In the 1730s, Protestant Christianity was in full swing as evangelicalism took hold in Britain and the American colonies. The Great Awakening, which would forever alter the course of American religion, renewed spiritual devotion – especially within Puritanism and Presbyterianism. It was at odds with American Enlightenment, the movement of radical philosophical ideas that led the colonists to revolution against the British Empire since the Enlightenment and soon-to-be American government were nonreligious and non-denominational.
The Great Awakening, which lasted until the 1740s, is a subset of colonial history already covered in a previous article. Instead of retelling transgender-related history already covered, this piece sets the stage by explaining the fundamental religious background those mindsets drew from. There are also modern connections that can relate to today’s political climate. Scholars theorize that we are amid a Fifth Great Awakening preceded by others in the 1740s, 1800s, 1890s, and 1960s.
George Whitefield preaching to the crowd during the First Great Awakening.
New Ideas for a New World
Compared to organized religion in Europe, the Great Awakening brought ideas that challenged centuries-long notions. Regardless of what denomination one identified with, religion was formal and institutionalized—you couldn’t be saved from damnation without direct guidance from the Church of England or the Catholic Church. The Great Awakening prompted the forbidden question: Can Christians save themselves from faith alone?
This question changed the course of Christianity in the United States. While organized religion through churches is still valuable across all denominations, American Christianity especially values self-salvation over tithes or church attendance. The Great Awakening proposed that all people are born sinners, but can be saved through maintaining a direct and emotional connection with God. Before these ideas, salvation was something ‘bought’ by donating enough time or money to a church.
Despite these radical ideas, the Great Awakening also cemented strict ideas about gender. Settlers sailed to North America in search of religious freedom to pursue faiths obstructed in Britain – but they were ironically intolerant of Christian denominations different from their own. Puritans, Lutherans, Quakers, Baptists, Anglicans, and other subsets of Christians did not get along – which contributed to more colonies being founded when groups became too divided. Something they all had in common, however, was a tendency to morally surveil each other – evidenced by the use of the judicial system to execute during the 1692 Salem Witch Trials.
There’s also a layer of hypocrisy within the Great Awakening and the ideas it bolsters – one of its core tenets is the duty each individual holds to achieve self-salvation from the damnation of hell. However, religious revival intertwines itself with organized religion as seen with the misuse of the court system by religious fanatics in Salem. The ideas behind the Great Awakening pose one’s personal connection and morality as superior to authority figures, but religious enlightenment pushes individuals to seek scripted guidance from authority figures like traveling preachers and then use religious teachings to enforce morality-based law onto others.
Without the Great Awakening, Puritanism might have died out in America. Religious fervor was steadily declining in the colonies, and figures like Jonathan Edwards and George Whitefield used to instill fears of hell by harping on sloth and other deadly sins. The dominant branches of Christianity utilized an “all or nothing” approach to morality, pushing gender-diverse individuals either to the closet or the courts like Thomas(sine) Hall. Gender variance undoubtedly existed during the Great Awakening, but the political climate obsessed with moral purity pushed individuals to secrecy while the historians of the time knowingly kept queerness out of documents as much as possible.
TRANS HISTORY KEY POINT History is subjective. Any history class outside of high school will make this point – history books are written by the victors, so they control the narrative of how great they were and how terrible their victims were. Good students of history acknowledge this subjectiveness.
Miss Preacher: Religion Among Women
The Great Awakening denied women the ability to openly preach or take leadership roles, but it encouraged women to write about their religious enthusiasm in diaries and memoirs, such as in the cases of Hannah Heaton and Phillis Wheatley. A prominent example of this is the life of Sarah Osborn, a Protestant writer from Rhode Island who traveled in colonial America preaching ideas of the Enlightenment – even though both the Great Awakening and Enlightenment were male-dominated. Osborn’s thoughts were in line with the thinking of the time – she disagreed with liberal humanism in favor of Calvinist self-salvation.
Religious thought was one of the few socially acceptable paths for women to philosophize and write alongside men, even if they were not allowed to publish their works. Evangelism “sought to include every person in conversion, regardless of gender, race, and status” (Taylor) even though it incited conflict between “Old Lights,” traditional and orthodox thinkers, and “New Lights,” who sought the teachings of the Awakening. However, moral purity instilled strict gender roles that delegated women to be nothing more than homemakers doting on their husbands and children. These roles would be largely unchallenged until the first wave of feminism despite the impact American women had on the history and politics of the forming United States.
The only exception to this is Quakerism, which had a significant role in inspiring the minds of early feminism – in Quaker circles, women were invited to speak during official meetings, publish their writing, preach, and question authority. The schisms of gender and colonial religion highlight how disconnected North America was during British rule – even though all American colonies ultimately reported to Britain, one colony could have laws completely different than another based on religious creed.
THINK PIECE: Great Awakenings or religious revivals happen every 30 to 45 years. As mentioned at the beginning of this article, the last one began in the 1960s – putting America on track for a Fifth Great Awakening. Transgender rights are the focus of this wave, alongside reproductive rights, police brutality, and other ideas that have been inserted into mainstream religion. What can history teach us about previous religious revivals to combat this one?
Knowledge Check
Fill in the Blank: _____ referred to individuals who subscribed to the radical ideas presented during the Great Awakening. –
According to preachers during the Great Awakening, the most important factor in spiritual salvation was… a. charitable donations to the Church. b. a personal relationship with God. c. being born into a righteous family. d. acts of kindness unto the unfortunate. –
True or False: During the Great Awakening, women were encouraged to preach in all thirteen colonies. –
Which of the following themes are true about the Great Awakening? a. Gender roles were deepened, putting men further into leadership positions and women as homemakers. b. In circumstances where queerness occurred during the Great Awakening, it was quickly punished and censored. c. Despite the focus on self-salvation, the Great Awakening revitalized organized religion. d. These are all true themes about the Great Awakening. –
It is theorized that the United States is undergoing a _____ Great Awakening.
ANSWER KEY
1. NEW LIGHTS / 2. B / 3. FALSE / 4. D / 5. FIFTH
Further Reading
DISCLAIMER: While the links below work at the time this article was originally published, they may not forever – especially when government officials are intentionally purging official reviewed research and censoring mainstream media.
CONTENT WARNINGS: ⚔️ Colonization, 🚻 Misgendering, 🙅 Lack of Consent
Native American History & Colonial Attitudes
Europeans were far from the first people in the Americas. Some scholars believe up to 18 million Native Americans populated North America alone before Columbus made contact with the Bahamas, known to the Indigenous people as Guanahani. Colonialism marks the exploitation and settlement of Europeans in North America from 1607 to 1765 through the overseas powers of Great Britain, France, Spain, Portugal, the Netherlands, Russia, and Sweden.
Native American cultures have a rich history in oral storytelling – which is why little of their history was formally written down. History was taught to new generations through spoken narratives that also brought lessons about cultural beliefs. However, when the unthinkable happened and Europeans warred with Native Americans over land, slaves, and wealth, histories were lost to time. Instead, we are left today with fragments retold by surviving tribes alongside the revised history told by European colonists.
Fragmented history informs us that, by our modern understanding, Native Americans were definitely queer. The term used today to refer to third-gender individuals in Native communities is two-spirit, a pan-Indian word that applies to any tribes when they lack the language in their Indigenous tongue to describe the experience. Researching the two-spirit identity is the best way to start learning about pre-colonial LGBTQIA+ history.
“It is estimated that 155 tribes across Turtle Island [North America] embraced a multi-gendered culture. The expanded conceptions of identity in these societies seem to have overshadowed sexuality. While homosexual relationships were common, they were not inherent.” – PRISM, “Homosexuality in the Pre-Colonial Americas.” June 11th, 2024.
The rest of our current knowledge of Native American history and attitudes towards LGBTQIA+ ideas comes from the European colonizers who wrote down what they saw, heard, and interpreted. These writers called Native Americans who transgressed traditional gender roles “berdache” and “passing women” offended when they witnessed both men and women live outside of their small-minded norms on gender. These terms are outdated and considered deeply offensive – they were used negatively against Native Americans as Europeans forcibly converted them to Christianity. Still, these accounts affirm the existence of transness even when it is written out of history – from the Navajo nádleehi to the Zapotec muxe, transgender people have always persisted.
Photo of Hastiin Klah of the Diné or Navajo, who lived in the 1800s as a nádleehi person.
Vogue México 2019 cover featuring Estrella Vazque, a self-identified muxe.
More interestingly, European accounts condemning two-spirit Native Americans tell us more about Europeans during the colonial period. Beyond these condemnations, there is no evidence of transness in early America. Fixated on their survival, most colonists made poor history writers – but most of these settlers were deeply religious, pushed into sailing across the ocean in pursuit of religious freedom separate from the dominating Church of England and Catholic Church. The repulsion documented most by British and Spanish colonizers affirms that they knew of transness – settlers were morally outraged by the deviants that claimed the Americas home since they were informed of the immorality of transness and other LGBTQIA+ identities by religion overseas. It was during this same period that molly houses flourished in Britain – taverns, public houses, and coffeehouses where queer and gender-nonconforming people met to socialize and meet possible sexual partners. LGBTQIA+ relationships were deemed illegal as a capital offense from 1533 onwards from the Buggery Act passed by King Henry VIII, which is why British molly houses were the frequent targets of raids and blackmail during the 1720s like queer bars were in 1960s America. European colonizers knew of transness, and they learned to keep accounts of gender-diverse behavior as sparse as possible when writing down history.
“We know and have been informed without room for doubt that all [the Indigenous people] practice the abominable sin of sodomy.” – Hernando Cortés in his first letter back to Spain in 1519, translated by Bayard J. Morris.
“Young men must cease to go about in female garments, to make a livelihood by such cursed lewdness.” – Bernal Díaz del Castillo on the demands made by Cortés to the Native Cempoala, translated by John Gibson Lockhart.
“The sodomite is an effeminate – a defilement, a corruption, filth; a taster of filth, revolting, perverse, full of affliction. He merits laughter, ridicule, mockery; he is detestable, nauseating. Disgusting, he makes one acutely sick. Womanish, playing the part of a woman, he merits being committed to the flames, burned, consumed by fire. He burns; he is consumed by fire. He talks like a woman, he takes the part of a woman.” – Friar Bernardino de Sahagún on the local Nahua he was trying to convert to Christianity in the Florentine Codex, translated by Arthur Anderson and Charles Dibble. Sahagún wrote the passage stating the above is what the Nahua did to queer people, although later revisits to the texts Sahagún based his information on show he purposely mistranslated the Nahau as shown by Kimball’s translation of the same passage in 1993.
TRANS HISTORY KEY POINT History is censored. History is written by a minority who control the narrative. If the writers disagree with reality, they can literally rewrite history – after a certain point in time when no one is around to remember reality, their revised history will be left to tell the story. Remember this point when considering that primarily white cisgender heterosexual men of relative wealth were the only ones writing for much of history – the lack of transgender history in their books does not disprove transness, but rather affirms that they purposely censored reality.
The European settlers of North America were deeply religious – the contract agreed upon by the men on the Mayflower stated their journey was “for the glory of God and advancement of the Christian faith.” As a result, colonial America was founded largely on the Puritan faith and their idea of the heterosexual cisgender nuclear family. Colonists had strong beliefs on gender and what they assumed to be natural and moral order of the world – early Puritans used gender norms as the basis for the governments created in North American colonies, pushing men to leadership positions and women towards submissive roles to “please [their] husbands and make him happy.”
The current most common two-spirit flags
Colonizers were distraught by Native Americans’ fluid gender roles and society that included third genders. Further evidence that Europeans were knowledgeable on gender diversity comes from the Bible – while European Christianity punished queerness, third-gender roles have been documented as part of the innate human experience. Isaiah 56:3-5, Matthew 19:10-12, and Acts 8:26-40 relate to eunuchs, individuals who were traditionally assigned male at birth but were accepted in society similar to two-spirit folks since they held roles within their pre-Christian religions. The power that eunuchs held during Biblical times directly relates to the verses written in the Bible to condemn them since those holding the pen wanted to demean their power and claim it for themselves.
In La relación de Álvar Núñez Cabeza de Vaca, explorer and colonizer Cabeza de Vaca wrote of his overland journey from Florida to Mexico from 1528 to 1536 – this became the first published narrative of European exploration within the modern United States. He describes several encounters with what he referred to as hombres amarionados impotente, or impotent effeminate men – Native individuals who were biologically male but lived and worked as women. These encounters are further affirmed by the writings of Jacques Marquette, the first European who visited the Upper Mississippi when he observed “men who do everything women do” while traveling in modern Illinois between 1673 and 1677. Marquette wrote, “I know not through what superstition some Illinois, as well as some Nadouessi, while still young, assume the garb of women, and retain it throughout their lives. There is some mystery in this, For they never marry and glory in demeaning themselves to do everything that the women do. They go to war, however, but can use only clubs, and not bows and arrows, which are the weapons proper to men. They are present at all the juggleries, and at the solemn dances in honor of the Calumet; at these they sing, but must not dance. They are summoned to the Councils, and nothing can be decided without their advice. Finally, through their profession of leading an Extraordinary life, they pass for Manitous,-That is to say, for Spirits,-or persons of Consequence.” At the same time, Spanish missions in the Southwest were committing a “gendercide” of all Indigenous people who failed to conform to Eurocentric gender norms (United States National Park Service, 2016) as written by Deborah A. Miranda in “Extermination of the Joyas: Gendercide in Spanish California.”
Jacques Le Moyne gives us another perspective on the Native American culture – he was an artist who arrived in Fort Caroline in 1564 to help René Laudonnière colonize Florida. Although Laudonnière failed, Le Moyne succeeded in his own way by depicting Native American life and culture through his drawings. One of these drawings was “Enjoyments of Hermaphrodites,” where Le Moyne wrote a travel memoir of his journey – although the engraving was nearly lost to history. It remains one of the earliest known depictions of Native Americans, yet it presents gender-diverse and intersex individuals in a more positive light that Indigenous communities would have seen them at the time.
While these are some of the notable examples, they are far from the only ones – Hernando de Alarcon wrote of “three or foure [Native] men in womens apparell” while surveying California in 1540. Renne Goulaine de Laudonniere wrote four accounts from 1562 to 1567 of intersex or two-spirit Native Americans he came across in Florida, like Le Moyne. Nearly all written retellings of the transness that colonists encountered are condemnation: Juan de Torquemada (1609), Francisco Coreal (1666), Pierre Liette (1702), Joseph Francois Lafitau (1711), Pierre Francois Xavier de Charlevoix (1721), Pierre Francois Xavier de Charlevoix (1721), Georg Heinrich Loskiel (1750), and Jean-Bernard Bossu (1751) all write similar versions of history over the great depths of sin that Indigenous Americans are addicted to as they engage in gender-diverse behaviors incompatible with European norms.
The Case of Thomas(sine) Hall
Civil documents dating to the 1620s tell the story of Thomas(sine) Hall, an indentured servant who caused a scandal in Jamestown due to their purposefully genderfluid expression. The Spanish wrote significantly more than British colonizers, but Hall’s story was committed to history when they were accused of sexual misconduct – their biological sex became a focal point when rumors circulated of them having an affair with Virginia’s former governor’s maid, which was punishable as a criminal offense if Hall was biologically male. In response to being asked why they wore feminine clothing, Hall replied, “I goe in womans apparel to get a bitt for my Catt.” (Brown 1995)
Once the accusation was made, residents claimed that Hall’s gender expression and tendency to have sex with people of all genders were causing disorder in the community. However, the community lacked an official local court or church to determine Hall’s biological sex, so the authority to determine Hall’s sex assigned at birth was left to married women of the village who came to Hall’s home at night multiple times while they slept to observe Hall’s genitalia.
These married women determined that Hall lacked a “readable set of female genitalia,” giving the responsibility instead to Thomas(sine) Hall’s plantation master, John Atkins. After inspecting Hall while they slept, Atkins agreed with the women that Hall was biologically male since they had “a small piece of flesh protruding from [Hall’s] body” (Brown). Atkins directed Captain Nathanial Bass to punish Hall – but Bass confronted Hall directly and asked bluntly if they were a man or a woman.
A drawing often attributed as a depiction of Thomas(sine) Hall, dated 1640 by Hollar
Hall responded that they were both but admitted they had a non-functional 2.5-centimeter penis. In today’s terms, this means Thomas(sine) Hall was intersex and would have likely identified with terms like nonbinary and genderfluid. In colonial terms, Hall was legally protected since male incompetence was classified as being the female sex and not being a “proper man,” so they could not be prosecuted for allegedly having sex with the governor’s maid.
However, the villagers of Jamestown were not pleased with this decision. They argued Hall should be treated like similar individuals of “dual nature” sex in Europe, where Hall would be forced to choose to be a man or a woman as their gender regardless of biological sex. Hall’s case was sent to the higher Quarter Court, presided over by Governor John Pott on April 8th, 1629. While previous individuals classified as “dual nature” or intersex were forced to adopt either a permanent male or female identity, Hall was a new and truly unique case for colonial America. As the court ruled, “hee is a man and a woeman” – Hall had dressed as both genders throughout their entire life, and the Quarter Court could not determine if Hall was “more male” or “more female.” Instead, the court ruled that Hall was to dress in clothing that symbolized this confusion: “Goe clothes in man’s apparell, only his head to bee attired in a coyfe and crosscloth with an apron before him.” In the end, Hall proved that intersex people existed both in Europe and North America – while Hall was the first to be given the ruling to dress androgynously, they were certainly not the first individuals of “dual nature sex” to be seen in court. After the ruling in 1629, nothing further is known of Hall’s life.
Crossdressing Colonists
Hall was far from the only American settler that caused panic due to gender-diverse behavior. Later, in 1652, Joseph Davis was charged by the court of New Hampshire for “putting on women’s apparel and going from house to house in the night time with a female.” Massachusetts summoned Dorothie Hoyt to the Salem Court “for putting on man’s apparel,” but fled from the county before being caught and didn’t appear in court. These cases pepper the civil documents of colonial America – Mary Henly’s case in 1692 directly contributed to the anti-crossdressing law Massachusetts passed in 1696. It’s also worth noting that Massachusetts, and specifically Massachusetts Bay Colony, were established because the colonists firmly believed they made a “covenant with God to build an ideal Christian community,” – which is why they were among the first to criminalize sodomy by whipping, banishment, and execution as a sex crime in 1631.
“The cultural inclusion of individuals who assumed different genders in some Native American societies stands in contrast to the general lack of recognition within the white-dominated American colonies in the 17th and 18th centuries. To the extent that individuals who cross-dressed or who lived as a gender different from the one assigned to them at birth were acknowledged in the colonies, it was largely to condemn their behavior as unnatural and sinful…
“Relatively few instances of gender nonconformity are documented in the colonial and postcolonial periods. A number of these cases that became known involved female-assigned individuals who lived as men and whose birth gender was discovered only when their bodies were examined following an injury or death. Fewer examples of male-assigned individuals who lived as women are recorded, perhaps because they had less ability to present effectively as female due to their facial hair and physiques.” – “Trans Bodies, Trans Selves” on transness in early America by Genny Beemyn in 2014.
In 1637, Massachusetts brought Anne Hutchinson to trial for hosting regular religious meetings in her home despite the protocol for such to be held in male-controlled churches. Her trial lasted until 1648, ending with Hutchinson being banned from her community. While her story fits strongly within feminist history, it’s also worth including with transgender history – there is no way to fully know how, in the modern day, Hutchinson would have identified with modern gender. At the very least, we know from court records that she defied the established gender norms that rooted her during the 1600s through her work preaching to locals in her community regardless of gendered requirements. Today, Hutchinson’s act of defiance to lead in faith would still cause trouble in conservative religious circles that hold strict beliefs on gender roles – making her act to purposely lead meetings in her colonial period revolutionary.
Massachusetts is the stage for many traces of LGBTQIA+ history in early America. The religious objection that manifested during the Great Awakening obstructed history elsewhere in the colonies, which will be covered in a later article. In comparison, Massachusetts wasn’t particularly remarkable to hold so much of transgender history during this time – it was overwhelmingly Puritan and actively persecuted non-Puritans from their colonies, such as the dissenting Quakers who were whipped, executed, and driven out. Despite this, Thomas Morton called Massachusetts home when he founded the colony of Merrymount that would become Quincy. It may have been the 1620s, but Merrymount celebrated both interracial marriage and same-sex desire – and fostered near atheist ideas in published anti-Puritan work Morton wrote like New English Canaan, which became the first banned book in the present-day United States.
Considered the first school textbook of colonial America, the New England Primer (1687) was published with approved religious-based prayers and instruction for students, stating that “God created man, male and female, after his own image, in knowledge, righteousness, and holiness, with domination over the creatures.” Relatedly, sodomy laws were written and enforced throughout the American colonies and militia by 1714, which would remain in place entirely unchallenged until 1925.
While not as common as in later American history, individuals assigned female at birth joined male trades under masculine identities – the following newspaper clipping details one such case in a Massachusetts port in 1756. The clipping also mentions Hannah Snell, an English soldier who joined the British army as a man under their brother-in-law’s identity of James Gray in 1747. Snell’s military career took off after joining the Royal Marines as a cabin boy and came out willingly later before petitioning the Duke of Cumberland for their military pension. Not only was Snell honorably discharged, but the Duke agreed to officially recognize their military service and grant their pension.
The time difference between Snell and the story in Massachusetts further implies that Snell’s adventures as “The Female Soldier” inspired many individuals assigned female at birth to pursue similar paths under male identities. While not all of these individuals would have identified as transgender today, such as Snell themselves, since they openly identified as a woman outside of their military career, some of them certainly would have – and this tradition dates thousands of years, as evidenced by would-be transgender men who purposely lived their entire lives under male identities as monks during the Medieval period.
In 1764, we have evidence of another American tradition that would become common later on through the story of Deborah Lewis. An article was published in Newport Mercury in Rhode Island, detailing a warrant issued by the governor due to Lewis being assigned female at birth but began openly dressing as a man in public and aiming to marry a local widowed woman. Compared to later cases, Lewis caused a stir due to remaining in the community they grew up in – other stories often circle transgender men who traveled far from home under new identities.
Language Matters
Overseas, William King authored the mock-heroic poemThe Toast in 1732 – which he originally wrote to demean his opponents suing him over a Galway estate. By 1736, The Toast was being published throughout Great Britain in four books. Even though it’s unlikely The Toast ever made it to the colonies, it currently holds the title as the first published work to contain the word “lesbian” since King used the work to allude to the story’s heroine Mira being the Countess of Newburgh and a woman attracted to other women. Culture is flexible, and the relationship between Great Britain and the American colonies meant settlers surely knew of the word if it was common enough for King to use it in a published work, even if it wouldn’t be published in American literature until later.
Knowledge Check
Thomas(sine) Hall was a genderfluid colonist who caused local scandal in _____. a. Virginia b. Pennsylvania c. Massachusetts d. Maryland –
The modern term used to describe third-gender Native American identities is _____. –
‘The Female Soldier’ centers on the adventures of Hannah Snell, who was a… a. lesbian spy working against the French government. b. crossdressing sailor for the Royal Marines. c. intersex merchant under the East India Company. d. literate female journalist reporting on important military battles. –
True or False: The Quarter Court ruled Thomas(sine) Hall was truly both man and woman but required Hall to dress androgynously. –
Who wrote the following quote: “Womanish, playing the part of a woman, he merits being committed to the flames, burned, consumed by fire. He burns; he is consumed by fire. He talks like a woman, he takes the part of a woman.” a. Bernal Díaz del Castillo b. Hernando Cortés c. Jacques Marquette d. None of the Above
ANSWER KEY
1. A / 2. TWO-SPIRIT / 3. B / 4. TRUE / 5. D
Further Reading
DISCLAIMER: While the links below work at the time this article was originally published, they may not last forever – especially when government officials are intentionally purging official-reviewed research and censoring mainstream media.
Surgery can be an important step in the journeys of many transgender people in their pursuit to live comfortably and authentically as themselves. The ability to get necessary medical care is integral for democracy, and the ability for transgender folks to choose when, how, and why they get gender affirmation surgery is important for bodily autonomy. Learn about the basics of related surgeries in this post. Looking for information about HRT or general transgender resources?
DISCLAIMER: It is still common for people to believe transgender people must get “the surgery” or at least be actively pursuing it. There are even people who believe you must get “the surgery” before identifying as transgender – while “the surgery” usually refers to bottom surgery, also known as genital surgery or sex reassignment surgery, these notions are both false. Surgery is a personal choice, and there are many reasons why a transgender person may want or not want a procedure – it doesn’t make them less transgender.
Glossary
The following are frequently used terms that will help guide your understanding of this article. It isn’t comprehensive, but it’s a great starting point.
GENDER AFFIRMATION SURGERY
The most modern term for any surgery done to affirm the gender of a transgender person – which includes all of the surgeries in this article. There is no single surgery all transgender people seek to get, which is why “gender affirmation surgery,” or GAS, fits in today’s language. Other terms include gender confirmation surgery, gender reassignment surgery, and sex reassignment surgery – while they have different connotations, they generally mean the same thing.
The only term not advised to use is “sex change.” This term is usually considered offensive due to its negative connotation and usage.
PRE-OP/POST-OP/NON-OP
These terms are all short-hand and slang used within the transgender community to describe surgery status.
Pre-op, or pre-operative, refers to a transgender person who seeks a gender affirmation surgery of some sort but has not received it due to a variety of reasons, like medical barriers, cost, physical health, safety, etc.
Post-op, or post-operative, refers to a transgender person who sought a gender affirmation surgery and has received it.
Non-op, or non-operative, refers to a transgender person who does not seek a certain gender affirmation surgery and does not plan to pursue it out of personal choice, rather than the barriers mentioned for pre-op individuals.
It is possible to be pre-op, post-op, and non-op at the same time – these terms are usually used within the community for specific surgeries as well as surgical status as a whole. Someone can consider post-op for having a chest reconstruction surgery, pre-op for seeking bottom surgery like metoidioplasty, and non-op for not wanting to pursue a procedure like facial surgery.
MEDICALLY NECESSARY
This term is often used within healthcare and insurance to describe whether a treatment will be covered by your insurance provider. Medically necessary treatments are services that are deemed as important for diagnosing, treating, or preventing an illness or injury. To qualify as medically necessary, treatment must be regarded as effective for your condition and must be done per generally accepted medical practices.
At the end of the day, transgender healthcare is considered medically necessary because it’s supported by all major medical institutions and is backed by decades of research proving the positive impact of trans-related treatments. Not all treatment options are considered medically necessary, though, and this article will point out which are and which are not.
Requirements for Gender-Affirming Surgery
Any surgeon who performs gender affirmation surgeries should follow the standards of care guidelines by the World Professional Association for Transgender Health (WPATH), which has produced these standards based on best healthcare practices since its founding in 1979. For historical context, WPATH was originally known as the Harry Benjamin International Gender Dysphoria Association – named after Harry Benjamin, who worked with Magnus Hirschfeld to provide healthcare to transgender and queer folks in pre-Nazi Germany.
WPATH has recently gotten negative media attention, sparked by the executive order by President Donald Trump “Protecting Children from Chemical and Surgical Mutilation.”The order, fueled by Project 2025, falsely accuses WPATH of being “junk science” despite decades of peer-reviewed research and being internationally agreed as the best treatment standard for gender dysphoria. Ordering all government agencies to rescind any policies that use WPATH, Trump and Project 2025 use actual junk science to fuel their anti-transgender claims.
The 8th edition of the Standards of Care was released in 2022, and research and guidelines on surgery are detailed in Chapter 13.
“In appropriately selected TGD individuals, the current literature supports the benefits of GAS. While complications following GAS occur, many are either minor or can be treated with local care on an outpatient basis. In addition, complication rates are consistent with those of similar procedures performed for different diagnoses (i.e., non-gender-affirming procedures)… The efficacy of top surgery has been demonstrated in multiple domains, including a consistent and direct increase in health-related quality of life, a significant decrease in gender dysphoria, and a consistent increase in satisfaction with body and appearance. Additionally, rates of regret remain very low, varying from 0 to 4%… Although different assessment measurements were used, the results from all studies consistently reported both a high level of patient satisfaction (78–100%) as well as satisfaction with sexual function (75–100%). This was especially evident when using more recent surgical techniques. Gender-affirming vaginoplasty was also associated with a low rate of complications and a low incidence of regret (0–8%).”
“If written documentation or a letter is required to recommend gender affirming medical and surgical treatment (GAMST), only one letter of assessment from a health care professional who has competencies in the assessment of transgender and gender diverse people is needed…
Criteria for Surgery: a. Gender incongruence is marked and sustained; b. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care; c. Demonstrates capacity to consent for the specific gender-affirming surgical intervention; d. Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options; e. Other possible causes of apparent gender incongruence have been identified and excluded; f. Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed; g. Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).”
There are two main takeaways from WPATH’s standards on surgery: the main qualifier to be eligible for gender affirmation surgery and have it be considered medically necessary is identifying with having gender dysphoria for a substantial length of time – usually between six to twelve months; most additional requirements like letters and use of hormone replacement therapy are optional.
Just like I explained regarding HRT, you are not going to find a licensed provider that would be willing to operate on someone who just suddenly ‘decided’ they are transgender – they must firmly believe that you understand the gravity of gender-affirming surgery, that you can fully consent to the procedure, and you are aware of its potential benefits and risks. Any media outlet or online personality that states otherwise is purposely lying to garner attention. While letters are not necessarily required according to WPATH guidelines, written documentation from a healthcare professional or mental health provider establishes the first requirement under WPATH – it gives proof to both your prospective surgeon and insurance company that you have experienced gender dysphoria for a set amount of time.
A decade ago, it was common for surgeons to require additional hoops for transgender people to access gender-affirmation surgery. Most often, surgeons required their prospective patients to have written documentation proving they had been on hormone replacement therapy for up to three years before they would consider them eligible for surgery. These HRT requirements weren’t usually pushed by insurance providers but existed as an additional safeguard for surgeons to lengthen the process of care – but it also served as a method of gatekeeping. Hormone replacement therapy is still a requirement for select surgeries where the effects of HRT have a direct positive impact on the result of a surgery, like testosterone and metoidioplasty. Other surgeries, like vaginoplasty or phalloplasty, may require electrolysis or laser hair removal. Going back further in time, surgeons also commonly required patients to have “real-life experience,” or proof that they were living as their chosen gender “full-time” – these requirements disproportionally barred individuals who were unable to transition out of safety, which is why they fell out of favor, although today’s societal acceptance of transgender people means more folks can live as themselves before surgery.
These requirements are not the same as those placed on transgender minors – WPATH has different guidelines for youth procedures:
“Criteria for Surgery: – A comprehensive biopsychosocial assessment including relevant mental health and medical professionals; – Involvement of parent(s)/guardian(s) in the assessment process, unless their involvement is determined to be harmful to the adolescent or not feasible; – If written documentation or a letter is required to recommend gender-affirming medical and surgical treatment (GAMST), only one letter of assessment from a member of the multidisciplinary team is needed. This letter needs to reflect the assessment and opinion from the team that involves both medical and mental health professionals (MHPs).
a. Gender diversity/incongruence is marked and sustained over time; b. Meets the diagnostic criteria of gender incongruence in situations where a diagnosis is necessary to access health care; c. Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment; d. Mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed; sufficiently so that gender-affirming medical treatment can be provided optimally. e. Informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility; f. At least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.” – Standards of Care Version 8, WPATH summary requirements for youth surgery.
