    3. How long have you been working with gender patients?
    4. What is your educational background?
    5. What books on transgender issues most influenced you?
    6. Have you written any books or articles on the subject?
    7. What got you interested in working with transgender people?
    8. What is your basic philosophy about how to treat this condition?
    9. Do you follow the Harry Benjamin Standards of Care?
    10. What is your hourly rate?
    11. What length of session do you usually prefer?
    12. Is it possible to do longer or shorter sessions?
    13. How long do you usually see patients before you might OK them for hormonal therapy? SRS?
    14. Are you affiliated with any endocrinologists or plastic surgeons?
    15. Are you part of my insurance network?
    16. Would you be willing to classify our sessions as depression in order to meet insurance requirements?
    17. What are your hours?
    18. Do you have weekend or evening appointments?
    19. Do you work from your home or from an office?
    20. (Anything else you want or need to know)


There have been a lot of gender patients who've been totally screwed over by their therapists. The general concensus is that NO therapy is better than BAD therapy. Below are some of the pitfalls often faced by gender patients seeking therapy:

The "Gate Keeper"
Gate Keeper therapists are those that actively try to prevent gender patients from transitioning. Some of the reasons a therapist may be a Gate Keeper:

  • The therapist is actually prejudiced against transgender people and the gate keeping is employed to purposely frustrate the patient in the hope they will simply give up on trying to transition.
  • The therapist is actually well-intentioned but misguided by a belief that all peripheral psychological problems must be addressed and "fixed" before tackling the gender issues. This is often a bad approach given that many of the peripheral problems can stem from the underlying gender issues, so failure to address the gender issues means the peripheral problems persist.
  • The therapist believes the patient does not actually have a Gender Identity Disorder, and therefore transition is inappropriate therapy. If a patient suspects their therapist is gate keeping because they do not believe that GID is present, they should either insist the therapist render a diagnosis or seek help from another therapist.

If the therapist rendered a diagnosis of "Borderline Personality Disorder" (or some other personality disorder) or "Body Dysmorphic Disorder" the patient should definitely seek a second opinion. Misdiagnosis is more likely to occur with a therapist with little or no experience treating patients with gender disorders.

Psychiatrists have something of reputation for trying to medicate problems away by prescribing drugs. Some, on the misbelief that a patient with Gender Dysphoria is delusional may prescribe anti-psychotic medications. Depression (even suicidal depression) is quite common among people with gender disorders. While anti-depressant medications may help mitigate some of the depression it is only a "band-aid" that ignores treating the underlying cause(s) of the depression. GID does not respond to anti-depressant or anti-psychotic drug therapies.

this can often be a method employed by Gate Keepers, though it may also be used by therapists who are particularly concerned that they may make a mistake in treating a gender patient. They employ the Standards of Care - which are intended to be more of a guideline - as if they are law. The SOC is intended to be somewhat flexible to be tailored by a therapist for each gender patient, not applied as a Draconian Rule Book or "one-size-fits-all" form of therapy. Specifically be wary of therapists who insist patients need to begin their Real Life Test/Real Life Experience without the benefits of HRT. Note, however, that in some countries (such as Germany and Italy) the Standards of Care have actually been incorporated into the laws governing the National Health guidelines doctors MUST follow.

Your Neighborhood GIC
"Gender Identity Clinics" are not as common in the United States as they once were, but they still exist in many nations with National Health systems. These clinics are usually affiliated with a major teaching hospital and/or University. Some may even still provide "one-stop shopping" for all your gender therapy needs - providing a therapist, Endocrinologist, possibly even surgeons - under one roof (often called a "Gender Therapy Team" or something to that effect). The potential pitfall with such a Clinic or Program is that the doctors who participate are often involved in gender-related research and may be more interested in the patient as a research subject than in treating their gender issues. There are many reports of people who have been kept in "transition limbo" for a decade or more by such programs, allegedly for little reason other than their value as long-term research subjects, sometimes without being informed that they ARE research subjects. Another potential problem is if the particular program or clinic has a "philosophy" about transgenderism that is outside of mainstream science the patients may be forced to subscribe to some "pet theory" that is not widely accepted in order to receive treatment at all. Definitely ask other transgender people who have experience with such an institution what their experience was and whether or not they would recommend others seek help there. Again, in some nations with National Health systems the government may dictate that individuals seeking gender therapy go through such a clinic or program. If you discover it has a bad reputation you should seriously consider seeking therapy through private practitioners.

