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Episode 7 Transcript

Transgender Therapy Topics with Tali Boots, LPC

Erin Everett: All right, so welcome back everybody. Welcome to Exclusively Inclusive. I’m your host, Erin Everett, Nurse Practitioner, and today we’re going to be having on our show Miss Tali Boots, who is local to Atlanta and had moved from Austin, but she is actually one of the most fierce therapists and mental health care providers that I refer to. Tali is well versed in sexual therapy but also works with nontraditional couples and LGBTQ care and all other types of specialties. Tali, why don’t you go and say, “Hi.”

Tali Boots: Hey guys. Thank you for that awesome introduction.

Erin Everett: Could you go ahead and tell us your preferred pronouns before we get started?

Tali Boots: Of course. My name is Tali Boots pronouns are she, her and hers.

Erin Everett: Excellent. Thank you. I know I touched on some of your specialties, but did you want to go into a little bit more detail about what all that means for listeners?

Tali Boots: Yeah, so I’m an LPC, which is a licensed professional counselor, and I’m licensed in the state of Georgia and Texas. I’m also a member of WPATH and AASECT, which is the American Association of Sex Educators, Counselors, and Therapists. Those are the main organizations that I am a part of, but I’ve been in private practice now since 2013.

Erin Everett: Yay, that’s awesome. Good for you.

Tali Boots: Mm-hmm (affirmative). Yeah, I love it.

Erin Everett: Yeah, I’m sure. Having a lot more control and being able to see the patients you want to see and really increase access to care is amazing.

Tali Boots: Exactly. Yeah. I like to call my own shots.

Erin Everett: Yeah, exactly. So you mentioned that you moved from Texas and now here in Atlanta. Do you mind going over like a little bit of your personal background?

Tali Boots: Yeah. I’m from Austin, Texas. I lived there until I was about 20 and then I moved to Colorado actually for 10 years and lived in Boulder. That’s where I got all of my schooling and began my licensure hours in Colorado. Then I moved back to Texas and became licensed and started my practice there in Austin and then happened to move out here in Atlanta and started my second location out here in Atlanta. Now I see my Texas clients online and my Atlanta clients in person and online.

Erin Everett: I think that’s so awesome that you can still have your clients do video sessions and online sessions because that is still hopeful for so many people who feel like they can’t make it into your office.

Tali Boots: Yeah. It was really hard when we decided to move up here to Atlanta. I was, I was very sad about all my Texas clients. I didn’t want to leave them. Being able to offer them that opportunity to come with me virtually was really great. Otherwise, I would have never thought of doing online therapy. But it really just kind of opened up my eyes to that and it’s very helpful. I’m able to work with people and their sexual disorders and experiences via the internet, which can be very helpful on your own couch, in your own house where you feel nice and safe.

Erin Everett: Absolutely. That’s actually one of the selling points that I have for patients who are hesitant to establish a relationship with a mental health care provider. When I’m talking about you and a couple of others, being able to offer that service makes them a lot more comfortable, especially if they’re also battling with social anxiety.

Tali Boots: Oh yes, for sure. It is very nice to be able to do a video session from your own bed or your couch.

Erin Everett: What’s one little fun fact about you or something that maybe a lot of people don’t know about you.

Tali Boots: Okay. I was thinking about that and I think I finally actually have a good answer because most of the time I don’t prepare for this question.

Erin Everett: Right.

Tali Boots: Yeah. Growing up I used to ride a Arabian horses on a national level. I did that.

Erin Everett: Wow.

Tali Boots: Yeah, I did that for like 10 plus years and I just recently unpacked some of my medals and I don’t know what to do with them.

Erin Everett: That’s super cool.

Tali Boots: It felt like another lifetime ago.

Erin Everett: Yeah, that’s a super fun fact. Well, cool. So we kind of touched on your professional background a little bit and your training and education, but what was it that drew you to this community with a sub-specialty in sexual therapy, or the main specialty really, I guess.

