Everything You Need to Know About Gender Affirming Care

Gender affirming care (GAC) refers to any combination of social, legal, and medical measures that help people feel happy, healthy, and safe in their gender. GAC takes a holistic approach to making sure a person’s mental and physical needs surrounding their gender identity and expression are met.

GAC is for anyone who needs it. It involves a wide range of healthcare approaches that differ depending on your individual needs.

However, GAC continues to be a source of stigmatization and stress for many transgender people. Healthline aims to dispel misinformation surrounding GAC, showcase its complexity, and explain why it is so vitally important.

Below, we highlight key terms and definitions, as well as share insights about access and availability.

How many trans people are in the United States?

A 2016 report by the UCLA Law Williams Institute suggests that around 1.4 million Americans identify as transgender.

Key terms to consider

Learning the words and phrases related to GAC and LGBTQIA+ identity may feel overwhelming at first. But this terminology is really important to learn and use — not just so we can respect others, but so we can understand ourselves better, too.

Human beings are complicated, and our languages aren’t always able to fully capture who we are and how we feel.

Plus, our understanding of language is constantly evolving. We’ll continue to update this article as our understanding of gender identity and the best care around it grows.

Here are key terms to know:

Sex assigned at birth. This refers to how clinicians established your sex and gender at birth (or beforehand in sonograms). While often understood to be a simple choice between male or female, human sex is much more complex, with many intersex variations. It’s impossible to truly know what your sex is without having your chromosomes mapped.

AFAB: assigned female at birth

AMAB: assigned male at birth

Gender identity. Your gender identity is your personal, internal sense of what your gender is (or isn’t). Learn more about terms for gender identity and expression.

Cisgender. Describes a person who identifies with the gender assigned to them at birth.

Transgender. Describes a person who identifies with a gender other than the one assigned to them at birth. This is an umbrella category that can include many different gender identities, such as nonbinary, gender nonconforming, or genderqueer.

Gender expression. Refers to how a person chooses to present their gender. Gender expression may include someone’s preferred aesthetics, physical traits, or simply their stated identity.

Gender dysphoria. A sense of misalignment or dissatisfaction with your gender. It’s a form of body dysmorphia.

Gender euphoria. Feelings of alignment or joy about your gender identity or expression. Finding what aspects of gender feel good or make you happy can be an important part of your transition.

Diagnosis-first model. This traditional model of medical care adheres to the criteria in either the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition” (DSM-5)” or the “International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11).” In this model, you must use their standards of diagnosis to prove that you’re transgender, then proceed with one of their preapproved plans of care.

Informed-consent model. This modern form of medical care is based on the informed consent of the person seeking care. In this model, once you tell your clinician that you’re transgender, they will aim to help you build a healthy transition plan based on your goals.

Coming out. When someone comes out in an LGBTQIA+ context, they are sharing their gender or sexual identity with another person, group, or community. Being outed is when that information is given away by another person without someone’s consent or knowledge.

Pronouns. Words used to substitute for a noun. He, she, and they are the most common pronouns used in English, but there are also others. Learn more about gender pronouns.

What is a gender transition?

A gender transition refers to any combination of social, medical, and legal changes a person makes in order to support their gender identity. Usually, this involves transitioning (switching) from one gender role to another or moving away from the gender assigned to you at birth.

For trans people, a transition is usually the goal of GAC.

Here’s a short breakdown of what the different parts of a transition can look like:

Social transition. This is the process of shifting your social gender role, or the way you express and embody your gender out in the world. Often, this process involves coming out and making sure those around you know how best to respect and support your gender identity.

Medical transition. A medical transition refers to any combination of surgical and nonsurgical options you may pursue as part of your GAC. We’ll go over these categories more in-depth later in this article.

Legal transition. Some people find that legally changing their name and gender marker is an essential component of their gender journey. The process for changing your name or gender marker varies by state and country.

Accessing gender affirming healthcare

Historically, accessing GAC was difficult, expensive, and, at times, traumatizing. But today there’s a trend toward more informed-consent care.

If you’re a trans person seeking GAC, “informed consent” will be an important term to look for when researching a new clinician. Informed-consent healthcare is based around the idea that you know yourself best, and it’s your medical team’s job to help you access the care you need in the safest way possible.

