Gender-affirming care (GAC) helps support individuals in many ways, including physical transitions and mental well-being. It consists of medical, nonmedical, surgical, and nonsurgical services, mental health care, and social support.
GAC also helps treat and potentially prevent certain health conditions for trans and nonbinary people. Studies suggest it has helped
This article discusses more about what GAC entails, including types, benefits, and where to find support.
GAC covers everything from using gender-neutral language to gender-affirming surgeries. Previously, GAC has been difficult to obtain within the healthcare industry. However, over recent years, it has become more mainstream within healthcare professions.
Everyone can contribute to GAC. There are different transitions and affirmations of GAC, outlined below, and it is not a linear experience.
Social transitioning
Social transitioning refers to when someone makes changes representing social and gender identity, such as:
- appearance
- name
- behavior
- pronouns
For example, a person may alter their hairstyle or clothing to present a more masculine or feminine appearance. They may also change which public bathroom they use.
Learn more about the different types of gender identity.
Social affirmation
Social affirmation is a form of GAC that is important for everyone to be aware of — inside and outside healthcare. It includes gender-affirming language, such as using the correct pronouns and avoiding “deadnaming.” This is where someone refers to a transgender or nonbinary person by their birth, given, or former name without their consent.
Avoiding deadnaming is something particularly important for healthcare professionals to be aware of, as someone’s medical records may not necessarily reflect their chosen name, gender identity, or both.
Social affirmation also covers the ability for people to access the appropriate facilities that align with their gender expression, such as public bathrooms.
There are also nonsurgical interventions in GAC, such as speech therapy, shapewear, hair removal, chest binders, and laser hair removal.
Medical transitioning
Medical transitioning refers to both surgical and nonsurgical medical interventions that help someone outwardly portray their gender identity.
This can involve:
Medical affirmation
Medical affirmation within GAC
Adults can access care through a qualified medical professional and generally do not require psychological assessment before starting hormone therapy. However, they may need to be assessed prior to surgical interventions.
For minors, laws vary from state to state. However, access to services will generally require parental consent and an evaluation from a social worker or therapist before starting hormones or puberty blockers. This is to ensure a person has the correct support for their transition.
Fertility treatments, such as egg or sperm freezing, prior to surgical transitioning are also important factors in GAC.
Legal affirmation/transitioning
Currently, 85 countries allow people to change their legal sex. However, 40 of these countries require a person to undergo surgery.
GAC is fundamental in providing a safe and inclusive space for transgender, genderfluid, nonbinary, and intersex people.
The transgender and nonbinary communities
Early GAC is also vital to trans and nonbinary adolescents in terms of mental health support, puberty blockers, and early hormone therapies. Young trans and nonbinary individuals are more likely to experience issues with mental health, substance misuse issues, or both. They are also more likely to die by suicide than their cisgender peers.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Benefits of GAC include:
- Improved quality of life:
Studies show that trans people experience a better quality of life, such as experiencing improvements in psychological function and physical health. - Reduced depression: A 2023 study found that transgender people who were not on hormonal treatment were
four times more likely to experience depression than those on hormones. - Suicide prevention: Trans individuals are up to
nine times more likely than the general U.S. population to make attempts on their lives. Effective GAC can help reduce these rates dramatically. - Reduction in social stigma: A
2023 review reports that 9% of the general population and up to 55% of young people identify as gender diverse, but that some medical professionals may be reluctant to see beyond the gender binary. Elevated GAC will not only help the healthcare system to provide better care for individuals, but general social stigma will also experience positive changes.
There is no right way to transition, and it may look different for each individual. A transition
Hormone blockers
Puberty blockers or hormone blockers are types of hormones that pause puberty development in transgender and nonbinary individuals.
There are two types of puberty blockers: histrelin acetate and leuprolide acetate.
Histrelin acetate is a flexible rod that sits under the skin of the arm. This lasts for 1 year, which will then need replacing.
Leuprolide acetate is an injectable shot. Different forms of leuprolide acetate work for different amounts of time. A person will need repeat shots every 1–4 months.
