Access to gender-affirming healthcare can be lifesaving for transgender, gender diverse, and nonbinary people.
Gender-affirming healthcare is care that focuses on transgender people’s physical, mental, and social health needs and well-being while confirming their gender identity. It aims to validate transgender as an identity, rather than a disorder.
Transgender may be used as an umbrella term that describes people whose internal sense of gender is different than that which they were assigned at birth or who surpass traditional expectations of gender identity or expression.
Transgender people often experience considerable health disparities stemming from discrimination, ignorance, and systemic biases on top of less access to healthcare.
Until recently, little gender-affirming healthcare existed. But research strongly suggests that limiting gender-affirming medical care for people can have wide-ranging negative effects on their health.
Gender-affirming healthcare is patient-centered and works to align a transgender individual’s outward, physical traits with their gender identity. It may include a combination of medical, surgical, mental health, and other services.
As of 2022, this type of healthcare is coded in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) under the term, or diagnostic category, “gender incongruence” in the chapter “conditions related to sexual health.”
It’s now clearer that gender incongruence isn’t a mental disorder, but with a substantial need for gender-affirming healthcare, the World Health Organization decided there are needs that can best be met if gender incongruence remains coded under the ICD-11.
Hormone therapy involves using testosterone hormones for adults who were assigned female at birth and both estrogen hormones and testosterone blockers for adults who were assigned male at birth. It’s prescribed to help a person gain the outward characteristics that match their gender identity.
For children who haven’t gone through puberty, this involves using certain types of hormones to temporarily pause puberty. Puberty blockers allow more time to explore gender identity before the physical changes associated with puberty onset.
During this time, individuals can decide whether they want to eventually pursue less reversible gender-affirming medical interventions, such as hormone therapy or surgery.
If puberty is allowed to continue, more surgeries might be necessary to reverse the development of secondary sexual features such as breasts, facial hair, and body hair.
There are few surgical options depending on the desired outcome. Not every transgender individual will desire gender-affirming surgery. Surgical options include:
- Top surgery. Also known as chest reconstruction, this surgery creates either a male-typical chest shape or enhances breasts.
- Bottom surgery. This is gender-affirming surgery on the genitals or reproductive organs.
- Facial feminization. This involves a range of procedures that change masculine facial features into feminine features. It may include hairline reconstruction, cheek augmentation, jawline reduction surgery, and rhinoplasty (aka a “nose job”), among other procedures.
Social affirmation includes aligning clothing, hairstyles, names, pronouns, and use of facilities, such as restrooms, with a person’s gender identity.
For many transgender or nonbinary people, pronouns are a way to affirm an aspect of their gender that’s often not aligned with other people’s assumptions. Pronouns can help affirm a transgender person’s existence.
When an incorrect pronoun or gendered word is used to refer to someone, it’s called misgendering. These pronouns may be gender-specific or gender-neutral. Examples include:
For prepubescent children, listening and respecting a child’s identity, including using the name and pronouns the child identifies with, is the only care they can receive before they’re eligible for medical and surgical interventions.
Francis Kuehnle MSN, RN-BC (they/them/theirs), a lecturer at the University of Iowa College of Nursing, clarifies that, “Gender-affirming care for children is accepting them where they are at and listening to how they feel about their bodies.”
Mx. Kuehnle, who is trans and has experience working with trans patients as a nurse, describes spending “a lot of time validating the parent’s fears and encouraging them to process these with someone who is not their child.”
There are also nonsurgical options for aligning certain physical aspects of gender identity, such as:
- name and gender marker/sex marker changes
- exercise (to create more masculine or feminine frames)
- hair and makeup
- speech therapy to help match vocal characteristics with gender identity
- hair removal through laser treatment, electrolysis, or waxing
- chest binding
- breast padding
- genital tucking
- packers/stand-to-pee devices
- padding of the hips or buttocks
Gender-affirming healthcare improves the mental health and overall well-being of gender-diverse people. “It is important to realize that gender-affirming care is lifesaving,” says Kuehnle.
Gender-affirming healthcare involves both physical and psychological benefits for trans individuals. These benefits go hand in hand.
Gender-affirming healthcare allows a trans individual’s physical attributes to align more closely with their self-identified gender. These physical changes lead to improved body image and self-esteem.
Experts agree that access to gender-affirming healthcare can significantly improve the mental health of trans individuals, resulting in:
- lower rates of suicide
- lower rates of depression, anxiety, and other mental health concerns
- lower incidence of self-harm
A large-scale 2021 study, for example, showed a significant link between access to hormone therapy and lower rates of depression, suicidal thoughts, and suicide attempts among transgender youth in the United States.
