This information is only intended for you if you agree with the disclaimer!


Psychologists ask many questions about all the ins and outs of your life. Psychologists often ask the same question more than once to find out whether you are consistent in your answers. The more inconsistent your answers are, the longer the diagnostic phase will take. To prevent mistakes with this, follow this general directive: do not lie if you don’t have to. There are a few exceptions to this rule, we describe those below.


Diagnostic phase

In the diagnostic phase the criteria from DSM-5 are used. It doesn’t hurt to read those yourself, before you start talking with the psychologist. Also read this page about dysphoria on the website betterassumptions.nl: It doesn’t hurt to get angry with your psychologist because everything takes so long; the psychologist will see that as "dysphoria", which, according to DSM-5, is a requirement to be diagnosed as gender dysphoric.


Sexual orientation

Psychologists are afraid that people who are homosexual or lesbian (seen from the sex they were assigned at birth) confuse their sexual orientation for being transgender. By modifying their body parts homosexuals would fit into the stereotypic heterosexual picture again.

- Once you have told your psychologist about your sexual orientation, don’t change it! They ask the same questions more than once, but they do keep track of your answers!

- If you have a partner, don’t complicate things and simply say you fall for the sex of your partner.

- If you are single, tell them that you fall for people of the sex opposite to the one you were assigned at birth.


Sexual fantasies

Psychologists think that your self-image during sexual fantasies (which body parts do you have yourself in the phantasy) correspond to your ideal body after the complete transition.  The psychologist has no way to find out what you really see during sexual fantasies. Look at the personal story from 2007 (September/October 2007) to see how you can make use of that.


Fluid genders

We wrote it (here) already: psychologists who decide on treatments primarily think of risk management. Psychologists find it difficult to advise a hormone therapist to prescribe hormones to somebody who has a fluid gender identity. In their ideal image, people want to align their feelings (gender identity), looks (gender expression), behavior (gender role), and body parts, so someone who feels female, dresses as a woman, and behaves as a woman -> logically needs female body parts. The psychologist fears that if you have a fluid gender identity, your need for other body parts is “likely” to be fluid as well. We know these things can be completely unrelated, but many psychologists who decide on treatments don’t. And even if they do know it, they will want to examine whether that applies in your case (resulting in a longer lead time for the diagnostic phase).


Advice: diagnosis takes longer if the psychologist is more uncertain. Don’t make the psychologist feel more uncertain than he already is during the diagnostic. Psychologists will usually not ask questions about fluid genders if you haven’t brought up the subject yourself. So just go along as if you have a stable gender identity, possibly somewhere between man and woman. You can always explain your true feelings later, maybe a few months after the end of the diagnostic phase.

If you have already told your psychologist that you have a fluid gender identity, then pretend that your gender is gradually "stabilizing". Also see "development oriented thinking" below.


Hormones via internet

The reactions you get if you tell you are already using hormones acquired from internet may vary. There are psychologists who see this as a risk (see also here for the risks involved). On the other hand: if you have been using hormones from the internet for several months and no problems arise, this can also work in your advantage, because the risks the psychologists see (for instance increased emotionality in trans women, increased sexuality in trans men) apparently do not lead to the problems they fear.  


Tendency towards suicide

Indicating that you have the feeling it is better to end your life if you don’t get hormones/operations, is in general a bad idea. Nobody wants to be responsible for somebody else committing suicide. Hormones lead to a greater instability, and psychologists see this instability by hormones in combination with a danger of suicide as an additional risk. Threatening with suicide will not be seen as a reason to prescribe hormones or operations sooner. So even though thoughts about suicide are understandable, don’t talk about them. Do talk about how difficult it is to continue living in your body (see also the DSM-5-criteria).


"Fighting behavior" / authority issues

There are transgender people who have great problems with their psychologist taking (in their view) the right to decide about their own bodies out of their hands. This feeling is very understandable (and justified!), but you will have to perform a balancing act between the feeling that you need hormones and surgery so you need the co-operation of the gatekeepers on one hand, but on the other hand your loss of autonomy may cause feelings of rebellion against people who (uninvitedly) take a role in your transition process. It doesn’t hurt to discuss this with your gatekeeper, but try to be moderate in that. It may be prudent to keep quiet during the diagnostic phase and save your criticism for later, when you have received what you came for: permission for hormones and/or operations.

We once heard a gatekeeper say that transgender people "should learn that you cannot control everything in your live". That is bullshit from people who (often with the best intentions) don’t realize how absurd the current situation is and how bad it feels to be dependent on other people for something so important: your own body, your own psyche, and your own development. Half the Western world is currently filled with people who stand up against their governments. They can make themselves heard in elections; they are not forced to have their psyche “repaired” when they need medication or operations.


