TODAY'S GUEST: Dr. Z, PhD, psychologist and transgender psychology expert

I'm extremely happy to welcome Dr. Z., PhD to Hard Conversations!

Dr. Natalia Zhikhareva is licensed clinical psychologist in Beverly Hills. She has a Master’s Degree in Counseling Psychology from Lewis & Clark College Doctor of Clinical Psychology from Pacifica Graduate Institute. She interned at the Sexual & Gender Minority Youth Resource Center in Portland, OR, where she also founded and facilitated the Hormone Readiness Group for trans-youth. Her passion for working with transgender people fostered an interest in a much needed clinical research leading to the publication of "Interpretative Phenomenological Analysis of Projective Drawings of Pre-Operative Male-to-Female Transgendered Individuals Perception of Their Genitalia." She also wrote and contributed to Male-to-Female and Female-to-Male transgender courses, offered by the online training program Loveology University®. These courses have been added to Loveology University's® comprehensive coaching curriculum. She is a member of the Los Angeles County Psychological Association and the World Professional Association for Transgender Health.

• WEBSITE:

  https://drzphd.com/

• Instagram:

• https://www.instagram.com/dr.lbc/?hl=en

YOU'LL LEARN

• The ins and outs of erectile dysfunction among trans women

• Anatomical transition basics

• How to think about sexuality before and after transitioning

• The detriments of sexual shame

• Different ways of thinking about sexuality after transitioning

• The importance of sex positivity

• The importance of letting go of self-hate

• The impact of social constructs and narratives on sexuality

• The benefits of developing a personalized relationship to your genitals

• And more!

THANK YOU FOR LISTENING to my male sexuality and sex therapy podcast!

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About the Show

Introducing Hard Conversations, a podcast about male sexuality, and all things erectile, from the latest natural erectile dysfunction treatment to the best ed medical treatment. Therapist Tim Norton expands the conversation about male sexuality, adds context to why we struggle as a society to have hard conversations and breaks down how in a sex-positive environment there really is no room for taboos, judgment, or shame when it comes to penises.

YOUR online sex therapy and couple’s therapy HOST:

Tim Norton is a sex positive sex therapist working in private practice. He offers online therapy, online sex therapy, online sex coaching, and therapy and coaching for somatic symptom disorder.

Tim obtained his bachelor’s and master’s degrees from the University of Southern California. Tim is a proud member of American Association of Sex Counselors, Educators, and Therapists (AASECT), the Los Angeles Sexological Association, and works part-time with the Pain Psychology Center in Beverly Hills.

Hard Conversations Podcast Transcript

Tim Norton: Hello, and welcome to hard conversations. My next guest,Dr. Natalia Zhikhareva, also known as Dr. Z PhD, is a clinical psychologist specializing in gender issues and transgender care, and has worked with gender diverse individuals for over a decade. Her passion, working in the transgender community, fostered an interest in clinical research, leading to the publication of an article entitled preoperative trans women's perceptions of their genitalia.  Dr. Z's most recent work includes speaking on the effects of gender transition on sexuality.  the Los [00:01:00] Angeles County psychological association and at the center for healthy sex, she has been featured as a speaker on current transgender issues at the empowered trans women's summit has developed the comprehensive overview of transgender experience course offered by the online training program.

Love ology university and writes monthly on issues related to gender on the transformed blog. She is the founder and facilitator of two free monthly support groups for trans women and trans men. Thank you so much for joining us today Natalia -  or Dr. Z. 

Dr. Natalia Zhikhareva: Thank you. Thank you for having me here. 

Tim Norton: Yeah. And so can you give the listeners an introduction to male, to female transgender 

Dr. Natalia Zhikhareva: basics?

Sure, absolutely. I think for stars, it would be important too. Talk about what it entails to be a transgender individual. And I think transgender today generally encompasses pretty broad umbrella term under which a lot of gender diverse [00:02:00] individuals tend to cluster for the sake of today's conversation.

What I would mean by transgender and specifically male to female transgender. Is an individual's that was assigned to a male sex at bursts who does not feel comfortable or congruent with their assigned sex and desires to transition to a female gender. 

Tim Norton: Okay. And yeah, we had talked about this before the podcast.

We were. W we could probably do an hour on each situation. So maybe we'll come back and talk about this, but for today we are going to be really focusing on a male to female. 

Dr. Natalia Zhikhareva: Correct. And to clarify, even further to David who would be focusing on is not just only male to female, what, and I think it's a better terminology perhaps to use is a transforming.

Okay. Or a trans feminine person.  but we're also talking about a pre-operative individual. So in other [00:03:00] words, we're talking about trans women that are transitioning or have transitioned and ex present,  as women, but for whatever reasons, either personal or financial or otherwise have chosen not to undergo gender confirmation surgery also known as the bottom surgery.

Tim Norton: Okay. And that. To my understanding is the norm correct? Or the majority of,  transgender women don't get bottom surgery, don't get 

Dr. Natalia Zhikhareva: bottoms. 

Tim Norton: Yeah. Or they do. Are there numbers on that? I 

Dr. Natalia Zhikhareva: think it depends. I think generally the way we look at transition and what I mean by transition is transition as usual as a process that individuals undergone in order to get closer to the gender.

They are entered addition may usually Intel social transition, which is coming out to family and France legal transition, where you change your legal paperwork. And then there's the medical and surgical [00:04:00] transition, which what we'll be talking today about. And that can be anywhere from taking hormone regimen to kind of,  undergoing very surgical procedures in order to get your body aligned as close as possible to desire gender.

And I think one of the misconceptions is that transition tends to be a linear process. And is that the end goal for transwomen that we're talking about today is to,  fully align their body, with the desire, gender. Yeah. And I think what we're finding out today is that that's really not. The case is a tradition is non-linear process.

