Unfortunately, transgender healthcare is often not covered by private insurance. However, under the Affordable Care Act (2010) any federal funded insurance programs cannot discriminate against transgender policy holders. Some private insurance corporations do cover trans-related care, either in part or in full. Contact your insurance provider to find out what is or is not covered by your policy. Learn more about your healthcare rights here.
Finding A Healthcare Provider
The relationship between any healthcare provider and the patient is very important, and it is essential that patients feel respected and affirmed by their healthcare provider. Unfortunately, many healthcare providers (even therapists) are not trained or have much experience with working with LGBTQ+ patients and may not be affirming. In order to reduce the negative effects of non-affirming care, here are some resources to find an affirming provider.
Nationwide Directories of LGBTQ+ Affirming Healthcare Providers
Unfortunately, there is not a comprehensive list of all therapists and doctors who are knowledgeable about working with trans patients. Here are several things you can do to find out. First, do a web search to see if any trans health or LGBTQ+ specific health care providers exist in your area. This is the easiest, and the rarest, way to find a provider. Second, check the websites of doctors or therapists in your area. Under doctor or therapist bios there should be a description of the specialty areas. Anyone specializing in LGBTQ+ healthcare should be a safe bet. Finally, you can contact any practice as specifically ask if any of their clinicians specialize or are familiar with working with LGBTQ+ patients. You can even be more specific and ask if they have experience working with transgender patients. Unfortunately, trans healthcare is still in its infancy, and you may have a hard time finding competent and compassionate clinicians, especially in rural areas. Here are some places you can check
Questions to Ask a Prospective Healthcare Provider
- Do you support lesbian, gay, bisexual, transgender people and their relationships?
- What type of professional education do you have in working with LGBTQ+ patients?
- What kind of training have you had in working with the LGBTQ+ population?
- What is your experience working with LGBTQ+ patients?
- What is your experience working with transgender/gender creative/gender nonconforming clients?
- What kind of training have you received on gender identity?
- Are you familiar with the WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People?
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) is a common appropriate clinical treatment as defined by WPATH. HRT is a combination of different prescription hormones which help to give transgender folk the secondary sexual characteristics of their gender.
Transgender Women: take a combination of androgen blockers, estrogen, and progesterone. Everyone is different, and there is no standard timeline for what will change and when. Taking higher doses of hormones will not necessarily speed up the process, and in some cases will do more harm than good. Generally, you can expect to see breast growth (up to tanner 4), skin changes (thinner, softer), hot flashes and headaches (short-term side effects), body fat redistribution to hips, thighs, buttocks, and face, body hair thinning and slower growth, decrease in muscle size, and moodiness and emotional fluctuation (think a second puberty). You will also be rendered infertile, so consider your desires to reproduce before beginning HRT. Find more information here.
Transgender Men: take testosterone. Find more information here.
If HRT is undertaken prior to puberty, transgender youth will not develop the secondary sex characteristics associated with their sex assigned at birth. Find more information about trans youth health here.
These hormones are prescription drugs which should be obtained from a qualified physician or nurse practitioner. While you could obtain them online, doing so is legally dubious and can be harmful to your health. Some providers will required that you receive a note from a therapist. Often this is just a technicality which is common for many major medical therapies. Other providers operate under an informed consent model, meaning they believe that patients can make the right decision for them with all the facts. You should find out from your provider what their requirements are.
Gender Affirming Surgeries
There a a number of gender affirming surgeries (also known as sexual reassignment surgery or gender reassignment surgery) which can be performed in order to help transgender folk feel more themselves. Not all transgender people choose to have these surgeries, and it is up to each transgender person to to decide if surgery is best for them.
Transgender Women (MtF)
- Orchiectomy: removal of the testicles
- Tracheal Shave: reduces cartilage in the throat to make the appearance more feminine
- Breast Augmentation: implants and/or fat grafting to create female breasts, optimizing for size, shape, and texture
- Buttock Augmentation: implants and/or fat grafting to alter the size, shape, and texture of the buttocks
- Facial Feminization Surgery (FFS): is a set of surgical procedures that makes face look more feminine.
- Body Sculpting: provides the desired feminization of the body
- Hair Grafting: augments female-pattern body hair developed with hormone therapy
- Clitoroplasty: creation of a clitoris
- Labiaplasty: creation of labia
- Urethroplasty: reconstruction of the urethra
- Vaginoplasty: reconstruction of the penis into a fully-sensitive vagina.
Transgender Men (FtM)
- Mastectomy: removal of breasts
- Hysterectomy: removal of the uterus
- Oophorectomy: removal of the ovaries
- Salpingectomy: removal of the fallopian tubes
- Vaginectomy: removal of all or part of the vagina
- Hair Grafting: augmentation of male-pattern body hair developed with hormone therapy
- Facial Masculinization Surgery (FMS): changes the feminine features of a female face to be more masculine
- Body Sculpting: enhance the appearance of the body to have more masculine feature
- Scrotoplasty: creation of a new scrotum
- Glansplasty: construction the glans penis, the sensitive and bulbous structure at the tip of the penis
- Urethroplasty: reconstruction of the urethra
- Penile Implant: insertion of a prosthetic substance that will serve as a replacement for the spongy tissue inside a penis that normally fills with blood during an erection
- Metoidioplasty: moves the clitoris into the approximate position of where a penis would be
- Phalloplasty: construct, enlarge, or repair the penis
Transgender individuals have very unique sexual healthcare needs. Often, it is necessary for transgender folk to have annual checkups which are associated with their sex assigned at birth. This does not make you less of a man or less of a woman. It is important for you to care for the body you have, and affirming providers will approach these exams with respect and compassion. Check out these resources from the UCSF Transgender Health Center for trans women and trans men.
It is possible to transgender folk to have affirming sexual relationships. However, transgender individuals are disproportionately more likely to be sexually assaulted, abused by their partners, and contract STIs. A key reason for these disparities are barriers to healthcare and a fear of talking to providers about sexual health issues. Check out the resources below to learn more about protecting your sexual health and enjoying affirming sex:
Fertility & Reproduction
It is possible for transgender folk to have children of their own without adoption. Learn more about reproduction here.
Of course, not having children is also okay! Depending on your sexual practices, you may need to consider birth control.
Transitioning can be a hard experience for everyone involved. If you ever feel overwhelmed and in need of help, visit our crisis resource page.