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William Macaulay Counselling Perth

Gender Therapist
Perth, WA

Phone 0401 316 977

for enquiries or appointments

Gender Diverse & Transgender
Counselling Perth

Coming out as transgender can be a challenging journey for a number of reasons, including discrimination, social stigma, and lack of support from loved ones. Accepting and embracing one's transgender identity can also be difficult for some individuals.


If you are unclear about your gender orientation or experiencing excessive fear, stress, anxiety or depression as a result of the reactions of others, it may be helpful to seek support from a gender therapist. While therapy cannot change one's gender identity, it can provide a safe space for individuals to understand themselves better and navigate the challenges associated with being transgender.


In this article, I aim to provide a brief overview of various gender-diverse and transgender issues, with the goal of fostering a better understanding of this complex and often misunderstood topic.

What is gender?


Gender is a multifaceted concept that goes beyond the traditional categories of male and female. While biological sex is determined by physical and reproductive characteristics, gender is a broader concept that encompasses cultural, social, and psychological aspects.

Traditionally, gender has been understood within a binary framework, consisting of two categories: male and female. However, many societies and cultures recognise that gender is not solely limited to these binary categories and that a spectrum of gender identities and expressions exists.

Gender identity refers to an individual's deeply ingrained sense of being male, female, or another gender. Some individuals may identify as transgender, indicating that their gender identity does not align with the sex assigned to them at birth. Others may identify as non-binary, signifying a status that is neither exclusively male nor female, existing somewhere in between or beyond both genders.

It is essential to approach gender with respect, openness, and an understanding that individuals have diverse experiences and identities. Gender is a complex and personal aspect of human identity that varies across cultures and individuals. Understanding and respecting various gender identities and expressions are crucial for cultivating an inclusive and equitable society.

Cisgender versus Transgender


Cisgender refers to individuals whose gender identity matches the sex they were assigned at birth. Transgender is a word that defines people whose gender identity differs from the sex they were assigned at birth. This could mean in between, the opposite of or something entirely different from the sex they were assigned at birth.

Important to note that being transgender is different from being gay. People who identify as transgender have the same range of sexual orientations as the general population, including being heterosexual, gay, lesbian, bisexual, pansexual or asexual.


Confused about your gender?


If you are confused about your gender, there are several options that you may want to consider. Important to note that there is no 'one size fits all' experience for people who identify as transgender. As everyone is different, these options should be matched against your current needs, level of comfort and support, age, mental health status, and financial circumstances.

Social transitioning

Accepting who you are:

Accepting who you are is an important first step. It's okay to be unsure, and it's okay to take your time. Be patient with yourself. Acceptance may be a gradual process. Becoming well informed about transgender issues can help with the process.


Disclosure to others:

It is your decision whom to confide in, when to do it and how. Do not pressurise yourself into talking about your gender before you feel ready to do so. Being transgender is normal, but it's not common. So, some people may react negatively at first and need some time to adjust. Try not to respond angrily or defensively. Acceptance may be a slow and gradual process. You may find reading my LGBT Coming Out article helpful.


Changing your appearance is another way in which you can experiment with expressing your gender. It may be important to you that your appearance aligns with your gender orientation. Ideally, your appearance should simply be whatever makes you feel comfortable.



Name change:

Sometimes people who identify as transgender decide to change their birth name to a name that better reflects their gender orientation. Important to note that it may take friends and family a while to adjust to using your new name. In Australia, you can change your name legally for any reason. However, if you are under 18 years of age, you will need parental consent.



Pronouns are other words we use as substitutes for people's names. There are gender pronouns such as he/his/him and she/her, as well as gender-neutral pronouns such as they/their/them. You may want to consider asking people to change to a gender-neutral pronoun when referring to you.


Speech pathology:

Speech pathology is vocal training to help change the pitch of your voice and speech patterns to something you're more comfortable with. There is no age restriction to access these services.

Medical transitioning


Medical transitioning is when a person who identifies as transgender decides to access medical options, such as hormones or surgery, to feel more comfortable in their own skin. As an experienced gender therapist, I can provide information and support on how to proceed with any of the following medical transitioning options.


Puberty blockers:


Puberty blockers are drugs that delay the onset of puberty, allowing you more time to figure out your gender identity. They work by blocking the hormones testosterone and estrogen that lead to puberty-related changes in your body. This stops things like periods and breast growth, or voice-deepening, Adam's apple and facial hair growth. 


Puberty blockers are most effective for people in the early stages of puberty. If you are under 16, this option may be worthwhile discussing with your parents and GP. Accessing puberty blockers requires psychiatrist approval, consent from both parents and an endocrinologist.