Some of the requirements are the same – but there are important distinctions. WPATH has a longer length for HRT usage than adults, and their standards also dictate the requirements for HRT and puberty blockers in transgender youth. They must have reached Tanner stage 2 of puberty to be eligible for either treatment and have their parents or legal guardians involved in the process. Written documentation has a higher bar set on who can write it for it to be valid for surgery. Youth must also demonstrate emotional and cognitive maturity in addition to proving they fully understand their treatment options. Combined, these standards make surgery incredibly difficult for transgender youth to pursue and push them to wait until after they turn 18, and the requirements lessen. These requirements also firmly debunk false accusations by anti-transgender individuals who claim minors are getting these surgeries en masse – the only surgery trans youth tend to have access to is top surgery or chest reconstruction, which still has all of the above requirements associated with it.
Financing Gender-Affirming Surgery
Surgery is expensive – especially in the United States, which makes money one of the primary barriers in whether transgender folks can pursue gender affirmation surgery. The first step towards financing your surgery is to deep-dive into your insurance coverage. Federal law prohibits most commercial and government insurance programs from discriminating against transgender-related care – but it still happens.
Before continuing, here are some main legal points to keep in mind:
Insurance providers cannot place blanket exclusions. Any plan that states something akin to “all care related to gender transition is excluded” violates federal law.
Insurance providers cannot place categorical exclusions on specific transition-related treatments deemed medically necessary. Plans that purposely exclude coverage for procedures like facial feminization surgery or voice surgery would violate this part of the law.
Insurance providers cannot place discriminatory limits on transition-related care. Any treatment covered for cisgender people must be covered for transgender people, too. For example, plans that cover breast reconstruction for cancer treatment in cisgender women cannot deny transgender people also seeking chest reconstruction for their gender dysphoria.
Insurance providers cannot cancel your coverage, refuse to enroll you, or charge you higher rates because of your transgender status.
Insurance providers cannot deny coverage because it is typically associated with one gender. If a healthcare professional recommends a procedure that is traditionally gendered, like prostate exams or pap smears, insurance providers cannot deny coverage simply because that individual is listed as the “wrong gender” on their paperwork.
If you believe you are experiencing discrimination, there are several steps you can take. Firstly, appeal any insurance denials you receive and keep in mind that you should apply for preauthorization before undergoing any procedures to ensure you know your standing regarding coverage. If your appeals do not go through, you may need to talk to an attorney or legal professional – like the National Center for Lesbian Rights, Lambda Legal, the Transgender Law Center, ACLU, or local organizations. You can also report anti-transgender discrimination with the United States Department of Health and Human Services and state agencies – check out Advocates for Trans Equality’s page for more information.
Confused by the American healthcare system and don’t know where to start with insurance? Click here.
Public Health Providers
Medicaid is the largest public insurance provider in the United States, run as a joint federal and state program to provide free medical coverage to low-income Americans based on income. Each state and territory has its own requirements for Medicaid, so you have to look into the specific policies relevant to where you live. In the majority of the country, transgender-related care is covered by Medicaid for adults – either explicitly by state protections or implicitly by the above protections in federal law. However, Trump’s executive order “Protecting Children from Chemical and Surgical Mutilation” currently bans any transgender-related coverage to minors through government programs like Medicaid, Medicare, and TRICARE. This order is being sued in court, but it has not yet been paused by federal courts – until then, the order causes immense harm as it shuts down gender-related care at major hospitals.
At the time of this article, 10 states ban transgender-related coverage in their Medicaid programs: Idaho, Arizona, Texas, Nebraska, Missouri, Kentucky, Tennessee, Florida, Ohio, and South Carolina. However, as mentioned in this post, it’s worth remembering that not all adults are eligible for Medicaid since 10 states also ban single adults from applying entirely, regardless of income.
Medicare is a federal program that provides medical coverage to people with disabilities as well as older adults ages 65 and older, regardless of income status. Since it is run federally and not controlled by individual states, Medicare offers less flexibility than programs like Medicaid but is less discriminatory as a whole. Since 2014, Medicare has covered transition-related surgery, and there is no national exclusion for transgender treatments. In practice, Medicare deals with trans-related healthcare the same as it does other forms of coverage – each individual is covered on a case-by-case basis based on whether the care is deemed clinically necessary. Learn more here.
The US Department of Veterans Affairs provides free healthcare to anyone who has served in the armed forces and did not receive a dishonorable discharge, while active service members are covered by TRICARE until their service is complete. The VA will cover most transgender-related procedures, including hormone replacement therapy, binders, prosthetics, mental health care, and voice coaching – but the VA still prohibits any coverage of transition-related surgery regardless of medical need.Read more about VA coverage here.
Due to Trump’s executive order “Prioritizing Military Excellence and Readiness,” transgender people are again banned from serving in the United States armed forces. It is unclear whether this ban will dishonorably discharge American servicemembers, similar to the previous Trump ban, but a similar act would bar transgender people from using VA health services despite their service. Since transgender individuals are banned from the military, TRICARE does not offer transition-related services to its active members – although it still currently provides limited treatment coverage to family members of active members as long as they are at least 19 years old.
All Native Americans recognized by a Federally recognized tribe are eligible for free healthcare coverage through Indian Health Services within their official IHS district or reservation. While IHS provides gender-affirming coverage for treatments within their scope, there is no information about their procedures due to the Trump directive to purge government health websites of data – including transgender issues and other unrelated topics. While the federal courts have ordered the administration to restore the data, this story is still developing.
Incarcerated individuals are one of the few groups in the United States entitled to healthcare protected as a constitutional right – although there are no standards of what minimum healthcare must be provided for free since it is not codified or elaborated in law. Gender-affirming care, including hormone replacement therapy and surgery, are supposedly protected rights – but most prisons have barriers in place, like requiring proof of care before arrest. These barriers are what cause a quarter of transgender inmates to be denied healthcare, even though accrediting organizations like the National Commission on Correctional Health Care recommend transgender procedures.
Commercial Providers
The majority of Americans use commercial insurance through the Healthcare Insurance Marketplace or their employer when they do not meet the criteria for other providers like Medicaid, CHIP, Medicare, IHS, VA, TRICARE, etc. Anyone at least 18 years old and not currently incarcerated is eligible for the Marketplace as long as they are lawfully living in the United States and are not eligible for Medicare – individuals eligible for Medicaid are recommended to use the Marketplace since it also issues coverage for those meeting their state guidelines. Out2Enroll is the best national resource for researching care guidelines – their information is entirely free and user-friendly, and their Trans Health Insurance Guides page has up-to-date data for transgender coverage in each state.
Historically, these laws focus on whether commercial providers are allowed to deny transgender-related care. Zero laws intend to outlaw transitional treatments entirely and prevent providers from opting to cover them – in Arkansas, there are still insurance companies that cover transgender treatments even if they’re ‘allowed’ to deny coverage. While there are entities that seek to outlaw transgender care entirely (ex. Project 2025 and the Heritage Foundation), it’s exceedingly unlikely to take that jump – and if it did, the crisis in the United States would cause an international precedent of allowing transgender Americans to flee as refugees due to the depth of that jump. Instead, it is more likely that anti-transgender organizations and people in power will tear away at American healthcare protections in attempts to federally legalize coverage discrimination rather than outright banning coverage.
For information about commercial insurance that is not covered by Out2Enroll, check out Advocates for Trans Equality’s Trans Health Project – their site goes in-depth on legal rights regarding commercial coverage and how to navigate its systems.
Crowdfunding & Grants
In the age of the internet, crowdfunding is a common route many transgender folks use to finance transgender-related surgeries when their primary insurance provider fails them, or they lack coverage entirely. The most commonly used platforms are GoFundMe, Donorbox, and Facebook – although all of these sites take a percentage of the money raised. GoFundMe is the largest crowdsource site, but it’s known to take the largest cut compared to alternatives. Non-personal organizations and nonprofits have a larger variety of sources out there, like Givebutter, while individuals can raise money without losing a percentage through direct money transfer apps like Cash App, Venmo, Paypal, and Zelle.
This option is less advised compared to the above routes – if possible, use any insurance coverage you have and work your way down this list. Personal loans through online lenders and credit unions are the best route for borrowing money for gender affirmation surgery, with their own pros and cons. Online personal loans can be used for nearly any purpose, including medical costs, and range up to $100,000 but can be expensive if you don’t pay attention to your monthly payment and annual percentage rate. Credit unions offer similar personal loans at lower interest rates but use your credit score to determine whether you qualify for their funding.
The most common credit card associated with healthcare costs is CareCredit, which offers zero-interest financing for a designated term. However, the downside to CareCredit is that it defers interest after its promotional period if you fail to finish your payments within that period – and CareCredit’s standard APR is 29.99%. Depending on your credit score, other credit cards offer alternatives with lower interest rates than CareCredit.
Lastly, some surgeons and healthcare providers offer payment plans similar to credit financing that break up large medical bills into more affordable monthly payments. Make sure you read the terms before signing and negotiate with your provider to understand additional billing fees associated with using a payment plan.
Common Gender-Affirming Surgeries
🚻BODY CONTOURING. Associated with: Any/All Genders. Set of surgical procedures that uses liposuction, fat grafting, and skin excision techniques to sculpt the body to appear more feminine, masculine, or androgynous. Can be covered as medically necessary on a case-by-case basis with sufficient documentation of gender dysphoria. Recovery time of two to three weeks, average cost of $8,500 to $19,500 without coverage.
🚺BREAST AUGMENTATION. Associated with: Transfeminine. Surgical procedure that utilizes breast implants to create a female breast contour, especially when combined with estrogen-based hormone replacement therapy. Can be covered as medically necessary, especially if breast contour from HRT is insufficient to alleviate gender dysphoria. Also known as MTF top surgery. Recovery time of four to eight weeks, average cost of $5,000 to $10,000 without coverage.
🚹CHEST RECONSTRUCTION. Associated with: Transmasculine. Surgical procedure that removes the breasts through a variety of techniques to create a male chest. Widely considered medically necessary and is the most common gender-affirming surgery for transmasculine individuals. Also known as FTM top surgery or a mastectomy. Recovery time of six to eight weeks, average cost of $3,500 to $10,000 without coverage.
🚺ELECTROLYSIS. Associated with: Transfeminine. Non-surgical technique that permanently removes hair regardless of hair type or skin color but is slower than laser hair removal (which works best for dark hair and light skin and does not work on blonde, gray, white, or red hair). Widely considered medically necessary and commonly covered with prior authorization. Recovery time of two to three weeks per session, average cost of $30 to $150 per session without coverage.
🚺FACIAL FEMINIZATION. Associated with: Transfeminine. Surgical procedures that transform traditional male facial features into shapes, sizes, and proportions associated with female features. Considered medically necessary. Also known as FFS. Recovery time of six to twelve months, average cost of $4,500 to $100,000 without coverage.
🚹FACIAL MASCULINIZATION. Associated with: Transmasculine. Surgical procedure that masculinizes facial features, especially in individuals who do not receive sufficient masculinization from testosterone through hormone replacement therapy. Can be considered medically necessary with sufficient documentation of gender dysphoria. Also known as FMS. Recovery time of six to twelve months, average cost of $1,000 to $20,000 without coverage.
🚻HAIR TRANSPLANTS. Associated with: Any/All Genders. Surgical technique that creates hairlines associated with male or female stereotypes and restores hair loss. Can be deemed medically necessary but not commonly covered by most insurance providers without sufficient documentation for gender dysphoria. Recovery time of ten days per session, average cost of $4,000 to $15,000 without coverage.
🚹HYSTERECTOMY. Associated with: Transmasculine. Surgical procedures that remove the uterus or womb. Total hysterectomies remove the cervix, although the removal of the ovaries varies based on patient preference and medical need. The three main procedures include laparoscopic, vaginal, and abdominal – while abdominal is the most common, it is the most invasive and has the most associated complications. Widely considered medically necessary. Also known as masculinizing lower surgery or hysto. Recovery time of six weeks, average cost of $16,000 to $17,000 without coverage.
🚺LARYNGOCHRONDOPLASTY. Associated with: Transfeminine. Surgical procedure performed as a type of facial feminization surgery to reduce the size of the Adam’s apple by removing thyroid cartilage. Can be considered medically necessary. Also known as a tracheal shave. Recovery time of two to four weeks, average cost of $3,000 to $10,000 without coverage.
🚹METOIDIOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a small phallus from existing genital tissue formed from clitoral enlargement from testosterone-based hormone replacement therapy. Widely considered medically necessary when accompanied by medical documentation. Also known as meta. Recovery time of six weeks, average cost of $4,000 to $60,000 without coverage.
⚧️NULLIFICATION. Associated with: Nonbinary. Surgical procedure that reroutes the urethra to the perineum to create a gender-neutral appearance to the genitals. Compared to other genital surgeries, gender nullification is relatively new and was introduced as an option due to the growing number of medical professionals well-versed in nonbinary identities. Can be considered medically necessary, although you may have to combat your insurance provider due to it being considered more experimental than other genital surgery options. Also known as nullo or eunuch surgery. Recovery time of six to eight weeks, average cost of $15,000 without coverage.
🚹OOPHORECTOMY. Associated with: Transmasculine. Surgical procedure that removes the ovaries, halting the natural production of estrogen. Considered medically necessary and often done alongside hysterectomies. Recovery time of two to six weeks, average cost of $7,000 without coverage.
🚺ORCHIECTOMY. Associated with: Transfeminine. Surgical procedure that removes the testicles/testes, halting the natural production of testosterone. Widely considered medically necessary and can be done alongside other gender-affirming genital surgeries. Recovery time of two to four weeks, average cost of $2,000 to $8,000 without coverage.
🚺PENECTOMY. Associated with: Transfeminine. Surgical procedure that removes the penis and relocates the urethra to allow the individual to urinate more freely. Considered medically necessary. Recovery time of four weeks, average cost of $8,000 without coverage.
🚹PHALLOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a penis using tissue grafted from another part of the body, such as the forearm or hip. Widely considered medically necessary when accompanied by medical documentation. Also known as phallo. Recovery time of twelve weeks, average cost of $25,000 to $50,000 without coverage.
🚹SCROTOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a scrotum using skin from the labia and a silicone implant, often done in conjunction with other genital surgeries like metoidioplasty or phalloplasty. Considered medically necessary. Recovery time of eight weeks, average cost of $3,000 to $5,000 without coverage.
🚹 SCROTOPLASTY. Associated with: Transmasculine. Surgical procedure that creates a scrotum using skin from the labia and a silicone implant, often done in conjunction of other genital surgeries like metoidioplasty or phalloplasty. Considered medically necessary. Recovery time of eight weeks, average cost of $3,000 to $5,000 without coverage.
🚹URETHROPLASTY. Associated with: Transmasculine. Surgical procedure that repairs and lengthens the urethra during gender-affirming genital surgery to allow the individual to urinate while standing using their new anatomy. Widely considered medically necessary. Recovery time of six weeks, average cost varies based on accompanying procedures.
🚹VAGINECTOMY. Associated with: Transmasculine. Surgical procedure that removes the vaginal lining and closes the vagina, reducing the complications associated with other genital surgeries like metoidioplasty and phalloplasty. Widely considered medically necessary. Recovery time of six to eight weeks, average cost varies based on accompanying procedures.
🚺VAGINOPLASTY. Associated with: Transfeminine. Surgical procedures that transform male genitals into functional and aesthetic vaginas and vulva. Widely considered medically necessary. Recovery time of six to eight weeks, average cost of $20,000 to $30,000 without coverage.
🚺VOICE SURGERY. Associated with: Transfeminine. Surgical procedure that alters the voice to better fit traditional male and female stereotypes. While possible for transmasculine and nonbinary individuals, it is more commonly associated with transfeminine transitions since testosterone-based hormone replacement therapy naturally alters the voice, whereas estrogen-based HRT does not. Can be considered medically necessary. Recovery time of six months, average cost of $5,500 to $9,000 without coverage.
🚺VULVOPLASTY. Associated with: Transfeminine. Surgical procedure that removes the penis, scrotum, and testicles while also creating a labia, clitoris, and urethral relocation – but unlike vaginoplasty, it does not create a vaginal canal and instead has a zero/shallow-depth dimple constructed. Can be considered medically necessary. Recovery time of six to eight weeks, average cost of $20,500 to $22,000 without coverage.
Curious about the basics of gender-affirming care? The use of HRT has been foundational and approved as the best form of treatment for transgender people for nearly a century. Learn the facts about hormone replacement therapy and its importance in this week’s post. Looking for other transgender resources? Click here.
What is HRT?
HRT, also known as hormone replacement therapy, is the use of synthetic hormones to mimic traditional sex hormones. Hormone treatments were originally invented in the early 1900s, related to when researchers discovered how to isolate and synthesize testosterone and estrogen, and became widely prescribed to cisgender folks by the 1960s.
Even though HRT is commonly associated with transgender people and our transitions, it’s utilized more often by cisgender individuals – these hormone treatments were created to help with the lower levels of sex hormones cisgender men and women experience as they age. The use of hormone replacement therapy as gender-affirming care and a means to allow transgender people to medically transition began in the 1950s through the John Hopkins School of Medicine, Harry Benjamin, and Christian Hamburger. Gender-affirming hormone therapy (GAHT)/hormone replacement therapy (HRT) is the use of prescribed synthetic hormones to align one’s secondary sex characteristics with their gender identity – which ranges from body fat, breast growth, muscle mass, vocal range, hair, Adam’s apple, etc.
What are Puberty Blockers?
Puberty inhibitors and blockers suppress the natural production of sex hormones like testosterone and estrogen, created and approved by the FDA to treat precocious puberty in cisgender children. Due to the growing trend of children starting puberty earlier than normal, puberty blockers became more commonplace for doctors to prescribe to cisgender patients. Around the same time, puberty blockers were being used experimentally abroad to help transgender children explore their gender identity more thoroughly by the 1990s via the Dutch Protocol. The primary purpose of puberty blockers is to pause cisgender-associated puberty in youth wanting to explore their gender identity without the use of HRT. After spending an ample amount of time solidifying their gender identity, they can continue their medical transition through hormone replacement therapy to mimic puberty aligned with their internal gender; if they change their mind regarding their gender identity, puberty blockers can be stopped at any time and puberty will begin/resume as normal.
Before continuing, I cannot stress enough that puberty blockers and hormone replacement therapy are widely considered safe by the scientific community. Both treatments have been used to treat gender dysphoria for decades and it’s been established blockers are the best and most humane way to allow gender-diverse children to explore gender since blockers are entirely reversible. The only genuine negative side effect associated with blockers is lower bone density that is created by bone mineralization during puberty – but this is easily managed with exercise, calcium, and Vitamin D. There is not much high-quality research on the long-term effects of puberty blockers, just as there is little long-term research on transgender people as a whole – but information available supports that the use of puberty blockers. Even if all parents/legal guardians approve of a child receiving puberty blockers, many additional steps are required to ensure they are the best option for the child’s health and well-being. Despite this consensus, many bad actors intentionally lie to harm transgender people: it has been leaked and proven that anti-trans politicians are purposely using funds to back pseudo-scientific research against gender-affirming care in their bills. It is incredibly easy for institutions and figures to create misleading research to support inaccurate beliefs; the foundations that host their findings are non-profit, using governmental 501(c)(3) status to legitimize their work even though anyone can create a non-profit by filling the appropriate paperwork. Many organizations have tried to ‘debunk’ puberty blockers and the Dutch protocol out of a political agenda – but none of them can debunk the actual use of blockers in trans children, which is to simply pause puberty temporarily (not ‘cure’ gender dysphoria, force children to take cross-sex hormones, etc.) As such, there are no reputable organizations, institutions, or research groups that dispute the effectiveness of gender-affirming care.
Puberty blockers are most often prescribed for gender-diverse youth between the ages of 9 to 16, but this can vary based on your needs since bodies vary. Once prescribed, blockers come in two forms: the histrelin acetate rod can be inserted under the skin in your arm and lasts for one year, while the leuprolide acetate shot can work up to 1, 3, or 4 months at a time. However, puberty blockers and gender-affirming care for minors are currently highly controversial for reasons stated above – as of 2025, there are six states that make it a felony crime to provide gender-affirming care to transgender youth.
On January 28th, 2025, President Donald Trump signed the executive order “Protecting Children from Chemical and Surgical Mutilation,” which prohibits federal funding and research on gender-affirming care for all individuals under the age of 18 in the United States. On paper, this bans the use of Medicaid, TRICARE, and other government programs from prescribing puberty blockers, hormone replacement therapy, and other well-supported forms of care until age 19. However, this order has long-reaching effects which is why it is being challenged in court – hundreds of hospitals and clinics are preemptively stopping gender-affirming care entirely out of fear, and even more facilities have stopped providing gender-affirming care entirely to all transgender people regardless of age since they rely heavily on federal funding.
I would normally try and insert an information video about puberty blockers – but YouTube is infested with anti-transgender content on the topic due to recent news from both the Trump administration and overseas in the United Kingdom.
Mythbusting HRT: Fact-Checking Gender-Affirming Care
MYTH: GENDER-AFFIRMING CARE IS UNSAFE. FACT: As I mentioned above, gender-affirming care is supported by every major medical and mental health association. Age-appropriate transition care is considered both medically necessary and life-saving for individuals who experience gender dysphoria, or a disconnect between their internal gender identity and sex assigned at birth. While there are some negative health risks associated with hormone replacement therapy that I will cover later, they are immensely manageable and outweighed by the positive impacts of gender-affirming care. Over 1.3 million licensed doctors in the US support gender-affirming care, as well as leading organizations like the American Medical Association, American Academy of Pediatrics, and American Psychological Association.
MYTH: ONLY EXTREMIST LEFTIST DOCTORS SUPPORT GENDER-AFFIRMING CARE. FACT: In the United States alone, over 1.3 million licensed doctors support gender-affirming care. That’s because transgender healthcare is overwhelmingly backed by research! That’s essentially every single registered physician considered active by the American Medical Association. Not every doctor agrees on gender-affirming care, and there are plenty of physicians that are not well-informed on how to interact with transgender patients – but the underlying consensus no matter what is that gender-affirming care is necessary.
MYTH: BUT [INSERT STUDY HERE] SAYS GENDER-AFFIRMING CARE IS DANGEROUS! FACT: Also mentioned above, there is a growing wave of anti-trans pseudoscience being funded by politicians with bigoted and nonscientific agendas. We live in a universe where you can purchase a degree from nonreputable sources, and astroturfing proves how widespread fake movements are in funneling money to bad science. If someone lacks integrity, it is not hard to manipulate research into creating “proof” that supports your claim – most commonly, these individuals will manipulate the data gathered in their research by deleting objecting evidence and using misleading questions. The amount of junk science that opposes transgender rights and healthcare is overwhelmingly outweighed by real researchers and associations – which have real relevant experience, qualifications, peer-reviewed work, and publications by reputable journals.
Lastly, federal law states that insurance providers can limit care, even if it’s deemed medically necessary – but they are not allowed to deny care based on patients. If a provider covers mastectomy for cancer or genetic predisposition, they must also cover it for gender dysphoria. Providers that cover hormone treatments for cisgender people cannot deny HRT for transgender individuals. Doing so is considered discrimination and blatantly against the law.
MYTH: MOST PEOPLE THAT TRANSITION REGRET THEIR DECISION! FACT: Any “research” you read regarding this, I invite you to reread the above section on junk science. Detransitioning, or the act of reverting to your sex assigned at birth, is exceedingly rare and studies report “transition regret” as low as 1% to 2% of all cases – although these numbers vary drastically due to the political slant in the research. In reality, gender-affirming care actually has the lowest regret rates in the medical field – your average major surgery has a 5% to 10% regret rate, knee replacement surgeries have rates up to 30%, and pregnancies have roughly a 7% rate of regret. You wouldn’t dream of preventing someone from having knee surgery or a baby because they might regret it later.
Potential regret is why puberty blockers exist for trans kids. Blockers allow transgender youth to explore their gender identity before medical transition since they’re reversible. Even for adults, gender-affirming care is not someone people just wake up and decide one day. Surgery requires letters of approval from mental health professionals, which can take three to twelve months of appointments to get. While informed consent clinics make it easy for transgender adults to access hormone replacement therapy, they’re still not going to prescribe hormones for someone who “decided” they were trans that same day – they’re going to make sure you have fully thought through your decision and can give medical consent.
MYTH: PEOPLE ARE ONLY BECOMING TRANSGENDER NOW BECAUSE IT’S TRENDY. FACT:Transgender people have existed as long as humanity has existed. We will continue to exist no matter what laws are passed, even if we are forced back into the closet. While more people are open about their transgender identities, it’s not because it’s suddenly trendy – it’s just safer and more socially acceptable to be open about it. Language changes, so more people are able to become familiar with words like transgender to describe their experiences – in the past, people who would identify as transgender today might have identified as drag performers, crossdressers, transsexuals, transvestites, or even butch women and femme men.
The right-wing “social contagion” theory has been repeatedly debunked. The theory asserts that “rapid onset gender dysphoria” occurs in today’s youth due to social media – but there is zero empirical evidence to support this claim. This conspiracy theory is used by lawmakers to justify anti-trans legislation, and most medical associations have made official statements to eliminate this term from being used.
MYTH: CHILDREN SUBJECTED TO GENDER-AFFIRMING CARE HAVE MEDICAL PROCEDURES THAT WILL PERMANENTLY ALTER THEIR LIVES. FACT: News articles that claim this are sensational and intentionally trying to mislead you. Before puberty, transition is entirely social for children – as well as for most adults in the beginning processes of exploring their gender. Social transition involves no medical interventions and therefore is completely reversible, such as using a new name, pronouns, clothing, or hairstyle. The only possible negative consequence of social transition is potential bullying and discrimination – but it is in no way that person’s fault they are being bullied or harmed due to a society that is adverse to exploration.
If a child is exploring their gender identity at the onset of puberty and they have supportive parents, they might have access to puberty blockers to pause puberty temporarily while they continue to explore. Blockers have been approved as the gold standard by the FDA since 1993 to pause puberty. Complications like bone density are easily remedied with supplements and existing research on puberty blockers used on cisgender youth with precocious puberty shows normal fertility and reproductive functioning after reversing their blockers.
There are no young children who are being subjected to transgender-related surgeries. In extremely rare cases, 16 and 17-year-olds can get specific surgeries like chest/top surgery only if they have been consistent in their current gender identity for years, have been taking gender-affirming hormones for an extended amount of time, and have approval from all parents/legal guardians and doctors. Once all of those factors are achieved, they still have to get additional approval from multiple mental health providers and physicians to determine that surgery is the best course of action. By the time that process is done, that young person is most likely 18 – which is why the overwhelming majority of transgender youth wait until that age to pursue gender-affirming care.
The only form of “mutilating” sex surgery performed on children is perpetrated by conservatives. Intersex medical interventions, or genital mutilations, are performed on intersex infants to align with stereotypes on how male and female genitals should look – with or without parental knowledge.
MYTH: ANTI-TRANS BILLS ARE ALL ABOUT PROTECTING KIDS! FACT: Politicians who insert partisan debates in private conversations never genuinely care about science, medicine, or evidence. If these bills were about protecting kids, anti-abortion politicians would ensure the United States has an immaculate foster care system, education program, and policies to uplift youth. Instead, those same politicians have zero empathy for new mothers, purposely try to destroy public education, disavow sexual education entirely, attempt to dismantle foster care systems, create higher costs for giving birth and parenthood, and penalize youth at every possible chance. Anti-trans bills and their lawmakers are fueled by bad faith – politicians that regularly try to defund services like mental health cannot be taken seriously when they try to claim they are “protecting kids.”
There have been clear, well-established, and evidence-based standards of care for transgender people for nearly a century – the World Professional Association of Transgender Health (WPATH) has maintained these standards for decades. These standards advocate that gender-expansive youth have access to socially explore their gender before anything else.
How Do I Get HRT?
There are two primary routes to get prescribed hormone replacement therapy: letter approval and informed consent. Both are acceptable ways to legally get access to hormones – but the path you should take will depend on your needs and local laws.
INFORMED CONSENT
The informed consent model of care is the most modern and reduces gatekeeping that bars many folks from receiving healthcare. The idea behind informed consent is that most adults can make decisions about their own healthcare when given accurate and in-context information. After finding a provider that uses the informed consent model, they’ll educate you on the possible benefits and risks to HRT before having you sign off on the paperwork needed to state you are officially consenting to the medication plan.
To be able to use informed consent, you will need to be your own legal guardian. Most people automatically do this upon turning 18, although your situation may vary. Upon meeting that standard, your provider must feel confident that you understand the information given to you, so they’ll likely break down medical terms and videos, photographs, and guides.
Wanting to find an in-person informed consent provider? Erin Reed has a detailed map and Planned Parenthood is one of the largest providers in the United States. Due to the current administration, it is advised to find a provider you can see in person – political attacks on trans-related telehealth make online options less viable for the immediate future. However, FOLX and Plume are the best telehealth HRT providers that prescribe hormones online.
The greatest pro to informed consent HRT is the speed of the entire process. Some clinics will prescribe you hormones the same day that you make your appointment. A common complaint about the traditional route where you’re required to get a letter from a mental health professional is that trans folks feel like they’re performing their transness for their provider – giving a long story on when they first realized they were transgender, often embedded with many of the stereotypes cisgender people have about transness to get their medication. By removing that barrier, trans people are more free to be themselves.
LETTER APPROVAL
Until 2012 upon the release of WPATH’s 7th edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, the approval letter model was the only way to access hormone replacement therapy – the 7th edition officially opened the path for providers to prescribe HRT through informed consent.
The letter approval model requires transgender people to acquire a letter from a therapist or other mental health professional stating that gender-affirming care like HRT is medically necessary for their well-being. This method is becoming less common since it encourages negative stereotypes about transgender people as they’re forced to cater to the understanding (or lack thereof) of transness that a mental health provider has to receive their letter of approval.
The process can take anywhere from three to twelve months since it requires the therapist to feel fully confident that gender-affirming care is medically necessary for their client before signing the letter. However, the letter approval model is more stable and tends to offer more financial stability – most insurance companies will put up a fight on covering any sort of medical care, and this is definitely the case within transgender healthcare. It’s also worth noting that since the letter approval model is more traditional and has been used for decades, it’s less likely to be impacted by anti-transgender laws or executive orders in the years to come.
Providers that offer gender-affirming care through the letter approval process often work on a much smaller scale and are significantly more common in rural settings. While large gender clinics have specialized staff to prescribe informed consent HRT, these providers may be primary care physicians, endocrinologists, gynecologists, urologists, psychologists, or psychiatrists.
Feminizing Hormone Therapy (FHT)
Feminizing HRT uses a combination of several hormones to create physical changes in the body typically caused by female puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender girls. Most individuals take a combination of estrogen (estradiol) and antiandrogens (spironolactone) since a testosterone-blocking medication is required to ensure the synthetic estrogen works best. While it’s not as common, some providers also prescribe progesterone to aid FHT.
Estradiol is prescribed as a pill, injection, and skin patch. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of FHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at women you’re immediately related to. The combination of testosterone blockers and estrogen causes breast growth, softer skin, less facial and body hair, decreased muscle mass, and more – but FHT can’t change the pitch or sound of your voice, which is why some people opt for voice feminization surgery or voice therapy.
There is a lack of substantial research on the long-term effects of hormone replacement therapy on transgender bodies – however, it’s important to note in any research that you read regarding the risks that HRT makes your body medically female. Women are more at risk of developing conditions like osteoporosis and osteopenia. Current information about transgender healthcare will reflect this, but older studies are often cited with bad intentions without including this. Genuine risks associated with gender-affirming care include things like infertility and erectile dysfunction. In the event that you wish to pursue parenthood, some transgender people pause their FHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Masculinizing Hormone Therapy (MHT)
Masculinizing HRT primarily uses testosterone to create physical changes in the body typically caused by male puberty. Gender-affirming hormones stimulate nearly all of the same changes that occur during puberty for cisgender boys. Compared to FHT, only one medication is prescribed – testosterone does not need additional medication used since it naturally overpowers the effects and production of estrogen. That process is the exact reason why FHT tends to require both estrogen and testosterone blockers to have a noticeable effect.