"Rubber Stampers"
These are therapists that don't really provide any psychological service to their patients. Some patients actively seek out "Rubber Stampers" because they're just looking for someone with credentials to go through the motions as a "formality." The potential pitfall here may be if a patient actually wants or NEEDS actual psychological care but does not receive it. A therapist who gives the "OK" to a patient to proceed with HRT and/or GRS, when that patient wasn't a good candidate for such therapy, is doing a disservice to the patient (and technically committing malpractice). More than one regretful post-op has blamed their therapist for "not stopping" them. The Standards of Care, while an annoying hurdle, also exist for a reason - to hopefully screen out those for whom transition is not an acceptable therapy.

"My Therapist is a God"
Some patients are reluctant to question their therapist or their therapist's motives. NEVER surrender your own will or judgement to a therapist. Remember that you are a "consumer" who is paying the therapist for his or her "expert" services. You have the right to "fire" a therapist who is providing substandard or questionable service. Don't be afraid to seek a second opinion or to dump a therapist in favor of another. The therapist works for YOU, not the other way around!

I have yet to hear any transitioner say they didn't wish they'd started sooner. No matter what age a person is when they decide to transition they feel they've wasted too many years already. However, being in a hurry to be done isn't necessarily a good thing either. Things like coming out to friends and relatives, or seeing the effects of HRT, take time. There is little to be gained by jumping into living "Full Time" before one is psychologically, socially, or physically ready to do so. In fact, rushing into transition can, for some, be a recipe for disaster (the so-called "failed transition" many people in the Transgender Community talk about).

OBSESSION with Reassignment Surgery
This can be related to "Haste" as well. There are people who become absolutely obsessed with having GRS/SRS, to the extent that they convince themselves that having it will somehow magically cause society to accept and treat them as their target gender. Here's something to think about, unless you walk around in public displaying your genitals (which I'm sure you don't or you'd be arrested for indecent exposure), in most social situations nobody is going to be able to tell how your genitals are configured! Whether you've had genital surgery or not, in most social situations nobody will be able to tell if you're properly clothed. If you are concerned about your ability to pass for the opposite sex in public (particularly M2F transitioners), FFS - Facial Feminization Surgery - would be money better spent toward the goal of being socially perceived as a woman. The first determination people make upon meeting someone is what sex they are, and that determination is largely made based off of facial structure. GRS/SRS, if desired, shouldn't be the FIRST step in one's transition, it should be a LAST step. There are transitioners who initially were fixated on getting GRS, but once they'd been on HRT for a while they found a level of comfort with their bodies and some even decided to forego surgery altogether (i.e., they identify as "non-op transsexuals").

Assuming Transition is the Only Answer - d
Don't fall into the trap of believing that transition is the only correct therapy to address one's gender issues. There are many different forms of gender identifications and expressions and transition is not an appropriate therapy for them all. There have been people who were more crossdressers than transsexuals, but either decided (or were convinced by others) that transition to living in the opposite gender role and surgical reassignment was the ONLY option. Gender patients should first consider the coping mechanism that is least disruptive to their lives before considering something like tranition! In medicine the smallest treatment is tried first, if it proves insufficent/ineffective then a more potent treatment is tried. All too often in gender therapy patients come into a doctor and demand the "Maximum Dosage" (GRS/SRS) without first trying something a little less disruptive (like living part-time in role or low-level HRT).

Which leads me to my final point:

Okay, this is going to seem like a rather strange thing to say, but the purpose of Gender Therapy is NOT to transition from one gender role to another. It is to relieve the dysphoria (the unhappiness and distress) the patient is experiencing, and help them to be comfortable with their social role, identity, and physiology. Some may only find that relief through transition and gender reassignment. Others may find that point of relief by some other means. If you transition and undergo surgery when it wasn't the right therapy for YOU, the end result may be you're even less happy than how you began. Ultimately, though, only YOU can make the decision, only YOU must take responsibility for your actions. But a qualified therapist can play a major role in guiding you to your personal happiness.