Tali Boots: Right. Well, I finally, it felt like… In under undergrad, it took me forever to figure out what I wanted to when I grew up. I finally figured out that there was a thing called a sex therapist. Once I learned that you could get paid to talk to people about their sex lives and help heal their sexual lives, I started doing all the research involved in that and got wrapped up in the American Association of Sex Educators, Counselors and Therapists. Then within that there is specialty training to work with transgender people.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: It’s just right in grad school. Back then it was Gender Identity Disorder and I had a really big issue with that and that was one of my grad school projects was talking about how that didn’t need to be in the DSM. I didn’t understand what was going on. I was brand new and I felt like this was obvious to me so why wasn’t this obvious to-

Erin Everett: Everybody else.

Tali Boots: Yeah.

Erin Everett: Yeah.

Tali Boots: When I was working at the Mental Health Center of Boulder, everybody knew that I was getting my training in sex therapy. I got all of the clients who had any sort of sexual topic to go over along with the trans clients. So not only was it a passion in grad school, it just kind of fell into my lap and I started doing community work. I was able to get guidance through supervisors when I was getting my licensure. Then when I went into private practice, it was something I knew I needed to find a supervisor and continue training to be able to work with the trans community.

Erin Everett: Yeah, that’s awesome. I mean I’m so glad that you’re able to land in that niche. I recall thinking the exact same thing when I… I have a Bachelor of Science in Psychology.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: I remember thinking the same thing when we’re going over the DSM about the gender identities dysphoria code and thinking, What the hell? Why are we even talking about this like it’s a disease process.

Tali Boots: Right. I thought the same thing too. In my simplistic graduate school mind, I didn’t know much at the time, but I was like, I don’t understand. The only treatment here is to transition?

Erin Everett: Right.

Tali Boots: Why is this a disorder? It didn’t make any-

Erin Everett: It’s a disorder because of our social construct, not because anything else. Society basically dictates the way that we’re supposed to present based on what we’re assigned at birth. It seemed very archaic and non-progressive. Hopefully, even though we’re making slow progress on that front, one day it won’t even be included. They’re actually talking about making with ICD 11, which is the medical diagnoses codes, updating it to just be a non-binary or a non-conforming. But non-binary would be even better.

Tali Boots: Right.

Erin Everett: Yeah.

Tali Boots: Oh, I love that.

Erin Everett: Yes. So with all that in mind, that would be a nice segue into the first thing that I wanted to talk to you about today, which would be some of our listeners are well versed in the community and the terms that we talk about, but there are others who are allies who are tuning in or may identify in a different part of the community who aren’t that familiar with gender identity. I was wondering if you could explain to them kind of the main differences between gender identity versus sexual orientation versus assigned sex at birth and what that kind of all means for people.

Tali Boots: Yeah. Okay. I would love to. First I want to plug an awesome graphic called The Gender Unicorn. I use this a lot when I’m teaching my clients and their family about the differences between gender identity, expression, sex assigned at birth, who you’re physically attracted to, and who you’re emotionally attracted to. Just Google The Gender Unicorn.

Erin Everett: I’m going to look it up now.

Tali Boots: Yeah, I love it. Sex assigned a birth is what the doctor does when you’re born and looks at your external genitalia and assigns you a sex.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: Then sexual orientation is who you’re attracted to. I feel like a really easy way to remember this is sex assigned at birth is who you’re going home as. Sexual orientation is who you want to take home with you.

Erin Everett: Oh yes.

Tali Boots: Our gender identity is our own conception of our gender. This happens if you can think about it in your mind. It’s also, I feel like, in your soul. Wherever you find your soul in your body. But it’s your mind talking. Then your gender expression is how you look like on the outside. That’s how you’re expressing yourself for others. That might be like one day you might be more feminine or one day you might dress more masculine or you might dress gender nonconforming one day. That one is how others basically see you.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: We already went over sex assigned at birth, usually it’s female, male or intersex. Then there’s who you’re physically attracted to. That might be what people consider sexually attracted to or your sexual orientation. Then that might be different than who you’re emotionally attracted to. That kind of emotional and romantic connection is a little bit more complicated and that definition is more wide. But it’s what you feel like in your heart instead of what you feel like from your genitals.