And there's a lot more individual trans women today that desired not to get a bottom surgery or not to get other surgical procedures, perhaps, maybe they'll just undergo hormone regiment, and that's pretty much it or a mixture of all above.  I think that's becoming much more common. 

Tim Norton: Okay. And, and, and it goes without saying like, this is [00:05:00] not a familiar territory for me.

And that, that was one of the reasons I wanted to have you on. And it gets talked about a lot in the therapy community that,  people who don't specialize in working with this population really probably shouldn't try to fake it. I think this is a very, Dr. Z has a lot of experience in this area. And as I said in the introduction has a,  free drop-in group a couple of times a month.

And this is your field, and this is something that like I've heard from multiple practitioners that you, you want him do your homework. 

Dr. Natalia Zhikhareva: Absolutely. In a, a stronger stand by that. I think that.  unfortunately today we have a lot of clinicians at,  do every single, I think it's impossible to design. I think it's important to focus, have specialists, you know, Tim it's completely okay.

Not to have much knowledge in this, again, your field sexuality.  and I think it's great that you are open enough,  to have somebody like myself to [00:06:00] be interviewed, to kind of expand not only your understanding, but the audience is understanding as well. 

Tim Norton: So you started to talk about hormone therapy and for trans women, is, are we just talking about adjusting levels of testosterone, lowering, testosterone levels, raising estrogen levels or, or, or what all is involved?

Dr. Natalia Zhikhareva:  for transwomen, the hormone therapy regimen usually entails for starters, but what we want to do. So we want to kind of suppress or bring the Starstone levels down. Right? So would those add by introducing antiandrogens and that's usually is a spider or by glutamine and Zen. What we want to do is we want to introduce estrogen, so that way we can enhance secondary sex, characteristics of desire, gender in this case, female.

And sometimes we'll introduce progesterone to further enhance secondary sex characteristics. And the hormone is really usually the initial step and tradition and a very important one because not only does [00:07:00] it give a physiological,  alignment or closer alignment of the desired gender, but also it has a psychological effect on,  bringing you even closer to congruency because you desire gender.

Okay. 

Tim Norton: And is it, is estrogen more common than progesterone or is it about the same or. 

Dr. Natalia Zhikhareva: Sort of estrogen is E is not only common, but it's a very vital part of, of hormone regimen. Progesterone is, is an add on hormone and progesterone can do really wanders to some people. And for some people it doesn't really work, but progesterone really firs helps enhance secondary sex structures.

For example, primarily really helps maybe,  expedites,  breast crows in San transwomen. 

Tim Norton: Okay. So, but if estrogen is going up and testosterone is going down, erections are going to go down. Correct. And that's [00:08:00] why we're here today. 

Dr. Natalia Zhikhareva: Exactly. And we're, we're really talking, I think, for transforming the origin of diverse people, listening to this conversation.

 what I would like to talk today about,  is trans women preoperative who have not had surgery. So in other words, transwomen that still have penis who really do want to engage in sexual activity, but,  cannot because their sexual organ is no longer functional. And so we're talking about really two subsets of transwomen.

Want that feel comfortable with our penis? And want that feel incredibly dysphoric about her. Okay. 

Tim Norton: Good word. Dysphoric with their penis. How might a lay person,  describe dysphoria? Hmm. 

Dr. Natalia Zhikhareva:  if I were, what comes to the top of my hat, when I think about just four is an incredible [00:09:00] feeling of an incredible discomfort.

Okay. Kind of a cheap sheet of discomfort. Zara is persistent and consistent and does not go away. 

Tim Norton: And as you say that the audience can't tell, but you're really looking inward. You're really thinking about it. And I get the sense that you've heard a lot of stories. You've heard a lot of people really open up about this.

Dr. Natalia Zhikhareva: Yes, I think, well, just worry is incredibly predominant in gender community.  that's really the origin of, of, of this issues, right?  to feel completely in-congruent in your body. It feels incredibly just for it to this individuals. So imagine yourself to him,  for yourself and myself who take our gender for granted.

We almost never really think about our gender per se. We wake up, we put on our closes whenever we really have to question our gender. Right? So imagine [00:10:00] yourself, it can up one day and having this feeling of incredible discomfort about your body.

Tim Norton: It is really hard to imagine just, and would it be like feeling like my penis doesn't belong, like attached to me? 

Dr. Natalia Zhikhareva: So it would depend. So just who I am is different for everybody. And everybody has a different sense of dysphoria, a society. When we think about dysphoria, we think about a classic trans narrative.

Fitch goes something like I am, let's say I'm a man stuck in a woman's body. Well, the truth is that narrative no longer applies. Most individuals don't really feel like that. So they feel a range of feelings and dysphoria tends to range from really severe to less a shift here to I'm being dysphoric about my penis too.

I'm not just worried about my penis, but I am just worried about my. Facial hair [00:11:00] or about my bone structure or my Adam's Apple or my voice. So it really depends.  and that's why it's important to remember that transition is non-linear because there's some people that feel comfortable with their penis.

For example, samp SOPs set of transwomen were taken aback today who don't want to have surgery completely comfortable and are sexually functional and have zero just worried about their genitals. 

Tim Norton: Okay. And would you, would, you know, off the top of your head, like the rate of dysphoria and people who identify as transgender women, where is it in a sense 

Dr. Natalia Zhikhareva: of 

Tim Norton: like what the happened to quarter?

Yeah. Like 

Dr. Natalia Zhikhareva: percentages of individuals who have gender issues who suffer VCs. Faria. Yeah. I would say the percentage is pretty high.  whether it's dysphoria by their genitals, that would be hard to pinpoint. Okay. But. So it will be just for an to laugh. Yeah. 

