Gender-affirming care frequently appears in discussions involving transgender people, ranging from divisive news articles to medical jargon. Despite the term’s growing popularity, many people remain unsure what “gender-affirming care” actually means.
Table of Contents
- What Is Gender-Affirming Care?
- Understanding the Different Types of Gender-Affirming Care
- Debunking Common Myths About Gender-Affirming Care
- Frequently Asked Questions
What Is Gender-Affirming Care?
Gender-affirming care refers to any treatment or service to support one’s gender identity. Although most people associate gender-affirming care with medical treatments like hormone replacement therapy and surgery, it encompasses a wide range.
The World Health Organization defines gender-affirming care as any social, psychological, behavioral, and medical intervention “designed to support and affirm an individual’s gender identity.” Due to the extensive history of establishing gender-affirming care as the best evidence-based treatment for gender dysphoria, this definition is the universal standard among organizations like the American Medical Association and American Psychiatric Association.
Not every transgender person needs or wants to transition. There is no singular way to be transgender, and individuals may choose not to pursue some aspects of gender-affirming care due to health issues or personal preference.
Cisgender individuals also utilize gender-affirming care. Although gender-affirming care is strongly associated with transgender medicine, it was originally researched for cisgender application. Some examples of cisgender gender-affirming treatments include:
- Estrogen hormone therapy was engineered to help cisgender women experiencing menopause-related symptoms.
- Testosterone hormone therapy was developed to support cisgender men with male hypogonadism.
- Breast augmentation was designed to support cisgender women’s gender expression, while breast reduction surgeries were developed to support cisgender men with gynecomastia.
- Many forms of cisgender hair care, such as laser hair removal and hair plugs, exist to support gender expression and alleviate internal distress.
- Cisgender men frequently use medication like sildenafil and tadalafil to treat age-related erectile dysfunction.
- Puberty blockers were originally developed to treat central precocious puberty among cisgender children.
Anti-transgender activists and politicians hyperfixate on transgender medicine when discussing gender-affirming care. When targeting gender-affirming care, cisgender lives also get negatively impacted because it is impossible to distinguish between cisgender and transgender gender-affirming care without infringing on fundamental rights.
It is increasingly common for media outlets to write divisive articles about gender-affirming care and transgender people to monetize and fuel growing anti-transgender resentment. Many of these opinion pieces, including those written by the New York Times, focus on debunkable arguments like the cost of transgender healthcare to taxpayer dollars, forced transitions on children, and a lack of evidence supporting treatment.
Media literacy is critically undervalued. When media outlets and content creators use “gender-affirming care” as a buzzword, it is important to consider:
- What kind of gender-affirming care are they referring to?
- What age group does this form of gender-affirming care apply to?
- What is the purpose of this form of gender-affirming care?
- What restrictions are currently in place regarding this form of gender-affirming care?
- What non-anecdotal sources are being cited to support this material?
- What benefit does this outlet or creator gain from this material?
Understanding the Different Types of Gender-Affirming Care
There are many forms of gender-affirming care. Although gender-affirming care is misunderstood as purely medical, it is an umbrella term that applies to all treatments designed to support one’s gender identity.
Social-Based Gender-Affirming Care
The most accessible form of gender-affirming care is social-based, making it the most common initial step for transition. These processes involve how others interact with you and are entirely non-medical.
Examples of social-based forms of gender-affirming care include:
- Coming out to others about your transgender identity.
- Choosing a new name and honorifics to better reflect your gender identity.
- Determining which pronouns best suit your gender identity.
- Experimenting with clothing, hairstyles, makeup, accessories, and other forms of gender expression.
- Updating social media accounts with your chosen name and gender identity.
- Participating in gender-segregated groups, spaces, and activities based on your gender identity.
- Adjusting mannerisms and voices to reflect your gender identity.
- Using chest binders, breast and hip padding, packers, and tucking devices to alleviate dysphoria.
All forms of social-based gender-affirming care are reversible, and very few require professional guidance. It is the most experimental stage of identity, which is why it’s strongly associated with early transition – but it is also the foundation for other forms of gender-affirming care since it has historically been used as a prerequisite requirement to HRT and surgery.
Social Transition for Minors and Legislative Restrictions
Social-based gender-affirming care encompasses the vast majority of transition for transgender youth. While some transgender minors access and pursue medical treatments like HRT, most explore social-based gender-affirming care with their peers, family, and communities.
Due to the nature of social-based gender-affirming care, it is difficult to regulate. When anti-transgender legislation promises to ban “transgender care on minors in schools,” it is referring solely to reversible social-based changes. Regulation of this type of care rides the line between personal choice, freedom of expression, and parental rights.
