Transgender health care

In the 1920s, physician Magnus Hirschfeld conducted formal studies to understand gender dysphoria and human sexuality and advocated for communities that were marginalized.{{Cite web |last1=Caraballo |first1=Alejandra |last2=Delaware |first2=Mary |date=2023-06-21 |title=To protect gender-affirming care, we must learn from trans history |url=https://harvardpublichealth.org/equity/to-protect-gender-affirming-care-we-must-learn-from-trans-history/ |access-date=2024-07-26 |website=Harvard Public Health Magazine |language=en-US}} His research and work provided a new perspective on gender identity, gender expression, and sexuality. This was the first time there was a challenge against societal norms. In addition to his research, Hirschfeld also formed the term, "transvestite" which in modern terms is known as "transgender". Unfortunately, all of Hirschfeld's work was silenced during the Nazi German era when many transgender individuals were arrested and sent to concentration camps.

File:HarvardPublicHealth Transgender Health Rights History mhvorbibliothek.webp

In 1966 the Johns Hopkins Gender Clinic was started. It was a great step towards transgender healthcare as it provided care for transgender individuals, including hormone replacement therapy, surgery, psychological counseling, and any other gender affirmative healthcare. The clinic required patients before a gender affirmation surgery to go through a program called "Real Life Test".{{Cite journal |last1=Coleman |first1=E. |last2=Radix |first2=A. E. |last3=Bouman |first3=W. P. |last4=Brown |first4=G. R. |last5=de Vries |first5=A. L. C. |last6=Deutsch |first6=M. B. |last7=Ettner |first7=R. |last8=Fraser |first8=L. |last9=Goodman |first9=M. |last10=Green |first10=J. |last11=Hancock |first11=A. B. |last12=Johnson |first12=T. W. |last13=Karasic |first13=D. H. |last14=Knudson |first14=G. A. |last15=Leibowitz |first15=S. F. |title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 |journal=International Journal of Transgender Health |date=2022 |volume=23 |issue=Suppl 1 |pages=S1–S259 |doi=10.1080/26895269.2022.2100644 |issn=2689-5269 |pmc=9553112 |pmid=36238954}} The Real Life Test was a program where before a gender affirming surgery the patient was required to live with their desired gender role. In 1979 the clinic was closed due to{{How|date=July 2024}} the newly appointed director of psychiatry Dr. Paul McHughs. Over the years, gender affirming care was labeled "experimental", causing many facilities to deny access to it.

Many efforts were made to advocate for gender affirming care even though there were many obstacles. However, in 2010 there was a resurgence in transgender healthcare efforts and an expansion in the protection and action of gender affirming care. This caused a positive shift towards gender affirming care and an increase in transgender healthcare advocacy.

Gender variance is defined in medical literature as "gender identity, expression, or behavior that falls outside of culturally defined norms associated with a specific gender".{{Cite journal|last1=Simons|first1=Lisa K.|last2=Leibowitz|first2=Scott F.|last3=Hidalgo|first3=Marco A.|date=2014-06-01|title=Understanding Gender Variance in Children and Adolescents|journal=Pediatric Annals|language=en|volume=43|issue=6|pages=e126–e131|doi=10.3928/00904481-20140522-07|pmid=24972420|issn=0090-4481}} For centuries, gender variance was seen by medicine as a pathology.{{Cite journal|last1=Byne|first1=William|last2=Karasic|first2=Dan H.|last3=Coleman|first3=Eli|last4=Eyler|first4=A. Evan|last5=Kidd|first5=Jeremy D.|last6=Meyer-Bahlburg|first6=Heino F.L.|last7=Pleak|first7=Richard R.|last8=Pula|first8=Jack|date=May 2018|title=Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists|journal=Transgender Health|volume=3|issue=1|pages=57–A3|doi=10.1089/trgh.2017.0053|issn=2380-193X|pmc=5944396|pmid=29756044}}{{Cite book|title=Psychopathia Sexualis|last=von Krafft-Ebing|first=Richard|year=1894|publisher=Camion blanc |isbn=9782357792173}} The World Health Organization identified gender dysphoria as a mental disorder in the International Classification of Diseases (ICD) until 2018.{{Cite journal|last1=Reed|first1=Geoffrey M.|last2=Drescher|first2=Jack|last3=Krueger|first3=Richard B.|last4=Atalla|first4=Elham|last5=Cochran|first5=Susan D.|last6=First|first6=Michael B.|last7=Cohen-Kettenis|first7=Peggy T.|last8=Arango-de Montis|first8=Iván|last9=Parish|first9=Sharon J.|date=October 2016|title=Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations|journal=World Psychiatry|volume=15|issue=3|pages=205–221|doi=10.1002/wps.20354|pmid=27717275|pmc=5032510}} Gender dysphoria was also listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, where it was previously called "transsexualism" and "gender identity disorder".{{Cite journal|last1=Reed|first1=Geoffrey M.|last2=Drescher|first2=Jack|last3=Krueger|first3=Richard B.|last4=Atalla|first4=Elham|last5=Cochran|first5=Susan D.|last6=First|first6=Michael B.|last7=Cohen-Kettenis|first7=Peggy T.|last8=Arango-de Montis|first8=Iván|last9=Parish|first9=Sharon J.|date=October 2016|title=Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations|journal=World Psychiatry|volume=15|issue=3|pages=205–221|doi=10.1002/wps.20354|pmc=5032510|pmid=27717275}}{{Cite journal|last1=Cohen-Kettenis|first1=Peggy T.|last2=Pfäfflin|first2=Friedemann|date=2009-10-17|title=The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults|journal=Archives of Sexual Behavior|volume=39|issue=2|pages=499–513|doi=10.1007/s10508-009-9562-y|issn=0004-0002|pmid=19838784|hdl=1871/34512|s2cid=16336939|url=https://research.vumc.nl/en/publications/ecd5b365-8b86-45bb-ac42-53b0026db32c|hdl-access=free}}

