When a person’s gender identity doesn’t match their assigned sex at birth, they may need gender-affirming care. But what does that mean?
“Many people think of gender-affirming care as just starting hormonal therapy, but it’s so much more,” says Natasha Ramsey, MD, MPH, a pediatrician and adolescent medicine at Columbia University’s Vagelos College of Physicians and Surgeons. Medically necessary, evidence-based, gender-affirming care helps a person whose gender identity is not the one assigned at birth is confirmed in a way that is meaningful to him or her.
What is Gender Affirming Care?
Gender affirmative care comes in many forms. “When we talk about gender-affirming care, we’re talking about a wide variety of social, psychological, behavioral, and medical options designed to support and affirm one’s gender identity,” Ramsey says.
- Recognizing a person’s gender identity and using the correct pronouns
- Correct pronouns make people feel comfortable and safe
- What if you are not sure of someone’s gender? Use them instead of him or her. Or ask what they want to be called
- Don’t make assumptions about someone’s sexual orientation or sexual activity
- Using gender-inclusive language and terms
- Example: “freshman”, not “freshman”
- Displaying medical office signs and health information so people know they are safe
- Recognizing that not every patient desires medical or surgical intervention
“Gender affirmative care also includes connecting patients and their parents with support groups and legal services to assist with changes in legal documentation,” Ramsey says.
Youth and Gender Affirming Care
Studies show that it is important for children as young as 4 years old to have a stable sense of their gender identity. Adolescence and young adulthood (11 to 25 years) is also a critical time. During this period of life, physical and psychological development takes place. People discover who they are. Accordingly, Ramsey says, “Young people whose gender identity is not confirmed by their community, family or friends are at high risk for depression and suicide. This is a population of patients who need support and care.”
Restricting or prohibiting access to all forms of care for gender-diverse adolescents and young adults can harm mental health.
Gender-affirming care is essential for mental health
Because of stigma, discrimination and limited social support, transgender and non-binary youth often experience mental health problems and have high rates of self-harm and suicide. They are at increased risk for depression, suicide, homelessness, sexual behavior that puts them at high risk for negative health outcomes and legal problems.
Studies show that gender-affirming care improves well-being and reduces negative mental health outcomes.
“Being seen for who you are is a critical part of your well-being,” says Ramsey. “Being transgender, gender-expansive or gender-non-binary in itself is not a risk to mental health or a reason to take more risks in life. It is repeatedly unconfirmed in gender and unprovided care that puts people at risk. For this reason, gender-affirming care is life-saving.”
Gender Confirming Medical Options
“Gender affirming care should be tailored to a person’s goals and circumstances,” Ramsey says. “There’s not one way to confirm someone’s gender identity, it’s really up to them.”
For people who want gender-affirming medical care, Columbia pediatricians can help. Choosing and undergoing an intervention is determined by each patient and their care team. Options include:
- Learning safe ways to change appearance and express gender identity
- Reversible puberty blockers before puberty is complete to prevent changes in the body, such as voice deepening and breast development
- Testosterone to Reduce the Effects of Estrogen
- Intervention to suppress menstruation, such as hormonal intramuscular injections, tablets or intrauterine devices.
- Laser hair removal
- voice training
“We welcome children and their families and guardians, wherever they are, to receive gender-affirming care from our extraordinary teams,” said Jordan Orange, MD, PhD, chair of pediatrics at Vagelos College of Physicians and Surgeons. “Our commitment – to the priorities of inclusion, safety, best practices and understanding – ensures the best outcomes for our children.”
For more information, make an appointment with an Adolescent Medicine provider on the Ambulatory Care Network of Columbia Doctors.