Health Care for Transgender and Nonbinary Adults

Most people are told they are a man or a woman (male or female) based on the genitals they were born with. This is the sex you are assigned at birth. For some people, that male or female label may not feel right.

Someone assigned female at birth may feel that they are really a male, and someone assigned male at birth may feel that they are really a female. People who feel this way are called transgender.

Some people may feel that they belong to neither gender or to both genders. People who feel this way are sometimes called gender nonbinary, gender fluid, or genderqueer. Some other terms may include androgynous, agender, gender neutral, and gender nonconforming.

It may be helpful to talk with a counselor, doctor, or other health care professional about your gender. You can talk with friends or join online communities of other transgender or nonbinary adults. There are also websites and hotlines where you can get information anonymously. They can help you educate your loved ones about what being transgender or nonbinary means. Read the Resources section below for details.

Trans-friendly doctors, including obstetrician–gynecologists (ob-gyns), and other professionals can help you

• find gender-affirming care (health care that supports your gender identity, such as medications that can stop your periods or help with a gender transition)

• get routine health care (including vaccines, screenings, and birth control)

• get documents for your workplace, college, or health insurance company that reflect your gender identity

• find information and resources near where you live

• figure out the best way to talk with your friends and family about your gender identity

The Resources section below has websites that can help you search for a trans-friendly doctor or other health care professional in your area. Your doctor may refer you to other professionals such as therapists and social workers to find help as well.

Gender dysphoria and gender euphoria describe two emotions related to gender identity.

Gender dysphoria is a feeling of discomfort or distress. You may feel this when your appearance does not match your gender. Or you may feel this when people treat you like a gender that is not yours.

Gender euphoria is a feeling of happiness and contentment. You may feel this when your appearance matches your gender. Or you may feel this when people acknowledge your true gender.

You may experience both or neither of these feelings.

A gender transition is a process you go through to express your gender. There are many ways people can transition, including

• changing how they dress or act

• changing their name and pronouns (she, he, they, etc.)

• taking medication (such as hormone treatment)

• having surgery

You can think about doing some, all, or none of these options. If you are interested in a medical transition, talk with your primary care doctor. They may ask you to see an ob-gyn or other health care professional. Health care professionals can help you transition safely.

Laws in some states may limit your doctor’s ability to talk with you about transitioning or offer you this care. If you can’t talk with your doctor, there are online resources that can help you find care. Read the Resources section below.

Remember, taking medical treatments from anyone without a medical license can be dangerous.

There are a few techniques people can use to change their appearance without surgery. For those assigned female at birth, these techniques include packing and chest binding.

Packing is using an item inside your underwear to simulate a penis. There are a wide range of packers, from do-it-yourself options like athletic socks to specially made prosthetic penises. There are not many risks to packing. Some people may have skin irritation from their packer or from tape that they use to attach it.

Chest binding is a way to make breasts look flatter. It is done with a binder, tight bra, shirt, or cloth bandages. Binding is safe, but binding for a long time can be painful, especially in your back and shoulders. It can also irritate your skin or lead to a fungal infection.

Don’t use binders that are too small, elastic bandages, or tape that isn’t made for chest binding. Binding too tightly or with unsafe materials can

• cause skin irritation, rashes, and bruising

• cut off blood flow to the skin under the binder

• make it hard to breathe

• deform or break ribs

There are a few techniques people can use to change their appearance without surgery. For those assigned male at birth, these techniques include tucking and padding.

Tucking is smoothing the crotch by moving the penis between the legs and the testicles to another position. There are several methods for tucking. Some transgender people wear special underwear or use tape to keep their genitals tucked. Risks of tucking can include skin irritation, problems with sperm, or urinary tract infections (UTIs) from holding urine too long.

Padding is using undergarments or silicone inserts to make your breasts, hips, or buttocks look bigger. There are not many risks to padding. Some people may have skin irritation from silicone inserts or from the tape used to attach them.

Hormone treatment is medication that helps you look or sound more masculine or feminine. This may also be called cross-sex hormone treatment or gender-affirming hormone therapy. Depending on the treatment, these medications can help you develop sex characteristics such as

• deepening your voice

• growing facial hair

• developing breasts

• changing your body shape

Most of these changes cannot be reversed. Depending on the hormone, medication may be given as a shot, pill, patch, gel, cream, or implant.

No, hormone treatment is not a replacement for birth control. If you have female sex organs and you have sex with a person with male sex organs, you can still get pregnant. Everyone who is sexually active and wants to prevent pregnancy needs to use birth control. Read Birth Control to learn about birth control options.

Hormone treatment is shown to help transgender people with depression and boost self-esteem. It can also lower anxiety, reduce stress, and improve quality of life.

Hormones to make you more feminine (such as estrogen, also called “E”) may increase your risk of

• blood clotting problems

• gallstones

• high triglycerides

• high levels of potassium in the blood (hyperkalemia)

Hormones to make you more masculine (such as testosterone, also called “T”) may increase your risk of

• too many red blood cells (polycythemia)

• high cholesterol

• high blood pressure

• male pattern balding

• sleep apnea

Gender-affirming surgery alters parts of your body to help you look or feel more like your experienced gender. It can help with gender dysphoria.

