Advice for Choosing a Qualified Gender-Affirming Provider

There are several factors to consider when it comes to finding a provider who is knowledgeable about transgender health care needs and who can support transgender patients by providing high-quality gender-affirming care, primary care, or other specialty care. Dr. Maurice Garcia, transgender surgeon and director of the Cedars-Sinai Transgender Surgery and Health Program, and Dr. Sheryl Kingsberg, psychologist and chief of the division of behavioral medicine at MacDonald Women's Hospital/University Hospitals Cleveland Medical Center, shared advice for transgender patients on this topic.

Start with cultural competency.

On a base level, the providers and staff members at the health care center should demonstrate cultural competency. “Look for signs like using the correct language,” said Dr. Garcia. “Do they ask you about your gender separately from your biological sex? Do they ask you which pronouns or name you prefer?”

Regarding using proper language and indicating one’s own pronouns, Dr. Kingsberg said, “I think it should be a matter of course. Besides including their names and credentials on presentations, [some providers] are now putting their pronouns as well, which is the slow inching towards a more self-aware health care setting. It isn’t enough to not assume the pronouns of your patients, it’s also important to present your own.”

Those who have experience working with transgender patients and/or providing gender-affirming care should be familiar with using correct language and demonstrating cultural competency. If you notice that these things are missing, it could be a sign that the provider in question is not knowledgeable about transgender health care.

Consider different areas of health care.

Providers have different specialties, so it is a good idea to find providers who can address different areas of care. A primary care provider can help with general health concerns, but if you are an individual who is transitioning, you will need to find providers who are experts in transition-related care. This applies to both gender-affirming hormone therapy and gender-affirming surgery.

Licensed therapists, counselors, or psychologists who specialize in gender identity issues can support patients as they are transitioning or if they are experiencing any psychological distress.

“One reason a transgender individual might seek psychological support is because they’re distressed by their coming out process or gender confusion,” said Dr. Kingsberg. “This is not about pathology. That’s very important. Being transgender is not pathologic and that is not why somebody would need psychotherapy or treatment, and a transgender-informed therapist would know that.”

Take a look at the World Professional Association for Transgender Health (WPATH) Standards of Care to see an international agreement on the guidelines for care for transgender and gender-nonconforming individuals.

Look for providers who are members of relevant professional organizations.

Providers who are truly committed to offering high-quality care to a specific group of patients often join professional organizations related to that population so that they are informed and up to date on the latest health care guidelines and practices. It is usually a good sign if your provider is a member of a group like WPATH, because it shows that he or she is interested in and supportive of transgender health organizations. 

Look for a gender-affirming surgeon who knows a variety of current methods.

Gender-affirming surgery techniques, like other surgery techniques, are often being updated and improved. “It would be a good idea to look for a surgeon who has experience with a diversity of surgical techniques and who is up to date on current methods,” said Dr. Garcia.

A surgeon’s knowledge of various surgical techniques is important because gender-affirming surgery is deeply personal and should therefore be tailored to each individual’s unique needs. Dr. Garcia explained, “For example, in a traditional vaginoplasty, a vaginal canal is created, but not all patients need a vaginal canal, so the patients who don’t might look for a surgeon who has experience doing shallow-depth vaginoplasties.” (A gender-affirming surgery in which the labia and clitoris are created, but a vaginal canal is not).

If possible, find a local gender-affirming surgeon.

In some cases, it might not be possible for those seeking gender-affirming surgeries to find an experienced, well-qualified surgeon in their area, especially if they live in remote locations. However, whenever feasible, Dr. Garcia recommends finding a local surgeon. This is important because it is possible that patients may require follow-up care if they develop an infection or experience urinary obstruction after surgery. With a local surgeon, it may be easier to address these complications quickly and on short notice.

Finally, don’t underestimate the importance of a good bond.

Researching a provider’s credentials can only take you so far. In the end, if you do not have a good connection with your provider or you do not feel comfortable discussing your personal health needs with him or her, it probably isn’t the right fit.

“I would encourage patients to look for a provider that they have good rapport with,” said Dr. Garcia. “This is really important because patients should be able to talk to their providers about their sexual health and sexual function, especially when it comes to transgender health care. If you find that when you bring up your sexual function your provider is somewhat responsive to it, well that might be okay, but if they’re completely unresponsive to it, it may be time to look for a new provider.”

Of course, finding knowledgeable, qualified providers is just one part of the equation when it comes to transgender health. “The health care should go beyond just medical care,” said Dr. Kingsberg. “We want to make sure that all the specific needs that a transgender individual might have are addressed. That would certainly be mental health needs, but also social support. Since there’s such stigma for transgender youth, we want to make sure that schools have adequate support. Workplace support is also important – making sure that human resources have guidelines that are protecting somebody’s gender expression.”

Contribution to article by Maurice Garcia, MD and Sheryl Kingsberg, PhD, IF.

The following is a list of health-related resources for transgender individuals:

• World Professional Association for Transgender Health (WPATH): https://www.wpath.org/
• Fenway Health: https://fenwayhealth.org/
• CDC Lesbian, Gay, Bisexual, and Transgender Health: https://www.cdc.gov/lgbthealth/index.htm
• American Sexual Health Association: ashasexualhealth.org
• The National LGBTQIA+ Health Education Center: http://www.lgbthealtheducation.org/