A. Standards Of Care and Evidence-Based Clinical Guidelines
The following evidence-based guidelines and standards of care represent the most up-to-date resources for providers across different disciplines serving youth with gender dysphoria. The two most widely known guidelines are published by the Endocrine Society and the World Professional Association of Transgender Health (WPATH).
Human Rights Campaign – Supporting Transgender, Non-binary, and Gender-Expansive Children
This guideline is designed for pediatricians and mental health professionals working with transgender and gender diverse youths and provides specific information for managing social and medical transitions with patients and families.
American Psychiatric Association - A Guide for Working with Transgender and Gender Non-conforming Patients
The American Psychiatric Association publishes this guide for clinical work with transgender and gender non-conforming patients.
American Psychological Association – Guidelines for Psychological Practice with Transgender and Gender Nonconforming People
The American Psychological Association provides these guidelines to assist psychologists in providing “culturally competent, developmentally appropriate, and trans-affirmative psychological practice with TGNC people.”
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
The Endocrine Society provides this guideline on treating gender dysphoria from an interdisciplinary perspective.
The World Professional Association for Transgender Health (WPATH) - Standards of Care for the Health of Transgender and Gender-Diverse People
The Standards of Care document is the international gold standard outlining the guidelines for the clinical treatment of gender dysphoria.
B. Notable Texts on Delivery of Clinical Care
The following are key academic texts that provide clinical guidelines for providers working with gender diverse youth.
Janssen, A., & Liebowitz, S. (2018). Affirmative Mental Health Care for Transgender and Gender Diverse Youth: A Clinical Guide. Cham, Switzerland: Springer International Publishing.
This book provides practical, evidence-based information for providers working with transgender and gender diverse youth and their families. It covers assessment, social transitions, non-binary identities, psychiatric comorbidities, and other complex topics.
Keo-Meier, C., & Ehrensaft, D. (2018). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children. Washington, DC: American Psychological Association.
This book serves as a guide to the gender affirmative model for gender diverse youth and their families. It explores strategies for building resilience in culturally-informed contexts.
C. Additional Resources for Patient Care
AACAP Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents (2012)
AACAP provides guidelines intended to assist clinicians in psychiatric decision making and associated discussion. These guides are endorsed by AACAP and its Sexual Orientation and Gender Identity Issues Committee.
AACAP Statement Responding to Efforts to Ban Evidence-Based Care for Transgender and Gender Diverse Youth (2019)
AACAP provides guidelines on evidence-based treatment for transgender and gender diverse youth.
American Academy of Pediatrics - Office-Based Care for LGBTQ Youth
The American Academy of Pediatrics policy statement on outpatient care including terminology, sexual health, and recommendations.
American Psychological Association – LGBT Resources and Publications
The American Psychological Association's list of LGBTQ resources on topics ranging from addressing bias/discriminiation and education to marriage/families and policy/advocacy.
Association of American Medical Colleges (AAMC) - Speaking with Patients About Sexuality and Gender
A two-part video from the Association of American Medical Colleges of a moderated panel discussion between professional health educators. Part One provides an overview on terminology and guidance in creating a welcoming environment for patients to enhance understanding, doctor-patient relationships, and clinical care. Part Two discusses communication skills including how to teach trainees, strategies for improvement, and most impactful lessons learned.
Brill, S.A., & Kenney, L. (2016). The Transgender Teen: A Handbook for Parents and Professionals Supporting Transgender and Non-binary Teens. Jersey City, NJ: Cleis Press.
This book provides accessible, practical information for families with gender diverse teenagers.
Brill, S., & Pepper, R. (2008). The Transgender Child: A Handbook for Families and Professionals. San Francisco, CA: Cleis Press.
This book provides accessible, practical information for families with gender diverse children.
Gay and Lesbian Medical Association (GLMA) – Cultural Competency webinars
This free webinar series explores cultural competence and the health concerns and healthcare of LGBTQ people and is geared toward clinicians, administrators, researchers, and academics.
Gender Spectrum – Medical
Gender Spectrum provides a useful list of clinical resources targeting physicians and nurses who care for gender-expansive youth.
Substance Abuse and Mental Health Administration. (2014). A Practitioner’s Resource Guide: Helping Families to Support Their LGBT Children. HHS Publication No (PEP14-LGBTKIDS)
SAMHSA’s Practitioner’s Resource Guide provides information and practical guidelines for providers working with families of LGBTQ youth using data from family research studies.
SAMHSA – Practice Brief: Providing Services and Supports for Youth Who are LGBTQ
SAMHSA provides resources for providers, administrators, and policymakers to develop culturally and linguistically competent programs, including a system level approach to help youth and families and a checklist of recommendations and strategies.
SAMHSA - Top Health Issues for LGBT Populations: Information & Resource Kit
SAMHSA provides this free guide on health issues affecting diverse LGBT populations.
UCSF Center of Excellence for Transgender Health
The website for UCSF’s Center of Excellence for Transgender Health includes information about transgender healthcare access and policy, routine care, HIV prevention, cultural competency, and mental health.
D. Conversion Therapy/Sexual Orientation Change Efforts
AACAP Policy Statement on Conversion Therapy (February 2018)
This AACAP Statement summarizes the limited evidence on conversion therapy and explains why AACAP opposes this harmful practice.
