Bystrom Counseling and Consultation

Let's see what's possible

Gender Identity/Expression and Sexual Orientation

"You skillfully allowed me to find my own questions and answers.  I couldn’t imagine a more skilled, gentle counselor/advisor/confidant.  I trusted you with my relationship with my daughter; that trust was so well placed.  I’ve met many parents of trans people.  The conversations often include the worries, fears and tears that I’m so familiar with.  I always tell these worried parents of your invaluable help.  I am eternally grateful."

M.M.~ Parent

I am highly qualified by interest, training and years of practical experience to support people who are exploring matters related to sexual orientation and gender identity, especially adolescents, young adults and those who love them.   I have supported people living in a wide variety of romantic/sexual relationship configurations and those seeking a safe place to discuss the impact of past abuse on their current experience of sexuality and gender.  

In the last 20 years, I have consulted with more than 300 clients around gender and sexuality.  I facilitated a group for gay, lesbian and bi-sexual teens for 10 years and a group for transgender identified youth for 15 years.   

My primary goal when working with people around gender and sexuality is to help them have a positive/loving relationship with themselves and ultimately with others.  This process takes many forms and the pace is unique to each person.

I have supported many people prior to a decision to alter some aspect of their bodies to increase their sense of internal and external gender congruence.  I do encourage people to take the time to prepare really well emotionally, practically and financially.  Those who do, tend to enjoy much better outcomes overall.   

Before beginning hormones or undergoing surgery, I recommend that people undergo both a Global Review of risks and benefits to be completed with a therapist (see below) and a Medical Review of risks and benefits to be completed with a physician.

I am qualified to write letters on behalf of those who are seeking gender related surgery.

Topics I review in-depth with people in the Global Review include but are not limited to: 

  • Insurance coverage
  • Finances
  • Legal actions such as changing name and gender marker, etc. 
  • Living Situation
  • Employment/School
  • Mental Health (previous mental health history)
  • Mood (potential changes as a result of hormones)
  • Fertility
  • Sexuality/Sex Drive (potential changes due to hormones)
  • Sexual History
  • Self-Care
  • Substance Use
  • Sharing With Others
  • Influence of Social Factors on Decision Making (race, sexism, western medical practices, religion, etc.)

Medical Review of risks and benefits should be completed with a physician.  An example of areas typically covered by a doctor are: 

The practice landscape has changed in Minnesota and a number of physicians are now comfortable prescribing hormones without written documentation of completion of Global Review of risks and benefits from a therapist.  Please be aware that many of these medical clinics have significant wait lists for new patients.  Clinics most frequently accessed are: 


Here are two organizations that have therapists familiar with the Global Review and have low cost and/or sliding fees for mental health:

RECLAIM (ages 13-25)