After years of battling depression, anxiety and suicidal thoughts, Sam Jeffrey hit a crossroad.
"It felt like a decision between being really depressed and hiding who I was, and being trans and being myself and being happy, but also having that threat of discrimination," he said.
About a year ago, the 27-year-old naturopath transitioned.
"It was very obvious, looking back at my teenage years, and how much anxiety and depression I've had around puberty and lots of different signs of gender dysphoria around disordered eating.
"Fortunately, I had really quick access to gender-affirming hormones and lots of support."
The severe struggle Mr Jeffrey experienced is not uncommon in the LGBTQIA+ community, and the rates of attempted suicides are disproportionately higher.
New set of guidelines for support services
Experts estimate 1 in 10 young people will identify as gender or sexually diverse and research shows those within the community aged 16 to 17 are almost five times more likely to have attempted suicide compared to the general population.
About 50 per cent of transgender and gender diverse people aged 14 to 25 reported that they had attempted suicide in their lifetime.
"It's just an incredibly sad statistic… It's not someone's trans-ness that makes them more likely to attempt suicide, it's the discrimination and lack of inclusion that causes that," Mr Jeffrey said.
In an Australian first, a new set of guidelines, outlined in a report developed by the Telethon Kids Institute in Western Australia, involves 290 recommendations for clinical and support service providers to improve suicide prevention strategies for young LGBTQA+ people.
The co-head of youth mental health at the Telethon Kids Institute, Yael Perry, said experiences of stigma and discrimination were usually compounded by poor access to appropriate professional support.
"Some people have experienced outright homophobia, transphobia discrimination in their service settings," Dr Perry said.
She said many young people experienced a lack of understanding by service providers of their unique needs, and the guidelines would provide a practical tool to better support them.
"If you're working with young people at all, chances are you will be working with LGBTQIA+ young people, and it's important that everyone has the skills to create a sort of inclusive and supportive environment for anyone who walks through the door," she said.
LGBTQA+ young people 'not an optional extra'
The policy and project coordinator at the Youth Pride Network in WA, Charlotte Glance, said she was optimistic the new guidelines would change the way support services deal with people in her community.
"It's really exciting to see that culture start to change … and being more of a widespread understanding that LGBTQA+ young people are not an optional extra, they're actually part of a service's core," she said.
Poor service delivery for vulnerable young people was particularly damaging, she added, and the guidelines would help for them to receive the right care and avoid further traumatisation.
"These guidelines are really important because … when a young person is at the point where they have been identified as being at risk or they are reaching out for help, they're actually able to receive the help they need, and they don't disengage from the service because they have a bad experience.
"Combating discrimination against LGBTQIA+ young people is a form of suicide prevention."
'Lack of education' in healthcare
Clinical psychologist Geoff Carastathis, who specialises in providing care for the LGBTQIA+ community, wants to see the guidelines be a part of training for all healthcare professionals.
"There's a lack of education … it does rely on individual practitioners to look for guidelines, education, to better inform their practice in working with LGBTI clients. So, the variation can be quite large," he said.
"During my clinical training and in my education studies, there was nothing on sexual diversity or gender diversity."
He said dealing with the intersectionality of identities added another layer of complexity.
"For example, an Aboriginal gender diverse young person, we'll be dealing with not only gender dysphoria [and] rejection in society for perhaps how they might present in society regarding their gender presentation, but then also on top of that, inherent racism, discrimination and prejudice within our society as well," he said.
"There's a twofold problem, I suppose, where the services that are targeting populations don't have enough staff and funding, and the lack potentially of very unique services to try target those with intersectionality in the community."
Dr Carastathis said implementing the guidelines at GP practices was key because they were often the first point of contact and a referral point to other services.
"If LGBTI people aren't feeling comfortable accessing health through their GP, then we lose a large portion of people who could actually be linked in with appropriate services," he said.
Gap in intersex health research
Mr Jeffrey welcomed the guidelines, but pointed to a gap in research into intersex health.
"The trauma for many intersex folk of having surgeries at birth which they cannot consent to is huge, and we know that almost 40 per cent of intersex folk don't identify with the gender they were assigned at birth," he said.
"Whilst I have struggled as a trans person, I am relatively privileged as a white trans man and don't experience nearly the amount of discrimination and trauma that trans women, particularly trans women of colour, experience," he said.
Mr Jeffrey wants those struggling to know "they are worthy, that there is a community of people who will accept them unconditionally, that LGBTQIA+ folk create their own exceptional chosen families".
"I'm incredibly grateful to be a trans man and have a beautiful community," he said.