Transgender people are most commonly prescribed testosterone as a shot, skin patch, pellet, or gel. Testosterone also comes in a pill form, but it is not often prescribed as gender-affirming care since its pill variant is harsh on the body long-term. Throughout your healthcare journey, your provider will regularly check your hormone levels with blood tests to ensure they’re in an optimal and healthy range. The effects of MHT vary from person to person – puberty is different for cisgender and transgender people alike, and the best way to predict what your results will be is to look at men you’re immediately related to. Testosterone generally causes facial hair, body hair, voice changes, greater muscle mass, oily skin, possible hair loss, and more – like with FHT, you can’t choose which effects of hormone replacement therapy you’ll receive since it’s based on genetics.
As mentioned above regarding feminizing hormone therapy, there is a lack of substantial research on the long-term effects on transgender bodies. Despite this, gender-affirming care is considered medically necessary and important to provide since it alleviates gender dysphoria and allows transgender people to live as their authentic selves. Many of the associated risks documented in older research on HRT are common health risks that cisgender men are generally more likely to have than women – like high blood pressure, male-pattern baldness, acne, and diabetes. The most typical genuine risk associated with gender-affirming care is infertility; while testosterone may decrease the chance of pregnancy, it is not an effective birth control method and does not fully prevent it. In the event that you wish to pursue parenthood, some transgender people pause their MHT temporarily to increase their fertility – but it’s not guaranteed since the longer you are on HRT, the more likely you are to become permanently infertile. Complications with HRT can be lowered and managed by regularly seeing your healthcare provider.
Nonbinary Hormone Therapy (NHT)
There is no one way to be nonbinary – but some nonbinary people pursue hormone replacement therapy as part of their journey to live comfortably in their own bodies. Compared to FHT and MHT, nonbinary hormone treatments aim to balance the levels of estrogen and testosterone in the body to create an androgynous appearance. The most common route is microdose HRT, or when hormone replacement therapy is prescribed at a much lower dose than traditional levels. Changes take significantly longer to occur but allow the individual to stop more immediately when they are satisfied with the changes. Since it is impossible to directly choose what changes will occur on HRT, this gives a small level of control since the changes associated with HRT are gradual like cisgender puberty.
For individuals assigned female at birth, testosterone is often prescribed at a low dose for a short period of time. Those assigned male at birth may choose to use a low dose of both testosterone blockers and estrogen or opt for just estrogen. In both cases, it is important to remember that not all changes caused by HRT are permanent – some, like voice changes, breast growth, and clitoral growth are permanent while others like fat redistribution, acne, and periods are not.
Further Reading: Learn More About HRT
Cleveland Clinic is a major academic medical center based in Ohio, ranked as one of the best hospitals in the United States. Its site hosts comprehensive information about gender-affirming care for both feminizing hormone therapy and masculinizing hormone therapy.
FOLX Health is the largest HRT telehealth provider in the United States and offers prescribed medication to registered members. Since FOLX has in-person facilities in major cities, it is available in all states – including ones that are banning transgender telehealth like Florida. Learn about their programs for feminizing hormone therapy, masculinizing hormone therapy, and nonbinary hormone therapy.
GoodRx is a free website and mobile app that provides users with discounts on prescription drugs at over 75,000 pharmacies across the United States, including major retailers like Walmart, CVS, Costco, and Kroger. These discounts also apply to medications prescribed for gender-affirming care – GoodRx is the primary alternative for individuals needing prescription medications but does not have insurance coverage to pay for those medications. Due to this, GoodRx is a valuable resource if Medicaid or commercial insurance bans transgender-related healthcare coverage. It also hosts information about both masculinizing hormone therapy and feminizing hormone therapy.
Johns Hopkins Medicine is a teaching hospital and biomedical research facility based in Baltimore’s Johns Hopkins School of Medicine, most well-known for being one of the first gender clinics in the United States. Its Center for Transgender and Gender Expansive Health offers information on a variety of gender-affirming services like hormone replacement therapy, surgery, fertility, voice therapy, primary care, etc.
Planned Parenthood is an American nonprofit reproductive and sexual healthcare provider, which continues to be the largest single abortion provider in the United States. Planned Parenthood is also one of the largest national HRT providers, although not all of their locations offer HRT services. Learn more about some of the gender-affirming services Planned Parenthood provides.
Plume is another large HRT telehealth provider and takes a large range of commercial insurance plans. While Plume operates throughout the majority of the United States, their lack of in-person facilities means they are not able to prescribe HRT to states banning transgender telehealth like Florida. Its site contains a great deal of information on both estrogen hormone therapy and testosterone hormone therapy.
Trans Health Project is a site maintained by Advocates for Transgender Equality (A4TE) to educate transgender people about their legal rights and better access to gender-affirming healthcare. The project contains information on medical insurance, state laws, HRT providers, etc.
University of California San Francisco Transgender Care, also known as UCSF’s Gender Affirming Health Program, is a multidisciplinary program that provides gender-affirming care out of the research university and hospital. Its site contains information on hormone therapy as well as other forms of gender-affirming care like surgery, sexual health, sexual health, and voice therapy.
University of Virginia Health is an academic healthcare center based in Charlottesville and maintains a transgender health clinic. Its site has information on hormone replacement therapy, although its content is not as in-depth as other resources on this list.
We live in dangerous times – when does it become time to move from the United States to another country? What is the correct phase during a genocide to finally decide it’s too unsafe to remain in the US? This post outlines the best countries for transgender rights and the easiest countries to immigrate to, as well as what is required for each country.
As of the time of this article, there are no countries that have opened their refugee immigration paths for transgender Americans – although this may change. In the event refugee paths open, an update to this post will be made; until then, this post outlines non-refugee paths. Immigration is a complex process that varies drastically from country to country – refugee status grants you faster routes to move, find work, and become a permanent resident.
It is ultimately up to you when and why you leave the United States. I advise you to self-reflect and seriously consider what types of laws, actions, and policies would be your determining point for immigration so you are not caught entirely off-guard if that time comes. Not everyone can immigrate – children, disabilities, criminal history, and wealth can all impact your ability to move. However, it is not selfish to consider your own best interests. It’s not selfish to immigrate or become a refugee to survive, even if people are trying to continue the fight at home. Use your personal determining point to decide when it is no longer safe for you to continue your work and activism at home.
Legal immigration to the United States is complicated and expensive – but that isn’t the norm elsewhere in the world. The United States uses a lottery system to randomly select 675,000 applicants each year to immigrate without a US sponsorship or green card refugee status. Additionally, only 55,000 individuals can be approved from each country – this places individuals coming from large countries at a disadvantage compared to others. If you are not selected among the 55,000 people who were approved that year, you have to wait until next year for the next lottery – and you are no closer to getting legal immigration status due to your wait time.
Barriers to Immigration
The most common barriers that transgender Americans will experience while attempting to immigrate relate to their identity documents – the current administration has already made moves to halt gender-affirming changes on federal legal documents, requiring transgender individuals to use their sex assigned at birth on new passports for the next four years. While we wait for this executive order to be blocked by the courts, it prevents transgender Americans from freely moving throughout the world safely. Documents that do not match your gender identity or expression can put you at additional risk when traveling, since the chance of discrimination increases when immigration agencies are not well-versed in transgender issues. On the plus side, transgender Americans still have the right to a passport and travel documents – although we are barred from updating our gender markers on them, we can still legally leave despite the increased risks that will appear due to gender marker discrepancies.
The documents you will need to legally immigrate will depend on the country you are immigrating to. At the very least, you will be required to present a passport or similar travel document – but you may also need proof of language proficiency, education, medical examination, criminal history, work experience, job offer, and funds to immigrate.
Future decisions by the current administration and Congress will determine whether other countries open refugee paths for transgender Americans. As mentioned above, refugee status allows you to move more easily than traditional immigration routes – and this concept applies everywhere in the world. Compared to the documents required for traditional immigration, refugees typically just need a travel or identity document – they don’t need to prove language proficiency, education, funding, or any of the other mentioned factors to be permitted. However, refugee status is granted to groups in desperate need – until the political situation in the United States is seen as hostile enough by the international community, transgender Americans will have to use traditional immigration.
Trans Right Havens
There are 195 different countries recognized by the United Nations – this post does not list out the rights of each country since that would be lengthy and distract from the point. Instead, I have used various research put out by other entities on LGBTQIA+ travel safety and combined it with the easiest countries for American citizens to immigrate to – the table below gives you some of that data, and I’ll be going into detail later.
The countries are not in any particular order – each has its pros and cons, and it is your personal decision on which is the best path for you. Numerous countries have high scores for transgender rights and safety not included in this post because they are more difficult to immigrate to – such as France, Belgium, and Cuba. Some countries are easy for Americans to immigrate to but do not have great track records for transgender rights – like the United Kingdom, Japan, and Mexico. Instead, this post combines both to guide you to trans-affirming countries with simple immigration policies.
COUNTRY
ASHER & LYRIC
EQUALDEX (AVG)
EQUALDEX (LEGAL)
Canada
247 / A
78
95
Iceland
200 / A –
94
98
Malta
250 / A
76
100
Spain
222 / A –
83
100
Portugal
248 / A
76
93
Greece
224 / A
66
93
Australia
173 / B +
76
90
Ireland
200 / A –
72
85
Germany
200 / A –
81
100
Switzerland
224 / A
69
74
Thailand
117 / C
72
75
Asher & Lyric is a travel research site that utilizes publicly available information to rate countries on LGBTQIA+ inclusiveness based on transgender-related murder rates, legal identity laws, hate-based violence criminalization, legal discrimination protection, and queer worker protections. I specifically use their data from their global trans rights index, but their general LGBTQIA+ travel safety guide is also useful. On the other hand, their data was last updated in June 2023 – it’s become exponentially outdated regarding US laws (ranking the US at #40 for trans rights and #25 for LGBTQIA+ travel safety), but it is still a great starting point despite how quickly the political landscape can shift.
The other two columns of data I use are from Equaldex, an international collaborative project that provides information about LGBTQIA+-related laws and public opinion around the world. Equaldex’s data is extremely up-to-date – their website even includes recently changed laws before making mainstream headlines and information about upcoming laws set to take effect around the globe. The average column, which they refer to as their equality index, combines the average from their legal index and public opinion index. I believed it was worth knowing whether a country has a good combined total compared to general public opinion – although I recommend reading their data further if you’re interested. The legal Equaldex column focuses only on the legal rights of LGBTQIA+ people in a given country – Equaldex rates countries on thirteen different legal aspects based on the most current laws.
Best Countries for Transgender Americans
Canada
As the United States’ northern neighbor, Canada is the most common choice for any American to move to. It’s the most culturally similar to ours, and it’s one of the few countries Americans can drive through rather than deal with TSA and airport immigration other than Mexico.
The largest cons associated with immigrating to Canada relate to the weather and high taxes. Since Canada is so far north, most of its citizens live close to the southern border it shares with the United States. All American citizens are expected to continue paying taxes to the United States, even if they do not live or work in the US unless they renounce their citizenship – but doing so means you’ll lose access to permanently return without citizenship elsewhere and you won’t be able to vote.
Canada is renowned for its universal healthcare, but it’s also infamous for long wait times for certain healthcare services – but not to the extent as the UK’s. Depending on the province, you’ll be looking at a combined tax rate of 23% to 31% – but since Canada has a good index score for its cost of living, these expenses are mitigated by excellent wages. Similarly, the argument can be made that Canada’s quality of life score overshadows its healthcare wait times since residents can get the care they need despite occasionally having to wait.
IMMIGRATION PATHS There are three federal programs for Canada’s Express Entry system, which is the easiest and fastest way to legally immigrate to Canada. These programs are competitive and score-based, so they use your submitted criteria to determine your eligibility among other candidates.
If you have at least one year of skilled work experience, meet the minimum fluency requirements in either French or English and score at least a 67 out of 100 on their selection grid, you can be eligible for the Federal Skilled Worker (FSW) Program. Skilled work is determined by occupation field – you’ll want to look up your occupation on Canada’s National Occupation Classification (NOC) system to see where you fall since most programs will require you to be at least TEER 3 or more. For the FSW Program, you will have to be TEER 0, 1, 2, or 3. The FSW Program has a job seeker visa option, which allows you to find work after arriving in Canada without an existing job offer – although you’ll still have to wait for your ITA. However, the FSW Program has a higher income requirement needed to prove you have the funds to support yourself.
If you have at least two years of skilled trade work experience, meet the minimum fluency requirements in French or English, and have a certificate approving your trade to be practiced in Canada, you can qualify for the Federal Skilled Trades (FST) Program. The FST Program applies to specific occupations like industrial, electrical, construction, and other related trades. To be eligible, you have to either have a certificate that proves you are qualified to practice your trade in Canada or have a job offer of at least 12 months of full-time employment in Canada. Like the FSW Program, FST Program applicants must have at least CAD 14,690 in their bank accounts to qualify.
The last Express Entry federal program is the Canadian Experience Class (CEC) for individuals who have at least one year of skilled work in Canada at NOC 0, 1, 2, or 3 on a valid work permit and meet the minimum language requirements in French or English. Compared to FSW and FST, the CEC requires you to already be working and present in Canada – but once you are, it’s significantly easier than the other paths.
Generally, the largest barrier to Canadian immigration is securing work. US citizens can get employer-specific work permits as well as CUSMA work permits. CUSMA permits allow workers to find work faster via the International Mobility Program compared to traditional permits. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Individuals between the ages of 18 to 35 can work under International Experience Canada (IEC), which has three additional permit categories: working holiday open work permit, international co-op internship, and young professional employer-specific permit. However, the US is not a full member of the IEC agreement, so you will have to be approved by a Recognized Organization.
Canada is one of several countries that offer a Golden Visa program, which provides residency to foreigners looking to make investments, start a business, or buy a business in Canada. There are multiple options available, so you’ll need to determine which best suits your situation.
Spouses, common-law partners, and dependent children can be sponsored once you have permanent residence status in Canada.
Prospective students can apply for a study permit, but you’ll need a provincial attestation letter (PAL) or territorial attestation letter (TAL) and a letter of acceptance from a designated learning institution.
Iceland
Iceland has a slightly higher cost of living than the United States, but it severely outranks America in every other major category. It is one of the safest countries in the world and is a beacon for transgender rights. Although English is not the native language of Iceland, over 90% of the population speaks it fluently.
It has a lot in common with the other Nordic countries, but Iceland has a reputation for being a trailblazer for LGBTQIA+ rights. On the other hand, Iceland is admittedly more expensive – and since it’s even further north than Canada, you’ll be dealing with even colder weather. While Iceland is further from the US than Canada, it’s still significantly closer than elsewhere in the world.
IMMIGRATION PATHS Since US citizens do not qualify under Iceland’s EEA/EFTA permits, you will have to obtain a residence permit to stay for longer than three months. However, like Canada, you won’t need a visa to enter. Traditional immigration paths all require a signed employment offer showing your contract to government officials for both the residence and work permit required to move to Iceland. The Multicultural Information Centre is a great resource that outlines the basics of Icelandic immigration.
One of the issues regarding Canada is that all employers must do additional paperwork to hire foreign workers, so you’re not able to just apply for any job you see. Iceland doesn’t have this – while there are fewer routes outlined compared to Canada, the process is more straightforward. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS While technically not a retirement visa, the Financially Independent Person Permit allows individuals who have sufficient passive income to get a visa in Iceland. This permit is eligible for anyone at least 18 years old and makes 239,895 ISK per month.
The Family Reunification Visa applies to married spouses and cohabiting partners to get an Icelandic visa once a traditional visa is secured. Children under the age of 18 as well as adult parents over 67 can also get this visa.
Prospective students can apply for an Icelandic student residence permit, which requires both proof of the financial support you will be using to live in Iceland as well as confirmation of your study program admission.
Malta
If the weather in Canada and Iceland is a deterrent for you, Malta is the next suggested choice – it’s less heard of, but Malta has the best scores for transgender rights in all metrics. The country has a perfect 100 for its legal rights and protections and has a public opinion rating of LGBTQIA+ people on par with Canada and Australia.
Approximately 88% of Malta’s population speaks English fluently, which is why it’s one of its official languages alongside Maltese. Since it is Mediterranean, it has a warm and sunny climate – so it draws in a lot of retiring Americans who want to experience Europe’s high quality of life at a lower cost than other European countries.
IMMIGRATION PATHS United States citizens are considered Third Country Nationals (TCNs) since we are not part of the EU or EFTA. All TCNs must go through the single permit procedure to work and reside in Malta unless they qualify for an exception. Malta requires applicants to submit a copy of a valid employment contract among other documents – if approved, foreign workers are allowed to reside for at least one year. Malta is notably difficult to immigrate to – it’s a small country, so they have limited resources. Like Canada, Malta requires employers to prove they have sufficiently tried to fill their open job vacancies with domestic workers – but unlike Canada, you are free to apply to any job openings. Use the buttons below to view common job openings to foreign workers.
OTHER EXCEPTIONS Individuals aged 55 and older can utilize the Malta Retirement Program, which gives residency to anyone receiving a pension income seeking to live in Malta.
Malta has a Golden Visa program for potential foreign investors looking to gain residency as well as citizenship. The main route for this is the Malta Permanent Residence Program – although the program also works for non-investors with enough funds since you just have to prove you have sufficient funds in your EU accounts.
Since 2021, Malta has also had a Digital Nomad Visa available to remote foreign workers to reside in the country for up to one year as long as their employer is based outside of Malta. Digital nomads must have proof of a salary of at least €3,500 per month or €42,000 per year.
The Malta Family Reunification Visa allows legally married partners to obtain an additional visa once a traditional option is secured. Children under the age of 18 may also get this visa as well as financially dependent adult children.
Students can pursue higher education in Malta via a Schengen visa if they can prove they have enough income to support themselves for each month of their studies in addition to their admission letter. Malta has a specific requirement that you must have at least 75% of the minimum wage to meet the international student income requirement.
Spain
While the cities of Spain have a higher cost of living, it’s a much cheaper alternative than other Western European countries – when coupled with its famous laid-back culture, inclusive policies, and public programs, Spain is a solid choice. Its quality of life index score is only a couple of points behind the US, but it outranks America elsewhere – such as its trans-inclusive laws, cost of living, and safety.
Spain does have one drawback compared to many of the other countries that made my list: you will have to speak Spanish. Spain has one of the lowest English proficiency scores in Europe, with about 20% of its population knowing English. While you’ll be able to survive in its major cities without knowing Spanish, you won’t get very far – and the type of Spanish you likely know as an American (Latin American Spanish) isn’t the same as Castilian Spanish.
IMMIGRATION PATHS Spain allows for job seeker visas for anyone wanting to search for work for up to twelve months at a time, as long as you can prove you can provide for yourself in the meantime. This means that you can obtain a Spanish visa without having an existing job offer, unlike the above countries. However, to get a job seeker visa, you will have to apply at a Spanish consulate or embassy in your home country by booking an appointment and bringing all the required documents. One of the reasons for the job seeker visa is that Spain has a heavy tradition of networking for finding and offering employment, so it gives future employees time to make connections.
Once a job offer is secured, you can get a regular work visa that is valid for up to five years max with renewals before pursuing permanent residence. Seasonal visas also exist for individuals with short-term employment contracts of up to nine months in specific industries like retail, hospitality, and construction. Lastly, Spain offers a special visa for freelancers and self-employed individuals who wish to reside in the country. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS The retirement D7 program allows retirees eligible to reside in Spain if they can demonstrate they have enough passive income to support themselves – unlike Malta’s retirement program, there is no minimum age requirement.
Individuals who invest in a Spanish business can secure indefinite residence via their Golden Visa program – although the Spanish Congress is working to eliminate the program. There are similar routes for foreign entrepreneurs looking to start a business in Spain without the immensely heavy investment requirement.
Digital nomads can work online while residing in Spain for up to two years if they can prove they have a monthly income of at least €3,040 and savings of €36,500.
Individuals can also obtain a visa if they are married or partnered with an individual with a visa or residence in Spain. Immediate children can be given this visa if they are under 18 years old as well as adult parents if they are older than 65.
The student visa allows for international study for up to three months, six months, or longer – but you’ll need an offer letter before you can apply. Folks with a long-term student visa can work up to 20 hours per week after applying for a foreign identity card.
Portugal
Considered one of the more affordable countries in Western Europe, Portugal is affordable even in its major cities. Like Spain, Portugal has a great work-life balance and healthcare system that attracts plenty of Americans. Unlike Spain, Portugal has better transgender rights and is significantly more proficient in English – they’re ranked #6 in the world, making them the most English-fluent on this list for a country whose native language isn’t English.
These factors are why Portugal maintains a large expat community, so you’d likely find yourself among many other American newcomers upon arrival. The majority of goods, housing, and other general expenses are significantly cheaper in Portugal than in the United States – although they do have higher prices on imported goods.
IMMIGRATION PATHS Non-EU residents like American citizens must secure both a residence permit and a work visa to live and work in Portugal. Akin to Spain, Portugal has a job seeker visa available for individuals to search for job opportunities within Portugal for up to 120 days before getting a traditional work visa with an offer of employment.
For a work visa, you must have a job offer from a Portuguese employer – but like in Spain, your employer will apply for your work permit on your behalf to the Portuguese Labor Authorities. Similar to Iceland, you are free to apply for any job openings since the paperwork required is put upon the employer if they are interested in hiring you. After securing your permit and job offer, you then must apply for a work visa at the Portugal Embassy. All visas and permits, including all exceptions listed below, must be applied to at a local embassy. Your residence permit will be applied for when you enter Portugal at the Portuguese Immigration and Borders Services. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Portugal has a very similar retirement or D7 program to Spain – if you can prove you have the passive income to support yourself, the only requirement associated with the visa is that you must be at least 18 years old to qualify.
Young people between the ages of 18 to 30 are eligible for the youth mobility program since Portugal has an agreement with the United States to allow citizens to work and study for up to twelve months.
Like other countries, Portugal has a Golden Visa program for foreign investors wanting to live full-time in Portugal. Similar to the Golden Visa, prospective entrepreneurs can use the D2 Startup Visa to expand or start new business projects within Portugal.
The Portugal digital nomad visa is known as the D8 Visa, which authorizes residence permits for remote workers and freelancers who want to work within Portugal. The D8 Visa requires individuals to make at least four times the minimum wage, which totals at least €3,480 per month.
If you have family in Portugal, you can use the D6 Visa to obtain residency. Commonly, the D6 is used to bring immediate family and partners with you after obtaining another visa.
For student visas, you must be accepted to study at one of Portugal’s fourteen universities or polytechnic education institutions. The Type D student visa allows for long-term students over 90 days.
Portugal has a special visa for individuals trained in the tech industry outside of the European Union. Applicants must be at least 18 years old and have a Bachelor’s degree in a relevant field.
Greece
Most people wouldn’t think of Greece when considering trans-friendly countries to immigrate to, but it’s a much stronger contender than other countries. Even though it marks the entrance to Eastern Europe, Greece is progressive – especially so when compared to its neighbor Italy. About half of its population speaks English fluently, but English is so innate to Greek life that it sits #8 in the world for English proficiency.
One possible drawback to Greece is that due to its progressive nature, you’ll experience more strikes and demonstrations that can interfere with daily life – while they’re generally peaceful and not to the size of France, they still have the same spirit.
IMMIGRATION PATHS Anyone seeking to reside in Greece longer than 90 days must get a long-term D visa, which is used for both work and students. You will need either an official offer of employment from a Greek business or an admission letter to be approved for a type D visa. Applications are only received by in-person appointment at the Consular Office of the Embassy of Greece in Washington DC. After seven years of residency in Greece, you can apply for naturalized citizenship if you demonstrate basic fluency in Greek. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Like other European Union countries, Greece offers a Financially Independent Person visa similar to a retirement visa. Applicants must be at least 18 years old and make €3,500 per month from passive income sources like rent, pension, and investments.
Foreign investors can use Greece’s Golden Visa program if they can pass the minimum checks alongside purchasing real estate or investing in Greek businesses.
The Greek Digital Nomad Visa was launched in 2021 to provide travel work visas to remote workers who have employers outside of Greece. These visas authorize you to work for up to 12 months and permit you to bring immediate family members. To be eligible, you must meet the minimum financial requirement of €3,500 per month.
If you are a spouse or child under the age of 18 of an individual living in Greece under another visa, you are eligible for a family reunification visa. Like all Greek visas, it must be submitted in person.
Non-EU students must get a type D long-term visa, which can be renewed annually and allows them to apply for a residence permit as well as work part-time for any Greek employer.
Australia
As one of two countries on this list to beat the United States on all major key points, Australia is a great choice – there are plenty of good salaries to go around, and the country maintains both a lower cost of living and a higher quality of life than the US. You’ll only find high costs of living in Sydney and Melbourne, but Australia’s economy and environment make up for it. Like Canada and Ireland, English is Australia’s primary language.
Compared to other entries, there are fewer locations further from the United States than Australia. It experiences geographical isolation, so it’ll be difficult to return home to see friends and family – as well as for them to visit you. It’s also worth mentioning that one of the major reasons Australia has its fantastic environment is because it’s so climate conscious – the country experiences more extreme weather events than elsewhere in the world, although this might not be a major factor if you’re living in a weather-extreme region in the US.
IMMIGRATION PATHS Australia has a LOT of visas – so I recommend using the Australian government’s online matching service to find which is best suited for you. Most individuals seeking work will want to look into the Skilled Employer Sponsored Regional Provisional Visa (Subclass 494). The 494 is similar to Canada’s work visa since it requires you to have an employment offer from an Australian company – but you are only eligible if you are under the age of 45. The similar Skilled Regional Provisional Visa (Subclass 489) has no age limitation and does not require an employment offer, but you have to get a nomination from a state or territory government – but the 489 is currently only available as an extension of short-term visas like the 475, 487, 495, and 496. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Since 2018, the Australian government has remodeled its retirement visa program as a pathway to permanent residency – there is not a ton of information on how to apply under their program as a prospective retiree, but allowed individuals aged 55 and older to immigrate through the Investor Retirement Visa (Subclass 405) or Retirement Visa (Subclass 410).
Australia has a youth mobility work holiday agreement with the United States, which allows American youth between the ages of 18 and 30 to work in Australia for up to three years through the Work and Holiday Visa (Subclass 462).
While Australia does not have a proper digital nomad visa, their general tourism and visitor visa allows individuals to stay up to twelve months as long as they have the funds to support their stay and leave once their visa expires. This visa allows you to work remotely for a non-Australian employer, but you won’t be able to formerly work or sell goods or services within Australia without an additional work permit.
Visa holders are entitled to bring partners and family members when moving to Australia. For family members other than parents or children, you must get either an alternative visa or go through the sponsorship system if your Australian connection is an official citizen or permanent resident.
Students with an official admission letter to an Australian university can apply for a Student Visa (Subclass 500), allowing them to legally reside for up to five years and work part-time while studying.
Ireland
For transgender-related rights and immigration, Ireland makes this list while the United Kingdom does not. The UK falls just short of making it, largely due to growing anti-trans sentiment copied from the United States. Ireland is known for its friendly culture, natural beauty, and high standard of living which makes it on par with other countries in the European Union.
Similar to Greece (and many of the countries on this list), Ireland’s progressive spirit means demonstrations are commonplace and an integral part of the country’s history. Compared to elsewhere, Ireland has a poorer housing market – while Ireland is one of the safest places in the world, you’ll likely have trouble finding an apartment to rent.
IMMIGRATION PATHS Due to Americans being non-EEA/Swiss nationals, you will need to obtain an employment permit or atypical permission to work in Ireland. You’ll also need to register with immigration, assuming you plan to stay in the country for over three months. The long-term Type D Employment Visa issued by the Department of Enterprise, Trade, and Employment covers most occupations, although there are a couple of other visas for specific fields like the Atypical Working Scheme Visa and Scientific Researcher Visa. Like most countries, you must have a job offer from an Irish employer to be granted work visas – but the process is pretty straightforward and can be done entirely online well in advance before flying to Ireland. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Anyone, regardless of age, can retire to Ireland under a Type D Visa with Stamp 0 as long as they have a passive or non-working income of €50,000 per year and can prove they have enough savings to cover any sudden major expenses.
Ireland has a unique agreement with the United States for its youth mobility program – unlike other programs that are purely based on age, the working holiday program for Americans seeking to travel to Ireland for work and travel has no age limit. Instead, it requires you to be a recent graduate of any third-level education within the past 12 months. These include any educational degree or certificate program after high school, such as community college, university, graduate school, etc.
Married and civil partnered couples can use family reunification to apply for a second visa in addition to traditional working visas, as long as your partner is at least 18 years old. Ireland also recognizes proxy marriages and extends family reunification to immediate family members, according to the traditional understanding of the nuclear family, and elderly dependent parents.
Students wanting to remain in Ireland longer than three months to pursue their education must get a long-term visa, which requires a letter of acceptance at an Irish school.
Germany
Even though Germany does have an alt-right party, Germany is an extremely progressive place to live compared to the United States – Alternative for Germany (AfD) exists on the outskirts of German society since Germans have no tolerance for neo-Nazis. Equaldex rates Germany’s LGBTQIA+ laws and protections as nearly perfect, similar to the laws in Spain and Malta. It’s also the other country on this list that beats the US on every major metric on the key data listed below.
Germany’s social welfare system is a magnet that draws many Americans abroad, including its strong job market, work-life balance, and healthcare system. Like Greece, about half of Germans know English fluently – knowing German will make your experience better, but it’s not required.
IMMIGRATION PATHS Germany has two routes for its job seeker visa, which explicitly allows you to come to Germany without an existing job offer for one year. The first route requires you to show vocational or academic qualification that is recognized by Germany, while the second route uses a variety of factors like education and language proficiency to determine your eligibility – for both methods, you’ll have to prove you have enough funds to support yourself while you search for a job.
Individuals with a job offer from a German employer can be granted either a Visa for Professionally Experienced Workers or a Work Visa for Qualified Professionals – the first is for more general employment while the latter is used for specialized occupations that require certification to practice. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS While Germany does not have a Golden Visa program, it does offer several visas for foreign investors and entrepreneurs considering moving to Germany – as well as its self-employment visa. Their investment visas require less funding than Golden Visa programs and the amount varies by region. Since Germany does not have a retirement visa, many people use these visas to secure long-term residency if they are unable to get a work visa before retirement for a later settlement visa.
Germany’s self-employment visa, as mentioned above, is used frequently in place of a digital nomad visa seen elsewhere in the world. The freelancer aspect of the visa allows for remote work as long as you can prove you have the funding and income to support yourself.
The German Family Reunion Visa allows non-German residents to bring family members once they have settled in the country, even if they do not have permanent residence status. Americans are classified as TCNs, so you will need a settlement permit, long-term European Union residence permit, German residence permit, or EU Blue Card to sponsor family members’ visas. Germany has a lax approach to its family visa, allowing adult children, siblings, cousins, and other extended family members to use the system if you attest that they need your support to avoid hardship.
Unsurprisingly, Germany also has several student visas available. The Student Applicant Visa allows students to lawfully reside in Germany if they are waiting for admission confirmation, related to the fact that German universities have several steps required like interviewing and testing before confirmation is given. The applicant visa is only granted if you have a genuine chance of being admitted and you are required to have already applied to the university beforehand. Once confirmed, you can receive the Student Visa for full-time study. Lastly, Germany offers a German Language Course Visa to reside in Germany while taking language courses without requiring you to enroll in full-time study.