Erin Everett: That’s super interesting because I don’t think a lot of people talk about that and how those two might not communicate well together. Meaning you might actually get the tinglies for someone different than who you actually would sit down or go on a trip with and share all your most personal details with and be more inclined to do that with. That’s really cool.

Tali Boots: Mm-hmm (affirmative). What I love about what I do is I work with a lot of nontraditional couples. The wonderful thing about open couples and poly couples and the swinging community is that they’ve kind of figured this out. That they can be romantic and emotionally connected to some people and it might have nothing to do with their sexual or physical connection to somebody else.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: That you can have more than one person to fit all those different places within your life.

Erin Everett: Right. Yeah. I often get asked by people who don’t identify as poly or participate in that way of life that, Well, how do they do that? How are they not jealous? Again, I’m like, Well that’s part of the reason why you are not a part of the Poly community because this doesn’t work for you. But this works for them and that’s awesome.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: But that’s an interesting concept too. That really does help highlight the difference between sexual attraction and emotional attraction as well, and how those two could be totally compartmentalized.

Tali Boots: Right. Also, being part of those communities doesn’t mean you’re not going to have jealousy. It’s just you’re expected to talk about that jealousy and you’re expected to work that through and claim your own jealousy as yours and not as what your partner’s doing to you.

Erin Everett: Mm-hmm (affirmative). Yeah. That’s an interesting way to look at that. Oh, that was so therapeutic. Well, that actually is really a great summary, I think, of all the different ones. I looked up The Gender Unicorn and I do think my listeners need to go and look at that because that is awesome. It’s a great way to actually visualize what you just explained.

Tali Boots: Cool. Yeah, I love it.

Erin Everett: Yeah, it’s great. I might actually have to print some of those and put it in my exam rooms.

Tali Boots: Oh, smart. Yeah, I like to keep it a bunch of them to just hand out to people.

Erin Everett: Yeah, I think it’s really great. Well that also is interesting and brings me to my next thing that I wanted to, to explain because I have a lot of patients that identify as asexual. While I know what all this means, and I’m obviously not as well versed as you, but I am familiar with it, a lot of people don’t know what that means and often need help in finding other ways to express love and share intimacy. I was wondering if you could summarize and explain what asexuality means and how people who identify as asexual might give and receive love.

Tali Boots: Right. Okay. Asexual, just like all the other sexual orientations is a label that you put yourself. Nobody can ever give you this label. I think that’s very important because I have clients come in a lot and they’ll say to me, “Well, maybe I’m just asexual. Could you just tell me if I’m a sexual or not?” I have to say, “Well no. I couldn’t tell you if you’re gay or bi or straight. I can’t do that for you. This is a label that you get to claim for yourself.”

Tali Boots: But asexuality basically means that you do not have the desire to be sexual with anybody. That’s a little bit different than your libido. You libido is almost like the drive to have a sexual release or response. You might be asexual and still have a libido to deal with. But I’ve heard asexuals describe that more as something they have to do, like a job they have to do, like a checklist they have to do. It’s not as pleasurable as somebody who might be sexual, that they see that as something they want to either do by themselves and they’re having a great time, they’re looking forward to it, or with others. Asexual people are looking at their libido as more of a sexual release but not something they want to connect with others around.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: Does that make sense?

Erin Everett: Yeah, absolutely. Because, basically, what you’re saying is someone who’s sexual but may not want to be sexual with other people, still might really look forward to private intimacy sessions or masturbation. But someone who’s asexual might just do that, climax just as a release so they can move on about their day.

Tali Boots: Correct.

Erin Everett: Yeah.

Tali Boots: Yes.

Erin Everett: Cool. Yeah, I think that’s a really good explanation. When you’re talking to these patients, do you notice that they have a lot of shame or guilt about this? Or is it something that is just kind of that they struggle with to get other people to understand?

