Transgender women

Transgender, nonbinary, and otherwise gender-diverse people often need to seek gender-affirming health care. Gender-affirming providers support a person’s gender identity without trying to change or “fix” them. And care may include mental health services, hormone therapy, surgery, and other medical care.

Goals of Gender-Affirming Care

The most important goal of gender-affirming care is to promote the person’s overall health and well-being. Trying to “fix” or change a person’s gender identity can lead to severe mental health problems and even self-harm.

Gender-diverse people have often experienced stigma, the negative social attitude of others toward them because of who they are. Stigma can be traumatic for gender-diverse people, and they may then feel shame or depression. Trans people are four times more likely to have depression than people whose gender identity matches their sex assigned at birth.

Gender-affirming care can reduce the effects of stigma and support a person’s mental health. Treating a person’s trauma and depression will also reduce the likelihood of them harming themselves. Four out of 10 U.S. trans adults have attempted suicide in their lifetime, compared to only five out of 100 for the general population.

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Social Aspects of Gender-Affirming Care

Gender-affirming care starts with using the correct name and pronouns of the gender-diverse person. Doctors should ask gender-diverse people their pronouns and note their requested names and pronouns on their charts.

Gender-Affirming Hormone Therapy

A common gender-affirming treatment is taking sex hormones. A trans woman may need to take estrogen to support the growth of breasts, reduce body hair, and soften her skin. She may also be prescribed progesterone later in her transition to further feminize her body, and may take medication to block testosterone production.

A trans man may need to take testosterone to deepen his voice and encourage growth of body hair.

Nonbinary and other gender-diverse people also may seek gender-affirming hormone treatment.

Gender-Affirming Surgery

The two main types of gender-affirming surgery for trans and gender-diverse people are top surgery and bottom surgery. Top surgery can be used to feminize or masculinize the chest.

Bottom surgery for trans feminine people can include a vaginoplasty, where a doctor reconstructs a feminine vulva and/or vagina surgically from the existing genitals. A surgeon can also remove only a trans woman’s testicles to reduce testosterone production. For trans masculine people, bottom surgery can involve reconstructing a penis and scrotum using other tissue from the person’s body.

Facial surgery is an option if they wish to make their face more masculine or feminine.

Vocal surgery is also an option for those who wish to change their voices and cannot achieve their desired outcome with speech therapy alone.

Mental Health Care

Trans and otherwise gender-diverse people face many questions that can be helpful to discuss with a counselor. A therapist can help a trans or gender-diverse person come out and transition to the gender that matches their identity. Therapy can also help them communicate with their family or deal with possible rejection from loved ones. While many people may wish to speak with a therapist, it is not required for care.

Talking with a counselor about a person’s preferences for clothing and grooming may be part of gender-affirming care. Therapists can also help trans patients prepare for gender-affirming surgery.

If a gender-diverse person has symptoms of depression or anxiety, they need care from a health provider who affirms their gender. Treatment for depression or anxiety can involve therapy or medication. Management of other medical health conditions does not restrict you from getting gender-affirming care.

Other Gender Affirmation

Trans masculine people who have not had or do not plan to have top surgery may use chest binding to flatten their chest. If they have not had or do not plan to have bottom surgery, they may choose “packing,” which involves wearing a prosthetic penis in their underwear.

Trans feminine people who have not had or do not plan to have bottom surgery may choose to tuck away their genitals. Tucking moves the testicles and tucks the penis back in order to achieve a flatter groin area.

Speech therapy can help trans and gender-diverse people achieve an authentic voice and pattern of speaking that matches their gender identity. Speech therapy can also help with learning gender-specific social rules of verbal and nonverbal communication.

Laser hair removal and electrolysis can remove unwanted body hair to help a trans and gender diverse woman better match her appearance to her gender identity. Facial hair removal may be part of this care.

If a trans person wants to have children, they should consider fertility preservation. This could include sperm banking, egg storage, and ob-gyn care during pregnancy.

Gender-affirming care is important throughout a person’s lifetime for health screenings also. Trans men may need screenings for cervical cancer or breast cancer, and trans women may need screening for prostate cancer.

Sources

American Psychiatric Association. Gender-Affirming Therapy. Link

Cécile A. Unger. Hormone therapy for transgender patients. Translational Andrology and Urology. December 5, 2016. Link

Darshan P Patel, Isak A Goodwin, Omer Acar, Ervin Kocjancic, James M Hotaling. Masculinizing gender-affirming surgery for trans-males and non-binary individuals: what you should know. Fertility and Sterility. August 14, 2021. Link

Depression. National Institute of Mental Health. Link

Jae A. Puckett, Peter Cleary, Kinton Rossman, Michael E. Newcomb, Brian Mustanski. Barriers to Gender-Affirming Care for Transgender and Gender Nonconforming Individuals. Sexuality Research and Social Policy. August 4, 2017. Link

Jonathon W. Wanta, Joshua D. Niforatos, Emily Durbak, Adele Viguera, and Murat Altinay. Mental Health Diagnoses Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Study. Transgender Health. November 2019. Link

Nicolette V Siringo, Zoe P Berman, Daniel Boczar, Bachar F Chaya, Gustave K Diep, Jorge Trilles, Sara Mazzei, Ricardo Rodriguez Colon, Eduardo D Rodriguez. Techniques and Trends of Facial Feminization Surgery: A Systematic Review and Representative Case Report. Annals of Plastic Surgery. July 13, 2021. Link

The Report of the 2015 U.S. Transgender Survey.National Center for Transgender Equality. Link

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