In 2018, the ICD-11 included the term "gender incongruence" as "marked and persistent incongruence between an individual's experienced gender and the assigned sex", where gender variant behaviour and preferences do not necessarily imply a medical diagnosis.{{Cite web|url=https://icd.who.int/|title=ICD-11|website=icd.who.int|access-date=2019-03-24}} However, the difference between "gender dysphoria" and "gender incongruence" is not always clear in the medical literature.{{Cite journal|last1=Defreyne|first1=Justine|last2=Kreukels|first2=Baudewijntje|last3=T'Sjoen|first3=Guy|last4=Staphorsius|first4=Annemieke|last5=Den Heijer|first5=Martin|last6=Heylens|first6=Gunter|last7=Elaut|first7=Els|date=April 2019|title=No correlation between serum testosterone levels and state-level anger intensity in transgender people: Results from the European Network for the Investigation of Gender Incongruence|journal=Hormones and Behavior|volume=110|pages=29–39|doi=10.1016/j.yhbeh.2019.02.016|pmid=30822410|s2cid=72332772}}

Some studies posit 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.{{Cite journal|last1=Castro-Peraza|first1=Maria Elisa|last2=García-Acosta|first2=Jesús Manuel|last3=Delgado|first3=Naira|last4=Perdomo-Hernández|first4=Ana María|last5=Sosa-Alvarez|first5=Maria Inmaculada|last6=Llabrés-Solé|first6=Rosa|last7=Lorenzo-Rocha|first7=Nieves Doria|date=2019-03-18|title=Gender Identity: The Human Right of Depathologization|journal=International Journal of Environmental Research and Public Health|volume=16|issue=6|pages=978|doi=10.3390/ijerph16060978|pmid=30889934|pmc=6466167|issn=1660-4601|doi-access=free}}{{Cite journal|last=Latham|first=J.R.|title=Making and Treating Trans Problems The Ontological Politics of Clinical Practices|journal=Studies in Gender and Sexuality|volume=18|issue=1|pages=40–61|doi=10.1080/15240657.2016.1238682|year=2017|s2cid=152123850}} Other studies argue that gender incongruence diagnosis may be important and even positive for transgender people at the individual and social level.{{Cite journal|last1=Vargas-Huicochea|first1=Ingrid|last2=Robles|first2=Rebeca|last3=Real|first3=Tania|last4=Fresán|first4=Ana|last5=Cruz-Islas|first5=Jeremy|last6=Vega-Ramírez|first6=Hamid|last7=Medina-Mora|first7=María Elena|date=November 2018|title=A Qualitative Study of the Acceptability of the Proposed ICD-11 Gender Incongruence of Childhood Diagnosis Among Transgender Adults Who Were Labeled Due to Their Gender Identity Since Childhood|journal=Archives of Sexual Behavior|volume=47|issue=8|pages=2363–2374|doi=10.1007/s10508-018-1241-4|pmid=29971651|s2cid=49681691|issn=0004-0002}}

As there are various ways of classifying or characterizing those who are either diagnosed or self-affirm as transgender individuals, the literature cannot clearly estimate how prevalent these experiences are within the total population. The results of a recent systematic review highlight the need to standardize the scope and methodology related to data collection of those presenting as transgender.{{Cite journal|last1=Collin|first1=Lindsay|last2=Reisner|first2=Sari L.|last3=Tangpricha|first3=Vin|last4=Goodman|first4=Michael|date=2016|title=Prevalence of Transgender Depends on the "Case" Definition: A Systematic Review|journal=The Journal of Sexual Medicine|language=en|volume=13|issue=4|pages=613–626|doi=10.1016/j.jsxm.2016.02.001|pmc=4823815|pmid=27045261}}

Various options are available for transgender people to pursue physical transition. There have been options for transitioning for transgender individuals since 1917. Gender-affirming care helps people to change their physical appearance and/or sex characteristics to accord with their gender identity; it includes hormone replacement therapy and gender-affirming surgery. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan.{{Cite journal|last1=Coleman|first1=E.|last2=Bockting|first2=W.|last3=Botzer|first3=M.|last4=Cohen-Kettenis|first4=P.|last5=DeCuypere|first5=G.|last6=Feldman|first6=J.|last7=Fraser|first7=L.|last8=Green|first8=J.|last9=Knudson|first9=G.|date=2012-08-01|title=Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7|journal=International Journal of Transgenderism|volume=13|issue=4|pages=165–232|doi=10.1080/15532739.2011.700873|s2cid=39664779|issn=1553-2739}} Preventive health care is a crucial part of transitioning and a primary care physician is recommended for transgender people who are transitioning.

In the 11th version of the International Classification of Diseases (ICD-11), the diagnosis is known as gender incongruence. ICD-11 states that "Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis."

The US Diagnostic and Statistical Manual of Mental Disorders (DSM) names it gender dysphoria (in version 5{{Cite web|url=https://www.psychiatry.org/psychiatrists/practice/dsm|title=DSM-5|website=www.psychiatry.org}}). Some people who are validly diagnosed have no desire for all or some parts of sex reassignment therapy, particularly genital reassignment surgery, and/or are not appropriate candidates for such treatment.