Tali Boots: I do think everybody’s an individual. I have seen plenty of asexuals who claim this very proudly and and they have worked through their own internalized shame around it.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: But yeah, you could romantically fall in love with somebody who’s sexual and for example, say that person wants to be in a monogamous relationship, then that could create a lot of problems for the asexual person. But usually I find that my asexual people get into non-monogamous relationships so that their partner, if they have a partner who’s sexual, has an outlet for that. It just might not be them.

Erin Everett: Yeah.

Tali Boots: So asexuals could be romantically or emotionally attracted to people. They might like to cuddle. They might like to spoon. They might like massages. There’s a lot of body touch that can happen that’s not sexually based.

Erin Everett: Mm-hmm (affirmative).

Erin Everett: Speaking of asexuality, I guess all these topics meld together a little bit. They’re a little bit more uncomfortable and may create barriers for people to feel like they have a healthy sex life. One of the other things would be genital dysphoria. I know that this is when people have a gender dysphoria they’re not able to go through their transition yet and they’re already having internal conflict because they aren’t living their true selves yet. This is also lumped into there. But those that are, for the most part that they can, live their true selves, they’re passing, but they still have sexual desire but have a lot of genital dysphoria. I’m sure you’ve run into this a lot with your clients and you try and help them to have like creative ways to have sex reach comfort around that. Could you talk on that a little bit for us?

Tali Boots: Yeah. That is an added complication. That you want to be sexual, but you’re having a lot of genital dysphoria, which might mean that you do not identify with the genitals that you have there and those genitals might be talking to you and you’re wanting to express in a sexual way. How do you do that? I think it’s very helpful for you and your partner to have your genital labels correct. So how you want to refer to your genitals need to be understood by your partners so that they can be talked about in the way that feels good for you. There are a lot of toys out there that can really help. I always say that a vibrator speaks louder than the mind. It’s a good addition in anybody’s bedroom. Sex toys can be very helpful to kind of keep the focus off just your genitals. They can add some newness to what’s going on in the bedroom.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: Making sure that you’re talking to your partner about what you want, what’s expected, what’s okay, what’s not okay. Having these conversations outside of the bedroom. Don’t wait until you’re about to be sexual to be like, Oh maybe I should talk about this.

Erin Everett: Right.

Tali Boots: Talk about this when you’re having a glass of wine before you ever head up to the bedroom. That way you’re not on the spot. Often times when we’re in the sheets, we say things probably about 20 times in our head before we actually start to say that out loud to our partner. You don’t want to do that when it’s wrapped up in your genital dysphoria concerns also.

Erin Everett: Right. It’s going to make the next time even more uncomfortable if you’ve had a not so pleasant experience because you haven’t been able to express your needs properly.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: Yeah. So you mentioned names for genitals. Outside of, obviously, the anatomical names, what are some more gender diverse names that people may want to use in case they’re having a hard time with that?

Tali Boots: Yeah. Well, you know it can be as colorful as you want it to be. But some people say, “My clit.” Some people say, “My penis.” Literally referring to your genitals as the genitals you want them to be instead of perhaps what the doctor would have named it. But there’s so many terms online. You can Google all sorts of different terms online. But using perhaps for a trans man chest instead of any of the other things that you might’ve referred to their top as. Then vice versa, making sure for a trans woman you’re labeling that them they like the word tits or breasts.

Erin Everett: I think too when I ask patients how would you like me to refer to it? They don’t really know sometimes because no one’s ever asked them that. They just in their head they ignore the subject or they may not even be sexually active yet so they haven’t had to verbalize it. So you know, having those terms in my toolkit helps my patients as well.

Tali Boots: Oh, I know. I love that. Honestly, as a therapist, I try not to assume anybody’s labels for their body parts. I always either, if I have to ask, I’ll ask. If not, I’ll just wait for my client to refer to their genitals how they want to and then I’ll mirror that.

Erin Everett: Mm-hmm (affirmative).

