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How Sexual Surrogates Are Helping Transgender Clients

“You don’t go through 20 or 30 years of being uncomfortable with your body and then, through hormones and surgery, be able to experience your body in all its richness. It just doesn’t work quite that way."
Lola D. Houston. Photo by MJ Mont-Reynaud

Sex surrogates work alongside licensed therapists, using sexual contact and coaching to help clients struggling with various forms of sexual dysfunction. While the industry experienced a boom in the 80s, things slowed dramatically with the AIDS epidemic. These days, the practice is moving back into the spotlight, but things look much different now than they did in its heyday. Surrogates once appeared to be all but reserved for male clients; as society inched forward, an increasing number of women began voicing an interest in improving their sex lives, as did gay men and lesbians. Today, surrogates say an increasing number of transgender people are turning to their services in order to become more comfortable with their sexuality.


When Dr. Laurie Bennett-Cook was pursuing her doctorate in human sexuality, there was a point at which she thought it would lead to a career as a sex therapist. She said she always enjoyed helping people in that particular area of their lives, and as a former sex worker, she's had solid experience doing so.

But there was something about the therapist's chair that just didn't sit well with her. "It's impossible for me to sit across from somebody pouring their heart out and just nod my head," she said. According to ethical guidelines laid out by the American Psychological Association, therapists are not allowed to engage in sexual contact with patients. So Bennett-Cook decided not to apply for her license to practice when the program ended. Instead, she looked into life as a sex surrogate.

"Sex is tactile," said Bennett-Cook. "It's hands-on." And for the past four years, Bennett-Cook has enjoyed a career in the field, helping cisgender and transgender clients unlock a deeper connection to their bodies and sexuality.

The sexual surrogacy model was first introduced in Human Sexual Inadequacy, a text penned by the famed sex research duo William Masters and Virginia Johnson back in 1970. The therapist helps the patient unearth issues impacting their sexual performance, while the surrogate relies on a more intimate approach to help them hammer it out. According to the International Professional Surrogate Association, one of the world's leading authorities on the model, a surrogate's job is to participate in a series of structured and unstructured activities with a client to help them achieve a therapeutic goal. That can include verbal instruction, sensual touching, and yes, sometimes sexual intercourse. The idea is to to help clients "build self awareness and skills in the area of physical and emotional intimacy."


Laura A. Jacobs began her transition in the late 90s, around the same time that she decided to pursue a career as a therapist specializing in queer and gender non-conforming issues. "I think being trans inherently involves a complicated relationship with your body," she said. Unfortunately, she explained, body parts that tend to cause some trans individuals discomfort are the same ones typically used for sexual pleasure.

It goes without saying, but that's not always the case—not all transgender people choose to transition, and many can't or don't want to receive sex reassignment surgery. Of those who do, many have no problem with their sexuality or having sex, either pre- or post-surgery. But for some, it can be intimidating or confusing to sexually engage their new bodies.

"You don't go through 20 or 30 years of being uncomfortable with your body and then, through hormones and surgery, be able to experience your body in all its richness. It just doesn't work quite that way," she said. "It can take a while to reconnect with your body and really experience yourself as a sexual being." Surrogates, she explained, can help in that process.

Bennett-Cook explained that while the majority of her trans clients approach her excited about transitioning, some worry about their bodies' ability to operate in a sexual context. But Dr. Sherman Leis, who has performed sex reassignment surgeries for over 30 years and today heads the Philadelphia Center for Transgender Surgery, said they may have little to fear. "I would say almost every patient is able to have sex in any variety that a non-transgender patient could have" after surgeries he performs, he explained. While certain procedures require him to reposition the genitalia, important nerve endings are kept intact. That way, everything remains functional from a stimulatory standpoint.


Bennett-Cook encourages her clients to find pleasure after sex reassignment surgery through a series of touch and exploration exercises. Her job is to guide them, offering support and, occasionally, a helping hand. To be sure, not all surrogates are able or willing to help trans clients, and because there is no single certifying body for surrogate partner therapy, surrogates aren't trained in any uniform way. Keeping up to date with the curriculum, so to speak, is a responsibility that falls largely with each surrogate.

Lola D. Houston began her transition three and a half years ago, and she is currently enrolled in a training program to become a surrogate partner. When she completes the process, she will be one of the the few trans surrogates working in the field. For her, the process of becoming comfortable with one's sexuality after transition doesn't start in the body—it starts in the mind. "You have to get past all that shitty enculturation in order to really claim a new way of experiencing your own sexuality," she said. "You have to let that go so that you can really sit back and enjoy what you're now becoming."

Helping others find a new mindset is one of the many ways a surrogate's duties can extend beyond sex. For Lola, being out in a time of political peril is its own sort of burden. "I think it's a huge challenge, and it's probably worse now than it has been," she said with a nod to the current administration. "To what extent can you retain your own sense of identity and still walk out the door and not feel unsafe?" she asked. "I'm not just talking about the possibility of being assaulted. I'm talking about feeling safe in that I don't want people to stare at me. I don't want people to ask me funny questions. I don't want to be misgendered."

Many therapists who work with transgender clients appreciate those concerns. "We teach clients how to get into and out of conversations," said Dr. Susan Kaye, who spent seven years working as a surrogate partner before becoming a therapist. In her sessions, Bennett-Cook covers things like consent, eye contact, how to talk about your sexual history and boundaries. "While it is very physical, surrogacy covers a lot of emotional aspects," she said.

"People just want to feel normal," said Kaye. "I think it's really the same conversation with everyone. You just have to tweak the language a bit."

Lola, for her part, sees surrogacy as the beginning of a journey for her future clients. "My goal here is not to become someone's sex partner," she said. "That's not the point of surrogate partner therapy. My goal is to help them open that door and then step away as they walk through."

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