Transgender health care, is also known as gender-affirming care.
Gender affirming care includes the prevention, diagnosis and treatment of physical and mental health conditions, as well as sex reassignment therapies, for transgender individuals.
Gender variance is defined as gender identity, expression, or behavior that falls outside of culturally defined norms associated with a specific gender.
Gender variant behavior and preferences do not necessarily imply a medical diagnosis.
Some studies suggest that treating gender variance as a medical condition has negative effects on the health of transgender people and claim that assumptions of coexisting psychiatric symptoms should be avoided.
Other studies indicate that gender incongruence diagnosis may be important and even positive for transgender people at the individual and social level.
Sex reassignment therapy helps people to change their physical appearance and/or sex characteristics to accord with their gender identity: hormone replacement therapy and sex reassignment surgery.
Hormone replacement therapy is primarily concerned with alleviating gender dysphoria in transgender people.
Trans women are usually treated with estrogen and complementary anti-androgenic therapy.
This therapy induces breast formation, reduces male hair pattern growth, and changes fat distribution, also leading to a decreased testicular size and erectile function.
Trans men are normally treated with exogenous testosterone, which is expected to cease menses, to increase facial and body hair, to cause changes in skin and in fat distribution, and to increase muscle mass and libido.
After at least three months, other effects are expected, such as the deepening of the voice and changes in sexual organs such as atrophy of vaginal tissues, and increased clitoral size.
Transgender people may seek any one of a number of gender-affirming interventions, including hormone therapy, surgery, facial hair removal, interventions for the modification of speech and communication, and behavioral adaptations such as genital tucking or packing, or chest binding.
Lower quality research has found improvements in a range of psychosocial measures after gender-affirming treatments such as hormones or surgery.
Denial of access to gender affirmation is associated with high risk behaviors and increased rates of HIV infection.
Conversely, not all transgender people seek all interventions, and some may seek none.
Past practices set pathways involved a requirement of psychological assessment → hormones → genital surgery, the current standard of care is to allow each transgender person to seek only those interventions which they desire to affirm their own gender identity.
Gender-affirming hormone therapy is the primary medical intervention sought by transgender people.
Gender-affirming hormone therapy allows the acquisition of secondary sex characteristics more aligned with an individual’s gender identity.
A wide range of gender-affirming surgeries are available to the transgender: include surgeries specific to gender affirmation, as well as procedures commonly performed in non-transgender populations.
Surgeries specific to transgender populations:
Feminizing vaginoplasty
Masculinizing phalloplasty / scrotoplasty
Metoidioplasty (clitoral release/enlargement, may include urethral lengthening
Masculinizing chest surgery (“top” surgery)
Facial feminization procedures
Reduction thyrochondroplasty (tracheal cartilage shave)
Voice surgery
Surgeries not specific to transgender populations:
Augmentation mammoplasty
Hysterectomy / oophorectomy
Orchiectomy
Vaginectomy
Other interventions include:
Facial hair removal
Voice modification
Genital tucking and packing, and chest binding
In a Dutch study, adolescent transgender care with early treatment, puberty, blockers and gender altering hormones used those 16 years of age Involving 315 participants over 24 months participants reported, appearance congruence, positive effect and life satisfaction increases, and depression and anxiety decreases.