Tim Norton: And is that something [00:12:00] in treatment that well, what are you doing with that?

Are you trying to like help someone become more congruent or are you helping someone transition both. 

Dr. Natalia Zhikhareva: Right. So tradition is. A pathway to congruency. Okay. So really essentially what I'm doing is I'm helping an individual. First of all, I'm helping them identify what their gender identity is. And once we identify that I help educate individuals.

What entails transition, because again, it's not one size fits all. There's some people that, you know, we're very comfortable with starting hormones and having a few surgeries. And there's some people that really want to go from one binary strictly into another binary. And to be asked congruent as possible.

So it really depends. Okay. 

Tim Norton: So, so let's talk about it then. So with,  congruent individuals who suddenly are taking a much higher levels of estrogen [00:13:00] and, and presumably that leading to two struggles with erections,  what, what happens? What's that like? 

Dr. Natalia Zhikhareva:  well, I think what happens for us individuals is,  struggles in relationship and intimacy because here we have a group of trans women.

That are fully comfortable. Is there a penis hor sexually active or want to be sexual active, whether it is through penetrative intercourse or oral sex or any other forms of sexual intercourse? Really. And what we're seeing is that because of the introduction of estrogen and antiandrogens that bring down the testosterone levels we're seeing struggle of is being able to obtain a reaction, being able to maintain erection and thus can really interfere with the sex.

Tim Norton: Okay. Now, is it off, is it often that trans women need a hard penis? Is that typical for trans sex? 

Dr. Natalia Zhikhareva: Depends. [00:14:00]  I think it depends what your sexual preferences and what's your sexualities for transwomen that are attracted. Two male sexual partners and who sexually interested in penetrating us male partners.

Right.  that would be pretty important for trans women that are interested in is, are male or female sexual partners and are interested in oral sex. That would be pretty big deal. So I think it really depends on sexual preference. I don't think there's such a thing as transects. I think there's just sex.

And then I think there's just us and how we see ourselves in a context of the text. Okay. 

Tim Norton: Well, that's really well said. And so that, but that is kind of, I mean, it sounds like this whole process would be pretty overwhelming just in general. And now to add on. Sexual complications on top 

Dr. Natalia Zhikhareva: of that. Right.

Right. And you're absolutely right about that, because imagine, imagine even, even if [00:15:00] this trans woman per se doesn't feel, and you just worry about her penis, right. But she feels a very strong, let's say dysphoria about her breasts or her, her shoulders or her botics. Right. So she's already feeling some of them out of discomfort is her body.

And then on top of that, she realizes that her penis is now non-functional, that can add an Ozzie and other and as a mixed into that. Sure. 

Tim Norton: And that's the last thing you want to do is be in your head during sex about all these different parts of your body, whether it's your penis or your shoulders, right.

And to really be in your head about that. So, What does this kind of thing come up in,  the groups that you run or are people usually pretty talking a lot about sex and what goes on and 

Dr. Natalia Zhikhareva: in the groups that are run, I tend to get a mix of,  transwomen that for majority [00:16:00] part don't really feel comfortable with their Chantels and we have to keep in mind that for a lot of transwomen that cannot get the surgery, but once surgery.

A lot of them do feel very dysphoric. And so to have erectile issues is actually a relief. So that's another split of the client. Right, right, 

Tim Norton: right. Like, thank goodness this doesn't work. I don't want this thing anyway. 

Dr. Natalia Zhikhareva: Exactly. Right. But for those who really don't want to be sexually functional, this becomes a conundrum.

So what I do here, so in a way we really want to work with this individuals and helping them redefine their sexual roadmap. And they're kind of, recontextualize the ways that she's themselves and the ways that she's her body and the ways they she's her sexuality. 

Tim Norton: Okay. And so give us some of that.

Recontextualization like, what, what, what are some of the things you're trying to help these women understand about themselves? 

Dr. Natalia Zhikhareva:  I think one of the things that I try [00:17:00] to do is shift some away from this. Focal point off my PNS is a primary functional sex organ too. How can you still get sexual pleasure and sexual Oregon?

So what are the parts of your body are sexual? So for example, with brass gross nipples can become very sensitive and very, you know, very sensate for a lot of individuals. What about some areas of your neck? What about other types of sexual intercourse that does not include penetration? So you really try to, in a sense, broaden out their understanding of sexuality and shifts them away from this kind of fixation of, well, as the way I relate to my sexuality is through.

Being able to use my penis. And now that I no longer can use my penis, I can no longer have sex. So in other words, sex doesn't have to stop when the penis longer malfunctions, right. Sex continues. And in same thing for Duvass is for example, [00:18:00] males who have Eric Delicias right. We teach them that while sex doesn't.

Have to stop it, you know, you penis not getting hard, it can continue and just different types of 

Tim Norton: different types of sex. Right. And where I think that's what the current sexual education movement really is redefining what sex is and that's happening.  and, and the groups that you run on and the people that you work with so one other thing. Well, I was gonna, I was wondering about the partners and. Are you, are you often helping individuals help re-educate their sex partners as to how to. have sex with them and be sensitive. And, 

Dr. Natalia Zhikhareva: yeah, that's a great question, Tim. Absolutely. I think that if there's a partner involved, that become huge. Usually in those cases, to be honest, I'd refer them out to people [00:19:00] like yourself specialists and secretary P because I no longer really focused on sex therapy. And I just primarily deal with this kind of a gender issue of individuals. But absolutely. I think it's, it's really important when I talk to  sexologists and I educate them about how to work with this population that's becomes very significant point to bring in the partner to educate the partner also about,  erectile difficulties that the couple will face with the introduction of estrogen and antiandrogens. And to kind of help them also reshapes their sex life. So if the partners, for example, is a female, right?

