How to write a gender dysphoria treatment plan

In short, treatment of gender dysphoria is focused on reducing the distress or impairment caused by a marked and persistent incongruence between a person's gender identity/expression and their sex assigned at birth (including physical and/or social attributes). For a diagnosis this significant to a client’s sense of self, there are some top treatment options to keep in mind.

Gender-affirming therapy 

The American Psychiatric Association (APA) defines gender-affirming therapy as “a therapeutic stance that focuses on affirming a patient’s gender identity and does not try to ‘repair’ it.” It centers on exploration of the client’s understanding in relation to their own gender, gives them the space to explore this, and helps them clarify their own goals. The APA goes on to say that this type of therapy can provide support around topics such as trauma, experiences of violence, depression, shame, self-harm, sexuality, navigating societal stigma, and assisting with medical and social transition if desired. It also encompasses exploring how an individual can find joy in their body as they affirm their gender, how they can seek out support from the trans community and society at large, and how to find sources of resilience against societal transphobia and gender minority stress. The World Professional Association of Transgender Health (WPATH) has produced a Standard of Care which can be a helpful guide for clinicians.

Coordination with medical transition care 

A therapist's role through the medical transition process primarily involves biopsychosocial assessment and diagnosis, facilitating social support for the client, assessing a client's ability to understand the risks and benefits of gender-affirming care as part of an informed consent process, collaborating with the medical team, writing letters of recommendation for the process, and providing care throughout the transition process. This is a significant process, as mental health professionals often provide assessments and documentation for medical transition care. The role requires providing thoughtful companionship to the client in helping them to understand the risks and benefits of gender affirming medical care and to make informed decisions that align with their values and gender affirmation goals..

The American Association of Clinical Endocrinology recommends that “clinicians who recommend gender-affirming endocrine treatments should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition.”

Whether that’s hormone replacement therapy, laser hair removal, voice coaching, or surgery, the therapist and medical providers can provide the best services when in close contact about the client’s progress.

Peer support and LGBTQIA+ groups 

Peer support groups can play a significant factor in promoting mental health, resilience, and quality of life for clients with gender dysphoria. Research has shown that these groups are a significant protective factor, particularly against suicide. Clients may already be aware of these groups and should be encouraged to join. If clients are interested, but do not know where to start, making referrals to local community groups or online groups, such as those provided by The Trevor Project, can be a catalyst for the client. Exploring gender identity in a supportive space can be an important part of treatment for clients. 

Psychoeducation on identity, dysphoria, and transition

Psychoeducation on core components of treatment can help facilitate a more effective treatment process and increase the level of empowerment and autonomy in clients. Providing definitions, such as those noted in The New England Journal of Medicine, can distinguish between gender identity, gender expression, assigned gender at birth, and sexual orientation in order to help clients with gender dysphoria make sense of their experience. This education on dysphoria can help clients to understand the distress of the incongruence between their gender identity and their assigned gender at birth. It’s important to note that not all gender-diverse individuals meet the criteria for gender dysphoria. 

The American Association of Clinical Endocrinology recommends that psychoeducation include a clear explanation of expected effects, risks, benefits, the partially irreversible nature of some treatment approaches, and the need for ongoing support. The steps to be explained can include social transition, puberty suppression (for eligible youth), gender-affirming hormone therapy, and surgery options. Explaining this to the client — and involved family members if applicable — is a crucial part of treatment. 

Addressing co-occurring mental health concerns 

Co-occurring mental health conditions can be common among clients with gender dysphoria. Among the most common are depression, suicidality, anxiety, trauma-related disorders, substance use disorders, and ADHD. It’s also important for providers to screen for suicidal ideation and addiction.

Minority stress often plays a central role in a client’s mental health state. The clinician should attempt to identify all mental health disorders present and explore their relationship to one another. Co-occurring disorders can be distinct from their gender dysphoria but are often interwoven and not easily separated. Once this conceptualization is in place, appropriately related treatment approaches can be applied in a holistic and affirming manner. Clinicians should work within the scope of their practice and competence. When co-occurring conditions require specialized expertise beyond a therapist’s training, appropriate referrals should be made while maintaining coordinated care.

Involving family and support systems

Involvement of supportive friends and family members can be significant protective factors and help enable improved treatment outcomes. Assessment is a key phase in understanding the state of the client’s social life. The National Alliance on Mental Illness (NAMI) suggests that 40% of LGBTQIA+ adults have experienced rejection from a family member or close friend. It can be important to tread lightly and avoid pushing involvement from family members who seem unsupportive to the client. When true supports are involved, not only do they improve outcomes, but they help with protection against suicidality and homelessness, which tend to be higher rates in gender-diverse individuals. 

Crisis support and safety planning

Research from The Trevor Project reports that 46% of transgender and nonbinary young people have seriously considered attempting suicide in the past year. With these elevated levels of suicide risk, assessment should be conducted at intake and throughout treatment, with particular attention to warning signs. Minority stress, substance use, discrimination, and trauma are some factors for clients with gender dysphoria that can trigger a crisis. 

When risk is present, safety planning should be conducted. This includes identification of warning signs, identified coping skills (e.g., DBT or mindfulness skills), social supports who can be contacted, removal of means of harm, and professional contacts. It’s important to help the client identify where they can find immediate access to gender-affirming emergency care if needed. Access to online or community support resources such as NAMI or The Trevor Project can also be a useful part of a safety plan. 

Connecting with affirming community resources 

Whether it’s in the midst of a crisis or just for ongoing support, affirming community resources can play a vital role in a client's treatment. Aside from the previously mentioned support groups, there are other resources that clients with gender dysphoria may find beneficial, including affirming sexual health clinics, legal and advocacy services, youth- and school-based programs, as well as employment and housing support. GLAAD offers a comprehensive list of resources at a national level, but local resources can be found through local affirming programs, community centers, and networking in support groups.