Real-world examples of regulation include Indiana’s HEA 1608, Idaho’s HB 822, and Tennessee’s SB 1810. Other examples can be tracked and visualized on the Movement Advancement Project’s Forced Outing map.
- HEA 1608 requires schools to notify parents if students request to use a different name, pronoun, or honorific that does not match their sex assigned at birth. If Elizabeth privately tells their teacher that they don’t like “she/her” pronouns, their teacher must give a written notice to Elizabeth’s parents – even if Elizabeth isn’t out to their parents.
- HB 822 forces schools, medical providers, and childcare workers to inform parents of minors seeking any sort of social transition care. Sam shaving their head requires their daycare worker to tell their parents that Sam might be experimenting with social transition, just as CeCe’s teacher aide has to write a letter because they overheard her come out to her friends in the hallway.
- SB 1810 requires schools to notify parents of gender-affirming accommodations. Jeffrey’s parents must be informed that he asked to use the gender-neutral bathroom in the nurse’s office, potentially putting him in danger if his parents are deeply unsupportive.
Social-Based Gender-Affirming Care Resources
Behind the Name
Hey I’m Trans
Point of Pride
Pronoun Dressing Room
REFUGE
Strands For Trans
Trans Wardrobe Project
Undead Voice
VCP
One of many websites that allow users to browse names. Behind the Name has hundreds of thousands of entries, which can be filtered by culture, time period, gender, popularity, meaning, and other criteria.
A website developed by the Trans Lifeline to guide people through the complex process of coming out. There are developed guides for coming out to family, friends, coworkers, and online spaces – as well as other resources to improve allyship.
A nonprofit organization that operates several programs to financially support transgender people in the United States, including access to binders, femme shapewear, and other needs. Point of Pride maintains the largest binder donation program in the US.
A website developed in 2014 that lets users try out names and pronoun sets on their own. Users can enter custom pronouns or use any set from the provided list to generate a Project Gutenberg-based story to help internalize how they feel about those pronouns being associated with them.
A web application and mobile app connecting users to transgender-friendly restrooms based on location and user entries. Originally based on the data gathered by Safe2Pee, REFUGE utilizes user-generated data to improve restroom access.
A website that lists transgender-friendly salons and barbershops based on business self-registration. Users can search based on location and offer a guide to help shops become more inclusive.
A Portland-based nonprofit that donates gender-affirming clothes to anyone within the United States based on local donations. Wardrobes are provided to anyone at least 18 years old, although priority is given to TransPOC and folks living in communities without alternative LGBTQIA+ resources.
A free beginner course to help transgender individuals alter their voice, best combined with their downloadable guide.
Learn more about transfeminine and transmasculine voice training resources.
A map directory developed to assist transgender individuals in connecting with speech-language pathologists and other professional voice trainers.
Learn more about transfeminine and transmasculine voice training resources.
Mental Health-Based Gender-Affirming Care
Mental health-based gender-affirming care supports transgender individuals in exploring their gender identity based on well-established research. Historically, mental health providers were the primary gatekeepers who allowed (and denied) transgender people access to medical transition. Like social-based gender-affirming care, these treatments are reversible and non-medical.
Examples of mental health-based gender-affirming care include:
- Talking with a therapist about gender identity.
- Getting support for gender dysphoria and internal distress.
- Obtaining assessments and letters of support documenting gender identity.
- Discussing long-term goals of transition.
- Navigating the coming out process and struggles.
- Supporting new social dynamics with family and friends.
Anti-transgender activists claim mental health professionals intentionally “convince” individuals that they are transgender, supporting claims of Rapid-Onset Gender Dysphoria pseudoscience – ironically similar to real-life conversion therapy, where individuals push pseudoscience to convince transgender individuals that they are cisgender.
It is never a mental health professional’s job to “convince” someone that they are transgender. Therapists have provided spaces to explore all gender identity possibilities for decades based on international evidence-based standards. These spaces are designed to be nonjudgmental to allow individuals to understand themselves and make informed decisions.
Mental Health-Based Gender-Affirming Care Resources
LGBTQIA+ Hotlines
American Psychiatric Association
LGBTQ+ Healthcare Directory
NAMI
PFLAG
ZocDoc
A curated directory of transgender-inclusive hotline services throughout the world. Trans Solidarity Project maintains similar directories for transgender-inclusive sexual assault support, substance use, homelessness, veterans, youth, and elders.
A national professional group for psychiatrists and medical students, which establishes diagnostic criteria for gender dysphoria and provides guidance for mental health providers to best provide assessment letters for insurance requirements and WPATH requirements.
