The Professional Counselor | Volume 11, Issue 4 455 contributions to the literature. The dissonance-to-consonance model presented here could be used as a program theory for evaluation. RCTs in the vein of what has been used to test the effectiveness of specific counseling modalities, using an approach influenced by the dissonance-to-consonance model compared to a control sample using “therapy as usual” (Ramsauer et al., 2014), may also be valuable for informing best practice while avoiding the ethical dilemma presented by denying treatment. Quantitative investigation may also benefit from further qualitative exploration of the present research questions in a way that addresses the demographic limitations of this study. For example, a grounded theory study of parents who identify as Black may produce different results (Armstrong et al., 2013; Gibbons, 2019; Zheng, 2015). Conclusion The present study examined, for the first time, the experiences of parents of TGD youth as they decided to give informed consent for their child to undergo GCEI. They named a variety of inhibitors and contributors to this process, and a “dissonance-to-consonance” model for using contributing factors to overcome inhibitors to the process was illuminated. We found the research process to be emotionally moving and rich with guidance for both parents of TGD youth who are making decisions of considerable consequence for their children and the professional counselors working with them in supportive roles. The model appears to provide fertile ground for further study to support services that affirm and support TGD youth and their families. We relish the opportunity to continue this work and look forward to the contributions of others who advance this topic in service of TGD well-being throughout the life span. Conflict of Interest and Funding Disclosure The authors reported no conflict of interest or funding contributions for the development of this manuscript. References Ainsworth, M. D. S., & Bowlby, J. (1991). An ethological approach to personality development. American Psychologist, 46(4), 333–341. American Counseling Association. (2014). ACA code of ethics. https://bit.ly/ACAcodeofethics Armstrong, K., Putt, M., Halbert, C. H., Grande, D., Schwartz, J. S., Liao, K., Marcus, N., Demeter, M. B., & Shea, J. A. (2013). Prior experiences of racial discrimination and racial differences in health care system distrust. Medical Care, 51(2), 144–150. https://doi.org/10.1097/MLR.0b013e31827310a1 Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books. Bränström, R., & Pachankis, J. E. (2020). Reduction in mental health treatment utilization among transgender individuals after gender-affirming surgeries: A total population study. The American Journal of Psychiatry, 177(8), 727–734. https://doi.org/10.1176/appi.ajp.2019.19010080 Bunim, J. (2015, August 17). First U.S. study of transgender youth funded by NIH: Four sites with dedicated transgender youth clinics to examine long-term treatment effects. UCSF News & Media. https://bit.ly/UCSFstudy Burnes, T. R., Singh, A. A., Harper, A. J., Harper, B., Maxon-Kann, W., Pickering, D. L., Moundas, S., Scofield, T. R., Roan, A., & Hosea, J. (2010). American Counseling Association competencies for counseling with transgender clients. Journal of LGBT Issues in Counseling, 4(3–4), 135–159. https://doi.org/10.1080/15538605.2010.524839 Burt, N. (2016). When girls play with G.I. Joes and boys play with Barbies: The path to gender reassignment in minors. Florida Law Review, 68(6), 1883–1913. https://bit.ly/3GkpSPK
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