Notably, the World Health Association (WHO) and the upcoming ICD-11 have declared that gender dysphoria is no longer a mental health disorder and is now called gender incongruence https://www.who.int/health-topics/gender# . However, the current diagnosis/symptoms as they exist in the DSM-V for gender dysphoria are a “marked incongruence between one’s experienced/expressed gender and their assigned at birth gender of at least 6 months.” These symptoms also have been insistent (e.g., informing others to use pronouns), consistent (e.g., the client presents/insists their gender in multiple contexts-school, work, home), persistent (e.g., insists gender over time).

The role of a mental health provider is to support a client who is exhibiting gender dysphoria through assessment of general mood, body dysphoria, self-esteem, and behavioral concerns. The initial evaluation is to determine if the client needs any additional therapy above-and-beyond supporting their gender journey. The provider can then initiate evidence-based therapy for any other issue and supportive therapy for gender exploration—if needed. A mental health provider supports the client in discovering/exploring their gender to cope with any type of transition that the client decides to make. This can include medical interventions, such as hormones, surgical interventions, and support in the client’s transition in all relevant contexts (e.g., work, family, friends, school, etc.).

Many medical interventions currently require an assessment or gender evaluation by a mental health provider who has extensive specified training in gender health. These evaluations have previously been called a “readiness evaluation.” These evaluations are meant to support the client’s informed consent (i.e., the risks/benefits) and in assessing the client’s gender as insistent, consistent, and persistent. This evaluation is NOT meant to place the provider as a “gate keeper” or a barrier to medical care (e.g., a client can be depressed and still receive their hormones). During the gender evaluation we will cover four areas:

1. Gender Journey/Psychological Concerns— the client shares their gender experience over the course of their lives and when/what they have done to transition (if they have) and their current gender identity. The provider will also assess any other mental health concerns that may place the person at risk for some of the effects from the medical interventions (e.g., emotional reactivity).
2. Medical Adherence— the client’s ability to adhere to a medical regimen (e.g., take medications as    prescribed,      follow the post-surgical plan, any identified support people in their lives to help them). The client will also share their pre/post-surgical plans.
3. Risks— the client’s understanding of the risks of the medical intervention and any thoughts/plans for irreversible consequences (e.g., sterility, voice change). The provider can also refer the client to a medical provider in gender health who can support any questions/concerns about risks.
4. Realistic Expectations/Benefits— the client shares their expectations associated with the medical intervention. If the client shares unrealistic expectations a mental health provider can support the client with any disappointment and refer them to a medical provider in gender health who can support any questions/concerns about what they are hoping to achieve.

Upon completion of the assessment the writer will provide a letter to the client that reviews the evaluation in all four areas. The client can then share the letter with whomever they choose, and/or with a “release of information” form signed by the client, the mental health provider can then submit the letter on the client’s behalf to any medical provider who the client has provided consent.