A directory of transgender-inclusive healthcare providers within the United States and Canada that allows users to search for providers. Unlike OutList, the LGBTQ+ Healthcare Directory includes filter options for mental health support and therapy.
A national directory of affiliated support groups led by trained facilitators. NAMI is the largest affiliation of peer-led support groups, which are entirely free and transgender-inclusive.
An advocacy organization that supports friends and family of LGBTQIA+ people, as well as LGBTQIA+ individuals themselves. PFLAG chapters hold regular meetings and free support groups for community members.
A massive directory that connects users with healthcare providers based on need, insurance coverage, and availability. ZocDoc offers telehealth and in-person provider options, as well as search criteria for gender-affirming therapy.
Learn more about transgender mental health resources with Trans Solidarity Project.
Hormone Replacement Therapy Gender-Affirming Care
Hormone replacement therapy (HRT) is arguably the most represented form of gender-affirming care, which is a medical-based form of gender-affirming care. HRT uses synthetic hormones to mimic traditional sex hormones, aligning one’s physical body with secondary sex characteristics associated with their gender identity over time.
Examples of hormone replacement therapy as gender-affirming care include:
- Using prescription testosterone to masculinize oneself.
- Using estrogen, progesterone, testosterone blockers, or a combination thereof to feminize oneself.
- Using puberty blockers to temporarily pause secondary sex characteristics.
- Using other medication, such as DHT blockers and DHT creams, to further feminize or masculinize oneself.
Many transgender people seek or use HRT, although it is not suitable for everyone. Personal preference, health complications, and barriers to access limit individuals’ ability to have gender-affirming care.
Unlike mental health and social-based gender-affirming care, hormone replacement therapy is partially irreversible. While some aspects of HRT naturally reverse if discontinued, other physical changes are permanent.
Since HRT requires medication and produces potentially permanent results, it is highly regulated by healthcare professionals. It is advised to undergo hormone replacement therapy under the supervision of a medical professional for safety and efficacy.
Navigating the Traditional HRT Model
The traditional route to HRT requires getting an official letter from a mental health provider documenting your gender identity and gender dysphoria diagnosis to give to a knowledgeable provider, such as endocrinologists and some primary care physicians. There are benefits to this route, although it can be a lengthy process to secure the prerequisite documentation – and historical gatekeeping by mental and medical providers has pushed people away.
Throughout the decades when the traditional letter process was the only way to access hormone replacement therapy under doctor supervision, transgender people sought alternative gender-affirming care through DIY HRT. Although DIY hormone replacement therapy is necessary for survival and part of transgender history, it can be extremely dangerous.

Navigating the Informed Consent HRT Model
Informed consent is the most popular route to hormone replacement therapy today. Rather than requiring an official third-party letter, providers who practice informed consent go over potential benefits and risks associated with HRT. If the provider feels confident that you are well-informed and legally capable of consent, they will prescribe HRT without needing a separate mental health diagnosis.
Informed consent is popular because it is a much quicker process than the traditional letter route and eliminates some of the gatekeeping associated with gender-affirming care. This process is essentially identical to other medications providers prescribe to patients, such as having individuals read and sign off on potential side effects to a vaccination or birth control pill.
Understanding Puberty Blockers in Youth Care
The HRT process is further complicated for individuals seeking puberty blockers. Puberty blockers were originally engineered to treat precocious puberty in cisgender children, pausing the formation of unwanted secondary sex characteristics until the children were the correct age to undergo puberty. Puberty blockers are used similarly in transgender youth to pause secondary sex characteristics.
Puberty blockers are not a permanent solution and are never prescribed as such. Puberty blockers are a temporary medication that allows gender-diverse young people to explore and question their gender identity before making irreversible changes with testosterone- or estrogen-based HRT.
Puberty blockers and hormone replacement therapy are widely considered safe by the scientific community despite misinformation and bad actors. Puberty blockers have been established for decades as the best and most humane method to allow gender-diverse youth to explore gender since it is entirely reversible.






If a youth changes their mind regarding their gender identity, puberty blockers can be stopped at any time, and puberty will begin or resume as normal. Alternative approaches, such as the use of testosterone, estrogen, or natural puberty, all cause irreversible side effects.
The Trump-Vance executive order “Protecting Children from Chemical and Surgical Mutilation” prohibits Medicaid, TRICARE, and other government programs from covering gender-affirming care like puberty blockers to anyone under the age of 18.