Medications
There are some medications that doctors may recommend within GAC.
Anti-androgens
These lower levels of testosterone in the body, reducing the masculinizing effects of testosterone. Transgender, nonbinary, and intersex people can use this. Doctors may prescribe them in conjunction with hormone therapies.
Mineralocorticoids
Cortisol and aldosterone are both mineralocorticoids. Most transgender and nonbinary people will not require treatment for mineralocorticoid deficiency or excess. However, some intersex people
HRT
HRT is an important therapy for many transgender, intersex, and nonbinary people. However, its use is usually at the discretion of the individual and has no bearing on someone’s gender identity or expression. Common HRTs include:
- Masculinizing hormones: Individuals assigned female at birth can access gender-affirming hormone therapies in the form of testosterone hormones to reduce the feminizing effects of estrogen and enhance masculine physical character traits.
- Feminizing hormones: Individuals assigned male at birth can access estrogen hormones to reduce the masculinizing effects of testosterone and develop more feminine physical traits.
Some of the changes caused by HRT are permanent and long term, but others are reversible.
Hair and body changes
If someone is receiving GAC medication via HRT, they will likely experience changes to their hair and body. HRT can include:
Feminizing hormones
Estradiol and/or anti-androgens in transgender women
Estrogen may also cause breast duct and tissue development, as well as a change in fat deposition, resulting in greater fat distribution on the hips, thighs, and breasts. Breast development and size will vary from person to person.
Masculinizing hormones
Masculinizing HRT with testosterone may increase facial and body hair growth, as well as potentially inducing or accelerating AGA.
- skin oiliness or acne
- voice deepening
- increase in muscle mass
- absence of menstruation
Surgeries
Gender-affirming surgeries or gender-confirmation surgeries include:
Top surgery
This can be either feminizing, which is enhancing breasts with implants, or lipo-filling, or masculinizing, which is removing breast or chest tissue.
Learn more about top surgery.
Masculinizing or defeminizing bottom surgeries
This surgery includes:
- hysterectomy, the removal of the uterus
- vaginectomy, the removal of the vagina
- metoidioplasty or phalloplasty, which is the construction of a penis
- salpingectomy, the removal of the fallopian tubes
- oophorectomy, the removal of the ovaries
- metoidioplasty, the release of tissue around the clitoris to enlarge it
- phalloplasty, the construction of a penis from a skin graft
Learn more about masculinizing bottom surgeries.
Feminizing or demasculinizing bottom surgeries
This surgery includes:
- Orchiectomy: This is the removal of the testes. An orchiectomy can be stand-alone or in conjunction with vaginoplasty.
- Vaginoplasty: This procedure removes the penis, testicles, and scrotum and creates a vaginal canal and labia. The surgeon also forms a clitoris using a portion of the glans penis.
- Vulvoplasty: This involves creating a vulva, which is the the outer genitals. It is similar to a vaginoplasty but without making a vaginal canal. This surgery can be a stand-alone procedure for people who may not be interested in receiving vaginal penetrative sex or who do not want to commit to the healing time involved in a vaginoplasty. It can also be in conjunction with a “minimal depth vaginoplasty.”
Facial feminization or masculinization
Various plastic surgery techniques
Various organizations provide further information and support around GAC. These include:
- Intersex Society of North America (ISNA): This aims to achieve systemic change to help intersex individuals and provide support for mental health potential unwanted surgeries. Learn more.
- The Trevor Project: This is an online support group for young LGBTQ+ people ages 13–24 years. Learn more.
- TransFamily Support Services: This offers supportive resources for trans individuals and families of trans youth. Learn more.
Gender-affirming care (GAC) is a vital form of healthcare for transgender, genderfluid, nonbinary, and intersex people. It encompasses medical, nonmedical, surgical, and nonsurgical services, mental health care, and social support.
GAC is starting to gain the global traction and recognition that it deserves, but there is still some way to go.
If a person is having issues with their gender identity or recognition within a medical setting due to their gender identity, there are various resources of support available.