schedule
an appointment for counseling online 24/7
The
Counseling Process
The counseling process with Michele
O'Mara is designed to help you access the insight and understanding
necessary to assist you in living more happily with your gender.
The counseling process does not give you the answer to your gender
dilemma, it gives you the tools and processes to allow you to uncover
these answers for yourself. There
are no right answers, just answers that are right for you.
Fees
Sessions are 50 minutes and cost
$90.
Michele does
request full payment from each client at the time of
service unless a special arrangement/agreement has been made
in advance. She will provide you with receipts
and related documentation (codes for service, diagnosis, and dates of
service as requested by insurance company) for your reimbursement.
Michele is a Licensed Clinical Social
Worker in the state of Indiana (License # 34003162A). These
credentials are recognized by most insurance companies and as a result I
am most often a reimbursable provider. (Meaning, if you see me, even if
I am out of your network, which I probably am, your insurance company is
still likely to cover me for out-of-network services).
Michele
does not submit insurance claims
on behalf of clients. She will provide receipt of services for you to
submit to your insurance company for reimbursement, for tax-deduction
purposes, or for use with your Flex Accounts.
Local
Support Group
Michele
O'Mara, LCSW MTF Support Group
This
is a support group that I conduct in my counseling office on every other
Wednesday from 7pm-8pm. The cost is $20 per group and group
attendance offers several benefits, particularly to those seeking HRT.
In accordance with the Standards of Care, I require the minimum of 3
months counseling prior to providing a letter of recommendation for
Hormone Therapy. Because this can become a costly experience, I
have created a support group which is an excellent supplement to
individual therapy, and can reduce the overall expense of the counseling
experience as much as 40%.
If
you identify as a male-to-female transgender woman, there are many
options to explore as you begin to consider how to make peace with the
realization that you have the female-oriented mind and a male-oriented
body. There are many situations that significantly complicate your
ability to begin addressing your gender conflicts, and among the most
common are:
-
Age:
under age 18 requires consent of parents for treatment and care.
Old age can also be an obstacle to medicinal or surgical transitions
because of health concerns.
-
Marriage:
often transgender men and women will marry with the hope that his
incongruent feelings about his gender will disappear.
Unfortunately, this does not happen. In some cases the
feelings are exacerbated by the feeling of deception and shame.
Considering how to come out to your husband or wife, and how to
negotiate the best path for your transition is a delicate process
that counseling can assist you with. If your spouse knows, it
is ideal to have him or her join you in the counseling process.
If he or she does not know, then it is helpful to begin counseling
to gain the skills and confidence to sort through what will lead to
your greatest sense of peace.
-
Children:
Often transgender men and women have children. Concern for how
a gender transition will affect children is often a serious
deterrent for transgender persons.
Among
the most common desires of a mtf persons is to feminize appearance.
Hormones are the first line of response to achieve this goal. To
learn more about the requirements for use of hormones, read
this.
Effects
of Feminizing Hormones
Breast development -
This will vary greatly, as it does
with the genetic female population. The breast tissue growth
typically takes at least two years to reach maximum size, and it is rare
for breast development among MtF's to exceed a B cup size.
Within the first couiple months of
hormone therapy ,a nodule-like formation behind the nipple develops and
along with this is significant tenderness/sensitivity in the area. These
changes are induced by an increase in the ductal system behind the
nipple which is a part of the transition process that will typically
normalize in a matter of months.
Body Hair
- Depending on the amount of body
hair to begin with, there is a significant decrease in hair over the
course of time and after several years and may diminish entirely over a
period of several years. Arm and leg hair as well as hair on the
abdomen, chest, and shoulders will greatly lessen and in some instances
disappear completely. Hair growth in specific regions including
that around the areola, armpits and pubic area will not lessen to the
same extent. Whatever beard hair is present at the start of HRT,
will remain. Electrolysis or laser hair removal will expedite the
removal of this hair and it makes sense to begin with this facial hair
that will not go away on it's own, and save hair removal treatments for
chest and shoulders until later to see if HRT does reduce or eliminate
it.
Skin
- This will change greatly, becoming softer and less coarse.
Fat Distribution
- Over a period of time (1 to 2 years time), a change in the
subcutaneous fat (located just beneath the skin) will occur. The
hips, thighs and buttocks will collect the majority of this
distribution, and the tendency to collect fat in the stomach will
diminish somewhat. The resulting redistribution will result in a smaller
waistline and larger hips.
Muscle Mass
- Through the process of feminization
much of the upper body bulk will disappear over depending on the amount
of muscle mass an individual starts with.
Genitals - Testes
will lessen quite significantly in size. The production of
testosterone and sperm is also greatly reduced. Penile
size will also likely diminish. Sexual function will decrease, but
the extent to which performance is affected is unpredictable. Erections
may still continue, but will probably be less frequent, and not last as
long, and in some cases may not be possible. Ejaculate will lessen,
probably to the point of only producing a very small, clear discharge as
a result of the prostate and the associated structures responsible for
semen production being impeded.
Prostate Gland
- The prostate will diminish in size
due to the effects of estrogen and finasteride (Proscar), the latter
being administered as an anti-androgen. Beside from the feminizing
effect of these medications, both drugs are helpful in the treatment of
benign prostatic enlargement. This condition is often responsible
for the difficulty with urination experienced by many older individuals.
Through the course of hormone therapy, this urinary complaint will
likely be relieved.
Cardiovascular
- Coronary heart disease is the
leading cause of death in the United States. Due to various lifestyle
and hereditary factors, cardiovascular conditions may pose additional
risks to those undertaking elective medical therapies, such as the
variety of drug treatments engaged in the feminization process.
However, the effects of hormonal therapy may be similarly beneficial to
the male-to-female transgender patient with respect to arteriosclerotic
plaque disease and cardiovascular conditions, as it demonstrates itself
in the genetic female population.
Infertility/Impotence
- Long term use of estrogens may
likely result in infertility, with permanent infertility being a
distinct possibility. Sexual responsiveness will likely diminish
over the course of hormonal therapy, potentially resulting in the
inability to achieve or maintain an erection. These effects are
the basis for feminizing hormone therapy being termed chemical
castration.
*
Sperm-Banking - If the
transgendered individual has any concern or desire to
"father" children in the future, it is imperative that the
male-to-female transgendered individual choose the option of sperm
banking – having samples of their sperm frozen and stored for
later use – prior to beginning hormone therapy.
Voice is UNCHANGED by
hormone therapy.
However, inflection and manner of speech are very well suited to change.
Additionally, pitch can be raised through persistent vocal practice.
Given the importance of a gender congruent voice, surgical options have
been explored in an attempt to alter pitch, but this most delicate of
instruments is not likely to be properly retuned through surgery.
Web
Resources
Indiana
Transgendered Rights Advocacy Alliance
Transgender
Crossroads: News and Views from the Midwest
NAME
CHANGE SELF-SERVE LINK