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Gender-Affirming Care

Updated: Dec 28, 2023

What is Gender Affirming Care?

Gender-affirming care refers to a range of support systems that help transgender and gender-diverse people achieve “lasting personal comfort with their gendered selves."


Gender-affirming care is highly individualized, based on the unique needs of each person. It includes non-medical forms of support, such as voice therapy and hair removal, as well as medical treatments like puberty blockers, hormone replacement therapy, and surgeries.



What is Gender Dysphoria?


Transgender people often seek gender-affirming care as a way to reduce gender dysphoria. Gender dysphoria describes the deep distress many transgender people feel when their bodies do not match their gender identity. Gender dysphoria is linked to negative mental health outcomes, including depression, anxiety, and suicidality. Not all transgender people experience gender dysphoria. Some transgender people experience gender incongruence, or the feeling of mismatch between their bodies and their gender identities, not deep distress. According to the WPATH’s 2022 Standards of Care, both gender dysphoria and gender incongruence should qualify patients to receive gender-affirming care as long as feelings have been notable and consistent.


What are Pubertal Blockers?


Physical changes associated with puberty can increase gender dysphoria for trans youth. Puberty-blocking medications suppress the body’s release of sex hormones. This can decrease the growth of facial and body hair, prevent voice deepening, limit the growth of genitalia, limit or stop breast development, and stop menstruation. As with other forms of gender-affirming care for youth, puberty blockers are only prescribed after careful consultations between a medical provider, the patient, and the patient’s parent or legal guardian. If the patient stops taking blockers, pubertal changes will resume.


What is Hormone Replacement Therapy (HRT)?


Hormone Replacement Therapy (or HRT) describes the process of taking hormones to promote physical changes that affirm one’s gender identity. For transmasculine people, taking testosterone can lead to changes like body fat redistribution, facial and body hair growth, and voice deepening. For transfeminine people, taking estrogen can lead to changes like breast development and body fat redistribution. Like all medical procedures, HRT can have side effects, but for many transgender people, the physical and mental health benefits of HRT greatly outweigh any potential risks.


What are Gender Affirming Surgeries?


Top Surgery


Not every trans person wants surgery, but there are lots of options for those who do. For transmasculine people, top surgery involves removing breast tissue, creating a natural chest contour, and removing or altering the nipples. For transfeminine people, top surgery often involves implants that make the chest bigger. Facial reconstruction surgeries can alter the cheekbones, nose, jaw, chin, or Adam’s apple.


Bottom Surgery


Bottom surgery for transmasculine people is more complicated and less common. Options include metoidioplasty, in which the existing genital tissue is rearranged, or phalloplasty, in which a penis is constructed from grafts and implants.


Some transfeminine people get bottom surgery, most commonly a vaginoplasty, in which a vagina and a vulva are created from original genital tissue or grafts.


Other Surgeries


Transmasculine people who plan to stay on HRT for life often get a hysterectomy, or removal of the uterus. Transfeminine people who plan to stay on HRT for life often get an orchiectomy, or removal of the testes.


Non-Medical Care


Counseling


Counseling from an affirming mental healthcare provider can empower trans individuals to explore their gender identity, plan their social transition, and prepare for gender-affirming surgery if desired.


Appearance


Experimentation with visual style gives trans folx an opportunity to explore their gender expression. This may include wearing different hair, makeup, or nail styles. Trying different clothing styles and body part occlusion, like binding or tucking, or accentuation, like hip or butt padding, are other avenues by which a trans person may pursue gender affirmation. In some cases, seeking hair removal treatments, such as shaving, waxing, laser, or electrolysis, can contribute to a person's sense of affirmation.


Voice


For some, changing the pitch, intonation, timbre, speed, or other qualities of the voice may be an important aspect of their gender-affirming journey. Voice training, vocal cord surgery, or changes associated with masculinizing HRT can facilitate such auditory changes.


Why Gender Affirming Care Matters


Gender-affirming care is a powerful support for the overall physical, mental, and emotional well-being of transgender and gender-diverse youth and adults. It significantly reduces negative mental health outcomes, including depression and suicidality. It also supports the overall physical health of transgender people, ensuring they receive respectful and effective care that centers their needs.


Attacks on Gender-Affirming Care


Despite the clear evidence for the benefits of gender-affirming care, transphobic politicians and medical providers are working to restrict and even prohibit access to it. In November 2022, the Florida Board of Medicine voted to ban access to puberty blockers, hormone replacement therapy, and gender-affirming surgeries for youth. Then, in April 2023, the Senate advanced a bill that would:


  • Heavily penalize healthcare providers for administering gender-affirming care to patients

  • Revoke the medical licenses of those providers

  • Prohibit Medicaid from covering gender-affirming care

  • Allow the state to remove children from their parent(s) if their parent(s) have authorizedor might authorizegender-affirming care

  • Classify gender-affirming care as “serious physical harm" despite consensus from the medical community that gender-affirming care is safe and effective for treating dysphoria


However, this ban was blocked in June 2023 by a Federal district court on the basis that it violates the Constitution's equal protection clause by singling out trans minors. While this temporary block is in place, minors can still legally access gender-affirming care.


Myths About Gender-Affirming Care


There is a wealth of misinformation and misunderstanding surrounding gender-affirming care. Visit our article to learn what these myths are and how to counter them.



This article was written by Yarrow Koning


 

References


Boyle, P. (2022, October 13). What is gender-affirming care? Your questions answered. AAMC. https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered


Cleveland Clinic. (n.d.). Gender affirmation (confirmation) or sex reassignment surgery. https://my.clevelandclinic.org/health/treatments/21526-gender-affirmation-confirmation-or-sex-reassignment-surgery


Cleveland Clinic. (n.d.). Voice feminization surgery. https://my.clevelandclinic.org/health/treatments/21779-voice-feminization-surgery


Coleman, E. et al. (2022) Standards of care for the health of transgender and gender diverse people, version 8. International Journal of Transgender Health. 32 (1). S1-S258. https://doi.org/10.1080/26895269.2022.2100644


Federal judge blocks Florida ban on Medicaid funds for transgender treatment. (2023, June 22). CBS News. https://www.cbsnews.com/news/florida-ban-medicaid-funds-transgender-treatment-federal-judge-blocks/


Gender affirmation nonsurgical services. (2023, March 8). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-nonsurgical-services


Hysto.net. (n.d.). Reasons for transgender men to get a hysterectomy. https://www.hysto.net/reasons-transmen-get-hysterectomy.htm


Nolan, I. T., Kuhner, C. J., & Dy, G. W. (2019). Demographic and temporal trends in transgender identities and gender confirming surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626314/


Weiss, E. (2022, September 20). Gender-Affirming Care When Your Gender is Nonbinary. Plume Health. https://getplume.co/blog/gender-affirming-care-when-your-gender-is-nonbinary/

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