Transitioning in the Workplace: A Guidebook

Transitioning in the Workplace: A Guidebook

by Dana Pizzuti


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Product Details

ISBN-13: 9781785928024
Publisher: Kingsley, Jessica Publishers
Publication date: 08/21/2018
Pages: 248
Sales rank: 577,898
Product dimensions: 6.00(w) x 8.90(h) x 0.80(d)

About the Author

Dana Pizzuti is a physician and is currently a Senior Vice President at a U.S. pharmaceutical company. She successfully transitioned at work in 2015, and is now a recognized transgender advocate and a representative for LGBT+ workplace equality in San Francisco.

Read an Excerpt



Anyone contemplating a transition faces a multitude of decisions. Each decision builds on the previous one, creating a path forward to a new life both in and out of work. In order to start making these decisions, I believe you need to connect with a grounded idea of where you are emotionally and physically, what you may be afraid of, and who is there to support you.

Psychiatrist Aron Janssen has been seeing transgender patients exclusively since 2011 at the Gender and Sexuality Service at New York University (NYU) Langone Health. Dr. Janssen told me that he typically sees a few general categories of individuals who are in distinct places along their journey. The first group includes people who are just addressing their thoughts and feelings about their gender identity. The second are people who have already made the decision to transition but need a psychiatrist's help accessing the appropriate medical interventions. The third group falls somewhere in between: they want to transition and need help figuring out how best to do it, including navigating the "coming out" to friends, family, partners/spouses, and work.

Dr. Janssen believes, as I do, that allowing yourself the opportunity and the time to be introspective, thorough, information-seeking, and thoughtful about the transition will set you up for the most positive experience. If you have been wanting to transition for a long time and are focused on the goal, you can be so blinded by your sense of urgency that you dismiss both logical steps as well as potential setbacks. It is human nature to expect the best, but I believe that the unknown is what really makes people feel afraid. The more you know what to expect, both good and bad, the more prepared you are for every aspect of the transition, and the better off you will be.

Slowing the process down and making sure you are emotionally and physically ready is the goal for this chapter. Transitioning has substantial emotional challenges and knowing them up front and creating a game plan for how you will deal with them is key. There is a dizzying array of issues you are going to be dealing with, so let's start at the very beginning. The first step is to assess exactly where you are in terms of gender dysphoria, how you are presenting to the rest of the world and who you can count on for support throughout the transition. I strongly feel that the first person you have to get on your team is a qualified and empathetic therapist who is a good fit for your needs and personality.

Work with a therapist

Working with a therapist is critical for beginning a medical transition. I always knew that there was something different about me. I always had secret desires to be female, but I was so closeted that I never reached out to talk to a professional therapist about my gender concerns until later in life. But after so many years of having this secret desire, there came a point where I realized that I needed to talk to somebody about it. Once I started going to therapy, I wished I had gone earlier.

A good therapist will be your confidential and experienced ally, especially if you aren't ready to tell anyone. When I first started seeing my therapist, Judy Van Maasdam, I wasn't ready to tell anyone else. My fear surrounding the repercussions of my kids and co-workers learning my secret completely overshadowed my need to tell anybody. However, Judy was so supportive that she allayed my fears; otherwise, I'm not sure I would have ever been ready to transition.

Many transgender folks have told me that they were so worried about saying something that will prevent the therapist from endorsing future medical treatment (specifically hormones). I have spoken with many healthcare providers, including therapists, internists, and surgeons, and they uniformly state that this worry is completely unfounded: there is no "right" or "wrong" answer to any question. A good therapist will understand what you are going through, so just be honest and they will help you.

Finding a good therapist may not be difficult at all but finding the right therapist for you may take some time. Most importantly, you want to connect with someone who has a practice that focuses on gender dysphoria or transgender patients. These therapists have an empathetic and thorough understanding of what concerns you and will know exactly how they can help you. The best option is to find a therapist and meet with them in person. If you live in a remote area, you might not have many options for in-person therapy. But even in small towns, we are starting to find doctors and therapists who are educated and exposed to the trans community.

