Gender-affirming care

Gender identity is your inner sense of being male, female, both, neither, or another gender. For some people, their gender identity doesn't match the sex they were assigned at birth.

Most children start to identify their gender around age 3. Many transgender and gender-diverse adults remember feeling at a young age that there was a difference between their bodies and their gender identity. Others didn't feel this way until later in life.

Many transgender and gender-diverse people go through a process of coming to know, accept, and express their gender identity. This is called gender affirmation or transition. There are many ways to affirm your gender. These may include medical or nonmedical options. Nonmedical options can include using makeup, clothing, hair removal, or voice therapy to express your gender. Medical treatment options can include taking hormones and having surgery to help your body match your gender identity.

Nonmedical options for gender affirmation include:

• Living as your gender identity. You choose how you feel most comfortable expressing your gender identity. Non-medical options include:
  • Clothing, hairstyles, or makeup.
  • Voice therapy or coaching.
  • Hair removal.
  • Breast binding or padding.
  • Penis tucking or packing.
  • Name and gender marker corrections on official documents.
• Counseling. This is professional guidance to help a person, family, or group of people. It can be done one-on-one or as a family or group.
• Getting support. It can be comforting and helpful to talk to people who know what you're going through. You can find these people through local or online groups. If you don't know where to find support, check with:
  • Your doctor.
  • Your school counselor or a trusted teacher.
  • Websites and online organizations. Visit the LGBT National Help Center site at www.glnh.org to find a list of organizations.

Medical options for gender affirmation include:

• Hormone therapy. This is medicine to help increase or decrease sex characteristics. For example:
  • You may take testosterone to develop more masculine physical traits. These include hair growth on the face and body.
  • You may take estrogen to develop more feminine physical traits. These include breast development and a change in where body fat is stored. You may also take a medicine that blocks testosterone (anti-androgen) or a hormone called progestin.
• Puberty blockers. These are medicines that block the hormones that cause body changes during puberty. They can delay development of physical traits that don't match your gender identity.
• Surgery. There are different surgeries that can change the look and the function of your body. They can help your body match your gender identity.

Gender-affirming surgery is a procedure that changes the look and function of your body. There are many kinds of gender-affirming surgery. They make your body more closely match your gender identity. Some people choose surgery. Some don't. It's up to you to decide if it will be part of your gender affirmation.

There are different types of surgery that can help you have a more feminine body. Most fit into two groups: top surgery and bottom surgery.

Top surgery

Top surgery is also called breast augmentation. You and your surgeon can work together to choose your breast size, shape, and positioning.

Bottom surgeries

The types of bottom surgeries include:

• Orchiectomy. It removes the testicles. The scrotum may be left behind to create the labia.
• Penectomy. It removes the penis.
• Vaginoplasty. It creates a vagina.
• Labioplasty. It creates the labia.
• Clitoroplasty. It creates a clitoris.

Other surgeries

These include surgery to:

• Reduce the Adam's apple.
• Change the pitch of your voice.
• Make your face look more feminine.
• Take fat cells from another part of your body and use them someplace else. This is called lipofilling.
• Remove fat from your body (liposuction).

There are different types of surgery that can help you have a more masculine body. They fit into two groups: top surgery and bottom surgery.

Top surgery

Top surgery is also called chest reconstruction. The breasts are removed to flatten your chest.

Bottom surgeries

The types of bottom surgeries include:

• Hysterectomy. It removes the uterus. Sometimes the ovaries are also removed.
• Vaginectomy. It removes the vagina.
• Metoidioplasty. It creates a small penis.
• Phalloplasty. It creates a larger penis.
• Penile implant. It allows the penis to be firm enough for sex.
• Scrotoplasty. It creates a scrotum.
• Testicular implants. They give shape to the scrotum.

Hormone therapy is treatment that affects hormones, which are chemicals made by the body. Medicines or surgery may be used to add, block, or remove hormones from the body.

Hormones can be given as medicine if someone has levels that are too low, such as with diabetes or during menopause. Or they may be given to block the body's natural hormones to slow or stop cancer cell growth, such as with breast or prostate cancer. Hormone therapy can also be used as a part of gender-affirming care.

Sometimes surgery may be used to remove the gland that makes the hormone.

With estrogen and anti-androgen therapy, you take hormones to develop more feminine physical traits. It also suppresses masculine traits. It may be a part of gender affirmation for some people. Hormone therapy can help you change your body to better reflect your gender identity.

Estrogen is given as a pill, a patch placed on your skin, or a shot. You may also take medicines (called anti-androgens) that block the hormone testosterone. Or you may also take a hormone called progestin.

Hormone therapy causes physical, emotional, and sexual changes. What they are and when they happen varies. Physical changes may include breast growth, changes in where fat is stored, shrinking of testicles, and decreased muscle mass. You may notice changes in emotions, a reduced sex drive, or changes in who you're attracted to.

Hormone therapy is safe for most people. But there are some risks. The treatment may make you more likely to get blood clots. It can also cause infertility. But it's not an effective form of birth control. So talk with your doctor about your reproductive goals.

With testosterone therapy, you take the hormone testosterone to develop more masculine physical traits. It also suppresses feminine traits. It may be a part of gender affirmation for some people. Hormone therapy can help you change your body to better reflect your gender identity.

Testosterone is given through a shot or through a patch or a gel placed on your skin. For people who need higher testosterone levels to meet their physical goals, the shot may work best.

Hormone therapy causes physical, emotional, and sexual changes. What these changes are and when they happen can vary. Physical changes may include acne, facial and body hair growth, voice changes, and growth of the clitoris. You may notice changes in emotions, an increased sex drive, or changes in who you're attracted to.

Testosterone therapy is safe for most people. But there are some risks. It can cause your body to make too many red blood cells, which may cause blood clots and other problems. It may also cause infertility. But it's not an effective form of birth control. Talk with your doctor about your reproductive goals.