Gender and Identity

There is more freedom and information available than ever before. If you are a teen, you have easy access to peers, bloggers, social media groups, etc. where gender expansive peers exist and express themselves. If you are a parent, you may feel overwhelmed by all the new vocabulary, experimentation and expression related to gender occurring in current youth culture.

Whether you are a youth, adult or a parent you may wonder how sexual identity intersects or influences gender identity (research has shown that these two identities are separate and do not influence the other.) People may be any gender identity with any sexual identity.

If you are a transgender or gender expansive adult, you may want to come to a therapist for any number of reasons and don’t want to have to “educate” your therapist about issues related to your gender identity. Many transgender or gender expansive adults come to work with me for reasons related to relationships, anxiety, stress management, parenting, etc knowing they are safe with me in my understanding of their realities and struggles as a gender expansive adult.

As a Gender Specialist, I have been working with gender expansive youth and adults for over a decade. With some gender exploring/expansive youth I provide whole-being therapeutic support for their/your identity exploration. For others, I perform gender “assessments” and can provide any letters needed by medical professionals for those of you seeking gender related medical advice and interventions.   

In this work I collaborate closely with the UCSF Child and Adolescent Gender Center, the Stanford Pediatric and Adolescent Gender Clinic, as well as area endocrinologists and surgeons as needed. 

I have a strong commitment to supporting Gender expansive and LGBTQ+ youth and adults in many ways. I continue to attend conferences on how best to support gender expansive individuals and take part in various consultation and support groups for clinicians who support gender expansive and LGBTQ+ clients.

My perspective is that gender is culturally influenced and unique for each individual. No two individuals are exactly the same in their experience and expression of gender. My goal for all of my clients, LGBTQ+ or gender expansive and questioning is for them/you to be able to become their/your full unique selves and not a replica of a cultural stereotype or a social media peer, etc.

If you or your loved one is gender expansive then your WHOLE family will be on a journey of self-exploration and transformation. As a Gender Specialist I aim, where appropriate, to support the whole family in this journey.

Gender Assessments

Some Doctors and insurance companies will require that a youth or adult have a formal “gender assessment” by a Gender Specialist before being able to consider any type of medical interventions as a result of Gender Dysphoria. These are NOT assessments to determine a client’s gender. Only you (or your child) can know their inner experience of their gender. It IS an assessment of your/their overall knowledge about gender, gender dysphoria, the many many options for living in the world with a gender expansive identity, future implications of medical interventions, etc. The ‘letter’ will meet the guidelines of WPATH (World Professional Association for Transgender Health) and include a mental health diagnosis and general information about your/their readiness to pursue medical interventions.

A “Gender Assessment” will take anywhere from 5-8 sessions. My office is in Half Moon Bay. I require that the first 2 sessions and last session be in person but, if appropriate for you or your child, the other sessions can be done via Teletherapy if needed. If the assessment is being done for a minor, the parents will need to be present for at least one session as part of the evaluation. More details about the assessment process will be discussed in our first session together.

Common Vocabulary

These are a few examples of the dozens of new and old words used by members of the LGBTQ+ community to identify themselves:

Gender Expansive: Having a unique gender identity that is beyond the female/male binary genders in our culture.

Trans: A gender identity that is not the gender assigned at birth

Cisgender: A gender identity that matches the gender you were assigned at birth

Gender Queer: An umbrella term for any gender identity that is not cisgender

Agender: A lack of a relationship with a sexual orientation or the concept of gender

Gender Fluid: A changing gender identity that can shift day to day or week to week

Gay/Lesbian: A sexual orientation towards those of the same gender

Queer: A general term that covers any identity that is not cisgender or heterosexual

Pansexual: A sexual orientation felt toward people of all genders

Client Stories


Nathan (not real name) came to my office at age 14 completely terrified that he might be gender expansive. He was an early adolescent who was drawn towards wearing female clothing, hated his body hair and did not like his deep voice. Over a many month process, we were able to explore Nathan’s experience of himself. As a 16 year old, he become clearer that he was fine with male pronouns and had no desire to have bottom surgery (to remove his male genitals and create female genitals) but wanted to remove some of his dark body hair, wear more feminine cloths and be known to his friends as gender queer. As Nathan experimented with his presentation he became more comfortable just being himself in his own unique manner.


Martha (not real name) came to me in her mid-40’s for support in creating her new family with her new female partner and her children from a previous marriage. Martha needed guidance in how to mentor her children in coming out to friends as having a Lesbian mother. Martha also needed a safe, accepting therapeutic space to discuss how to create a new community of LGBTQ+ friends as well as integrate her new partner into her old circle of friends.


Alex (not real name) came to see me when she (gender assigned at birth) was 13 years old. Her mother had referred her to see me after Alex started telling her Mom that she wasn’t sure if she was really a girl. I met with and supported Alex on and off over 5 years. During this time Alex experimented with different pronouns, names, haircuts, clothes, etc. Alex eventually discovered that she was gender fluid and chose to begin HRT (Hormone Replacement Treatment) to develop a more male looking face and voice. She switched to using they/them pronouns but kept their name. Alex authentically enjoyed days where they dressed and presented in a traditionally male manner and days where they wore makeup and skirts. Alex now has a unique and fluid gender experience.


Amir (not real name) came to my office at age 25 to explore her gender (female identity at the time we started our exploration together). Over 2 years, Amir explored his (later chosen name and pronouns) lifelong gender story and his discomfort with his female body. Amir chose to begin HRT and have top surgery (a breast removal or reduction surgery). Amir returned to therapy in his mid-30’s for support with work related stress. Amir is thriving in his authentic body and gender, is in a long-term relationship and presents fully male to the world.

Questions and Answers

For Parents

How do I know my teen is not just saying they are trans due to something they read on the internet?

Although most teens are influenced by material viewed in social media and the web, a true gender expansive identity is something that will hold up over time and when identified, lead to increased mental health and well-being.

What if this is a phase? I don’t personally think my child is trans.

In my decade plus years of practice working with gender expansive teens and adults I have never met a youth who was exploring gender and then realized it was a mistake and reverted to a completely cisgender identity. Some youth discover they are more androgynous or gender fluid but end up with no desire for pronoun changes or medical intervention. Some youth end up requiring medical and legal interventions to be authentically themselves. We can’t know where the journey will end for your youth. My hope is that you will journey with them.

Can’t I just have my child experiment at home but stay presenting as cisgender in public places?

Any individual who needs to change their way of being from their authentic selves to navigate public spaces will experience stress or other mental health challenges. We all want to be our true selves everywhere in our lives. Part of my work with gender-expansive youth is discerning how to keep safe in a world where there are both affirming spaces and spaces where discretion in expression is (sadly) necessary for emotional or physical safety.

It feels like my youth is moving way to fast and I have many concerns about my child’s future. Can’t they just wait until they are older to think about their gender?

Usually, youth have been thinking about their gender for months, or even years, before coming to a parent to discuss their feelings about this. It often takes parent’s months, or even years, to ‘get caught up’. This is why part of my practice is meeting with parents to hear and work with and through their feelings and concerns, as well as helping them learn more about the issues surrounding their child’s therapy.

Resources for Gender Expansive Individuals and Families:

Gender Spectrumresources for families and educators of gender expansive youth

HRCInformation about gender and sexual identity for people of all ages

Trevor ProjectCrisis hotline and support services for gender expansive individuals

Adolescent Counseling Services – OUTLET programPeninsula area clinical and support services for LGBTQ+ youth

CoastPrideHalf Moon Bay area support services for LGBTQ+ people of all ages

San Mateo Pride CenterCounty supported and funded LGBTQ+ community support services

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