As a clinician, I promote and practice the informed consent model for gender affirming care. More information about this model is available at www.icath.org. Like other ICATH professionals, I believe that trans people should have the right to make informed decisions about their care, without mental health professionals serving as gatekeepers. To act as a gatekeeper to care is to reinforce the perception that being trans is a mental illness. It is not. Being trans is an identity, one that is particularly stressful in a world that pathologizes and attacks gender nonconformity. Part of my commitment as a mental health professional to "do no harm" means that I do not endorse pathologizing trans identity and experience.
The experience of questioning your gender and/or navigating gender transitions can be confusing and terrifying. Anyone questioning their gender deserves a supportive, non-judgmental space that affirms a variety of gender expressions and identities. Requirements for a therapist's letter to access HRT and surgery too often keep transgender people unable to access real counseling--the sense of being in a space where you can share your whole complicated experience, a space where you don't have to tell the "right narrative" in order to have the right to make medical decisions about your own body. When I write letters advocating for my clients to receive gender affirming care, I always do so with the caveat that I do not think they should have to ask for my approval for their informed health care decisions.