In Phase 3, you’ve become a Gender Experienced therapist—you’re confidently guiding transgender and gender-expansive clients through diagnoses and transitions. Gender-affirming care helps young people live in alignment with their gender identity, with treatments like puberty blockers and hormones potentially improving mental health and reducing distress (Wright, et al., 2024). Though some in the medical community still misunderstand your work, you know how vital your support is for a population facing ultra-high rates of suicidality driven by social rejection, not by medical care.
You’ll frequently encounter families full of doubt or fear—especially when minors require parental consent—and many may surprise you by embracing the process. We know that gender-affirming care improves mental health in youth and adults and reduces gender and appearance incongruence (Olson-Kennedy, et al., 2025). Your challenge is to hold space for your client’s needs while meeting worried parents where they are, acknowledging their pain, and offering clear information. If you side too heavily with one party, you risk losing the other—and potentially your client’s access to care.
By employing expert negotiation skills—walking parents through their own emotions, validating their fears, and gently guiding them toward understanding—you increase the odds that they’ll become allies. Many parents move from resistance to full advocacy, often crediting their child with teaching them about gender diversity.
When working with couples, you’ll see similar dynamics: one partner’s transition can trigger sadness, betrayal, or internalized transphobia in the other. You’ll need to create a safe space for both to process at their own pace, helping them maintain connection and support each other’s journeys.
You’ll also serve families in diverse constellations—gay and polyamorous couples, non-binary individuals, adoptive parents—each facing unique minority-stress challenges. You’ll help them navigate new language and cultural shifts, like the growing visibility of non-binary identities, which can feel overwhelming to outsiders.
Reaching this phase of your gender-affirming practice is highly valuable, as the experience you’ve gained allows you to face challenges with growing confidence. This work is powerful and necessary, and growing bodies of evidence continue to show the significant impact of such care on transgender and nonbinary youth and adults (McNamara, et al 2024; Rastogi, et al, 2025). While direct work with clients is essential, you can further strengthen your skills and save time by participating in specialized seminars and mentorship programs. There is a significant shortage of qualified gender specialists, and building an effective, affirming practice not only supports your growth as a therapist but also meets a real community need. However, it’s important to stay mindful of the systemic barriers the trans and gender expansive community faces—limited access to education, employment, and basic opportunities. Even with the current imbalance between demand and available services, we must ensure that our work is rooted in care, not exploitation, and that we remain grounded in a commitment to ethical, community-centered support.
McNamara, M., Alstott, A., Baker, K., Connelly, K., Janssen, A., Olson‑Kennedy, J., Pang, K. C., Scheim, A., & Turban, J. (2024, July 1). An evidence‑based critique of “The Cass Review” on gender‑affirming care for adolescent gender dysphoria [White paper]. The Integrity Project, Yale Law School. https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf
Olson-Kennedy, J., Wang, L., Wong, C. F., Chen, D., Ehrensaft, D., Hidalgo, M. A., Tishelman, A. C., Chan, Y., Garofalo, R., Radix, A. E., & Rosenthal, S. M. (2025). Emotional health of transgender youth 24 months after initiating Gender-Affirming Hormone therapy. Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2024.11.014
Rastogi, A., Menard, L., Miller, G. H., Cole, W., Laurison, D., Caballero, J. R., Murano‑Kinney, S., & Heng‑Lehtinen, R. (2025, June). Health and wellbeing: A report of the 2022 U.S. Transgender Survey. Advocates for Trans Equality. https://transequality.org/sites/default/files/2025-06/USTS_2022Health%26WellbeingReport_WEB.pdf
Wright, D., Pang, K. C., Giordano, S., & Gillam, L. (2024). Evaluating the benefits and risks of puberty blockers and gender‐affirming hormones for transgender adolescents. Journal of Paediatrics and Child Health, 61(1), 7–11. https://doi.org/10.1111/jpc.16734