I conduct gender-affirming assessments for individuals seeking gender-affirming services, such as hormone therapy or surgical interventions.

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What is a gender-affirming assessment? What are they used for?

Currently, the World Professional Association for Transgender Health (WPATH) has advised physicians that clients pursuing gender-affirming surgeries must have a letter from a mental health provider attesting to whether they meet several guidelines.

It is crucial to state that the role of a psychologist is not to tell an individual what their gender is. Rather, gender-affirming evaluations can provide documentation of gender dysphoria and an individual’s capacity to provide informed consent for gender-affirming treatment, such as surgery or hormone replacement. Recommendations can also be provided for obtaining support in the processes of psychological, social, and/or medical transition.

My approach to gender-affirming assessments

I take a non-pathologizing and non-generalizing approach and view these evaluations as a chance to learn about your “gender story,” which is unique to you. My aim is to support you in obtaining gender-affirmative care, not to serve as a gatekeeper for such services.

With young (pre-pubertal) children, gender-affirming assessments are conducted in the context of decision making about social gender transition.

In older children and adolescents, gender-affirming assessments are often sought when a child identifies as transgender or gender non-conforming and is seeking pubertal suppression, cross-gender hormone therapy, and/or gender-affirmation surgery.

In adults, gender-affirming assessments are likewise sought when an individual is seeking gender-affirming surgery or hormone treatment.

Gender-affirming assessments can help distinguish the relationships among gender diversity or dysphoria, emotional maturity, self-understanding, decision making, and psychological diagnoses or challenges. Specifically, they can help elucidate the degree of gender dysphoria and its impact on emotional functioning, as well as the stability and persistence of gender dysphoria over time.

The impact of co-occurring psychological challenges are explored, including whether they may impair the diagnostic understanding of gender dysphoria. An individual’s emotional maturity, strengths, and decision-making capacity around desired physical interventions are also taken into account. Practical matters, such as family support and potential school or peer issues, are explored and problem-solved. Finally, these evaluations help link individuals with community resources and social supports.

How long does the assessment take?

Assessments often occur over 2 to 4 sessions, during which we explore:

  • gender identity over time
  • expectations for medical interventions
  • degree of social support, particularly during pre- and post- intervention periods
  • mental health concerns (e.g., depression, trauma, anxiety)
  • sources of strength and resilience

With children and adolescents, the evaluation includes interviews with parents alone, children alone, and joint sessions. These evaluations may be conducted in person or virtually, via secure video conferencing.

What is included in the report?

Following the assessment, I provide recommendations to the client and family (if applicable), including, if appropriate, a letter or referral for medical transition.

Psychological treatment may be recommended if mental health concerns are identified. Family therapy may also be suggested, particularly if an individual is relying upon their family for support, and the family is not fully supportive.

With children and adolescents, I may provide recommendations for interventions within the school system, such as working with teachers or administrators on issues related to social transition.

Finally, I provide suggestions for peer support, including support groups, community meet-ups, and online meetings.

Do I need a referral?

No referrals are required for gender-affirming assessments.

Are gender-affirming assessments covered by insurance?

Insurance companies may reimburse for these evaluations, as they are medically necessary for gender-affirming medical interventions. However, each individual policy may differ, and clients should check with their insurance companies to determine level of coverage.