Blessing or BS? The Therapy Experiences of Transgender and Gender Nonconforming Clients Obtaining Referral Letters for Gender Affirming Medical Treatment

Many transgender and gender nonconforming (TGNC) clients seek to obtain referral letters for gender affirming medical treatment from their mental health providers, but little is known about how the process of obtaining referral letters impacts TGNC clients' therapy experiences. We conducted semistructured interviews with 15 TGNC individuals who obtained a referral letter for gender affirming medical intervention from their therapists. Thematic analysis revealed 2 core themes: (a) "bullsh *t" (or "BS") participants endured due to the referral letter requirement and (b) "blessings" that TGNC individuals experienced because of this requirement. Participants revealed that they had better therapy experiences when their therapists actively affirmed their gender and choices related to transition, acted to facilitate transition, provided knowledge and resources to help them navigate transition, and collaborated with them to determine the focus of therapy. Recommendations for training, practice, and future research are provided.