Excellent resources for finding transgender support include:

• World Professional Association for Transgender Health (WPATH): the website has a dropdown menu to locate practitioners for various specialties who are members of this premier organization (

• American Psychiatric Association: provides useful information about gender dysphoria, support groups, and finding a psychiatrist (

• LGBT CenterLink: this is a way to find an LGBTQ+ support center anywhere in the US. These centers often provide the names for support groups and local health/mental health providers for transgender care (

• TransHealthCare Surgeon Directory: a worldwide directory built on the largest and most comprehensive database of surgeons performing gender reassignment surgery and related procedures. They will be able to refer to other local providers for mental health services (

• University medical centers and community health centers: many have renowned transgender programs, such as the University of California — San Francisco, NYU Langone Health, Mount Sinai Medical Center, and Callen-Lorde Community Health Center in New York City, Fenway Health in Boston, and Howard Brown Health in Chicago. More of these centers are opening every year, so check with your local hospital or university.

• National Alliance on Mental Illness (NAMI): a national network of mental healthcare providers, as well as a provider database (

• National Council for Behavioral Health: national network of community behavioral health centers, as well as a provider database (

• Psychology Today Therapist Finder: a list of therapists around North America. Once a city or state is selected, there is a filter for therapists working with transgender clients under the 'Issue' area on the left-hand menu (https://therapists.

Many sites can even arrange for telephone consultations, which are critical for those who live outside major metropolitan areas. If you are fortunate to live near a large city, you may find that you have many options to choose from. I've also found that if you're around a large university with a medical center or a graduate school that teaches counseling, you can find some very good resources.

Once you find the right therapist, you'll be able to set the parameters of a successful therapeutic relationship. A therapist should be able to tell you up front how many times they typically meet with a client. The answer might vary, depending on the number of topics or concerns you want to discuss. You may even find that having a non-threatening, completely impartial person to support you is something you'll want to continue for a very long time. Ultimately, the most important thing to remember is that the therapeutic relationship is confidential and completely guided by you.

There are pros and cons to using a therapist a friend has recommended. If you know someone who has gone through a similar experience and they had a great therapist, you can be confident that they will be able to address your concerns. But the reality is that finding a great therapist is like finding a soulmate. It's a very personal relationship, so what might have worked for a friend might not work for you.

Unfortunately, and in rare instances, a therapist can do more harm than good. Some are just not supportive or helpful. There is no specific training or certification required to qualify as an "expert" in transgender care. In order to find a good therapist, you have to be a smart patient. Some red flags that will show a lack of empathy or understanding for your particular needs include:

• the use any type of slang (derogatory or otherwise)

• an insensitivity or reluctance to using your preferred pronouns

• the use of the term "transgendered" (with an -ed on the end) or "transsexual"

• a lack of basic knowledge relating to the larger community; for example, if they don't know what the Q stands for in LGBTQ+ or are not familiar with the terms non-binary or gender non-conforming.

According to the WPATH guidelines, the training of mental health professionals considered competent to work with gender dysphoric adults can include any discipline that prepares mental health professionals for clinical practice, such as psychology, psychiatry, social work, mental health counseling, marriage and family therapy, nursing, or family medicine with specific training in behavioral health and counseling. The following are recommended minimum criteria for mental health professionals who work with adults presenting with gender dysphoria:

• A master's degree or its equivalent in an accredited clinical behavioral science field. The mental health professional should have documented credentials from a relevant licensing board.

• Competence in using the Diagnostic Statistical Manual of Mental Disorders and/or the International Classification of Diseases for diagnostic purposes.

• Ability to recognize and diagnose co-existing mental health concerns and to distinguish these from gender dysphoria.

• Documented supervised training and competence in psychotherapy or counseling.

• Knowledge of gender non-conforming identities and expressions, and the assessment and treatment of gender dysphoria.

• Continuing education in the assessment and treatment of gender dysphoria. This may include attending relevant professional meetings, workshops, or seminars; obtaining supervision from a mental health professional with relevant experience; or participating in research related to gender nonconformity and gender dysphoria.

In addition to these minimum criteria, it is recommended that mental health professionals are knowledgeable about current community, advocacy, and public policy issues relevant to transgender clients and their families.

Assessing your gender questions

Gender is traditionally considered as binary, either male or female. In some cases, it might be both, which is referred to as gender fluid for those who express themselves as male or female depending on their preference at the time, or neither, which is referred to as non-binary for those who do not consider themselves on the binary spectrum at all.

