1. Supporting Transgender
Students’ Mental Health
Vermont Queer and Allied Youth
Summit
May 14, 2011
Morganne Ray
Director of Client Services
Outright Vermont

2. Reasons To Access
Mental Health Care
• Support in coming out or social
transition
• Sort out identities and feelings
• Access to medical transition
services
• Pressure from family or other
adults
• Any and all of the same reasons
every one else may choose to
access mental health care

3. Dominant Assumptions
• Trans youth might just be gay or
questioning
• Trans youth will later regret any
permanent changes made to their
body
• Trans people identify with the
opposite gender from an early age
• Trans people only seek therapy to
be allowed to transition
• Trans people hate the body they are
born with
• Trans people wish to fully transition
including hormones and all available
surgeries

4. Social Transition
• Allows the youth live as if physical
transformation had already taken
place, including:
– Using a new name congruent with
stated gender identity
– Switching gender pronouns
– Changing clothing and hairstyle to be
congruent with stated gender identity
– Adopting gender-specific behaviors
congruent with stated gender identity
• Clinically referred to as the “Real Life
Test” or the “Real Life Experience” and
requires that family, friends, school and
other social contacts be informed about
the wish for sex reassignment and the
intention to undergo gender transition.

5. Gender Identity Disorder
DSM-IV-TR Diagnostic
Criteria
A. A strong and persistent cross-gender
identification
B. Persistent discomfort with his or her sex or a
sense of inappropriateness in the gender role
of that sex. In adolescents and adults, the
disturbance is manifested by symptoms such
as preoccupation with getting rid of primary
and secondary sex characteristics or belief
that he or she was born the wrong sex.
C. The disturbance is not concurrent with a
physical intersex condition.
D. The disturbance causes clinically significant
distress or impairment in social, occupational
or other important areas of functioning.

6. Gender Identity Disorder
Diagnosis and Intervention
• gather information on early
development, current school
functioning, peer relationships and family
dynamics from family members
• ask about sexual
behavior, experiences, fantasies and
attractions
• Harry Benjamin Standards of Care require
that the therapist work with the youth for a
minimum of 6 months before writing a letter
recommending hormones. The frequency of
sessions is left up to the rapist, and sessions
are expected to continue throughout and
beyond medical transition.

7. Medical Transition Hormones
• Therapists and physicians usually
require a youth be 16 before
seeking hormones
• In order to receive
hormones, youth must:
– Have a strong cross-gender identity
from an early age
– Be psychologically relatively stable
– Live in a supportive environment
• Parental consent required

8. Medical Transition Surgery
• Therapists and physicians usually
require a youth be 18 before
seeking surgery, and must be
satisfied with the effects of
hormones
• 18 year old youth are required to
have two full years of “Real Life
Experience” before surgery may
be considered
• 19 year old youth are treated as
adults, and guidelines are slightly
more flexible

9. Who Is Left Out?
• Youth who are questioning their
gender identity
• Youth with a non-binary gender
identity
• Youth who do not want to
transition
• Youth who want to transition
without doctors
• Youth who have already
transitioned
• Youth who want to transition but
do not have the require support
systems

10. Barriers to Care
• Uneducated or unsupportive
providers
• Problematic guidelines and
diagnostic criteria
• Lack of familial support
• Lack of resources
– Time
– Transportation
– Insurance
• Negative previous experiences

11. What Can We Do?
• Always affirm the youth’s current
gender identity
• Allow the youth to share what
feels comfortable
• Help youth locate friendly
providers, and the resources
needed to access care
• Be available and supportive
• Trust the youth’s choices
• Educate others about the needs
of trans youth

12. Finding Friendly
Providers
• Ask for referrals and suggestions
from queer-friendly community
members
• Utilize provider lists through
resources like:
– Vermont Diversity Health Project
– Vemonters Ending Transgender
Oppression
– World Professional Association for
Transgender Health
• Check in with individual providers
• Let Outright know who you find!