Tali Boots: Yes, I’ve heard many different terminologies for their genitals and I think it’s wonderful that we have so many different ways of labeling our body parts in the way in which we want to.

Erin Everett: Hey everyone, I have a quick favor to ask. If you wouldn’t mind taking a moment and just clicking the subscribe button on whichever platform you use to listen to my show, that would be wonderful. Not only does it allow you to get notified every time I publish an episode, but it also helps with my ratings and reviews. What that means in podcast world is that I’m able to climb up in the rating scale and reach other listeners. The whole reason why I started this show is to access people who needed the information. Please just go ahead and click subscribe. Then we can all be happy and continue to listen to this good quality free information. Thank you so much.

Erin Everett: Is there anything you wanted to add in on that or anything that you feel like our listeners should know or things that they should be asking their providers for?

Tali Boots: We also have to remember that trans men have to still get gynecological exams and that can be very uncomfortable for a man to be sitting in the waiting room with a bunch of cis women just sitting around. So having a provider like yourself… I’ve referred many of my clients, perhaps they’re not even coming to you for hormones, but they have to come to you for just what I say a normal doctor’s visit. I love that you can provide that service so it’s not a traditional gynecological office where they’re sitting around with cis women and probably a lot of pregnant cis women.

Erin Everett: Right. When something presents to my office, like a medical issue that I’m not equipped to manage whether it’s because of lacking specialty knowledge or like equipment or tools, I do have a lot of… I have two in particular that are really great gynecologists that will actually provide really affirming care. Actually one of their offices will see a lot of same sex and nontraditional couples for fertility treatments. So often the waiting area is not so scary because there’s cis men sitting there and people don’t even know why you’re sitting in that gynecological office because you could be there to get your sperm tested. You could be there just to consult with your partner for any number of reasons. I remind my patients that. That’s Dr. Betsy Collins with Emory. But their office has a lot of different people sitting in the waiting area. It’s a little bit more stealth than if you’re going to a traditional GYN office.

Tali Boots: I love it.

Erin Everett: Yes.

Tali Boots: That’s awesome. That’s a good resource to have.

Erin Everett: Yes. Actually, it’s so interesting that you brought that up. This is a little bit off topic, and I’m actually going to have a little session on this another time, but I get this journal. It’s the journal for nurse practitioners and it has it’s The Journal for Nurse Practitioners. It has a lot of evidence-based literature in there and articles. One of the articles that it presented was Gender Affirmation in Adult Primary Care. One of the things that I thought was such a good resource in there were for providers who might not actually be providing gender affirming care right now but want to, or don’t know how to meet the needs of their clients. It actually went through on how to give a sensitive speculum exam. I think that is so important. For anybody too. We get a little bit hung up on, not hung up on by rightfully so we should be hung up on it. But what about cis women who have undergone sexual trauma or just, in general, are really uncomfortable with that area of their body?

Tali Boots: Yeah.

Erin Everett: I think everybody needs to know how to give a sensitive speculum exam.

Tali Boots: I love that. I would love a copy of that.

Erin Everett: Yeah, I’ll have to figure out a way to send it over to you.

Tali Boots: Yeah. In the sex therapy world that I also work in, I work with a lot of women who experience pain with intercourse. That is a huge concern is that the majority of the gynecologists out there they’re just so used to giving those exams. I don’t know how much of their training is actually focusing or talking to them or cluing them in that this can be very, very stressful and painful for people. And how to, I don’t know, maybe ask a couple of questions looking where you get somebody naked from the bottom half.

Erin Everett: Oh, for real. Yeah. Not only that, ditch the stirrups for the love of God.

Tali Boots: Oh, I know.

Tali Boots: That’s completely unnecessary. This is where nurse practitioners and advanced practice RNs come in because a lot of the certified nurse midwives who are providing these services are doing these very sensitive exams where people will sit frog legged and not in stirrups. And actually letting people do their own cervical brush because… I have to find the study. But there is data to support that people with cervices can actually get enough cervical cells with their own brush more than often the provider. Then when it comes back abnormal, yeah, the provider may have to visualize the cervix, but if it was a normal exam. I mean, you have to do risk versus benefit. If it means that the patient will actually come in and get some type of screening modified.

