Gender-Affirming Care

Providers should support the sexual and reproductive health care needs of all people regardless of their gender identity by providing gender-inclusive and affirming care as well as information on gender-affirming hormone therapy and preventive care. 

ACOG, SFP, and WPATH make the following recommendations regarding health care for transgender and gender-diverse (TGD) individuals:170

• Create inclusive and inviting clinical environments. Providers should take steps to educate themselves and their medical teams about appropriate language and the health care needs of transgender patients.
• Clinics should ensure that gender identity and sex assigned at birth are clearly documented in the medical record as well as the patient’s legal name, their chosen name(s), and pronouns.
• Fertility and parenting desires should be discussed early in the process of transition before the initiation of hormone therapy or gender affirmation surgery.
• Gender-affirming hormone therapy has not been studied as contraception. Individuals who do not wish to become pregnant or cause pregnancy in others should be counseled about the possibility of pregnancy if they are having penis-in-vagina sex. All currently available contraceptive methods can be offered for use in TGD patients, including those currently or previously on gender-affirming testosterone therapy, with consideration for commonly accepted medical contraindications in cisgender women.
• Hysterectomy with or without bilateral salpingo-oophorectomy is medically necessary for patients with gender dysphoria who desire this procedure.
• To guide preventive medical care, screening should be based on the organs that a person currently has, regardless of the person’s gender identity, sexual orientation, or sexual activity.

In addition, providers can ask TGD patients about perceived levels of social support and social connectedness and refer them to available community support systems. Clinics should have a list of LGBTQI+ groups in the community available to share with patients; a list of national resources is available below:

• Lesbian, Gay, Bisexual, and Transgender (LGBT) National Help Center provides multiple hotlines for peer counseling; online peer chat options; and local resource searches for gay, lesbian, bisexual, transgender, and questioning people.
• PFLAG (formerly known as Parents, Families, and Friends of Lesbians and Gays) provides peer-to-peer support through in-person and virtual meetings, online outreach, and a variety of additional resources and programs. Hundreds of local PFLAG chapters are in operation across the country.
• Trans Lifeline provides a hotline—staffed by transgender people, for transgender people—to provide individual support for the needs of members of the community.
• The Trevor Project provides phone, instant messaging, and text services for LGBTQ individuals to communicate with a trained specialist; an online social networking space for youth and their friends and allies in the LGBTQ community; and an online resource center.

Finally, providers should be aware of policies and laws that protect youth and adults who identify as transgender and gender diverse from discrimination and violence.171

For sample language providers can use to deliver gender-affirming care, see a job aid created by the Reproductive Health National Training Center.172