So we're talking about trans woman and a woman partner, and they have always penetrative vaginal intercourse, right? Well, what can they do now? If your partner can no longer penetrate you with a penis, can you park and penetrate you with a strap-on or with a dildo? And what does that mean to you? So helping them also navigate [00:20:00] and reformulates their sex life is really important.

Hmm. 

Tim Norton: And, and would you say that a lot of the people that you're working with even in longer-term relationships are experiencing. Comments from their partners,  microaggressions and that kind of thing. That just insensitive comments. 

Dr. Natalia Zhikhareva: Oh, that's a good question. I think. Yes and no, I think it depends on the partners and I think it depends on a lot of factors. So it depends how long has it been together? How much? What I call emotional traction they have as a couple, right.  how, you know, how soon after being together, the partner came out. How receptive was the partner?  but it is common to sometimes I do see partners being what you describe, what kind of microaggression, right?

 I do she specialists out in a lot of female partners where,  you know, is there's this, [00:21:00] this feeling of I have lost,  not only my husband, but I, or my partner, but I have also lost my sexual partner. And now not only do I have to transition with that, but also have transition my sex life is,  Hmm. 

Tim Norton: And so how do you, how do you deal with that?

Dr. Natalia Zhikhareva: Well, I think the trick is how to tread the water very lightly and gently because we want to essentially what we want to do. So want this couples to thrive, right? We want them to have less friction and more cohesion. And,  I think was a way to achieve with this. What, and you really good couples therapist, again, I don't see couples really, but, and you could couples, therapist stasis, straightening the water lightly and being knowledgeable and educated about gender issues and also how tradition, not only facts, the primary person who is transitioning, but a partner as well.

Yeah. 

Tim Norton: And so that [00:22:00] question of like, how do we have sex now? And when somebody transitions in the middle of a relationship, is that usually the question or is it more often that they'd already been having sex? That was the kind of sex that the, the eventually transitioning partner would want it to be having?

Or does it, does it usually change significantly that the sex and that kind of relationship. 

Dr. Natalia Zhikhareva: You ask him he's a sex change, this relationship. Yeah.  I think it can, I think it depends on a couple and a couple base on how couples are sexually open or receptive. So if, for example, and we're using now again, re kind of using a stereotypical, you know, transforming in a woman partner.

Right.  but. For example, if for that female partner, if she has been Euston she's her orientation about sex is only penetrative intercourse. Does that bring in [00:23:00] something else? Even sexual twice in the bedroom can be very uncomfortable. So changing the sexual map of this couple can also change sexual interviews and values and maybe even morals.

Around this individual sexuality. So it's, it's really can shift and rugs the boss, so to speak, but what doesn't in our lives, 

Tim Norton: right? Well, yeah, no, I'm just thinking about how so if, if a trans woman was using her penis to penetrate for a long time, I mean, is she often doing that and not wanting to do that and maybe can't tell, well, 

Dr. Natalia Zhikhareva: sometimes that happens, right?

So sometimes we have people who are just worried about their genitals. And so here we have a couple and suddenly the partner is very dysphoric and suddenly does not want to engage in sexual intercourse at all, or any kind of sex. And suddenly the party can feel very [00:24:00] alienated and very alone. And I think what happens is unfortunately I think a lot of this couples forget to, to really communicate and ask questions during this times.

 and I can understand why, because transition can be often confusing and a difficult process for both of them and an immune. So everything else I think. People are less likely to be flexible and receptive and say, well, let's talk about our sexuality, but haven't had sex in a month. What's going on? I know that, you know, because of estrogen year erections, you know, will diminish,  also know you feel just worried about your penis or you don't feel it just for eco penis, you know, how do you feel about that?

And I think that's where people like yourself and sex therapists really come in.  and I refer couples a lot of times to sex therapists for those reasons. To open up the conversation, right? 

Tim Norton: Yeah. Cause that's, those are hard conversations for everybody. Absolutely.  [00:25:00] And, and even, even that question that you pose right there is, is pretty blunt.

 but, but crucial. So sweetheart, you know, what do you want me to do with your penis, right? Yes. And, and, you know, have you been not feeling great about putting your penis in me,  for a while, would you rather we waited something different, 

Dr. Natalia Zhikhareva: right. And vice versa. Right, 

Tim Norton: right. And vice versa.  and just getting to a level of comfort and sensitivity to those kinds of questions and answers because you have to be able to say it out loud.

Dr. Natalia Zhikhareva: You do, and you'd be surprised how many couples stoned and I think 

Tim Norton: not surprisingly, are you hearing that a lot? 

Dr. Natalia Zhikhareva: I think what happens for, for the partnership transwomen with, as a partner, sir, male or female,  or by gender or any other gender? I think [00:26:00] what happens is people, people feel terrified. Two asks equations that they feel is a very sensitive topic for that person.

And what they do is which you probably know is pretty quick to assume, say shrooms that, Oh, because you're transitioning, you must be very uncomfortable with your penis, right? You just want a bottom. And that's not the case for everybody. Right? Right. Or because you transitioned to your soldiers fork. I can't even touch your genitals again, not always the case.

Right. So suddenly communication goes out the window and the couples tend to really suffer. Right. 

Tim Norton: Hmm. And, and now I'm, I'm thinking with. My, my sex therapist cap on that. Okay. Well, when we're talking about sex, we're talking about touch and joy and intimacy, and these are the things that people want out of intimate experiences.

And so those, we get to make sure that people are doing all [00:27:00] that all, all the foreplay, all the cuddling, all the caressing. 

Dr. Natalia Zhikhareva: Right. We want to bring, play back in the bedroom, right? We want to bring experimentation and fun into our sex life.  you know, w we want to move away from stagnation into movement. And so I think it's important to look at the transition as everything is going to transition - your body's going to transition your mind is going to transition, your partner's going to transition with you. Guess what your sex life is going to transition with you as well. For sure. Right? So it's important to put that cap on and helps the client see it from that perspective.

