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Gender-Affirming Care

  • Writer: Rachel
    Rachel
  • Sep 26, 2024
  • 4 min read

What is Gender-Affirming Care?


Gender-affirming care is a supportive form of healthcare for transgender patients of all

ages. It includes a wide range of services, including medical, surgical, mental health,

and social services. Patients seeking gender-affirming medical care often receive

counseling for extended periods. If goals include medications or surgery, further

assessments are performed to ensure they meet prescribing criteria. At all stages,

gender-affirming care is only delivered after patients and families have been counseled

and informed consent is given.


Affirmations


Social affirmation is the most common form of gender-affirming care since it can be done at any age. This includes adopting gender-affirming hairstyles, clothing, names, and pronouns. Individuals can also pursue affirmation by changing names or gender markers on legal documents, not limited to birth certificates, identification, and school documents.


Medical affirmation is the process of using cross-sex hormones to allow patients to develop secondary sex characteristics after puberty. It includes the use of gonadotropin-releasing hormone analogues (GNRAs), testosterone, androgen inhibitors, or estrogen. Medications can only be prescribed by licensed, experienced providers, usually extensive discussions and work-up with the patient.


Surgical affirmation is sometimes referred to as “top surgery” or “bottom surgery” and can be the creation of a gender-typical chest shape or facial features. Procedures in patients with gender dysphoria have been validated in other situations, including hysterectomy, mastectomy, and plastic surgery. Of all types of affirmation, surgical affirmation is the most controversial. Understanding concepts of gender identity and gender dysphoria can foster a supportive environment for all individuals.


Adolescents and adults who identify as transgender have high rates of depression, anxiety, eating disorders, self-harm, and suicide. The Trevor Project’s 2021 National Survey on LGBTQ+ Youth Mental Health found that 52% seriously considered attempting suicide in the past year. Increasing medical and psychosocial gender-affirming care practices have yielded lower rates of adverse mental health outcomes. The American Academy of Pediatrics, American Medical Association, and American Psychiatric Association support the provision of age-appropriate, gender-affirming care for transgender and non-binary patients.


Inclusion & Belonging

Common Terms (in alphabetical order):


Cisgender: Describes a person whose gender identity aligns with their sex assigned at birth


Gender diverse or expansive: An umbrella for a person with a gender identity and/or expression broader than the male or female binary. Gender minority is also used interchangeably with this term.


Gender dysphoria: Clinically significant distress that a person may feel when the sex or gender assigned at birth is not the same as their identity.


Gender identity: One's internal sense of self as man, woman, both or neither


Nonbinary: Describes a person who does not identify with the man or woman gender binary.


Transgender: Describes a person whose gender identity and/or expression is different from their sex assigned at birth, and societal and cultural expectations around sex.


Diversity & Inclusion

The Role of Pharmacists & Healthcare Providers


Patient Advocacy

In 2014, a study of youth groups in Seattle revealed many obstacles that transgender youth face in accessing essential healthcare services. Youth who identify as transgender often face stigma and discrimination, which contribute to feelings of rejection and isolation that can negatively impact well-being. In 2017, 1 in 4 adults who identified as transgender avoided a necessary doctor’s visit due to fear of mistreatment. Maintaining a safe clinical space allows for at least one consistent refuge for patients and families. 


Healthcare providers have an essential role in assessing patient concerns and providing evidence-based information to assist in medical and shared decision-making, and not doing so can prolong gender dysphoria and contribute to stigmatization. If a provider does not feel prepared to address gender concerns, referral to a healthcare provider with more expertise is appropriate. 


Pride


Resources for Providers:

American College of Physicians (ACP) Points on Providing Gender-Affirming Care: https://immattersacp.org/archives/2024/02/points-on-providing-gender-affirming-care.htm


Regardless of training, experience, and position in the world, we can all participate in gender-affirming care by understanding common terminology, being inclusive, seeking information from reputable sources, and requesting policies and protocols for practice sites.


References:

  1. Health and Human Services Office of Population Affairs. Gender-Affirming Care and Young People. Accessed September 25, 2024. https://opa.hhs.gov/sites/default/files/2022-03/gender-affirming-care-young-people-march-2022.pdf

  2. Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022;23(Suppl 1):S1-S259. Published 2022 Sep 6. doi:10.1080/26895269.2022.2100644

  3. Rafferty J; American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4):e20182162. Pediatrics. 2023;152(4):e2023063756. doi:10.1542/peds.2023-063756

  4. Gridley SJ, Crouch JM, Evans Y, et al. Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth. J Adolesc Health. 2016;59(3):254-261. doi:10.1016/j.jadohealth.2016.03.017

  5. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, gay, bisexual, and transgender-related content in undergraduate medical education. JAMA. 2011;306(9):971-977. doi:10.1001/jama.2011.1255


This article was written by:

Emily Gaidos, BSc

Columbus, Ohio


Reviewed & Edited by:

Rachel Chandra, PharmD, MPH

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