Paul Garcia-Ryan
Licensed clinical social worker · President, Therapy First
Paul Garcia-Ryan is a licensed clinical social worker and psychotherapist in New York City and the president of Therapy First, a nonprofit focused on raising the standard of care in youth mental health. He works with young people experiencing gender dysphoria and their families, and with trans adults.
Reviewed October 2026Paul Garcia-Ryan is a licensed clinical social worker and the president of Therapy First, a nonprofit focused on raising the standard of care in youth mental health. He identified as a woman from age 15 to age 30, then chose to detransition, and he trained as a psychotherapist at a leading gender clinic in New York City.
Paul now works with young people and their families, and with trans adults. He argues that the debate over gender and young people has a lot less to do with sides than the culture war makes it look.
On The Ryan Vet Show, Paul shared his story in his own words, from an early childhood sense that he was different to his training as a psychotherapist and what changed once younger patients began arriving in his practice. He explained how the field has moved from prioritizing a mental health model to prioritizing a medical model, and why he believes therapists so often talk past each other, using the same words with different definitions.
His advice for parents is to stay with a child's distress, however scary it feels, and to avoid locking horns. For clinicians, it is to hold a young person's identity with an open palm. His closing call: this is an all hands-on-deck moment for the mental health profession, and it needs leaders to step up.
I actually don't think that there are sides. I think that there's an illusion of sides.
I think there's actually a lot more agreement amongst therapists than disagreement.
Every therapist working with a young person experiencing gender dysphoria ought to hold a young person's gender identity with an open palm.
Who is Paul Garcia-Ryan?
He is a licensed clinical social worker and psychotherapist in New York City and the president of Therapy First. He works with young people experiencing gender dysphoria and their families, and with trans adults.
What is Therapy First?
Therapy First is a nonprofit focused on raising the standard of care that young people receive in the mental health field. It trains therapists and mental health professionals and offers professional development online and in person. It is at therapyfirst.org.
What does Paul Garcia-Ryan mean by an illusion of sides?
He believes there is a lot more agreement among therapists than disagreement, and that much of the apparent division comes from therapists using the same words, like affirm, with different definitions.
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