Tim Norton: Everything's going to transition. Yes, I like that. That's really good.  so what are some of the struggles that transgender women face? What are some of the awards? Typical struggles. 

Dr. Natalia Zhikhareva: I think one of the, one of the bigger things that probably would be struggling, which is, you know, I think became [00:28:00] quite apparent now is a sense of dysphoria.

Right? And I think one of the things we don't understand is how, how do you work? It can be even somebody gets mis-gendered. I think mis-gendering is crucial. I think, especially for transfer men, when they start transitioning. For a lot of transwomen, there's going to be a part in between when they're not going to be possible or it's going to struggle to pass as women.

Right. And I think the biggest thing to understand for the public is when you come across somebody, anybody, whether they're transitioning or even not, whose gender is ambiguous to you, remind yourself that even though we live in society of binary and we still think in a very binary realms, There are a lot of expressions to gender.

And just to be careful not to gender individual, you'd be surprised how easy it is. Sexual to have a conversation of is out gendering. Anybody. All you have to do is just use a person's first name, 

[00:29:00] Tim Norton: pretty easy. That is easy. Dr. Z, huh? One thing that I often think about though, when thinking about this topic is hormones, are it can, it can be nasty, can be really tense and affecting a person's personality.

 we see this most often in society when,  when a woman goes on the pill,  for whatever reason,  there can be major changes to how somebody feels. And I always like to cite the study where they tried to do, they were trying to find,  hormone therapy for guys to,  as a form of birth control and they can't get through the studies because the guys would wouldn't finish taking the damn hormones.

Cause it was just messing them up too much. And it gives us some insight on what women have had to deal with for years. [00:30:00]  but. That's gotta be kind of intense to suddenly be throwing like all this estrogen and sometimes progesterone and other supplements in your body. And then, so what happens to a person's personality and sense of themselves and all that.

Dr. Natalia Zhikhareva: And I think it's be, I think intensity really will vary. I think we have to be careful.  To stay away from kind of gender stereotypes that estrogen will make, you know, a transwoman, Morse, emotional or sensitive for she's going to cry all the time. And the SaaStr is going to make a transmasculine person aggressive suddenly, or have angry outbursts.

And I don't really think the hormones necessarily to do that.  there will be changes for sure. For starters, you'll feel much more congruent because,  I see gender dysphoria. My understanding of gender dysphoria is that it's a medical condition, not a psychological one, meaning it's not a psychiatric disorder.

[00:31:00] It's it's medical, genetic people are born this brains that are more in alignment. This is a gender said they really want to be versus there assigned sex at birth. And so as the result of that, there's to speak in congruency, that happens. Right. And so. If we introducing estrogen, for example, to transforming and reducing their testosterone saddle is our brainstorm more in alignment, right?

Fizzer their gender. And suddenly the turbulence that they may have experienced having to Stastrom going through their bodies no longer there, and that can give tremendous relief. Right. And that can be intense for some people, but I think. It's often not. I think if anything, it's a sense of really a peace and relief is in yourself.

Having, you know, as a hormone that was meant to be there to floor Sue body. It's a big deal. Pretty powerful, actually 

Tim Norton: I bet. [00:32:00] And I'm thinking,  one of my favorite words in psychology is congruence. And in just thinking about,  That, that, that sensation of the inside being the same as the outside and that alignment and feeling at peace with yourself and,  that does wonders for anxiety reduction.

Dr. Natalia Zhikhareva: Right. And also, when you think about the word congruent, it's such a subjective word, right? So with congruent to you may not be what congruent to me. And I think that's one of the things to keep in mind when working with this population is art. Just because a person identifies as a trans woman and you automatically think, Oh, congruency for this person, me and S you know, a full transition, including a bottom surgery that may not be what congruent for this person.

So congruency also varies, and it's a very kind of subjective sense of who we are, 

Tim Norton: but [00:33:00] once they've gotten there, once they feel that authenticity and in the like themselves,  probably easier, easier to do life, but also easier to have sex. Also easier to obtain erections 

Dr. Natalia Zhikhareva: if, if Losada and the oldest pressure is lifted off, right?

Imagine if you will, your brain right now and imagine struggling is dysphoria. Now, does this worry will occupy a enormously big part of your brain capacity to the extent where you will really struggle. This maintaining attention with trying to do your job with trying to deal with this day to day things,  and on and on, including your sex life.

Right? If dysphoria is occupying such a big part of your brain, and you're not out here through, you're not, you know, comfortable with your gender yet. That's a pretty big deal. That's pretty difficult to do. And once we introducing hormone or [00:34:00] introducing you kind of transition, that is starting to get person to whoever they see congruency, all of that space is cleared up and suddenly the person can suddenly focus.

People can on the, go off living their lives and finish, you know, does it decrease? I always wanted to, to complain and so forth and so on. So it's really. It is a really big deal,  sense of congruency and sense of self. 

Tim Norton: I bet. You know, as you're talking about that, I'm kind of putting myself in that position and just thinking God, and to, to have such a constant source of anxiety, really how I wouldn't be surprised if the erectile issues were.

Really really common.  we're just with, with all of that in a dysphoric 

Dr. Natalia Zhikhareva: person, right. So yes, you bring it out a great point. Right? How often do our anxieties interferes our [00:35:00] sexual response period dissolve in congruency? Right? Let's look at just cisgendered, man. If you're anxious about your work or you finance or whatnot, chances are.

You're going to have a hard time getting an erection. And now imagine you're feeling really uncomfortable about your body, right? 

Tim Norton: Which happens at work at home everywhere. Yeah. 

