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Guide to health and wellness for the transgender community

Explore a comprehensive guide to health and wellness for the transgender community, covering inclusive healthcare, mental and physical well-being, and advocacy for rights and support
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By | Aug. 20, 2024 Medically reviewed by Peter Lourgos, MD, JD
A group of smilling adults standing shoulder to shoulder: Transgender community health and wellness

Key takeaways

  • To find transgender-friendly healthcare providers, seek recommendations from trusted friends, use telehealth options, and consult online directories.

  • Telehealth visits may be a great first step in seeking gender-affirming care, as you can receive the visit in the comfort of your own home.

  • Finding a telehealth provider with a physical location near you may be best. Then, if an in-person visit is necessary, it will be feasible.

  • Vet a healthcare provider by asking about their experience with transgender patients and inclusivity training.

  • Make sure the provider has familiarity with the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People.

  • Insurance coverage for transgender healthcare services varies by state and provider, but you can file an appeal if you are denied coverage for medically necessary care.

  • Legal protections against discrimination in healthcare settings exist at both federal and state levels and advocacy groups can provide support.

In this article:

Members of the LGBTQ+ community typically have physical and mental health concerns that the rest of the population does not. Transgender members, in particular, often require additional health care, including gender-affirming healthcare, personalized primary care, and mental health care from medical providers experienced in transgender health and wellness. Although there are still barriers to health care for transgender individuals, it’s becoming easier to navigate health care and find the right transgender-friendly provider.

Finding transgender-friendly healthcare providers

Transgender individuals who have experienced discrimination in a healthcare setting may be distrustful of healthcare providers. However, sharing your gender identity with your healthcare providers will give them a more complete understanding of your healthcare needs. Finding the right provider may be a tricky task, but you can make it easier by:

  • Asking trusted friends, especially other transgender individuals in your life, for provider recommendations. 
  • Finding telehealth providers to initiate non-urgent transgender-friendly health care, especially mental health services. This allows you to have an initial appointment in a comfortable setting, such as your home, minimizing the need for anxiety-inducing in-person appointments. You may choose to ask to turn your camera off for the session if you feel uncomfortable for any reason.

Questions to ask when seeking care

Although specific questions depend on the type of gender-affirming care you are seeking, some general questions to ask when vetting transgender-friendly healthcare providers are:

  • Have you treated transgender patients in the past?
  • Have you and your staff undergone inclusivity training?
  • Can you provide information on what gender-affirming care you offer?
  • Is there an LGBTQ+ healthcare provider at this clinic?
  • Do you follow the WPATH Standards of Care for the Health of Transgender and Gender Diverse People? 

Online resources and directories

A checklist for finding transgender-friendly healthcare providers

Insurance coverage

As with most healthcare services, coverage varies significantly between states and insurance providers. Some states allow insurance policies to omit coverage for important services for transgender individuals, such as “sex reassignment surgeries.” HealthCare.gov recommends carefully checking the wording of your health insurance contract for terminology such as “transgender” or “gender/sex change,” as well as any variations and truncations (e.g. “trans”). You may also choose to apply for preauthorization with your insurance company for any transition-related services just to make sure your plan covers them.

Tips for advocating for coverage

Healthcare coverage for transgender individuals continues to expand each year, but some plans may illegally discriminate. Knowing your rights may be critical to ensuring you receive the care you are entitled to. One is the right to file an appeal if your insurance company refuses to pay a claim or ends your coverage due to medically necessary transgender healthcare. 

Resources for navigating insurance challenges

An insurance company that excludes transgender health services is likely engaging in unlawful sex discrimination, as healthcare laws prohibit discrimination based on sex for specific health programs and activities.

If you experience discrimination, file a complaint with your state’s Department of Insurance or email the Centers for Medicare & Medicaid Services. If possible, speak with an attorney to help navigate this process, especially if you feel the discrimination is illegal.

Advocating for your health

Advocating for your health is essential for receiving the care and respect you deserve. By taking an active role in your healthcare, you’ll assert your rights and find providers who support your identity.