Hormone Replacement Therapy (HRT):


For many transgender people, hormone treatments are the first step in the process of transitioning and are often followed by surgical procedures. For others, taking hormones will be the only type of medical treatment they ever have. Hormone treatments for transgender people involve substituting the sex hormones of an individual's assigned sex with those of the opposite sex. For male to female, this means taking estrogens, and in some cases anti-androgens (to stop the production of male hormones), while for female to male, treatment means taking testosterone. Such treatments are used for two purposes: to reduce or eliminate secondary sex characteristics of an individual's assigned sex and to induce those of their new sex. Not all secondary sex characteristics will be eliminated or obtained, and the extent to which these goals are achieved varies from person to person. If the gonads (e.g. testicles or ovaries) are removed, sex hormone therapy is necessary for the remainder of the individual's life to avoid side- effects of hormone deprivation (e.g. Osteoporosis).


Research indicates that people who have undergone hormone therapy report both positive and negative aspects of the therapy. Careful thought and sound medical advice should, therefore, be considered before commencing with this option. Your GP, an endocrinologist or a psychiatrist can provide you with the appropriate guidance and information.

Gender affirming surgery:


As part of transitioning, surgery is sometimes performed on genitals, breasts and other physical features. While not considered the final stage of transitioning, as there is usually a period of adjustment post-surgery, surgery is often viewed as the central and major step in an individual's journey to transition. In Australia, access to surgery remains limited, and it is predominantly performed in Sydney and Melbourne.


Increasingly, studies have found that surgical interventions result in positive outcomes across a range of domains, including psychologically, socially, physically, and sexually. Extensive screening processes, psychological therapy and staged levels of treatment prior to surgery (e.g. hormone treatment, real-life test) are used to prepare the individual for the surgery and minimise the chances of regret after irreversible surgical procedures. Although disappointment after surgery has been reported to occur, satisfaction is generally high, and few have reported any regrets after such procedures.


Mental health


Gender diversity in itself does not cause mental health problems. However, transgender and gender diverse individuals may experience a range of stressful occurrences that increase the likelihood of developing a mental health issue. Some may frequently experience harassment and stigmatisation, and sometimes violence because of social, cultural and religious norms. Some may become estranged from family and friends. Some may find it challenging to secure suitable employment and housing. And for some, the constant exposure to negative messages about their gender identity can have a devastating impact on their self-worth and wellbeing.


Sadly, these harmful exposures have resulted in people who identify as transgender experiencing higher rates of mental illness, self-harm, and drug and alcohol misuse, than the general population. A gender therapist such as myself can provide support and gender counselling to help you work through these issues.


Gender diverse terminology


As with any identity, individuals should choose their own language to describe or identify themselves. Always listen for and respect a person's self-identifying terminology. Also, the correct use of language to describe others demonstrates respect and encourages understanding. Here is a guide to some of the commonly used terms concerning gender:  


Crossdresser: a person who needs to express an alternative gender identity by dressing and being accepted in that role on a less permanent basis. Crossdressers are usually content with their biological sex.


Drag: a stage or theatrical performance involving a male performer dressed as a woman or a female performer dressed as a man to entertain others at bars or clubs.


Female to male (FtM): adjective to describe individuals assigned female at birth who are changing or who have change their body and/or gender role from birth assigned female to a more masculine body or role.

Gender binary: the classification of sex and gender into two separate categories of masculine and feminine. These two categories exclude many people who do not fit neatly into either category.


Gender dysphoria: distress that is caused by a discrepancy between a person's gender identity and that person's sex assigned at birth.

Gender expression: is how someone presents their gender to the world. This can mean through the way a person physically presents as well as the way they act. This can be through appearance, dress, mannerisms, speech patterns and social interactions.


Gender identity: refers to a person's internal sense of being male, female, something other or in between.

Gender nonconforming: adjective to describe individuals whose gender identity, role, or expression differs from what is normative for their assigned sex in a given culture and historic period.

Gender reassignment: the physical, legal and social process of transitioning gender – usually from the gender that society thinks the person should be to the individual's own sense of gender. This may include surgery, hormone treatment, a change of name, a different pronoun, and a change of birth certificate gender.

Internalised transphobia: discomfort with one's own transgender feelings or identity as a result of internalising societies normative gender expectations.

Male to female (MtF): adjective to describe individuals assigned male at birth who are changing or who have change their body and/or gender role from birth assigned male to a more feminine body or role.

Non-binary: a term used to describe individuals who may experience a gender identity that is neither exclusively male or female or is in between or beyond both genders.


Transgender: an umbrella term used to describe people who sit outside the gender binary of masculine and feminine, or whose gender identity is different from the sex assigned to them at birth.


Transsexual: a person whose gender identity is opposite to their biological sex. Many transsexuals will change their bodies through hormones and possibly surgery to better match their gender identity.


Transvestite: someone who dresses in clothes usually worn by the opposite sex for fetish or arousal purposes.

 🏳️‍⚧ Transgender and Gender Diverse Counselling and Support 🏳️‍⚧

How can seeing a gender therapist help? If you are confused or unclear about your gender identity and what this means for you or would like to discuss any of the issues raised on this page, please contact me to schedule an appointment. Overall, a gender therapist can play a crucial role in providing guidance, support, and resources as you navigate your gender identity journey, helping you achieve personal comfort and well-being. Click here to view the range of gender counselling services I offer.

Confussed About Gender
Medical Transitioning
Social Transitioning
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