Gender-Affirming Care: Thoughts & Perspectives from Therapists

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From the front page of your favorite news source to recent laws that limit access to care in multiple states. Everyone seems to have their own stance on gender-affirming care, despite not clearly understanding it themselves.

This subject is too important to simply gloss over while scanning the news and drinking your morning coffee. Gender-affirming care is a lifeline for many people - and losing access can lead to adverse health outcomes for transgender and nonbinary people all across the country.

To help curb any confusion or stigma surrounding this topic, I’d like to provide some helpful insight from therapists that works to inform and humanize a subject that’s often unfairly exaggerated and politicized.

What is Gender-Affirming Care?

Gender-affirming care is any form of health care designed to affirm an individual’s gender identity. This is gender-affirming care at its core, and shouldn’t be misconstrued with other ideas. Various surgical and non-surgical interventions work to assist transgender people with aligning different areas of their lives (emotional, biological, and interpersonal) with their chosen gender identity.

It’s important to note that trans or gender nonconforming people can always choose not to pursue medical interventions or gender-affirming care. Trans identities are still valid in the absence of any physical transformations.

Clinicians Share their Perspectives on Core Themes of Gender-Affirming Care

Below, you’ll find words from several clinicians sharing their perspectives on the core themes of gender-affirming care. Each of these therapists has experience working with LGBTQ+ clients and are actively working to provide better health care to trans and nonbinary identities.

The core theme of gender-affirming care is that when we let people become who they are they shine and allow everyone else around them to shine and feel joy. There is no deficit on queer joy, we enjoy sharing that joy with others.

— Grant Pike

The “affirming” part. Trans and gender-expansive clients just want to be themselves - just like cis clients do. For the most part, my job is just to be there and to believe my clients when they tell me who they are.

— Josephine Bibby

Each person has the right to choose the life that is best for them. To be a gender-affirming provider is to allow gender expansive individuals the same agency and self-determination we allow all other clients to express themselves fully and honestly. If someone tells you and shows you who they are, believe them.

— Parker Morris

Undoing the beliefs society had implanted due to transphobia. Acceptance. Self-compassion. Trusting their gut.

— Jacqueline Hynes

Reducing gender dysphoria, finding emotional support, promoting safety. Always ensuring that the person will be safe and supported. The statistics are very concerning and people should help as they look for support.

— Marcos Apolonio

Forms of Gender-Affirming Care

Despite what some may think, gender-affirming care is much more than just surgical intervention. Examples of non-surgical medical interventions that can support a transgender or gender nonconforming person’s identity includes puberty blockers, gender-affirming hormones, speech therapy, and psychiatric services. It’s each person's choice to choose the interventions that best fit their needs as they transition.

Two medical interventions in particular, hormone replacement therapy and puberty blockers, garner lots of attention from the public eye. Look at the summaries below that add transparency to these popular interventions.

Hormone Replacement Therapy

Female-to-male (FTM) hormone therapy or masculinizing hormone therapy minimizes unwanted female characteristics while promoting masculinization. People undergoing FTM hormone therapy can experience several changes that may include:

Growing facial hair and/or body hair
Changes in their voice
Increases in muscle mass
Temporary hairline recession
Sweat and odor patterns

Male-to-female (MTF) hormone therapy or feminizing hormone therapy reduces undesired masculine characteristics and promotes feminization. People undergoing MTF hormone therapy can also expect changes that may include but aren’t limited to:

Breast development
Reduction in muscle mass
Absent/ reduced sperm count
Reduction in body hair and a change in sweat/ odor patterns
Changes in libido

People undergoing these treatments can also expect possible sexual changes that may include vaginal dryness, a reduction in erectile function, and a drop in sperm count.

Those considering hormone replacement therapy should consult their doctor for more information about possible side effects.

Puberty Blockers

The physical changes accompanying puberty can lead to high stress levels for adolescents who identify as transgender and/or gender-diverse. As a result, these young people may use medication called puberty blockers (also known as gonadotropin-releasing hormone or GnRH) to temporarily suppress their puberty. When taken regularly, puberty blockers can stop the body’s release of sex hormones, including both testosterone and puberty.

For those identified as male at birth, puberty blockers work to limit the growth of facial/body hair, prevent voice deepening and limit the growth of genitalia. And for those identified as female at birth, treatment limits breast development and halts menstruation.

Benefits of Gender-Affirming Care

Heightened levels of societal stigma, discriminatory politics, and decreased social support often impact transgender and nonbinary youths the hardest. And unfortunately, there’s been no shortage of anti-trans stigma occupying major headlines nationwide.

While figureheads bicker over political talking points in an effort to win votes and push an agenda, transgender and non-binary young people all over the country are experiencing heightened rates of depression, are being forced to relocate, and are increasingly taking their own lives partly as a result of this crude rhetoric.

