Gender Affirming Care

A Brief Overview

  • Sex and gender are separate, but related concepts.
  • Transgender and gender diverse individuals have special health care needs, but are the most likely to be dissatisfied with their health care or avoid medical care.
  • Gender affirming care is about knowledge and understanding, which can lead to better health care outcomes for individuals who are transgender or gender diverse.

Gender identity has become a hot topic in today’s political world. But beyond the politics, there are many young people that are struggling and often it is their physical and mental health that suffers the most from the misunderstanding between sex and gender, and the meaning of gender affirming care.

What is the difference between sex and gender?

Sex is determined by chromosomes passed down through genetics, with XY being male and XX being female. These chromosomes are responsible for the majority of our sexual-based differences, including genitals and hormones.  Most people are born with either XY or XX but not everyone is.

Gender, on the other hand, is a ‘social construct’ based on an individual’s apparent sex. Gender refers to an expressed societal norm often attached to a person’s sex, so a person with XX chromosomes would be expected to be feminine. For centuries, the English words sex and gender have been used interchangeably, so female and woman meant essentially the same thing.  Modern sociologists and psychologists state that although these terms are tightly bound together, they are not synonyms

Individuals who have a gender in alignment with their biological sex chromosomes are known as cisgender, while those whose gender is different than their biological sex chromosomes are known as transgender. Individuals whose gender does not fit neatly in either category are known as non-binary, genderfluid, or genderqueer, and are often referred to as gender diverse.  Some societies, including several Native American/Native Alaskan communities, recognize a third gender. Two-Spirit is a common term used in many indigenous communities throughout the Americas that encompasses cultural, spiritual, sexual, and gender identity.

What health care issues are there for individuals who are transgender or gender diverse?

Transgender persons are more likely to need some specialized care than their cisgender peers. Healthcare issues that disproportionately effect the trans community include sexually transmitted infections, depression, and substance use. These healthcare issues/needs are not solely due to the person being transgender but due to societal and medical ignorance and/or discrimination. Medical interventions can lessen the impact of these health issues, if an individual can find medical experts that they trust.

Transgender and gender diverse individuals are often more hesitant to go to a doctor because of perceived prejudices or past negative experience with doctors. According to the National Institute of Health, “Transgender men and women had the highest prevalence of being “not at all satisfied” with the healthcare they received.” In another survey, 29.3% of transgender and gender-diverse individuals said that they had experienced health care discrimination, and 21.6% postponed care due to fear of discrimination. This hesitancy to visit medical providers can result in the lack of preventative, and even emergency care, and negatively impact the healthcare and quality of life of transgender and gender diverse individuals.

The belief that medical personnel are not well equipped to deal with transgender patients is also felt by providers. While only around 10% of emergency department trainees surveyed felt uncomfortable treating trans patients, only 55.7% felt well prepared in attending to their transgender patient’s needs. Experts on transgender health believe that the best way to combat prejudice and lack of knowledge is through gender affirming care.

What is gender affirming care?

Despite what some political and media personalities may maintain, gender affirming care is concerned with the entirety of a person who is transgender or gender-diverse and is not wholly focused on hormones and gender-affirming surgeries.

The Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 describes the goals of transgender health care services: “The goal of gender-affirming care is to partner with TGD [Transgender and Gender Diverse]  people to holistically address their social, mental, and medical health needs and well-being while respectfully affirming their gender identity. Gender affirming care supports TGD people across the lifespan—from the very first signs of gender incongruence in childhood through adulthood and into older age—as well as people with concerns and uncertainty about their gender identity, either prior to or after transition.”

What does gender affirming care look like for those under 18?

For most pediatricians, gender affirming care revolves around asking a child’s pronouns, and using those pronouns when talking to them. An awareness of disproportionate health issues, including risks to mental health, is important as well.

In some instances, puberty suppressants or hormones may be given to children or teens, but only after several visits and consultations with psychologists. Gender affirming surgeries are almost never performed on individuals under 18 years old. It is the knowledge and acceptance of a medical professional that makes the health care they provide gender-affirming.

Findings suggest that having a transgender-inclusive provider is associated with decreased rates of depression and suicidality. The Association of American Medical Colleges quotes one physician as stating “‘Most of them are happier, less depressed, and less anxious,’ says Adkins at the Duke Child and Adolescent Gender Care Clinic. “Their schoolwork often improves, their safety often improves.’”