Switzerland
It stands similarly to Nordic countries like Norway, Finland, and Sweden, Switzerland is a strong enough contender to be included on this list – although the entire Nordic region further north has good laws protecting transgender folks. Switzerland is most well-known for its incredibly high quality of life, job security, and political stability.
On the other hand, Switzerland is one of the more expensive countries to live in and has the highest cost of living on this list. Major cities will have high rent, grocery prices, utilities, and everyday expenses. While the country has multiple official languages, being an English-speaking American won’t hold you back – but there is a limited job market available to foreigners.
IMMIGRATION PATHS Even though Switzerland is not part of the European Union, it uses many of the same trade and immigration agreements as its neighbors – so non-EU/EFTA citizens like Americans will need a long-term visa to work in the country. You are only eligible for a Switzerland Work Visa if you have an existing job offer that could not better be performed by an EU/EFTA citizen – once you have a job secured, you can apply for a work visa while your employer applies for your residence permit. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS The Switzerland retirement visa allows financially stable adults to reside if they are at least 55 years old if they can prove they have the passive income required to not become dependent on Swiss social security benefits.
At the end of 2024, Switzerland agreed with the United States for a youth mobility program to grant visas for young people seeking working holidays abroad. The program allows Americans to work and live in Switzerland for up to 18 months, as long as they are between the ages of 18 to 35, and have completed any post-secondary education.
The Swiss Golden Visa grants residency and citizenship to foreign investors through the Swiss Residence Program and Swiss Business Investor Program, but you must be between the ages of 18 to 55 to be considered eligible.
Switzerland does not have a digital nomad visa program, although non-Swiss nationals are permitted to work remotely if they have a contract with a non-Swiss employer and can prove they have the income to support themselves. You will not be able to sell goods and services non-remotely within Switzerland without a valid work permit. However, most people seeking remote nomad work use the Golden Visa program instead.
Family reunification is granted based on your residency permit and the nature of your marriage and family unit. The C permit gives individuals the right to bring their married or registered spouse and dependent unmarried children or grandchildren, while the B permits leave family reunification to the discretion of authorities looking over your case.
For Student Visas, you are required to submit proof of acceptance from a Swiss education institution. Non-EU/EFTA nationals must contact the Swiss embassy or consulate in their home country to apply for their student visa and the requirements associated with it.
Thailand
There are several Americans that move to Asia when immigrating, like Singapore and Japan. Unlike other Asian countries, Thailand has more trans-inclusive laws – although Thailand is not perfect, it’s on a similar path to queer success as Japan but ranks better on LGBTQIA+ laws than other common Asian countries Americans immigrate to.
While Thailand has a fantastically low cost of living, it has a large income inequality gap – which is why so many Americans flock there like Mexico. However, you’ll experience significantly more pollution (about twice as much), and you will have to know Thai since only 20% of the country knows fluent English.
IMMIGRATION PATHS For Thai work permits and visas, you must have a Thai company or related entity file an application for your permit on your behalf, which allows you to get a work visa valid for one year. Once you have a job offer, you should consult with the Ministry of Foreign Affairs and the Royal Thai Embassy in Washington DC. Use the buttons below to view common job openings for foreign workers.
OTHER EXCEPTIONS Thailand allows foreigners to obtain a retirement visa if they are at least 50 years old and have a steady income that comes from outside of Thailand. Applicants must either have a regular income of 65,000 THB per year or a savings account of at least 800,000 THB.
The Thailand Privilege Visa is the country’s version of the golden visa, which grants long-term residency to foreign investors. This visa option has a very high price since you must have at least $1,000,000 USD in assets and have made at least $500,000 USD in Thai investments.
Since 2024, the Destination Thailand Visa (DTV) has become a more doable option that replaces other countries’ digital nomad visas. Remote workers and freelancers are allowed to work up to five years if they can produce a certificate or professional portfolio showcasing their work or employment contract. Workers must also prove they have at least 500,000 THB in total to support themselves in an emergency.
Non-Thai nationals may bring spouses, parents, and children to live in Thailand under the Type O Visa if they currently hold a valid work or residency permit in Thailand.
Frequently Asked Questions
What is an expat? I keep seeing that word around when I research options. Expat is short for expatriate, referring to anyone who lives in a country other than their own. Generally, expats expect to live in another country for a limited time while immigrants seek to settle permanently – but expat resources are immigrant resources and vice versa.
What about the countries not included on your list? My list is extremely condensed, so there are lots of countries that just fell short – but that doesn’t mean you shouldn’t consider them. Use sources like Equaldex and ILGA to determine how queer-friendly a prospective country is, and consider how much power anti-trans and fascist groups have there (if any). Japan, the United Kingdom, Norway, Argentina, and many other countries are decent options based on both their transgender rights and the process of immigration.
Getting a job is hard! How do I immigrate without a work offer? Technically, I am supposed to advise you to either search for jobs online before moving overseas, look into countries with established job-seeker visas, or use other visa programs available like youth mobility and digital nomad work.
Americans have a unique advantage compared to elsewhere in the world – we don’t often need visas to travel abroad for short trips lasting up to 90 days. The only exception to the countries I listed above is that the European Union will begin requiring American citizens to apply for travel authorization via their new ETIAS screening process, which gets linked to your passport once filed. It’s not quite a visa, but similar and meant to enhance EU border security. That being said, there’s nothing technically stopping an individual from considering foreign jobs while staying abroad on a tourist visa as long as it’s within the three-month time frame. Job seeker visas generally last up to twelve months to give you ample time for your search – just be prepared to potentially fly back to the US if you don’t have a job offer and work visa by 90 days or risk becoming an illegal immigrant.
How does sponsorship work? I heard that’s another way to immigrate! If you have family living in another country, you can use their citizenship status to get a visa granted if they agree to be your financial sponsor while you’re looking for work. Non-immediate relatives like cousins and in-laws will take a longer time to process your visa, but it still grants you a visa.
Under certain conditions, private individuals who are not related to you at all can also sponsor immigrants – but you’ll want to look up the exact laws for the country you have in mind. Sponsorship works the same way, so they’ll have to sign documentation that they are financially responsible for you until you are self-supporting.
Why aren’t transgender Americans able to have refugee status? This might change soon, but humanitarian-focused countries have not deemed the political climate in the United States dangerous enough yet to give refugee status solely based on trans identity. In the event something drastic happens in the US, that will likely change – refugee and asylum seekers get a variety of benefits in addition to their visa, like financial support, healthcare, case management, housing, etc. If transgender Americans are granted refugee status anywhere in the world, that would be a better route than any of the countries listed for traditional immigration.
This week brought us a second Trump administration, inevitably eroding many of our rights. The fight for a better society is a long journey filled with struggle, especially since figures in power actively work to keep people from resisting. While pursuing equality, it’s important to make efforts to protect your digital safety – especially when hostile groups or the government can target your activism. It’s nearly impossible to exist without connecting to the internet. Save yourself the headache now by learning about what you can do to become safer online.
Author’s Note: Digital security becomes outdated extremely fast. This article will become obsolete at some point, so make sure to review the advice given here and apply it with updated ideas.
The more your movement wishes to change the status quo, the more likely you will be targeted by cyberwarfare. In fascist and conservative societies, simply being marginalized is seen as opposing the status quo – even if it is not something that can be changed. Being vocally and visibly out puts you at risk, but it’s also where you can create the most change. Online harassment and doxxing are commonplace for non-activists that merely upset the wrong people, but targeted surveillance and hacking are weaponized if your movement is deemed an ideological threat.
The largest real-world examples are the actions taken by the United States Federal Bureau of Investigation against the civil rights movement, which spied on figures like Martin Luther King Jr., Malcolm X, Elijah Muhammad, and Aretha Franklin. COINTELPRO was the official series operated by the FBI, which covertly and illegally surveilled, infiltrated, discredited, and disrupted groups they deemed subversive like Black power, civil rights, the American Indian Movement, Brown Berets, United Farm Workers, and numerous feminist, environmental, and left-wing organizations. COINTELPRO is the most notable example, but similar programs most certainly exist today to allegedly secure national security. Even when the government is not involved, ill-intentioned individuals and organizations put energy into disrupting equality.
Watch It! Do Risk Assessment!
Before you get the conspiracy hats on, it’s important to note that most people will not be targeted by large-scale operations or the government. By nature, activists are at a higher risk, but simply being transgender won’t land you under increased surveillance unless you’re part of a group that can feasibly undermine others.
Risk assessment refers to identifying potential hazards so you can plan to avoid them as much as possible. Digital security is complicated, long-winded, and limiting – the more secure you become, the less freedom you’ll have online. For those reasons, not everyone needs to have a high level of security if it’s unneeded. Before continuing, think about these five questions:
What do I need to protect?
Who do I need to protect it from?
How much do they want that information and how easy is it for them to get it?
What happens if they get it?
What am I willing to do to stop that from happening?
The Secure Communications Framework
The SCF is an open-source model that was created to help activists, human rights researchers, and other individuals interested in security determine the best tools and practices for their situation/work. The following chart is the secure communications framework, but I’ll break down the lingo used.
The “x” axis, or spectrum going rightward, represents your work:
Limited Impact: The item or work is not publicly available. Becoming public or taken might reduce the speed or impact of your work, but your message and strategy would be safe.
Public: The item or work is publicly available information. There are no inherently negative consequences of it being publicly available, so it doesn’t need security.
Significant Impact to Research/Organization or Limited Impact to Individuals: Confidential information and work being publicly exposed would likely need organizational strategy revision. Individuals are impacted in non-physical ways.
Significant Impact to Individuals: The unplanned public release of this information would result in an individual being physically detained, arrested, or harmed.
The “y” axis, or spectrum going upward, represents who you are targeting with your mission:
Interest Groups and Individual Actors: Interest groups are organizations and communities that share a common interest or goal. Individual actors refer to any single person who plays a role in your work – these are often regular people who can be persuaded to work with or against you.
Governments, Corporations, and Non-State Actors: Organizations that can use passive or untargeted methods to monitor your work. Most entities fall here until you have drawn their attention.
Highly Capable and Motivated Adversaries: Organizations that are taking active/targeted steps to learn or interfere with your work.
Using the bullet points on the SCF above, you can tell there is a significant difference in the risk involved. A draft press release wouldn’t require any changes, even if it was annoying if it got exposed early, but a list of projects might need alteration if it got leaked. Personnel information being exposed might lead to online harassment, but a testimony being leaked might cause an individual to be detained.
Work that falls in the purple sectors requires regular basic security practices. Individuals should use an encrypted email and device, and should only use organization-issued computers and phones if part of a larger group.
Work that falls in the orange sectors needs to use end-to-end encryption for all communications and border crossing security.
Work that falls in the red sector should consult with a trusted security expert in addition to the previous guidance. It’s also recommended to only work from devices disconnected from the internet and not use any closed systems communications.
As I’ll get into below, digital security is extensive – there is little reason to use top-tier safety mechanisms for work that does not need protection. The more secure something becomes, the more tedious it is to use. The more your work is guarded, the fewer people will hear your message.
Back to Basics: Safety Anyone Can (and Should) Do
Browsers Matter!
Regularly update your operating systems (OS), browsers, and apps. More than 90% of software updates are security patches – forgetting or refusing to update your devices is more likely to put you at a data breach than your device just becoming slow. This is especially important on organizational computers and devices you use for your work!
Speaking of browsers – not all internet applications are created equally. Google Chrome stands as the industry leader, which is incredibly fast and the default for most users – but they’re one of the worst browsers for data security, going to great lengths to obtain and sell user information to the highest advertising bidder. Microsoft Edge is forcibly installed on all Windows devices, the modern version of Windows Explorer – it consumes less power and battery resources than Chrome and sets the precedent for in-browser AI. Apple-based devices use Safari, which boasts robust privacy protections that separate it from its competitors – but it’s difficult to trust one of the tech industry’s leaders at face value. Arc is a new face on the scene, released in 2023 using Chromium to focus on user productivity and multitasking.
The two most secure internet browsers that actually provide digital safety are Firefox and Brave. Opera used to claim this title too, flaunting its free VPN feature built into its programming, but it’s come under fire for selling user data to advertisers. Both Firefox and Brave prioritize user privacy, but it’s personal preference between the two. Supposedly, Brave is better at privacy out-of-the-box, while Firefox requires more set-up – but in turn, Firefox is more customizable.
Special Feature: Tor
Occasionally known as the “dark web browser,”Tor (which stands for The Onion Router) is an open-source overlay network that takes user privacy to an extreme by using numerous networks to encrypt information multiple times. This makes it nearly impossible for entities to track you, making your internet browsing anonymous. Compared to other internet browsers, Tor takes more user knowledge since it’s complicated and has fewer features than mainstream browsers like Chrome, Safari, or Firefox. Tor also hides your IP address (discussed below in VPNs) – but despite the sketchy reputation the dark web has, Tor is fully legal to use. It’s used for tons of legitimate purposes like journalism and activism! However, Tor is not lawless – if you get caught engaging in criminal activities, you can still get in trouble.
HTTPS What?
All websites use either HTTP or HTTPS – it’s included at the very beginning of a web address like https://transsolidarityproject.wordpress.com/. HTTP (Hypertext Transfer Protocol) transfers data over your network, but your information can be read by anyone monitoring that website’s connection. For that reason, HTTP sites are more likely to expose user data like passwords, credit card numbers, and other important details.
HTTPS (Hypertext Transfer Protocol Secure) encrypts HTTP transfers. When someone tries to monitor an HTTPS website, they’ll only get random encrypted characters instead of private user information. HTTPS is considered vastly safer, so websites that utilize it are boosted in search engines to steer users. That doesn’t mean HTTP sites are bad – it just means you should be wary when using them and consider additional security protections if you don’t fully trust the site.
Secure Your Network: VPNs
Virtual private networks, or VPNs, are always brought up quickly when discussing digital privacy. VPNs establish a digital connection between your device and a remote server, encrypting your personal information and masking your IP address. Both of these functions serve important purposes:
Your IP (Internet Protocol) address is a unique number given to your device while using the internet, allowing it to communicate and connect with the rest of the world. If someone obtains your IP address, they can pinpoint your location up to the postal code you live in – IPs don’t show exact locations, but combined with other information hackers can obtain like birthdates and Social Security numbers, fraud can occur under the right circumstances.
Information that has been encrypted can only be unlocked through a unique digital key since the encryption process scrambles the data into a secret code. Even if someone gets access to your network, they won’t be able to unscramble the encryption placed on your devices or cloud storage – keeping data confidential.
People use VPNs for a variety of reasons – while I’m focusing on data privacy, many users have VPNs to bypass regional content locks. Once your IP is masked, your location can be set to anywhere in the world – allowing you to access websites and content in other countries. Others use VPNs to simply block internet service providers from logging and tracking their search history, and some users have VPNs to get around government censorship and surveillance. While VPN usage and IP masking can look suspicious to police, there is no way to track live encrypted VPN traffic – and you can’t get in trouble just because your internet usage looks a bit suspicious.
Most people don’t need to use a VPN. Digital privacy feels great, but it’s a lot of steps that most people don’t need if they’re unconcerned with their browsing data being sold to advertisers since most people aren’t worried about being censored or surveilled. At the end of the day, regular folks only need a VPN if they’re connected to a public or otherwise untrusted internet network – which is when you’re at the most risk of having your data stolen. Otherwise, members of the general public can get by using an ad blocker like Privacy Badger – a browser extension available on Chrome, Firefox, Edge, and Opera that stops third-party trackers.
If you have never used a VPN ever, I recommend Tunnelbear – it’ll get you used to the mechanics of how VPNs work for free and has a user-friendly interface. That’s important because VPNs can get complicated if you’re unaccustomed and don’t have high data privacy literacy, which is most people.
For the majority of people, Proton VPN is the best choice. There are hundreds of VPN providers that all promise specialized features and user security. It’s not terribly hard to use, and it’s free. Entirely free, with a connection speed similar to premium versions – the only downside to Proton is that you can only connect their free VPN service to one device at a time. Proton also hosts a secure email service, cloud storage, password manager, calendar, and wallet for users, too.
If you really want to pay someone for a VPN (and it’s not Proton), NordVPN is an industry-standard. It has a little bit of everything, providing slightly more encryption than Proton, and has built-in antivirus protection among its many tools. It has something to offer for everyone – but it’s definitely more pricey than other VPN providers. If you’re curious about other VPNs, the r/VPN subreddit has a datasheet comparing major providers.
Why would I use a VPN and not Tor?
User-friendliness, mostly. You don’t need both – if you have Tor, you don’t need a VPN, and if you have a VPN, you don’t really need Tor unless you’re going for the freedom and anonymity that Tor provides. Generally, VPNs are more user-friendly and significantly faster than Tor but it’s personal preference. Like Proton, Tor is entirely free to use.
Security Management & 2FA
Two-step or two-factor authentication (2FA) requires two forms of identification to access an account, which protects your devices and information even when passwords are leaked. With standard single-factor authentication (SFA), a user just inserts one password to access their account – but if their password becomes compromised, all of their account data is at risk. With 2FA, users provide that same password but also have to provide a different second item like a security token, fingerprint scan, facial recognition, or pressing a button on an additional device.
You don’t need 2FA on everything, but you should enable it where possible – especially on password managers, finances, and social media profiles. It’s a simple step that saves you a lot of hassle! It’s rumored that the 2016 Hillary Clinton campaign actively rejected security advice to use 2FA on its accounts, leading to the thousands of emails that were leaked by Russian hackers – if they had used 2FA, we might be living in a very different America.
Most 2FA apps are entirely free, but it’s up to you which one to go with. GoogleAuthenticator is the go-to for most folks, followed by 2FA Authenticator, Microsoft Authenticator, and Duo Mobile. However, I’d actually recommend 2FA out of the above options since it allows for cloud back-ups and provides protection that Google doesn’t.
Don’t Dox Yourself, Use an Alias
You have the power to determine how much of yourself is online. Make an effort to review what information is publicly available so you don’t accidentally dox yourself. Doxxing refers to when personally identifiable information about an individual or organization is released without their consent, and it can be done maliciously by all sides of the political spectrum. A handful of US states have criminalized doxxing, but assuming the perpetrator has taken steps to not get doxxed themselves, it’s difficult to tackle.
By using an online alias or alternate name, you can protect your real-life identity since your actual name and contact information aren’t readily available. However, aliases are less common today outside of certain communities and forums.
Do You Trust Meta?
Just like internet browsers, not all social media sites equally value your personal information and privacy. Some of the most privacy-friendly sites used in the US include Reddit and Snapchat – Reddit is filled with anonymous accounts used for their forums, and Snapchat deletes messages after being read while also notifying users if someone tries to screenshot their content. Similarly, Amazon, Grindr, Pinterest, Spotify, and Lyft all collect minimal data compared to other major sites. Not on the below list, Bluesky is a growing platform and alternative to Twitter/X that does not sell data – they’re an open-source network with a focus on privacy meant to resemble what Twitter used to be like before its takeover by Elon Musk.
Some of the worst offenders for digital security include Meta, YouTube, LinkedIn, and Uber. Despite lobbying by Meta owner Zuckerberg, Meta sells insurmountably more user data than supposedly dangerous sites like TikTok – which is why its sites are poor choices for privacy, including Facebook, Instagram, WhatsApp, Threads, and Messenger. Since it’s owned by Google, YouTube is slow to delete its user data even after account deletion. Uber obtains a large quantity of user information, which can be used to target individuals seeking criminalized services like gender-affirming care and abortions if given to the wrong entities. Lastly, while LinkedIn isn’t as malicious as other sites, they’ve suffered the greatest number of data breaches.
Protect Your Messages
The use of artificial intelligence is growing – which means privacy theft, scams, and blackmail schemes are becoming more complicated. There are very real people willing to buy private chat logs, photos, and videos from your phone. One step you can take towards protecting yourself online is switching messaging platforms.
For secure messaging, there is no better alternative than Signal. All messages are secured with end-to-end encryption and it’s used by government agencies as well as activist groups. While you must have a phone number to sign up for a free Signal account, your information is secure and isn’t sold.
After Signal, WhatsApp is an internationally used platform that automatically deletes messages and images – but many users don’t inherently trust its privacy claims since WhatsApp is owned by Meta. Most messaging platforms are more secure than direct SMS or texting since texting generally lacks encryption, although this varies depending if you’re using mobile data or a local internet connection.
Messages aren’t the only thing you should keep secure – Jitsi is the most recommended platform for video calls and conferencing. Unlike Zoom, Jitsi actually uses end-to-end encryption and passwords to protect users. Zoom has been targeted by numerous security threats and data breaches.
While I am recommending Signal and Jitsi for digital privacy, the same rules apply to everything else I’ve mentioned. Most people do not need everything on this list – targeted ads are mildly annoying but worth the freedom and ease that comes with mainstream browsers like Chrome. Even if you’re transitioning to these sites, it’s impossible to get all of your contacts to stop using their preferred messaging platform like Facebook for something like Signal instead. For those reasons, this means digital security in practice is ‘use what you need, as needed.’ The majority of your messages don’t necessarily need tons of protection since they shouldn’t contain sensitive information – so I recommend using platforms like Signal as needed for sensitive topics and contacts, kept separately from your other messages.
Protect Your Device (Physically)
It’s essentially impossible to exist in modern society without a cell phone or similar device. They store our credit cards, identification, maps, contacts, and photos – you can hardly apply for a job without having a reliable phone number. Some people believe that old phones (or dumb phones) are safer than modern cell phones – this is untrue. The information you likely want to protect from the SCF can’t be secured with dumb phones because they cannot encrypt data and cannot use encrypted apps like Signal or VPNs. True dumb phones can’t operate in most places since they lack the modern VoLTE required, and modern dumb phones are just lobotomized smartphones without the capability to use apps or security updates.
It is remarkably easy to get caught up in data breaches in the cloud when discussing digital security, but you can have your data stolen just as easily IRL.Physical and external devices like your phone, USBs, and micro USBs can leak your information if stolen – having your devices encrypted is vital for this possibility. The most dangerous information you can have on your device is photos, contacts, recordings, and login information – especially if you are part of a sensitive movement or organization. In those cases, that data should only be stored on select devices that just a few people can access. When your device is stolen by thieves or law enforcement, it’s more than just your information they’re accessing if they can see your entire contact list.
Out of all the security options available, facial recognition is one of the worst since it allows your device to be accessed easily – if someone looks too similar to you, it’ll automatically unlock. Worse yet, it’s entirely possible for someone to use your face while you’re restricted or unconscious to unlock the device for them. Following that, finger sensors are only slightly more secure since it is easy for police to force individuals to unlock their phones through their fingerprints. Six-digit passcodes and complex patterns are the most secure way to lock your phone since they are the hardest to hack – as long as you aren’t using a code that’s overtly generic like your birthdate or home address. Beyond passcodes and patterns, the strongest passwords are ones that use a combination of different characters or make up a passphrase that you can memorize.
Create a Paper Trail
In the event that your data is exposed or stolen, document it. Failing to do so means you can’t track the incident – just make sure to shred physical paper copies once you’re done. Documentation allows you to think more carefully about how and why a breach occurred, regardless of whether it was an error on your end or a breach in a remote server like Google. This is exponentially more important when other people are involved, such as in an organization, group, or movement, so all affected individuals can verify their data and reset security protections. Further, you’ll be able to take legal action later on if you find the perpetrator of your leak.
High-Level Security
The following guidance is not for most people – it’s for individuals and organizations at high risk of being targeted and surveilled by opposing groups or the government. The majority of people will only need the following protections sparingly when they engage in high-risk work.
License plates trace your identity, allowing people to find your home address, criminal history, and accident history just by searching online or calling their local DMV. SIM cards work the same way – they can be searched to find out your phone number, contacts, text messages, location, and other identifying information. When engaging with high-risk work, such as going to a protest, it’s better to purchase a burner SIM with cash. Burner phones do not inherently make your digital information more private unless you have a generic SIM you buy to later discard. With as little information on the device as possible, you minimize your risk even if your phone is taken by law enforcement.
Not everyone can be on the front lines at a protest. To maintain security, you should limit high-value individuals from going to actions like protests and demonstrations – if they are detained, their data is the most at-risk. This includes admins and anyone who has login details, contacts, and sensitive messages for your group. Best practices advocate having these individuals stay back and message others remotely during a demonstration through the burner devices people IRL should have, since that both protects your data from possible exposure while also giving your activists access to data as needed by messaging you.
Speaking of which, law enforcement in the United States must have a warrant to search your phone – including if they’ve already seized it after arrest or if they believe they have probable cause for evidence of a crime. Your cell phone is covered under the Fourth Amendment from unreasonable searches and seizures, backed by the 2014 Supreme Court decision inRiley v. California. However, police are allowed to force you to unlock your phones in certain states if you use biometric logins like fingerprints or facial recognition. The courts are especially conflicted about this since it should fall under the Fifth Amendment’s right to not testify against one’s self, but it hasn’t reached the Supreme Court.
Additional Resources
Access Now has information about censorship, surveillance, and data – “A First Look at Digital Security” runs you through what exactly needs protecting and how to do it based on your needs. They even have a free 24/7 digital helpline available in English, Spanish, French, German, Portuguese, Russian, Tagalong, Arabic, and Italian.
ActionSkills has some pretty cool websites worth checking out – like the Commons Library, which hosts educational resources that you can browse for free. The Library even has information on digital security.
Association for Progressive Communications’ Digital Security First Aid Kit for Human Rights Defenders is a collection of tools and links for better online safety. The site is geared towards activists, covering how to send information without being tracked, hacks, abuse, and surveillance.
Digital Defenders has several online publications, ranging from digital support for civil rights, internet blockages, and related topics.
Digital First Aid gives you advice on how to best handle common digital security issues, like losing access to your device or account, viruses, hacking, impersonation, harassment, and surveillance.
Electronic Frontier Foundation is another large digital privacy and free speech group, which hosts tools for activists like the Surveillance Self-Defense (learn the basics on data surveillance), Privacy Badger (a tracking blocker for those who don’t want VPNs), Certbot (enables HTTPS on manually-administered websites), Atlas of Surveillance (documents local police technologies for users to search), Cover Your Tracks (check how well you’re protected from digital tracking), and Street Level Surveillance (which explains how various technologies are used to spy on the public).
Free Software Foundation believes in software freedom, but one of their best resources is their email self-defense guide for individuals wanting to secure their personal email from surveillance but don’t want to move to a platform like Proton.
Front Line Defenders has numerous projects worth looking at, including Security-in-a-Box – an open-source tool that teaches users how to protect their passwords, communication methods, devices, internet connections, and files. Read their entire digital security section here.
Medium has a good article about digital privacy for normal people who don’t need to be overly concerned with security.
Mozilla, which owns and operates Firefox, actually has a ton of information about digital security – including best practices for digital activism.
Oregon State University has a free book on cryptography, a key focus on cybersecurity since it relates to encryption. The book explains why digital security matters and the history of both digital privacy activism and suppression in the United States.
Prism Break is a great reference tool for comparing various software and companies, giving you information on the best platforms for digital privacy.
Rise Up is an autonomous body that values digital liberation and hosts numerous projects for independent forums and media.
SAFETAG is an international network of white hat hackers for small organizations – auditors who intentionally try to penetrate your security to improve your framework.
Security Planner is another free beginner guide to digital security, which gives personalized advice for free based on your needs.
Tactical Tech is a major digital security organization – but they have just as many creative demonstrations and physical exhibitions as they have reference guides and projects. Some of their online projects include the Data Detox Kit (teaches basic digital health, AI, and misinformation), Digital Enquirer (self-paced modules for users interested in online media literacy), the Influence Industry Project (effects of data collection on politics), the GAFAM Empire (information on the monopolized empire by Google, Amazon, Facebook, Apple, and Microsoft), Our Data Ourselves (learn about data, activism, politics, and yourself), Holistic Security (approach to teaching digital security as an aspect of general wellbeing)
The Movement Hub hosts free online resources for grassroots activism, which includes digital campaigning. Digital Activism is a private website that supports verified organizers with tools after registering.
Watch Your Hack uses everyday language to explain simple internet safety to protect yourself from common hacking techniques.
Looking for resources to better support yourself or a trans loved one? Everyone deserves to lead happy, healthy, and fulfilling lives.
Author’s Note: This list is not comprehensive – future blog posts will have details on trans resources not included in this article, which serves as a basic intro to trans resources and information. Also, some legal rights and resources contained in this post may change due to the hostile political environment regarding trans lives.
Get Help Now: Crisis Resources
If you are thinking about harming yourself or others, please get immediate support. The National Suicide Prevention Hotline has call, text, and online chat options available for free confidential support 24/7/365 for anyone in crisis.
I’ve previously mentioned various hotlines and mental health resources, outlining how to navigate counseling, support groups, and telehealth options. Remember that anyone can and should use hotline services – there’s no minimum level of “crisis” you have to have to call, and you’re never wasting their time by doing so.
LGBTQIA+ people, and especially transgender and nonbinary individuals, are more likely to become homeless than cisgender heterosexual folks. Queer individuals have less family support than others due to anti-LGBTQIA+ hostility, so they have limited options for doubling up and staying with family during housing instability. Despite sexual orientation and gender identity being included in discrimination protections under federal laws like the Fair Housing Act, queer people are still turned away from potential landlords and houses unless they have the financial means to fight for their legal rights. Due to these factors, queer and transgender people are more prone to engage in survival sex and sex work as a way to find shelter when employment and traditional services are restricted. While homelessness is a crisis of its own, being unhoused individuals are exceedingly likely to experience other crises.
Even homeless shelters are not necessarily safe for LGBTQIA+ people – most shelters in the United States stem from religious charity work that eventually evolved into the modern nonprofit industry that exists today. It’s not exactly uncommon for homeless transgender people to feel unsafe while trying to get help from shelters that discriminate on their gender identity, using gendered binary shelters to designate their arrangements regardless of their gender identity. When shelters require ID, LGBTQIA+ people risk discrimination when gender identity and expression don’t fit their ID or legal name. The best way to combat anti-LGBTQIA+ discrimination is to report an official complaint with the US Department of Housing and Urban Development, which can be filed online, over the phone, or by mail. LGBTQIA+ community centers and organizations local to your area can also be helpful in advocating for your rights.
Unfortunately, there aren’t any comprehensive national directories of LGBTQIA+-friendly homeless shelters. Instead, it’s best advised to look at the reviews of local shelters and ask community members in your region whether they’re affirming of queer and transgender people. Ultimately, the best way to determine whether a homeless shelter or program is LGBTQIA+-inclusive is by calling them directly and asking about their policies. Trans Lifeline cites giving direct support in calling homeless shelters in this manner on behalf of transgender callers for free in the United States.
My previous hotline post covers major LGBTQIA+ hotlines around the world – none of them discriminate based on gender identity, and transgender crisis support is a key aspect of their work. The following hotlines are a condensed LGBTQIA+ version of that post with only national US listings, although many major cities have regional LGBTQIA+ hotlines available in addition to those below.
DEQH provides free confidential counseling to LGBTQIA+ South Asians through trained peer support volunteers. DeQH is the first and only national queer Desi helpline and serves anyone from the South Asian diaspora. They are only available to take telephone calls on Thursday and Sunday evenings, although they can be reached during the week through their online contact form for a reply.
Fenway Health is an LGBTQIA+ healthcare, research, and advocacy organization that also provides free information and referrals for LGBTQIA+ issues, harassment, and violence. Both of their helplines are available during select evening hours from Monday to Saturday: the Fenway LGBT Helpline for individuals ages 25 and older can be reached at 617-267-9001, while the Peer Listening Line for those ages 25 and under can be called at 617-267-2535.
