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Transgender and Gender Non-Conforming Children


Working with transgender and gender non-conforming (TGN) children and adolescents requires much knowledge and awareness. They may experience severe mental health conditions, lack support from their family, and show suicidal behavior. This paper discusses the issues a psychiatric mental health nurse practitioner (PMHNP) should be aware of when interacting with such patients. It describes the possible implications for practice and suggests the strategies a care provider should use to provide a safe environment for youth.

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Identification of Major Issues and Rationale for Issues

Working with TGN children and adolescents may be both rewarding and challenging. There are several issues that a PMHNP should address to ensure the best quality of care. First, it is vital to understand that TGN individuals are in need of help and support as they experience the issues many other children and adolescents never encounter. Often, they cannot disclose their identities to their friends and families because of the fear of being rejected.

Second, as many TGN young people experience the lack of support from their parents, they may show depressive symptoms and suicidal thoughts, which should be addressed to prevent possible adverse outcomes. Guss, Shumer, and Katz-Wise (2015) note that an individual’s relationships with their family members may be one of the primary aggravators for their mental state. Moreover, it is crucial to assess individuals’ risk for homelessness as TGN individuals’ families may reject their children due to their inability to accept their gender identifications.

The third issue a PMHNP should be aware of is potential substance abuse and its consequences. Guss et al. (2015) report that TGN adolescents may be at a higher risk of abuse due to bullying than non-TGN individuals. Finally, the major condition that should be addressed is gender dysphoria, which may result in high levels of anxiety, fear, and recurrent suicidal thoughts.

Implications for Practice

The significant barrier to care for TGN youth is the fact that their conditions are still under-discussed in the professional literature. Tishelman et al. (2015) note that many guidelines on working with TGN individuals do not focus on the issues related to young people specifically. It means that PMHNPs should develop an individualized approach to any child or adolescent based on their conditions, relationships with family, and the presence of aggravating factors, such as bullying or suicidal thoughts.

It is vital for a care provider to avoid the actions that may enhance individuals’ gender dysphoria. For example, PMHNPs should ask their patients whether they have a preferred pronoun. Moreover, PMHNPs should know the terminology related to TGN youth, which includes, for example, such terms as genderqueer, transition, and male-to-female (Tishelman et al., 2015). Finally, it is vital for nurses not to insist that a TGN person should change their identity. A nurse practitioner should be aware that this condition is not a person’s choice.

It is vital for care providers to create a safe and welcoming environment for patients to establish trust-based relationships and ensure that individuals’ needs for support and care are met. If a person shows signs of suicidal behavior, a PMHNP should consider referring them to a psychiatrist or psychologist. It is also crucial to note individuals’ behavior, including eye contact, voice, and motor activity (Western Australian Clinical Training Network, 2016). These signs can provide additional information about the patient’s attitude, thoughts, and mental state.

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There are many issues PMHNPs should be aware of when working with TGN youth. They include gender dysphoria, the lack of support from individuals’ families, substance abuse, bullying, and suicidal thoughts or behavior. To address these issues, it is vital for a nurse practitioner to ensure a welcoming environment for the patient, know the related terminology, and understand the needs of TGN individuals to feel valid.


Guss, C., Shumer, D., & Katz-Wise, S. L. (2015). Transgender and gender nonconforming adolescent care: Psychosocial and medical considerations. Current Opinion in Pediatrics, 26(4), 421-426.

Tishelman, A. C., Kaufman, R., Edwards-Leeper, L., Mandel, F. H., Shumer, D. E., & Spack, N. P. (2015). Serving transgender youth: Challenges, dilemmas, and clinical examples. Professional Psychology: Research and Practice, 46(1), 37-45.

Western Australian Clinical Training Network. (2016). Simulation scenario – Adolescent risk assessment. Web.

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