Transgender Education Network of Texas
Health Organization Sign on:
Support & Care of Trans Youth
Joint Statement Support and Care of Transgender Children
Supporting and providing access to gender affirming care for transgender children promotes health and well-being. It is not child abuse. This approach is recommended by the prevailing standards of care, best practices, and guidelines endorsed by national and international professional organizations including the World Professional Association of Transgender Health, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the National Association of Social Workers, and the Australian Professional Association for Transgender Health and is associated with improved mental and physical health outcomes.
The gender affirmative model of care includes obtaining a child’s assent before engaging in any medications or surgical procedures. Until puberty, there are no medical or surgical interventions involved related to gender affirmative care. After the onset of puberty, comprehensive gender health planning — including consideration for medical interventions (e.g., pubertal suppression, hormone therapy, gender affirming surgery) — is completed with interdisciplinary teams, following established guidelines, and only with the assent of the youth.
As signatories to this letter, it is our position that all children should be able to express their gender identity without fear of rejection. Supporting transgender children and children who are expressing a different gender than expected includes providing opportunities for the child to explore their gender identity freely. This can include facilitating a social transition where a child is able to live in the gender role that is most authentic to that child. This usually includes a new name, pronouns, attire, hair length and/or style in order to present as their self-identified gender. Parents are also encouraged to seek gender affirming medical and mental health care services from experienced providers to support their child’s healthy development and wellbeing.
This gender affirming model of care is based on the latest scientific evidence which demonstrates that family acceptance of a child’s gender identity and providing gender-affirming care are associated with improved well-being and mental health including reductions in symptoms of depression, anxiety, and suicidality. Children who experience negative family and caregiver responses of indifference, rejection, and/or attempts to change their gender identity or expression are more likely to experience negative psychological and social outcomes including depression, anxiety, suicidality, substance abuse, as well as heightened risk of lower educational attainment and homelessness.
The signatories of this statement support parents’ rights to support their child’s gender identity and access gender affirming care for their child without fear of Child Protective Services’ (CPS) involvement. It is a CPS mandate that they must act in the best interest of all children, which also means protecting the rights and needs of children including needs of gender expression. We also oppose any efforts to restrict the ability of healthcare professionals to provide care consistent with established standards and best practice guidelines, or the ability of parents to access and consent to such care for their child.
- American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832-864.
- Anton, B. S. (2009). Proceedings of the American Psychological Association for the legislative year 2008: Minutes of the annual meeting of the Council of Representatives. American Psychologist, 64, 372–453. doi:10.1037/a0015932
- Austin, A., Craig, S. L., Alessi, E. J., Wagaman, M. A., Paceley, M. S., Dziengel, L., & Balestrery, J. E. (2016). Guidelines for transgender and gender nonconforming (TGNC) affirmative education: Enhancing the climate for TGNC students, staff and faculty in social work education. Alexandria, VA: Council on Social Work Education.
- California Academy of Family Physicians. (2019). Principles for the Protection and Care of Transgender and Gender-Expansive Patients. https://cafponcloud.egnyte.com/dl/93sD0J8k9J/
- Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., ... & Monstrey, S. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism, 13(4), 165-232.
- De Vries, A. L. C., McGuire, J. K., Steensma, T. D. , Wagenaar, E., Doreleijers, T., Cohen-Kettenis, P. T. (2014). Prospective young adult outcomes of puberty suppression in transgender adolescents, Pediatrics, 134, 696-704. doi:10.1542/peds.2013-2958
- Ehrensaft, D., Giammattei, S. V., Storck, K., Tishelman, A. C., & Keo-Meier, C. (2018). Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. International Journal of Transgenderism,19(2), 251-268.
- Gottlieb, A. R., & Lev, A. I. (Eds.). (2019). Families in Transition: Parenting Gender Diverse Children, Adolescents, and Young Adults. Columbia University Press.
- Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., ... & T’Sjoen, G. G. (2017). Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(11), 3869-3903.
- Hunter, S., & Hickerson, J. (2003). Affirmative practice: Understanding and working with lesbian, gay, bisexual, and transgender persons. NASW Press.
- Jacob, J. A. (2015). Conversion therapy ineffective and inappropriate for LGBTQ youth. JAMA,314(20), 2121-2121.
- Keo-Meier, C. E., & Ehrensaft, D. E. (2018). The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children(pp. xii-226). Washington DC, US: American Psychological Association.
- Kuvalanka, K. A., Weiner, J. L., & Mahan, D. (2014). Child, family, and community transformations: Findings from interviews with mothers of transgender girls. Journal of GLBT Family Studies, 10, 354-379. doi: 10.1080/1550428X.2013.834529
- National Association of Social Workers National Committee on Lesbian, Gay, Bisexual, and Transgender Issues. (2015). Sexual orientation change efforts (SOCE) and conversion therapy with lesbians, gay men, bisexuals, and transgender persons. https://www.socialworkers.org/LinkClick.aspx?fileticket=IQYALknHU6s%3d&portalid=0
- 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), e20153223
- Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267.
- Rafferty, J., & Committee on Psychosocial Aspects of Child and Family Health. (2018). Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics, 142(4), e20182162.
- Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health,63(4),503-505.
- Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791-793.
