By Dr. Shawn V Giammattei
It’s Shawn here again.
Lately, I’ve been thinking a lot about what it really means to become gender competent; especially in the moment we’re living in right now.
The political climate has intensified scrutiny around gender-affirming care, legislation continues to shift, and clinicians are increasingly finding themselves under a microscope. Many of you are feeling it in your offices, in consultations, and even in conversations with colleagues.
And because of that… Phase 2 of the Gender Affirmative Specialist Journey has never been more important.
This phase isn’t just about learning new terminology or understanding diagnostic criteria. It’s about developing the clinical competence and confidence to navigate complexity — ethically, thoughtfully, and collaboratively — while staying grounded in the well-being of the people we serve.
Why does this matter?
Because we are being asked — implicitly and explicitly — to hold more than ever before.
We are holding our clients’ lived experiences.
We are holding family systems.
We are holding legal realities.
We are holding institutional pressures.
And increasingly, we are holding our own fears about “getting it wrong.”
It’s no wonder clinicians sometimes feel pulled in multiple directions.
On one side, there are voices pushing for increased gatekeeping — suggesting we slow everything down, question more deeply, and approach gender diversity with suspicion. On the other, there are urgent needs from clients seeking timely access to care that can profoundly improve, and often save, their lives.
Phase 2 is where we learn to navigate this tension.
Becoming gender competent means understanding gender dysphoria and gender incongruence in a nuanced way. It means differentiating co-occurring issues without assuming causation. It means recognizing minority stress and trauma as contextual factors. It means collaborating with clients rather than positioning ourselves as arbiters of identity.
And importantly — it means moving beyond fear-based practice.
When clinicians lack competence, they often fall into one of three patterns:
Over-pathologizing and delaying care
Avoiding the work altogether
Or moving too quickly without thoughtful evaluation
None of these serve our clients — and none of them protect us professionally.
Competence creates balance.
It allows us to conduct thoughtful, collaborative gender health evaluations.
It helps us document clearly and ethically.
It strengthens our clinical reasoning.
And it gives us the confidence to stand behind our decisions — even in a challenging political climate.
This is not just about skill-building. It’s about sustainability.
When we are grounded in competence, we reduce burnout. We reduce anxiety. We stop second-guessing ourselves at every turn. And we begin to trust both our training and our clinical intuition again.
But there’s another layer to this phase that often gets overlooked.
Gender competence is not developed in isolation.
The complexity of gender-affirming care — particularly for youth — requires collaboration. Schools, medical providers, families, legal systems, and community supports all intersect in this work. When we build competence, we also become better collaborators. We learn when to consult, when to refer, and how to function as part of a gender-affirming team.
In today’s climate, that collaboration also offers protection — for our clients, for our practices, and for the integrity of the work itself.
So if you find yourself questioning your confidence…
If you’re wondering whether you’re doing enough…
If you’re feeling the weight of increased scrutiny…
You’re not alone. And you’re exactly where this phase is designed to support you.
Phase 2 is about stepping into clarity.
It’s about strengthening your clinical voice.
It’s about moving from uncertainty to grounded competence.
Because when we are gender competent, we don’t just respond to the moment — we help shape it.
And our clients deserve nothing less.
I’d love to hear from you.
What challenges are you experiencing as you work toward greater gender competence?
What questions are coming up for you in this climate?
Hit reply and let me know — I always appreciate hearing from this community.
Warmly,
Shawn