Phase 1 of the Gender-Affirming Therapist is focused specifically around understanding disparities, structural barriers, and the need for gender-affirming competence, and about learning that competent gender-affirming care is trainable, standardized, and professionally regulated, not improvised or ideological. When integrated with medical and social support, therapists can form part of a coordinated, affirming system of care in the best interests of TNG patients.
Gender-Affirming Care Is Not Neutral—It Is Associated With Real Psychological Benefit
Many TGD individuals experience gender dysphoria—a significant incongruence between one’s gender identity and assigned sex that causes distress or impairment, and evidence-based treatments include hormone therapy, surgery, psychotherapy, and changes in gender identity or expression (Jasuja, et al., 2024). TGD individuals often delay or skip needed healthcare because they fear encountering transphobia (Quint, et al., 2025). TNG people face real-world stigma and discrimination across healthcare settings, and the sooner therapists understand these systemic obstacles, the sooner we can actively reduce fear and stigma, and recognize the emotional terrain of care avoidance. Research consistently shows that gender-affirming care can enhance mental health, improve quality of life, and reduce the risk of suicidal thoughts and attempts in TGD individuals (Jasuja, et al., 2024).
Understanding Disparity, Minority Stress, And Barriers To Accessing Care
Understanding the value of integration and affirming training starts with understanding disparity, minority stress, and barriers to accessing care. An important aspect of gender-affirming care therapists must recognize as early as possible is that minority stress isn’t abstract, it’s a lived cause of differential mental health outcomes that therapy must respond to. Transgender, nonbinary, and gender-diverse (TNG) people experience higher mental health needs while facing systemic, cultural, and political barriers to accessing competent care (Goetz, et al., 2024).
The Priority Patients Place On Affirming Competence And Integrated Support Across Care Modalities
As TNG patients face systemic obstacles, embedding mental-health care inside gender-affirming medical settings may directly counter these barriers. TNG patients emphasized the need for clinicians who are both affirming and knowledgeable, with the ability to work across disability, race, and a wide range of mental health concerns (Goetz, et al., 2024). This underscores that simply being well-meaning isn’t enough, and that affirmation and knowledge are essential. TGD patients who have to educate their providers about transgender issues are four times more likely to postpone necessary healthcare compared to those who don’t (Quint, et al., 2025). Psychotherapy for TNG clients tends to be most effective when it is not isolated from medical and social care, but is woven into an affirming, coordinated system of care. Early awareness involves seeing the patient as a whole person, not just through the lens of gender.
Gender-Affirming Care Is Governed By Standards, Not Vibes
Gender-affirming training isn’t about techniques—it’s about structuring care and training so that basic therapeutic settings are affirming and accessible. Patients want psychotherapy built into gender-affirming care, and providers have emphasized the importance of providing psychotherapy and training all staff in gender-affirming care, noting telehealth is especially important for TNG and other marginalized groups (Goetz, et al., 2024). This shows integration is not just administratively useful — it also aligns with what TNG patients themselves say they need from care systems and better reaches people who may be otherwise pushed out of care. Clinician participation in gender-affirming training increases adherence to guidelines and proper screenings for gender-affirming therapy initiation (Jasuja, et al., 2024). This reflects clinician training directly improves patient safety, adherence to best practices, and quality of care.
One main reason Phase 1: Gender Awareness is important is that it lays the foundation for safe, affirming, and non-harmful clinical practice—therapists cannot effectively support TNG clients without first understanding their identities, experiences, and the systemic barriers they face. Therapists who support clients with affirming medical and psychological interventions are grounded in evidence, not experimental or fringe practice (Jasuja, et al., 2024). Therapist education and training in including gender-affirming care is not a checklist to mark off as you go along, but an ongoing commitment to broad competence, intersectional awareness, and humility.
The GHTI Advanced Coaching & Mentorship Program supports therapists in this phase by providing structured training, expert guidance, and mentorship, helping clinicians build confidence, deepen understanding, and develop practical skills. Through the program, therapists can advance their competence, excel in affirming care, and translate awareness into ethical, evidence-based practice, setting the stage for progression into Phase 2: Gender Competent, where they can apply this understanding in fully competent, evidence-based clinical care.
Goetz, T. G., & Wolk, C. B. (2024). A formative evaluation to inform integration of psychiatric care with other gender-affirming care. BMC Primary Care, 25, 239. https://doi.org/10.1186/s12875-024-02472-8
Jasuja, G. K., Wolfe, H. L., Reisman, J. I., Vimalananda, V. G., Rao, S. R., Blosnich, J. R., Livingston, N. A., & Shipherd, J. C. (2024). Corrigendum: Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1086158
Quint, M., Bailar, S., Miranda, A., Bhasin, S., O’Brien-Coon, D., & Reisner, S. L. (2025). The AFFIRM Framework for gender-affirming care: qualitative findings from the Transgender and Gender Diverse Health Equity Study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-024-21261-7