A lot of cisgender people struggle to grasp the gravity and inhumanity of puberty blocker bans, obsessing over children being “forcibly transitioned.” Puberty blockers are a new buzzword and are being banned throughout many states – but puberty blockers have existed since the 1990s and, again, are reversible. In reality, puberty blocker bans forcibly transition transgender youth with cisgender-related puberty because people are too concerned with trans panic to allow youth to explore their gender identity safely.
Hormone Replacement Therapy Gender-Affirming Care Resources
FOLX Health
GoodRx
Informed Consent Map
Planned Parenthood
Plume
Point of Pride
QueerDoc
Trans Health Project
Trans Legal Health Fund
WPATH
A gender-affirming care telehealth provider that provides services in all US states, although access to hormone replacement therapy varies based on state law. FOLX also provides mental health services, primary care, reproductive services, and fertility treatments.
A website and mobile application that provides users with discounts for prescription medication at affiliated pharmacies, including major retailers like Walmart, CVS, Costco, and Kroger.
A directory map developed by Erin in the Morning to connect users with informed consent clinics throughout the United States and other select countries.
The largest reproductive healthcare provider in the United States, which offers informed consent hormone replacement therapy through virtual and local clinics.
A telehealth provider that offers hormone replacement therapy, mental health support, letters, and other services to support transgender healthcare. Available in most US states, although testosterone HRT is restricted.
A nonprofit organization that operates several programs to financially support transgender people in the United States, including access to hormone replacement therapy.
A hormone replacement therapy telehealth provider that prescribes medication to individuals residing in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming.
A program to help individuals navigate healthcare insurance coverage to access gender-affirming care. Maintained by Advocates for Trans Equality with a video series to explain the complicated process for using American health insurance for gender-affirming care.
A resource provided by the Transgender Resource Center and If/When/How to financially support transgender people experiencing investigation, arrest, or prosecution for accessing healthcare. Individuals can request assistance from the Trans Legal Health Fund through the Help Desk.
The leading medical association for best practices regarding transgender medicine. The World Professional Association for Transgender Health has set international standards and requirements for gender-affirming care like hormone replacement therapy since 1979.
Gender-Affirming Surgery
There are multiple forms of gender-affirming surgery (GAS), a form of gender-affirming care that helps transgender individuals live more comfortably and authentically as themselves. While “the surgery” generally refers to genital reassignment surgery, there are many forms of GAS.
Examples of surgery as gender-affirming care include:
- Breast augmentation and chest reconstruction
- Electrolysis and hair transplants
- Body contouring
- Facial feminization and masculinization
- Hysterectomy, metoidioplasty, oophorectomy, phalloplasty, scrotoplasty, urethroplasty, and vaginectomy
- Gender nullification
- Clitoroplasty, labiaplasty, orchiectomy, penectomy, vaginoplasty, and vulvoplasty
- Voice surgery
Lots of transgender people seek or undergo gender-affirming surgery, but it is not suitable for everyone. Personal preference, health complications, and barriers to access limit individuals’ ability to have gender-affirming care. One’s surgical status does not determine their transgender identity.
Gender-affirming surgery and associated physical changes are generally irreversible, which is why it is highly regulated by medical professionals trained to perform GAS.
In the United States, GAS typically requires obtaining official letters from a mental health provider documenting your gender identity and gender dysphoria diagnosis. WPATH requires one letter for top surgery, facial reconstruction, and electrolysis, and requires at least two letters for any sort of bottom surgery (also known as genital surgery, sex reassignment surgery, and gender confirmation surgery).
Select gender-affirming surgeries may not require a letter of support, but require treatment to be paid entirely out-of-pocket when using only the informed consent model.
Under federal law, most commercial and government insurance programs cannot discriminate against transgender-related healthcare that is deemed medically necessary. However, insurers can impose burdensome coverage requirements.
Access Restrictions and Regulation of Gender-Affirming Surgery
The Trump-Vance executive order “Protecting Children from Chemical and Surgical Mutilation” prohibits all forms of gender-affirming care for minors under government programs like Medicaid, Medicare, and TRICARE. 10 states prohibit transgender-related Medicaid coverage for all ages.
It is incredibly difficult to obtain gender-affirming surgery, regardless of age, since it requires researching techniques, locating a provider, obtaining letters, and financing the treatment. Despite mass hysteria, GAS has always been highly regulated for minors.
In states where transgender youth have access to gender-affirming surgery, minors only have access to select techniques like chest reconstruction. The vast majority of GAS is gatekept to adults only, including all forms of bottom surgery.
