Gender Affirming Mental Health

Transgender and gender diverse students in higher education experience exacerbated rates of mental health challenges, typically because they must constantly interact with systems that are not designed for them. As such, providing gender affirming mental health services in higher education systems is crucial. Explore this page to learn some best practices and helpful services to support trans students.

Inclusive Clinic Guide!

Are you providing competent gender affirming mental health services?

Intakes

Intake Assessments

When doing intakes, there are some helpful tips and considerations that contribute to creating a safe environment for students to explore and disclose their gender identity. Check out these tips:

Allow a space for students to write-in their gender. You can give examples or have check boxes. Use "not listed" instead of "other" so as to not "other" the students.
Allow a space for students to indicate a name they use if different from their legal name. Sometimes this is called a chosen name or lived name, though try not to refer to it as a "preferred" name.
Avoid using the word "preferred" as pronouns are not preferred. You would not want someone to use the wrong pronouns for you, so these are really a directive.
Inform students who will be able to see this information. Tell them how they can update it if it changes and urge colleagues you work with to adhere to the information listed in the student's chart. This is part of the radical informed consent process. Click here to access a radical informed consent script.
Be mindful to use gender-neutral language. If asking about dysphoria, do not assume all trans people will experience dysphoria in their body. When describing body parts, use this clinical guide to ensure your language is affirming.

Letter Writing

Letters of Support

Transgender students who are seeking medical and legal transition procedures often will need a letter of support from a mental health clinician. As a licensed professional, it is your ethical obligation to seek training, mentorship, and consultation to provide these letters. Below are some quick facts about letters of support.

Almost all letters require a diagnosis of Gender Dysphoria (DSM: F64.0, ICD: 64.0). Despite this, students do not need to be in acute distress for us to use this diagnosis in the letter. It should not become a barrier to services and you should discuss this with your student.
Write your letter collaboratively. Ask the student what language they do or do not want included. Inform them of the necessary components (i.e., legal name, sex assigned at birth, etc.).
Always allow clients to see a draft. This encourages collaboration and instills trust in you as the provider.
Do not disclose irrelevant information. Typically insurance companies require the letter as well as surgeons. Do your homework to find out what specifics they need and refrain from providing more than necessary. Oftentimes trans people will be denied services due to irrelevant information being shared.
Advocate! Cisgender people are able to seek these services without involving any mental health professionals. It is a social justice issue that letters are required in order for life-saving care to be provided. Lobby to end these dehumanizing practices.

Intersectionality

Exploring Gender

As mental health professionals, we must help clients explore their gender using an intersectional lens. Culture, race, religion, nationality, language, ability, and other identities change how we understand our gender identity, roles, expression, and behaviors. Consider the following tips:

Refrain from making quick assumptions about gender. Someone wearing a head covering (hijab, tichel, headscarf, etc.) may identify as transgender despite being assigned female at birth.
Explore with open curiosity and bring up gender in a non-judgmental way. Students' gender expression is likely connected to their other identities.
Talk about gender roles. Bring up gender as it relates to students' concerns so you communicate an openness and willingness to explore.
Don't expect gender identity to stay the same. It is not our job as clinicians to help students "decide" their gender. Changing their mind, going back and forth, and being able to play with gender is crucial. Many identities and factors will prompt fluidity. Change is not to be feared, especially by us professionals. Rates of regret for gender affirming medical interventions is less than 1%.
Do not refer to someone by a past gender identity, name, or pronouns. If someone is trying out new pronouns or has transitioned in any way, do not refer to them in the past by anything other than their current identity. Ex: When you were little NOT When you were a little boy....

Resources

Resources for Clinicians

Below you will find some templates to use for working with TGD students. The trans community is not a monolith, so these guides cannot and are not intended to be exhaustive. As there are many ways to explore gender, please adapt these forms based on your students' unique needs.

Templates:

Letters of Support Resources:

Books

Peer-reviewed Resources:

How can I provide gender affirming therapy?

Below are quotes from a study conducted in 2023 with TGD college students who were asked about their experiences in therapy.

Hover over the quotes to learn important tips to support TGD clients.

Be open to clients changing gender identities and presentations. Help them explore, find joy, and play with their gender. The freedom to explore is gender affirming care.

^^Hover above for a clinical tip!^^

Be proactive in exploring intersectional identities. Gender is understood uniquely across different races, ethnicities, religions, cultures, generations, and more.

^^Hover above for a clinical tip!^^

Practice talking about common concerns for TGD students and practice using pronouns to increase linguistic fluency.

^^Hover above for a clinical tip!^^

Mental Health Services in College Settings

Group Therapy

Community and belongingness is fundamental to any marginalized group. Peer support groups, gender identity groups, and affinity groups can improve rates of depression, anxiety, and suicide.

Individual Therapy

Individual gender affirming care is crucial for students to have a space to explore their gender, ways of presenting, and seek support in building their support networks and seeking transition-related care. This can include writing letters of support for medical or legal transition procedures. Clinicians must be trained in the Standards of Care to ensure students are being properly supported.

Psychiatry

Psychiatrists are pivotal to providing gender affirming care. These professionals must be well-trained in distinguishing symptoms that result from transphobia and transnegativity from clinical symptoms. This can include writing letters of support for medical or legal transition procedures. Providers must be trained in the Standards of Care to ensure students are being properly supported.

Understanding Gender

The image below is a visual guide to help explain gender and some of the components that contribute to gender identity. Click on the image for an educational guide from GLSEN.