Ideally, you should feel comfortable discussing your transition with your healthcare team. Even if you aren’t pursuing medical transition procedures, they’ll be able to update your information with your desired name and pronouns.

If you’re having trouble finding a healthcare professional that is able to do so, this map of informed-consent clinics in the United States may be useful.

If you’re unable to find a clinic that specializes in GAC, it may be helpful to contact your healthcare professional prior to your appointment to let them know about the types of treatments you’re interested in. This will give them time to research anything they’re not familiar with.

Read writer KB Brookins’ tips for how medical professionals can better support trans patients.

Is gender affirming care just for trans people?

Nope! While GAC is most often talked about with respect to transgender people, anyone can seek out or participate in it. In fact, many people may not realize they’ve already received a form of this care. This includes cisgender men who take testosterone therapy, cisgender women who undergo breast augmentation, and more.

Even though GAC is for anyone who needs it, the general discussion of this care centers around transgender people. Unlike GAC for cisgender people, GAC for trans folks is heavily stigmatized and restricted. Trans people often have to go through a great deal of hurdles and red tape that cis individuals do not need for the same procedures.

Accessing gender affirming therapy and mental health care

A 2022 study found that only 20 percent of clinicians received relevant training on transgender topics during their graduate studies. Instead, they were more likely to pursue this training on their own after meeting trans people in need of care.

While that can be frustrating to know, it does show that the mental health community is working to fill in the gaps left by their establishments, often through mentorship or professional conferences.

So if you’re having trouble finding a therapist or psychiatrist, you might consider reaching out to one that you’re interested in to see if they would be willing to continue their education and take on a trans client.

Many online-based therapy platforms have filters that allow you to search for therapists specializing in queer and trans care. Psychology Today also has a database of trans therapists that you can search to find one in your area.

Why bring a therapist along on your gender journey?

Unpacking the role of gender in your life and the effects of growing up transgender (“in the closet” or otherwise), can take a lifetime.

A mental health professional can help you gain perspective and create a plan for personal growth. A good therapist, for example, can become an essential part of a healthy support system, especially for people with difficult family dynamics.

Additionally, if you pursue some methods of medical transitioning (like surgery), you may need a letter stating the medical necessity from either a therapist or psychologist. Your insurance company or surgical team will let you know if you need this information.

Why is gender affirming care important?

Accessing GAC can improve all areas of life for a trans person, but often it can be difficult to come by.

When it comes to trans youth, this can be due to lack of family support.

For trans adults, this commonly takes the form of medical incompetence. A 2018 study reported, for example, that up to 70 percent of trans men had to educate their healthcare professionals in order to access the care they needed.

In another study from 2018, only 20 percent of endocrinologists reported feeling comfortable discussing gender identity with a patient. That means up to 80 percent of endocrinologists felt ill-equipped to discuss, let alone take action on, gender-related care.

Read what experts want you to know about the mental health effects of GAC.

These barriers affect more than just the healthcare related to a gender transition. Because the traditional healthcare system is designed for cisgender people, it creates gaps that trans and other gender-diverse people may slip through.

For example, in the United Kingdom and other places, nationwide efforts to increase cancer awareness send reminders for cervical cancer screenings only to those with a “female” marker on their identification. This leaves trans men and some intersex people out of these life saving measures.

Likewise, trans women over age 50 may not be receiving regular mammograms, even though current guidelines recommend them for people who have been receiving hormone therapy for at least 5 years.

Receiving GAC is vital to mental health stability, especially for young people. One 2022 study of transgender youth in the United States showed that being able to receive hormone therapy reduced reports of recent depression and suicide attempts in the previous year by 61 percent.

A 2018 analysis of the current research has also shown that getting necessary GAC drastically reduces levels of anxiety and depression, as well as improves body image in a variety of trans people.

WPATH’s Standards of Care

The prevailing clinical criteria used to diagnose gender dysphoria or incongruence come from the DSM-5 and the ICD-11. However, many trans people and experts find these criteria problematic or limiting.

