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Transforming Practice: The First Book for Health Providers Working With Transgender Men

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Transforming Practice: The First Book for Health Providers Working With Transgender Men (1 Viewer)


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Mar 24, 2019
Transforming Practice (Ethica Press, 2013) is an exploration of life satisfaction, health and wellness among transgender men, as told in their own words. Author Marcus Greatheart asked satisfied, post-transition trans men what worked well in their transitions in order that health providers might better support those questioning or struggling with gender transition. These stories are what resonated most with people who attended author Greatheart’s workshops at transgender conferences like Gender Odyssey in Seattle.

Grounded in a strengths-based model, Greatheart explores how FTM peers and service providers alike perpetuate a “negative transition story” that falsely assumes all trans men struggle with mental health problems and life-long gender dysphoria. The subjects describe having positive, even enjoyable, transition experiences while demonstrating resilience and self-efficacy.

Greatheart also proposes a new assessment tool for health providers to assist trans clients unpack and process potential transgender-related stress and trauma.

Transforming Practice is an excellent resource for counselors, therapists and social workers and their transgender clients, and physicians and psychiatrists working with transsexual men.

1 | Introduction

2 | Conceptual Context

3 | Stories of Trans Men

4 | Going Deeper

5 | How These Stories Change Our Practice

6 | An Assessment Tool for
Transgender-related Stress & Trauma

7 | Final Thoughts

8 | References
Transgender people
Recent issues in transgender health
Personal connection to trans health and wellness
My own social locations

The utility of feminism in transmasculine studies
Life satisfaction, subjective well-being, and quality of life

Models of transgender identity development
Medical & psychiatric etiologies as pseudo-identity models

Role of the care provider in transgender mental health
Using a strengths-based approach to research


The importance of transition in the lives of trans men
Positive stories from other trans men offer hope
Personal supports & resources impact transition ‘success’
Trans men chart their own course to satisfaction

Ed’s Story: “I was like, ‘Yeah, who’s the man!’”
Kaleb’s Story: The “Guys in the Woodwork”
Eric’s Story: The bright orange egg
Weaving the stories together

The road to satisfaction
The “negative transition story”
Two narratives converge

A feminist lens on the lives of trans men
Satisfaction and subjective well-being
Mental health and the DSM
Implications for Developmental and Identity Theory

Strengths-based generalist practice with trans men
Advanced clinical practice with trans men
My Personal Connection to Trans Health and Wellness | Pages 19-21

On a road trip along the West Coast of the United States from May to July 2007, I met a number of trans men, many of whom are now good friends. As a person with a longtime interest in gender and its impacts on peoples’ lives and social interactions, I listened intently as these men shared their stories. One friend spoke of his teenaged years when, on a monthly basis and coinciding with his menstrual cycle,[1] he would “get crazy, get wasted and fuck around.” On reflection he said he could ignore what was in his underwear rather effectively most of the time, but he was unable to cope with the physical manifestations of menstruation. Another friend spoke about the challenges of dating as a queer trans man in a phallocentric gay community. His politics of disclosure were considered radical by many of our friends — he would not reveal being trans until absolutely necessary or not at all — and as a result more than a few of us were concerned for his safety. Yet another recalled the absurd, unsympathetic and often degrading interactions he had endured with healthcare providers as he negotiated the obstacle course of medically‑supported gender transition; sadly these stories are far too commonplace among the many trans people with whom I have spoken since. There were many other stories about the challenges trans men have faced and yet, despite these, they seemed generally well-adjusted and content with their lives.

These stories still echoing through my head, I surveyed the extant literature for research that explored mental health and wellness among trans men. I was operating with the Canadian Mental Health Association’s (n.d.) definition of ‘mental health’ as a measure of life enjoyment, resilience in the face of stress or challenges, balance among different areas of life, self-actualization of our abilities and strengths to reach our full potential, and the flexibility to balance emotions and expectations. While the literature was small, I did find a number of psychiatric articles that presented trans men only as sufferers of mental illness (Cole, O’Boyle, Emory and Meyer, 1997; Lobato, Koff, Manenti, Salvador, da Graça, Petry, et al., 2006), an image that was a stark contrast to that of my friends. Many of the reports linked this so-called ‘illness’ to depression, substance abuse and suicide; here, there was even less resonance to the people I had met. As I looked deeper, I discovered an even smaller collection of articles, books and clinical guidelines, written by trans people and non-transgender allies, that began to resemble the narratives I had heard on my journey (Devor, 1997; Lev, 2004).

Having identified a clear gap in the literature and resources, and concurrently receiving support from friends and professionals working within trans communities, I decided to focus my graduate research on learning more from, and then sharing, the stories of trans men who are contented with their lives despite, and often in appreciation of, the challenges they have experienced in their lives. My intent remains that, by activating a critical lens within this research, I can provide for my professional colleagues and our allies some recommendations for effective and culturally appropriate practice with trans communities. More importantly, I hope that my findings will improve the future experiences of trans men who decide to employ our support and care as they consider, initiate and progress through an important stage in their lives: transition.

[1] Here I use a masculine possessive pronoun in reference to menstruation to honour the affirmed gender of the individual who shared the story, thus creating a conflict of gendered language that often happens when writing about and working with trans people.

Excerpt from:
Transforming Practice: Life Stories of Transgender Men that Change How Health Providers Work | 2013, Ethica Press | 178 pgs | ISBN 978-0-9917989-0-2

Amazon product

About the Author:
Marcus Greatheart is a trans ally, author, speaker and social worker in private practice. He provides counselling, workshops and conference presentations with a focus on sexuality and gender. This includes individuals and couples on the lesbian, gay and bisexual spectrum; trans people and those questioning their gender; kinky people, and those who are in alternative and polyamorous relationships. Marcus has more than 20 years’ experience in community health, particularly sexual health and HIV. He has a BA (History in Art) from the University of Victoria, BC, and a Master of Social Work from the University of British Columbia. He currently attends the Michael de Groote School of Medicine at McMaster University and lives in the Niagara Region of Ontario. Find him online at

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