Tali Boots: Mm-hmm (affirmative). Wow. I love that.

Erin Everett: I mean we could talk for days just on that.

Tali Boots: I love that.

Erin Everett: Yes. I mean we could talk for days just on that.

Tali Boots: I know.

Erin Everett: There’s some good stuff and perhaps we should address that in another podcast. Talking about pelvic discomfort for cis or even trans men.

Tali Boots: Well that’s what I was going to bring up. That it is very important since trans men are taking testosterone, thus their estrogen gets blocked, that there can be vaginal atrophy that’s happening. That would make pap smears extremely painful and uncomfortable. All those things really need to be considered. Not only is it an exam that feels uncomfortable on many emotional levels, but also on the physical levels.

Erin Everett: Yeah, absolutely. A lot of providers aren’t aware, but for trans men it’s often offered to post-menopausal cis females, the topical Estrace creams. But I have a lot of trans men taking those topical Estrace creams. It will not feminize. It’ll just help that vaginal tissue, so they don’t have as much pain. They have less urinary incontinence and their pH is a little bit more restored so that they don’t get chronic BV and yeast. It’s really, really helpful.

Tali Boots: That’s great. What about a cycling them on progesterone?

Erin Everett: Yes, I do have patients on progesterone. A lot of them don’t like to cycle it just because of the mood shift.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: But I often recommend either the progesterone only daily low-dose pill or the IUD. The nice thing about the IUD is they could go for an exam, have it placed, and then it’s working for contraceptives. It’s working for that whole area.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: But also then they don’t have to necessarily go back and get another exam unless they’re having a medical issue for their three to five year screening time. Whereas if I’m prescribing the progesterone only pill, I’m not requiring a pelvic exam every year, but a lot of GYNs do.

Tali Boots: Yeah. The progesterone does a good job of not interacting with the testosterone. For so many years that was ignored. So for trans men who weren’t able to go get a hysterectomy, there was a lot of damage happening.

Erin Everett: Mm-hmm (affirmative). Yeah and not just that, a lot of people think that once the menstrual period stops that they can’t get pregnant. I play MythBusters all the time with that. I’m like, absolutely not. You could still be ovulating without a cycle. So if you’re going to be using that organ and having a biological penis that you have to protect against pregnancy, and if you don’t want to think about that, then taking a daily pill or doing an IUD is perfect. They don’t have to necessarily… I’m not even talking about traditional oral contraceptives with estrogen in it. I mean just the progesterone only. Although, you can do traditional oral contraceptives. As long as we get that testosterone high enough, they’re still going to masculinize.

Tali Boots: That’s great. I’m sure you do a lot of education around that. IUDs are kind of painful to go into.

Erin Everett: Yes, they are.

Tali Boots: And if you’re experiencing pelvic pain down there.

Erin Everett: Oh, right. Absolutely. They’re not for everyone at all. Then you can also do the progesterone only implant in the arm. But if someone’s just starting their transition and so their biological female hormones is still very high, that’s usually when I’ll mention the IUD because that’s typically when they’ll have the less pain with insertion.

Tali Boots: Okay.

Erin Everett: But if they’ve been on testosterone for a really long time or even a couple of years and they’ve already experienced a significant amount of atrophy, it’s probably not the best option for them at that point.

Tali Boots: Okay.

Erin Everett: Just given the pain. I mean, they can still do it, but just given discomfort and whatnot, it would definitely need a proper bimanual exam and maybe even an ultrasound to assess for atrophy before going into that.

Tali Boots: Mm-hmm (affirmative). The one in the arm is the better choice.

Erin Everett: Yep, at that point. Or the daily pill.

