How I Talk With My Patients About Gender-Affirming Care

“I feel really uncomfortable in my body.”

“I don’t ever want to get a period.”

“Please take out my uterus. It doesn’t belong there.”

I often hear such words from people whose gender identity differs from the body they were born in. As an ob-gyn, I can help transgender patients feel and look more like their true selves.

About 2 million adults in the United States are transgender. But many do not fully understand their health care options or how to safely access care. Here’s what I tell my patients about gender-affirming care.

Note: I see patients across the gender spectrum in my practice. This article applies to anyone seeking gender-affirming care, including transmasculine, transfeminine, nonbinary, genderqueer, and gender nonconforming people.

Gender-affirming care is essential health care.

The lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community faces bias in all aspects of society, which can create barriers to health care.

But while our society is still learning to accept the LGBTQ+ community with open arms, transgender people already know who they are. And they have the right to feel comfortable in their own bodies.

When someone’s gender identity is at odds with their appearance and how others view them, they may experience discomfort and distress. This feeling is called gender dysphoria. In severe cases, it can lead to depression, anxiety, and suicidal thoughts. This underscores why gender-affirming care is so essential for those who need it. (It’s important to talk with your doctor about any feelings of depression and anxiety—we can help.)

You have a range of options.

Many people—transgender and otherwise—assume that surgery is an inevitable part of transitioning. In reality, surgery is only one of many ways to help you express your gender identity.

You can choose how you dress and style your hair, as well as the name and pronouns you go by. If you wish to go further, you can turn to an ob-gyn, primary care physician, or other doctor for gender-affirming health care. Options for physically transitioning include:

• Hormone therapy: People who are transmasculine can take testosterone to deepen their voice, grow facial hair, and possibly stop periods. People who are transfeminine can take estrogen to help breasts grow and redistribute their body fat.

• Chest surgery: People who are transitioning from female to male can have “top surgery” to remove the breasts and reconstruct the chest. Likewise, people who are transitioning from male to female can get breast implants.

• Hysterectomy: This surgery removes the uterus and sometimes the surrounding organs. It eliminates periods and the ability to get pregnant. If the cervix is removed, you may no longer need cervical cancer screening.

• Genital surgery: “Bottom surgery” is a series of procedures to construct genitals that better match a person’s gender identity.

Health insurance coverage for gender-affirming medications and procedures will depend on where you live and your insurance plan.

There is no one right path.

Gender-affirming care means something different for every transgender person. You can choose to pursue all the steps I’ve outlined, or none of the above. Like all health care, gender-affirming care should be patient-centered and patient-driven. (Note: links may contain gendered language.)

What’s more, your gender transition may evolve over time. You could start with hormone therapy, then seek top surgery years later, and bottom surgery years after that—or never. It all depends on what matters to you.

Take the example of a transmasculine person who wishes to prevent period bleeding and cramps. Many people don’t want to have a hysterectomy, as it is a major surgery with a long recovery time. If having a uterus doesn’t bother them, there are less invasive methods to stop monthly bleeding. Hormone therapy with testosterone can decrease or even stop periods. If testosterone doesn’t fully stop the bleeding, or if they also need birth control, another method such as an intrauterine device (IUD) could be the way to go.

On the other hand, I’ve had patients who are deeply distressed by their periods, and even the knowledge that they have female organs inside them. A hysterectomy may be the right choice in these individuals, for the sake of their mental health.

You will still need routine care.

Like everyone, transgender people should keep up with routine health care. Experts recommend screening for diseases that affect the organs you still have, even if they don’t align with your gender identity.

For example, anyone with breasts should get mammograms at the recommended age. If you have a cervix, we’ll want to check for early signs of cervical cancer based on your personal risk and family history. But most people can stop screenings if their breasts or cervix have been surgically removed.

These procedures should take your mental well-being into account. Some transgender people don’t mind getting cervical cancer screening every few years. Others are less comfortable with these screenings. Talk with your doctor about your comfort level. There may be ways to make these screenings easier for you.

Your ob-gyn can also help with:

• Birth control: Hormone therapy alone is not a replacement for birth control, even if you no longer get a period. To prevent pregnancy, you can choose a birth control option that fits your goals and lifestyle.

• Having children: Transgender people can still have biological children, so talk with your ob-gyn about your plans for the future. They can help you preserve your fertility before hormone therapy or surgery, and, if you want, help you navigate pregnancy in a way that minimizes gender dysphoria.

• Sexual health concerns: From testing for sexually transmitted infections (STIs), to treating pelvic pain and problems with having sex, your ob-gyn can help you with any questions you may have.

Doctors like me stand ready to help.

You have the right to seek treatment from doctors who are knowledgeable about gender-affirming care. Thankfully, more health care professionals are becoming trained in inclusive care. We are making our practices more welcoming to LGBTQ+ patients, from learning how to prescribe hormone therapy, to helping patients find birth control that fits their gender identity and lifestyle needs.

That said, finding gender-affirming care can be challenging. Laws in some states may limit your doctor’s ability to talk with you about transitioning, much less offer you this care, especially if you are younger than 18. If gender-affirming care is not available where you live, turn to your personal network for referrals. You can also search online. Resources like transcaresite.org are good places to start. If you live far away from the doctor you choose, be sure to ask if they offer virtual visits through video chat or if you’ll need to travel to visit their office.

Life-changing and lifesaving

I’ve had the privilege of providing gender-affirming care for countless transgender patients. This care has looked different for each patient, but they all give feedback that lets me know I’ve helped them. They say things like:

“It’s such a relief.”

“Now I can move on with my life.”

“This who I am. Thank you.”

If you’re considering this type of care, find a health care professional who can help you understand your options and choose what feels right to you. You deserve acceptance, respect, and the chance to express your whole, true self.

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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.