33 Gender-Affirming Healthcare

Within a healthcare context, gender-affirming care constitutes treatments that reduce gender dysphoria and validate gender identity and health goals. Gender-affirming healthcare occurs in a social context where trans people are not accepted and experience violence as a result. This means that healthcare itself can be a source of social justice and social change. Conversely, the institution of healthcare can be, and certainly has been, a cause of transphobia, violence, and injustice experience by trans and other gender-diverse people. Many trans and non-binary people have critiqued the healthcare system as an unnecessary gatekeeper to receiving gender-affirming treatments, particularly with regards to the need in some healthcare systems to be diagnosed by a psychiatrist with gender dysphoria. Indeed, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the diagnostic tool of the American Psychiatric Association, lists gender dysphoria, and until 2013 termed it a “disorder.” While the term “disorder” was amended to destigmatize gender-nonconformity, the healthcare system continues to be a major source of struggle and sometimes violence for trans and nonbinary people.

Gender-related care can involve pharmaceutical and surgical treatments, such as hormone therapy, top surgery (removal or creation of breasts), and bottom surgery (removal and/or creation of genitals). Gender dysphoria in children can be addressed with a staged approach, such as through the blocking of puberty. Another element of gender-affirming care is the recognition that non-binary people may also elect to receive treatment for dysphoria. Yet there is also the social care that comes with affirming gender identity, including use of patient-chosen pronouns and names, sensitivity regarding procedures that may be invasive or triggering of dysphoria, such as Pap smears, and treating the whole patient by addressing the mental and emotional health aspects of gender identity.

Gender-affirming care: treatments that reduce gender dysphoria and validate gender identity and health goals
Gender dysphoria: distress from dissonance between someone’s gender identity and the sex they were assigned