Dr. Natalia Zhikhareva: And where some of those things are kind of where's your anxieties about your work or finances is something that is not seen to everybody else.

It's kind of invisible. Your gender is pretty visible handicap because everywhere you go, people are relate to you based on how the sheer. And if you are not transitioning, get some people see you, how you do not want to be seen. And that's pretty painful existence from day to day. That is, but 

Tim Norton: is there like with regular anxiety,  It fluctuates, you know, even a person with generalized anxiety disorder is going to have good days and [00:36:00] bad days.

And would that apply to dysphoria as well? Would there be days where you're just not as preoccupied by it and might be able to just kind of be okay with who you are and 

Dr. Natalia Zhikhareva: sure is that will also vary from individuals, right? And yes, you're right. And there will be some days for some people where. They have accepted to deliver in a binary world and Wilder transitionings.

That will be mis-gendered and that is okay. That will happen. Right. And then there's going to be som days where every angry little sign, a little machine during Q gap. Can just really spiral you into a sense of depression or alienation or anxiety. So yes, it's absolutely will vary. And I think the more you have support and then we have people around you as that are, you know, kind of there for you, the better off you're going to be.

Tim Norton: And I, I bet like with most psychological issues, it's a two way street where if you just [00:37:00] are anxious because you have a really intense job and because you haven't been sleeping and because you're having relationship problems, That that might ramp up some of your dysphoric feelings or your,  experienced sensitivity to microaggressions out in the world.

Dr. Natalia Zhikhareva: Yeah, 

absolutely. 

Tim Norton: Okay. So, so what do we do? Right. So,  You're, you're not a medical doctor, but I'm sure you've at least heard anecdotally about taking Viagra on top of hormones and Sheridan and people running into any issues around 

Dr. Natalia Zhikhareva: that. Not that I know of. And, you know, to put the anecdote aside, I actually did inquire,  vis medical professionals who worked with this population.

So if I do have a transwoman patient that you know, would like to be sexually functional, Can I introduce,  erectile medication into the mix and the answer is yes, absolutely. You can. There's doesn't [00:38:00] seem to be any country in educating points from a medical standpoint, those that work for everybody. I think that depends.

 it may, may not. And another thing to think about is there will be a group of individuals who just don't want to add another medication to their mix period. But that is a very kind of simple streamlined solution. If it works for XOs transfeminine that comfortable with our penis and want to be sexually functional.

Okay. 

Tim Norton: And.  doctors, he's going to put this podcast,  on, on her website and blog and it's gonna get,  promoted through various channels. And if anybody out there is listening, you know, I've done already like 16 or 17 episodes on different ways to approach. And,  a lot, you know, I've talked to some, some pretty big psychologists about it and in a lot of those.

 tips around mindfulness and [00:39:00] relaxation and,  having good conversations with your partner are also going to apply. 

Dr. Natalia Zhikhareva: Absolutely. I think that's great point to bring out and I'm glad you do that. And I hope that if anybody snatches this off my blog, which is called transformed blog, I hope that they also go and listen to the other podcasts because it is absolutely relevant because we're talking about.

And Eric tile issues out, whether it is for transwomen or, or SIS, man, it's still an Erik tile issue. Right. And I think the tools that we can apply can be very usable across the board and very important. And again, I'm not affect surface. So,  my toolbox is very limited when it comes to that. So it's important to go to people like yourself and gets us a tool.

Tim Norton: Yeah. And so what about.  I was thinking when we were talking about, you know, a doctor and then recommending Viagra and things [00:40:00] like that, I'm wondering how that experience is like we're, we're in Los Angeles.  Dr. Z is based in Beverly Hills and I'm in silver Lake. And I feel like here in the community that we know each other from we, we know of trans friendly doctors.

Dr. Natalia Zhikhareva: right, right. Well, We're doing the daunt.  so there's definitely clinics that have become much more trans opened. For example, UCLA has a great trans program. Sheeter Sienna has a great trans program, right? State John stars.  all of this clearly listed on my website under gender resources for people who are interested.

 but yes, there are going to be medical providers that may be not going to be as knowledgeable and that's okay. That's why you get an education by token, to, to your sex therapist about you, Eric Talley shows any sex therapists can save a heavy considered an Eric drug. And that's when you go to a medical provider and, you know, [00:41:00] find out if that's kind of a medically viable option.

Right? Because my understanding is that this also may not be for everybody based on their medical conditions. 

Tim Norton: Right. And it, for various reasons, you know, it,  Viagra or sildenafil and the PD five inhibitors are,  were originally intentioned as heart medications. And,  and they still,  there, you know, Cialis, some people just take daily Cialis, honestly, more as a heart medication.

And then there's the added benefit of, of erections. And so, yeah, that's a whole other topic and field.  but. I bet LA is probably like a decent place to go and see doctors, but it's probably not like that around the country and certainly not around the world. 

Dr. Natalia Zhikhareva: Yeah. I think LA is definitely much more accessible.

And I think that's a very easy kind of fix. I think it's a bigger challenge. Tim really is transwomen that want [00:42:00] to be sexually functional. And for some reason cannot get the surgery. Usually is the reasons for financial or you have some medical conditions that preclude you from getting surgery and yet have incredible dysphoria.

Right? I think it's a little bit easier to work with. Trans women that don't have this worry about their genitals to the shifts, that paradigm, but what are the Duvass transfeminine that are incredibly dysphoric, want to be sexual function? 

Tim Norton: Right. Wow. That sounds really complicated. Right? So, and dysphoric in the sense.

All right. And would you mean specifically dysphoric about their 

Dr. Natalia Zhikhareva: genitals? Correct. Okay. You still want to be sexually functional, right? So you have a transwoman country office that says I transitioned and I can't get a surgery. I want to get a surgery, but I can't, they just can't afford it. Or I have medical conditions that prevent me from getting it.

