When I think about the most persistent challenges clinicians face in gender-affirming care, one rises to the top again and again—navigating relationships. I’m not just talking about the therapeutic relationship with our trans and gender-diverse clients, I mean the relationships that shape their lives: with parents, partners, siblings, and the people closest to them. As clinicians, we’re often laser-focused on just helping the individual. But in this work, that lens can be far too narrow.
Whether it’s a teenager who’s ready to socially or medically transition but whose parents are in denial, or an adult client whose partner is withdrawing emotionally after years of shared life together, we’re regularly asked to hold complexity that extends well beyond our client’s individual experience. And in today’s political climate—where anti-trans rhetoric and legislation are louder than ever—that complexity has only deepened.

Caught in the Middle

Many of us find ourselves caught between opposing needs. A young person is desperate to feel seen, affirmed, and safe in their identity. Their caregivers are fearful, skeptical, and not ready to accept the reality their child is living. You want to be aligned with your client, but you also know that alienating the parents or caregivers could mean losing the family bond beyond repair. I’ve been in that place and I know how easy it is to get emotionally pulled to one side—especially when every moment counts and a child’s well-being is hanging by a thread.
When we align too closely with the young person, we risk dismissing the families’ experiences. When we overemphasize the caregivers concerns, we risk betraying the trust of the youth. It’s a delicate dance and it’s even more difficult now, in a time when families are being directly told that affirming their child’s identity could bring harm—or legal consequences— based on where they live.

Meeting Families Where They Are

Here’s what I’ve learned through years of walking this road with families: most parents love their children. Their fear isn’t always about rejection—it’s often about protection. Many are trying to make the best decision they can with the (sometimes very flawed) information they’ve received. And as clinicians, we have an essential role in shifting that narrative.

One tool I’ve found invaluable is the Gender Journey Map—a visual representation of where families and partners typically find themselves along the path of understanding. While the child may be at Phase 4 or 5, needing alignment between body and identity, their parents may still be in Phase 1, asking, “Is this really happening?” or “Is this just a phase?” When families can see that their experience is normal, that it’s a process—not an endpoint—they’re more likely to stay in the room with you. That’s where the healing happens.
A thorough Gender Health Evaluation also helps bridge that gap. For youth, it feels like progress. For parents, it often slows things down just enough to allow understanding to catch up with urgency. That kind of structure helps everyone breathe a little easier, and sets the stage for aligned decision-making.

Don’t Forget the Partners

We see a similar dynamic play out with adult clients and their partners. I’ve seen it all: partners who become fierce advocates and allies, and others who grieve deeply, feeling betrayed, unseen, or abandoned. It’s tempting to believe a partner’s distress means the relationship can’t survive, or to assume that if they really loved their trans partner, they’d just “get it.”

But the truth is, partners go through their own gender journey—one that includes loss, fear, identity shifts, and a lot of unlearning and relearning. Some experience the revelation of a partner’s gender as a rupture in attachment, not unlike the fallout from an affair. That doesn’t mean they’re transphobic. It means they’re in pain. And just like parents, they need space to grieve, to ask hard questions, and to reconstruct a new vision for their relationship and identity.
Supporting these relationships doesn’t mean diluting our affirming stance. It means holding a broader, more inclusive vision—one that makes space for growth, even when it’s messy.

The Weight of the World

All of this is happening against the backdrop of an incredibly hostile political climate. We are watching an unprecedented wave of anti-trans legislation sweep across the country—targeting youth, healthcare providers, and families who lovingly affirm and support their children. I don’t think we can overstate the impact this is having on the families and communities we serve. Even those in affirming regions are absorbing the fear: “What if we have to move?” “What if we lose custody?” “What if my child isn’t safe at school anymore?”
As clinicians, we need to name this. The uncertainty and fear that families are carrying don’t exist in a vacuum. They are being fueled by loud, coordinated efforts to delegitimize trans lives—and that pressure often lands squarely on parents, partners, and caregivers. This context isn’t optional—it’s foundational. Without this context, we’re not just overlooking something—we’re compromising the integrity of the work.

What I Hope You’ll Hold Onto

Through it all, I come back to this: families and relationships can adapt. They can grow, expand, and even thrive in the face of enormous change. But they need support. They need our understanding, our patience, and our belief that it’s possible.
This is not easy work. It requires you to hold space for multiple truths at once, to sit with discomfort, to offer compassion even when you feel frustrated or scared. But you’re not alone. We’re in this together—and as a community of clinicians, we are constantly learning from one another.
So I’ll end with this: keep showing up. Keep asking questions. Keep expanding your own gender confidence so you can walk this road with clarity and compassion.
And if you’ve had a moment where a family came around, where a partner softened, or where someone said, “I didn’t understand, but now I do”—hold onto that. Because those moments remind us why we do this work.

In solidarity,
Shawn
Founder, TransFamily Alliance
Clinical Director, Gender Health Training Institute