Working With Transgender and Gender-Nonconforming Youth

Working With Transgender and Gender-Nonconforming Youth

Like all young people in care, transgender and gender-nonconforming (TGNC) youth are entitled to bias-free attention to their unique needs and to be safe in their placements and services. They should be supported in their gender identity and never required to conform to gender stereotypes in order to receive appropriate care. Professionals who work with TGNC young people should be educated about transgender issues and prepared to work sensitively with these clients. Knowledge about lesbian, gay and bisexual issues may be helpful in working with transgender young people, but gender identity issues may be very different from issues related to sexual orientation.

Know what it means to be TGNC and use the term appropriately.

Transgender is an umbrella term used to describe people whose gender identity, one’s inner sense of being male or female, differs from the sex assigned to them at birth. Gender-nonconforming people are people whose gender expression, the outward communication of gender through behavior or appearance, differs from expectations associated with the sex assigned to them at birth. Transgender girls are people who were assigned the sex of male at birth but identify as female. Transgender boys are people who were assigned the sex of female at birth but identify as male. Everyone has both a sexual orientation and a gender identity. Gender identity is different from sexual orientation. Transgender people may identify as heterosexual, lesbian, gay, bisexual or questioning.

Educate yourself on gender identity disorder.

The incongruity between people’s internal sense of self as either male or female and the sex assigned to them at birth can lead to depression and severe emotional distress. When these feelings rise to clinically significant levels, a person may be diagnosed as having gender identity disorder (GID) or gender dysphoria, a medical condition recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Treatment of GID is focused on providing support, not changing a person’s gender identity. It may include services like individual and family counseling and medical care such as hormone therapy and perhaps surgery to align the physical body with the internal sense of self as male or female.

When transgender people are able to express their gender identity, they are better able to lead happy, fulfilled lives. As a result, some people oppose the classification of transgender identity as a disorder, while others recognize the advantages of having explicit standards of health care for transgender individuals. In any case, transgender youth need to be supported, affirmed and safe and free to express their identities.

Be aware of health care protocols for transgender individuals.

The World Professional Association for Transgender Health ( has developed internationally recognized protocols for diagnosing and treating youth and adults with GID. Each patient must be evaluated on a case-by-case basis, with expert medical judgment required for both reaching a diagnosis and determining a course of treatment. There is not set formula for gender transition. These protocols recommend that transgender young people gain real-life experience through dressing in the clothes and using names and pronouns associated with their gender identity. Young people may be individually assessed as candidates for medical treatment to enable them to align their bodies with their gender identity.

Allow TGNC youth to express their gender identity.

Young people should be able to express their gender identity through their chosen attire, hairstyles, names, mannerisms and other physical presentations without punishment or ridicule. Don’t assume that TGNC youth are “acting out” when they express their gender identity. The clothing and personal style that an individual chooses are important aspects of self-expression. And, it could be a critical part of a young person’s gender transition to live in accordance with their gender identity, according to the medical community. Support TGNC youth in these choices and challenge restrictive policies that may not allow such freedom.

Treat information about a youth’s gender identity as confidential to ensure privacy.

Professionals have a legal responsibility to protect confidential information regarding youth in their care. This includes information about a youth’s gender identity. At times, disclosure to foster parents, school faculty or other child welfare professionals may be necessary, such as when making decisions about a youth’s housing, bathroom use, showering or health and mental health services. However, such disclosure should not be made without first obtaining the youth’s permission.

Use young people’s preferred names and pronouns.

Respect TGNC young people’s preferred names and gendered pronouns that best reflect their sense of self as female or male. By doing so, you validate their identity and sense of self-worth. If you’re unsure which pronoun an individual youth prefers, ask sensitively rather than simply making assumptions.

Protect TGNC youth from physical and emotional abuse.

TGNC youth are often at increased risk for abuse and violence by adults or other youth. Be clear that transphobic language, bias and bullying will not be tolerated, and respond to such behavior with swift and appropriate consequences. Model accepting and affirming behavior for all youth in your care.

Ensure that TGNC youth have access to trained and affirming medical and mental health care providers.

Advocate for transgender youth to receive competent and affirming mental health and medical services, including access to monitored use of hormones if deemed medically appropriate. In its official position statement affirming access to appropriate medical care for transgender people, the American Psychological Association states, “Significant and long-standing medical and psychiatric literature exists that demonstrates clear benefits of medical and surgical interventions to assist gender variant individuals seeking transition.”