And I'm here with a penis that are not functional. And I don't feel good about it. I hate it. I [00:43:00] want to be sexually functional. So how do I do that?

Tim Norton: Yeah, 

Dr. Natalia Zhikhareva: million dollar question, right? I think one of the things that I try to, to help sex therapists understand is aparts from just shifting the paradigm of sex life. Right. Also having an anatomical understanding of, of male genitalia and anatomical understanding of what happens during vaginoplasty. vaginoplasty is a procedure where a new vagina is created, right?

And that the surgery is that this individual in this case cannot afford or cannot get. And why is it understanding of the construction and I, me so important. Well, you can really help a person understand that. Although you have this word toward the penis, perhaps because you have all this masculine associations to it.

It's, it's a penis so it's a sign of masculinity and Manliness. And I hate it. Every time I get an erection reminds [00:44:00] me of a man. I once was right too. Let's talk about if you were to get vaginoplasty, right? This part of your penile. penile skin or scrotum skin is going to be your, your internal depths of your vagina.

And this part is going to be your labia and this part is going to be your clitoris. So just kind of reorienting the understanding and the ways of user genitals even, I think in hops, tremendous 

Tim Norton: teaching them to love their penis. 

Dr. Natalia Zhikhareva: And also reframing it, reframing it truly. That's what us happens during surgery.

For example, drink penile inversion. That's what happens. I mean, the surgery is, is really not performed in a way where the penis is just gets traded and then a new, new vagina is plastered on all of this parts of your penis are used to construct new vagina. 

Tim Norton: What is going to be the clitoris? 

Dr. Natalia Zhikhareva: So the penile gland.

Okay. becomes clitoris. Okay. And [00:45:00] then the skin of the penile shaft and sometimes part of the scrotum depending on what doctor likes to use her, how's it like to, to, to do the procedure? Really? It becomes you adapt becomes you canal imaginal canal. So you can see how talking about that and shifting the narrative from does a subpoenas and does this my shaft and does this my.

Scrotum too. This is actually what makes labia, and this is actually what makes well, it makes the labia, well, again, it depends on what surgeon would like to use, right? And sometimes people will go for a second procedure is called labioplasty, which is actually a construction of labia to make it look much more like female vagina.

So depends how much skin people have, because shrinkage is again, very common on estrogen and testosterone suppression. But I think the important thing here is to remember how to shifts that narrative from seeing a justice penis to 

Tim Norton: my eventual [00:46:00] vagina. 

Dr. Natalia Zhikhareva: Absolutely. Yeah. That's one way to put it. Yeah. 

Tim Norton: Hm.

And that's really empowering. 

Dr. Natalia Zhikhareva: Very much so. And I think people who do, especially people who do and you kind of bodywork, right. Is this population or any kind of,  sexual body work and having that understanding in work and visit the segment of population is really important. Like you said, incredibly powerful.

Yeah. 

Tim Norton: Yeah. That, that, that congruence and that, that just self-love  cause you've got to love your body and love yourself in order to be. And I, and a loving sexual relationship. 

Dr. Natalia Zhikhareva: Yeah, absolutely. Very 

Tim Norton: important. Yeah.  you know, it's one thing if it's casual sex or a one night stand, but you know, we're talking about it over the long term, you know, I'm sure people can drag themselves out of gender dysphoria, just like any anxiety and you know, over the course of a night.

 but in the long-term you have to come to a grounded [00:47:00] self-acceptance in order to have regular. Yes. 

Dr. Natalia Zhikhareva: Yeah. And sometimes, you know, I, I tell people, look,  it sounds like surgery is for, for all of the reasons is not viable option here. It sounds like you're human being and you shall going to leave and you're going to be intimate and you're going to engage in lovemaking.

And I think it's pretty painful to continue to hate yourself and hate your penis every single time you have to engage in lovemaking. And I think it's really unnecessary because all this association real is that we have to, to what constitutes and what penis represents or just social construct. That's really all.

It is just our social narrative doesn't mean it has to be that way. And it doesn't mean that your narrative has to be that way 

Tim Norton: now. So if we. Take that social construction. How of your relationship to your body? [00:48:00] It's, it's really nice. And that you get to determine what you want your genitals to mean. 

Dr. Natalia Zhikhareva: Yes.

I think the knowledge is to,  one of the, kind of a simplified analogy that comes to mind is a women.  and penis envy, right? Whether Freud was right on it or not. I doubt it. He was, I don't think many women, if any role have been a sandwich, but let's hypothetically for the sake of the, Synology say that people do,  understandings that your clutter says essentially.

Penis is, can be very powerful. And thus, now, if we're stuck about thinking about the reverse, right. Taken about the trans man that have not had bottom surgery, having Zad understanding that they're clutters is a penis is very, Hmm. 

Tim Norton: I bet. Yeah. Hmm. Okay. I'm really liking this. [00:49:00] I feel like I'm starting to get some 

Dr. Natalia Zhikhareva: fans, so broaden your understanding and that's, that's why we're here, right?

That's why we're having this. Heart's conversation 

Tim Norton: that's correct. Huh. So, so do you feel like we've, we've done a good job of, of covering the things that you were hoping to communicate at least in this hour? 

Dr. Natalia Zhikhareva: I think we have, I, I think my biggest,  point in this conversation was to, to help people understand that they are trans feminism.

 feel very comfortable with their penis and want to be sexual. And there's transformers that have a lot of dysphoria, but still, also want to be sexually functional. Now, of course,  we, you know, we've kind of eliminated transwomen that,  do not want to be sexually functional, not want to, and that's okay because that's, that's not what we're addressing here.