Thankfully, gender-affirming care has been associated with both lower odds of depression and suicidality. This is hugely impactful, considering the vast mental health disparities amongst transgender youths.

Transgender youths receiving gender-affirming care, including both puberty blockers and gender-affirming hormones, experienced a 60% drop in moderate or severe depression and 73% lower odds of suicidality over the course of a year. The benefits of gender-affirming care are very much real, and we must keep these advantages in mind when addressing recent laws and legislation.

Dispelling Myths about Transgender Identities

There’s no shortage of myths floating around about transgender identities. From thinking that medical transition is necessary to be considered trans, to people assuming that young people are getting indoctrinated into choosing trans identities. These myths are harmful and can lead to skepticism that fuels legislation that limits access to care for those that need it most. Read on as clinicians share their opinions on common myths that must be debunked.

I don't even know where to start. It seems the general discourse about trans people rarely if ever includes actual trans people. I am cisgender so I hesitate to speak for an experience that is not mine. That said, I often hear "trans issues" being discussed in an extremely sexualizing and pathologizing way. Being trans is not an illness or a diagnosis and it does not cause harm; being trans in a transphobic world is where harm enters the equation.

— Josephine Bibby

I think the idea that a person has to medically transition in order to be 'legitimately trans' needs to be debunked. People transition and express themselves in all sorts of ways and all of those ways are valid.

— Lindsey Hennawi

The myth that trans-ness is a choice or exists because of the influence of others. It is a myth that has been weaponized to the point of harming or shortening the lives of transgender Americans.

— Jacqueline Hynes

Trans kids know who they are, so to feign a misguided dangerous narrative that they have a contagion effect by social media for being gender expansive and queer is ridiculous.

— Grant Pike, LICSW

There are several myths that it is a phase, young people don't know what they are doing and shouldn't be allowed to have access to medical resources, and people are this way because they have mental conditions.

— Marcos Apolonio, LCSW

Guidance for Parents of Transgender Persons

The topic of gender-affirming care is increasingly being focused on trans youths, and parents may be confused on how to best help their children due to the conflicting information floating around these days. To better assist parents, some therapists here at Alma shared some advice on ways parents can better serve and guide their children.

I would encourage communication with their child, to join support groups, and offer psycho-education in family sessions. Most important be open to learning from their child.

— Margarita Kushner, LCSW

Educate yourself on the laws of where you are. Find a community of others with the same struggle. If you're a parent of a trans child, talk to them about what is possible now and reinforce they are loved for who they are and as they are. Find a therapist that can provide support.

— Mark Muse, LCSW

Seek as much outside support as you possibly can. Research, educate yourself about the likely direction of your state's politics. Keep you and your child emotionally safe, especially from harmful political social media.

— Rachel Lane, LMHC

Advice for Transgender and Nonbinary People

Lastly, some therapists on Alma’s platform wanted to share some personal advice for transgender and nonbinary people. We understand that life can be complicated right now with all these conflicting messages floating around. The below advice offers a much-needed boost for whoever may need it.

Continue to be you, and know that being trans and nonbinary does not equate always to external gender expressions. Knowing yourself and living that truth transcends binaries. Know that you have the right to come out and express yourself however you see fit.

— Grant Pike, LICSW

Don't let anti-trans legislation and the people behind it scare you back in the closet, PLEASE! It's highly detrimental to your mental health and the entire movement you all have created.

— Rachel Lane, LMHC

This is a difficult and dangerous time in this country, but I truly believe the hate-filled legislation we are seeing now is the dying gasp of a belief system on the wrong side of history. The LGBTQIA+ community will come out of this stronger than ever!

— Jennifer Broomfield, LCSW

There are resources available, it is totally possible to find a way to live authentically and to be who you are. Find support, and create a safety net. You have talents and gifts that will carry you through life. Your gift to the world is extremely valuable and can not be replaced. You are needed!

— Marcos Apolonio, LCSW

As a cisgender provider it is very important to me for all of my clients to know that they are the expert on their identity and care. I am more than willing to be educated, enlightened and corrected by my clients in order to be a more effective with clearer insight on how to provide the best possible care.

— Maria Atkinson, LCSW

You are deserving of love, existence, and to be seen and heard.

— Sherri Washington, LMHC, LPC

Resources are Here for You

When it comes to healthcare, everyone should be made to feel comfortable and seen. And Alma’s dedicated to providing a safe environment for everyone to pursue therapy, regardless of how they self-identity. Stop procrastinating with your mental health and use Alma’s provider directory to filter therapists by their area of specialty, race, sexuality, or whether they identify as LGBTQIA+. Click the link here to get started.