Gender-Affirming Surgery Resources
Get Covered Connector
Marketplace
Out2Enroll
Point of Pride
Transbucket
TransHealthcare
Trans Health Project
Trans Legal Health Fund
WPATH
An online tool that connects users with local nonprofit organizations to obtain healthcare coverage. Allows users to schedule telephone, virtual, and in-person appointments with providers and maintains information on whether providers are LGBTQIA+-friendly.
A government platform that enrolls users in commercial insurance plans, Medicaid, Medicare, CHIP, and other healthcare coverage options through the Healthcare Insurance Marketplace.
An online tool that connects LGBTQIA+ individuals with healthcare insurance coverage through the Affordable Care Act and compares plans based on gender-affirming care, same-sex partner coverage, and other criteria.
A community resource that allows users to share surgery photos and results related to gender-affirming surgery. Transbucket operates on the same principles as Transster, which requires users to register a free account to view, upload, and post on the site.
An international directory of surgeons that specialize in gender-affirming surgery. Users can search for providers by location and technique, and find detailed information about various GAS.
A nonprofit organization that operates several programs to financially support transgender people in the United States, including access to gender-affirming surgery and electrolysis.
A hormone replacement therapy telehealth provider that prescribes medication to individuals residing in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming.
A program to help individuals navigate healthcare insurance coverage to access gender-affirming care. Maintained by Advocates for Trans Equality with a video series to explain the complicated process for using American health insurance for gender-affirming care.
The leading medical association for best practices regarding transgender medicine. The World Professional Association for Transgender Health has set international standards and requirements for gender-affirming care like hormone replacement therapy since 1979.
A resource provided by the Transgender Resource Center and If/When/How to financially support transgender people experiencing investigation, arrest, or prosecution for accessing healthcare. Individuals can request assistance from the Trans Legal Health Fund through the Help Desk.
Routine Health-Based Gender-Affirming Care
When practiced by trained providers, routine healthcare can be an important form of gender-affirming care. Routine and preventative services promote well-being for healthy and happy transgender lives.
Examples of routine and preventive-based gender-affirming care include:
- Immunizations, physical exams, and disease management
- Organ-based cancer screenings on the cervix, uterus, breasts, and prostate
- Continued evaluations of bone density and heart health while on hormone replacement therapy
- Sexual and reproductive healthcare
Anti-transgender discrimination and stigma make many people hesitant to seek routine healthcare. Medical providers should be competent in LGBTQIA+ issues, but transgender patients frequently have primary providers unaware of their needs – like a transgender woman needing regular prostate exams or a transgender man having a higher risk of heart disease.
Primary healthcare can be gender-affirming care if it affirms transgender people’s gender identity while providing treatment. Nondiscrimination policies, cultural competency training, gender-neutral restrooms, and chosen name policies provide transgender individuals with safe spaces for necessary care.
Routine Health-Based Gender-Affirming Care Resources
AAFP
CostPlus Drugs
FQHC Directory
FOLX Health
Get Covered Connector
GoodRx
LGBTQ+ Healthcare Directory
Marketplace
NAFCC
Out2Enroll
OutList
Planned Parenthood
Plume
Rx Outreach
SAGE
Trans Health Project
An online tool that connects users with local nonprofit organizations to obtain healthcare coverage. Allows users to schedule telephone, virtual, and in-person appointments with providers and maintains information on whether providers are LGBTQIA+-friendly.
A directory of transgender-inclusive healthcare providers within the United States and Canada that allows users to search for providers.
An online tool that connects LGBTQIA+ individuals with healthcare insurance coverage through the Affordable Care Act and compares plans based on gender-affirming care, same-sex partner coverage, and other criteria.
The largest reproductive healthcare provider in the United States, which offers sexual and reproductive healthcare services through virtual and local clinics.
A telehealth provider that offers hormone replacement therapy, mental health support, letters, and other services to support transgender healthcare. Available in most US states, although testosterone HRT is restricted.
An online directory of healthcare facilities and organizations that provide free or reduced services, regardless of insurance status. The National Association of Free & Charitable Clinics also maintains a directory of pharmacies that offer free prescription medication.
A hormone replacement therapy telehealth provider that prescribes medication to individuals residing in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming.
A national advocacy organization for LGBTQIA+ elders that maintains several programs to promote better healthcare, like the Long-Term Care Equality Index, cultural competency training program, and National Resource Center on LGBTQ+ Aging.
A gender-affirming care telehealth provider that provides services in all US states, although access to hormone replacement therapy varies based on state law. FOLX also provides mental health services, primary care, reproductive services, and fertility treatments.
