Gender-affirming care is a term that covers an array of health care services and other interventions aimed at supporting and affirming an individual’s gender identity when it does not align with the gender they were assigned based upon their apparent sex at birth. This can include social, behavioral, medical, and psychological options.
Social Affirmation
One type of gender-affirming care is social affirmation. This can be achieved at any time when an individual adopts a gender-affirming name, pronouns, hairstyle, clothing, restrooms, and/or other facilities.
Gender-Affirming Hormone Therapy
Gender-affirming hormone therapy (GAHT) involves testosterone hormones for individuals who wish to develop what are traditionally considered to be “masculine” characteristics and estrogen hormones for those who wish to develop “feminine” characteristics.
GAHT promotes the development of secondary sex characteristics in the body. For people taking testosterone, this includes the development of a deeper voice, the redistribution of body fat away from the hips and thighs, increased body and facial hair, increased muscle mass, and changes to (or the possible cessation of) menstruation. On the other hand, for people taking estrogen and testosterone blockers, this includes the redistribution of body fat to the hips and thighs, breast growth, decreased muscle mass, and the slowing of body and facial hair growth.
Gender-Affirming Surgery
Gender-affirming surgery (GAS) refers to surgical procedures aimed at helping people transition their anatomic parts to match their gender identity. There are several types of GAS including chest or “top” surgery, genital or “bottom” surgery, and facial reconstructive surgery.
Chest GAS involves removing breast tissue for a more masculine look or enhancing the breast size for a more feminine look.
Genital/reproductive system GAS can refer to a variety of different surgeries. For transfeminine individuals, options include bilateral orchiectomy (the removal of both testicles) and vaginoplasty (the surgical creation of a vulva with or without a vaginal cavity). Options for transmasculine individuals include hysterectomy (the removal of the uterus and cervix), salpingo-oophorectomy (the removal of the fallopian tubes and ovaries), metoidioplasty (the creation of a penis through the enlargement of the clitoris and the use of surrounding tissue), and phalloplasty (the creation of a penis through the use of tissue from other parts of the body).
Facial reconstructive surgery can involve any surgery to change aspects of one’s head and neck to create more feminine or masculine features.
Psychological Counseling or Therapy
Psychological counseling with a professional who has experience working with transgender and gender diverse patients may be a helpful way to cope with challenges that may be experienced during transition or one’s day to day life. Some challenges may include discrimination, the financial burden of gender-affirming care, difficulties finding quality gender-affirming care and insurance coverage, unsupportive family members or friends, and so on. The following are a few resources for finding psychological support:
For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:
Development of a Decision Aid for Genital Gender-Affirming Surgery in Transmen
Evaluation and Treatment of Gender Dysphoria to Prepare for Gender Confirmation Surgery
A Simple Guide for Simple Orchiectomy in Transition-Related Surgeries
References:
Hadj-Moussa, M., Ohl, D.A., & Kuzon Jr, W.M. (2018). Evaluation and treatment of gender dysphoria to prepare for gender confirmation surgery. Sexual medicine reviews, 6(4), 607-617. https://doi.org/10.1016/j.sxmr.2018.03.006
Office of Population Affairs. (2022). Gender-Affirming Care and Young People. https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf
Siira, M., Getahun, D., Silverberg, M.J., Tangpricha, V., Goodman, M., & Yeung, H. (2023). Satisfaction with current hormone therapy and goals of additional gender-affirming care in transgender adults. The Journal of Sexual Medicine, 20(4), 568-572. https://doi.org/10.1093/jsxmed/qdad011
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