The young people who come into the office of Sara Wiener ’03 often have nowhere else to turn for help. They are scared, anxious and sometimes living with families who do not fully understand them.
But they do know one thing: they want to be able to live a fully authentic life. They know the body they were born with does not house their true selves. And even in a day and age when public discussion about transitioning to another gender is more commonplace, the social stigma is still strong, and support systems oftentimes are shaky at best.
“The kids I see have been so distressed,” says Wiener. “Some say they’ve attempted suicide. Some are bullied at school. Others have hurt themselves. The stress on them is often incredible. Trans and gender non-conforming kids have always existed, but often in the shadows.”
Wiener, 34, is extending a much needed helping hand.
Since 2008, she had been working as a clinical outpatient psychologist at a Massachusetts medical center, counseling “medically complex” young people—kids with genetic disorders, poorly controlled Type 1 diabetes, and other medical issues. The work was satisfying, but she had a yearning to return closer to her native home of Plymouth, Michigan.
“So I approached the University of Michigan Health System (UMHS) and said, ‘You don’t have a pediatric gender services office, and I’d like to start that here.’”
The health system listened.
The UMHS, which for 20 years had been attending to the health care needs of transgender adults—one of the first hospitals in the nation to do so—agreed it was a good idea. Wiener got the job and early this year became UMHS’s manager of comprehensive gender services.
“It’s my dream job,” she says. “It fits with who I am and my politics.”
The story of how Wiener landed in the growing world of transgender health care is a testament to the self-directed, lifelong style of learning championed so much at K. Wiener, who holds a Master of Social Work degree from Smith College in Massachusetts, had next to no formal training in gender dysphoria or transgender health care. During her graduate studies, she remembers exactly one course that dealt with gender issues, and then only in a cursory way.
“I got a bunch of books and journals and spread them out on a table and thought to myself, ‘How am I going to do this?’” she recalls. “But I knew I had the skills. K gave me the know-how to teach myself on my own. Embracing lifelong learning—that was kind of hammered into you as a K student. I was thinking of the College when I did this. And I did it.”
Research shows that about 80 percent of prepubertal children who identify with a gender other than that assigned at birth do not go on to become transgender adolescents or adults, she says. Instead, they may grow up to become gay, lesbian or bisexual.
The majority of adolescents in puberty who are struggling with their gender during or after puberty will go on to become transgender as adults, Wiener adds.
“It’s this constant voice telling them, ‘This is not me,’” she says. “For many people, it does not go away.”
She does a lengthy clinical assessment before making any recommendation for medical intervention, assessing the young person’s current functioning, family environment, any co-morbid mental health issues (PTSD, depression or chronic anxiety, trauma) and gender histories.
Young people enter her office looking for answers about everything from hormone therapy to surgical procedures. Their families—sometimes conflicted about how to address their child’s gender identity—also are a part of the consultation, receiving support from Wiener’s office as well. Any minor must have the consent of their parent of guardian before going forward with any therapy.
“Some parents have a hard time with what their child is going through,” Wiener says. “Some think it’s a phase the child will move through, or are having trouble accepting what’s going on. These parents need support, too. Here, we have a holistic approach.”
LuxEsto spoke with Wiener just a month after she started her new position. Already, she had seen young people and their families from across the state. In Michigan, there is only one other health care provider willing to prescribe hormone therapy to transgender young people, she says.
“Trans people want and deserve to be integrated. They often want or need specialized medical and any number of other support services. We can do that here.”
Wiener’s work also puts her on the front lines of the of the social justice movement for transgender rights and inclusion.
“It’s different from outpatient psychotherapy. When I did that work, the social justice advocate part of me wasn’t activated. I wasn’t making the kind of changes I wanted to help make. When I do this work, I feel like I am really making a difference—and it feels awesome.”
She’s already been emotionally touched by her work.
She remembers a father who brought his 6-year-old natal male child into her office for feedback regarding how to manage the child’s preferences for clothing typically associated with girls. The child came through the door “all dolled up,” Wiener says, wearing a pink dress, bows in his hair and clutching a magic wand.
“Dad came in looking for direction, wondering what he should do. After a thorough assessment, I was able to assure the father he was doing the right thing by supporting the child in the child’s unique gender expression. The relief I saw on his face was incredible, just that simple bit of advice ended up helping them both.
“I get to be a part of a young person’s life and help them become who they truly are, removing barriers so they can be their authentic selves and connect them with what they need. It’s an honor to see people become themselves. It is so rewarding.”