A government directory of healthcare facilities and organizations that provide treatment on a sliding scale and must accept Medicaid, Medicare, and CHIP. FQHC agencies must also provide non-emergency medical transportation to appointments upon request.
An organization that sets national standards for family medicine and primary care. The American Academy of Family Physicians maintains the AAFP Neighborhood Navigator to connect users with local social services.
A website and mobile application that provides users with discounts for prescription medication at affiliated pharmacies, including major retailers like Walmart, CVS, Costco, and Kroger.
An online directory managed by OutCare to connect users with LGBTQIA+-affirming medical providers based on zip code. OutCare also provides free PrEP and DoxyPEP, the OutCare Saving Program, and other community resources.
A nonprofit mail-order pharmacy that delivers affordable prescription medication regardless of insurance status in all 50 states, DC, Puerto Rico, and the US Virgin Islands. Rx Outreach also operates initiatives like Fill the Gap to provide free medication to eligible participants.
A mail-order pharmacy that provides users with cheaper prescription medication by selling directly from manufacturers.
A program to help individuals navigate healthcare insurance coverage to access gender-affirming care. Maintained by Advocates for Trans Equality with a video series to explain the complicated process for using American health insurance for gender-affirming care.
A government platform that enrolls users in commercial insurance plans, Medicaid, Medicare, CHIP, and other healthcare coverage options through the Healthcare Insurance Marketplace.
Learn more about transgender medical health resources with Trans Solidarity Project.
Legal-Based Gender-Affirming Care
Legal services are fundamental gender-affirming care to support transgender individuals and their gender identities. Similar to primary health care, legal services are often forgotten as an aspect of gender-affirming care.
Examples of legal-based forms of gender-affirming care include:
- Changing one’s legal name on identification documents
- Changing one’s legal gender on identification documents
- Accessing government programs under the correct name and gender marker
- Accessing bank and lending services under the correct name and gender marker
- Being treated equally as one’s gender identity while incarcerated
- Traveling freely domestically and internationally
- Filing reports and lawsuits for anti-transgender discrimination
Legal-based forms of gender-affirming care are reversible, generally by filing the same paperwork required for updating changes in the first place. However, many transgender rights vary drastically by state since there are few rights defined by federal law.
Legal-Based Gender-Affirming Care Resources
A4TE
ACLU
Black & Pink
GLISTEN
Justia
Lambda Legal
Modern Military
SPARTA
Transgender Law Center
TCP
An online database of court decisions, legal codes, regulations, dockets, and laws within the United States. Justia maintains additional directories to find lawyers, pro bono services, and ask lawyers questions.
A military advocacy organization that supports LGBTQIA+ military members with legal policy, programs, and peer networks.
A mutual aid organization that helps LGBTQIA+ individuals move domestically within the United States with grants, transportation assistance, and other resources.
The largest reproductive healthcare provider in the United States, which offers sexual and reproductive healthcare services through virtual and local clinics.
A telehealth provider that offers hormone replacement therapy, mental health support, letters, and other services to support transgender healthcare. Available in most US states, although testosterone HRT is restricted.
A national civil rights organization that works to support transgender rights within the United States. TLC runs a free help desk as well as an attorney solidarity network, prison mail program, and asylum assistance.
A hormone replacement therapy telehealth provider that prescribes medication to individuals residing in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming.
A national advocacy organization for LGBTQIA+ elders that maintains several programs to promote better healthcare, like the Long-Term Care Equality Index, cultural competency training program, and National Resource Center on LGBTQ+ Aging.
A prison abolitionist organization that provides support to LGBTQIA+ people and people living with HIV/AIDS who have been impacted by the criminal punishment system.
A national civil rights organization that specializes in LGBTQIA+ rights. Lambda Legal maintains guides to explain legal rights and offers assistance through their help desk.
A nonprofit mail-order pharmacy that delivers affordable prescription medication regardless of insurance status in all 50 states, DC, Puerto Rico, and the US Virgin Islands. Rx Outreach also operates initiatives like Fill the Gap to provide free medication to eligible participants.
A nonprofit organization that supports transgender military members with transgender-inclusive support groups, grant programs, and other resources.
An advocacy agency that maintains several guides about transgender rights. Advocates for Trans Equality operates the ID Document Center, the largest tool for legal transgender name and gender marker change in the United States. A4TE also hosts the Name Change Project to financially assist transgender individuals in updating their legal information in select cities and the Trans Legal Services Network to connect users with transgender-inclusive services in their local area.
A national civil rights organization that operates chapters in all US states, DC, and Puerto Rico. In addition to their legal rights guides, all ACLU state chapters provide legal assistance and connect users to other local agencies.