While is illegal in Washington to deny care based on gender identity, it still may be difficult to find a healthcare provider that is transgender friendly. Word of mouth from other individuals who are transgender or gender diverse can be a great start. There is also an online LGBTQ+ Healthcare Directory which can be of assistance.

Additional Resources:

Gender Affirming Medical Coverage Rights – Both state law and the federal Affordable Care Act prevent health insurance companies from discriminating against someone based on their gender identity and related medical conditions. These rights apply to youth and adults.

Lavender Rights Project – Lavender Rights Project elevates the power, autonomy, and leadership of the Black intersex & gender diverse community through intersectional legal and social services

National Center for Lesbian Rights (serves all LGBTQIA+ identities) – NCLR is a national legal organization committed to advancing the civil and human rights of lesbian, gay, bisexual, and transgender people and their families through litigation, legislation, policy, and public education.

Seattle Children’s Gender Clinic Patient & Family Education – Includes resources for working with Seattle Children’s and general education documents regarding gender affirming care.

LGBTQ+ and Disability Rights in School

A Brief Overview

  • Youth and young adults with disabilities may also have diverse sexualities and gender identities.
  • Students can experience discrimination based on disability, and face discrimination based on sexual orientation, gender identity, and gender expression.
  • LGBTQ+ is an acronym that stands for lesbian, gay, bisexual, transgender, queer (or sometimes questioning), and others. The “plus” represents other gender identities including pansexual and Two-Spirit.
  • LGBTQ identities are NOT disabilities, but students with disabilities
  • may also be LGBTQ+.
  • LGBTQ+ youth with disabilities report high rates of harassment and are more likely to be bullied or harassed than students without disabilities.
  • Race, ethnicity, nationality, disability, sexual orientation, gender identity, and gender expression are all protected classes under Washington law.
  • PAVE’s Parent Training and Information (PTI) staff help families understand and navigate service systems for children 0-26. Click Get Help on the PAVE website or call 800-572-7368.

Full Article

LGBTQ+ is an acronym that stands for lesbian, gay, bisexual, transgender, queer (or sometimes questioning), and others. The “plus” represents other gender identities including pansexual and Two-Spirit.

Youth and young adults with disabilities may also have diverse sexualities and gender identities. LGBTQ+ identities are NOT disabilities, but students with disabilities may also be LGBTQ+. The prevalence of disability among LGBQT+ youth is not clear, but research is emerging. The Human Rights Campaign (HRC) Foundation 2018 LGBTQ+ Youth Report surveyed over 12,000 LGBTQ+ youth aged 13-17 from across the United States. One in seven (15%) LGBTQ+ youth said they had a disability. A 2020 Trevor Project survey found that 5% of LGBTQ+ reported having deafness or a hearing disability, whereas a 2021 Trevor Project survey found that 5% of LGBTQ+ youth were diagnosed with autism.

Discrimination often refers to a person or a group of people being treated differently because they belong to a protected class. According to the HRC, “For LGBTQ+ youth with a disability, stigma associated with their intersecting identities places them at even more risk for bullying and harassment. More than one-third (36%) of disabled LGBTQ+ students say they have been bullied or harassed in school because of their disability, while three in ten (30%) say they have felt unsafe at school because of their disability.”

Washington is one of only 19 states that explicitly protects LGBTQ+ students in public schools from discrimination based on sexual orientation, gender identity, and gender expression. Washington also has laws to protect students from discrimination based on disability.

Effective January 31, 2020, all districts in Washington must have a policy and procedure that includes all elements of Washington Association School Board Directors Association (WSSDA) model policy for gender inclusive schools and procedure (numbered 3211 and 3211P, respectively). Gender-inclusive schools benefit all students, help to equalize student experiences and outcomes; and prioritize student health, safety, and wellbeing.

The HRC, National Association of School Psychologists, National Association of Secondary School Principals, National Center for Lesbian Rights, and the National Education Association produced a Guide for Educators and Parents/Guardians on Supporting LGBTQ Students with an IEP or 504 Plan. This guide emphasizes that “Ideally, students should be allowed access to needed resources, services, restrooms and locker rooms without such access being written into a Section 504 Plan or IEP, but there are times when including specific provisions about equal access may be necessary to ensure that students are able to access school programs and facilities and benefit from classroom instruction.”

If you are concerned about your child’s rights in school:

Additional Resources:

Resources for LGBTQ+ People Living with Disabilities: