What is gender-affirming care?

In the US, Donald Trump wasted no time in rolling back rights for trans people, restricting access to puberty blockers for trans youth who want to delay puberty in order to transition. In the UK, a review of gender services available on the NHS cast doubt on the “evidence on medicine” for gender issues.

In the media, gender-affirming care has been reduced to being about trans people and medication, when it really encompasses so much more than that. We hope this piece helps you understand its importance and its broad applications, beyond inflammatory headlines and misinformation. 

At its heart, gender-affirming care is an approach to healthcare that validates and recognises a person’s gender. This means taking someone’s gender into account when talking to them and assessing their needs, rather than applying a one-size-fits-all approach. For example, awareness campaigns around the health of particular parts of the body, like cervical smear reminders or information on prostate exams, might be aimed largely at cisgender people, when trans men and trans women also need to access those services. 

When it comes to health conditions that affect people of one biological sex more than another, cis people can also be affected by the language used. For example, men can, in rare cases, get breast cancer, and one study suggested many men had no idea breast cancer could even affect them as they perceived it as a “feminine illness”. 

Using language that includes all genders also makes it easier for gender nonconforming people to engage with healthcare – a review of health literature concluded that it was important to use gender-affirming language in health questionnaires to ensure they weren’t excluded. 

We’ll look in more detail at different aspects of gender-affirming care throughout this piece.

What is Gender-Affirming Care?

Affirming someone’s gender in healthcare isn’t just about hormone medication or language – it’s a combination of factors including social, medical and legal approaches. Respecting someone’s pronouns and gender identity would fall under the social element; treatments and procedures would fall under medical, and the legal element refers to the underpinning principle of informed consent. This means that someone must be given all the information about a treatment, including possible risks, benefits, and available alternatives. They must have capacity to make a decision about whether to proceed with the treatment. One could argue that restricting access to hormonal treatment or talking therapy for trans people also restricts their ability to freely decide whether to pursue these treatments.

Cisgender people also experience gender-affirming care, but they might not be aware of it. Cisgender women experiencing the menopause, for example, are receiving gender-affirming care if they’re taking hormone replacement treatment (HRT) as it restores estrogen to its pre-menopause symptoms. This alleviates unpleasant menopause symptoms in many women. Some trans people also use HRT – either estrogen or testosterone-based. Cis people usually have fewer barriers in accessing gender-affirming care as it isn’t restricted in the same way it is for trans folk, but that’s not to say there are never issues – a global shortage of HRT made it more difficult for many cis women to access the treatment in the last few years. 

Medical Perspectives on Gender-Affirming Care

The medical elements of gender-affirming care can involve surgeries and hormones, as we’ve mentioned above. This might include: 

• Gender-affirming hormone therapy (GAHT): Some trans and non-binary people may want to take hormones to induce changes in the body that align with their gender identity. Trans women and trans feminine people would take estrogen-based feminising hormones, while trans men and trans masculine people would take testosterone-based masculinising hormones. This can help reduce feelings of gender dysphoria and improve mental wellbeing.
• Hormone replacement therapy (HRT): The term HRT is commonly used to refer to estrogen-based treatments for post-menopausal cis women. Testosterone-based HRT can also be used for cis men with low testosterone. Data suggests between 2-8% of men have low testosterone, with it being more common in older men and those with existing health issues. It can affect sex drive and cause erectile dysfunction as well as causing low mood and low sperm count. 
• Gender-affirming surgery: You’ve probably heard of bottom and top surgery. Not all trans people have surgery, but some do opt for genital surgery to align with their gender identity. Bottom surgery covers vaginoplasty (construction of a vagina) and phalloplasty (penis construction). Top surgery is the removal or construction of breast or chest tissue. There are other surgeries too, like hysterectomy (removal of the uterus); removal of the ovaries and fallopian tubes; removal of the testicles and facial surgery. 
• Psychological support: Gender-affirming therapy is an approach that supports and affirms someone’s gender identity. Therapy can also help with managing distress from gender dysphoria, coming out as trans, non-binary or gender-nonconforming to family and friends, and mental wellbeing.

Cosmetic Perspectives on Gender-Affirming Care

Some trans, non-binary and gender-nonconforming people choose to have cosmetic surgery to align their appearance with their gender identity. This is, of course, an individual choice, and it goes without saying that it’s not necessary to look a certain way to validate your gender identity. 