- Telfer, M. M., Tollit, M. A., Pace, C. C., & Pang, K. C. (2018). Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. Medical Journal of Australia, 209(3), 132-136.
- Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2019). Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults. JAMA Psychiatry, 1-9. doi: 10.1001/jamapsychiatry.2019.2285. [Epub ahead of print]
Health organizations who have signed on:
Supporting and providing access to gender affirming care for transgender children promotes health and well-being. It is not child abuse. This approach is recommended by the prevailing standards of care, best practices, and guidelines endorsed by local, national and international professional organizations.
- Endocrine Society
- Fondazione Genere Identità Cultura
- Pediatric Endocrine Society
- Trans Resilience Project
- World Professional Association for Transgender Health
- World Association for Sexual Health
- American Academy of Pediatrics
- American Association of Sexuality Educators, Counselors and Therapists
- American Dance Therapy Association
- American Family Therapy Academy, Inc
- American Public Health Association LGBTQ Health Caucus
- Asian American Psychological Association
- Asian American Psychological Association Division on LGBTQQ Issues
- Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling
- Australian Professional Association for Trans Health
- Child Welfare League of America
- GLMA: Health Professionals Advancing LGBTQ Equality
- Kaiser Permanente
- National Center for Gender Spectrum Health
- National Association of School Psychologists
- National Association of Secondary School Principals
- National Association of Social Workers
- National Council on Family Relations
- National Latinx Psychological Association
- National LGBT Cancer Network
- National Partnership to End Interpersonal Violence Across the Lifespan
- Orgullo Latinx: Sexual Orientation and Gender Diversity, National Latinx Psychological Association
- Physicians for Reproductive Health
- Planned Parenthood Federation of America
- Psychoanalysis for Pride
- Queer and Trans Advocacy Network, American Association for Marriage and Family Therapy
- Reproductive Health Access Project
- School Social Work Association of America
- Society for Community Research and Action, Division 27 of the American Psychological Association
- Society for Adolescent Health and Medicine
- The Gender Dysphoria Affirmative Working Group
- Trans Lifeline
- US Professional Association for Transgender Health
Texas Based Organizations:
- Borderland Rainbow Center
- Doctors for Change
- Hogg Foundation for Mental Health
- Legacy Community Health
- the Montrose Center
- National Alliance on Mental Illness - Texas
- National Association of Social Workers – Texas Chapter
- the Resource Center - Dallas
- Texas Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling
- Texas Counseling Association
- Texas Counselors for Social Justice
- Texas Pediatric Society
- Texas Transgender Nondiscrimination Summit
- Texas Psychological Association
- University of Houston Graduate College of Social Work
- University of Texas Southwestern Medical Center and Children’s Medical Center
Other State Organizations:
Other State Based Groups:
- Arizona Psychological Association
- DBT Center of Arizona Lavender Clinic
- El Rio Community Health Center
- Pridecorps LGBTQ Center
- California Academy of Family Physicians
- Central Coast Psychological Association
- Children's Hospital Los Angeles
- Counseling and Support Services for Youth
- Gay and Lesbian Alliance of the Central Coast
- Tranz Central Coast
- University of California San Diego
- University of California San Francisco Child and Adolescent Gender Center
- West County Health Centers
- Connecticut Children's Medical Center
- Council of Administrators of Special Education
- Mercer Family Therapy Center
- Ann & Robert H. Lurie Children's Hospital of Chicago
- University of Iowa Adolescent Clinic
- University of Iowa Stead Family Children’s Hospital
- Chase Brexton Health Care
- Baystate Health
- Boston Children's Hospital
- Boston Medical Center
- Massachusettes General Hospital Transgender Health Program
- The Fenway Institute
- William James College
- MassGeneral Hospital for Children
- Family Tree Clinic
- Program in Human Sexuality, University of Minnesota Medical School
- The Gender Wellness Center, Bassett Healthcare Network
- Callen-Lorde Community Health Center
- Einstein Healthcare Network
- NYU Langone Medical Center
- The Gender and Family Project at The Ackerman Institute for the Family
- Psychotherapy Center for Gender and Sexuality
- University of Rochester Medical Center
- Duke Child and Adolescent Gender Care
- University of North Carolina Psychiatry Gender Equality Initiative
- University of North Carolina School of Medicine
- University of North Carolina Pediatric and Adolescent Clinic for Gender Wellness
- North Carolina Counseling Association
- Charlotte Transgender Healthcare Group
- The Physicians Action Network
- Anchored Behavioral Health Consulting
- Diversity Center of Oklahoma Inc.
- University of Oklahoma Children's Hospital
- TransActive Gender Project at Lewis & Clark Graduate School
- Oregon Health & Science University
- Legacy Health
- Children’s Hospital of Philadelphia Gender and Sexuality Development Clinic
- The Children’s Hospital of Philadelphia
- Mazzoni Center
- Einstein Healthcare Network
- Alpert School of Medicine, Brown University
- Rebirth OBGYN
- American Academy of Pediatrics Vermont Chapter
- The University of Vermont Children's Hospital - Transgender Youth Program
- Ingersoll Gender Center
- The Evergreen Clinic
- Country Doctor Community Health Centers
- UW Medicine
- American Family Children's Hospital, UW Health
- Children's Wisconsin
- Trans Research Lab, Department of Counseling Psychology, University of Wisconsin-Madison