Preferred Name

Charles F. Shepard

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Graduate Psychology


Debbie Sturm

Robin Anderson

Amanda Evans


Transgender and gender-diverse (TGD) identity during the Twenty-first Century in the United States has been associated with pervasive patterns of mistreatment and discrimination across social, educational, occupational, legal, and healthcare experiences (Drescher, 2010; James et al., 2016; Stryker, 2008). Despite these trends, affirming stances toward TGD identity has been developing almost simultaneously tracing its roots to Christine Jorgensen’s transition in the 1950s. About a decade later, endocrinological interventions were pioneered that aimed to medically support TGD patients who wished to feminize or masculinize their bodies to be more congruent with their gender identity without surgery. These gender-confirming endocrinological interventions (GCEI) have been associated with positive physical and mental health outcomes and have been made available to people across the developmental life span from pre-puberty through late adulthood. However, nearly all of the research regarding GCEI has been conducted on adults. GCEI have been growing in popularity among TGD minors, but in the United States minors almost always need their parents or legal guardians to provide informed consent for GCEI. The literature on the long-term risks and benefits of GCEI on minors is ongoing but not complete. This leaves both TGD youth and their parents in a position to make meaningful decisions without a body of rigorous research to instill confidence in giving or denying consent. This qualitative grounded theory study is the first of its kind aimed at better understanding the decision-making process that parents and guardians of TGD youth go through when providing informed consent for the minor in their care to undergo GCEI. Using primarily intensive interviews supported by observational field notes and document review, this study examined the decision-making processes of a national sample of participants who identified as a parent or legal guardian of at least one TGD youth and who have given informed consent for the youth in their care to undergo GCEI. A variety of inhibiting and contributing factors were illuminated as well as a “dissonance to consonance” model that participants used to combine contributing factors to overcome inhibitors and grant informed consent. Implications for professional counseling practitioners and counselor educators are discussed.



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