You deserve to discover and embrace your authentic self, without fear or shame.
But I understand that this is not always easy. Sometimes, the people who are supposed to love us the most don’t know how to support us. Sometimes, we face discrimination and stigma from society because of our gender and sexuality. Sometimes, we struggle with our own internalized negative beliefs about ourselves.
I am here to help you heal from these wounds and grow into your full potential; to find your voice. I offer a safe and accepting space for you to explore all aspects of your identity and expression. I welcome and affirm people of all gender identities, sexual orientations, and relationship styles. I use evidence-based approaches that integrate mindfulness and trauma theory. I am also an open and proud member of the LGBTQ community and can relate to your experiences with empathy and curiosity.
Exploring Gender Identity, Sexual Orientation, Transitioning, or Coming Out
You might be getting to know your gender identity or sexual orientation for the first time. You might be coming out or transitioning and seeking help in managing all that surfaces in that process. Having a gentle and informed guide can be empowering in this liberating but scary process of self-discovery, coming out, and transition. Accepting and living out your gender and sexual identities can be both difficult and transformative, and I would be honored to support you as you live your truth.
Gender Affirmative Surgery Evaluations
If you or a loved one are in the process of transitioning or are looking to have a gender affirmative surgery, I want to help.
I offer psychological evaluations for gender affirmative surgery candidacy for clients (ages 18 and up). I am dedicated to helping the transgender, non-binary, genderqueer, and gender-expansive community by providing this evaluation service.
I also recognize that transphobia and transmisogyny are interwoven into our society and that mental health professionals have had an unfortunate history of perpetuating these ideas. I am committed to being part of the change for good and live more fully within our values – you deserve nothing less.
What is a gender affirmative surgery evaluation?
Under the current guidelines, transgender, non-binary, and gender non-conforming clients seeking gender affirmative surgeries must have letters from mental health providers attesting to whether they meet the guidelines for surgical intervention established by the World Professional Association for Transgender Health (WPATH).
Anyone who is seeking an attestation letter must meet with a mental health provider for an evaluation (typically just an interview, but occasionally more than one session) to determine whether they are good candidates for surgery. Based on the results of the evaluation, I will write a letter summarizing your candidacy and recommendations.
Do you need an evaluation for hormone replacement treatment (HRT)?
No. In Texas (and in most other states), we now use an informed consent model in place for HRT. So, you no longer need letters from mental health providers in order to receive HRT.
What does a gender affirmative surgery evaluation asses for?
I recognize the inherent gatekeeping role that mental health providers have in this compulsory letter-writing process, and I seek to reduce any undue gatekeeping while also having to work within the structure of the WPATH Standards of Care.
I have a welcoming and affirmative stance toward gender-diverse clients and want to help clients receive the gender-affirming medical care they seek. I am trained and experienced in this area, and I actively consult with other LGBTQIA+ mental health providers in this process.
I say all of this so that you can rest easier knowing that my process is designed with your rights in mind. My goal is not to keep you from getting the surgery you need, but rather to ensure that you are the right fit and have the support you need to succeed.
I will ask you questions about your gender story, past and current emotional well-being, social supports you can lean on before and after surgery, what sorts of surgical interventions you are seeking, and your own understanding of the risks and benefits of surgery.
I understand that there is no one gender story narrative. Your story is unique and does not have to be tied together with a sense of certainty. Likewise, I understand that your past and current emotional well-being could be impacted by both gender dysphoria and the effects of living in a cis-normative society, and I want to give you the support you deserve.
In addition to my asking you questions, I also welcome questions from the client. I recognize how hard it is to get to this point, and I want to be here for you however I can.
Who can write an attestation letter?
In Texas, some insurance companies require all letters to be written by doctoral level (PhD or PsyD) clinicians. Some insurance companies and surgery centers allow master’s level clinicians (LMFT, LCSW, LPC) to provide letters, but not all will. To make matters a bit more complicated, some insurances and some procedures may require multiple letters from different providers.
Before scheduling a session, it can be helpful to talk with your insurance company and/or surgery center about what they each require in the letter and who can write the letters.
If you do not have financial means to pay, please reach out to Waterloo Counseling Center. They are a sliding scale LGBTQIA+ Affirming Therapy Office covering all of Texas.
Olivia-Beth Horak Counseling 