An education organization that supports LGBTQIA+ students and educators in K-12 schools and provides resources and information regarding allyship, legal rights, and student empowerment.
Learn more about transgender legal resources with Trans Solidarity Project.
Types of Care Providers and Accessibility Breakdown
Due to the vast array of gender-affirming services and treatments, there are many types of professionals who provide gender-affirming care. Gender-affirming care requires multiple providers rather than a singular specialist, based on personal goals and needs.
| Type of Care | Type of Professional Required | Accessibility | Pathway | Examples |
|---|---|---|---|---|
| Legal Updates | Circuit Clerk Lawyer None | 2/5 Difficult | Individuals can request legal name and gender changes without an attorney by filing with a circuit clerk. However, filing can be complicated and not possible in all states. | Changing one’s legal name or gender on birth certificates, driver’s licenses, passports, bank accounts, etc. |
| Mental Health | Therapist Psychologist Psychiatrist | 4/5 Easy | Book an appointment or obtain a referral for a mental or behavioral health provider. | Exploring gender identity with a therapist. Obtaining a gender dysphoria diagnosis. |
| HRT | Primary Care Provider Family Doctor Ob/Gyn Endocrinologist Therapist Psychologist Psychiatrist | 3/5 Medium | Book an appointment with a provider knowledgeable in HRT. May require a mental health letter or gender dysphoria diagnosis. | Using prescription estrogen, testosterone, and other medications to feminize, masculinize, or androgenize oneself. |
| Puberty Blockers | Primary Care Provider Pediatrician Pediatric Endocrinologist Therapist Psychologist Psychiatrist | 1/5 Very Difficult | Book an appointment with a provider knowledgeable in puberty blockers. Requires additional documentation from mental health certifying readiness. | Using puberty blockers to pause natal puberty during gender identity exploration. |
| Routine Health | Primary Care Provider Family Doctor Nurse Practitioner Physician Assistant Registered Nurse | 4/5 Easy | Book an appointment with a primary provider knowledgeable in transgender identity. | Getting regular immunizations. Completing cancer screenings. Disease management. |
| Social | Life Coach None | 5/5 Very Easy | Explore gender roles, expression, and identity. Coaches and mentors exist to navigate social norms. | Choosing a new name. Using a chest binder. Exploring gender expression |
| Surgery | Surgical Specialist Endocrinologist Primary Care Provider Therapist Psychologist Psychiatrist | 2/5 Difficult | Book an appointment or obtain a referral to a gender affirmation surgical specialist. May require letters or a gender dysphoria diagnosis. | Chest reconstruction. Vaginoplasty. Phalloplasty |
| Voice Training | Speech-Language Pathologist Voice Coach None | 4/5 Easy | Book an appointment or obtain a referral to a SLP or vocal coach. Online tools exist for self-coaching. | Training one’s voice to be more masculine, feminine, or androgynous. |
Debunking Common Myths About Gender-Affirming Care
Many people struggle to understand gender-affirming care, further complicated by anti-transgender misinformation. These are the most common myths about gender-affirming care.
“Children and adults have access to the same gender-affirming care.”
Transgender adults and children have access to different levels of gender-affirming care. Transgender adults are assumed to have the personal autonomy to make decisions about their bodies, whereas youth have all medical decisions determined by their parents or legal guardian.
It is understood that adults are entitled to make decisions for themselves, even if you disagree or have personal objections. Gender-affirming care is further supported by decades of research establishing it as the best method to treat gender dysphoria. As a result, transgender adults have the right to hormone replacement therapy, surgery, and other types of care.
However, care can be restricted. Even for transgender adults, treatment like surgery and HRT may require therapy, official diagnoses, and documentation establishing that your gender identity is long-standing.
Some states seek to ban gender-affirming care for all ages despite ethical, medical, and legal concerns. Under the logic of Dobbs v. Jackson Women’s Health Organization, anti-transgender activists believe the government possesses a right to ban medically necessary care and effectively make decisions for adults about their bodies.
Similar restrictions exist for social and legal gender-affirming care. Some states, like Tennessee and Texas, forbid transgender adults from updating their gender on government documents regardless of biological changes accrued from medical transition. In the end, the government is making decisions to override adult autonomy under the falsehood that corrected documents “misconstrue” gender presentation.
When states like Florida and Kansas create bathroom bans, they supersede individuals’ ability to use the restroom best suited for their current gender presentation. Rather than allow adults to choose facilities, some governments have determined adults cannot be given that choice despite medical transition status or outward expression due to unfounded hysteria about transgender people in public restrooms.