Erin Everett: Well, since we were talking about genital dysphoria and creative ways to have intimacy and sex, one of the other topics that come up a lot just in my exams, and I would say that the majority of my patients don’t go on to have gender reassignment surgery, or vaginoplasty, metoidioplasty, or phalloplasty, for those of you wondering what that means.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: But the ones that do sometimes run into issues having a sex afterwards. Maybe it’s not necessarily issues because the new organs aren’t functioning, but that’s just like, Okay, so now I have this new organ, what do I do with it?

Tali Boots: Mm-hmm (affirmative).

Erin Everett: I have to build a new relationship. I actually have had trans women in the past go on for vaginoplasty and say, “Okay, well now that I have the vagina, I’m so excited about it, I just feel like I need to look at it everyday and get to know it. It’s this new part of me that I’m just not familiar with and it feels very strange not to have an erection.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: So do you run into that in that? And what are some tips or things that you could give listeners? Or just some insight information on that.

Tali Boots: Okay, so first, I agree with you the majority of my practice people don’t end up getting bottom surgery for whatever their reasons are. I’m sure the majority of the reasons are money. But there are other people who don’t have gender dysphoria and are trans and so they don’t want the surgery. That’s their experience also.

Erin Everett: Yeah. Thank you for highlighting that because that’s super important.

Tali Boots: Yeah, no problem. I think that used to be the case. Sorry to get off on a tangent again. That used to be the case that people wouldn’t prescribe hormones even unless somebody said that they had genital dysphoria also. That’s not the case anymore. That’s really lovely that it’s starting to move towards everybody is different and let’s just listen to the person. But what is very, very important after post-surgery is to hook up with a pelvic floor physical therapist who is specialized with trans people.

Tali Boots: We happen to have somebody here in Atlanta. His name is Lance Frank. I think he’s that Activcore right now. That’s what his LinkedIn page says.

Erin Everett: Yes, I know Lance. He’s wonderful. He’s a wonderful resource.

Tali Boots: Yes, he’s so great. He’s going to help you get to know your new body very well. You’re right, there’s a learning curve. It’s brand new. It’s not like you grew up with this and understand it completely. So you have to think that you have to go through an exploration stage. So you might be having to use dilators, you might be having to use pumps. There’s a lot of learning curve to go along with it. Then not only that, there might be complications of you might not have a partner.

Tali Boots: Then how do you begin dating in this new world with this new body part. And all of that you just have to take slowly and understand it for yourself before you introduce anybody else into the bedroom. Then seeing somebody like a physical therapist to make sure that you’re healing correctly, that the scars are working themselves out. Just because you have a scar there doesn’t mean you can’t work that scar out. You can do a lot of like scar rehabilitation and muscle rehabilitation through pelvic floor physical therapy.

Erin Everett: Mm-hmm (affirmative). What do you mean when you say, “Work that scar out”?

Tali Boots: Oh, well, that’s a good question. It depends on where it is. If it’s internal, you might be working it out with a dilator and kind of getting the sensitivity of this scar to go away so it’s not so triggering or painful. Then getting the right cranes and lubes and tools to help you learn your new body. Then incorporating sex toys again with your new body can be very helpful. A lot of people like vibrators or dildos or pocket pussies. There’s all sorts of fun things.

Erin Everett: Yeah, that’s awesome. A lot of patients wonder too if they’re going to be able to climax after surgery. Especially after vaginoplasty because the penis is gone and so they wonder, Am I going to be able to use my new clitoris? I would have to say my experience with my patients who have undergone surgery that, yes, after time they definitely can.

Tali Boots: Mm-hmm (affirmative).

Erin Everett: It’s not 100% guaranteed but the majority of people do get full sexual function. I don’t have a lot of patients who have had phalloplasty. Do you have more experience with that and what to expect, postsurgically?

Tali Boots: Yeah. Unfortunately, phalloplasty is just not up to par with many of my client’s standards. They are waiting for it to get better. The majority of my clients who might even be able to afford it are just choosing not to do it yet because the technology is just not there yet.

Erin Everett: I agree.