American Psychological Association- Report of an APA Taskforce (2009) entitled Appropriate Therapeutic Responses to Sexual Orientation
This report, which focuses on sexual orientation change efforts exclusively (not gender identity) is largely viewed as the most comprehensive literature review and evidence-based guide regarding the harmful methodologies associated with conversion therapy practices.
Substance Abuse and Mental Health Services Administration, Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth. HHS Publication No. (SMA) 15-4928. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
This report was produced after convening a panel of experts to obtain consensus statements on defining conversion therapy, and broadening the definition beyond sexual orientation. It includes statements on gender identity across development and summarizes existing research on sexual orientation and gender identity. The take home message in this report is that a priori attempts to change a person’s sexual orientation, gender identity, and/or gender expression are harmful.
Williams Institute at UCLA School of Law - Conversion Therapy and LGBT Youth (January 2018)
This report provides information on state-specific conversion therapy bans, people affected by conversion therapy, and perspectives on the issue.
E. Gender Dysphoria in Childhood & Adolescence
Aitken, M., Vanderlaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-Harm and Suicidality in Children Referred for Gender Dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 513-520.
In this study, investigators examine self-harm, suicidal ideation, and suicidal behavior (by parent report) in children with gender dysphoria. They report that children with gender dysphoria showed an increase in self-harm and suicidality as they got older.
Dhejne, C., Vlerken, R. V., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1), 44-57.
This article provides an overview of existing studies on psychiatric disorders in transgender patients. The authors suggest that, generally, trans patient populations are at higher risk of psychiatric morbidity, though symptoms improve with affirming care and mental healthcare.
Durwood, L., Mclaughlin, K. A., & Olson, K. R. (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth. Journal of the American Academy of Child & Adolescent Psychiatry,56(2).
In this study, researchers leading the TransYouth Project examined depression, anxiety, and self worth in children 9-14 years old who had socially transitioned. Results showed that transgender children had similar rates of depression and marginally higher rates of anxiety.
Leibowitz, S., & Vries, A. L. (2016). Gender dysphoria in adolesence. International Review of Psychiatry,28(1), 21-35.
In this article, Drs. Leibowitz and de Vries provide an overview of the literature pertaining to care for adolescents with gender dysphoria.
Olson, K. R. (2016). Prepubescent Transgender Children: What We Do and Do Not Know. Journal of the American Academy of Child & Adolescent Psychiatry, 55(3).
In this Clinical Perspectives article, Dr. Olson reviews existing perspectives and data on gender dysphoria as well as methods of past studies.
Olson, K. R., Durwood, L., Demeules, M., & Mclaughlin, K. A. (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, 137(3).
This study published in Pediatrics examines depression and anxiety in transgender children who have socially transitioned. The research team concludes that transgender children who socially transition and receive support for their gender identities demonstrate normative rates of depression and minimal elevations in anxiety.
Sharon, N. (2016). Psychiatrys Role in Supporting Healthy Development in Gender Diverse Children. Psychiatric Annals, 46(6), 355-360.
This article provides an overview of treatment challenges related to gender diversity and gender dysphoria.
F. Trauma-Informed Care
American Academy of Pediatrics - Childhood Exposure to Violence
This site provides a general overview for approaching traumatic events in youth.
The National Child Traumatic Stress Network (NCTSN) Resources:
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Resources:
The following resources provide training on TF-CBT, an evidence-based intervention for children and adolescents impacted by trauma. The implementation manual for LGBTQ youth assists providers tailor the intervention specifically to LGBTQ youth and their caregivers.
- Cohen, J.A, Mannarino, A.P., & Deblinger, E. (2017). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guilford Press.
This brief guide provides an overview of terminology and approaches to trauma in LGBTQ youth.
- Cohen, J.A, Mannarino, A.P., Wilson, K. & Zinny, A. (2018). Implementing Trauma-Focused Cognitive Behavioral Therapy for LGBTQ Youth and Their Caregivers. Pittsburgh, PA: Allegheny Health Network. (Free)
- TF-CBT Web 2.0: A course for Trauma-Focused Cognitive Behavioral Therapy.
G. Training Resources & Curricula on LGBTQ Mental Health
Association of LGBTQ Psychiatrists (AGLP) LGBT Mental Health Syllabus
This website teaches psychiatry residents and other clinical care providers about “caring for lesbian, gay, bisexual, transgender, and intersex patients.”
Fenway Institute
This list summarizes programs and centers, grants and funding opportunities, data sources, and professional organizations supporting LGBTQ research at the graduate and post-doctoral levels.
National LGBT Health Education Center (Fenway Institute) Webinars & Video Training (CME available)
This comprehenesive resource center provides educational modules on LGBTQ health, youth, older adults, people of color, families, PReP, HIV/STI prevention and treatment, primary care, behavioral health, cancer, data collection, and organizational change.
SAMHSA and Health Resources and Services Administration (HRSA) – List of professional training curricula
SAMHSA provides this list of professional trainings for behavioral health and primary care providers in LGBTQ health and well being. Topics covered include effective communication, substance use treatment, elders, and HIV.
Stanford University - Health Across the Gender Spectrum Online Course (Free)
This case-based, online beginners' course is intended for families, educators, and providers and teaches about gender identity and the gender spectrum and provides tips to create a more supportive environment.
UCSF Lesbian, Gay, Bisexual and Transgender Resource Gender - Education & Training
UCSF’s LGBT Resource Center curates this list of articles, training, and education materials to “help promote education and awareness of gender identity, gender expression, and sexual orientation.”