From the Guidelines
Comprehensive gender affirming care should include a multidisciplinary approach with psychological support, medical interventions, surgical procedures, voice therapy, social transition support, and primary healthcare, prioritizing the individual's autonomy and needs, as recommended by the most recent guidelines 1. The care should be tailored to each individual's needs and goals, addressing gender dysphoria and related mental health concerns through therapy and counseling. Medical interventions may include puberty blockers like GnRH agonists, hormone therapy (testosterone for transmasculine individuals or estrogen with anti-androgens like spironolactone for transfeminine individuals), and surgical procedures such as chest reconstruction, genital surgeries, or facial feminization, as outlined in the update in adult transgender medicine 1. Key components of care also involve:
- Psychological support through therapy and counseling
- Medical interventions such as hormone therapy and surgical procedures
- Voice therapy to develop speech patterns congruent with gender identity
- Social transition support including name changes and navigating social environments
- Primary healthcare addressing routine preventive care and screenings based on both natal anatomy and hormone-influenced risks
- Reproductive health counseling discussing fertility preservation options before medical interventions
- A multidisciplinary team approach including mental health professionals, endocrinologists, surgeons, speech therapists, and primary care providers, as emphasized in the guidance for clinicians and departments 1. Effective care requires respecting the individual's autonomy, using their preferred name and pronouns, and providing a safe and supportive environment, as highlighted in the state-of-the-art review 1.
From the Research
Components of Comprehensive Gender Affirming Care
The components of comprehensive gender affirming care include:
- Hormone therapy, such as feminizing and masculinizing hormone regimens 2, 3
- Puberty blockers, which are used to pause puberty and delay the development of secondary sex characteristics 3
- "Top" surgeries, such as chest reconstruction surgery 2
- "Bottom" surgeries, such as vaginoplasty, phalloplasty, and metoidioplasty 2
- Other medical interventions, such as gonadotropin-releasing hormone agonists and anti-androgens like spironolactone and cyproterone acetate 3, 4
Medical Intervention for Transgender Youth
Medical intervention for transgender youth can be broken down into stages based on pubertal development:
- Pre-pubertal: no medical intervention is recommended 3
- Pubertal: youth are eligible for puberty blockers 3
- Post-pubertal: youth are eligible for feminizing and masculinizing hormone regimens 3
Barriers to Gender-Affirming Care
Barriers to gender-affirming care include:
- Finances and insurance issues 2, 5
- Lack of service availability 2, 5
- Fears or worries 2
- Systemic issues and incidents of bias within medical and mental health fields 2, 5
- Lack of medical provider awareness and education 2, 5
- Interpersonal barriers, such as fears of rejection 2
- Age and need of parental consent for minors 2
- Other medical issues 2
- Lack of information about how to acquire care 2, 5