Cover of Dr. Jack Turban's new book Free to Be

A Q&A with the Director of the Gender Psychiatry Program at the University of California, San Francisco.

Dr. Turban, I had the great honor of having you on our advisory board when I was running The Upswing Fund for Adolescent Mental Health, a philanthropic fund where we funded nearly 100+ youth mental health organizations focused on supporting adolescents of color and LGBTQ+ teens. What impact do you think local community-based organizations can have for trans and gender diverse adolescents? 

The UpSwing Fund was such a spectacular opportunity at a much-needed time, when minoritized youth were struggling with their mental health after the pandemic. One of the things I loved about our approach there was that we were meeting young people where they were. Due to a range of factors (not enough pediatric mental health providers, poor insurance coverage, fear that providers won’t be affirming, etc.), LGBTQ youth often don’t make it to formal mental health treatment settings. Community-based organizations can be essential in getting those kids support.In gender psychiatry, we also think a lot about the minority stress framework, which explains how societal stigma negatively impacts mental health for LGBTQ kids. Research on that model has shown that one of the most powerful ways to combat stigma-related mental health challenges is community connectedness. Knowing other queer people and spending time with them is incredibly protective for one’s mental health.

What should our audience of health plans know about providing gender-affirming medical and psychological care?

The number one thing I would remind people of is that mental health providers are essential for this care. While gender-affirming medical interventions are consistently linked to improved mental health, they are just one domain of needed supports. Non-medical supports are also essential. In addition to that, under current guidelines, adolescents cannot access gender-affirming medical interventions without an evaluation by a mental health provider. The problem is, very few mental health providers are trained to do this work. And due to how difficult it is for them to work with insurance companies, most don’t. This creates devastating disparities in which only wealthy families are able to access care for their children. It’s absolutely essential that insurance plans work to make it easier for these clinicians to take insurance, and that they proactively reach out to get them on their panels.

What advice do you have for employers who want to support their employees and their dependents who are navigating gender identity?

Again, providing an excellent health plan that covers the range of care trans youth need (including mental health care with an adequate provider network) is essential. But also, any initiatives to work on pride-building (reminding queer people that they are respected and valued) and community connectedness (bring queer people together in community to feel less alone) are incredibly helpful.

Finally, for the digital health entrepreneurs in the audience, is there an opportunity for technology to support better access to gender affirming tools and resources? 

I think everyone in the mental health field is exciting at the prospect of digital resources improving access to care for people. One thing that has come up in the field of transgender healthcare is that standard mental health treatments (e.g., cognitive behavioral therapy for social anxiety) were designed for cisgender populations and haven’t been adapted and tested for transgender populations. A lot of us would love to see digital health companies building therapy platforms that are tailored to trans youth, then rigorously tested through clinical trials.