LGBT Switchboard of New York is recognized as the oldest LGBTQIA+ hotline in the world and provides free peer support Monday through Saturday. Despite their name, the LGBT Switchboard of New York offers support, care, resources, and information to anyone regardless of where they live by calling 212-989-0999 – including outside of New York and the United States.
MASGD, or the Muslim Alliance for Sexual and Gender Diversity, operates the Inara Helpline every Friday and Saturday evening for LGBTQIA+ people who identify or are perceived as Muslim. The MASGD Inara Helpline can be reached by calling 717-864-6272.
National Suicide Prevention Lifeline, or the 988 Suicide & Crisis Lifeline, is the largest mental health and crisis hotline in the United States. Using support from the Substance Abuse and Mental Health Services Administration, 988 routes callers to licensed mental health services based on their location to provide 24/7/365 services by calling the general 988 number. The Lifeline is fully accessible in English, Spanish, and American Sign Language (ASL) and also provides services via text/SMS and online chat.
For specifically LGBTQIA+-trained counselors, individuals should press 3 after dialing 988, texting “PRIDE” to 988, or checking the relevant box for LGBTQIA+ support when completing the pre-chat online survey.
SAGE x HearMe is a collaborative project between SAGE, the nation’s largest organization for LGBTQIA+ elders, and HearMe to modernize the national queer senior hotline. SAGE x HearMe operates a mobile app that users can reach anonymously 24/7 to find instant support.
SGR Hotline, or the Sex, Gender, and Relationships Hotline that spun from the LGBTQIA+ Switchboard of San Francisco, provides free confidential counseling on STDs, HIV, pregnancy, birth control, gender identity, sexuality, kinks, sex work, anatomy, and more. Their number at 415-989-7374 is available for callers Monday through Friday.
The Network/La Red is a survivor-led organization that focuses on LGBTQIA+ partner abuse, as well as abuse in kink and polyamorous communities. Their free 24-hour hotline can be fully used by both English and Spanish speakers by calling 800-832-1901 (toll-free) or 617-742-4911 (voice).
The Trevor Project is the primary crisis organization for LGBTQIA+ youth in the United States between the ages of 13 to 24. Their services are available 24/7/365 in collaboration with the 988 Suicide & Crisis Lifeline: The Trevor Project can be reached by phone at 866-488-7386, text/SMS at 678-678, and online chat. TrevorSpace is a moderated online forum available at any time.
Trans Lifeline is a peer support hotline run by trained transgender volunteers for trans, nonbinary, and questioning folks in need of support. Services are fully anonymous, confidential, and do not engage in non-consensual active rescue every Monday through Friday.
THRIVE (Thriving Harnesses Respect, Inclusion, and Vested Empathy) is a text-based crisis line staffed by trained professionals with marginalized identities, catering to people of color, LGBTQIA+ individuals, disabled people, and other vulnerable people. The text/SMS line is available 24/7/365 by texting “THRIVE” to 313-662-8209.
Trans Rights & Me: Legal Resources
The best source for legal information and steps to update legal names and gender markers on identity documents (such as state IDs, driver’s licenses, birth certificates, passports, social security, selective service, and immigration documents) is Advocates for Trans Equality. Their ID Document Center is a one-stop online hub for transgender folks looking to update their information and is the most current national directory of related resources.
The ability to change one’s legal name or gender marker varies by state – so while it may be easy to update identity documents for individuals who were born in California or Oregon, it’s prohibited elsewhere in the country. Federal documents, like passports, can have their gender marker updated despite state law – although this may change due to the current administration.
Get Help: Transgender Legal Organizations
Advocates for Trans Equality operates its Impact Litigation Program to take on a small number of court opportunities each year to establish trans-affirming precedents in the law through the work of the Transgender Legal Defense and Education Fund. Their Trans Legal Services Network represents over 80 organizations throughout the United States that provide legal services to transgender people local to their area.
American Civil Liberties Union is one of the primary human rights organizations in the United States that has fought for individual rights and freedoms since 1920. The ACLU operates chapters in each US state to handle court opportunities and case litigation – individuals should contact their local ACLU chapter for legal assistance. In addition, the ACLU also maintains comprehensive legal resource guides on a variety of topics such as LGBTQIA+ rights, disability, religious freedom, criminal law, racial justice, HIV, reproductive freedom, voting, immigration, free speech, etc.
Black & Pink is an LGBTQIA+ prison abolitionist organization with multiple programs aimed to resettle queer and transgender individuals through transitional housing and opportunities.
Equality Federation is a non-partisan lobby and LGBTQIA+ policy organization that pursues pro-equality legislation throughout the United States. Their legislation trackers include current information on both positive and negative trans-related bills among other queer issues.
Gay and Lesbian Advocates and Defenders is a national litigation organization that takes on several LGBTQIA+ cases to advance queer and transgender rights throughout the country. They also operate their own Transgender ID Project, although it is more limited than A4TE’s. Unlike A4TE, GLAD has a public online contact form for free and confidential legal information, assistance, and referrals.
Gay, Lesbian, and Straight Education Network, or GLSEN, is an education organization that provides support to LGBTQIA+ public students and educators. The GLSEN Navigator directs online users to the most appropriate GLSEN branch/chapter near them and also provides information on local laws, protections, and research. The Public Policy Office also serves as a hub for legal protections and information about previous court cases GLSEN has provided assistance and litigation for.
GLAAD is an American media and legislation nonprofit that serves to create better representation and visibility for LGBTQIA+ in entertainment. The GLAAD Accountability Project provides public information GLAAD collects by monitoring and documenting high-profile figures and groups that use their platforms to spread misinformation and false rhetoric about LGBTQIA+ communities.
Immigration Equality is America’s leading LGBTQIA+ and HIV-positive immigrant rights organization, providing expert guidance on queer and transgender immigration legal policy while also using impact litigation to advance LGBTQIA+ and immigration rights through far-reaching court cases.
International Lesbian, Gay, Bisexual, Trans, and Intersex Association is a federation of 2,000 organizations in over 160 countries around the world dedicated to promoting LGBTQIA+ rights alongside the United Nations. Through their networks, ILGA brings international attention to human rights violations to the UN and media.
interACT is an intersex rights organization centered on youth empowerment, which employs full-time lawyers to fight for intersex bodily autonomy in the United States.
Lambda Legal is a litigation organization that represents the interests of LGBTQIA+ people in the United States alongside the ACLU and GLAD. Like GLAD, Lambda Legal operates a Help Desk to provide general legal information and resources – although their assistance is not legal advice to the same level as GLAD.
National Black Justice Coalition is the leading civil rights organization for LGBTQIA+ Black Americans, offering toolkits and resources in addition to legislation lobbying in favor of pro-equality bills for queer and transgender rights.
National Center for Lesbian Rights is a civil and human rights organization that supports the rights of all LGBTQIA+ people. Despite their name, the NCLR advocates for all queer and transgender rights through litigation, policy, and public education. They also operate a free legal helpline, available at 800-528-6257 and 415-392-6257.
National Gay and Lesbian Task Force is the oldest national LGBTQIA+ rights organization in the United States that collaborates with over 400 organizations in federal policy advocacy to organize census and voting campaigns through FedWatch.
NMAC, or the National Minority AIDS Council, leads HIV policy and legislation related to communities of color in the United States. Their Advocacy 101 section guides users to become politically active and involved in local legislation with their elected representatives.
Outright Action International is an advocacy organization dedicated to LGBTQIA+ human rights around the world that works with the United Nations to develop global programs and initiatives towards creating a safer world for queer and transgender folks.
Pride Law Fund is a funding service that sponsors legal projects, services, education, and outreach that promote LGBTQIA+ people and individuals living with HIV.
Sylvia Rivera Law Project is a collective that increases the political voice and visibility of low-income people and people of color who are transgender, nonbinary, intersex, or gender-nonconforming. SRLP’s programs and legal assistance are geared towards transgender people who are at risk of homelessness, have criminal records, or are immigrants.
Transgender Law Center provides impact litigation on select court cases to advance transgender rights in the United States. TLC also provides basic information about laws and policies through their Legal Help Desk, although they do not take on individual cases through the Desk.
Trans Legislation Tracker is an independent research organization that tracks bills related to transgender and nonbinary people in the United States through the work of academics and journalists who publish the Trans Legislation Tracker’s data.
Looking for more information about legal issues, information, and rights? This resource post can guide you through the basics of legal jargon, rights, important court cases, and general resources.Advocates for Trans Equality also has an extensive database of trans-related protections and laws. Both the Movement Advancement Project and Erin in the Morning have up-to-date maps on LGBTQIA+ laws.
Healthcare is a Human Right
Looking for general healthcare resources? This post outlines what medical care is, how to navigate healthcare insurance, and general resources/programs.
Coverage of gender-affirming care by state government healthcare programs like Medicaid and CHIP varies by state, although the Affordable Care Act prohibits discrimination based on gender identity – which has been further backed by federal courts. This means that all state Medicaid programs have to provide general and gender-affirming healthcare, but each state is allowed to impose specific guidelines or restrictions on having that care paid by Medicaid similar to commercial insurance policies. While some transition-related care can be denied on a case-by-case basis, it has been established that “blanket bans” on transgender care is discriminatory and illegal. However, it’s worth noting that Medicaid access is not equal throughout the United States – 10 states completely deny Medicaid to single adults without children or disabilities. The Movement Advancement Project has an up-to-date map of current Medicaid policies by state and whether gender-affirming care is protected or excluded. A4TE has a directory of Medicaid policies.
On January 28th, 2025, President Donald Trump signed the executive order “Protecting Children from Chemical and Surgical Mutilation.” While executive orders often carry the power of federal law, they do not override the US Constitution, federal statutes and laws, or established legal precedent – nor do they have the longevity of passed laws. The order bans gender-affirming care being covered by state Medicaid programs for anyone under the age of 19, including puberty blockers and hormone replacement therapy.
Federal programs vary, and their consistency is subject to the current presidential administration. Medicare currently covers medically necessary gender-affirming care, which includes hormone replacement therapy, surgery, and related consultations – these are listed under Medicare Part D and should be fully covered when prescribed. Indian Health Services (IHS), which covers Native Americans recognized in federally recognized tribes, implies that gender-affirming care is covered by their programs – although there is less explicit guidance of this practice online. TRICARE, the primary healthcare coverage for active service members and their families, only covers select parts of gender-affirming care like HRT – although this is extremely likely to change in 2025 under the new presidential administration and TRICARE will likely deny all gender-affirming coverage in the event transgender people are banned from military service again. This is similar to coverage provided by the Veterans Health Administration (VHA), which still only covers some transition-related medical care despite early promises made by the Biden administration to lift the bans imposed by Trump’s first administration. Finally, while all incarcerated individuals are entitled to medical care as determined by Estelle v. Gamble, there is no minimum quality of healthcare required as long as the prison offers any form of medical care – and that care does not have to be free, despite popular belief. While gender-affirming care is considered necessary and intentional barriers are seen as a violation of the Eighth Amendment, it is difficult for transgender prisoners to fight for their medical rights while incarcerated. American prisons are not required to be accredited, although one of the main accrediting bodies – the National Commission on Correctional Health Care – supports gender-affirming care for incarcerated individuals. In other words, gender-affirming care for incarcerated transgender people varies drastically based on the facility they are at.
The Trans Health Project, an initiative through Advocates for Trans Equality, is the primary resource for understanding and navigating healthcare insurance and gender-affirming care in the United States as a transgender person. The site guides users through the process of applying for commercial healthcare, understanding their coverage, and navigating the laws in their state. Half of US states explicitly prohibit health insurance companies from excluding transgender-related services, while the other half of the country has no regulations on what services commercial insurance can prohibit.
Most healthcare insurance programs, regardless of whether they are commercial or government-based, have requirements before gender-affirming care can be covered. Reputable programs will base their requirements on WPATH, or the World Professional Association for Transgender Health, which has held the standard for ethical transgender healthcare since 1979. The Standards of Care for the Health of Transgender and Gender Diverse People is used as the international standard for transgender healthcare similar to how the Diagnostic and Statistical Manual (DSM) is the standard used for mental health treatments. WPATH and the SOC have clearly stated that gender-affirming care such as hormone replacement therapy and gender confirmation surgery is the best practice based on scientific research for decades. As such, insurance plans and programs use WPATH and SOC guidelines to require transgender people to have “persistent, well-documented gender dysphoria,” the ability to make a fully informed consent, and a set amount of counseling with a mental health professional to receive a medical necessity letter to submit for insurance coverage. A4TE also provides a free template for users to appeal insurance denials of gender-affirming care. Transgender adults have the option to pursue gender-affirming care out-of-pocket to bypass the restrictions imposed by insurance coverage programs – which is covered in financial resources later in this article.
There are additional restrictions for transgender minors, which is a hot topic in current politics during this heightened war on transgender rights. In states where minors are allowed gender-affirming care like puberty blockers, hormone replacement therapy, or surgery, there are additional requirements and consent must be given by the minor’s parents or legal caregivers. There are currently six states that make it a felony crime to provide gender-affirming care to transgender minors: Oklahoma, Florida, Alabama, South Carolina, Idaho, and North Dakota.
How to Find Gender-Affirming Care
Just like other medical fields, gender-affirming care can be done in-person or through telehealth – in-person providers are more often covered by healthcare programs, but can be more difficult to access than telehealth.
Will gender-affirming care be banned? The current political distribution of Congress, the President, and the Supreme Court has many transgender people rightfully anxious about the future of their care – especially since the GOP has declared war on “transgenderism.”
It’s not impossible – I’m not going to lie to you. There *is* a worst-case scenario out there where transgender people of all ages are denied gender-affirming care and we are given the options to forcibly detransition, become refugees and leave the United States, seek care illegally, or die. However, this scenario is unlikely. The American public has complicated views on transgender topics, but the majority believes that transgender people should have additional rights to protect them from discrimination. The last two elections have shown that American voters are not nearly as gung ho about erasing transgender rights as the GOP is hedging their bets on – which is what ultimately lost the GOP their “red wave” in 2022. While the upcoming years will be rough, we just have to survive two years before Congress can swing back blue – assuming that Democrats have given up claiming they lost the 2024 election due to being “too woke.”
So what’s realistic? Within the next two years, I can easily see Medicaid no longer being able to cover gender-affirming care like hormone replacement therapy or surgery – although any decision to do so would immediately end up in court since it would violate the Affordable Care Act. On the other hand, that’s likely something the anti-trans GOP wants since they want to eliminate the Affordable Care Act and give in to the commercial healthcare industry’s demands. It is something that would rely on Trump – likely an executive order that bars federal funding from any healthcare provider that performs gender-affirming care. While the GOP has a majority in Congress, their majority is extremely slim and fragile due to their own infighting so any massive bill is improbable unless Democrats fold on LGBTQIA+ rights. Don’t get me wrong – that’s no small thing. Medicaid is used by millions of Americans, including myself, but it would be survivable with enough resourcefulness. Out-of-pocket expenses would increase for transgender folks and we would be more likely to rely on older methods of self-prescribed gender-affirming care before the wide access to providers. However, it would be survivable – especially with the likely increase in mutual aid, donations, fundraising, and international support that would come with such a decision. I don’t think it’s realistic that the act of prescribing gender-affirming care to adults will be nationally criminalized or prohibited, as I described in the above worst-case scenario.
IN-PERSON PROVIDERS
The OutList Provider Directory is a free resource through OutCare, a nonprofit health organization that advocates for comprehensive LGBTQIA+ health. The directory provides information about providers from all fields – including HRT and surgery. For best results, search by tag (“gender-affirming medical care” pulls a good number of results) rather than specialties. Other directories also exist, such as Rad Remedy and MyTransHealth, although these other independent projects have not survived the pandemic as well as OutList.
In a similar vein, TransLine is an information and medical consultation service that explains various gender-affirming techniques like HRT and surgery and includes many of the billing codes that providers have to use for care to be covered by healthcare insurance.
Both WPATH and the Gay and Lesbian Medical Association (GLMA) have online directories of healthcare providers that are listed with them. Out of the two, GLMA’s directory is extensively better since its LGBTQ+ Healthcare Directory is larger and more user-friendly. Similarly, TransHealthCare provides information about transgender-specific surgeons in a more user-friendly format than WPATH. While not necessarily listed in the above directories, Planned Parenthood is one of the largest gender-affirming care providers in the US since most of their local health centers provide HRT and puberty blockers in addition to their other services like STD treatment and abortions. Planned Parenthood didn’t used to provide HRT as widely as now before the rise of anti-transgender legislation – although now it’s a focal point and cornerstone of their mission to provide equitable healthcare.
TELEHEALTH PROVIDERS
During the COVID-19 pandemic, an influx of telehealth created a wealth of transgender healthcare accessibility. There are a number of virtual HRT providers that prescribe gender-affirming care.
An important note on gender-affirming telehealth: HRT through telehealth may soon no longer be an option for transmasculine people seeking testosterone. Due to its history of being abused by predominantly cisgender men, testosterone is a highly classified drug compared to the treatment prescribed to transfeminine folks. Even though more than just transgender men use testosterone, COVID-19 opened the doors for testosterone to finally be able to be prescribed (temporarily) through telehealth for transmasculine people. However, in the years following the pandemic, the FDA and state governments have been attempting to shut down the prescription of testosterone through telehealth despite the well-documented benefits of telehealth for transgender communities during this turbulent political time.
Most major cities have gender clinics (described below in informed consent options), which almost always give telehealth options when available. Additionally, Planned Parenthood has telehealth options available for their services like gender-affirming care. The following are the largest purely telehealth HRT providers in the United States.
QueerDoc is the oldest large-scale HRT telehealth provider, although they’re smaller than the following two options. They operate in Alaska, California, Florida, Hawaii, Idaho, Oregon, Montana, Utah, Washington, and Wyoming. They don’t accept insurance, but they offer a sliding scale since you’ll be paying out-of-pocket. Compared to FOLX and Plume, QueerDoc is a worse choice due to the pricing but without QueerDoc, there wouldn’t be a FOLX or Plume.
FOLX Health was started a year after QueerDoc and is the largest telehealth option between themselves, QueerDoc, and Plume. FOLX accepts a number of insurance plans to cover their monthly membership fees, copays, medications, and labs. Since FOLX is large enough to have in-person facilities in major cities, FOLX is available in all states – including ones that are banning trans telehealth like Florida. Unfortunately, neither FOLX or Plume are available for minors to use – you have to be at least 18 in most states to use either service, although a few states have an even higher age requirement of 20.
Plume is the youngest of the three main telehealth options and accepts a range of insurance plans. Plume requires a monthly membership to access their providers, which can be covered by insurance plans alongside the copay required for appointments. Unlike QueerDoc, Plume operates as a telehealth provider in nearly the entire US with limited exceptions in states like Florida that are currently banning transgender-related telehealth.
INFORMED CONSENT
Gender clinics refer to medical centers that specialize in transgender-related care – they were especially popular during the 1960s and 1970s and have made a modern resurgence due to the widespread medical consensus that gender-affirming care is the most appropriate treatment for gender dysphoria. These organizations often use informed consent, a process where hormone replacement therapy (or any other treatment) is prescribed to a patient after discussing the potential risks and benefits of HRT and the patient has signed a legal agreement stating they understand and fully consent to the treatment. Compared to traditional routes of pursuing gender-affirming care, informed consent is much faster – after a couple of consultations with a provider, you can physically have your prescribed medication in a couple of weeks. Informed consent allows transgender adults to make their own decisions about their bodies when given complete and accurate information about HRT.
While A4TE has a list of gender centers, I actually recommend Erin in the Morning’s collection. A4TE’s list is limited to facilities associated with research institutions, teaching hospitals, and academic settings – which are more likely to provide care to transgender minors, but woefully incomplete since thousands of informed consent clinics are community health based and not academic (including Planned Parenthood).
LETTER OF NECESSITY
Outside of gender clinics, traditional healthcare providers like most of those listed in directories like OutList will require a letter before they will begin prescribing hormone replacement therapy. This practice dates back to the previous SOC guidance by WPATH (then known as the Harry Benjamin International Gender Dysphoria Association), which requires individuals to find a therapist or counselor to write a letter stating that HRT was deemed suitable and medically necessary. While mental health counseling is recommended for everyone, the required use of letters bars more transgender people than it helps – trans folks are often led to feel like they have to “perform” their transness to get a letter, adhering to common stereotypes that cisgender people have about trans people.
Most mental health professionals qualify to write a letter, as long as they feel comfortable enough doing so – if they don’t feel comfortable and won’t agree to write a letter on your behalf, they’re likely not a good fit for you as a counselor anyway. After receiving your letter, you’ll take it to your HRT provider and soon be prescribed medication. The largest downside to the letter process is the wait times, since mental health care is already considerably less accessible than other medical fields on top of the fact that most counselors will require at least three to six months of regular visits before they will sign off on the letter. On the other end of the spectrum, the vast majority of insurance companies and programs will require a letter to cover HRT since they need it proven that the care is medically necessary enough to cover. Beyond hormone replacement therapy, other forms of gender-affirming care like surgery almost always require at least one letter (if not more) to have a gender confirmation surgeon see you or for insurance companies to pay for your care.
Community Support
For the majority of trans people, online support is the first step to finding support. Trans Lifeline’s Resource Library has a large selection of online support groups, ranging from general support to marginalized groups like people of color, disability, youth, etc.
Nearly all online spaces and social media platforms have transgender-related spaces – like communities on Twitter and Tumblr, groups on Facebook, subreddits, and Discord servers. There are thousands of them, so it’d be impossible to create an exhaustive list – but here are a few major ones on each platform.
Transgender forums have a LOT of history – before the creation of places like Reddit, independent forum websites were the predominant place where transgender people connected in the 1990s when they were unable to find people easily IRL. They were a modern extension of the underground journals and magazines like Transvestia, Drag, Transgender Tapestry, and FTM International. Even though social media platforms like Reddit and Facebook are the mainstream today, many of these forums still exist if you know where to look for them:
There aren’t many large-scale support group organizations – most national LGBTQIA+ groups tend to lead toward activism, politics, and human rights. PFLAG remains the United States’ largest organization dedicated to supporting, educating, and advocating for LGBTQIA+ people and their loved ones and dates back to 1973. PFLAG has over 400 chapters across the country, each offering regular support through their national resources. Further, PFLAG also has regular virtual meetings and moderated community spaces.
All major cities have an LGBTQIA+ community center of some nature – there are rural towns as small as 15,000 where I live with local queer groups. Urban settings have multiple community centers, queer bars, and other hangouts to find support – finding them is just a matter of searching online for local listings. Trans Resources is a directory of advocacy organizations, legal resources, support and social groups, and other resources – although the site isn’t comprehensive, it lists major organizations.
Beyond support groups, transgender mentorship and letter programs exist to provide folks with an added layer of community.Point of Pride operates a letter program that sends written cards to transgender individuals in need of support, which can be sent to PO Box 7824, Newark DE 19714 where the letters will be received before being sent along. Similar programs exist like the Queer Trans Project (mailed to 3733 University Boulevard W, Suite 216, Jacksonville, Florida 32217), Black and Pink, and the Prisoner Correspondence Project – although the latter two focus on incarcerated LGBTQIA+ people rather than the general public. In contrast, mentorship programs pair individuals with an older or more experienced trans person to help answer questions while guiding you along your journey – some programs include the Sam & Devorah Foundation for Transgender Youth and the Trans Empowerment Project.
Money Matters: Financial Resources
Finances can be a genuine barrier to transgender people’s ability to live authentically as themselves. Without a stable income, it’s difficult to maintain housing or get gender-affirming clothes. Court and legal fees aren’t free – it costs money to update your identity documents to reflect who you are. And of course, you either have to have a healthcare insurance plan that covers counseling and medical bills or be forced to pay for them out-of-pocket.
Resources for employment, housing, and clothes have to be sourced locally through mutual aid networks and community organizations – although this post has some basic resources for low-income individuals.
Legal fees for identity documents can be waived if you qualify based on income.Point of Pride has a list of fee waivers by state, although you’ll want to double-check to ensure your waiver is the most up-to-date method. Most states will use your income itself or other connecting program to determine whether you are eligible – like whether you’re already on government assistance programs like SNAP or Medicaid.
Relatedly, there’s also a growing amount of organizations providing funds to help transgender people move to safer locations to live or access gender-affirming care. Some of these programs include Elevated Access, Trans Justice, TRACTION, and the Trans Continental Pipeline.
Beyond nonprofit and mutual aid funds, many transgender people fundraise to cover their transition costs – especially when their insurance refuses to cover surgery or if they have to unexpectedly move. The most commonly used platforms are GoFundMe, Donorbox, and Facebook – although all of these sites take a percentage of the money raised. GoFundMe is the largest crowdsource site, but it’s known to take the largest cut compared to alternatives. Non-personal organizations and nonprofits have a larger variety of sources out there, like Givebutter, while individuals can raise money without losing a percentage through direct money transfer apps like Cash App, Venmo, Paypal, and Zelle. Out of those options, Cash App is the most widely used underdog since they don’t require a bank account and utilize usernames on their customizable cards, and are easier to navigate with incomes revolving around sex work.
Reproductive health is more than just abortion – it’s also preventative primary care, birth control, cancer screenings, fertility treatments, and safe access to abortion procedures. The right to one’s body, or autonomy, is tied to reproductive healthcare and gender-affirming services. Despite the shame and hate tied to these fields, few services are linked to human rights and equality worldwide.
Looking for general information about non-reproductive medical healthcare or health insurance?Click here.
Bodily autonomy is tied to certain laws around the world, like age, ability, or gender. In the United States, children are denied bodily autonomy for most medical decisions until they turn 18 – they’re only able to see a medical provider under their parent’s supervision and decision rather than their own. Likewise, disabled people of any age are generally denied bodily autonomy – so it’s not uncommon for disabled people to be denied the ability to marry or have sex because other people like their parents or guardians get to make that decision for them. In countries like South Sudan, women are denied the bodily autonomy to deny or reject marriage (or get divorced) since their families make those decisions on their behalf. Likewise, in places like Egypt, transgender people are denied the bodily autonomy to gender-affirming care such as hormone replacement therapy.
Author’s Note: All aspects of reproductive health and gender-affirming care are rather unstable due to the national political stage. It’s unlikely (but not impossible) for a nationwide ban on care, but it is likely for national protections to be removed – making it difficult to find abortion or gender-affirming care in hostile states.
Birth Control & Contraception
Contraception is the technical term for “birth control,” which is any medication, device, or surgery that prevents pregnancy. Birth control techniques can be temporary, reversible, or permanent – and a few also prevent sexually transmitted diseases (STDs). They achieve this by killing sperm, making a physical barrier between the sperm and egg, preventing eggs from being released in the ovaries, and altering the uterus tissue so fertilized eggs can’t be implanted.
Types of Birth Control
Intrauterine devices (commonly referred to as IUDs and IUCs) are one of the most effective kinds of birth control available. There are five main brands approved by the FDA for use in the United States: Paragard, Mirena, Kyleena, Liletta, and Skyla – most of which are hormonal-based and use the hormone progestin to prevent pregnancy, whereas Pargard is wrapped in copper to prevent pregnancy instead of hormones. As a result, Paragard IUDs prevent pregnancy up to 12 years while hormone-based ones range from 3 to 8 years.
The reason Paragard works so well is because sperm naturally dislike copper, so it’s a natural non-hormonal deterrent that creates an internal barrier between the egg and sperm.
Since copper-based IUDs don’t use hormones associated with other birth control methods, it’s often a common choice among transmasculine people since it won’t interfere with hormone replacement therapy or their gender-affirming care.
Progestin mimics the progesterone that bodies naturally make, which will either thicken the cervix mucus to physically block and trap sperm or prevent ovulation entirely.
IUDs are highly recommended for pregnancy prevention since they’re extremely low-maintenance, highly effective, long-lasting, and reversible. After being inserted by a medical provider, you’re covered by a 99% effectiveness rate until it’s removed – there are no daily pills to take, days to track, or mistakes to avoid.
Birth controlimplants, or Nexplanon, are another highly effective and low-maintenance form of birth control that prevents pregnancy up to five years after it’s originally inserted. Just like IUDs, implants release the hormone progestin to prevent pregnancy – but instead of being inserted in the cervix, the implant is placed in the upper arm. Compared to IUDs, implants aren’t associated with as much pain during insertion since numbing agents are used to ease the process – but implants aren’t covered by as many government programs to be offered for free as IUDs.
Birth control or depo shots are injections received once every three months – but unlike IUDs and implants, depo shots can occasionally be done at home without a doctor’s appointment. Just like most IUDs and implants, birth control shots use progestin to prevent pregnancy. While shorter lasting, the shot doesn’t require anything to be implanted or inserted but it must be taken every 12 to 13 weeks to remain effective. Additionally, birth control shots are massively easier to pay for out-of-pocket without insurance or government programs – the IUD can cost up to $1,800, the implant can range upwards of $2,300, but the shot costs $150 at most.
Did you know birth control can also be taken as a vaginal ring? The birth control ring is a small, flexible ring placed inside the vagina to prevent pregnancy for up to a month at a time – which has some caveats. As such, the ring and other forms of birth control have lower effectiveness rates than IUDs and implants since they require more upkeep and are accident-prone. That being said, the ring is still 93% effective when used correctly. There are two main types of birth control rings:
NuvaRing is capable of stopping periods and is replaced every month. It lasts up to five weeks at most, so if you forget to replace it, you’re at risk of becoming pregnant.
Annovera rings are used for three weeks before being removed for seven days. After one ring-free week, the Annovera ring is re-inserted into the vagina. While NuvaRings have to be discarded each month, Annovera rings last one year each if used on schedule – but they don’t stop periods.
Both ring types prevent pregnancy by stopping ovulation through the use of estrogen and progestin, which is absorbed from the ring into the vaginal lining. Like IUDs, implants, and the shot, a prescription is required – but unlike them, you have the freedom (and responsibility) to take the ring on your own time.
The birth control patch is another safe and convenient option, where a prescribed transdermal patch is worn on the skin to prevent pregnancy by releasing estrogen and progestin just like traditional birth control pills. The patch must be replaced weekly to be effective and only work if they’re stuck properly – so no lotion, creams, powders, or makeup can be used near them and you can’t be sensitive or allergic to its adhesive. All forms of birth control that are taken on your own, such as the ring, patch, or pill, can be prescribed online by telehealth.
The most popular form of birth control today is the pill, a 93% effective oral medicine that prevents pregnancy if taken every day. Once approved by the FDA in 1957, the pill had a profound effect on feminism and women’s sexual liberation since it was the first mainstream medicine that allowed them to choose motherhood. Birth control is covered by nearly all American health insurance and welfare plans, and Opill has been the national form of birth control available over-the-counter without a prescription or doctor’s visit since 2024.
Those aren’t the only options for birth control, either – some additional (but less common) forms include:
Cervical caps are soft silicone cups placed deep inside the vagina to cover the cervix, creating a physical barrier between sperm and the egg. A prescription is required and they’re around 71% to 86% effective – but they work even better when used with spermicide. Smaller than the diaphragm, cervical caps can be left for up to two days before being removed.
Diaphragms are soft silicone cups that are bent and then inserted into the vagina to cover the cervix, creating a physical barrier to stop pregnancy. Like cervical caps, a prescription is required for diaphragms. They can’t be left inside the vagina as long as caps, but they’re generally more effective (83%) since they don’t have the larger range caps do. Similar to cervical caps, diaphragms work best when used with spermicide.
Contraceptive sponges are made from soft, squishy plastic that’s placed inside the vagina before sex to cover the cervix, creating a barrier to prevent sperm from reaching the egg and causing pregnancy. Sponges vary from 78% to 86% effective and need spermicide to work best – but unlike cervical caps and diaphragms, contraceptive sponges don’t require a prescription.
Spermicide and contraceptive gels contain chemicals that stop sperm from reaching the egg, placed inside the vagina before sex. It ranges from 79% to 86% effective at preventing pregnancy and doesn’t require a prescription – it’s found over-the-counter at most drugstores, pharmacies, and supermarkets. However, spermicides don’t work on their own; you have to use a diaphragm or cervical cap alongside it.
Condoms are thin pouches that create a physical barrier between genitals during sex, and they’re the only option that prevents both pregnancy and sexually transmitted diseases.External or male condoms are worn on the penis, collecting semen and preventing sperm from reaching the egg. Internal or female condoms are worn inside the vagina or anus, similarly collecting semen. Condoms must be worn every time you have sex to be effective. Remember you should always check condoms’ expiration date before use, look for potential tears, and never store condoms in hot or cold places or direct sunlight – and double-layering condoms increase the risk of a tear or breakage, not protection.
Most condoms are made of latex rubber, which can be found in any supermarket, pharmacy, online, or at health centers. They’re also the cheapest, so they’re offered for free at many organizations. Latex condoms can only be used with water and silicone-based lube – oil-based lubricants can damage latex condoms. Note that silicone-based lube can damage silicone toys and prosthetics, so check your items prior to use.
Plastic latex-free condoms are made from materials like polyurethane, nitrile, and polyisoprene to create an alternative that’s better suited for individuals with latex allergies. However, plastic condoms are slightly more expensive than their latex counterparts so they’re not as commonly found in some regions. Water and silicone-based lube is best suited for plastic condoms, although oil-based lube can be used for any plastic condom not made from polyisoprene.
Internal condoms are made from plastic, not latex – so the same rules apply. Latex and animal skin condoms are not options for female condoms.
Lambskin and animal skin condoms are made from the lining of the intestines, but they’re only able to prevent pregnancy. Compared to other condom alternatives, animal skin condoms don’t prevent STDs due to the materials used. Unlike other condoms, lambskin condoms can be used safely with any type of lube.
Experts advise regular use of both condoms and birth control for sexually active individuals at risk of pregnancy. In relationships where pregnancy isn’t possible, condoms and/or PrEP should still be used since STDs don’t discriminate against gender identity or sexual orientation.
Outercourse can prevent pregnancy, but it can’t prevent STDs. Remember to wear a condom if STDs are a potential risk.
Some people purposely don’t have sex or become temporarily abstinent when they’re at risk of becoming pregnant based on their menstrual cycle. This is called “natural family planning,” “the rhythm method,” and fertility awareness methods (FAMs) and requires a higher level of dedication since it’s your personal responsibility to track ovulation.
In a similar vein, some individuals practice the withdrawal method as their primary form of birth control – also referred to as pulling out. By pulling out the penis from the vagina before ejaculation (or cumming), pregnancy can be prevented since sperm is physically kept from the egg. Pulling out only works when done correctly before ejaculation since any amount of semen (no matter how little) can cause pregnancy if inside the vagina. It doesn’t prevent STDs, and it’s notoriously difficult to do correctly – leading it to have lower efficacy rates than other birth control methods.
One large reason condoms and birth control practices like those mentioned above are considered best is because pregnancy and STDs can also occur from precum – meaning before ejaculation. While the chances are low, it is possible to become pregnant from precum since sperm mixes with the alkaline fluid in the urethra. In other words, pregnancy can still happen even when you perform the withdrawal method perfectly since just one viable or healthy sperm is needed to fertilize an egg.
The last non-permanent form of birth control is breastfeeding since regular breastfeeding stops the body from ovulating and therefore prevents pregnancy. It’s also called the lactational amenorrhea method (LAM) because it also naturally stops the period and works at similar rates as oral birth control pills. However, LAM only works if you’re breastfeeding – which requires you to have recently been pregnant.
There are two main types of permanent birth control, referred to as sterilization. They are 99% effective at preventing pregnancy (but not STDs). These are not reversible and considered life-long decisions – which is why they can be difficult to access since the economy and government have a weighted interest in forcing young people to have children. On the other hand, certain groups of individuals have been targeted for forced or coerced sterilization like women of color, disabled people, and transgender people.
Individuals assigned female at birth can undergo tubal sterilization (“getting the tubes tied”). There are three subtypes of tubal ligation, which all physically prevent sperm from reaching a viable egg by blocking or removing the fallopian tubes.
Tubal ligation surgically closes, cuts, or removes pieces of the fallopian tube.
Bilateral salpingectomy removes the fallopian tubes entirely.
Essure sterilization uses a tiny coil to block the fallopian tube – while it used to be a common form of sterilization, essure sterilization is no longer available in the United States.
Individuals assigned male at birth can opt for a vasectomy, a procedure where the small tubes inside the scrotum are cut or blocked that carry sperm.
Incision vasectomy utilizes one or two small cuts on the vas deferens by tying, blocking, cutting, or closing with electrical currents. It is an extremely fast procedure that takes about 20 minutes before it’s stitched up.
No-scalpel vasectomy requires the doctor to make one small puncture to both of the vas deferens tubes before tying off, blocking, or cauterizing the tubes. Since the skin isn’t cut with a scalpel, there’s no need for stitches or scarring and it heals quickly.
Accidents Happen: Emergency Contraception
Birth control prevents pregnancy ahead of sex, relying on the various methods above to be used before/during sex. In contrast, emergency contraception prevents pregnancy after sex- most EC is 95% effective up to five days after unprotected sex (as well as other reasons for emergency contraception like contraception failure, incorrect use of birth control, or assault).
Emergency contraceptive works by temporarily stopping the body from releasing an egg, preventing ovulation that puts you at an increased risk of pregnancy. Pregnancy doesn’t happen immediately after sex nor does it happen every time you have sex – that’s why EC works and why it is different from abortions.
IUDs are more than just birth control: they’re considered one of the most effective forms of EC. Unlike other emergency contraceptives, IUDs don’t decrease in efficiency if taken within five days – they’re just as effective at preventing pregnancy on day five as they are on day one. And as an add-on, IUDs aren’t weight-based and work for all body sizes. On the downside, it’s more difficult to get an appointment for an emergency IUD compared to the following EC pills.
There are two types of “morning-after pills,” which are the more commercially available forms of emergency contraception available for purchase. It is important to note that emergency contraceptive pills work best when taken as soon as possible after sex because their effectiveness decreases with time, even if you’re within the appropriate five-day span.
Ulipristal acetate-based pills (brand name Ella) are the most effective EC pills but require a prescription. It can be taken up to 120 hours after sex and works best for individuals who weigh 195 pounds or less.
All forms of morning-after pills don’t work if you’re already ovulating. Ella is capable of working closer to ovulation, but an IUD may be a better EC option if you’re ovulating.
Levonorgestrel-based pills (brand names Plan B, Take Action, My Way, Option 2, AfterPill, etc.) are available over the counter at any drugstore, pharmacy, or supermarket. It should be taken within 72 hours after sex – it works best for individuals 165 pounds or less, although it’s not uncommon for people who weigh more to take an additional dose.
There’s a lot of misinformation about Plan B and its variants (often on purpose to confuse buyers and those in need). Since 2013, there hasn’t been an age requirement to buy Plan B over-the-counter – regardless of where you are in the United States. Some stores may lock Plan B in security packaging to deter theft, but it can be purchased any time of the day and can’t be restricted if the store is open. No IDs are necessary to buy Plan B, either.
Under the Affordable Care Act, most commercial insurance plans fully cover Plan B as well as government alternatives like Medicaid. However, having insurance or Medicaid pay for Plan B requires a prescription.
Out of pocket, Plan B costs about $40 over the counter. Pro-tip: it’s significantly cheaper to buy Plan B ahead of a crisis, like via Amazon, but it will take longer to arrive while it ships. Part of the reason Plan B can sell so high is due to demand since $40 is still significantly less than the cost of having a baby. There’s also select organizations and programs that provide Plan B for free (listed below in Additional Resources), although their supply is limited.
Emergency contraceptive pills are considered extremely safe. They’ve been around for over 30 years and haven’t had any reports of serious complications. EC doesn’t have any long-term side effects and won’t have any impact on your ability to potentially get pregnant in the future.
It is not advised to use two different kinds of morning-after pills at the same time, such as Ella and Plan B. By doing so, they may counteract and not work at all.
Emergency contraceptives shouldn’t be used in replacement of regular birth control methods. While it’s safe to take EC pills multiple times as needed, it’s not as effective at preventing pregnancy – it’s also significantly more expensive.
Health is a state of complete physical, mental, and social well-being – which includes reproductive wellness. Nearly all of the clinics and organizations that provide abortion services and birth control also offer in-depth services for reproductive health, which is why entities like Planned Parenthood are important.
Reproductive healthcare refers to the services provided to support one’s physical, mental, and social well-being concerning one’s reproductive system. Most diseases are preventable or treatable if caught early, so seeing a healthcare provider regularly is critical to staying healthy. Everyone should see a provider annually for screenings best suited for their age and health – and all sexually active people should be tested every three to twelve months depending on their risk factors.
Sexually transmitted infections (STIs) and diseases (STDs) spread during vaginal, anal, oral, and blood-to-blood contact. All STDs are treatable, and most are completely curable – but only if you get care from a healthcare professional. Most STDs do not have any symptoms, which is why regular testing is a necessary commitment for sexually active people to stay healthy. Otherwise, you are at risk of serious health problems later in life! They can be tested through blood samples, urine tests, saliva swabs, spinal tabs, and visual examinations. It varies by jurisdiction, but most US states allow people ages 13 and older to be tested and treated for STDs without parental consent.
Vaccines exist to prevent STDs like hepatitis B and HPV, which are given to most children in the United States around age 11 or 12. These vaccinations are recommended for all young people regardless of gender since these illnesses do not discriminate based on gender.
Regular self-exams are necessary in order to know what your “normal” is – everybody is unique and covered in various lumps and bumps, so self-examining your body lets you know when something is potentially wrong and worth professional attention.
People of all genders should know what their breast tissue normally feels like through breast self-exams (BSEs). Everyone, including cisgender men, has breast tissue – which is capable of producing cancer. Individuals with a high family risk of breast cancer as well as all women 40 or older are recommended to get mammograms, which can detect cancer in its earliest stages when it’s most curable.
Folks with uteruses need to get pelvic or internal exams once they turn 21 years old, which requires a doctor’s visit where a professional examines the vulva, vagina, cervix, ovaries, fallopian tube, and uterus. Pelvic exams are recommended annually, whereas pap smears (which are different from pelvic exams) are advised every three years to check for early signs of cervical cancer.
Individuals with testicles need to do a testicular self-exam (TSE) at least once a month at age 15. That’s much younger than most people realize or what most public schools teach, but AMAB individuals are at the greatest risk of testicular cancer from the ages of 15 to 35.
People with prostates get prostate or rectal exams when there’s an issue with the anus, prostate itself, or constipation. Younger folks only get prostate exams if there’s a cause or concern, but anyone with a high risk of prostate cancer or age 55 or older is recommended to get a prostate exam annually.
Infertility is characterized as the inability to cause a pregnancy despite regular unprotected sex. The World Health Organization estimates that 17.5% of adults experience infertility issues, which translates into 1 in 6 adults. Healthcare providers can perform semen analysis, hormone testing, genetic testing, thyroid testing, biopsy, imaging, hysterosalpingography, and other methods to determine if someone is experiencing infertility.
As an aside, hormone replacement therapy can have long-lasting and permanent effects on fertility among transgender people. While puberty blockers do not affect fertility, the use of HRT can make someone incapable of having biological children later in life – which is why aspiring trans parents can freeze sperm and eggs for later use. Temporarily pausing HRT can improve fertility, although it is generally believed that the longer someone is on HRT, the more likely they will become infertile regardless.
Infertility for individuals assigned male at birth revolves around a lack of healthy sperm. As a result, men are prescribed lifestyle changes as a first step to resolving infertility – although lifestyle and habits play a significant role in anyone’s fertility regardless of gender. Some of these prescribed habits include more frequent sex, increased exercise, diet changes, and stopping alcohol and nicotine use alongside other substances. While many of these are manageable, some lifestyle impacts are difficult to control – like one’s exposure to radiation or pesticides in their environment or neighborhood, which is known to cause infertility.
Half of male infertility cases have no determined cause – it’s a complex issue that can be influenced by countless factors like genes, hormones, and lifestyle.
Age 40 is the general guideline when cisgender men are expected to become naturally less fertile. The decrease in fertility is relatively insignificant at 40, although it gradually increases with age.
Unresolved sexually transmitted diseases account for a chunk of male infertility problems since STDs like chlamydia and gonorrhea are notorious for doing so. Individuals assigned male at birth are less likely to experience symptoms associated with STDs like chlamydia, but regular testing is important since later infertility issues can still occur if the infection is not treated.
Physical blockages can naturally occur similarly to how vasectomies purposely prevent pregnancy. In these cases, surgery can be performed to reverse the blockage and restore fertility.
Some medications cause infertility, although you should only stop taking a prescribed medication under the direction of your healthcare provider after discussing fertility options. There are also several medicines available to promote male fertility, which often boost testosterone levels and lower estrogen levels as a means to promote sperm production. However, synthetic testosterone (medication that is prescribed to transmasculine people as HRT or to cisgender men experiencing conditions like erectile dysfunction) does not help with male infertility – the medical consensus is that synthetic testosterone lowers male fertility rates.
Lastly, a doctor may recommend assisted reproductive techniques like IUI or artificial insemination – individuals produce a semen specimen to be processed, drastically increasing the concentration of healthy sperm before it’s placed into a uterus before ovulation. While IVF is more popular with lesbian same-sex couples (as described below), other assisted reproductive techniques include cryopreservation and surrogacy – which is employed by many gay same-sex couples otherwise unable to have biological children.
Individuals assigned female at birth can also experience infertility issues. The same lifestyle changes suggested for men can also promote female fertility, such as bettering nutrition and quitting cigarettes.
Between 20% to 30% of female infertility causes have no established cause, although this estimate fluctuates by source.
There’s more misinformation regarding female infertility and age, especially since there is an economic interest in having women pay for fertility treatments. 35 is the estimated age when female fertility begins to decline – but it’s a gradual continuum like men’s fertility. Language like “geriatric pregnancy” purposely tries to scare women into having children young, even if they’re unsure about parenthood. The limited research out there actually proposes the decline is nowhere as extreme as the fertility industry wants you to believe – one of the largest studies on the subject found 73% of women between the ages of 34-40 naturally conceiving within one year of regular sex at least twice a week. That’s not much lower than the 88% of women aged 30-34 or the 84% of women between 25-29. Female fertility is complex!
Pelvic inflammatory disease (PID) is a complication associated with untreated STDs that damage and scar the fallopian tubes, leading to infertility since it obstructs the egg from traveling to the womb for fertilization.
Hormone and ovulation issues are the most associated with female infertility since conditions like polycystic ovary syndrome (PCOS) and thyroid-related diseases prevent ovulation. Both an overactive and underactive thyroid gland prevents ovulation.
While ovulating, the cervix naturally produces thinner mucus to allow sperm to swim more easily. Some female fertility issues stem from problems with the cervical mucus itself since it can make it harder to conceive.
Non-cancerous growths called fibroids can affect fertility, especially when they’re in or around the womb since they can block the fallopian tube or prevent a fertilized egg from attaching to the womb. Endometriosis is also associated with female infertility, where tissue similar to the endometrium lining of the womb grows in places other than the womb – eventually damaging the ovaries and fallopian tubes. Hysteroscopy and related surgeries can improve fertility by removing scar tissue, polyps, and fibroids, while laparoscopic surgery can treat large fibroids and infertility caused by endometriosis.
Certain medications have negative impacts on fertility, like non-steroidal anti-inflammatory drugs (NSAIDs), neuroleptic drugs, and other substances. There are several medications used to promote female fertility, like clomiphene citrate, gonadotropins, metformin, letrozole, and bromocriptine.
The assisted reproductive technique recommended for women is in vitro fertilization (IVF), although this procedure is ongoingly under attack by religious conservatives in America. During IVF, eggs are taken from the ovaries to be fertilized by sperm in a lab – after they’ve developed into embryos, they’re placed into the uterus to resume pregnancy. IVF is especially popular with same-sex couples alongside surrogacy and egg/embryo donation.
Reproductive healthcare also includes prenatal care, which refers to the specialized services given during pregnancy to promote both the health of the pregnant person and the baby. Without prenatal care, it’s impossible to know the pregnancy is staying on track and ensure the baby is healthy, which is why ultrasounds and testing are used to gauge health. Tests like amniocentesis check for certain birth defects, while chorionic villus sampling tests for genetic abnormalities that can happen during pregnancy.
It takes more than just one doctor to ensure a healthy pregnancy – doulas are non-medical professionals trained to guide a pregnant person and their family. The use of a companion during childbirth dates back to prehistoric times, and doulas provide support with childbirth, miscarriages, induced abortions, stillbirth, and death. Similarly, midwives are medical professionals who can provide care and medicine to pregnant people, new mothers, and newborns. Midwives are used for ultrasounds and are best for monitoring the progress of labor – the defining difference between midwives and doulas is that doulas provide more emotional support but are unable to practice medicine like certified midwives.
Abortions are Healthcare
One-quarter of women will have an abortion by age 45 for a variety of reasons – like already having children, health issues, money, being in school, not wanting kids, etc. There’s no singular reason, and they’re all valid reasons to not want to pursue parenthood. Abortions are medical procedures that terminate a pregnancy.
Mifepristone and misoprostol pills are effective at terminating pregnancies that are at ten weeks or fewer, forcing the body to expel the pregnancy tissue in the uterus. The pills are known for feeling unpleasant, causing intense cramping and bleeding for several hours related to the length of the pregnancy. Pill abortions range from 94% to 98% effective at terminating pregnancy, but require a health center’s approval for the prescription. The effectiveness of the pill decreases the further along a pregnancy is unless an extra dosage is prescribed. Unlike emergency contraception, there are no over-the-counter options for abortion.
Suction abortion or vacuum aspiration is the most common in-clinic abortion procedure with a 99% effectiveness rate. It’s performed on pregnancies between 14 to 16 weeks along and gently sucks the embryo/fetus from the body.
Pregnancies at 16 weeks or more must be terminated by dilation and evacuation, which uses a combination of suction and medical tools to remove the fetus. It also maintains a 99% efficiency rate like vacuum aspiration.
All-Options is a toll-free talkline that can be reached at 888-493-0092, giving professional emotional support and resources on pregnancy, adoption, parenting, infertility, and abortion in a non-judgemental space and more advisable than traditional “abortion hotlines,” which use misinformation to scare callers.
Most abortions occur in an abortion clinic or hospital, although they can be performed in a variety of settings. Planned Parenthood is most known for abortion services, but they’re also the leading provider of all reproductive healthcare services in the United States. AbortionFinder is the best way to find a provider near you, which uses information based on your location, age, and pregnancy state to recommend nearby legitimate clinics.When seeking information about abortion, it’s important to look out for crisis pregnancy centers (CPCs) or “fake clinics.” CPCs and mobile vans look exactly like real health centers but are run by anti-abortion activists to promote their agenda and scare, shame, and pressure individuals into continuing their pregnancies. After promising to provide pregnancy testing, counseling, and STD testing, they use false information to miseducate people about abortions, birth control, and sexual health – and they do everything in their power to look legitimate by using biased doctors, providers, and researchers (who have been kicked out of the larger legitimate scientific community). Since CPCs are not real clinics, they are not required to adhere to any of the laws real clinics have to – like HIPAA. It’s not uncommon for CPCs to share personal and private information with other organizations and CPCs to continuously harass you. The Anti-Abortion Pregnancy Center Database, Crisis Pregnancy Center Map, and Expose Fake Clinics all have maps with location-based data on CPCs – although CPCs often change their names and locations frequently to confuse the public.
These numbers indicate that despite the false rhetoric by anti-abortion activists, third-trimester abortions are extremely rare. Most often, these late-term abortions happen because of health concerns or other causes unrelated to simply “not wanting” a pregnancy. By the third trimester, the majority of pregnant individuals have already had their baby shower, have told their friends and family members of their upcoming birth, and very likely have names picked out. All abortions are necessary since first-trimester abortions prevent unwanted pregnancies that are at a higher risk of poverty, illness, and abuse in homes unable to sustain them whereas third-trimester abortions are medically necessary to preserve the life of the would-be mother.
The overturn of Roe v. Wade means that each state is given the complete freedom to determine which abortions are legally allowed to be performed – if any. Before the Supreme Court’s decision, every state had to legally permit abortion in some capacity although they were still given the freedom to regulate abortion past the first trimester. This has led to some horrific situations that the rest of the world looks down upon – like forced pregnancies by children through rape and incest. There are states with no minimum protections, and political figures that claim to be protecting children from LGBTQIA+ people actively cause them harm – such as the 10-year-old who made national headlines when she had to travel from Ohio to Indiana for an abortion after being raped post-Roe.
There’s a lot of political discourse that could be written here, but the short version is that religious and conservative groups are disproportionally more likely to assault, groom, and generally harm children through abuse, rape, and legislation than queer and transgender people. However, a growing number of conservative-controlled states are entirely banning abortion in all forms and criminalizing the act – as well as calling for a national abortion ban to criminalize abortion outside of their own state jurisdiction. The Center for Reproductive Rights has a live map with information on abortion laws and protections throughout the United States, detailing its legality in all states and territories.
Additional Resources
2 + Abortions is a collection of stories, support groups, and testimonies of individuals who have had two or more abortions in their lifetimes. Their website is geared to dismantled the stigma and shame associated with abortions.;
Abortion Care Network is a national association of independent community-based abortion care providers, which make up the majority of abortion professionals in the United States.
Abortion Diary Podcast is a story-telling platform to share the experiences of the millions of people who have had abortions.
Abortion Finder is a search tool to connect users with over 750 verified abortion providers across the United States, using information like age, location, and last menstrual cycle to list clinics.
Abortion Out Loud is a national network through Advocate for Youth to support young people in need of abortion services or support.
Abortion on Demand provides abortion pills via mail around the US in judications where they are legally allowed to do so through telehealth.
Abortion on Our Own Terms is an advocacy campaign that seeks to change the culture surrounding abortion – especially self-managed abortion done through abortion pills.
Abortion Resolution Workbook is a free resource for individuals wanting self-help with emotional and spiritual conflict after an abortion.
ACLU Reproductive Freedom Project is a litigation and advocacy program of the American Civil Liberties Union to uphold the rights of individuals to freely seek sexual education, contraception, abortion, prenatal care, and childbearing assistance.
Advancing New Standards in Reproductive Health is a research program based at the University of California San Francisco that conducts multidisciplinary research on sexual and reproductive health.
Advocates for Youth is a collective for youth people’s access to reproductive and sexual health, which partners with thousands of youth-focused organizations around the country.
Aid Access facilitates online abortions in all US states with FDA approved abortion pills. The site uses telehealth alongside licensed providers to mail abortion pills to be used at home.
Alliance for Period Supplies hosts a network directory of organizations throughout the United States that provide free period products like pads and tampons.
All-Options, formerly known as Backline, is a toll-free talkline for abortion, pregnancy, parenting, and adoption support available in the United States and Canada.
AMAZE is a free series of sexual health videos hosted on YouTube that uses animation to education young people, parents, and teachers with age-appropriate content.
American College of Obstetricians and Gynecologists is a professional association of providers that are specialized in obstetrics and gynecology to ensure best medically accurate and up-to-date practices in the field.
American Sexual Health Association operates Yes Means Test, a free tool that allows users to find free and confidential STD testing throughout the country based on their zip code and CDC information.
Apiary for Practical Support is an online directory of organizations across the US that provide logistical assistance for people seeking abortion, referred to as Practical Support Organizations (PSOs).
Bedsider is an online birth control support network for individuals between the ages of 18 to 29 through Power to Decide, which explains various birth control methods with comprehensive information.;
Centers for Disease Control and Prevention (CDC) is the official national public health agency of the United States that operates under the Department of Health and Human Services to control, prevent, and treat disease, injuries, and disability in the general public. The CDC is staffed by the current presidential administration to tackle ongoing health concerns and educate the American public.
Center for Excellence in Transgender Health advances health equity and research among transgender and nonbinary communities through the University of California San Francisco.
Center for Reproductive Rights is a global human rights organization that uses partnered attorneys and advocates to ensure reproductive rights are protected in law. Their websites maintains comprehensive information about reproductive health and abortion laws to help users visualize data.
Condom Collective is an Advocates for Youth program made up of youth-led grassroots movements to normalize condom use on college campuses by distributing free condoms and sexual health information.
Doctors Without Borders is an international non-governmental organization that provides free medical and mental health care to people in need, including abortion services in crisis communities they serve.
Ending a Wanted Pregnancy is a group for individuals who made the decision to end a wanted pregnancy, often due to a poor prenatal diagnosis or maternal health reasons.;
Exhale Pro-Voice is a confidential textline available in the United States and Canada for post-abortion emotional support. While Exhale Pro-Voice does not sell abortion pills, they provide professional counseling support.
Fòs Feminista is an alliance of over 250 organizations around the globe that work to advance sexual and reproductive health, rights, and justice.
Guttmacher Institute is a leading research and policy organization that provides data on reproductive topics like abortions, contraception, and STDs.
How to Use Abortion Pill is an online community that shares facts and resources on the abortion pill, such as how to access and use the pill and what to to expect while having a pill-based abortion.
If/When/How is an association and movement for lawyers dedicated for reproductive justice, which also provides funding for bail and legal fees associated abortion, pregnancy issues, immigration, and criminal law.
I Need An A uses non-personally-identifiable information to connect users temporarily with abortion providers most relevant for their circumstance, which is deleted and not stored afterwards. I Need An A works with organizations like Abortion Care Network, Apiary for Practical Support, and the National Network of Abortion Funds to be a starting point for individuals unsure where to begin regarding abortion care.
Ipas is an international non-governmental organization that improves access to abortion and contraception around the world, especially in Africa, Asia, and Latin America.
Ipis Reproductive Health conducts research to advance sexual and reproductive health rights around the world, such as in the United States, Latin America, Caribbean, and Africa.
Just the Pill is a mobile telehealth clinic that mails abortion pills, contraception, and other sexual health services to users in select US states.;=
Love is Respect is a project of the National Domestic Violence Hotline that serves as the national resource in the United States regarding domestic violence for young people ages 26 and younger.
Marie Stopes International, also known as MSI Reproductive Choices, works in 36 countries to provide reproductive healthcare such as birth control and abortion.
Miscarriage + Abortion Hotline is a free hotline for people seeking information and support on abortion and miscarriages through experienced healthcare professionals.
Out2Enrollconnects LGBTQIA+ people and their families with any and all healthcare coverage options through the Affordable Care Act, including Medicaid, Medicare, and commercial insurance. O2E helps users compare plans based on LGBTQIA+ factors, like gender-affirming care or coverage for same-sex partners.
Our Bodies Ourselves is a comprehensive website that provides information on sexual health topics, including abortion, birth control, menstrual cycles, menopause, pregnancy, and more. The site also writes related news articles and posts about topical sexual health information and events.
National Abortion Federation is a professional association of abortion providers, which includes private and public providers. NAF also hosts the National Abortion Hotline – the largest toll-free multi-lingual hotline for abortion information in the US and Canada.
National Network of Abortion Funds is a directory of organizations that provide financial assistance for individuals seeking abortion care. There is a large number of financial providers across the United States, but they operate in small localized regions – so NNAF connects users to relevant organizations they are eligible for.
Pills by Post is a trusted online abortion pill provider that uses telehealth to prescribe abortion services in select approved states. While they operate in less state than other online abortion providers, Pills by Post is significantly cheaper if paying for services out of pocket.
Plan C Pills connects users with online abortion providers in all US states, although they do not directly provide abortion pills themselves. Plan C Pills provides abortion advice and options for all users, even in states where abortion is completely banned and criminalized.
Planned Parenthood is the largest reproductive health services provider in the United States. Although not an FQHC, Planned Parenthood has several safety nets in place to see patients regardless of their ability to pay. In addition to screenings, gender-affirming care, and abortion services, Planned Parenthood also provides free condoms, emergency contraception, and sexual education – including trained counselors available via online chat.
Power to Decide operates a number of other important resources included in this list, like AbortionFinder and Bedsider, as well as other initiatives aimed to advance reproductive health in the United States.
Reddit is a social media platform that operates through thousands of forums (referred to as subreddits) for users to find related communities and discussions. Relevant subreddits include: r/abortion, r/STD, r/auntienetwork, r/antinatalism2, r/prochoice, r/pregnant, r/Miscarriage, r/birthcontrol.
ReproCare is an anonymous healthline that provides accurate information and emotional support about reproductive and sexual health.
Reproductive Freedom for All mobilizes activists and allies to fight for better access to abortion, birth control, paid parental leave, and protections from pregnancy discrimination.;
Reproductive Health Access Project trains and supports healthcare providers to create health equity within the sexual wellness and reproductive healthcare field.
Repro Legal Helpline provides free legal advice about abortion, pregnancy loss, and birth. In addition to their telephone services, their website also provides guidance on abortion laws and policies, as well as associated protections and criminalization.
Resources for Abortion Delivery gives grant funding, technical assistance, and legal compliance assistance to abortion providers in the United States.;
Safe2Choose is an online community that supports individuals seeking abortion with counseling and information with pro-choice healthcare providers.
Safe Abortion Access Fund is a global fund that provides financial support to low and middle income countries around the world in need of abortion advocacy, research, and attitude-transformation.
Scarleteen is a massive online resource and advice website for comprehensive LGBTQIA+-inclusive sexual and relationship education. They have been operating their message boards, advice columns, live chat, and text service for decades.;
Self-Managed Abortion Safe and Supported is a project of Women Help Women to support the rights of people seeking information and access to abortion in the United States.
Sex, Etc. improves teen sexual health through free education resources, videos (like AMAZE), glossaries, and advice to connect young people with accurate data on sex, relationships, pregnancy, STDs, birth control, sexuality, gender identity, etc. It’s operated by Answer, a national organization that promotes sexual education for all ages.
SisterSong Women of Color Reproductive Justice Collective is a national membership organization for individuals and organizations centered on improving reproductive policies that impact marginalized communities – such as women of color.
United Nations Population Fund is the official agency under the United Nations that manages sexual and reproductive health programs to promote gender equality and safe access to reproductive services.
We Testify is a platform for individuals who have had abortions to tell their stories and experiences, creating better representation and visibility of abortions and those who receive them.
Who Not When is a people-centered resource for information and support on late-term abortions, and how abortion bans negatively impact reproductive health.
Women on Web is an international nonprofit that works to provide safe abortion pills in 200 countries via their online consultation.
Women’s Reproductive Rights Assistance Project is the largest independent nonprofit abortion in the United States, which provides financial assistance for abortion care and emergency contraception.
World Health Organization is the international authority on health research and best practices, which asserts that access to all healthcare (including sexual and reproductive healthcare) is a fundamental human right alongside the United Nations.
Young Women of Color 4 Reproductive Justice Collective is an Advocates for Youth program for women of color between the ages of 14 to 24, which aims to dismantle the discrimination and stigma young women of color experience while pursuing abortions.
Youth.GOV Adolescent Sexual Health is a government website that strengthens youth programs in the United States, which includes sexual health.
Shelter is a necessary human right that influences physical and emotional well-being. Individuals without safe and stable environments are prone to increased stress, health problems, and poorer quality of life.
What is Homelessness?
Individuals without stable, safe, and functional housing are considered homeless. It’s one of the most visible social problems – it exists in some capacity in every single country throughout the world, but it’s one of the most common crises that the general public ignores. These are people who live outside, in cars and RVs, tents, or otherwise have no permanent place of residence.
