Over the course of many years working with gender dysphoria, my practice in this area has come to be guided by the following clinical conclusions:

1) Psychosocial support should be the first-line intervention for gender dysphoria and individuals who are experiencing distress regarding gender or secondary sex characteristics should have access to thoughtful, developmentally appropriate psychotherapy.

2) Given the lack of long-term, peer-reviewed, longitudinal evidence, medical interventions for gender dysphoria in children and adolescents are experimental and should be avoided if possible.

3) Adults have the right to bodily autonomy, and the role of psychotherapy is to create a space where the client can deepen their understanding of gender dysphoria and identity in the broader scope of their lives, bolstering their capacity to make informed decisions about what’s best for them.

4) The gender affirmation model is outdated and inadequate as it calls for a one-size-fits-all approach that fails to consider:

• Identity is complex, develops over time, is influenced by many factors (biological, psychological, social, etc.), and remains in flux during adolescence.

• It is impossible to determine if a gender identity experienced during childhood and adolescence will remain fixed into adulthood.

• Gay and lesbian youth are often gender nonconforming and can experience gender dysphoria as they come to terms with their sexual orientation.

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