The general standard for diagnosing, as well as treating, gender dysphoria is outlined in the WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. As of February 2023, the most recent version of the standards is Version 8.{{cite journal|title=Standards of Care for the Health of Transgender and Gender Diverse People, Version 8|year=2022 |doi=10.1080/26895269.2022.2100644 |last1=Coleman |first1=E. |last2=Radix |first2=A. E. |last3=Bouman |first3=W. P. |last4=Brown |first4=G. R. |last5=De Vries |first5=A. L. C. |last6=Deutsch |first6=M. B. |last7=Ettner |first7=R. |last8=Fraser |first8=L. |last9=Goodman |first9=M. |last10=Green |first10=J. |last11=Hancock |first11=A. B. |last12=Johnson |first12=T. W. |last13=Karasic |first13=D. H. |last14=Knudson |first14=G. A. |last15=Leibowitz |first15=S. F. |last16=Meyer-Bahlburg |first16=H. F. L. |last17=Monstrey |first17=S. J. |last18=Motmans |first18=J. |last19=Nahata |first19=L. |last20=Nieder |first20=T. O. |last21=Reisner |first21=S. L. |last22=Richards |first22=C. |last23=Schechter |first23=L. S. |last24=Tangpricha |first24=V. |last25=Tishelman |first25=A. C. |last26=Van Trotsenburg |first26=M. A. A. |last27=Winter |first27=S. |last28=Ducheny |first28=K. |last29=Adams |first29=N. J. |last30=Adrián |first30=T. M. |journal=International Journal of Transgender Health |volume=23 |issue=Suppl 1 |pages=S1–S259 |pmid=36238954 |pmc=9553112 |display-authors=1 }} According to the standards of care, "Gender Dysphoria describes a state of distress or discomfort that may be experienced because a person's gender identity differs from that which is physically and/or socially attributed to their sex assigned at birth... Not all transgender and gender diverse people experience gender dysphoria." Gender nonconformity is not the same as gender dysphoria; nonconformity, according to the standards of care, is not a pathology and does not require medical treatment.

The informed consent model is an alternative to the standard WPATH approach which does not require a person seeking transition related medical treatment to undergo formal assessment of their mental health or gender dysphoria. Arguments in favor of this model describe required assessments as gatekeeping, dehumanizing, pathologizing, and reinforcing a reductive perception of transgender experiences.{{Cite journal|last=Ashley|first=Florence|date=2019-07-01|title=Gatekeeping hormone replacement therapy for transgender patients is dehumanising|url=https://jme.bmj.com/content/45/7/480|journal=Journal of Medical Ethics|language=en|volume=45|issue=7|pages=480–482|doi=10.1136/medethics-2018-105293|issn=0306-6800|pmid=30988174|doi-access=free}} Informed consent approaches include conversations between the medical provider and person seeking care on the details of risks and outcomes, current understandings of scientific research, and how the provider can best assist the person in making decisions.{{Cite journal|last1=Lambert|first1=Cei|last2=Hopwood|first2=Ruben|last3=Cavanaugh|first3=Timothy|date=2016-11-01|title=Informed Consent in the Medical Care of Transgender and Gender-Nonconforming Patients|url=https://journalofethics.ama-assn.org/article/informed-consent-medical-care-transgender-and-gender-nonconforming-patients/2016-11|journal=AMA Journal of Ethics|volume=18|issue=11|pages=1147–1155|doi=10.1001/journalofethics.2016.18.11.sect1-1611|pmid=27883307|issn=2376-6980|doi-access=free}}

Local standards of care exist in many countries.

While a mental health assessment is required by the standards of care, psychotherapy is not an absolute requirement but is highly recommended.

Hormone replacement therapy is to be initiated from a qualified health professional. The general requirements, according to the WPATH standards, include:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (however, the WPATH standards of care provide separate discussion of children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.

Often, at least a certain period of psychological counseling is required before initiating hormone replacement therapy, as is a period of living in the desired gender role, if possible, to ensure that they can psychologically function in that life-role. On the other hand, some clinics provide hormone therapy based on informed consent alone.

While the WPATH standards of care generally require the patient to have reached the age of majority, they include a separate section devoted to children and adolescents. Prepubescent children do not have access to medical intervention for gender-affirming therapy. After puberty, some medical intervention is available for adolescents depending on specific criteria for gender incongruence diagnosis, capacity for informed consent, and mental and physical health.

According to a study by JAMA Pediatrics published in January of 2025, less than 0.1% of adolescents covered by private medical insurance in the US take gender-affirming medication to treat gender dysphoria.{{cite web|url=https://www.nbcnews.com/nbc-out/out-health-and-wellness/less-01-us-minors-take-gender-affirming-medication-study-finds-rcna186139|title=Less than 0.1% of U.S. minors take gender-affirming medication, study finds|author=Matt Lavietes|publisher=NBC News|date=January 26, 2025}}

{{Main|Transgender hormone therapy}}

File:MTF hormone replacement therapy before after.png before and after two years of hormone replacement therapy.]]

Hormone replacement therapy (HRT) is primarily concerned with alleviating gender dysphoria in transgender people. Hormone therapy targets the secondary sex characteristics. Trans women typically use feminizing therapy, the goal of which is to develop female characteristics while suppressing male characteristics. Trans men typically use masculinizing therapy, which has the opposite goal – to develop male characteristics while suppressing female characteristics.{{Cite web |title=Overview of feminizing hormone therapy {{!}} Gender Affirming Health Program |url=https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy |access-date=2024-07-29 |website=transcare.ucsf.edu}}

Trans women are usually treated with estrogen and complementary anti-androgenic therapy. According to UCSF Transgender Care, "The primary class of estrogen used for feminizing therapy is 17-beta estradiol, which is a 'bioidentical' hormone in that it is chemically identical to that from a human ovary." The anti-adrogenic medications include spironolactone and the 5-alpha reductase inhibitors, finasteride and dutasteride. This therapy induces breast formation, reduces male hair pattern growth, and changes fat distribution, also leading to a decreased testicular size and erectile function.{{Cite journal|last=Unger|first=Cécile A.|date=December 2016|title=Hormone therapy for transgender patients|journal=Translational Andrology and Urology|volume=5|issue=6|pages=877–884|doi=10.21037/tau.2016.09.04|pmc=5182227|pmid=28078219 |doi-access=free }}

