It’s about that time of year. You know the drill. You realize the year is coming to an end, the new year is just around the corner, and panic sets in. You start thinking about all the things you wanted to get done but didn’t, all the things about yourself that are still…well, you.

What happens when moralizing about authenticity becomes an accusation? When anyone who chooses not to disclose their truest gender expression is seen as a fake, sellout, or impostor, even if they have valid reasons to hold the lines between their private and public selves?

It can be hard, at times impossible, to separate out the different pressures we face living day to day in our trans and non-binary bodies. When it comes to existing in relative comfort, it’s not just about aesthetics. It’s about safety, access, all the things we are not talking about. And we need to talk about eating disorders in the trans community because they are killing us.

I want to shift the conversation to talk about how mental health providers can be helpful in supporting trans patients through the process of seeking and receiving gender-affirming medical care. As a health care system, we need to move away from gatekeeping based on gender narratives and toward a more client-centered, collaborative approach that focuses on informed consent.

I envision a future, maybe not one that I will ever witness myself, in which bodily autonomy and body liberation exist for all people…What is the world you envision and want to fight for?

So how does one make space for these difficult dialogues? There is no simple “how-to” guide because none of these conversations sound the same. But here are some key considerations and suggestions for application that you may find helpful.

I’m not saying this isn’t an authentic narrative for some, possibly many, trans people. It’s just that the people for whom this narrative does not apply are often excluded from gender-affirming health care—care that could provide them a better quality of life or even save their lives. These people are not members of the slam dunk club.