Many people think of gender as existing on this binary spectrum: male or female, or somewhere in between. Along this spectrum, we have our original gender assignment, and there is also one's gender identity, gender expression, and sexual orientation or attraction. Gender identity is how you define your preferred gender choice. Gender expression is the way you present yourself through your dress, your actions, and your demeanor. Your sexual orientation or attraction, which is who you are romantically or sexually attracted to, is also a completely separate consideration from the others. There are many possible combinations of these characteristics. A helpful website which can convey these concepts is called the Genderbread Person and can be found at

A therapist's role is to help you find answers to your questions surrounding your gender identity. They can help educate you regarding the diversity of gender identities and expressions and the various options available to alleviate gender dysphoria. They can assist you as you explore various options, with the goals of finding a comfortable gender role and expression, and becoming prepared to make a fully informed decision about available medical interventions, if needed.

All good therapists will begin the conversation by talking to you about gender dysphoria. According to the American Psychiatric Association, gender dysphoria is defined as discomfort or distress caused by:

a conflict between a person's physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender.

Gender dysphoria is not the same as gender non-conformity, which, according to the Institute of Medicine, refers to the extent to which a person's gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex. Examples of gender non-conformity (also referred to as gender expansiveness or gender fluidity) include girls behaving and dressing in ways more socially expected of boys, or occasional cross-dressing in adult men. Only some gender non-conforming people experience gender dysphoria at some point in their lives. Gender dysphoria and gender non-conformity are also not the same as being gay or lesbian.

Even if you haven't told anyone about your desire to transition, and you're cross-dressing on your own privately, quantifying how much dysphoria you feel is a good place to start. The amount of distress caused by gender dysphoria and gender non-conformity is the issue a therapist wants to address and treat, not the fact that you experience it. Having a gender dysphoria diagnosis is what facilitates access to healthcare and guides your treatment options. The fact that you are "gender non-conforming" is not an illness or a mental health concern; it is a characteristic, like your personality. Therapists who specialize in gender understand this fact and their major concern will always be how your gender dysphoria affects your daily life, and how it should be treated. The point of these statements is to reassure you: there is no blame, and there is nothing "wrong" with you.

However, it would not be realistic to believe that there is no stigma, prejudice, or discrimination against people who transition. Psychologists refer to living with this social stigma, or any other minority position as minority stress. Living with this stress can make transgender or gender non-conforming individuals more vulnerable to developing mental health concerns, such as anxiety and depression. A stigma can also contribute to abuse and neglect in one's relationships with peers and family members, which in turn can lead to psychological distress.

Questions therapists want you to ponder

Have you told anyone about your gender questions and desires? If you have confided to anyone and had a positive or supportive response, these people can be an emotional resource or an ally as you contemplate your transition. These are people you already trust. For instance, there was a time before I transitioned at work where I was living in two separate worlds and I didn't let them intersect. By day I was Dave, and at night and at weekends I was Dana. However, once I told someone who had known me as Dave that I knew I was trans, I was creating an intersection of both worlds, which for me was at first both scary and risky.

One of the most anxious times of my life was when I was first telling someone from my old life my intentions for a new one. For instance, after I separated from my wife of 26 years, there was a time when I was dressing and living differently at work from how I was on the weekends. I was living as Dave at work and with my two children, and as Dana among my new friends. At some point, with the help of my therapist and a support group she ran, I realized I just couldn't continue living this way, and started to develop a plan to fully transition so that I could live as my most authentic self with all of my various relationships. The first people I told about my plans were James and Tom, a couple I met at my children's school, who I continued to stay friendly with after my wife and I divorced. They had invited me over for dinner at their house one evening, and I decided that I could trust them. I walked them through my recent gender odyssey. As I hoped, they were amazingly supportive. Before I left their home that night James had already changed my contact information to Dana in his phone!

Their positive response made me more comfortable, but my personal goal was to keep this information private until I was ready to transition at work. I had two issues to deal with: my office and my children. I also believe that withholding your intention to transition from others has an additional advantage in that it gives you a little more flexibility and at the same time, control about when and how you come out.


Excerpted from "Transitioning in the Workplace"
by .
Copyright © 2018 Dana Pizzuti.
Excerpted by permission of Jessica Kingsley Publishers.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Part I: Preparing to Transition. 1. Conducting a Personal Situation Analysis. 2. Charting Your Medical Future. 3. Knowing Your Legal Foundation. Part II: Bringing Your Transition to Work. 4. Making Your Initial Declaration. 5. Informing Colleagues and Customers. 6. The First Day Back. Part III: Beyond the Reveal. 7. Getting Back to Work. 8. Creating a Support System for the Workplace. 9. How to Deal with Difficult People. 10 Making Your Next Move: The Best Places for Trans persons to Work. 11. It All Comes Together.

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