When talking about homelessness, related terms like houselessness and the state of being unhoused come up. Unhoused and houseless are terms that activists have begun using in recent years to reestablish the humanity that unhoused people have since most people subconsciously reject houseless people as their peers. The word “home” has a more personal connotation, whereas “house” applies just to a structure. To quote the common saying, if “home is where the heart is,” then homeless people do have homes since they still maintain a sense of self while unhoused – they just don’t have shelter.
On the other end of the spectrum, terms like houseless and unhouse aren’t always popular since some activists perceive them as virtue signaling under the belief that exact language doesn’t matter as much as resolving the crisis at hand. Like all identifying language, it’s best to ask individuals in your local community what they prefer to be called: some might prefer being labeled as homeless, others might ask to be called a person experiencing houselessness.
Other terms used to describe homelessness include squatters, refugees, vagrants, hobos, and tramps. The act of squatting is often political, where an individual or community purposely occupies a property they do not own, rent, or otherwise have lawful permission to use. Refugees are those who are forced to flee their home country out of safety, whereas internally displaced people (IDPs) are individuals who are forced to leave their home communities but remain in that country. The last three terms (vagrant, hobo, tramp) are all considered derogatory due to the negative way they’ve been used throughout the centuries.
There are four main types of homelessness: transitional, episodic, chronic, and hidden. Houselessness is a spectrum that doesn’t discriminate based on age, race, gender, sexuality, or ability.
Most homelessness is classified as transitional, or a brief state of homelessness due to a major life change or catastrophic event such as job loss, a health condition, divorce, domestic abuse, substance misuse, etc. Transitional houselessness is categorized as individuals experiencing housing instability for under one year. These people often (but not always) have jobs but can’t afford housing and other expenses – leading them to sleep in cars, outside, or couch surfing. Statistically, transitional homelessness consists of younger people who are harassed when seeking alternative housing. Due to their circumstances, these individuals rarely access homeless services – making them difficult to track or collect information on.
Individuals who experience at least three periods of homelessness within the last year are labeled episodic homelessness. These people are often associated with disabilities, substance misuse, and mental health conditions that make them more prone to housing instability. While less likely to have stable or permanent employment, individuals experiencing episodic homelessness often have seasonal or minimum-wage jobs. Without adequate resources and support, episodic homelessness can easily evolve into chronic homelessness.
Homelessness that has occurred for over a year is classified as chronic homelessness, especially if the individual has a disabling condition. Statistically, these individuals are often older, unemployed, and live on the streets or other unsafe places. Additionally, these folks are more likely to have a disability, mental health condition, or addiction that restricts their ability to climb out of homelessness. It is worth noting the phrase “the sidewalk is quicksand;” in countries like the United States, it is extremely easy to become unhoused and to escalate from transitional to chronic homelessness due to the hostile culture and resentments attached to being unhoused.
Hidden homelessness refers to individuals who purposely live with others temporarily because they lack a permanent home. They’re considered hidden compared to the other three types since they rarely access housing resources or support, so they aren’t included in traditional houselessness data. These individuals are often younger and turn to friends, family, and neighbors to take shelter due to an inability to pay rent or afford other living expenses – but they can be further categorized as transitional, episodic, or chronic depending on how long, how often, or why they are experiencing housing instability.
By the Numbers: How Common is Homelessness?
Housing instability is difficult to compare reliably because it requires countries to self-report data and there are no consequences or motives for lying versus reporting honestly. It’s also difficult to track homelessness due to qualifiers that countries may use (ex: who exactly is ‘unemployed’ in the United States?), as well as other variables like hidden homelessness where a large portion of the houseless population doesn’t access social services and therefore can’t be counted by tracking data.
According to the United States Department of Housing, approximately 770,000 people were considered homeless in 2024 – which comes out to about 0.2% of the American public. The US Census found that 11.1% of Americans live in poverty, which accounts for 36.8 million people. 48 states criminalize homelessness, and unhoused individuals are arrested for sleeping outside or panhandling in the majority of the country – which was affirmed by the 2024 Supreme Court ruling in City of Grants Pass v. Johnson. Even though homeless people technically hold the same civil rights as other Americans, they are targeted and harassed by law enforcement, legislation, and other members of the general public. The following chart is daily averages based on self-reported information throughout the world:
COUNTRY
HOMELESS POPULATION
HOMELESS PERCENTAGE
United States
771,000
0.22%
Canada
235,000
0.57%
Mexico
14,000,000
10.89%
Brazil
281,000
0.13%
United Kingdom
380,000
0.56%
Ireland
14,000
0.27%
Spain
29,000
0.06%
France
330,000
0.49%
Germany
263,000
0.31%
Italy
96,000
0.16%
Switzerland
2,200
0.03%
Sweden
27,000
0.26%
Australia
122,000
0.46%
New Zealand
102,000
1.96%
Russia
11,000
0.01%
South Korea
9,000
0.02%
India
1,770,000
1.24%
Japan
3,000
0.00%
Kenya
20,000
0.04%
Egypt
2,000,000
1.77%
South Africa
56,000
0.09%
As noted above, these figures are only rough estimates and self-reported – even though the United States has a relatively low percentage compared to Canada, the United Kingdom, or Australia, any American will cite how pervasive homelessness is in their communities regardless of how urban or rural it is. In countries like the US, homeless individuals are more likely to be arrested and imprisoned rather than counted for in these figures and given social services. Countries like Germany, France, and Spain have higher amounts of refugees seeking safety from persecution, which are included in their statistics. There are very few places like Japan and South Korea that have genuine near-zero rates of homelessness, although they still experience poverty and other social issues.
What Causes Homelessness?
There isn’t one sole reason why homelessness occurs and there isn’t one sole way to resolve it either. For some, homelessness is caused due to low wages and high living expenses that make it impossible to find a place to rent; others have difficulty maintaining an income due to a disability, mental illness, or drug addiction. Gentrification and unfair housing policies force families out of their homes, and countries without strong welfare safety nets or mutual aid communities fail to prevent the poverty that leads to becoming unhoused.
While homelessness is inherently a housing problem, it is not only a housing problem. It’s impacted relational poverty, where unhoused individuals lose their family, friends, and community as society grows to see them as a burden that doesn’t belong. As such, all models that aim to resolve homelessness must reconnect homeless people as equal members of society. Otherwise, it is nearly impossible for chronically homeless people to escape their circumstances.
Surviving the Night: Emergency Shelter
If possible, overnight shelters are the best emergency option for those experiencing homelessness since they provide safety and protection from exposure to the weather. These shelters are temporary and generally only allow individuals to stay for one night at a time, so they aren’t great for building financial stability. Overnight shelters typically have specific intake hours but serve as a vital resource for those in critical need – in some communities, overnight shelters also act as warming and cooling centers to prevent hypothermia and heat exhaustion.
Throughout most of the United States, 211 serves as the free three-digit hotline to connect individuals with social services including emergency overnight shelters. This service is provided in all US states, Washington D.C., and Puerto Rico and uses a network of nonprofit agencies to support users with emergency crisis care, shelter, financial assistance, food programs, and healthcare. The Homeless Shelters Directory also hosts an online directory that can be accessed without telephone service, although their range and information are more limited than local 211 providers.
211 works under the assumption that you have access to a telephone with local network coverage – although some regions have 211 services available through online chat or mobile app. Most libraries will offer free phone services to patrons, as well as some businesses, and internet-based apps like WhatsApp allow users to make calls and send texts while connected to free internet such as in Walmart, coffee shops, and other community spaces.
Several government programs provide free cell phones if individuals meet certain income requirements or participate in other federal programs like SNAP, Medicaid, or SSI, such as the Federal Lifeline Program. Generally, unhoused individuals just have to submit proof of a government-issued ID, social security card, and/or birth certificate to be approved for a Lifeline cell phone.
Another safe option for emergency shelter is doubling up, which refers to temporarily living with friends or family rather than on the street. Doubling up is often more stationary than overnight shelters, but still has similar challenges due to overcrowding, lack of privacy, and stress. On the other hand, one’s ability to double up is dependent on their connections to friends and family members who are willing and able to share space.
The CDC estimates that 40% of homeless people live entirely unsheltered, such as in a car, outside, or other place considered unsafe for humans to reside. Individuals live in parks, bridges, subways, and makeshift camps to take care of their basic needs while carrying essential items with them like clothes, toiletries, blankets, and identification. Due to the exposure, living rough is unsafe compared to other alternatives from the risk of crime, violence, and weather. Despite this, some individuals prefer it to housing shelters since it provides more freedom than the rules and requirements shelters enforce. The legality of sleeping rough varies by region since the Supreme Court decision in City of Grants Pass v. Johnson upheld the constitutionality of arresting and imprisoning unhoused individuals for sleeping outside.
Surviving Tomorrow: Primary Needs & Beyond
Basic needs must be taken care of before people can become financially stable; it’s difficult to look past the night and find employment when you’re hungry and don’t know where you’ll be sleeping. Transitional shelters, as well as the methods described for overnight shelter and sleeping rough, fulfill the basic requirements for shelter and sleep – although transitional shelters provide an additional layer of safety and security.
Transitional shelters, also referred to as interim shelters, allow unhoused people to reside for six to 24 months. These agencies provide significantly more comprehensive services than overnight shelters, such as regular food, employment assistance, case management, and counseling. Due to this, transitional services and related homeless shelters have entry requirements, applications, and stricter rules than overnight facilities. “Continuum of Care” agencies receive federal and state funding to provide local care to unhoused people, as well as connect them to larger programs geared to promote financial stability. The same resources like 211 and overnight agencies are the most reliable and up-to-date on nearby transitional shelter programs and case management.
In cities with high homeless populations, mobile hydration units are installed to provide easy access to clean water. Most regions throughout the world have public tap water available through water fountains at parks, businesses, and other community spaces, although this water is normally unfiltered and can contain pollutants. While businesses are likely to reserve water as customer-only, most community centers, nonprofit organizations, homeless shelters, and libraries have readily available water sources. Both overnight and transitional shelters have in-depth knowledge of resources in their communities, but unhoused community members generally share their local tips.
Both hot meals and pantry items with long shelf lives are necessary to feed unhoused people regularly. Soup kitchens provide free or inexpensive meals to their communities (housed or unhoused) – while the name implies they only serve soup, soup kitchens actually provide a large variety of meals based on charity. Similarly, locally owned restaurants and businesses are more likely to donate extra food both to their communities directly as well as to shelters. On the other end of the spectrum, food banks and pantries provide food for individuals to take with them and eat later.
The USDA National Hunger Hotline is available every Monday through Friday at 1-866-348-6479 to provide callers with information on emergency food options, government assistance programs, and social services in their communities. The Hunger Hotline also operates an automated text service at 914-342-7744.
Feeding America is the national network of food banks, pantries, and related programs throughout the United States. Their website allows users to virtually search for pantries locally based on their zip code without needing a cell phone, which is typically required for 211 programs and the Hunger Hotline.
Public schools and childcare centers throughout the United States are required to have free and reduced meal options for students during the regular school year via the National School Lunch Program, School Breakfast Program, and Special Milk Program. However, these programs are not always enough due to their limited accessibility and eligibility requirements that cause many students to accrue debt by buying lunch meals – which is why some districts and advocates support universal school meal programs to provide food to all students.
Summer Food Service Programs (SFSPs) and SUN Meals provide free meals to youth in low-income areas through a network of charitable or nonprofit organizations when schools are otherwise closed for instruction. The US Department of Agriculture has an online map for youth-related meal programs, although details on programs must be directed to local agencies.
Some school districts operate Breakfast After the Bell programs, where students are given free meals during their first-period classes to ensure all students have access to meals.
The USDA also provides after-school snacks and meals through the National School Lunch Program (NSLP) and Child and Adult Care Food Program (CACFP) where youth are provided meals to enrolled students at participating public schools.
The Supplemental Nutrition Assistance Program (SNAP), also called food stamps, is a government program in the US that provides income for meals to low-income individuals. Money from SNAP can be used at participating supermarkets, farmer markets, and retailers throughout the country in addition to other programs like food banks.
The USDA maintains a national directory of farmer markets, which allow farmers and local retailers to sell products to their communities – often with government programs like SNAP and WIC.
The Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, is a federal program through the USDA that provides meals, nutrition education, breastfeeding support, and medical services for new mothers, young children, and other eligible caregivers. Each state has individual rules on the income necessary to be eligible, which can range from 100% to 185% of the Federal Poverty Limit.
While there are no federal or government programs for clothes, most charities and nonprofit organizations maintain individual programs to provide free clothes, blankets, pads and tampons, toiletries, condoms, and other essentials to better the health, safety, and well-being of their communities.
Health emergencies don’t stop when you’re homeless – if anything, they’re more likely to happen. As mentioned in my medical resources post, there are options available for low-income and unhoused people to receive care:
The National Association of Free and Charitable Clinics has a complete list of over 1,400 clinics that provide free primary care and preventative services in the United States. These clinics can be used by anyone regardless of income status or need, and similar programs exist for dental and vision care.
Federally Qualified Health Centers (FQHCs) are federally funded health centers and clinics that provide care on a sliding scale regardless of your ability to pay. Some free and charitable clinics are FQHCs, but not all FQHCs are free and charitable clinics – the US Department of Health and Human Services has an online directory of FQHCs for users to find a clinic local to them.
In addition to primary care, FQHCs often hold community events for anyone in the public to receive limited preventative care like annual check-ups, immunizations, and screenings.
FQHCs and similar organizations offer non-emergency medical transportation (NEMT) to provide free transportation to medical appointments based on income status – but you’ll have to check with your clinic for details.
Free and Charitable Pharmacies operate under the same model as free and charitable clinics to dispense prescription drugs and services for free to their communities.
While it doesn’t provide prescription medications for free, GoodRX is a free website and mobile app that provides users with massive discounts to mark down costs to near manufacture costs at over 75,000 pharmacies across the United States, including at major retailers like Walmart, CVS, Costco, and Kroger.
Special Populations & Extra Services
Certain groups of people are considered high risk for homelessness and other issues like addiction and mental illnesses, which is why additional programs and services exist to serve these needs. The following groups are the most common special populations served, but they’re not the only marginalized group at an increased risk for homelessness.
Veterans make up one of the largest groups within America’s homeless population, and account for about 13% of unhoused adults. Out of those veterans, half of them served in the Army followed closely by former Navy and Marines members. The United States spends over half of its annual budget on the military, but none of the military budget goes towards veterans – instead, it covers current salaries, equipment, facilities, and research. The Military-Industrial Complex (MIC) relies on low-income individuals to enlist for active benefits like healthcare and college education, but it fails to serve its veteran community. Veterans already have an increased risk of mental health issues and substance abuse while they attempt to transition to civilian life, leading them to become prone to homelessness if they are unable to secure a safety network with their loved ones and community. The following programs are national services provided via the Department of Veterans Affairs Homeless Programs to combat veteran homelessness, but are only applicable to veterans who were honorably discharged – veterans with dishonorable discharges are considered ineligible for VA services, but they can still use homeless programs for non-veterans.
The National Call Center for Homeless Veterans can be reached at 877-424-3838, which connects unhoused and at-risk veterans with housing solutions, healthcare, community employment, and other support services. They also operate the Homeless Veterans Chat for 24/7 confidential online support.
HUD-VASH is a collaborative program between the US Department of Housing and the Department of Veterans Affairs to provide free rental assistance vouchers for veterans to afford privately owned housing.
Low-income veterans and those at risk of becoming unhoused can use SSVF (Supportive Services for Veteran Families), even if they’re not eligible for HUD-VASH.
The Homeless Providers Grant and Per Diem (GPD) Program funds transitional housing and service centers for veterans through state, local, and tribal governments throughout the United States. The GPD Program allows veterans to stay up to 24 months while they’re seen by caseworkers to find alternative and more permanent housing.
The Domiciliary Care for Homeless Veterans (DCHV) Program is integrated with the Mental Health Residential Rehabilitation and Treatment Programs to provide residential care for veterans with eligible illnesses, challenges, or rehabilitative needs.
Veterans can find employment and vocational training under Homeless Veteran Community Employment Services (HVCES), which uses local community organizations and employers to give homeless veterans financial stability.
For those needing extra assistance, the Compensated Work Therapy (CWT) program allows homeless veterans to perform transitional work while preparing for competitive employment and HVCES.
The HCHV Program, HPACTs, and HVDP provide free healthcare, dental care, and case management to homeless veterans.
The American Legion is the largest US veterans organization that maintains programs for over 1.6 million members. Even though they are not owned by the federal government or VA, The Legion is only available for honorably discharged veterans.
The National Coalition for Homeless Veterans is a national organization that is not operated by the federal government and Department of Veterans Affairs, making it more eligible to serve dishonorably discharged veterans than official VA programs.
38% of all domestic violence victims become homeless at least once in their lives, and nearly all homeless women have experienced severe physical or sexual abuse at some point. Survivors are often required to choose between ensuring an abusive relationship or becoming homeless since their housing situation is commonly tied to their relationship. Further, it’s not unusual for abusive partners to monitor and restrict their victim’s finances. As a result, many victims of abuse choose not to leave their partner due to the fear and instability that fleeing would bring.
The National Domestic Violence Hotline is supported by the US Department of Health and Human Services to operate a 24/7 telephone line, text service, and online chat to victims of domestic abuse and allies. The Hotline also maintains a directory of providers for users to locate help in their local communities.
Although The Salvation Army has a controversial history with LGBTQIA+ people, the entire organization has a long-standing reputation for assisting victims of domestic and sexual abuse find temporary shelter. Their programs provide rent and utility assistance, food, addiction support, counseling, housing, and community outreach.
The Violence Against Women Act (VAWA) is a federal law that regularly updates practices regarding domestic and sexual abuse throughout the country to match best practices. It also provides a large amount of funding that is used by shelters centered on victims of abuse while experiencing homelessness or need other support services.
The National Network to End Domestic Homelessness is a social change organization that works within policy and movements to create a world where domestic violence no longer exists, and also operates WomensLaw – a free online tool for anyone needing easy-to-understand legal advice on abuse.
StrongHearts Native Helpline provides 24/7 anonymous support for Native Americans and Alaska Natives who are impacted by domestic and sexual violence. The Tribal Resource Tool is an online directory of services available to Native survivors.
RAINN, or the Rape, Abuse & Incest National Network, is the largest anti-sexual violence organization in the United States and operates the National Sexual Assault Hotline at 800-656-4673, which is available to call 24/7 or message through online chat.
The Department of Defense Safe Helpline is a specialized service for members of the DoD community affected by sexual assault, giving them one-on-one support and resources through their call center. The DoD Safe Helpline is managed by RAINN to help those in the intersection of sexual and domestic violence while being an active or former member of the United States military, available by phone, online chat, mobile app, and forum.
The National Human Trafficking Hotline is operated by the US Department of Health and Human Services to allow victims of human trafficking as well as those concerned about trafficking in their communities to report anonymous tips. The Hotline’s referral directory provides users with an online database of anti-trafficking programs and organizations throughout the country based on their location.
Approximately 10% of youth experience homelessness at a similar rate to veterans. Out of those youth, over 90% of them are between the ages of 18 to 24 – although, as mentioned previously, these individuals are the least likely to use homeless services and remain uncounted and hidden from the general homeless population. Many of these young people age out of the foster system, are LGBTQIA+, or are otherwise kicked out from their family homes with nowhere to go – leading them to become unhoused as soon as they meet the minimum age to be cast aside according to federal law.
Covenant House is the largest charity in North and Central America that provides shelter for unhoused young people and survivors of human trafficking. Their shelters accept individuals between the ages of 18 to 24 around the clock in nearly all major cities in the US.
Boys Town is a nonprofit organization with several locations around the United States that exists as one of the largest family care organizations in the nation that facilitates residential care in family-style homes to support at-risk youth regardless of gender.
Safe Place is a national youth outreach and prevention program for young people under the age of 18 in need of immediate help and safety. They have locations across the country and can be accessed by text for professional confidential help.
YMCAs and YWCAs often operate homeless shelters and other services for youth in their communities in major cities, similar to programs run by other religious organizations.
The National Runaway Safeline is the national communications system for runaway and homeless youth in the United States. Their call center provides 24-hour information on youth-related issues and services and can be reached by telephone, text, online chat, and forum. Their Home Free program partners with Greyhound Lines to transport runaway, homeless, and exploited youth to stable locations such as family homes, homeless shelters, transitional living programs, and other alternative living arrangements.
True Colors United is an agency centered on LGBTQIA+ and BIPOC unhoused youth since 40% of homeless youth identify as queer or transgender. As an advocacy organization, True Colors United guides policy on the federal, state, and local levels to be more inclusive when creating a world without homeless youth.
The Runaway and Homeless Youth Prevention Demonstration Project (RHY-PDP) provides federal funding to youth homelessness programs that serve individuals ages 22 and under to increase community resources and services available.
The Basic Center Program and Runaway and Homeless Youth Act grants funding to community-based organizations to give short-term emergency shelter, food, clothing, and medical care to young people under the age of 18.
Similarly, the Transitional Living Program is authorized by the Runaway and Homeless Youth Act to provide funding to organizations for living arrangements and shelter to youth between the ages of 16 to 22 while also giving access to life skills, education and vocational training, counseling, healthcare, and employment assistance.
The Maternity Group Homes for Pregnant and Parenting Youth Program is a federal service for pregnant and parenting youth between the ages of 16 and 22 who are experiencing homelessness to increase access to social services.
The Street Outreach Program supports organizations centered on unhoused youth, runaway youth, and street youth to help them find stable housing and social services to prevent sexual and physical exploitation.
The Foster Youth to Independence Initiative gives housing vouchers to young people between the ages of 18 to 24 in collaboration with public child welfare agencies to provide additional financial assistance.
Other federal youth-related homeless programs can be found at youth.gov, which contains current services operated by the United States government.
People who are at risk of losing their primary residence within 14 days and do not have the resources to find another living arrangement are classified as imminently homeless. Imminently homeless individuals may not be able to have the full range of services provided to fully unhoused individuals, but they are still able to apply for programs to better their support systems through various social services.
As mentioned previously, not all marginalized groups who are at an increased risk of homelessness have special services to combat their risk of being unhoused. Some regions may have programs and shelters specially catered for these causes, but they’re not nationwide. Some of these groups include LGBTQIA+ people, Black Americans, Native Americans, disabled people, and low-income households.
Additional Homelessness Resources
Alliance for Period Supplies hosts a network directory of organizations throughout the United States that provide free period products like pads and tampons.
American Job Centers is a service sponsored by the US Department of Labor to provide free assistance to job seekers looking for employment or training.
American Sexual Health Association operates Yes Means Test, a free tool that allows users to find free and confidential STD testing throughout the country based on their zip code and CDC information.
Ample Harvest maintains a national database of farmers and community gardens that donate their surplus food to those in need, similar to food pantries and banks.
Benefit Finder gives customized information on various government benefits and welfare programs to individuals in need, simplifying the process of researching programs.
Civil Rights Corps is a nonprofit organization that gives case litigation and policy information related to low-income and homeless individuals, who often don’t have the resources to find alternative options.
Community Action Partnership is a membership organization for agencies and groups that use federal funding to support individuals in need. Their map directory connects users with local organizations in their communities.
Continuum of Care (CoC) are programs supported by the US Department of Housing and Urban Development to improve communities throughout the country and end homelessness. CoC funding can be used for homelessness prevention, supportive services, transitional housing, and permanent housing.
Dress for Success is an international organization that connects women with free clothing and tools to become financially stable through employment.
Emergency Rental Assistance Program (ERAP) are state and local programs that can be located via 211 to help people at risk of becoming imminently homeless.
Eviction Lab is a research institution that tracks evictions throughout the United States to give individuals and their communities the tools necessary to confront unfair renting and housing practices.
Fair Housing Assistance Program (FHAP) funds state and local agencies to administer fair housing laws as determined by the US Department of Housing and Urban Development and requires cities to ensure fair housing regulations.
Food Not Bombs is a network of autonomous chapters that share free vegetarian food with those in need through grassroots activism in support of ending war and poverty around the world. Their directory map links users with chapters in their communities.
Habitat for Humanity provides safe and affordable homes to low and moderate-income individuals based on their eligibility requirements, which require users to attend training and seminars, volunteer, or physically help during the building process of their future home.
Housing and Urban Development (HUD) Resources is a federal agency through the United States government to administer national housing and development laws. HUD operates dozens of programs to improve local communities, and their offices can be located through their virtual map.
Job Corps is the US’s largest free residential career training and education program for low-income individuals between the ages of 18 to 24, maintained by the US Department of Labor.
Justia is a free collection of legal guides that explains laws, legal services, and policies around the world in everyday terms.
LawHelp is a program of Pro Bono Network to bring the power of law to everyone regardless of education or class. In addition to explaining the law in everyday terms, LawHelp and Pro Bono Net also provide legal assistance to immigrants via Immi and direct users to free legal documents as needed through LawHelp Interactive.
Legal Services Corporation acts as the largest funder for civil legal aid for low-income Americans. As a publicly funded nonprofit established by Congress, LSC provides funding for civil cases like loan repayment, personal injury lawsuits, contract disputes, and class action lawsuits to individuals traditionally unable to sue on their own.
Low-Income Home Energy Assistance Program (LIHEAP) is administered by the US Department of Health and Human Services to provide federal funding assistance to households regarding energy and utility costs.
Meals on Wheels is a national nonprofit organization that coordinates communities to deliver meals to individuals at home who are unable to purchase or prepare their own meals.
Modest Needs provides short-term financial assistance to households in temporary crisis considered ineligible for other social services due to living just above the poverty level.;
Money Management International is a free resource for financial education, providing easy-to-understand information and counseling on debt relief, housing services, and budgeting.
Naloxone for All is a network of affiliated programs throughout the United States that provide free naloxone as a means to avoid opioid overdose and harm reduction in affected communities. Their directory map connects users with mail programs in their state.
National Alliance to End Homelessness is a nonpartisan organization that works with federal and local agencies to create an online hub of homeless-related resources and policies to support unhoused individuals and their communities.
National Center for Homeless Education is operated by the US Department of Education to give training and information to organizations throughout the nation that interact with homeless populations.
National Coalition for the Homeless is a national network of groups centered on ending and preventing homelessness that also has a strong focus on serving the immediate needs of unhoused people. Their resources help imminently and currently homeless individuals connect with programs in their area.
National Employment Law Project is an advocacy organization that works with policymakers to improve the lives of workers across the country.
National Foundation for Credit Counseling connects individuals with certified credit counselors for free to improve their money management, debt payment plans, and credit scores.
National Homelessness Law Center uses the law and litigation to ensure unhoused individuals in the United States are treated humanely and are aware of their legal rights.
National Housing Law Project advances housing justice in low-income communities by fighting for the legal rights of tenants and low-income homeowners. NHLP’s resource center directs users to federal programs and laws like tax credits, rental assistance, vouchers, and public housing.
National Network for Youth is a youth-centered homeless agency that works in communities with young people at risk of becoming unhoused through service providers and welfare organizations in the United States.
National Skills Coalition hosts a number of networks to connect job seekers with the training necessary to fill skilled jobs like healthcare, software, plumbing, and manufacturing.
Operation HOPE uplifts communities through their programs to improve money management and create financial freedom.
Planned Parenthood is the largest reproductive health services provider in the United States. Although not an FQHC, Planned Parenthood has several safety nets in place to see patients regardless of their ability to pay. In addition to screenings, gender-affirming care, and abortion services, Planned Parenthood also provides free condoms, emergency contraception, and sexual education – including trained counselors available via online chat.
Projects for Assistance in Transition from Homelessness (PATH) is operated by the US Substance Abuse and Mental Health Services Administration to fund programs for unhoused individuals with mental illnesses, which includes housing, healthcare, job training, education, mental health counseling, and outreach in all US states and territories.
Propel App connects individuals using United States welfare programs like EBT and SNAP with additional tools, discounts, and benefits via their free mobile app partnered with the White House and other federal organizations.
Reddit is a social media platform that operates through thousands of forums (referred to as subreddits) for users to find related communities and discussions. Relevant health subreddits include: r/homeless, r/almosthomeless, r/vagabond, r/vandwellers, r/Survival, r/urbancarliving, r/StealthCamping, r/transitions, r/povertyfinance, r/Assistance, r/jobs.
Second Chance Employment refers to employers who will hire and provide career advancement to people with criminal records, who are traditionally denied jobs and therefore at an increased risk of homelessness.
Senior Farmers’ Market Nutrition Program (SFMNP) is a USDA program to provide low-income seniors with locally grown produce similar to SNAP and WIC programs at farmer markets.
ShelterApp is a mobile app available for Android and Apple devices – although it can also be accessed through non-mobile devices through its web function. The app displays shelters and resources for homeless youth across the entire United States (as well as other services for individuals in Colorado).
SkillUp America is a US nonprofit that helps individuals find high-opportunity employment through job training and career advice, regardless of their current education level.
Supplemental Security Income (SSI) provides monthly income to individuals with disabilities who have little other financial resources. SSI is different from SSDI (commonly referred to as “disability”), which requires a minimum recent work history but has no income requirements whereas SSI has no work history requirements but has income limitations.
Temporary Assistance for Needy Families (TNAF) is a federally funded and state-operated program that provides economic stability and security to low-income households that meet their eligibility requirements.
Unemployment Insurance (UI) refers to the number of programs handled by the US Department of Labor and state agencies to provide benefits to eligible workers who have become unemployed through no fault of their own while securing alternative employment.
United Way operates 211 to mobilize communities to serve those most vulnerable – in the event phone contact is not possible, United Way allows users to locate their local United Way agency through their website.
Volunteers of America is the largest comprehensive human services organization in the United States and uses their affiliate chapters to provide mental health, family services, food, clothing, affordable housing, and emergency shelter to individuals in need.
Weatherization Assistance Program (WAP) gives funding and resources to low-income households to become more energy-efficient and lower energy costs via tax credits and rebates.
While not a focus of this article, it’s important to note that health is holistic. Health isn’t the state of just not being sick – it is a commitment to take care of all aspects of your health, including your physical health, mental health, social health, environmental health, etc.
Types of Medical Healthcare
The human body is complex, which is why so many different healthcare fields exist. Providers spend years learning their practice to give the best care possible to their patients. However, knowing the difference between types of providers helps – you don’t need to go to a specialist whenever you want a flu shot.
The healthcare provider that you see most often is likely a primary care provider. These individuals serve as the first point of contact for most people’s health needs, usually employed at community health clinics, offices, and hospitals. Primary care providers (PCPs) cover a variety of health concerns to improve access to continuous and comprehensive care in their communities. From vaccinations and yearly checkups to routine screenings, PCPs manage the daily health concerns of the public – referring out to specialists as needed.
For health concerns that can’t be treated easily by a PCP, patients are directed to specialists who have additional training in their field. Most specialists work from private practices, clinics, and hospitals to see individuals as needed. In the United States, individuals often need to be referred by a PCP before they can be seen by a specialist – although there are exceptions like gynecology specialists generally don’t need referrals. The referral system ensures patients see the correct specialist for their condition, as well as make sure their treatment will be covered by insurance.
As noted above, a majority of preventative services can be done with a PCP – and many can also be accomplished through a retail clinic as described below. Preventative healthcare refers to free or low-cost services like immunizations, cancer screenings, and STD/HIV testing. PrEP, birth control, diabetes screening, and depression exams also fall under preventative care, which must be covered by all healthcare insurance plans in the US – even if you haven’t met your deductible. However, preventative care is only able to be covered for free or low cost through your plan if you get it from a PCP or another approved provider.
