LJ Cunningham

What Is Gender Affirming Care In Therapy?

Part of the conversation that’s overlooked is gender-affirming care in the context of mental health treatment. Everyone deserves helpful healthcare.

Post Published: May 2, 2023

Media pundits, white supremacists, and regular, everyday people across the globe can’t seem to stop talking about gender-affirming care. Most of the discussion revolves around legislative attempts to ban gender-affirming medical care. Because most of these talking heads can’t keep their minds away from other people’s genitals.

Part of the conversation that’s overlooked is gender-affirming care in the context of mental health treatment.
People who transition often need both medical and mental health care in order to achieve their identity goals, and lead fulfilling and satisfying lives. It’s important to acknowledge both types of care, and how they work together, because at the end of the day all human beings should have access to comprehensive healthcare that makes them feel cared for and complete.

If you’re a trans ally who believes everyone deserves helpful healthcare, you need to understand that bills against gender-affirming care also target licensed therapists.

Before we get into how political attempts at trans erasure, let’s clarify some terminology:

Terminology Related to Gender-Affirming Care (in the context of this article)

For the sake of clarity, I’ll be using umbrella terminology. “Therapy” is going to be the umbrella term for mental health treatment. This can be done by a licensed counselor, school counselor, social worker, marriage and family therapist, psychologist, and specially trained nurses and physicians in the U.S.

“Therapists” will be the umbrella term used for the professionals educated in how to do licensed mental health services.

“Trans” will be the umbrella term I use for gender non-conforming peoples. It’s important to note that each individual trans person chooses their own language that describes themselves. For the sake of clarity, this article will recognize that yet use “trans” to mean all GNC peoples.

“Therapy/therapies” are specific terms meaning evidence-based, studied, and ethical practice of therapy.

“Ethics” is the term which is specific to the professional ethics which all professional mental health professionals adhere to. Each license has slightly different ethical codes.

“Ethical treatment” means that all professional regulating bodies nationwide agree that this treatment provides a better quality-of-life for the client than not having the treatment; and that refusing treatment may cause grave harm.

What Does a Gender-Affirming Therapist Do?

A competent therapist will honor names and pronouns; even if they change.

Therapists will often assist trans people in exploring social transitioning.

Referrals may be provided for other medical or non-medical services.

A competent therapist providing gender-affirming care understands their own boundaries and centers treatment on client’s needs just as they would any other client.

Many gender-affirming therapists are also skilled in trauma and crisis counseling and therapies.

Gender-affirming care is increases the quality-of-life for trans adults and youth. The American Psychological Association, the American Psychiatric Association, the National Association for Social Workers, and the American Counseling Association determine this treatment as preferable for trans peoples for this reason.

Research concludes that gender-affirming care in various forms lessens adolescent depression and suicidal thoughts.

Gender-Affirming Care in Therapy Saves Lives

Trans people have a better overall life satisfaction and lowered depression symptoms with access to gender-affirming care. Rates of depressive symptoms decrease; as do rates of self-harm and thoughts of death by suicide. Republican conservatives want to claim that these are caused by being trans. Research shows that the social lack of support is directly what causes mental health symptoms.

Gender-affirming care is about facilitating a space for clients to be themselves in; just like counseling anyone else.

What Gender-Affirming Care Doesn’t Do

Right-wing Republicans misuse language steeped in old-fashioned bigotry to attempt to frame trans people–and their allies–as sinful, incurably mentally ill, and dangerous. Unfortunately, this includes therapists treating trans folks.

Common misused words and tropes about gender-affirming therapy include:

  • the idea that therapists “groom” clients into any kind of mentality, sexuality, or gender identity is false. This must be stated because Republican lawmakers make these false statements repeatedly as if they’re fact.
  • “sexualize” youth. See resources below.
  • that a gender-affirming therapist will build a secret, nefarious, wedge between parent and child “without parental consent.” While minor clients are granted confidentiality in sessions with a therapist, this is up to the discretion of the therapist. Therapy with minors always includes communication with caregivers, guardians, or parents. Republican lawmakers insinuating that a therapeutic relationship between a minor and therapist is harmful to children. This has already been established by the decades of research, infrastructure, and established laws, rules, and norms of professional organizations and the Federal government.

What You Need To Remember About Gender-Affirming Care

Gender-affirming care is ethical because it helps people stay alive and want to live. Republican religious extremists across the U.S. are attempting to dictate how mental health treatment is performed, in the name of erasing trans existence. This is beyond grim. Facing reality, we must stop these bills from becoming law.

Start here: Petition against Ohio House Bill 83 for Counseling Educators and Mental Health Professionals. This petition goes directly to the Presidents of the Ohio Counseling Association, American Counseling Association, and CACREP, the accreditation body for counseling educators.

Sign this petition for ongoing updates (and feel free to read the past updates from last year’s anti-trans bills here).

Sign up for my weekly emails for how this impacts mental health in Ohio.

Follow Honesty for Ohio Education and Equality Ohio for ongoing updates regarding trans and educational bills. Opponent testimony is coming up, so follow them on socials, too.

USE YOUR PLATFORM, your career, your workplace, to be loud and openly proud to support trans people if you are safe to do so. We need support.


Global Project Against Hate and Extremism

Ohio HB 83 Page

Image of screenshot from @NASWOhioChapter on Twitter. Post reads: Join NASW Ohio in taking action to stop HB 83. HB 83 is an attempt to dismantle diversity and inclusive efforts in higher education. Opponent testimony is scheduled for Wednesday, 4/19. Submissions are due 24 hours in advance. go to naswoh.org/StopSB83 to learn more. Image beneath is a graphic in white, orange, and blue. It has the NASW Ohio Chapter Logo at the bottom in green. STOP SB 83 is in the orange bubble in the middle of the graphic. Across the top of the image is a blue banner. White lettering reads: opposition testimony scheduled. The words above are also in the blue banner

The National Center for Trans Equality

APA Statement on gender-affirming care

Lower depression and suicidality after 12 months receiving gender-affirming care; from JAMA

Interactive Map: Comprehensive Care Programs for Gender-Expansive Children and Adolescents; from HRC

Learn the history of the world’s first trans clinic, so you know how to respond the next time someone near you says that being trans is “new.”




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