Self-advocacy tips

  • Stand up for yourself by asserting your right to receive the healthcare you are legally entitled to.
  • If you feel comfortable doing so, state your preferred pronouns and name.
  • Bring a friend or family member to the appointment if you have trouble speaking up for yourself. 

Overcoming barriers to care

Barriers to health care for transgender people may be individual (e.g., limited financial resources, lack of access) or organizational (e.g., discrimination, health system barriers). If you experience such barriers, don’t be afraid to switch providers to find one that affirms your gender. 

Asserting your rights in healthcare settings

Don’t feel you need to advocate for yourself alone. Some patient advocacy programs offer assistance specifically tailored to transgender patients navigating the healthcare system.

Mental health

Although the entire LGBTQ+ community faces discrimination, the additional challenges associated with being transgender may result in mental health disparities. Internalizing societal gender expectations may cause transgender individuals to be uncomfortable with their gender identity. These struggles lead to depression rates that are significantly higher than those of the general population.

Addressing stigma and discrimination

Although some of the causes of mental health struggles are internal, most are external and related to discriminatory acts perpetrated by people with anti-trans prejudices. 

Addressing anxiety and depression

The stigma and discrimination that comes from being a transgender individual lead to higher levels of anxiety and depression than in the general population and even within the broader LGBTQ+ community. 

Seeking professional help

You may feel uncomfortable with an in-person visit if you’ve experienced discrimination in a healthcare provider’s office. Telehealth visits may be a great first step in seeking gender-affirming care, as you can receive the visit in the comfort of your own home. Plus, becoming comfortable with a new healthcare provider may be easier over the Internet. Once you feel comfortable with the provider, you can move to in-person visits if such a need arises. 

Finding a telehealth provider with a physical location near you may be best. Then, if an in-person visit is necessary, it will be feasible. It’s also important to find a therapist who understands multiple intersecting identities, such as queer and trans people of color. 

Importance of support networks

Support networks play a vital role in the mental and emotional well-being of transgender individuals by ensuring they have a safe space to express themselves and receive guidance.

Building a supportive network

Transgender people who are further along in their transition journey are excellent sources of wisdom and information about what to expect during gender-affirming care. Plus, those who are further along in their transition journeys may find it fulfilling to mentor and guide people who are just beginning their transition.

Building affirming relationships

You deserve healthy relationships that make you feel secure and independent. Coming out to friends and family is often one of the most challenging parts of the transition journey. Finding the right partner and friends to support you may take time and may mean you need to form new relationships.

Finding community resources

Finding a community you feel comfortable in is crucial for a sense of belonging and validation. Online communities on social media, in-person support groups, and LGBTQ+ events are all great options for finding a community you feel a part of. 

It’s important to set firm boundaries with people in your life. It’s equally important to understand that these boundaries may shift over time as you become more comfortable with your gender identity. Let people know what pronouns you prefer, as well as your preferred name.

Addressing relationship challenges

Not everyone will be equipped to handle their partner’s transition journey, and that’s fine. You should be with a partner who affirms your gender identity. Sometimes, this means a breakup is necessary. Although it will initially be painful, it is important you are with a partner who makes you feel safe and secure.

Building self-confidence and respecting your identity

Throughout your gender-affirming journey, you may experience resistance and macro/microaggressions. These encounters may lead to negative self-talk that, if left unchecked, may cause you long-term distress. Rejecting these negative narratives and asserting your gender identity will help you maintain your authenticity while building your resilience to similar situations. 

Strategies for self-care and self-compassion

Treating yourself with compassion and kindness shifts negative thoughts about feeling unworthy. Some strategies for coping include:

Strategies for maintaining self-esteem and resilience

A good start is to realize that every emotion you experience regarding the challenges you face as a transgender person is valid. Building and maintaining self-esteem and resilience to these challenges will help you feel more comfortable with your authentic self. Mindfulness, meditation, and therapy are great ways to cope with challenges and build resilience.

Handling invalidation and microaggressions

Misgendering will likely happen at some point during your gender-affirming journey. Although it may be an awkward and demoralizing experience, it does not change who you are. If you’re comfortable doing so, correct the person immediately or later in private. You may need to be more firm with the person if it happens repeatedly. It may be helpful to explain how the experience made you feel and why it hurt you. When correcting someone who has misgendered you, always put your safety first.

Coping with gender dysphoria

Gender dysphoria is a feeling of discomfort in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. Transgender individuals might experience gender dysphoria, whereas others may feel comfortable with their sexual characteristics. This means some individuals will require medical intervention, whereas others may not.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) says gender dysphoria is when a person exhibits two or more of the following: 

  • A marked difference between experienced gender and primary and/or secondary sex characteristics. In adolescents, this includes a strong feeling of difference from their anticipated secondary sex characteristics.
  • A strong desire to be rid of primary and/or secondary sex characteristics because these are at odds with the person’s experienced/expressed gender. This manifests in adolescents as a desire to prevent the development of their secondary sex characteristics.
  • A need for the primary and/or secondary sex characteristics of the other gender.
  • A desire to be of a gender different from the one assigned at birth.
  • A desire to be treated as a gender different from the person’s assigned gender
  • Having feelings and reactions more closely associated with a gender different from the person’s assigned gender.

Healthcare providers have learned that individuals require tailored treatment approaches, which may involve some combination of hormone therapy and surgery to alleviate gender dysphoria. Other individuals may need only one or neither of these treatments.

Coping mechanisms and self-care strategies

Coping with gender dysphoria can be a deeply personal experience. Developing effective coping mechanisms and self-care strategies is essential for managing the stress and discomfort associated with gender dysphoria. Here are some practical coping mechanisms and self-care strategies to help alleviate the distress of gender dysphoria and foster a sense of acceptance:

  • Wear gender-affirming clothes
  • Use gender-affirming products
  • Use gender-affirming language
  • Engage in voice training

Physical health

Taking care of your physical health is important for your overall well-being. For transgender individuals, proper health care helps align physical appearance with gender identity, improving mental and emotional health. Accessing the right medical treatments (like hormone therapy) and understanding the risks and benefits of these treatments are important steps in this process.

Hormone therapy

Gender-affirming hormone therapy (GAHT) plays an important part in gender-affirming care for more than 80% of transgender people. GAHT is either masculinizing or feminizing. Feminizing hormone therapy involves taking testosterone blockers as well as estrogen, whereas masculinizing hormone therapy involves taking testosterone. For transgender youths, it may be possible to delay puberty by taking puberty blockers.

Risks and benefits

As with any medical intervention, hormone therapy has risks and benefits. 

Risks:

  • As with cisgender men, transgender men will likely experience some form of hair loss on their heads. Hair loss treatment may involve finasteride, dutasteride, minoxidil, or even hair transplants. 
  • It takes time to see the full effects of hormone therapy. Some patients may think that taking a higher dose will accelerate the process. However, doing so may not provide faster results and may endanger your health.

Benefits:

  • Bringing your physical appearance in line with your internal gender identity may improve your mental health, including a reduction in anxiety and depression.
  • Helps prevent menopause-like symptoms as people with ovaries age.

Accessing hormone therapy

In-person visits are generally preferable when accessing hormone therapy, as this gives your medical provider the chance to make a full assessment. However, if you cannot travel to a physical location, telemedicine appointments may be an option to receive HRT prescriptions and refills.

Sexual and reproductive needs

Sexual health considerations will depend on transgender individuals’ gender identity and age, as well as which reproductive organs they have. For example, transgender men receiving hormone therapy may still become pregnant. Condom use plays an important role in preventing the transmission of STIs and unwanted pregnancies. Other contraception methods include pills, coils, and injections.