Walk-in clinics located in retail stores, supermarkets, and pharmacies are called retail clinics, convenient care clinics, or nurse-in-a-box. Retail clinics are usually operated by physician assistants and nurse practitioners rather than fully fledged doctors, providing low-cost care for uncomplicated minor illnesses and preventative services. Compared to PCPs, fewer services are provided for free or covered by insurance – but the quantity of retail clinics keeps their costs substantially low and accessible even when community health clinics and hospitals aren’t available. Common US retail clinics include CVS, Walgreens, Target, Walmart, and Kroger, which offer a range of care for colds, flu, allergies, burns, sprains, UTIs, health screenings, physical exams, and vaccinations.
Healthcare services provided virtually, such as through video call, remote monitoring, or the phone, are known as telehealth. Telemedicine may not be fully available through all medical providers and conditions, but allows patients to save time and resources when physical visits aren’t doable. Most providers offer telehealth in some fashion, such as allowing patients access to virtually message their providers. As such, telehealth is a substitute for PCP and specialist care – services like vaccinations and laboratory exams require in-person visits.
Occasionally, care is needed due to an emergency even if there isn’t time to see a primary care provider. PCPs and specialists require appointments and aren’t viable for immediate or life-threatening emergencies. Urgent care clinics serve as the middle ground between PCPs and emergency care and are the best option for minor illnesses, injuries, or other conditions that can’t be resolved by a retail clinic and can’t wait for an appointment. These clinics have set hours where anyone can walk in for care, including basic labs and X-rays, with shorter wait times and lower costs than emergency departments. In comparison, emergency departments treat life and limb-threatening health conditions for anyone who needs immediate medical attention. They’re staffed 24/7 with physicians, nurses, and specialists best suited for severe situations – but can be notoriously expensive in the United States. A number of PCPs have same-day care options for non-emergencies that don’t require an appointment similar to urgent care clinics.
What Exactly is Healthcare Insurance?
Even in countries with universal healthcare, medicine isn’t free regardless of whether the patients have to pay themselves or it’s covered by government taxes. Universal healthcare refers to health systems that provide care to all people regardless of their ability to pay – but there are four major types of health systems. The majority of countries use one of the major systems, while the United States uses all four in some capacity.
Most often referred to as socialized medicine, the Beveridge model was created in the United Kingdom through the work of Sir William Beveridge and Nye Bevan through the National Health Service (NHS). Reformed welfare services and the NHS were promised in Bevan’s successful campaign against Winston Churchill to give British citizens better medical treatment through taxation. True Beveridge models provide healthcare almost entirely through the government and taxpayer dollars, where medical facilities are government-owned and providers are employed by the government.
Societies with Beveridge models usually see healthcare as a responsibility of the government the same way roads and schools are funded by the government. Economically, the government’s service removes competition within the healthcare market and purposely keeps costs low. Since the Beveridge model provides treatment to all citizens regardless of income, it’s one of the main universal healthcare systems used throughout the world. Countries that use some form of the Beveridge system include the United Kingdom, Spain, Cuba, and New Zealand. In the United States, we use the Beveridge model to operate medical services within the Department of Veterans Affairs, Indian Health Service, and Federal Bureau of Prisons.
The Bismarck model earned its name through the work of German chancellor Otto von Bismarck, who created a new healthcare system after a series of economic crises in the German Empire. In true Bismarck models, healthcare is privately funded through insurance companies – which are paid by employers and employees through mandatory payroll deductions to reimburse private medical facilities for their care. In the majority of Bismarck systems, a percentage calculated by the government is taken from citizens’ income – which most citizens use for the public healthcare system managed by non-profit organizations to keep medical costs low. Additionally, the government’s involvement in the calculation prevents price inflation in the market.
Most Americans use a version of the Bismarck model, where commercial healthcare insurance is provided by an employer to finance treatments. Other countries that use the Bismarck system include Germany, France, and Japan. Unlike other countries with the Bismarck model, a strong criticism is that the United States does not keep medical costs low due to the overbearing market commercial insurance has on treatment due to the lack of government involvement.
Another version of socialized medicine comes from the national health insurance model, which combines the Beveridge and Bismarck systems. In the NHI model, the government funds medical treatments through taxation (like the Beveridge system) at mostly private healthcare facilities (like the Bismarck model). NHI is another type of universal healthcare since the government is single-payer and does not use commercial insurance.
Canada is the world’s primary example of the NHI model, although many other countries use the NHI system in some capacity rather than true Beveridge or Bismarck models like South Korea, Australia, and Italy. Americans who use Medicaid or Medicare operate under an NHI model since the Centers for Medicare and Medicaid Services is the single-payer government agency that covers medical treatments provided by private healthcare companies.
In low-income countries, there are very few resources to provide its citizens with strong healthcare – medical treatment is only given to citizens who can pay to receive that care, and no care is given to those who cannot afford it under the uninsured healthcare model. Some exceptions exist, such as free vaccines or charitable nonprofits that provide services – but comprehensive care is limited to those who can afford it.
Countries that operate on the uninsured healthcare model include Nigeria, Armenia, and Cambodia. Millions of Americans also fall under the uninsured model and are expected to pay for medical care at clinics, urgent care centers, pharmacies, and laboratories unless they have another form of insurance.
Okay, but how do I navigate insurance?
Compared to other countries, healthcare is disproportionally more expensive in the United States. The US is the only high-income country in the world that does not guarantee health coverage to all its citizens, relying on the majority of people to purchase commercial insurance – which is notorious for denying care, regardless of how medically necessary it may be.
Additionally, American healthcare insurance does not promise fewer medical bills since commercial insurance uses contract loopholes like deductions – a minimum amount of medical expenses individuals have to pay every year before insurance companies will begin covering the cost. Breaking an arm in the United States will cost you up to $16,000 if you don’t have healthcare insurance – and may still be pricey with insurance. In any high-income country, the cost of breaking that same arm can be as low as zero. Outside of the United States, costs only accrue if you choose to use a private doctor rather than the public health system. This comparison can be made to any medical procedure – like childbirth, cancer treatment, diabetes management, abortion services, surgeries, and so forth. Worst still, the United States managed to have the worst quality of healthcare among high-income countries.
NOTE: Individuals can be covered by more than one healthcare policy as listed below. In other words, having commercial healthcare insurance does not prevent you from also having WIC if you are eligible under your state’s standards. Young people can be covered by both their parents’ healthcare insurance as well as Medicaid. Generally speaking, people are encouraged to use and apply for as many benefits as they are eligible for.
Medicaid: Healthcare for Low-Income Households
Each US state and territory has its own requirements for Medicaid, a joint federal and state program that provides free health coverage to low-income individuals. The Modified Adjusted Gross Income formula calculates the maximum income a household or individual can make and still qualify for Medicaid, which uses various income types like salaries, investments, pensions, and child support to determine someone’s need level for where they live.
In 10 US states, single adults are not allowed to qualify for Medicaid – only families, the elderly, and those living with disabilities can qualify for Medicaid. These states include Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming – which are ironically some of the poorest states in the country that offer very few opportunities for individuals to grow their economic status. Every other state qualifies individuals for Medicaid if they make up to 138% of the Federal Poverty Level – making the maximum income limit $20,782.80 for 2024. For each additional member of the household, like children, the maximum limit increases. Additionally, citizenship status is not necessarily required eligibility – some states like Colorado, Illinois, California, and Georgia cover immigrants based on their own qualifications. Click here to search for Medicaid results relevant to where you live, or visit the federal Medicaid and CHIP Scorecard to review your state’s Medicaid policies compared to other states.
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) CHIP is a Medicaid program that extends federal and state funds for comprehensive health insurance for uninsured children – originally implemented to cover American youth with household incomes too high for traditional Medicaid but too low to have commercial insurance.
As with Medicaid, states are given flexibility to design their CHIP programs and the eligibility requirements to apply. Most states begin CHIP coverage when families make 133% of the Federal Poverty Limit, although there is a great deal of range compared to Medicaid – eligibility changes whether the child is an infant, between the ages of 1 to 5, or 6 to 18 and some states like New Mexico, California, Iowa, and New Hampshire cover families up to 380% of the FPL. CHIP-eligible households can still be eligible for traditional Medicaid if they meet their state’s standards. Similar to Medicaid, immigrant status does not affect CHIP eligibility if state requirements allow non-citizens to apply.
Unlike commercial insurance (which covers youth under their parent’s insurance until age 26), young people lose CHIP and become uninsured upon reaching 19. On their nineteenth birthday, young people are able to apply for general Medicaid coverage if they are eligible under their state’s requirements or pursue an insurance alternative.
WOMEN, INFANTS, AND CHILDREN (WIC) TheSpecial Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program through the US Department of Agriculture to provide healthcare and food assistance to low-income pregnant women, breastfeeding women, and children under the age of 5. All states must cover households making between 100% to 185% of the Federal Poverty Limit, although many states automatically cover people already using welfare programs like SNAP, Medicaid, and TNAF.
Caregivers like fathers, grandparents, and foster parents are also eligible for WIC programs since WIC aims to support any and all major caregivers with young children. Pregnant people are able to be covered by both CHIP and WIC, as well as Medicaid – women are covered by either CHIP or Medicaid in addition to WIC in all states beginning at 138% of the FPL. Like Medicaid and CHIP, immigrant status does not affect WIC eligibility if state requirements allow non-citizens to apply.
MEDICARE Not to be confused with Medicaid (as defined above), Medicare is a federal healthcare program that provides care to both people with disabilities as well as older people ages 65 and older. Like Medicaid, Medicare is managed federally by the US Centers for Medicare and Medicaid Services – but unlike Medicaid, it does not have any income requirements. All individuals who meet either the age or disability requirement are eligible, although the amount of assistance given can vary based on household income.
As a federal service, Medicare covers hospital care, outpatient services, private plans, and self-administered prescription drugs through well-defined program guidelines. Since it is not run through individual states, Medicare is less flexible than programs like Medicaid and CHIP but has less discriminatory variation. Similar to the above programs, non-citizens are eligible for Medicare if they meet the basic Medicare requirements and meet a residency requirement of lawfully living in the United States for at least 5 years.
Special Status: Veterans, Native Americans, and Prisoners
Unlike the programs in the previous section, which use the National Health Insurance model, healthcare coverage for veterans, Native Americans, and prisons use the Beveridge system.
VA HEALTHCARE Individuals who have served in the armed forces and have not received a dishonorable discharge are eligible for healthcare offered through the US Department of Veterans Benefits. Generally, veterans become eligible after serving at least 24 continuous months or serving prior to 1980. Current service members are eligible for TRICARE, the healthcare program run by the Department of Defense. In both programs, family members of active service members and veterans are eligible for coverage. There are no minimum income requirements for eligibility, given that veterans and their families meet the standard service needed for coverage.
VA healthcare provides comprehensive coverage to veterans, similar to Medicaid. As a Beveridge model of healthcare, veterans have the choice to use their public benefits and healthcare coverage or choose a private provider – typically, VA healthcare only covers providers through the public system as approved by the government but gives veterans the ability to choose private professionals using other coverage like commercial insurance or Medicaid.
INDIAN HEALTH SERVICES All Native Americans who are recognized within a Federally recognized tribe are eligible for healthcare coverage through the Indian Health Service, a federal agency that operates within the US Department of Health and Human Services. As a Beveridge program, individuals are allowed to receive alternative coverage for non-IHS providers similar to the VA healthcare system. Once approved by the IHS, individuals are fully covered for services regardless of income. However, individuals lose their IHS eligibility if they are not residing in an official IHS district, such as a reservation – which denies Indian Health Services to many Native Americans who live in urban areas.
INCARCERATED INDIVIDUALS Individuals currently serving a term in prison or jail are classified as incarcerated, which prohibits them from using Marketplace healthcare insurance – the commercial standard for healthcare in the United States. Further, while inmates can apply for Medicaid coverage, they cannot use Medicaid for any medical care while incarcerated.
Most facilities, even if they are accredited by the National Commission on Correctional Health Care or the American Correctional Association, enforce copays on inmates which are disproportionally high compared to the amount of income incarcerated people can make while serving time. On average, inmates make between $0.25 to $0.86 per day – while a single sick visit might be $13, which deters most inmates from receiving care. The federal law only states that jails and prisons must provide care based on previous court cases, and does not regulate its quality or cost – to further case law, more lawsuits must be filed, which are intentionally difficult for incarcerated individuals to pursue.
The Marketplace: Healthcare for America
The Healthcare Insurance Marketplace, also known simply as the “Marketplace,” is the primary place most Americans find commercial healthcare insurance if they do not fall into one of the above categories like Medicaid, CHIP, Medicare, IHS, VA, TRICARE, etc. It originated from the 2010 Affordable Care Act or Obamacare – while it has been altered slightly, it gives millions of Americans the ability to choose their coverage. The Marketplace also determines eligibility for other government healthcare programs, such as Medicaid.
The Marketplace displays all available insurance options based on demographics and income status to users, listing available benefits alongside prices. Anyone at least 18 years old and not currently incarcerated is eligible for the Marketplace as long as they are lawfully living in the United States and not eligible for Medicare. As commercial plans, each insurance has individual contracts with varying deductibles, copays, and limitations.
Similar to Marketplace insurance, the majority of US employers are required to offer their employees private healthcare insurance options. Like Marketplace plans, private insurance plans vary in nature – the primary difference between them is that anyone can use insurance through the Marketplace, while employers use private plans to give very similar options to Marketplace coverage. Only small employers with 50 or fewer full-time employees can opt to not provide a private healthcare plan to their staff, according to the Affordable Care Act.
Common Healthcare Barriers
Due to the complexities described above, healthcare isn’t easy for all people to receive in the United States. Cost is one of the leading barriers in American healthcare since the potential expenses associated with both the care itself and healthcare insurance put off seeing medical providers as needed. Generally, this leads to fewer individuals receiving regular comprehensive and preventative care – prompting them to only instead pursue treatment in life-threatening emergencies. As such, many health-centered organizations have programs and initiatives to provide services:
Free & Charitable Clinics provide primary care and preventative services through nonprofit facilities, most often funded through grants and private donors. There are over 1,400 healthcare clinics that fall under this within the United States, which can be used by anyone regardless of income status or need. The National Association of Free & Charitable Clinics maintains a complete list relevant to the US, and similar programs exist for dental and vision care.
Federally Qualified Health Centers (FQHCs) refer to federally funded nonprofit health centers and clinics that provide services on a sliding scale, regardless of your ability to pay. Some free and charitable clinics are FQHCs, but not all FQHCs are free and charitable clinics – their status is determined by the amount of federal funding they receive to operate. The US Department of Health and Human Services maintains an online directory of FQHCs that provide primary care to those with Medicaid, Medicare, CHIP, or are otherwise unable to afford healthcare. FQHCs also regularly host community events where anyone in the public can receive limited preventative care like annual check-ups, immunizations, and screenings.
Direct Primary Care (DPC) is a new model of US healthcare that cuts out the use of insurance companies, instead having patients pay monthly membership fees directly to the healthcare facility rather than the insurance company. These fees give individuals access to unlimited primary care visits and lab work – but these practices don’t accept any forms of insurance, Medicaid, or government programs. Several websites, like the DPC Alliance, have online directories of DPC facilities around the country.
Free & Charitable Pharmacies are community pharmacies that use their nonprofit status to dispense prescription drugs and services for free through the same models used for free and charitable clinics.
GoodRx is a free website and mobile app that provides users with discounts for prescription drugs at over 75,000 pharmacies across the United States, including major retailers like Walmart, CVS, Costco, and Kroger. The site also serves as a price comparison tool, allowing users to find the lowest price possible for their medication. While pharmacies that accept GoodRx coupons almost always accept insurance, they do not accept insurance when used with GoodRx – which is why the website and app are best for individuals needing medication outside of insurance coverage.
Rx Outreach is a nonprofit online pharmacy that delivers medication via the mail regardless of insurance or citizenship status. Similar to GoodRx, Rx Outreach aims to make prescription medication affordable to all individuals in the United States by providing an alternative to commercial insurance and inflated medication prices.
Even communities with infrastructure to off-put costs associated with healthcare struggle with transportation barriers. A lack of public transportation and lengthy travels physically bar individuals from receiving healthcare, especially in rural communities. Relatedly, most healthcare facilities operate during the same hours that the majority of individuals work – forcing them to request off work for medical appointments, as well as potentially lose income. Some initiatives and programs proposed to resolve these barriers include:
Improved public transportation improves more than just healthcare. Greater access to buses, subways, cable cars, trolleys, and other forms of public transit create an increased quality of life in all communities, regardless of whether it’s a major city or a rural area.
FQHCs and similar health-centered organizations offer non-emergency medical transportation (NEMT) to provide free transportation for medical appointments based on income status or use of Medicaid or Medicare through agencies like Uber Health and Transdev. Some healthcare insurance companies also provide NEMT as an added benefit policy on top of transportation services offered by healthcare facilities.
Telehealth and remote appointments allow individuals to get medical care, even if they live in a ‘healthcare desert’ and don’t have transportation. While telemedicine doesn’t apply to all care and screenings, it’s a basic step that brings individuals back into receiving healthcare.
While smaller healthcare practices operate during traditional work hours, many larger facilities and health organizations have later hours available. These hours are purposely set with working adults in mind, giving them the freedom of receiving care without having to request time from work and their pay.
While not as universal as the other healthcare barriers mentioned, approximately 22% of people in the United States do not speak English as their first language at home. In rural areas, there is very little (if any) translation services available, which leads to miscommunication and worse health outcomes between patients and providers. Similarly, native English speakers lack healthcare literacy – the American healthcare system is complex, which pushes individuals away from receiving regular care.
FQHCs are required to provide translation services under Title VI of the Civil Rights Act and are not allowed to rely on patients with limited English proficiency to translate for them. These services may require advocacy in rural settings but are mandated by federal law to improve healthcare access through the use of bilingual staff, on-site interpreters, and telephonic interpretation services.
Healthcare providers should use common language that patients understand regardless of their education or background. While not a required practice, this difference sets good compassionate doctors from the rest of the crowd.
The healthcare industry is steeped with centuries of discrimination and a lack of cultural understanding plays another major role in preventing individuals from receiving healthcare. Discrimination and bias related to race, immigration status, gender identity, and sexual orientation are considerable barriers to healthcare that isolate people from getting necessary care from trusted medical professionals they trust.Half of all transgender people report healthcare discrimination where a provider has used demeaning language against them or refused care entirely. Queer people experience disrespect at twice the rate that straight cisgender adults do with healthcare providers. These rates increase exponentially when other factors, like race, ethnicity, disability, and citizenship status, are accounted for.
All providers have ongoing educational requirements to continue practicing medicine, although the amount and type of continuous training varies by state. Regulations regarding the amount of training healthcare providers must continuously keep up-to-date on is necessary to ensure that providers use medically accurate and culturally competent information.
Finding a Doctor Who Works
Everyone deserves to see a primary care provider, and they deserve to feel safe and respected while doing so. A substantial proportion of the US population has anxiety regarding going to the doctor, which pushes them from receiving preventative care on time. While most people find doctor’s offices nerve-wracking because of the potential of hearing bad news, marginalized people like people of color and LGBTQIA+ people get anxiety due to previous bad experiences.
It’s easier to find affirming doctors compared to LGBTQIA+-friendly retail clinics: even the smallest American towns (such as those with populations with 1,000 or fewer) have their own Reddit pages and Facebook groups. Doctors and providers that work from community clinics have detailed reviews through sites like Google, and research into their policies is relatively straightforward. To find a provider this way, you can either search through your healthcare insurance options and check the reviews of each available option, or find a recommended doctor by other people local to your community and then see how your medical coverage can apply.
This is not the case with retail clinics, since they’re normally large corporations with nationwide brand names – Walgreens, CVS, and Walmart have official policies that forbid anti-LGBTQIA+ discrimination when seeing patients, but it’s harder to keep track of the actual practices of local stores. The staff that work at retail clinics have little to no continuous training requirements compared to other providers and sometimes just need a high school diploma or certificate for their role, which associates them and retail clinics with a lower quality of care and personal relationship than traditional providers. While it’s always difficult to report harassment, large-scale organizations are notoriously so; the assumption is that any retail provider can be discriminatory, and will continuously get away with it until someone gets through the red tape involved in reporting their ill behavior.
It’s common practice to prepare before a medical appointment, especially if you have anxiety around it. Write down questions you have and list any concerns you’re having. You are fully allowed to ask about procedures, tests, and practices – and your doctor should take time to listen to your concerns. Going back to the above point, reviews matter: anyone can potentially provide healthcare if they have the time and resources to get a license, but not everyone has the compassion necessary to be a good doctor.
You’re allowed to bring loved ones to your appointments, regardless of whether it’s a family member, significant other, or close friend. As long as they have your permission, it’s up to you if they stay in the waiting room or come with you to the doctor’s office. Having a loved one present while seeing a provider can bring comfort, accountability, and support – they’re there with you in the event you experience discrimination and can repeat any questions or concerns you have.
Make medical appointments during times that won’t increase your stress. If you’re prone to being anxious at the doctor, avoid trying to squeeze in your visit during your 30-minute lunch break and opt for a less busy time.
You have the right to hear a second opinion about major medical procedures and diagnoses. Each doctor is an individual with their own expertise, so it’s not uncommon to look for a second opinion if your symptoms aren’t improving or if your regular provider is unsure about what treatment options are best. Even though most providers get frustrated by people misleading themselves through online self-research, almost everyone searches symptoms, diagnoses, and treatments on the internet – and your provider should listen to your concerns and questions.
Resources
340B Drug Pricing Program is a federal initiative to disperse national funding to provide comprehensive health services and medications. The program intended to provide deep discounts and financial assistance to hospitals serving vulnerable communities by mitigating inflated prescription drug costs. However, retail pharmacies have contracted with 340B hospitals to exploit the program and charge further increased costs to consumers while profiting from the program’s discounts.
American Academy of Family Physicians (AAFP) is a large organization that sets medical standards for family medicine and primary care. The Neighborhood Navigator coordinates and connects patients with over 40,000 social services via their zip code database, ranging from programs related to food, baby supplies, housing, transit, education, employment, and more.
American Academy of HIV Medicine is an independent organization for healthcare professionals dedicated to HIV care and prevention. In addition to credentialing, the Academy offers up-to-date educational materials, data, and guidance on HIV/AIDS.
American Public Health Association is a professional membership and advocacy organization for healthcare providers in the United States, dating back to its founding in 1872.
CancerCare serves as the leading organization in the United States that offers free, professional support services and information to the public on cancer. CancerCare manages support groups, counseling, resource navigation, educational workshops, publications, and financial assistance – as well as an advice column for users to post cancer-related questions.
CaringInfo, a program under the National Alliance for Care at Home, is an education and resource hub for end-of-life care. The organization provides support tools for patients, their families and caregivers, and healthcare professionals needing assistance navigating serious and terminal illnesses.
Centers for Disease Control and Prevention (CDC) is the official national public health agency of the United States that operates under the Department of Health and Human Services to control, prevent, and treat disease, injuries, and disability in the general public. The CDC is staffed by the current presidential administration to tackle ongoing health concerns and educate the American public.
Drugs.com is a pharmaceutical encyclopedia that provides free information on drugs, side effects, and interactions – as well as a pill identifier and a phonetic search engine. It’s considered the most widely visited and up-to-date site for medication information.
Federal Office of Rural Health Policy (FORHP) is the national agency under the US Department of Health and Human Services to provide healthcare to rural communities, which include approximately 61 million people.
Get Covered Connector is a free tool for users to find assistance regarding their healthcare insurance through nonprofits and community coalitions local to their zip code. The site lists organizations available by telephone, virtual appointment, and in-person visits as well as whether the organization is considered LGBTQIA+ friendly.
GLMA Health Professionals is the world’s largest and oldest association of LGBTQIA+ healthcare professionals. The Association has free educational materials and training for providers, as well as a detailed online directory of LGBTQIA+ friendly providers at lgbtqhealthcaredirectory.org.
GoodRxis a free website and mobile app that provides users with discounts for prescription drugs at over 75,000 pharmacies across the United States, including major retailers like Walmart, CVS, Costco, and Kroger.
Greater Than AIDS is a program under KFF (formerly known as The Kaiser Family Foundation or Henry J. Kaiser Family Foundation) to provide the latest information about HIV and other STDs to underserved populations. Under its partnership with the CDC, Greater Than AIDS connects users to HIV services for testing, prevention, and treatment, as well as other related conditions like Mpox.
Health Resources and Services Administration (HRSA) is a national agency under the US Department of Health and Human Services to improve healthcare access to individuals considered medically vulnerable, isolated, or otherwise uninsured. The HRSA operates a number of programs to help individuals receive medical care, which are also included within this section like Healthy Start and the Ryan White HIV/AIDS Program.
Healthy Start is an HRSA program for maternal and child health that connects new mothers with services for transportation, education, and housing assistance. By guiding individuals to existing programs through their directory, Healthy Start combats infant death while also eliminating health disparities.
Human Rights Campaign is the largest LGBTQIA+ lobbying organization in the United States and maintains a wealth of resources related to queer and transgender health – including topics like the Affordable Care Act, healthcare rights, discrimination reporting, best practices for healthcare professionals, and their Healthcare Equality Index. The HEI conducts an annual survey of healthcare facilities across the country and ranks their policies and practices regarding LGBTQIA+ identities.
Lambda Legal is an American civil rights organization that uses litigation and public policy to promote LGBTQIA+ equality in US law. One of their resource collections centers on healthcare and related information and news on LGBTQIA+ healthcare.
LGBTQ+ Healthcare Directory is a free online database maintained by GLMA Health Professionals and the Tegan and Sara Foundation to connect users with information on local LGBTQIA+-friendly healthcare providers.
Mayo Clinic is a not-for-profit medical group that provides free medical educational materials in addition to the real-world medical procedures they perform at their clinics. Their site search engine uses the expertise of over 3,000 physicians, scientists, and researchers to inform users about diseases, symptoms, and medical tests.
MedlinePlus is an official service of the National Institutes of Health (NIH) and National Library of Medicine (NLM) to provide high-quality and relevant health information that’s easy to understand. It is the world’s largest medical library and contains over 7 million journals, books, studies, reports, and microfilms that provide free access to various health topics, medical terms, diseases, drugs, exams, and genetic health information.
Medscape is a news site that’s considered a go-to for clinicians and medical professionals around the world – as well as everyday patients. The site and its membership are completely free and offer up-to-date medical news, drug development updates, and information on clinical trials.
MyHealthfinder is a service of the US Department of Health and Human Services to provide Americans with reliable information on wellness and prevention tools, including medical screenings and vaccinations. The site uses basic information from users to recommend best practices to stay healthy.
National Coalition for LGBTQ Health is a medical advocacy organization that seeks to improve the health of LGBTQIA+ people through education and research. In addition to news and information about general health, the Coalition also maintains a Mpox resource center for up-to-date guidance.
National LGBT Cancer Network is a resource site for cancer-related information and tools focused on LGBTQIA+ people. The Network runs multiple peer-support groups over online platforms such as Zoom and maintains a resource library on clinical information and screenings.
National LGBT Cancer Project was founded alongside Out with Cancer as the first national LGBTQIA+ cancer survivor support and advocacy organization in the United States. The Project covers a range of cancer topics in addition to their clinical trial search and resource library.
National LGBTQIA+ Health Education Center, a program of the Fenway Institute, provides educational resources and consultation to healthcare organizations interested in better serving LGBTQIA+ people. Their webinars, learning modules, and publications help further the continued education of healthcare professionals.
National Maternal Mental Health Hotline is a free and confidential service available 24/7 through the HRSA for new and expecting mothers. Services are available in both English and Spanish via telephone or text.
Organ Procurement and Transplantation Network Modernization Initiative is a federal program under the HRSA to increase funding related to organ transplants. The Health Systems Bureau manages the OPTN Dashboard, which makes data about organ transplants available to anyone in the United States.
Orphanet is a specialized encyclopedia of rare diseases and conditions, featuring information on over 6,000 rare diseases. While less used than sites like MedlinePlus, Orphanet contains data on both rare conditions as well as exceptionally rare drugs.
Out2Enroll connects LGBTQIA+ people and their families with any and all healthcare coverage options through the Affordable Care Act, including Medicaid, Medicare, and commercial insurance. O2E helps users compare plans based on LGBTQIA+ factors, like gender-affirming care or coverage for same-sex partners.
OutCare is a nonprofit health organization that creates comprehensive resources, support, and educational materials to lead to equitable LGBTQIA+ health outcomes in the United States. The OutList Provider Directory sorts LGBTQIA+ affirming providers for users to locate by zip codes local to their communities. The free OutCare Saving Program provides discounts for prescription medications at smaller pharmacy retailers compared to GoodRx. OutCare also offers paid research opportunities, peer support, mentorship, training, and webinars.
Point of Pride supports transgender and nonbinary health through a variety of programs, such as their trans surgery fund and HRT access fund. Other Point of Pride funds include the electrolysis support fund, thrive fund (for prosthetics, wigs, voice training, and other services traditionally considered medically unnecessary by insurance companies, and chest binder/femme shapewear fund.
Poison Help, also known as Poison Control and the National Capital Poison Center, provides users with free information and resources about common poisons in over 100 languages through their mobile app, virtual chat, and telephone hotline.
PubMed contains over 37 million medical publications through the National Library of Medicine to provide users with free access to biomedical literature around the world.
Reddit is a social media platform that operates through thousands of forums (referred to as subreddits) for users to find related communities and discussions. Relevant health subreddits include: r/medical, r/AskDocs, r/AskHealth, r/Ask Vet, r/askdentists, r/medical_advice, r/Healthcare_Anon, r/medicine, r/HealthInsurance.
Ryan White HIV/AIDS Program (also known as the HIV/AIDS Bureau) is the official US entity for HIV primary care, medications, and support services for low-income individuals living with HIV. The Bureau provides funding to local and state HIV organizations to better serve the general public.
Rx Outreach is a nonprofit online pharmacy that delivers medication via the mail regardless of insurance or citizenship status. Similar to GoodRx, Rx Outreach aims to make prescription medication affordable to all individuals in the United States.
SAGE is the United State’s largest advocacy and services organization for LGBTQIA+ elders. In addition to their HearMe app that provides queer and transgender elders with chat support, SAGE also operates an action coalition, Long-Term Care Equality Index (LEI), housing initiative, cultural competency training program, financial stability program, meal program, sexual wellness program, and the National Resource Center on LGBTQ+ Aging.
Smart Patients is an online community that connects patients and their families with others affected by similar illnesses and conditions. While few paths are identical, Smart Patients offers users the ability to not walk their journeys alone through online support.
Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency within the US Department of Health and Human Services that leads national efforts on behavioral health and substance abuse. SAMHSA Certified Community Behavioral Health Clinics (CCBHCs) operate similarly to FQHCs to provide care to people regardless of income status.
Trans Health Project is operated by Advocates for Trans Equality and contains detailed guidance for users to navigate health insurance coverage best for their comprehensive healthcare.
Trans Legal Health Fund is a service of the Transgender Law Center to provide transgender people with the financial resources necessary when facing investigation, arrest, or prosecution for seeking gender-affirming care.
US Department of Health and Human Services is a group of federal agencies aiming to enhance public health for Americans. The HHS administers over 100 different programs across its agencies, including healthcare coverage, social services and TANF, research, training, preventative care, public health and safety, and emergency response plans.
WebMD, which also owns Medscape, is one of the most visited websites for credible medical information. Like other sites listed, WebMD has a directory for information on diseases, medications, and symptoms – and also has a database of doctors through doctor.webmd.com.
World Health Organization is a United Nations agency that leads global efforts to expand universal health coverage and emergencies so that everyone can attain the highest level of health regardless of where they live.
World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association, is the leading medical association on best practices for transgender health and provides professional and educational research for evidence-based medicine to best serve transgender and nonbinary people around the world.