Surgeries for transgender women may include

• making breasts larger

• removing the penis and testicles

• creating a vagina, clitoris, and vulva

• making the facial structure more feminine

Surgeries for transgender men may include

• removing the breasts, uterus, or ovaries

• creating a penis and scrotum

• making the facial structure more masculine

Nonbinary people may also have gender-affirming surgeries.

Surgery can help transgender people feel better about themselves. Researchers have found that after gender-affirming surgery, transgender people

• have reduced gender dysphoria

• are happier with their appearance and have better body image

• are very satisfied with the result of the surgery

All surgery involves some risk. The following risks are associated with any type of surgery:

• Bleeding

• Wound infections

• Problems related to the anesthesia used

The risks of gender-affirming surgeries vary by procedure. Talk with your doctor about the specific risks of any surgery you may be considering.

Gender-affirming surgery cannot be reversed.

Your health care professional should give you directions for how to care for your surgical site and when to return for a follow-up visit. Some things to consider include

• how you will get home after surgery

• when it is safe to shower or bathe

• what medications you need to take

• how often to change your bandages

• when you can go back to work

• when you can exercise and have sex again

For more information, read Preparing for Surgery.

Yes, you need to keep seeing your health care professional to continue taking hormones. The dose or the type of hormones you take may change as you age or if you develop another health condition. Health care professionals can also help make sure you stay healthy, physically and emotionally, throughout your life.

Both transgender men and transgender women may need to see an ob-gyn. Make sure to see an ob-gyn if you

• have female sex organs (like a uterus or a vagina)

• are taking feminizing hormones (like estrogen)

Not all health insurance plans cover gender transition services. Read your health insurance plan’s Summary of Benefits and Coverage, sometimes called an SBC. This is a standard document that all plans are required to have. It lists the services the plan covers and how much of the cost they will pay.

If you use Medicaid, check to see what benefits are available in your state. Some transgender advocacy groups track which states’ Medicaid programs cover transgender care. The website LGBTMAP.org has a state-by-state guide to Medicaid coverage for transgender care.

There are also organizations that can help if you experience discrimination from your health insurance provider. Examples include Lambda Legal and the National Center for Transgender Equality.

All people who are sexually active are at risk of getting a sexually transmitted infection (STI). If you have a uterus and ovaries and are sexually active with someone who produces sperm, you can also get pregnant. Read Birth Control for a list of birth control options.

Condoms and dental dams help protect against STIs, but they are not the best protection against pregnancy. It’s best to use condoms or dental dams and another method of birth control, such as an intrauterine device (IUD) or a birth control implant, to protect against both pregnancy and STIs.

Some kinds of hormone treatments may make it harder for you to have a baby in the future. Some kinds of surgery may make it impossible. Talk about this with your doctor before you have treatment. If you think you may want to have a baby in the future, there are ways to help preserve your fertility.

• Sperm can be saved in a sperm bank and used later with in vitro fertilization (IVF).

• Eggs can be frozen (called oocyte cryopreservation) and used later in IVF.

Know that fertility treatments can be expensive. Many insurance companies don’t cover fertility treatments.

These are common problems that can be treated. Options may include birth control pills, the birth control shot, or an IUD. Talk with your ob-gyn or other health care professional about your options.

Using medications to skip or stop your period is called “menstrual suppression.” Menstrual suppression is safe and does not affect your long-term health.

Testosterone may also stop your periods. This usually happens within a few months of starting to use testosterone. But testosterone is not a method of birth control. Even though your periods have stopped, you still need to use a birth control method if you are having vaginal sex and do not want to get pregnant.

Transgender people who do not feel supported by their families are more likely to be depressed. Some people cope with these thoughts and feelings in harmful ways. They may try to hurt themselves. They may turn to drugs and alcohol. Some skip work or quit their jobs. They may be at risk of losing their homes.

Transgender and nonbinary people also have a higher risk of being in relationships with partners who act violently or threaten them. Read more: Intimate Partner Violence.

Help and support are out there if you need it. If you are feeling depressed or if you just want to talk to someone, think about talking with a counselor or doctor. The Resources and Hotlines sections also have places you can go to for help.

If you have just realized that you are transgender or nonbinary, it can be intimidating to think about who to tell. Maybe you knew that your gender identity was different from a young age, but you tried to ignore those feelings or make them go away (this is sometimes called “being in the closet”). Or you may be thinking about your gender for the first time as an adult. If you’re thinking about coming out, remember:

• You don’t owe it to anyone to come out. You do not have to come out if you feel that you may be harmed in some way, or if you’re just not ready.

• Find a community of other trans or nonbinary adults in your area or online. They can provide tips, tell their own stories, and support you while you make the decision.

• Seek out a trans-friendly therapist or counselor. They can help you work through any hesitations or fears, and figure out what to say. One place to find a therapist is the website www.transcaresite.org.

For more information, visit the Human Rights Campaign Coming Out webpage.