Fertility preservation options

Although both surgical and hormone gender-affirming care may affect your fertility, it doesn’t mean you’ll never be able to have children. Reproductive health experts can work closely with you to discuss your options for preserving your fertility, which may include freezing:

  • Ovarian tissue
  • Embryos
  • Oocytes (eggs)
  • Sperm

Reproductive health services

Transgender individuals require personalized reproductive health care that depends on their surgical history and goals. For example, transgender individuals require gynecologic care if they have retained their cervix, fallopian tubes, ovaries, or uterus. 

Regular health screenings

Preventive care screenings are just as important for transgender individuals as they are to the broader population. Individuals require a unique approach to preventive care depending on factors such as the sexual organs they have. Informing your primary care provider of any gender-affirming procedures you’ve had will help determine which screenings and check-ups are necessary.

  • Pelvic exams
  • Bone density scans for patients who have had their ovaries or testes removed and have not been on hormone therapy
  • Breast cancer screenings (mammographies)
  • Cardiovascular screenings, due to a higher risk of stroke and heart attack 
  • Cervical cancer screenings (pap smears)
  • Sexually transmitted infection (STI) screenings
  • Contraception counseling

Gender-affirming surgery and procedures

The length of a gender-affirming journey differs for each person and depends on individual needs and desires. Not every individual wants or needs all the procedures discussed in this section. A medical professional who is well-versed in transgender health issues will help you figure out where to begin and which treatments are ideal for meeting your goals.

Gender-affirming medical care is a multi-disciplinary approach that includes both surgical and non-surgical procedures. Many patients will require surgery to bring their body image in line with their internal gender identity, but non-surgical procedures also play a role in this process. Each procedure comes with risks and benefits. Transgender individuals should speak with their healthcare provider to gain a complete understanding of what to expect.

Non-surgical

Hair removal 

Hair removal plays a major role in helping transgender individuals express their gender identity and may even help improve mental health outcomes. Unwanted hair is typically removed by laser hair removal or electrolysis. 

Voice therapy

Treatments to help your voice match your identity may be an important part of asserting your identity. Voice therapy focuses on making your voice sound more feminine, masculine, or gender-neutral, depending on your goals. Since it is reversible, it carries a much lower risk than voice surgery, meaning pursuing this option before permanent voice surgery is recommended.

Facial feminization and masculinization procedures

As surgical procedures are expensive, permanent, and require downtime, many transgender people first opt for non-surgical procedures. These are temporary and reversible, allowing patients to preview how their appearance may change after a more invasive, permanent surgery. Dermal fillers are a common non-surgical option and typically require maintenance once or twice per year.

Surgical

Top surgery

Depending on your goals, top surgery may involve removing or augmenting breast tissue as well as surgery to contour the nipples. After being removed, breast tissue does not grow back. Such procedures are typically performed under general anesthesia as outpatient procedures that require only a few hours to complete, but it may take up to six months for swelling and scars to improve.

Bottom surgery (genital reconstruction and orchiectomy)

Bottom surgery refers to feminization and masculinization procedures that transform or reconstruct reproductive organs. Not every transgender individual receives these procedures—only 4% to 13% of transgender men and women elect to have them. 

Facial feminization and masculinization surgery

Both facial feminization and masculinization surgical procedures involve reshaping the bone structure of a person’s face. Facial feminization procedures produce features such as a smaller Adam’s apple, a more rounded jawline, and a lower hairline. Facial masculinization procedures may produce a larger, more pronounced Adam’s apple or more angular jawline.

Voice surgery

Gender-affirming voice surgery focuses on changing the pitch of your voice. As this surgery permanently changes your voice, you may wish to attempt voice therapy first. Speaking with a speech-language therapist will help you understand your options. 

Body contouring surgery

After other gender-affirming surgeries and non-surgical procedures, some transgender individuals may want body contouring to make their body shape more fully match their gender identity. This type of surgery involves changes to the skeletal structure and soft tissues and is performed on various parts of the body, including the chest and thighs. Common procedures include liposuction to redistribute fat, as well as tummy tucks and thigh lifts. 