Coping mechanisms

Psychologists also want to find out how you deal with setbacks; such behavior is known as "coping mechanisms". Part of this cannot be changed: they look at your attitude and your behavior; they may for instance pose statements they know you disagree with to see how you react to that. But another part can be influenced.

They may ask how many friends you have. If you have no friends you don’t score high on coping mechanisms; a psychologist may think that you first need more friends before he can allow you to take hormones or undergo operations. The reason behind this is that you need somebody to support you in difficult times. Our advice: you can play with this (if you have no friends, say that you have 2 or 3 friends), but don’t overdo it. Knowing you they can see that you are not a person to have 15-20 friends. Facebook friends and other people you only know from internet don’t count here.

For the same reason they can also ask about your family relations. Everybody needs their family to care for them when they are not able to take care of themselves for a week after an operation. Although many arguments can be made against this – ever heard of Albert Heijn delivery service? And why wouldn’t somebody survive for a week in their own house? – no psychologist who decides on treatments will agree with this.

The gatekeepers will also ask about your work situation. The background of this is that if things aren’t going well at work -and- things aren’t going well with your family -and- you don’t have any friends, you are probably not in a situation stable enough to deal with taking hormones or undergoing an operation.


Own development

When you are in the middle of your own transition process, it may happen that you gain new insights just before your next appointment. Our advice: don’t share these with your psychologist in the next meeting, but at least wait until the meeting after that, and even then only share them if your feelings tell you that you feel comfortable about it. The advantage is that you can first elaborate on these new insights (maybe together with your own, supportive psychologist), so that when you tell the gatekeeping psychologist you will appear more certain about your development. Immediately telling the psychologist who decides on your treatment has two risks: [1] you may find out in a follow-up conversation that you made a mistake (and then the auditing psychologist may start to think that you also made a mistake when you decided you needed specific body parts), or [2] the insight is still in development and you end up telling three different things in three subsequent meetings. That doesn’t have to be a problem if the three stories show a line of development (see next paragraph), but it can be a problem if the stories are in contradiction with each other. It raises the impression you don’t know what you want (and how certain are you about needing different body parts then?).


Development oriented thinking

Psychologists like to think in "developments": there is a beginning (born as a man, grown up as a man, but always felt as a woman), there is a transition (strike out the man and become a woman) and the goal is to become a woman. Although the therapists say that they no longer think along the binary f/m dichotomy, it is very difficult for people who feel themselves completely man OR woman to understand what it is like to feel differently about that. Especially when you are queer, take a holistic approach, have a non-binary gender feeling or a fluid gender identity, the diagnostic phase can be very complicated. In that case, take a development oriented approach: if you need female body parts, tell the psychologist about what female traits you have "acquired" since the previous conversation. Conceal during the diagnostic phase things that can be explained as "male" and feel very positive to you.

Psychologists often believe that gender expression is an indication for a need for body parts. Although we do not agree with that, you can make use of it. Example: if you are a trans woman, but you don’t worry about hair on your arms, you might after 1 or 2 "diagnostic" meetings suddenly start shaving your arms time and time again before you go to a session with the psychologist. Or suddenly start wearing a female bracelet if you weren’t wearing one before. Your psychologist will see this "progress" as a supportive argument for the need for hormones or operations.

If you never said you needed gender surgery and you spontaneously find out that you do feel you need it now, the psychologist will also see that as a positive development. Our tip: give them what they are looking for, that is: development.


This website

You may be asked whether you have read this website. In our view it is absolutely normal that you prepare yourself for every step in your transition and that you read all the information you can get your hands on. So you can honestly admit that you know this site and have read the information. That shouldn’t work in your disadvantage. If it does turn out to work as a disadvantage, please contact us, we will help you with that.


Finally: "I don’t want to lie"

Yes, we know. Telling lies doesn’t feel good, especially not when you have promised yourself, earlier in your transition, to finally be honest about who you are and what you feel. And that you only make choices that really fit you. That is exactly the reason why we are against this way of diagnosis and gatekeeping, because the diagnostic phase can take (much) too long if you -are- completely honest about your own feelings or your own background. If you have been dishonest during the diagnostic phase, you can always raise that subject a few months after your diagnosis and tell your psychologist about your true feelings then. Also see the personal story from 2007 ("further treatment") for the interesting effect this may have on the psychologist who decided on your treatment.