TYPES OF INTERVENTIONS
Mental health interventions
Mental health approaches — There are several mental health approaches to support transgender or gender-diverse (TGD) children and adolescents explore their gender identity and find a gender role that is comfortable [10,21]. Treatment options may be influenced by family expectations, cultural differences, opinions of health professionals, insurance coverage, and availability of services.
The specific approach for a given child or adolescent is individualized. The process may or may not involve recommendations for a change in gender expression or body modification; what helps to alleviate gender dysphoria in one person may differ from what helps to alleviate it in another.
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Preferred approach – Affirming approaches are preferred; they are recommended by many professional organizations. (See 'Society guideline links' below.)
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Affirming – Affirming approaches focus on gender identity/body congruence and actively promote exploration of gender development and self-definition within a safe setting [5,11,22,23].
A fundamental concept of this approach is that gender diversity is not a mental illness. It is inappropriate to pathologize the child or adolescent's behaviors or to assign a diagnosis. With the help of affirming psychotherapy, some individuals can integrate their gender-diverse feelings into their birth-designated gender; others may be able to alleviate their gender dysphoria through changes in gender role and expression [10,24]. (See 'Social transition' below.)
The authors of this topic review support affirming approaches for TGD youth – from medical and mental health professionals, as well as parents/caregivers. The growing medical evidence supports careful listening, thoughtful discussions, and patient-centered approaches to gender exploration.
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Approaches that are not recommended – Approaches that are not recommended and potentially harmful include wait-and-see approaches, redirection, and reparative therapy [5].
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Wait-and-see – The wait-and-see approach (also called watchful waiting) involves waiting to see if the child's gender identity will change as the child gets older [11]. Caregivers who take this approach may allow different-gender play and clothing within the home or support both masculine and feminine activities as the child explores their interests in other social settings.
The wait-and-see approach assumes that gender is binary and becomes fixed at a certain age; it pathologizes gender diversity and fluidity [5]. It is distinguished from following the child's lead, an affirming approach that allows the child to present in the gender role that feels correct and moves at a pace determined by the child. (See 'General suggestions' below.)
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Redirection – Some mental health therapists encourage caregivers to use positive reinforcement to try to "redirect" children toward behavior that is more typical of their birth-designated sex or less gender specific. The goal of redirection is to eliminate gender-diverse desires and expressions over time [25]. This approach is not recommended because negative reinforcement (eg, shaming the child for gender-diverse expression) has substantial negative mental and social health consequences.
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Reparative therapy – Reparative therapy (also called conversion therapy) claims to be able to "cure" a transgender identity. It is still practiced in certain religious and conservative communities. This approach was initially used in the 1970s [26,27]. Reparative therapy is considered unhelpful and potentially harmful by most professional organizations, including the American Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the World Professional Association for Transgender Health, the Society for Adolescent Health and Medicine, and the Substance Abuse and Mental Health Services Administration [5,10,28-34]. In the United States, several states, counties, and cities ban reparative therapy. The Movement Advancement Project provides a
map of localities that ban reparative therapy.
The few times I looked there, I got out soon as possible.
