What is it about?

This article discusses the history of mental health providers and transgender people from the start of U.S. gender clinics. It includes histories of attempts to "cure" people of being trans, efforts to "prevent" people from being trans through gender identity change efforts in children (often called "conversion therapy"), and clinic criteria that often enforced gender stereotypes. It looks at what early criteria for access to gender-affirming care mental health providers talked about and why they chose the criteria that eventually became part of professional guidelines.

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Why is it important?

Mental health assessment with trans individuals originally developed in a particular historical and cultural context. Understanding how assessment criteria were developed and why can provide important context for the ongoing use of mental health provider assessment for access to gender-affirming medical care. Historically, restrictive assessment practices have been linked to broader ideas that gender-affirming care should be limited and justified as a "last resort."


I conducted this archival research to better understand what criteria mental health providers originally used to determine who could transition and why they chose these criteria. What was their historical context? What has changed over time? How can psychologists be aware of these histories and avoid harm when working with this marginalized population?

Elliot Marrow
University of Massachusetts Boston

Read the Original

This page is a summary of: “I hope that as our selection becomes more accurate, the number … will be very few”: The creation of assessment criteria for gender-affirming care, 1960s–1980s., Psychology of Sexual Orientation and Gender Diversity, April 2023, American Psychological Association (APA),
DOI: 10.1037/sgd0000633.
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