The World Professional Association for Transgender Health (WPATH) offers a free, alternative resource covering every aspect of GAC for professionals. Now in its 7th edition, this is called the WPATH’s Standards of Care for the health of transsexual, transgender, and gender nonconforming people.

The dangers of conversion therapy

Conversion therapy, or reparative therapy, is a debunked tactic where so-called “experts” try to “cure” someone of being gay, bisexual, trans, or any other identity that isn’t cis and straight. These programs often involve verbal, and even physical, abuse.

Conversion therapy is wrong on every level. There is no proof that anyone’s sexuality or gender can be manipulated or changed with therapy of any kind. Most importantly, this practice operates on the false idea that being LGBTQIA+ is bad and something that needs to be “fixed.”

These types of programs are associated with increased rates of depression and suicide in LGBTQIA+ people. Learn more about conversion therapy laws in your state.

Types of gender affirming care

Let’s go over some of the most common types of gender affirming healthcare, particularly in relation to gender transitions. In addition to social and legal components, a transition may involve any combination of hormone therapy, surgical, and nonsurgical options.

Remember, there’s no one “right way” to transition, and everyone’s individual needs are different.

Hormone blockers

Hormone blockers (aka puberty blockers) allow you to (reversibly and temporarily) prevent puberty from starting while you decide whether to start hormone replacement treatment, according to 2020 research.

Being on puberty blockers can come with several side effects, 2017 research suggests. These include:

slowed development of libido

decreased bone density

halted height growth

A lot of opposition to puberty blockers stems from the false idea that they cause sterility and have permanent effects. People against GAC also argue that children and teens are just “going through a phase,” and can’t be trusted to make the right decisions for their bodies.

Going through puberty for a gender you don’t identify with can be deeply traumatizing and cause unwanted permanent changes to your body composition and sex characteristics.

The Endocrine Society advises that adolescents who meet the criteria for gender dysphoria and incongruence and are seeking hormone treatment “should initially undergo treatment to suppress pubertal development.”

Puberty blockers have been found to lead to better mental health outcomes in trans people who receive them, specifically a lower lifetime risk of suicidal ideation (thinking about suicide).

Anti-androgen medications

These medications lower levels of testosterone in the body, and can be used by cis, intersex, and trans people to reduce testosterone’s masculinizing effects.

Anti-androgens are often combined with estrogen hormone treatment. They are usually taken by people whose pre-transition dominant hormone is testosterone.

Hormone replacement treatment (HRT)

HRT involves receiving a regular dose of testosterone or estrogen to bring about desired changes to your secondary sex characteristics. The goal of HRT is usually to raise someone’s hormone level to the average level of that hormone found in cis people.

It’s important to remember that everyone’s body has some degree of both testosterone and estrogen, but our dominant sex hormones differ. HRT usually changes which sex hormone is dominant.

Some of the changes caused by long-term HRT are permanent, while others are reversible.

While HRT does cause substantial changes and has a risk of complications, it’s a common treatment that’s considered safe when monitored by a healthcare professional. Cis people, for example, have been using HRT for decades to treat erectile dysfunction and menopause symptoms, among other health conditions.

Types of HRT are:

Testosterone (T) therapy. Hormone replacement therapy with T involves receiving a regular dose via injection, topical gel, patch, or through an implanted pellet. Testosterone therapy causes changes that are usually considered masculinizing, per 2016 research.

Estrogen (E) therapy. Hormone replacement therapy with E involves receiving a regular dose via oral tablet, injection, or patch. Estrogen therapy causes changes usually considered feminizing, the 2016 research says.

Do all trans people medically transition?

Nope! Not all trans people pursue medical options like hormones or surgery.

About 80 percent of trans people take hormones at some point in their life, but this doesn’t mean they do so permanently. Some trans people only socially transition. Additionally, many nonbinary or gender nonconforming people take smaller doses of hormone therapy to fine-tune their body’s expression of their gender.

Everyone’s GAC needs are different. Some people’s needs change or shift over time, and that’s OK!

Laser hair removal

For some people, body hair is a source of gender dysphoria or discomfort. Laser hair removal offers a long-term (though not permanent) option for keeping skin smoother and hair-free. Laser hair removal is commonly used for the face, legs, arms, and back, among other areas.