Many workplaces accept and support transgender and nonbinary people. Others do not. You do not have to come out at work if you feel unsafe. If you do come out at work and you experience discrimination, there are organizations that can help you figure out what to do. Examples include Lambda Legal and the National Center for Transgender Equality’s Know Your Rights: Employment (General) and Know Your Rights: Employment (Federal) pages.

Centerlink
954-765-6024
www.lgbtcenters.org
Directory of community centers for LGBT people.

GLMA
202-600-8037
www.glma.org
Medical association of LGBTQ health care professionals. Provides a directory of LGBTQ-friendly health care professionals.

Lambda Legal
www.lambdalegal.org/know-your-rights#transgender-people
National organization working for the civil rights of LGBT people and everyone living with HIV.

National Center for Transgender Equality
202-642-4542
https://transequality.org
National organization that advocates to change policies and society to increase understanding and acceptance of transgender people.

PFLAG
202-467-8180
www.pflag.org
Network of communities for LGBTQ people, parents, and friends.

SAGE: Advocacy and Services for LGBTQ+ Elders
877-360-5428
www.sageusa.org/
Advocacy organization that focuses on the specific challenges faced by older adults.

Trans Health Project: Trans Health Care Providers
https://transhealthproject.org/resources/trans-health-care-providers/
List of websites to help find a trans-friendly health care professional.

Transgender Care Listings
www.transcaresite.org
Directory of trans-friendly health care professionals.

World Professional Association for Transgender Health (WPATH)
www.wpath.org
WPATH promotes evidence-based care, education, research, public policy, and respect in transgender health.
Find a WPATH provider: www.wpath.org/provider/search
Resources and services: www.wpath.org/resources/seniors-youth-schools-families

Hotlines

LGBT National Hotline
888-843-4564
Hours: Monday to Friday from 1 p.m. to 9 p.m. PST/ Saturday from 9 a.m. to 2 p.m. PST
www.lgbthotline.org/
Peer support hotline for all ages.

LGBT National Senior Hotline
888-234-7243
Hours: Monday to Friday from 1 p.m. to 9 p.m. PST/ Saturday from 9 a.m. to 2 p.m. PST
www.lgbthotline.org/senior-hotline
Peer support hotline for ages 50 and older.

Trans Lifeline
Toll-free: 877-565-8860
Hours: 7 a.m.–1 a.m. PST / 9 a.m.–3 a.m. CST / 10 a.m.–4 a.m. EST
www.translifeline.org
Peer support hotline that is run by and for trans people.

Birth Control Implant: A small, single rod that is inserted under the skin in the upper arm. The implant releases a hormone to prevent pregnancy.

Cholesterol: A natural substance that is a building block for cells and hormones. This substance helps carry fat through the blood vessels for use or storage in other parts of the body.

Clitoris: A female sex organ found near the opening of the vagina.

Dental Dam: A thin piece of latex or polyurethane used between the mouth and the vagina or anus during oral sex. Using a dental dam can help protect against sexually transmitted infections (STIs).

Depression: Feelings of sadness for periods of at least 2 weeks.

Estrogen: A female hormone produced in the ovaries.

Gender Identity: A person’s sense of being male, female, or something else. This identity may or may not match the sex assigned at birth.

Gender Nonconforming: A term used to describe a person who does not follow other people’s ideas about how they should act according to gender roles. Also called gender fluid, gender expansive, or genderqueer, among other terms.

Genitals: The sexual or reproductive organs.

Hormone: A substance made in the body that controls the function of cells or organs.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Intrauterine Device (IUD): A small device that is inserted and left inside the uterus to prevent pregnancy.

Nonbinary: A term used to describe a person whose gender identity is neither male nor female.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Oocyte Cryopreservation: A procedure in which eggs are removed from a woman’s ovaries and frozen for later use with in vitro fertilization (IVF).

Ovaries: Organs in women that contain the eggs necessary to get pregnant and make important hormones, such as estrogen, progesterone, and testosterone.

Penis: The male sex organ.

Scrotum: The external genital sac in the male that contains testicles.

Sexually Transmitted Infection (STI): An infection that is spread by sexual contact.

Sleep Apnea: A disorder that causes interruptions of breathing during sleep.

Sperm: A cell made in the male testicles that can fertilize a female egg.

Testicles: Paired male organs that make sperm and the male sex hormone testosterone. Also called “testes.”

Testosterone: A hormone made by the testes in men and in smaller amounts by the ovaries in women. This hormone is responsible for male sex characteristics such as hair growth, muscle development, and a lower voice.

Transgender: A term used to describe a person whose gender identity is different from the sex they were assigned at birth.

Transgender Man: A term used to describe a person who was assigned female at birth but has a male gender identity.

Transgender Woman: A term used to describe a person who was assigned male at birth but has a female gender identity.

Triglycerides: A form of body fat found in the blood and tissues. High levels can cause heart disease.

Urinary Tract Infection (UTI): An infection in any part of the urinary system, including the kidneys, bladder, or urethra.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Vulva: The external female genital area.