Tali Boots: The knowledge is just not there yet. I can’t answer that. This is the sex therapist in me, I would like to expand the definition of sexual pleasure to be outside of an orgasm. I think that’s really important to not just define sex as active lubrication, erection, orgasm, simultaneously please, because that’s not realistic. And if we put our definition that close then we’re just going to fail when it doesn’t get reached. So, instead, looking at your sexual experience as pleasure and intimate connection that you have either by yourself or with another that it’s this spiritual, emotional, mental, physical connection you have with another person.

Tali Boots: That sense of connection is the goal instead of orgasm. I got to tell you that everybody explains and defines orgasm differently. Some people have throbbing sensation, some people don’t have throbbing sensation. Some people have fluids that happen and some people don’t have fluids that happen. It’s really important to understand that that sense of pleasure the most important part. That way you don’t feel that perhaps if you can’t get the “orgasm you used to be able to get” after your surgery, you don’t feel like it’s a failure. Instead, you’re connecting to a different level of pleasure than what you think of an orgasm to be.

Erin Everett: Mm-hmm (affirmative). Wow, you just blew my mind. That is so true. You know, expanding that definition, that’s going to be so helpful to so many people. Not a lot of people think about sex like that. They might think about the emotions behind sex, but the actual physical act and the desired outcome I think for a lot of people are the traditional, like you said, “fluids, climax, often simultaneously, let’s do this.” But expanding that definition I think is really helpful. Especially even if we’re not talking about having surgery or not. But anybody who’s have it has a difficult relationship with sexual intimacy will benefit from that expanded definition.

Tali Boots: Right. Yeah. Well, the pressure that we put on ourselves to have an orgasm is counterintuitive to actually connecting to our sexual selves and our sexual experience. It’s not very helpful.

Erin Everett: Yeah. Right. Yeah, and I’m sure it makes the task even more challenging.

Tali Boots: Correct. We’ve got to be in our bodies, not in our.

Erin Everett: Right. Exactly. Right. Well, I think that was a really helpful discussion on sex post-surgery.

Erin Everett: I thank Tali for coming on today and giving us all that information. That’s good, solid information. But if there’s something that we touched on that you have additional questions about or you need clarification on, please feel free to reach out to either myself at erin@exclusivelyinclusivepodcast.com, or you can reach tali at… What’s the best email to reach you at, Tali?

Tali Boots: Yeah, it’s Tali T-A-L-I @sextherapyofatlanta.com. That’s my website too, sextherapyofatlanta.com.

Erin Everett: Or you can reach her on Instagram, which is @talibootslpc. And, Tali, you’re accepting new patients, right?

Tali Boots: I am. Yes, I am.

Erin Everett: All right. Excellent. Is there any other information about your practice that you want people to know, whether you hold group therapy sessions or other services?

Tali Boots: Yeah, I do actually. I have two groups. I have a When Sex Hurts group that meets on Thursday evenings. Then we also have a trans group that meets every Wednesday evening. That’s an open, ongoing group of all genders. So anybody on the spectrum can come to the trans group. Then also in February I’ve got a workshop for parents. It’s basically about what happens to our sex life after we have kids. This workshop is going to be two hours long and everybody’s encouraged to come. Babies in arms are allowed, but they’re walking around we’d like you to find a sitter, please.

Erin Everett: Okay. Well that’s awesome because that pertains to everybody. Any parents. That’s awesome. Well cool. Thank you again so much and I look forward to having you back on so we can cover other topics like kink and anything else that’s hot off the press we can address too.

Erin Everett: Wow. What a great show that was with Tali. I’m so thankful that she had the time to come on and talk with us about these subjects because they’re so important. I think we also limited how much we spoke about it because so much more can be said and we’ll continue to address these subjects. If anybody feels like, again, we didn’t touch on something that they have a question about, please feel free to reach out. And if you’re feeling isolated or alone about your gender identity or sexual orientation, just know that there’s people out there like myself and Tali who are ready and willing to help. Please feel free to reach out to either of us. Remember, stay fierce, love everybody and live your truth. Thanks again. Bye-bye.