Interplay between psychological and physical
The physical changes that come with puberty can cause extreme distress for many gender nonconforming teens and young adults.
“For some trans people, the symptoms of dysphoria can be debilitating, making it difficult to function in daily life. Affirming care is shown to improve quality of life and decrease thoughts of self-harm and suicidal ideation in trans people,” Kuehnle tells Healthline.
Physical aspects of gender-affirming healthcare can be crucial in helping transgender individuals feel comfortable in their own skin, which is essential for a person’s psychological well-being. This is especially true for adolescents.
“For example, some transmasculine people wear a chest binder to help with dysphoria brought on by having breasts. I myself wore one for years, and it helped me feel much more comfortable in my skin,” explains Keuhnle.
“However, it is only considered safe to wear a binder for about 6 hours, and I was working 12-hour shifts. So I had to pick between physical or extreme emotional discomfort prior to receiving top surgery.”
A ripple effect
Improved access to gender-affirming healthcare for one individual can cause a ripple effect throughout the trans community.
According to Kuehnle, “Trust is the most pervasive benefit I see playing out in care. Within the trans community, it is common to verify with others if a provider of any service is safe before going. So when you build those relationships you are very likely to see others come out of the woodwork.
“This happened locally at a hair salon,” Kuehnle continues. “It got around that they were affirming, and suddenly a large portion of their clientele were members of this community.”
Transgender individuals face considerable barriers to accessing healthcare, and a lot can be owed to a lack of general knowledge about best practices.
In one 2021 study, one-third of respondents reported having at least one negative experience in a healthcare office related to being transgender. These experiences involved being verbally harassed, having to teach their doctor about transgender people to get appropriate care, or even being refused care altogether.
Thus, “if a clinic provides gender-affirming care and publicly advertises and shows this, people with other concerns related to this may feel more comfortable bringing this up with their [doctor],” notes Kuehnle.
“And it communicates to anyone who may be struggling with their identity privately that this is a safer place to have that discussion.”
Nonbinary can mean different things to different people. In general, it’s a term to describe someone whose gender can’t be exclusively described within the binary of woman or man.
Gender diversity is an umbrella term that describes various gender identities and expressions that don’t conform to norms and societal expectations of the male/female binary.
Access to gender-affirming healthcare is important for everyone on the gender incongruent spectrum, even if they aren’t considering transitioning. It’s important that nonbinary individuals are able to express and explore their sense of self with their healthcare professionals in a safe environment.
Nonbinary individuals may have different surgical goals, but procedures can be customized and combined to help create the body which best affirms their gender.
Doctors are beginning to realize that gender identity is a spectrum and everyone’s path will be different. When talking with your doctor, it’s essential you start the conversation by telling them about yourself and your personal goals.
There’s a lot to talk about and you shouldn’t feel rushed to make any decisions. As you build a relationship with your doctor, also make sure to talk about the following:
- your medical history and your family’s medical history
- potential safety and side effects of hormone medications
- fertility and parenting desires, including contraception
- additional cancer screenings that may be needed once you start hormone therapy
- your sexual history and what you should be doing to reduce your risk of STIs and HIV (if you’re sexually active)
- if you’re experiencing anxiety or depression or engaging in any self-harm
If you still have questions or you’re scared or unsure about your journey, consider asking your doctor for a referral to a health educator who focuses on trans health.
For help finding a healthcare professional who is welcoming and knowledgeable of transgender folks, try the following resources:
- Mytranshealth, a free directory that connects trans people with qualified, culturally competent healthcare providers
- Outcare, a nonprofit that maintains a directory of providers who identify as specialized in the care of the LGBTQ+ community.
- Gay and Lesbian Medical Association (GLMA), a free directory of healthcare professionals with experience working within the LGBTQ+ community.
Keep in mind that current federal and state laws prohibit health insurance plans from excluding transition-related care.
With an estimated 150,000 youth and 1.4 million adults who identify as transgender in the United States today, understanding and improving the health and well-being of transgender people and other gender minorities is crucial for the trans community.
However, there are legislations and policies in some states working to take away some of the affirming care for transgender and nonbinary youth.
As Kuehnle advises, “This care has effects that span out into the rest of the person’s life.” Without it, transgender folks may turn to “unhealthy coping skills, which are often harmful in both the short and long term.”