Trans men are normally treated with exogenous testosterone. Several formulations of testosterone exist, and in the U.S., all formulations are "bioidentical" to endogenous testosterone of testicular origin.{{Cite web |title=Overview of masculinizing hormone therapy {{!}} Gender Affirming Health Program |url=https://transcare.ucsf.edu/guidelines/masculinizing-therapy |access-date=2024-07-29 |website=transcare.ucsf.edu}} Masculinizing therapy 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). Regular monitoring by an endocrinologist is a strong recommendation to ensure the safety of individuals as they transition.{{Cite journal|last1=Moore|first1=Eva|last2=Wisniewski|first2=Amy|last3=Dobs|first3=Adrian|author-link3=Adrian Sandra Dobs|date=2003-08-01|title=Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=8|pages=3467–3473|doi=10.1210/jc.2002-021967|issn=0021-972X|pmid=12915619|doi-access=free}}

Access to hormone replacement therapy has been shown to improve quality of life for people in the female-to-male community when compared to female-to-male people who do not have access to hormone replacement therapy.{{Cite journal|last1=Newfield|first1=Emily|last2=Hart|first2=Stacey|last3=Dibble|first3=Suzanne|last4=Kohler|first4=Lori|date=2006-06-07|title=Female-to-male transgender quality of life|journal=Quality of Life Research|volume=15|issue=9|pages=1447–1457|doi=10.1007/s11136-006-0002-3|issn=0962-9343|pmid=16758113|citeseerx=10.1.1.468.9106|s2cid=12727036}} Feminizing therapy has also been found to improve well-being. Interestingly, one systematic review determined that "Overall, the qualitative literature tended to support positive changes in well-being among people after starting feminizing hormone therapy, although often with the qualification that improvements in well-being were attributed to satisfaction with changes in appearance rather than to direct effects of hormones on psychosocial states."{{Cite journal |last1=Doyle |first1=David Matthew |last2=Lewis |first2=Tom O. G. |last3=Barreto |first3=Manuela |date=2023 |title=A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people |journal=Nature Human Behaviour |volume=7 |issue=8 |pages=1320–1331 |doi=10.1038/s41562-023-01605-w |issn=2397-3374 |pmid=37217739|pmc=10444622 }}

Despite the improvement in quality of life, there are still dangers with hormone replacement therapy, in particular with self-medication. Many transgender people lack access to a supportive, high quality, non-discriminatory health care system. Therefore, the only option for GAHT may be self-administered medications (testosterone, oestrogen, anti-androgens,..etc.), without professional guidance.{{Cite journal |last1=Kennedy |first1=Caitlin E. |last2=Yeh |first2=Ping Teresa |last3=Byrne |first3=Jack |last4=van der Merwe |first4=L. Leigh Ann |last5=Ferguson |first5=Laura |last6=Poteat |first6=Tonia |last7=Narasimhan |first7=Manjulaa |title=Self-administration of gender-affirming hormones: a systematic review of effectiveness, cost, and values and preferences of end-users and health workers |journal=Sexual and Reproductive Health Matters |date=2022 |volume=29 |issue=3 |pages=2045066 |doi=10.1080/26410397.2022.2045066 |issn=2641-0397 |pmc=8942532 |pmid=35312467}} An examination of the use of self-medication found that people who self-medicated were more likely to experience adverse health effects from preexisting conditions such as high blood pressure as well as slower development of desired secondary sex characteristics.{{Cite book|title=Transgender Care: Recommended Guidelines, Practical Information, and Personal Accounts|last=Israel|first=Gianna|publisher=Temple University Press|year=2001|isbn=978-1-56639-852-7}}

Hormone therapy for transgender individuals has been shown in medical literature to be safe, when supervised by a qualified medical professional.{{Cite journal|title= Hormone therapy in transgender adults is safe with provider supervision; A review of hormone therapy sequelae for transgender individuals |journal=Journal of Clinical & Translational Endocrinology |volume=2 |issue=2 |pages=55–60 |doi=10.1016/j.jcte.2015.02.003 |pmid=28090436 |pmc=5226129 |date=Feb 2015 |last1=Weinand |first1=Jamie D.|last2=Safer|first2=Joshua D.}}

Transgender people seeking surgery may be informed they will need to take hormones for the rest of their life if they want to maintain the feminizing effects of oestrogen or the masculinizing effects of testosterone. Their dose of hormones will usually be reduced, but it should still be enough to produce the effects that they need and to keep them well, and to protect them against osteoporosis (thinning of the bones) as they get older. If they are still on hormone blockers, they will stop taking them altogether.{{cite web |url=https://www.gires.org.uk/wp-content/uploads/2014/08/doh-hormone-therapy.pdf |title=A guide to hormone therapy for trans people |page=10 |date=August 2014 |access-date=March 2, 2021}}

Monitoring of risk factors associated with hormone replacement therapy, such as prolactin levels in transgender women and polycythemia levels in transgender men, are crucial for the preventive health care of transgender people taking these treatments.