Minors possess very few rights to autonomy. In addition to the above restrictions, transgender minors only have access to select forms of gender-affirming care.
Some transgender minors have access to puberty blockers and hormone replacement therapy, although this is exceedingly rare AND requires significant documentation from other professionals establishing that the minor’s gender identity is not a phase.
A very small number of transgender minors have access to chest reconstruction surgery, which requires documentation and proof of hormone replacement therapy. It is extremely rare for transgender minors to have any form of gender-affirming surgery since most surgeons require youth to wait until legal adulthood.
“Gender-affirming care is only for transgender people.”
Gender-affirming care refers to any treatment or service that supports an individual’s gender identity, which means it is not specific to only transgender people. Millions of cisgender people pursue gender-affirming care without realizing it.
Hormone therapy was developed to assist cisgender people experiencing low estrogen or testosterone levels occurring naturally in their bodies. Viagra helps cisgender men struggling with erectile dysfunction. Laser hair removal and hair plugs serve no purpose other than to support how cisgender people feel in their bodies.
Since cisgender people also rely on gender-affirming care, they are adversely impacted by anti-transgender restrictions. Autonomy is a fundamental human right.
“There is a singular gender-affirming care procedure, like ‘the surgery.’”
There is no singular gender-affirming surgery. While people commonly refer to bottom (or sex reassignment surgery) as “the surgery,” there are dozens of surgical techniques to support individuals’ gender identities.
Surgical status does not determine whether someone is transgender. Individuals are not lesser men, women, or nonbinary because they do not want surgery. Gender-affirming surgery is a deeply personal decision.
“Gender-affirming care is automatically prescribed to every transgender person.”
There are many forms of gender-affirming care, although the only one “prescribed” is hormone replacement therapy. Although informed consent makes it easier for transgender people to access HRT, both HRT and surgery are not automatically given to individuals upon request.
Transgender people must research and connect with licensed providers to access gender-affirming medical care. This may require additional appointments and referrals from mental health professionals, clearance from insurance providers, and other waiting periods.
“A therapist’s job is to tell someone they are transgender.”
Therapists, psychologists, psychiatrists, and other mental health professionals work to help individuals explore issues causing them distress. It is never a mental health professional’s job to “tell” someone that they are transgender.
Questioning individuals explore gender identity with mental health professionals in nonjudgmental spaces, which means they explore all possibilities of being transgender or cisgender.
Frequently Asked Questions
What is gender-affirming care in simple terms?
Gender-affirming care is an umbrella term for social, psychological, medical, and legal support designed to affirm someone’s gender identity.
Gender-affirming care ranges from coming out with a chosen name and pronouns to surgery. Every transition is unique, so gender-affirming care looks different to different people.
Is gender-affirming care only for transgender people?
No, millions of cisgender people utilize gender-affirming care every day without realizing it.
Examples of cisgender gender-affirming care include the use of hormone replacement therapy for menopause or low testosterone, hair loss treatments, breast reduction or augmentation, puberty blockers for central precocious puberty, and medications to treat erectile dysfunction.
Are puberty blockers reversible?
Yes, the effects of puberty blockers are reversible because puberty blockers temporarily pause the development of secondary sex characteristics.
If a young person stops taking puberty blockers, their biological puberty resumes as normal. Puberty blockers serve as a temporary pause to allow gender-expansive youth and their families time to explore identity safely before making permanent medical decisions.
Do transgender youth undergo gender-affirming surgeries?
Gender-affirming surgeries for minors are extremely rare and highly regulated. Standard medical guidelines and clinical practices reserve the vast majority of surgical procedures (including all forms of bottom surgery) for legal adults.
Gender-affirming care for youth primarily consists of non-medical social transition, mental health support, and, in select clinical cases, puberty blockers or HRT under medical supervision.
Are the effects of hormone replacement therapy permanent?
Some effects from hormone replacement therapy are permanent, although HRT causes a combination of reversible and permanent physical changes. Aspects like skin texture, muscle distribution, and body fat placement reverse if HRT is discontinued, while changes like voice deepening or breast tissue development are permanent.
Since HRT causes this combination of permanent and reversible effects, medical providers evaluate patients carefully to ensure informed consent and eligibility criteria.
Why are legal name and gender marker changes considered gender-affirming care?
Legal name and gender marker changes are considered gender-affirming care because having accurate identification documents (such as passports, driver’s licenses, and birth certificates) is essential for personal safety, privacy, employment, travel, and equal treatment under the law. Having the ability to update legal records affirms individuals’ identities and prevents anti-transgender discrimination in daily life.




