That said, many trans people do feel an uptick in their body image and mental health and reduction in gender dysphoria after surgery, studies suggest. 

On a Reddit post from a trans woman asking opinions on different treatments and surgeries, several respondents sung the praises of facial feminisation surgeries. Some were specific in the modifications they were particularly pleased with: brow reduction, rhinoplasty or ‘chin work’. 

Some trans women – and even cis women with prominent Adam’s apples – might decide to have a tracheal shave, where the cartilage of the Adam’s apple is reduced.  

For trans men and trans masculine people, it’s often the same areas of the face – brow, nose, jaw – that are changed if they decide to have cosmetic surgery, with the aim of enhancing those features to create a more masculine look. 

Self-Perception and Style in Gender-Affirming Care

Clothes and makeup can play a big part in the way someone expresses their gender identity. As the trans masculine, nonbinary writer Emrhys Ma said: 

“Before top surgery, I felt certain that my presentation was masculine of center. I love they/them pronouns, but he/him always feels a little fancier and more exciting to me. I love being sir’d by a barista. Those preferences haven’t changed.

“But now that I’ve had top surgery, I’m not determined to use fashion to prove that I’m masculine of center. I’m not fighting my body with every outfit. I can’t believe I get to type that sentence. I’m so so lucky.”

Before their top surgery, it was clothes that communicated Emrhys’s gender to the world, and the fashion and beauty industries are catching on to the need to support this. Sephora offers virtual classes on beauty for trans people, and ASOS and L’Oreal have workplace policies and support for transitioning employees. 

Some gender-affirming coaches and therapists offer advice on makeup and styling, and these services are also available privately. Passing – when you’re perceived in public as the gender that aligns with your identity – is a huge deal for many trans people, in the same way that being misgendered is distressing. Clothes and makeup can make a difference in this respect. 

Expanding the Understanding of Gender-Affirming Care

As you can see, there are many examples of gender-affirming care outside of the most well-known treatments often associated with trans people. Health conditions that impact hormone levels can impact cis peoples’ sense of self too, especially as low estrogen or testosterone can cause a decreased libido and low mood. Access to hormone treatment or talking therapy can improve not just someone’s sex life, but their overall wellbeing, just as it does for trans people.  

Surgery can sometimes be necessary for cis people, too. A 2022 op-ed on NBC News by Justin T. Brown, a cis man who’d experienced gynecomastia (breast tissue growth in men) emphasised the importance of gender-affirming care. “My breast reduction saved my mind. Receiving care that affirmed my perceptions of my gender drastically changed my life for the better,” he wrote. “Trans children deserve the same consideration.”

Medical misogyny impacting cis women also emphasises how vital gender-affirming care is. One study found that women with acute abdominal pain were less likely to be given pain relief than men, with researchers concluding gender bias could have been a factor. A Washington Post article highlighted several shocking examples of bias, like a woman being dismissed as “dramatic” when in actual fact she had a brain tumour, and dismissal of how painful having an IUD inserted was. Gender-affirming care would mean women’s pain being validated and taken seriously, rather than written off as an overreaction based on gender stereotypes.  

Intersex people – those with sex characteristics that don’t fit into the male and female binary – also benefit from gender-affirming care. A 2023 study found that they can be harmed by a healthcare system structured around a binary idea of sex, and their self-perception and autonomy hasn’t always been prioritised.

There’s much more to gender-affirming care than surgery or hormones, and as we’ve covered, people of all genders benefit when healthcare prioritises their autonomy and helps them regain their sense of self. 

A gender-affirming approach goes hand-in-hand with a patient-centred approach; this recognises that everyone has individual needs, and “empowers patients to become active participants in their care”. Trans, non-binary and cis people all benefit from gender-affirming care, because the underlying principle is that they are treated as individuals and assessed on a person-by-person basis. This is preferable to an approach that seeks to align all conditions with a binary model of sex, as such a framework can be influenced by gender bias, as we’ve seen in some of the examples in this article. 

Whether you’re a healthcare provider or just interested in the importance of affirming someone’s gender and individuality, we hope we’ve enhanced your understanding.