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William Macaulay
Gender Therapist
Perth, Western Australia

Phone 0401 316 977

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Gender Diverse & Transgender

Counselling Perth


Many factors can make 'coming out' as transgender challenging, such as discrimination, social stigma, and a lack of support from family and friends. Furthermore, some individuals may have difficulty accepting and embracing their transgender identity.


If you are unclear about your gender orientation or experiencing excessive fear, stress, anxiety or depression caused by the reactions of others, it may be helpful to seek support from a counsellor. Although therapy can't change one's gender identity, it can help people understand themselves better and deal with some of the challenges that may come with being transgender.


In this article, I aim to provide a brief overview of a range of gender diverse and transgender issues. I hope you will find it helpful to better understand this complex and often misunderstood topic.

What is Gender?


"Is it a boy or a girl?" is the first question that is often asked after we are born. And, an assumption is made that the child will fulfil one of those two distinct categories. The reality is that for some, gender is more complex than simply one of two categories.

We are all assigned a biological sex at birth. A male has XY chromosomes and a penis, and a female XX chromosomes and a vagina. Gender, on the other hand, is broader and more complicated than just assigned sex. Gender includes a set of expectations society has about behaviours, thoughts, and characteristics that go along with a person's assigned sex. These expectations of how males and females should be will vary depending on cultural, social, religious and family customs.

Cisgender versus Transgender


Most people are cisgender, which means that their inner sense of gender aligns with the sex they were assigned at birth. Transgender is a word that defines people whose inner sense of gender is different 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. Sadly, this group of people can face ridicule, intimidation and even violence simply for not fitting someone else's expectation of how a man or woman should be.


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 and, therefore, could be heterosexual, gay, lesbian, bisexual 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.


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 18, 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, drug and alcohol misuse, self-harm and suicide than the general population.




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.


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.


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 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.


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.

🏳️‍⚧  Gender Counselling & Support  🏳️‍⚧

How can I 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 in this article, please feel free to contact me to make an appointment. Counselling is a useful source of support and understanding, and I offer you a safe and non-judgemental space in which you can explore your concerns.