Gender Affirming Care in Texas: What It Is, What I Offer, and Why I'm Not Going Anywhere
If you're trans, nonbinary, or gender expansive, or if you're a parent trying to find support for your child, you already know that existing in Texas right now takes a particular kind of courage. The political climate around gender affirming care has shifted dramatically in recent years, and if you've been trying to navigate it, you've probably encountered a confusing mix of misinformation, fear, and closed doors.
I am an LGBTQ affirming therapist, I have been since I opened this practice in 2018, and that is not changing. This post is my attempt to clearly explain what gender affirming care actually means, what I offer, and how I can help, for adults, for families, and for anyone trying to figure out where to go from here.
What "Gender Affirming Care" Actually Means
Gender affirming care is an umbrella term for any physical, psychological, or social support that helps a person live more authentically in their gender identity. It's a range of care that looks different for every person depending on their age, needs, and goals.
It can include:
Social affirmation: using a chosen name and pronouns, changing how you dress or present, coming out to people in your life
Psychological support: therapy focused on gender identity, self-acceptance, family dynamics, and navigating a world that isn't always safe
Medical affirmation: hormone therapy, puberty blockers, gender affirming surgeries (provided by physicians and medical teams, not therapists)
Legal affirmation: changing name and gender markers on legal documents
Letters of support: documentation from a mental health provider supporting a client's readiness for medical interventions
As a therapist, my role sits in the psychological and documentation support categoies. I cannot prescribe hormones or perform surgery because I’m not a medical professional. What I do is provide a therapeutic relationship where you can explore your identity safely, process what you're navigating, and when appropriate, write letters supporting your access to medical care.
I had the honor of calling Lauryn Farris a friend, and she often said “My transness is not a choice. I was born with this gender. But my decision to live it is a choice.” I will support your choice for the level of expression that’s ok for you. Your safety has to balance with your expression, and that choice is yours.
Gender and our experience of it is complicated and affects many parts of our lives. Not just for trans and gender expansive folks either. Every human has a gender experience: how we feel about our gender, how we know it fits us, and how we show and express it to others. All the cis folks in the world who talk shit about trans and gender affirming care are also experiencing gender and they access gender affirming care freely (Hello testosterone clinics. Welcome to the chat, middle aged dudes…).
So what that means for my trans clients is that yes, we process what it means to you to live in this world and in your body, but we talk about other parts of your life too. You can come to therapy for anything; your gender experience doesn’t have to be the focus unless you need that. I just want you to feel welcome to bring all of it; your whole life and your whole person exist in my office.
My office is a space for you to feel whatever range of emotions you need. Grief, joy, dysphoria, euphoria, exclusion and inclusion; you’re free to feel here.
What I Offer
Individual Therapy for Trans and Nonbinary Adults
I work with trans and nonbinary adults across a range of presentations and life stages, people who are newly questioning their gender, people well into their transition, and everyone in between. I also work with people who are navigating the specific stressors that come with being trans in Texas right now: the grief, the anger, the exhaustion of existing in a political climate that debates and aggressively targets your legitimacy and rights.
My approach is rooted in Relational Cultural Theory, which means I don't pathologize gender diversity. Being trans is not a disorder to be treated. It's an identity to be supported. Our work together might include processing experiences of discrimination or family rejection, building community and connection, addressing anxiety or depression that has developed in response to minority stress, or simply having a space where you can be fully yourself without managing anyone else's reaction to you. We also get to celebrate your wins when they happen.
Family Therapy and Parent Support
If you're a parent trying to support a trans or gender expansive child, I can work with you too. Parenting a trans child in Texas is genuinely hard because you're navigating a system that is actively working against your family while also trying to stay present and supportive for your kid. You don't have to figure this out alone.
I work with parents who are fully affirming and just need support, and with parents who are still learning and want to do right by their child. Both are welcome here.
Gender Affirming Care Letters
For adults (18 and older) pursuing gender affirming medical care (hormone therapy, gender affirming surgeries, or other interventions) many providers and surgeons require a letter from a mental health professional. I write these letters for clients I work with in therapy.
I also write safety carry letters for clients who need documentation of their gender identity for personal safety purposes.
The process of obtaining a letter through my practice looks like this: we establish a therapeutic relationship through an intake and at least a few sessions together, I get to know you and your history, and I write a letter based on our work together that reflects your gender identity, your capacity for informed consent, and your readiness for the intervention you're pursuing. I follow the World Professional Association for Transgender Health (WPATH) Standards of Care as my clinical framework.
I want to be transparent: I do not do one-session letter assessments. Not because I want to create barriers, but because I believe you deserve more than a checkbox. A letter from me reflects a real therapeutic relationship, and that takes a little time to build.
About the Texas Political Landscape
I'm not going to pretend the political climate doesn't exist; it is affecting real people I care about and it’s wrong.
Texas has passed legislation restricting gender affirming medical care for minors, and the legal landscape continues to shift. If you're a parent of a trans minor looking for current legal guidance, I'd encourage you to consult with organizations like the Transgender Education Network of Texas (TENT) or Equality Texas. These organizations track the law in real time in a way that a blog post cannot.
What I can tell you clearly is this: therapy for trans and gender expansive youth is not restricted. I can provide affirming mental health support to young people and their families regardless of the broader medical restrictions. I work with young folks age 16 and up, and if gender comes up, I’m here for that conversation. Affirming your child's identity, processing what your family is going through, and helping a young person build resilience in a hard environment. That work is still here, and I'm still doing it.
For adults, gender affirming medical care, including access to hormones and surgeries, remains available in Texas. The restrictions that have passed largely target minors. If you are an adult pursuing transition-related medical care and need a supporting letter, I am here for that.
I know that finding a therapist who is genuinely safe can feel daunting, especially when you've had experiences of providers who were nominally affirming but made you feel like a diagnosis to be managed rather than a person to be known. I'm not interested in being that kind of provider. My commitment to this community isn't new. It predates the current political moment, and it will outlast it.
You Deserve Care That Sees You
One of the things I hear most often from trans and nonbinary clients is that they've spent lots of energy managing other people's discomfort; they’ve had educating providers, bracing for judgment, wondering if this therapist or that doctor is actually safe. Therapy with me will not feel like that.
You shouldn't have to earn the right to be affirmed in my office. You don't have to convince me of anything about your identity. You don't have to bring research or explanations or a defensible narrative. You just have to show up.
If you're in San Antonio or anywhere in Texas, I'd love to connect. The free 15-minute consultation call is a low-pressure way to ask questions, get a feel for whether we're a good fit, and talk through what support might look like for you or your family.
Ready to get started?
Request a free 15-minute consultation call →
Bonnie Scott is a Licensed Professional Counselor-Supervisor (LPC-S) in San Antonio, TX. She offers individual therapy, couples counseling, and LGBTQ+ affirming care in person and via telehealth throughout Texas.
