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Gender and ****ual binaries pathologize nonconformity and limit the full range of healthy gender and ****ual expression. Moving beyond the binary to a spectrum approach allows for the inclusion and affirmation of all gender identities and expressions. Unfortunately, research and practice have largely focused on negative ****ual outcomes for TGD people. Thus, age-appropriate psychotherapy aimed at developing ****-positive pleasure and satisfaction is critical. Lastly, gender-competent mental health practitioners need to hav