Bridging the Gap: Creating Gender Affirming Care by Us for Us
Uncertainty caused by executive orders, closures of programs in hospitals, and the heightened transphobia occurring in everyday life make the future of gender-affirming care (GAC) feel in doubt. GAC isn’t just hormone replacement therapy (HRT); it includes access to affirming health spaces where identities are respected and cared for, mental health support, substance/addiction treatment, puberty blockers, voice therapy, resources for social transitioning, and much more. We, as trans people, understand how life-saving it is to have access to all these services. The Williams Institute found that a majority of GAC providers are cisgender, which can create a wall of separation between these doctors and their patients. There needs to be more ways to support more transgender people to enter this line of work to alleviate the disconnect. Closing this gap will improve outcomes for transgender patients, as transgender and non-binary GAC providers can see themselves in the care they provide.
Research shows that Black, Indigenous, people of color (BIPOC) patients are more comfortable with BIPOC doctors compared to white doctors. This ease is created through engaging in higher-quality communication and focusing on patient engagement and their needs. Having the comfort of a shared identity extends to transgender and non-binary patients when their provider is another transgender person. This can be due to transgender providers not asking uncomfortable (and many times blatantly transphobic) questions, better engaging with the patient to meet their healthcare goals, and thoroughly explaining treatment plans. From my own experience, it makes a big difference to have a trans provider when starting GAC. They are more likely to take the time to explain each available path, provide tips and tricks for medication, readily write appropriate referrals, and ease the worries about the process.
As part of a volunteer clinic team, I unfortunately saw a doctor insistently ask unnecessary questions and order tests that cause extreme discomfort and dysphoria. As our team debriefed about it later, I realized that it would take me, as a transgender person advocating for another transgender person, to find resources that would prevent this situation from happening again. This experience, so early in my career, reinforced how meaningful it can be for a transgender patient to have a transgender person on their care team.
There are barriers outside of the clinic and politics that are not often highlighted. These barriers include housing status, navigating insurance approvals/denials, access to a phone, and substance use. Substance use, tobacco use specifically, is a disqualifier for getting access to top and bottom surgery due to smoking inhibiting blood flow, making it harder for the body to heal, and risking complications to the surgery. This barrier can be devastating after putting in the work to find a provider, just to be told you can’t access it while smoking. Therefore, having a provider acutely aware of the barriers trans people face when receiving care is important, as they will guide patients through different LGBTQ+ competent resources and how to navigate the different barriers.
At a time where GAC is being limited in every direction–clinics scaling back or shutting down services, providers leaving the practice out of fear, and critical research being defunded–we have to think intentionally about the future of this care and who will be there to provide it. We have to think about closing the gap between transgender people who want to serve the community and the medical system providing GAC. That includes making real investments in the people entering medicine now and creating pathways for transgender people looking to serve our communities through gender-affirming care. This can look like providing more scholarships for the transgender community to pursue higher education, creating mentorship programs between transgender providers and those looking to get into GAC, safe spaces where providers can debrief and share resources, and paid opportunities (like companions, scribes, medical assistants) to start their work in the field.
As we look toward the future of gender-affirming care, we need providers who are equipped to care for every patient with dignity and respect, regardless of identity. We also need to make space for transgender people who feel called to this work. For those of us who want to enter the field of GAC, that path should be protected, supported, and expanded. Because the future of this care depends not only on preserving access, but ensuring the people providing it understand what is at stake and are informed on what affirming care truly means.
Bio: River Wu (they/he) is an Asian transmasc person studying Human Biology at UCLA. They plan to attend medical school to specialize in gender-affirming care. River is currently interning with We Breathe, a program of the California LGBTQ Health and Human Services Network, hoping to uplift queer voices, especially those from the TGI (Transgender, Gender Non-Conforming, Intersex) community, to emphasize that we are not alone in our struggles and we will stand together in solidarity, no matter the circumstances.