Research has shown that living authentically improves mental health outcomes for transgender and gender-nonconforming (TGNC) individuals (Fredriksen-Goldsen et al., 2011; Riggle, Rostosky, McCants, & Pascale-Hague, 2011). We see helping TGNC people live authentically as part of fulfilling the American Psychological Association’s mission to use psychological knowledge to improve people’s lives.

TGNC individuals have the opportunity to transcend the socially defined gender binary, developing a unique perspective of what it means to be male and female. Those who come out report feelings of freedom, enhanced personal relationships, a greater connection to the LGBT&Q communities, a higher level of political activism, and an enhanced sense of self. Being transgender or gender-nonconforming represents a unique experience that may bring benefits not experienced by others (Riggle et al., 2011).

Most health insurance policies require TGNC individuals to obtain referral letters from mental health professionals in order to receive coverage for hormone replacement therapy (HRT) and gender-affirming medical procedures (Grant et al., 2010). The World Professional Association for Transgender Health (WPATH) requires that letters include the results of a mental health screening. Our staff will be available to work with you through your process. At our clinic, the collaborative development of a letter for medical providers entails the following steps:

• Schedule an initial one-hour consultation with a clinician to discuss your needs and goals.
• Complete a two-hour assessment, which includes a structured clinical interview and a mental health evaluation. Information gathered during the consultation and evaluation can be incorporated into the letter.
• Meet individually with the therapist to write the letter together. This usually takes about two additional hour-long sessions, but may require more.

Living out an authentic gender expression can pose practical and psychological challenges due to social and systemic factors, which can contribute to distress. Though not a requirement for obtaining a letter, WPATH strongly recommends participation in psychotherapy. Studies have found that TGNC individuals have a number of increased risks:

• Family rejection (Gay and Lesbian Medical Association, 2010; Grant, Koskovich, Frazer, & Bjerk, 2010)
• Stress (Riggle et al., 2011)
• Depression (Cook-Daniels & Munson, 2010; Fredriksen-Goldsen et al., 2011; Nuttbrock et al., 2015)
• Suicidality (Fredriksen-Goldsen et al., 2011; Hatzenbuehler, Phelan, & Link, 2013)
• Substance use disorders (Fredriksen-Goldsen et al., 2011; Mayer et al., 2008)
• Sexual trauma (Grant et al., 2011)
• Discrimination (Grant et al., 2011; Reed, Franks, & Scherr, 2015)
• Hate crime victimization (Fredriksen-Goldsen et al., 2011; FBI, 2015).

In addition to providing gender-affirming psychological care, we can address other mental health concerns you might have, including depression, anxiety, eating disorders, and OCD. Whether you’re seeking a letter for medical providers or need help with a mental health concern, our staff has the training and expertise to address your needs.