Laser hair removal involves multiple sessions. A licensed healthcare professional uses a special light beam to target hair follicles, damaging them and stopping hair growth, according to 2022 research.

There are many different types of lasers, and finding the right one for your skin type is key. This procedure can also cause scarring and skin irritation, and it can be very expensive.

Surgical options

Whether someone requires surgery as a part of their transition is entirely up to them. Trans people may pursue a variety of surgical options to help express their gender.

Surgical procedures that augment the chest are known colloquially as top surgery, and those that change genitalia are often referred to as bottom surgery.

Here are some common gender affirming surgical procedures:

Double mastectomy. There are many types of mastectomy, and the type of double mastectomy procedure you receive usually depends on the size of your chest. During this surgery, breast tissue is removed to create a flat or flatter chest. This may also involve removing and regrafting your nipples onto your flattened chest.

Breast augmentation. This surgery involves putting in breast implants to create a fuller chest. Breast augmentation is one of the most common plastic surgery procedures in the United States. Breast implants can also be removed or replaced.

Phalloplasty. This is a complex procedure that constructs a penis out of grafted skin tissue from another place on the body (such as from the thigh or arm) and threads the urethra through it. Phalloplasty (or phallo) often requires more than one surgery.

Vaginoplasty. This procedure can be used to construct a vagina. The most common type of vaginoplasty is called the penile inversion procedure.

Orchiectomy. This surgery involves the removal of one or both testicles. It is usually done together with a vaginoplasty but may also be performed on its own to reduce testosterone levels.

Hysterectomy. A hysterectomy is the removal of the uterus, and there are several different types of this procedure. A hysterectomy might be pursued during a gender transition if someone is experiencing endometriosis or polycystic ovary syndrome, or as part of a phalloplasty, among other reasons.

Facial surgeries. Gender affirming facial surgery can include a variety of plastic surgery procedures. This includes face and lip lifts, Botox injections, and resizing the jawline and forehead and browbone among others. The most common GAC facial surgery type is called facial feminization surgery.

Any surgery comes with the risk of complications, which can vary depending on the procedure. General risks of surgery include bleeding, pain, infection, or requiring revisions. It’s important you seek out an expert, and always follow your surgeon’s pre- and post-operative instructions.

Reproductive health and GAC

Because some surgeries related to GAC involve removing reproductive organs, some people opt to preserve eggs or sperm beforehand. Learn more about those processes below:

What to Know About Egg Freezing

What You Need to Know About Freezing Sperm

Here are some helpful resources about trans people and pregnancy:

Transgender Pregnancy: Moving Past Misconceptions

Trans and Pregnant: How to Find Competent, Gender-Affirming Healthcare

The bottom line

Gender affirming healthcare is for anyone who needs it. While cis people have used GAC for decades with relatively little oversight, trans people’s access to GAC is still heavily controlled and restricted. Major challenges to trans rights in the United States, specifically surrounding GAC access, are putting trans people’s well-being and lives at risk.

Everyone deserves to feel comfortable, safe, and happy in their body and their gender.

Research has repeatedly shown that having access to GAC reduces depression and suicidal thoughts in trans people, in addition to improving self-esteem and overall quality of life. Building a strong emotional support network — through family, friends, therapists, or mentors — is also an essential component of navigating a transition.

GAC has social, legal, and medical parts. Everyone’s needs regarding their gender are different, so no one’s gender experience or transition will look exactly the same.

There’s no right way or right time to process and come to terms with your gender identity — and the same goes for transitioning. Try to give yourself grace, educate yourself on your options, and remember that you aren’t alone.

Where to learn more

There’s a wide variety of nonprofits, institutions, and organizations that offer free resources and peer support to LGBTQIA+ people. This can include legal, medical, or emotional support, in addition to conducting surveys and other forms of research.

Below is a list of some trusted resources aimed at serving transgender people and others:

GLAAD Trans Resources

HRC Transgender Resources

LAMBDA Legal: Transgender Rights

National Center for Transgender Equality

PFLAG Transgender Resources

The Sylvia Rivera Law Project

The Trevor Project

Trans Lifeline

Posted : 2024-05-28 13:59

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