Therapy for gender diverse youth

For young people who are questioning their gender or who want to make a gender change, therapy is the first step in the medical parts of gender change. Not all gender diverse young people want or need therapy. It can be helpful for some young people ages 3 and up.

It is important to find a therapist who uses the affirmative model of care.

Models for children and adolescents

Affirmative models

• In this model, young people who identify or express their gender differently than expected are allowed to be themselves. Adults allow them to explore their gender identity and expression. In some cases the children are allowed to make a social transition. Studies show that this helps young people do better, whether or not they make another social transition later or go on to take medical or legal steps.
• In 2018, the American Academy of Pediatrics released a policy statement called Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents.

Harm reduction model

• The goal in this model is to lower the chances a young person might reach a crisis where they hurt or kill themselves.

Non-affirmative models

• Some “experts” believe that being transgender is bad. They try to stop young children from being themselves. They believe that if they discourage young children from being themselves, the children won’t make a gender transition. This model has several names:
  • Gender identity change efforts (GICE)
  • Reparative therapy
  • Conversion therapy
  • Watchful waiting
  • Gender exploratory therapy
• Dozens of organizations oppose this model, including the American Medical Association and the American Academy of Pediatrics, who call the harmful practice “delayed transition.” In some places, this model is against the law.

Here is the American Academy of Pediatric’s position on watchful waiting, published in 2016:

Delayed Transition: Prolonging Dysphoria

Certain clinicians, along with non-expert critics of transgender advocacy, have taken a position that they describe as “watchful waiting.” They contend that most children with gender dysphoria do not become transgender adults and, therefore, early social transition may be unnecessary, even harmful. They advocate waiting until adolescence, or even adulthood, to permit any type of gender transition. Because watchful waiting is a general phrase that could also apply to affirming a child’s gender identity as they grow, we use the phrase “delayed transition” to more specifically describe this approach.

It is true that most gender-expansive children, and even some children with gender dysphoria, do not become transgender adults. Indeed, some children become more comfortable with their assigned gender as they reach adolescence. Unfortunately, delayed-transition advocates often support their claims with misleading interpretations of research. More important, competent clinicians generally can tell transgender kids apart from other gender-expansive children. Many delayed-transition advocates say this is impossible until a child reaches puberty, but their own studies contradict them, identifying early characteristics that predict whether gender dysphoria will continue. 

Supporting and Caring for Transgender Children (2016) [PDF]

References

Rafferty J, AAP Committee on Psychosocial Aspects of Child and Family Health, AAP Committee on Adolescence, AAP Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4): e20182162 (PDF) https://doi.org/10.1542/peds.2018-2162

Resources

American Psychological Association (apa.org)

• Guidelines for Psychological Practice with Transgender and Gender Nonconforming People (2015 PDF)

Note: This page is for young people ages 13 and above.

Disclaimer: This is medical talk, not medical advice. Some of this may not apply to you. It is presented without warranty. It may contain errors or omissions. You must do your own research.