Affirmative Practice With Transgender and Gender Nonconforming Youth: Expanding the Model

Affirmative care with transgender and gender nonconforming (TGNC) children and adolescents is a new framework under which many mental health clinicians now practice. It rests on a premise that appreciates diverse gender expressions and identities within society, and encourages the highest potential for individuals to follow their own paths to positive emotional well-being. Scientific understanding of the phenomenology of gender development in children and adolescents is scarce, and the gaps in knowledge limit evidence-based practice when working with these youths. Interventions span many domains within the physical and mental health realms, calling for providers to navigate differing interdisciplinary perspectives when optimizing assessment and treatment goals. In addition, interventions differ according to developmental stage, and newer approaches and treatments have become more popular within the last decade. For children, the concept of social gender transition has remained controversial, as relatively historical approaches (discouraging cross-gender behavior) have become outdated and more recent methods (supporting gender transition) have gained backing. Fully reversible pubertal suppression has been introduced for TGNC adolescents as a means of buying time for exploration without the pressures of irreversible pubertal advancement. Given the current deficits in scientific understanding of gender-identity development in youth, the affirmative provider often faces decisions that are challenging, complex, and unclear. This paper describes the theoretical approaches to TGNC youth across development, provides a brief overview of the current research, and offers providers a way to conceptualize and provide care that can be both supportive and scientifically driven when done in a thoughtful, balanced way.