APA's Position on Gender-Affirming Psychological Care for Minors

May 12, 2026

Overview

Our position on psychological care for transgender, gender-diverse, and nonbinary minors rests on four principles:


  • Comprehensive, individualized psychological assessment without assuming or imposing a predetermined pathway.
  • Full parental and family involvement in the evaluation and decision-making process for minors.
  • Transparent informed consent that discloses the current state of the evidence, including uncertainties.
  • Professional ethics and a clear scope of practice — psychologists provide psychological assessment and care; decisions about medical interventions rest with medical professionals, patients and their families.


APA's position has held for more than a decade that access to qualified psychological care is essential for gender-diverse minors, who face elevated rates of depression, anxiety, and suicidal ideation — risks that are frequently exacerbated by discrimination, stigma, and minority stress.



Barriers to accessing mental health care for this population are a public health concern. Psychological support constitutes an evidence‑based service with intrinsic public health value and does not presume or require medical interventions.


APA's 2015 Guidelines for Psychological Practice with Transgender and Gender Nonconforming People and our September 2025 APA Services, Inc. (APASI) comment letter to the Federal Trade Commission reflect our ongoing commitment to individualized, evidence-based psychological care. A 2024 policy statement adopted by APA’s Council of Representatives addressed a broader set of concerns, including access to psychological and medical care. APA's core position, grounded in the 2015 Guidelines, has remained constant: psychologists provide careful, individualized assessment and support. This approach prioritizes structured engagement grounded in empathy and science, offering a safe environment for emotional processing and understanding.

APA's Position

Scope of practice

APA is the professional and scientific organization for psychology. APA Services, Inc. is a companion professional organization to APA serving members and advocating for psychology professionals. Our expertise — and the scope of our guidance — is psychological care: assessment, therapeutic support, evidence-based psychological practice, research, and the training and ethics of psychologists. Decisions about pharmacological and surgical interventions, including puberty suppression, hormone therapy, and surgical procedures, fall within the scope of medical specialties. Questions about those protocols are appropriately directed to the relevant medical professional organizations.


Other professional organizations, including the American Medical Association and the American Society of Plastic Surgeons, have recently issued their own statements advising that surgical interventions for minors be generally deferred to adulthood due to limited evidence. APA/APASI continues to focus on the role in which the profession has distinct expertise and scope of practice: psychological care.


Psychological care for gender-diverse minors

Gender-affirming care is not a synonym for medical transition. It is a framework for careful, individualized assessment and support — helping youth and families explore identity, understand the range of options available, and make decisions over time. One reason a young person may seek psychological care is gender dysphoria — a clinical term describing the distress that can arise from incongruence between a person's gender identity and their sex assigned at birth. This is distinct from transgender identity itself. The need for psychological assessment and care may also arise from a young person's self-identification or a family's concerns. In either case, a referral to a psychologist is a starting point for care— not an automatic pathway to social transition, medical intervention, or any other predetermined outcome.


Psychologists are trained to conduct individualized, comprehensive, multi-dimensional evaluations that consider a young person's developmental stage, family and social context, co-occurring mental health or neurodevelopmental conditions, and the effects of stigma, discrimination, and minority stress.  Competent psychological practice is designed to support young people — meeting them where they are. Screening for co-occurring conditions is a hallmark of competent psychological practice, not a dismissal of a young person's expressed identity. APA's 2024 policy statement addressed the political mischaracterization that all gender-diverse youth have trauma or neurodivergence; the clinical obligation to evaluate each young person's full presentation individually, including the possibility of co-occurring conditions, is a separate and complementary principle.


The role of parents and families

APA upholds the essential role and legal rights of parents and caregivers in directing the course of a minor's care. In clinical practice, psychologists commonly support both children and their families through a thoughtful, developmentally informed process of exploration and self-identification. Clinical care emphasizes comprehensive evaluation and support to parents or caregivers for tolerating ambiguity and uncertainty, taking care not to prematurely foreclose developmental pathways. Psychologists typically engage parents with empathy and acknowledge the fear and responsibility they may experience, providing a supportive environment for family reflection, decision-making, and open communication regarding the minor’s identity development over time. This reflects both APA's guidelines and long-established standards of psychological practice with minors.


Informed consent and the current evidence base

Psychologists are required to provide informed consent that fully discloses the current state of the scientific evidence, including limitations and uncertainties, for any assessment or intervention within their scope. APA recognizes that the evidence base varies across different types of care. The evidence supporting psychological assessment and mental health treatment for gender-diverse minors — including care for co-occurring depression, anxiety, and the effects of minority stress — is well-established. Recent systematic reviews, including the Cass Review (2024), have prompted international reevaluation of certain medical protocols for minors. APA supports continued rigorous scientific inquiry.

Conclusion

APA is dedicated to promoting dignity and access to quality, individualized, evidence-based psychological care for transgender, gender-diverse, and nonbinary children and adolescents, and adults, and for increased public accessibility to accurate information grounded in clinical and psychological science. Gender-affirming care for these populations should be noncoercive, adaptive to, and centered on the needs of the individual receiving care and rooted in psychological and clinical science.


APA also affirms that parents and guardians play an essential role in ensuring the well-being of children and adolescents experiencing gender-related concerns, including their involvement in healthcare decision-making. Psychologists are trained to provide comprehensive informed consent that fully discloses the current state of scientific evidence, including limitations or uncertainties, to ensure that parents, guardians, and minor patients are fully informed about potential risks and benefits of various therapeutic approaches and any alternative approaches available for addressing gender dysphoria and related concerns. 



The 2015 APA guidelines are psychological practice guidelines, not medical treatment protocols. The guidelines are not medical standards of care and do not address medical or surgical treatment protocols. APA practice guidelines are issued with the understanding that psychologists must follow the ethics of their profession. 


APA is committed to transparent engagement. Our public positions, including our 2015 Guidelines, 2024 policy statement and 2025 APASI FTC comment letter, are available in full. 


APA opposes legislative or regulatory actions that restrict access to psychological assessment and mental health care for gender-diverse youth. Questions about the regulation of specific medical interventions for minors involve considerations of medical evidence and patient safety that are appropriately addressed by medical professional organizations and the relevant regulatory authorities.