After a decade of working as a social worker within the LGBT community, together with my clinical experience working with individuals experiencing gender dysphoria, my practice in this area has come to be guided by the following clinical orientation:

1) Clinicians must respect client autonomy. Every mental health professional working with gender dysphoria should be sensitive and serious about respecting the rights and dignity of all patients, and especially those who are lesbian, gay, bisexual, and transgender. Practices that set out to change sexual orientation or gender identity have no place in healthcare.

2) Youth experiencing distress regarding gender should have access to mental health care that is developmentally appropriate and informed by the best available evidence, and psychotherapy should be the first-line clinical response. Given the lack of long-term, peer-reviewed, longitudinal evidence of the benefits of hormonal and surgical interventions and the risk of harm, and that the identities and decision making capacities of youth are still developing, such medical interventions for gender dysphoria in children and teens should be approached with the appropriate caution.

3) Gender dysphoria is best understood developmentally and as arising in a context. Gender-related distress is complex and is shaped by biological, psychological, and social factors. Gay youth are often gender nonconforming and may experience gender dysphoria while coming to terms with their sexual orientation. Exploration of identity is a normal part of adolescent and young adult development.

4) Psychotherapy provides clients with an individualized process through which they can deepen their understanding of gender-related distress within the broader context of their lives. Behavior, feelings, and beliefs, including those related to identity, are influenced by multiple factors, conscious and unconscious, and exploring these factors promotes resilience and supports thoughtful decision-making.

Recommended reading:

Gender Dysphoria in Young People Is Rising—and So Is Professional Disagreement

The Mental Health Establishment Is Failing Trans Kids

Summary of Key Recommendations from the Swedish National Board of Health and Welfare

Finland Takes Another Look at Youth Gender Medicine

As More Transgender Children Seek Medical Care, Families Confront Many Unknowns

A Trans Pioneer Explains Her Resignation from the US Professional Association for Transgender Health