Right. Again, it's important to remember that. [00:50:00]  once I see does not fit all. Everybody's Shandra and their transition and how this is our sexuality and relationship to transition is going to be drastically different. Right. 

Tim Norton: And, and as we said, at the beginning of the podcast, we, we haven't really spent much time talking about transgender men today.

And so. Can you summarize one hour and like a minute and like, what would we talking about if, if we had a conversation about that? Like what, what would be some of the basics? Oh, well, 

Dr. Natalia Zhikhareva: I think in a lot of ways, maybe it would be somewhat similar, right? We'd be talking about transplant that have not had phalloplasty rheumatoid reapply, CV, which the bottom procedures for the trans man,  who, some of them want to be.

Sexually functional. Right. Although, you know, for those who feel very comfortable with their vaginas and have no interest in getting bottom surgery, right. That would not necessarily be a problem. I mean, the only problem that they would struggle with is on [00:51:00] testosterone is, is that they will have dryness.

So did the vagina would not be lubricating as it once was an estrogen. And so just to remind yourself, to bring.  lubricant in the bedroom.  I think the problems are going to be slightly different. I think the understanding is going to be different.  so hard to summarize Tim. I don't know what to tell you.

Maybe another conversation. 

Tim Norton: Well, no. And I'd want to talk about like the functionality of, of that penis, like my, after an operation and if. I think that's probably a pretty common question, but also, yeah, normalizing,  people who are going to just keep their vaginas and that they'll still have to have those conversations about okay.

You know, even though there's a strap on, on, or whatever toy we're using, I would still like you to play with my vagina and still stimulate me in those ways. And when that person would probably still have to learn about loving their vagina, even if there was dysphoria or, and reframing. Yeah, 

[00:52:00] Dr. Natalia Zhikhareva: right.

Absolutely. 

Tim Norton: Okay. Well, we'll see if there's a huge demand for this.  and so, yeah, like I was saying in the, in your intro, you run a free drop-in group, which after this podcast airs, there's probably going to be a really long waiting list. 

Dr. Natalia Zhikhareva: Well, I don't know. My, my trans women groups that I started about, I would say about four, maybe even five years ago now.

Already has a wait list every single time.  and that's a pretty, pretty popular group and it's, it's a free monthly group and,  it has kind of a solid group of, of women. And that's a really great group. I have started a trans man group just in the recently this year that I'm still working on building up.

 So that's another free muscle support group. That was that one might get a weightlifter after this conversation. 

Tim Norton: Yeah. And I suppose I should have asked you this at the beginning. [00:53:00]  no, ma'am maybe I can just edit it, but why did you take an interest in working with this population? 

Dr. Natalia Zhikhareva: You know, it's him.

I have always been the type of person that likes to fight for underdog. Hmm. And I think in many ways we'll live in a society where we're so ignorant about gender and understanding of gender fluidity. And as a result, we tend to really marginalize people that express gender other than binary and as somebody that likes to fight for underdog.

Okay. They just kind of tick off my father's. Yeah. And I think that's why it's important to mention for this, for people who are listening for new genders, people is in my way of supporting community. What I do is I do all the trans surgical evaluations for new trans surgical procedures completely for free.

[00:54:00] So if anybody listening to this and NITSA ladders, they're welcome to just. Email me or call me and I'll do it for free.  again, that's a underdog in me. Yeah. Yeah. 

Tim Norton: For free. I don't know how I feel about the fed now. I was just from like a work-life balance.  that's. Do you work like really long hours?

And, 

Dr. Natalia Zhikhareva:  I do, I, I, I work five days a week, probably like yourself. I have Mondays and Fridays are my days off and I'm,  I'm very, I'm fortunate to have a good private practice. And,  I noticed that this is something that.  a lot of people need, and there's not a lot of clinicians that are skilled in how to properly evaluate and do a lot of write-up.

And a parts for me is there's really just only another clinician in LA, as far as I know, Aiden Kennedy said does the also for free, and I think it's really important service to the community. And I [00:55:00] think S S clinician says, psychologists, we should, we should be able to also give something back to the community.

Tim Norton: Well, that's. Awesome and admirable. Thank you. And, and thank you for doing that work. That's, that's really crucial. That's really, really important work. And so, yeah, like she's saying, if you need that letter,  reach out to her, how, how can people find you? 

Dr. Natalia Zhikhareva:  the easiest way to get ahold of me is you can just drop me an email at Natalia Dr.

Z phd.com com Natalia, 

Tim Norton: Dr. Z phd.com. 

Dr. Natalia Zhikhareva: Okay. Or you can just drop me a text at my number. Okay. (310) 946-6361. And all you have to say is, Hey, I heard your podcast and I need a ladder. And you said it's free. So let's get together. 

Tim Norton: Right. Okay. Well, and do [00:56:00] you, do you do social media stuff? 

Dr. Natalia Zhikhareva:  I do in a sense that,  I do have an Instagram page.

It's Dr. Z PhD, Dr. Z PhD. Right. And then it's a Facebook page is under the same name and that's pretty much, that's pretty much it. I do try to write regularly on my blog transforms and gender issues. And the last, last week I wrote about progesterone and why trans women should consider progesterone.  so I do try to write pretty regularly.

Okay. 

Tim Norton: Well, awesome. Thank you so much for coming out today. Thank you 

Dr. Natalia Zhikhareva: so much for having me here. This was 

Tim Norton: fun. Okay, good. And then, yeah, maybe we will, we'll have another conversation about this. Okay. Great. All right, well, thank you.

Shout outs to the sex positive community, including sex educators, sex therapists, sex coaches, other fellow sex, podcasters, sex, surrogates academics, sexual health, medical community, sex workers. The tantric community and everybody else involved with having hard conversations. [00:58:00] .