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Illustration by Joules Garcia

“A combination of social, legal, and medical measures that help people feel happy, healthy, and safe in their gender is called gender affirming care. GAC takes aholistic approach to making sure a person’s mental and physical needs are met.”

GAC is for anyone who needs it. It involves a wide range of healthcare approaches.

GAC is a source of stress and stigma for many people. Healthline wants to explain why GAC is so important and debunk misinformation.

We highlight key terms and definitions and 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.

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.

Our languages are not always able to fully capture who we are and how we feel.

Our understanding of language is constantly evolving. As our understanding of gender identity grows, we will update this article.

Key terms to know are:

  • 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.

“A gender transition is a combination of social, medical, and legal changes that support a person’s gender identity. This can be done by moving away from the gender assigned to you at birth or by changing roles.”

“GAC’s goal is usually a transition for trans people.”

A transition can look like this.

  • 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.

GAC was difficult to access and expensive. There is 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.

“You should feel comfortable talking about your transition with your healthcare team. If you aren’t pursuing medical transition procedures, they will 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 can’t find a GAC clinic that specializes in it, it’s a good idea to contact your healthcare professional to find out about the treatments you’re interested in. They will have time to research anything they don’t know.”

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.

“GAC is for anyone who needs it, but the discussion of this care centers around the people who are trans. GAC for trans people is stigmatized and restricted. cis people don’t need the same procedures that tran people do, so they have to go through a lot of hurdles.”

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.

It shows that the mental health community is working to fill in the gaps left by their establishments through professional conferences and mentorship.

If you want to see a trans client, you might consider reaching out to a therapist that you are interested in, to see if they would be willing to continue their education.

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?

It can take a lifetime to figure out the role of gender in your life and the effects of growing up trans.

A mental health professional can help you with your mental health. A good therapist can be an essential part of a support system 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.

It can be difficult to get GAC for a trans person.

Lack of family support can be a factor when it comes to trans youth.

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 healthcare. The healthcare system is designed for cisgender people, which can make it hard for trans and other gender-diverse people to get healthcare.

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

“Reparative therapy is a discredited tactic where experts try to cure someone of being gay, bisexual, trans or any other identity that isn’t cis and straight. These programs can involve verbal and physical abuse.”

Conversion therapy is not right on every level. There is no proof that anyone can be changed with therapy. This practice operates on the false idea that being LGBTQIA+ is bad and that something 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.

Some of the most common types of gender affirming healthcare are related to gender transitions. A transition may involve hormone therapy, surgical, and non surgical options.

Everyone has their own needs and there is no one right way to transition.

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:

  • Slower development of libido.
  • The bone density has decreased.
  • halted height growth.

“There is a false idea that puberty blockers cause sterility and have permanent effects. People against GAC argue that children and teens can’t be trusted to make the right decisions for their bodies.”

“It can be traumatic to go through puberty for a gender you don’t identify with, and can cause 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 can be used by people who arecis, intersex, and trans to reduce testosterone levels.

Anti-androgens and estrogen hormone treatment are often combined. They are usually taken by people who have testosterone.

Hormone replacement treatment (HRT)

“HRT is a method of changing your sex characteristics with a regular dose of testosterone or estrogen. The goal of HRT is to raise someone’s hormone level to the average level of that hormone found incis 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.

HRT is a common treatment that is considered safe when monitored by a healthcare professional. People with Cis have been using HRT for decades to treat a variety of health conditions.

There are different types of HRT.

  • 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! Trans people don’t always 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 has a different GAC needs. Some people’s needs change over time.”

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

It is up to someone whether they need surgery as part of their transition. Trans people may want to have a variety of surgical options.

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

Some common gender affirming surgical procedures are listed here.

  • 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.

“Depending on the procedure, the risk of surgery can vary. Bleeding, pain, infection, or requiring revisions are some of the risks of surgery. It is important that you follow your surgeon’s instructions, and seek out an expert.”

Reproductive health and GAC

Some people choose to preserve their eggs or sperm before they have a GAC surgery. Below are more details about those processes.

There are some helpful resources for trans people.

“Anyone who needs gender affirming healthcare is welcome. Trans people have access to GAC, but it is heavily controlled and restricted. Major challenges to trans rights in the United States are putting trans people’s well-being and lives at risk.”

Everyone deserves to feel safe and happy in their body.

Research shows that having access to GAC reduces depression and suicidal thoughts in trans people, as well as improving self-esteem and overall quality of life. A strong emotional support network is an essential component of navigating a transition.

GAC has a lot of different parts. Everyone has different needs for their gender and no one will have the same experience.

There is no right time or place to process and come to terms with your gender identity. Remember that you are not alone, and try to give yourself grace.

There are many organizations that offer free resources and peer support for people with queer identities. This can include legal, medical, or emotional support.

Below is a list of trusted resources that are for people who are different.