When youth don’t have access to the health care services they need, they may resort to buying hormones on the streets, which can lead to injury. Transgender youth may also engage in dangerous or illegal behaviors to pay for these services.

Make room assignments and housing decisions based on the well-being of individual youth.

In sex-segregated facilities, don’t assign transgender youth to the girls’ or boys’ units strictly based on the sex assigned to them at birth. Instead, make individualized, case-by-case decisions based on the physical and mental well-being of the youth, their level of comfort and safety, the degree of privacy afforded, the types of housing available and the recommendations of qualified mental health professionals. The safety of transgender youth should be protected without resorting to isolating or segregating them from the general population. However, single occupancy rooms in the unit that matches the young person's gender identity, if available, may be an acceptable alternative for transgender youth in sex-segregated facilities depending on that person's specific situation.

Provide transgender and gender-nonconforming youth with privacy, safety and respect.

Respect a young person’s transgender status as private, confidential medical information. Some young people may not be “out.” Anti-transgender harassment and discrimination are realities, and staff should take action to protect the privacy and safety of young people in their care.

Be prepared to make accommodations for transgender youth regarding bathroom use and showering. In these situations, the comfort and physical safety of the youth must remain an utmost priority. Allow transgender youth to shower in privacy, at a time set apart from other youth, and to use the bathroom that corresponds with their gender identity. If this option makes youth feel unsafe, they should be given access to a private, single-user bathroom.

Ensure that TGNC youth are safe in their placements and schools.

Identify and monitor appropriate placements for TGNC youth that ensure their safety and provide support. Educate others involved in the placement, including child welfare and juvenile justice professionals, other youth and foster parents, to create an environment that is accepting and respectful of TGNC youth. In situations where sleeping arrangements are dictated by gender, create an individualized housing plan that takes into account the youths’ wishes as well as their physical and mental well-being. TGNC youth often face serious safety challenges at school. It is important that TGNC youth be placed in schools that will affirm their identities. Be prepared to advocate on behalf of TGNC youth to ensure that their gender identity is respected. Work with school staff to address use of names and pronouns, clothing and grooming options, bathroom and locker room use and other accommodations.

Avoid assumptions about TGNC young people’s sexual orientation.

Sexual orientation is separate and different from gender identity. TGNC young people may identify as heterosexual, gay, lesbian, bisexual or something else. Learn to differentiate between sexual orientation and gender identity and to comfortably use relevant terminology. Understand that sexual orientation and gender identity are aspects of a person’s core understanding of themselves.

Provide TGNC-friendly role models and mentors.

TGNC youth, like all youth, need connections to adult role models and mentors. For TGNC young people in out-of-home care systems, these positive connections can be harder to find but are nonetheless crucial for their healthy development. Frequently cut off from their families of origin, and part of a misunderstood minority, TGNC young people can find a sense of family and belonging from mentors and community role models.

Locate and develop resources to help TGNC young people with unique legal issues.

TGNC young people may need assistance and advocacy to obtain proper legal identity documents like birth certificates, state identification cards and driver licenses that reflect the gender with which they identify. They may also need help to obtain legal name changes. Child welfare systems have the responsibility to locate and help develop these resources for TGNC young people in their care.

Provide support in finding employment.

TGNC youth face especially steep barriers to employment. Finding employment is even more complicated for those transgender youth whose identity documents do not match their chosen names and gender expression. Without adequate educational and job training opportunities, they’re at a further disadvantage. TGNC young people aging out of child welfare systems can be left with few options other than to engage in illegal and harmful activities in order to survive. Meaningful opportunities should be offered to transgender young people for education, job training and legal employment.

For more information about transgender people and their rights, consult Lambda Legal’s Transgender Rights Toolkit.

Adapted from Getting Down to Basics: Tools to Support LGBTQ Youth in Care, Child Welfare League of Am. & Lambda Legal (2006, revised 2012). This and other fact sheets for adults who work with or care for youth in out-of-home settings are available at


Jack Drescher & Ellen Haller, APA Caucus of Lesbian, Gay & Bisexual Psychiatrists, Position statement on Access to Care for Transgender and Gender Variant Individuals (2012), available at


Jody Marksamer, Dean Spade & Gabriel Arkles, Nat’l Ctr. For Lesbian Rights & Sylvia Rivera Law Project, A Place of Respect: A Guide for Group Care Facilities Serving Transgender and Gender Nonconforming Youth (2011), available at