What Is Gender-Affirming Care?

Gender-affirming generally refers to the medical, psychological, and social support provided to individuals who are transgender, non-binary, or gender expansive. to help align their gender identity with their outward appearance and improve their overall well-being.
This type of care can include socially transitioning by changing one’s name, pronouns or way of presenting; puberty blockers; gender-affirming hormone therapy; and gender-affirming surgeries.
At least 30 states have introduced or are considering laws that restrict access to gender-affirming care.

Gender-affirming care has been the subject of much debate in legislatures around the country in recent months, leading to countless misconceptions and myths about what it actually entails and who it’s for.< According to a report from The Williams Institute, 30 states had introduced or were considering laws to restrict access to gender-affirming care as of March 2023. The result is 146,300 transgender youth who have lost or are at risk of losing access to gender-affirming care. Several bans proposed in 2023 would also limit access to care for those up to age 26.

While misinformation on the subject abounds, it’s important to get the facts straight: Gender-affirming care is considered safe, effective, and medically necessary by the American Medical Association, the American Academy of Pediatrics, and the Endocrine Society.

“Gender-affirming care is considered life-saving,” said Rebecca Minor, MSW, LICSW, a gender specialist and therapist who provides gender-affirming care. “It plays a crucial role in improving the mental health, well-being, and overall quality of life for transgender, non-binary, and gender diverse individuals.”

What Does Gender-Affirming Care Involve?

Gender-affirming care refers to medical, psychological, and social support provided to individuals who are transgender, non-binary, or gender expansive, Minor explained. The goal of gender-affirming care is to assist individuals in aligning their sense of self with their outward appearance and to improve their overall well-being.

“Gender-affirming care means different things for different people,” Uri Belkind, MD, a pediatric medicine specialist who works in adolescent medicine at the New York-based LGBTQ+ health center Callen-Lorde, told Verywell. “It is not a specific process, but rather a collection of tools from which we can select to better fit the individual’s goals and needs.”

One aspect of gender-affirming care requires no medical intervention but instead involves transitioning socially. This may include changing one’s name and pronouns, and dressing or presenting in a way that affirms their gender identity, according to Sean Arayasirikul, PhD, an associate professor in residence of health, society, and behavior at the University of California, Irvine.

Beyond socially transitioning, there are three general medical options available when it comes to gender-affirming care, Belkind said, adding that some people may want or need all of them, while some may find happiness and well-being with only some. These include puberty blockers, gender-affirming hormone therapy, and gender-affirming procedures.

Puberty blockers are for younger patients who are entering puberty and are finding the changes their bodies are going through to be distressing. To access this kind of care, these patients must have shown insistent, persistent, and consistent identification with a gender that is different than their sex assigned at birth.

“This allows us to temporarily ‘pause’ these changes while the young person, with support from their family, further explores their needs and gains a better understanding of what is possible, medically speaking, and what it entails,” Belkind said.

Gender-affirming hormone therapy, on the other hand, refers to the process of using either estrogen or testosterone to promote certain physical changes and to inhibit others, Belkind said.

Gender-affirming procedures, both surgical and non-surgical, change certain physical characteristics that may not otherwise be modified with the use of hormone therapy. Belkind said these may include chest masculinization, facial feminization, permanent hair removal or hair grafting, and genital surgeries such as vaginoplasty or phalloplasty.

“One common misconception is that gender-affirming procedures are regulated only for trans and gender expansive people and that these procedures are experimental, lacking solid medical evidence,” Arayasirikul said.

In reality, cisgender people—or people who are not trans—also choose to undergo gender-affirming procedures to affirm their identity, Arayasirikul explained. This may include a breast augmentation, a mastectomy for gynecomastia, a hair transplant, a rhinoplasty, liposuction, facial fillers, or hormone therapy.

“These procedures and so many more are part of the health care of cisgender people,” Arayasirikul said. “Yet this same care is actively being criminalized for trans and gender-expansive people solely because they are different.”

Can People of All Ages Receive Gender-Affirming Care?

In states where gender-affirming care is not criminalized, trans youth can access puberty blockers to delay the onset of puberty and cross-sex hormones to develop their bodies in ways that align with their gender identity.

“Typically, gender-affirming surgeries are utilized by adults, not children,” Arayasirikul said.

And yet, much of the uproar surrounding gender-affirming care in the U.S. has been surrounding the subject of children undergoing surgery.

According to Belkind, some patients choose to start puberty blockers once puberty begins, while other patients may only begin to seek medical advice after puberty or much later into adulthood.

“It is important to note that, for children who strongly identify with a gender identity that is different from their sex assigned at birth, there are no medical interventions needed before puberty begins and only then do we consider the use of puberty blockers, if needed,” Belkind said.

Medical interventions always happen after a thorough evaluation of the patient’s needs, Belkind added.

Why Gender-Affirming Care Is Necessary

Gender-affirming care helps to reduce gender dysphoria, which is the distress an individual may experience when their gender identity does not align with their assigned sex at birth, Minor said.< “Gender-affirming care, such as hormone therapy or gender-affirming surgeries, can help alleviate gender dysphoria by allowing individuals to align their physical appearance with their gender identity” she said. “This reduction in distress and discomfort can have a significant positive impact on mental health and overall well-being.” Trans and gender-diverse individuals often face higher rates of mental health challenges, including depression, anxiety, and suicidal ideation.1 Gender-affirming care, combined with mental health support, can help reduce these risks by providing individuals with the tools, resources, and interventions needed to alleviate distress and promote a positive self-image, Minor said.

According to one recent study, providing trans and non-binary youths aged 13 to 20 years with gender-affirming care, including puberty blockers and gender-affirming hormones, lowered their risk of developing moderate or severe depression by 60% and lowered suicidality by 73% over a 12-month follow-up.2

Another study found that gender-affirming surgeries were associated with a 42% reduction in psychological distress and a 44% reduction in suicidal ideation when compared with transgender and gender-diverse people who had not had gender-affirming surgery but wanted it.3

“Gender-affirming care allows individuals to express their gender identity authentically, promoting self-acceptance and improved self-esteem,” Minor said. “By aligning their physical appearance, social interactions, and personal identity, individuals can develop a stronger sense of identity and self-worth, leading to improved mental health outcomes.”

Additionally, gender-affirming care often includes support groups, peer networks, and counseling services that provide a safe and inclusive environment for individuals to connect, share experiences, and receive emotional support, Minor said. These social support systems, she said, are critical in combating feelings of isolation and promoting healthy relationships.

This kind of care can help combat the societal discrimination, stigma, and marginalization transgender and gender-diverse individuals often face. Minor said gender-affirming care can empower individuals to assert their rights, advocate for themselves, and challenge discriminatory practices.

“By affirming their gender identity, individuals can experience improved resilience, reduced psychological distress, and increased social acceptance,” she said.

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