Tracheal shave

Patients desiring a more feminine appearance who want to reduce the size of their Adam’s apple undergo a tracheal shave procedure. 

Understanding your healthcare rights

Healthcare laws are constantly changing concerning transgender patient rights. Currently, many state and federal laws provide protections to members of the transgender community, such as the right to privacy under the Health Insurance Portability and Accountability Act (HIPAA). This act protects the privacy of medical information, including information related to a person’s status as a transgender individual, preventing a provider from revealing such information unless there is a valid reason for doing so.

Facing healthcare discrimination

Discrimination against transgender individuals in healthcare settings comes in many forms, some of which may not be immediately obvious. Recognizing discrimination (PDF) is the first step in stopping it from happening. Discrimination may include:

  • Refusing to treat you
  • Encouraging/forcing you to undergo conversion therapy before allowing you to receive medical treatment
  • Using your incorrect pronouns and name
  • Refusing to provide you with services provided to other patients
  • Harassing behavior of any kind by the providers or their staff

Going into a healthcare appointment armed with knowledge of what discrimination looks like will help you address it more quickly. Make sure you document every instance of discrimination you experience, as this will be helpful if you decide to file a complaint. Depending on its severity, you may be able to address these issues yourself, or you may require the services of a legal organization or lawyer to obtain a resolution.

If you feel you’ve been the victim of discrimination because of your gender identity, you may be able to sue a provider or healthcare company. In this case, it’s best to approach a lawyer well-versed in transgender issues and let the law firm handle your case instead of attempting to address it yourself. Not all issues will require a lawsuit—your lawyer may be able to resolve the issue by simply informing the organization of its legally mandated obligations to you.

Protection laws

A combination of federal and state laws have been passed to protect transgender individuals seeking gender-affirming medical care. In terms of federal protections, laws that protect transgender individuals in other situations have been extended to also apply in healthcare settings. A variety of states have “shield” laws that protect transgender individuals if officials from their home state try to extradite them based on charges for receiving treatment in another state where gender-affirming care is legal.

Advocacy opportunities

Many transgender individuals find meaning and fulfillment in advocating for their community. Those who are further along in their transition journey can advise someone else going through the same process. Various transgender advocacy groups list ways you can help on their websites, such as the National Center for Transgender Equality.

Advocacy groups for transgender individuals with multiple intersecting identities:

Resources

Government agencies

Mental health resources

Hotlines

  • The Trevor Project includes a 24/7 hotline for LGBTQ+ individuals needing immediate crisis support at (866) 488-7386.
  • TransLifeline at (877) 565-5560.

Support groups

Counseling services

Online resources for mental health support

Insurance resources

Guides for understanding insurance coverage

RELATED: Does Medicare cover hormone replacement therapy?

Assistance programs and advocacy groups

Tips for navigating healthcare expenses

  • Use in-network providers when possible
  • Seek telehealth providers if you are unable to travel
  • Get prior authorization for surgeries to ensure coverage

FAQ

How do I know what procedures are right for me?

The answer to this depends entirely on you and your goals. Talking with a therapist and provider may help you decide which gender-affirming procedures will ensure your external appearance matches your internal gender identity.

Where can I find transgender-friendly healthcare providers?

The easiest way is to search online directories for vetted transgender-friendly providers. You should also talk with friends or contact local LGBTQ+ centers for recommendations.

What if I regret my procedures?

The vast majority of transgender individuals who have undergone gender-affirming surgeries do not regret them. However, in patients who do have regrets, these are most commonly due to unrealistic expectations, according to the Gender Confirmation Center. By discussing your specific desires and goals with your surgeon and a therapist, you will have a better idea of what to expect and how to manage your expectations. 

What do I do if I’m not comfortable revealing my gender identity to a provider?

To offer the best medical care, your healthcare provider needs to have a comprehensive understanding of your health. Whereas not every appointment will necessarily benefit from you revealing your gender identity, in some cases, you may not even realize it is important. Talking to friends and using the resources above are great ways to find a provider you feel comfortable with.

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