On July 1, 2022, the FDA issued an update that gonadotropin-releasing hormone agonists, drugs that are approved for treating precocious puberty, may be a risk factor for developing pseudotumor cerebri.url=[https://web.archive.org/web/20220724191418/https://www.fda.gov/media/159663/download]]]

{{Main|Transgender pregnancy}}

There are frequent misconceptions within both patients and doctors about how hormone replacement therapy affects fertility. One common misconception is that starting it automatically leads to infertility. While it may impact the ability to be fertile, it does not mean it leads to a hundred percent infertility rate.{{Cite journal |last=Moravek |first=Molly B. |date=June 2019 |title=Fertility preservation options for transgender and gender-nonconforming individuals |url=https://pubmed.ncbi.nlm.nih.gov/30870185/ |journal=Current Opinion in Obstetrics & Gynecology |volume=31 |issue=3 |pages=170–176 |doi=10.1097/GCO.0000000000000537 |issn=1473-656X |pmid=30870185|s2cid=78091839 }} There have been numerous cases of transgender men experiencing pregnancy and abortion.{{Cite journal |last1=Light |first1=Alexis |last2=Wang |first2=Lin-Fan |last3=Zeymo |first3=Alexander |last4=Gomez-Lobo |first4=Veronica |date=2018-10-01 |title=Family planning and contraception use in transgender men |url=https://www.sciencedirect.com/science/article/pii/S0010782418302221 |journal=Contraception |language=en |volume=98 |issue=4 |pages=266–269 |doi=10.1016/j.contraception.2018.06.006 |pmid=29944875 |s2cid=49434157 |issn=0010-7824|url-access=subscription }} As trans men and doctors can be under this misconception about hormone replacement therapy impacting fertility and serving as a form of contraception, keeping people informed on fertility options remains crucial.

For trans women, it is possible for them to undergo cryopreservation before starting hormone replacement therapy. As evidence has shown that trans women tend to have lower motile sperm compared to their cisgender counterparts,{{Cite journal |last1=Marsh |first1=Courtney |last2=McCracken |first2=Megan |last3=Gray |first3=Meredith |last4=Nangia |first4=Ajay |last5=Gay |first5=Judy |last6=Roby |first6=Katherine F. |date=2019-08-01 |title=Low total motile sperm in transgender women seeking hormone therapy |url=https://doi.org/10.1007/s10815-019-01504-y |journal=Journal of Assisted Reproduction and Genetics |language=en |volume=36 |issue=8 |pages=1639–1648 |doi=10.1007/s10815-019-01504-y |issn=1573-7330 |pmc=6708020 |pmid=31250175}} fertility preservation can be important for individuals anticipating having biological children in the future. While fertility preservation is important to consider before starting HRT, it is possible in some cases to regain fertility after halting HRT for a period of time.{{Cite journal |last1=Barnard |first1=Emily P. |last2=Dhar |first2=Cherie Priya |last3=Rothenberg |first3=Stephanie S. |last4=Menke |first4=Marie N. |last5=Witchel |first5=Selma F. |last6=Montano |first6=Gerald T. |last7=Orwig |first7=Kyle E. |last8=Valli-Pulaski |first8=Hanna |date=September 2019 |title=Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients |journal=Pediatrics |volume=144 |issue=3 |pages=e20183943 |doi=10.1542/peds.2018-3943 |issn=1098-4275 |pmid=31383814|s2cid=199451284 |doi-access=free }}

It is also important to educate transgender youth on their fertility preservation options. This is because few adolescents end up doing so, alongside transgender adolescents reporting distress at the prospect of becoming infertile due to medical conditions and treatment relating to their transgender identity.{{Cite journal |last1=Nahata |first1=Leena |last2=Tishelman |first2=Amy C. |last3=Caltabellotta |first3=Nicole M. |last4=Quinn |first4=Gwendolyn P. |date=July 2017 |title=Low Fertility Preservation Utilization Among Transgender Youth |journal=The Journal of Adolescent Health|volume=61 |issue=1 |pages=40–44 |doi=10.1016/j.jadohealth.2016.12.012 |issn=1879-1972 |pmid=28161526|doi-access=free }}

{{Main|Gender-affirming surgery}}

The goal of gender-affirming surgery is to align the secondary sexual characteristics of transgender people with their gender identity. As hormone replacement therapy, gender-affirming surgery is also employed as a response to diagnosis gender dysphoria{{cite web|last1=Choices|first1=NHS|title=Gender dysphoria – NHS Choices|url=http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/Introduction.aspx|website=www.nhs.uk|access-date=9 December 2016|archive-date=26 May 2023|archive-url=https://web.archive.org/web/20230526090651/http://www.nhs.uk/conditions/Gender-dysphoria/Pages/Introduction.aspx|url-status=dead}}

The World Professional Association for Transgender Health (WPATH) Standards of Care recommend additional requirements for gender-affirming surgery when compared to hormone replacement therapy. Whereas hormone replacement therapy can be obtained through something as simple as an informed consent form, gender-affirming surgery can require a supporting letter from a licensed therapist (two letters for genital surgery such as vaginoplasty or phalloplasty), hormonal treatment, and (for genital surgery) completion of a 12-month period in which the person lives full-time as their gender. WPATH standards, while commonly used in gender clinics, are non-binding; many trans patients undergoing surgery do not meet all of the eligibility criteria.

{{See also|Gender-affirming surgery#Quality of life and physical health}}

Untreated transgender people experience high rates of depression, anxiety, addiction, and suicide compared to the general population. In systematic reviews, hormone therapy and gender-affirming surgery were associated with improved mental health outcomes.{{Cite journal |last1=Passos |first1=Taciana Silveira |last2=Teixeira |first2=Marina Sá |last3=Almeida-Santos |first3=Marcos Antonio |date=2020-06-01 |title=Quality of Life After Gender Affirmation Surgery: a Systematic Review and Network Meta-analysis |url=https://doi.org/10.1007/s13178-019-00394-0 |journal=Sexuality Research and Social Policy |language=en |volume=17 |issue=2 |pages=252–262 |doi=10.1007/s13178-019-00394-0 |issn=1553-6610|url-access=subscription }}{{Cite journal |last1=Shelemy |first1=Lucas |last2=Cotton |first2=Sue |last3=Crane |first3=Catherine |last4=Knight |first4=Matthew |date=2024-04-03 |title=Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria |journal=International Journal of Transgender Health |language=en |pages=1–21 |doi=10.1080/26895269.2024.2333525 |issn=2689-5269|doi-access=free }} In follow-up studies, most trans people experience improved psychological, social, and sexual functioning,{{cite journal|last1=Smith|first1=YL|last2=Van Goozen|first2=SH|last3=Kuiper|first3=AJ|last4=Cohen-Kettenis|first4=PT|title=Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals.|journal=Psychological Medicine|date=January 2005|volume=35|issue=1|pages=89–99|pmid=15842032|doi=10.1017/S0033291704002776|doi-broken-date=1 November 2024 |s2cid=6032916 |url=http://orca.cf.ac.uk/32618/1/Smith%202005.pdf}} improved global functioning,{{cite journal |doi=10.1007/s10508-009-9551-1 |title=A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder |year=2009 |last1=Johansson |first1=Annika |last2=Sundbom |first2=Elisabet |last3=Höjerback |first3=Torvald |last4=Bodlund |first4=Owe |journal=Archives of Sexual Behavior |volume=39 |issue=6 |pages=1429–37 |pmid=19816764|s2cid=22866694 }} and significantly reduced suicidal ideation.{{Cite journal |last1=Park |first1=Rachel H. |last2=Liu |first2=Yi-Ting |last3=Samuel |first3=Ankhita |last4=Gurganus |first4=Margot |last5=Gampper |first5=Thomas J. |last6=Corbett |first6=Sean T. |last7=Shahane |first7=Amit |last8=Stranix |first8=John T. |date=2022-10-01 |title=Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study |url=https://pubmed.ncbi.nlm.nih.gov/36149983/ |journal=Annals of Plastic Surgery |volume=89 |issue=4 |pages=431–436 |doi=10.1097/SAP.0000000000003233 |issn=1536-3708 |pmid=36149983}} Less than 1% of post-operative trans patients regret surgery.{{cite journal |last1=Bustos |first1=Valeria |last2=Bustos |first2=Samyd |last3=Mascaro |first3=Andres |last4=Del Corral |first4=Gabriel |last5=Forte |first5=Antonio |last6=Ciudad |first6=Pedro |last7=Kim |first7=Esther |last8=Langstein |first8=Howard |last9=Manrique |first9=Oscar |date=March 2021 |title=Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence |url=https://journals.lww.com/prsgo/fulltext/2021/03000/regret_after_gender_affirmation_surgery__a.22.aspx |journal=Plastic and Reconstructive Surgery |volume=9 |issue=3 |pages=e3477 |doi=10.1097/GOX.0000000000003477 |pmid=33968550 |pmc=8099405 |archive-url=https://web.archive.org/web/20220406104453/https://journals.lww.com/prsgo/fulltext/2021/03000/regret_after_gender_affirmation_surgery__a.22.aspx |access-date=2022-04-15|archive-date=2022-04-06 }} Gender-affirming surgery alone may not eliminate dysphoria or suicidality, and some trans people may need further mental health care in addition to surgery.{{cite journal |doi=10.1371/journal.pone.0016885 |title=Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden |year=2011 |editor1-last=Scott |editor1-first=James |last1=Dhejne |first1=Cecilia |last2=Lichtenstein |first2=Paul |last3=Boman |first3=Marcus |last4=Johansson |first4=Anna L. V. |last5=Långström |first5=Niklas |last6=Landén |first6=Mikael |journal=PLOS ONE |volume=6 |issue=2 |pages=e16885 |pmid=21364939 |pmc=3043071|bibcode=2011PLoSO...616885D |doi-access=free }}

Some researchers have expressed a need for further high-quality research on mental health outcomes following surgery. Certain statistically robust study designs, such as randomized controlled trials, are not applicable in studying some aspects of transgender health care due to ethical concerns (for example, it would be severely unethical to test the long-term efficacy of hormone therapy by treating some prospective patients with a placebo).{{Cite journal |author=Byne |first1=William |last2=Bradley |first2=Susan J. |author-link2=Susan Bradley |last3=Coleman |first3=Eli |author-link3=Eli Coleman |last4=Eyler |first4=A. Evan |last5=Green |first5=Richard |author-link5=Richard Green (sexologist) |last6=Menvielle |first6=Edgardo J. |last7=Meyer-Bahlburg |first7=Heino F. L. |author-link7=Heino F. L. Meyer-Bahlburg |last8=Pleak |first8=Richard R. |last9=Tompkins |first9=D. Andrew |date=August 2012 |title=Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder |url=http://www.psych.org/File%20Library/Learn/Archives/rd2012_GID.pdf |url-status=dead |journal=Archives of Sexual Behavior |volume=41 |issue=4 |pages=759–796 (pages cited as pages at link) |doi=10.1007/s10508-012-9975-x |pmid=22736225 |s2cid=26050161 |archive-url=https://web.archive.org/web/20130625010421/http://psych.org/File%20Library/Learn/Archives/rd2012_GID.pdf |archive-date=2013-06-25 |quote=For some important aspects of transgender care, it would be impossible or unwise to engage in more robust study designs due to ethical concerns and lack of volunteer enrollment. For example, it would be extremely problematic to include a "long-term placebo treated control group" in an RCT of hormone therapy efficacy among gender variant adults desiring to use hormonal treatments.}}{{Cite journal |last1=Budge |first1=Stephanie L. |last2=Abreu |first2=Roberto L. |last3=Flinn |first3=Ryan E. |last4=Donahue |first4=Kelly L. |last5=Estevez |first5=Rebekah |last6=Olezeski |first6=Christy L. |last7=Bernacki |first7=Jessica M. |last8=Barr |first8=Sebastian |last9=Bettergarcia |first9=Jay |last10=Sprott |first10=Richard A. |last11=Allen |first11=Brittany J. |date=December 2024 |title=Gender Affirming Care Is Evidence Based for Transgender and Gender-Diverse Youth |url=https://www.jahonline.org/article/S1054-139X(24)00439-7/fulltext |journal=Journal of Adolescent Health |language=en |volume=75 |issue=6 |pages=851–853 |doi=10.1016/j.jadohealth.2024.09.009 |access-date=19 February 2025|url-access=subscription }}

In rare cases, individuals may wish to "detransition," or to reverse or stop the gender-affirming medical therapy. Reasons can include physical adverse effects, changing view of gender identity, and social rejection/discrimination. Research is very limited into the process of detransitioning. The recommendation is to consult a team of providers in diverse specialties on how to proceed with the detransition process.

Transgender people are infected by HIV at disproportionately high rates worldwide. According to the U.S. Centers for Disease Control and Prevention (CDC), in the United States in 2019, 2% of patients newly diagnosed with HIV were transgender, a higher percentage than the 0.3% of the U.S. population which self-identified as transgender.{{Cite web |last=CDC |date=2024-05-16 |title=Fast Facts: HIV and Transgender People |url=https://www.cdc.gov/hiv/data-research/facts-stats/transgender-people.html |access-date=2024-07-27 |website=HIV |language=en-us}} HIV prevalence is higher in transgender women compared to transgender men. One systematic review and meta-analysis found that overall HIV prevalence around the world was 19.9% in transfeminine individuals and 2.56% in transmasculine individuals. Transgender sex work are at further enhanced HIV risk, and transgender populations in African and Latin American regions have higher HIV prevalence.{{Cite journal |last1=Stutterheim |first1=Sarah E. |last2=van Dijk |first2=Mart |last3=Wang |first3=Haoyi |last4=Jonas |first4=Kai J. |date=2021-12-01 |title=The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis |journal=PLOS ONE |volume=16 |issue=12 |pages=e0260063 |doi=10.1371/journal.pone.0260063 |doi-access=free |issn=1932-6203 |pmc=8635361 |pmid=34851961|bibcode=2021PLoSO..1660063S }}

Following CDC and USPSTF guidelines, UCSF recommends HIV screening for all transgender people at least once. Screening may be repeated on a case-by-case basis, depending on the person's risk for contracting HIV. The risk should be assessed based on the individual's sexual behavior. HIV risk assessment screening should account for the individual's specific anatomy and what type of sexual acts and behaviors the individual partakes in.{{Cite web |title=Transgender health and HIV {{!}} Gender Affirming Health Program |url=https://transcare.ucsf.edu/guidelines/hiv |access-date=2024-07-29 |website=transcare.ucsf.edu}} For instance, HIV prevalence in transgender women is notably high, and a risk factor is that transgender women are frequently noted to partake in receptive anal sex with biologically male partners.{{Cite journal |last1=Baral |first1=Stefan D |last2=Poteat |first2=Tonia |last3=Strömdahl |first3=Susanne |last4=Wirtz |first4=Andrea L |last5=Guadamuz |first5=Thomas E |last6=Beyrer |first6=Chris |date=March 2013 |title=Worldwide burden of HIV in transgender women: a systematic review and meta-analysis |url=https://doi.org/10.1016/S1473-3099(12)70315-8 |journal=The Lancet Infectious Diseases |volume=13 |issue=3 |pages=214–222 |doi=10.1016/s1473-3099(12)70315-8 |pmid=23260128 |issn=1473-3099|url-access=subscription }} There has been a tendency for these individuals to be grouped with "MSM" in research on HIV risk factors, due to a supposed shared mechanism of biological vulnerability to HIV transmission. This is problematic for a few reasons. This conflation fails to differentiate between external anatomy and gender. Additionally, this conflation may cause confuse the accurate reporting of data on the transgender population.

For transgender patients being treated for HIV with antiretroviral therapy (ART), there is risk of drug-drug interactions between the ART and hormonal therapies the patient may also be using, especially feminizing hormone therapy. There is limited data on interactions between ART and targeted feminizing therapy. However, studies have found interactions between ART and oral contraceptives, which trans-feminine individuals may take if they cannot access targeted feminizing therapy. According to a review by Wansom et al., "Significant drug–drug interactions exist between ethinyl oestradiol and two main classes of antiretroviral medications: non-nucleoside reverse transcriptase inhibitors (NNRTIs) and ritonavir-boosted protease inhibitors (PIs)."{{Cite journal |last1=Wansom |first1=Tanyaporn |last2=Guadamuz |first2=Thomas E |last3=Vasan |first3=Sandhya |title=Transgender populations and HIV: unique risks, challenges and opportunities |journal=Journal of Virus Eradication |date=2016 |volume=2 |issue=2 |pages=87–93 |doi=10.1016/S2055-6640(20)30475-1 |issn=2055-6640 |pmc=4965251 |pmid=27482441}} Ethinyl estradiol is commonly used in oral contraceptive medications, and it is not recommended for feminizing therapy due to enhanced risk of thromboembolism -related events.

Transgender Law Center is a national trans-led organization founded in 2002, that is dedicated to advocate for the rights and well-being of transgender and gender nonconforming people with legal advocacy, policy initiatives, and community empowerment. Transgender Law Center expand their work to multiple important areas, including but not limited to, healthcare access, education, employment and housing.{{Cite web |last= |title=Home |url=https://transgenderlawcenter.org |website=Transgender Law Center}}

They advocate for better healthcare access for transgender people with multiple efforts. With policy advocacy and litigation efforts, Transgender Law Center advocates for laws and regulations to require insurance companies to cover gender-affirming care and engages in legal actions to fight against and challenge practices and policies that are discriminatory towards transgender people. Transgender Law Center also engages in public awareness campaigns and community engagements to ensure the significancy of transgender healthcare along with the barriers and unmet needs that are being advocated reflects real-world experiences, hoping to shift public perceptions and gain support for necessary changes to be made. For the professionals, Transgender Law Center provides education and trainings for healthcare providers and other professionals to make efforts into increasing awareness and promoting equal and competent care for transgender people. In effort to provide more resources, they address systemic challenges and organize guides and reports on best practices for transgender healthcare. Last but not least, Transgender Law Center offers direct support and gives legal support to those who are facing healthcare discriminations, in need of resources or referrals, and more.{{Cite web |title=Transgender Law Center (TLC) |url=https://www.loc.gov/item/lcwaN0017366/ |access-date=2024-07-31 |website=Library of Congress, Washington, D.C. 20540 USA}}

Lambda Legal is a United States national organization that advocates for the rights of LGBTQIA+ people and those who are living with HIV since 1973. They make the effort to make changes to policies at all federal, state, and local levels for LGBTQIA+ rights, while engaging with health departments to ensure that the current regulations and guidelines are aligned with the needs of LGBTQIA+ community.{{Cite web |title=The right to health care |url=https://lambdalegal.org/issues/health-care/ |access-date=2024-07-30 |website=Lambda Legal |language=en-US}}

Notably, Lambda Legal's involvement has led to several successful legal attempts in expanding not only healthcare rights but also protections for transgender people. They served as legal attorneys for the LGBTQIA+ community along with those living with HIV, with all their closed to current active cases published on their website.{{Cite web |title=Litigation Library |url=https://lambdalegal.org/litigation-library/ |access-date=2024-07-30 |website=Lambda Legal |language=en-US}}

GLMA: Health Professionals Advancing LGBTQ Equality is the world's largest and oldest LGBTQ healthcare professionals association founded in 1981. It is also formerly known as the Gay and Lesbian Medical Association.

GLMA provides resources along with edcational programs to help healthcare professionals gain the knowledge and skills in giving appropriate care to LGBTQ patients whilst hosting conferences and workshops to foster the environment for discussion of the latest research or emerging issues in the field. They also conduct LGBTQ centered research to identify the disparities and health needs to publish guidelines and inform about evidence-based healthcare practices and policies to LGBTQ health.{{Cite web |title=Advocacy - GLMA: Health Professionals Advancing LGBTQ Equality |url=https://glma.org/advocacy.php |access-date=2024-07-30 |website=glma.org}}

The Center of Excellence for Transgender Health at the University of California, San Francisco was established in 2009, dedicated to improving health equity for trans and gender nonconforming communities. The Center of Excellence for Transgender Health is a national advisory board composed of transgender leaders from across the United States, bringing expertise in the research of transgender health.{{Cite web |title=Center of Excellence for Transgender Health {{!}} Division of Prevention Science |url=https://prevention.ucsf.edu/transhealth |access-date=2024-07-30 |website=prevention.ucsf.edu}} Guidelines for Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People contains guidelines developed by The Center of Excellence for Transgender Health that are widely used clinical guidelines for transgender healthcare.{{Cite web |title=Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People {{!}} Gender Affirming Health Program |url=https://transcare.ucsf.edu/guidelines |access-date=2024-07-30 |website=transcare.ucsf.edu}}

The heightened levels of violence and abuse that transgender people experience result in unique adverse effects on bodily and mental health.{{Cite journal|last1=Rood|first1=Brian A.|last2=Reisner|first2=Sari L.|last3=Surace|first3=Francisco I.|last4=Puckett|first4=Jae A.|last5=Maroney|first5=Meredith R.|last6=Pantalone|first6=David W.|year=2016|title=Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals|journal=Transgender Health|volume=1|issue=1|pages=151–164|doi=10.1089/trgh.2016.0012|pmc=5685272|pmid=29159306}} Specifically, in resource-constrained settings where non-discriminatory policies may be limited or not enforced, transgender people may encounter high rates of stigma and violence which are associated with poor health outcomes.{{cite journal |last1=Budhwani|first1=Henna|last2=Hearld|first2=Kristine R.|last3=Milner|first3=Adrienne N.|last4=Charow|first4=Rebecca|last5=McGlaughlin|first5=Elaine M.|last6=Rodriguez-Lauzurique|first6=Mayra|last7=Rosario|first7=Santo|last8=Paulino-Ramirez|first8=Robert |date=September 26, 2017 |title=Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic|journal=Suicide and Life-Threatening Behavior|volume=48|issue=6|pages=788–796|doi=10.1111/sltb.12400|issn=1943-278X|pmid=28950402|s2cid=26033883|url=https://bura.brunel.ac.uk/handle/2438/21606}}{{Cite journal|last=Lagos|first=Danya|date=December 2018|title=Looking at Population Health Beyond "Male" and "Female": Implications of Transgender Identity and Gender Nonconformity for Population Health|journal=Demography|volume=55|issue=6|pages=2097–2117|doi=10.1007/s13524-018-0714-3|pmid=30255426|s2cid=52822267|issn=0070-3370|doi-access=free}} Studies in countries of the Global North show higher levels of discrimination and harassment in school, workplace, healthcare services and the family when compared with cisgender populations, situating transphobia as a key health risk factor for the physical and mental health of transgender people.{{Cite book|title=Queering Paradigms VII: Contested Bodies and Spaces|isbn=978-1-78874-529-1|location=Oxford, United Kingdom|publisher=Peter Lang|oclc=1080428040|editor-last1 = Scherer|editor-first1 = Bee|date = 2018-12-20}}

Victimization is often the outcome to disclosure for transgender individuals.{{Cite journal |last=Stieglitz |first=Kimberly A. |date=May 2010 |title=Development, Risk, and Resilience of Transgender Youth |url=https://linkinghub.elsevier.com/retrieve/pii/S1055329009002180 |journal=Journal of the Association of Nurses in AIDS Care |language=en |volume=21 |issue=3 |pages=192–206 |doi=10.1016/j.jana.2009.08.004|pmid=20347346 |url-access=subscription }} Transgender individuals are pressured to conform to gender norms which make them vulnerable for victimization by peers and parents. A study done by Grossman and D'Augelli reported that transgender youth feared that may face physical and sexual violence because of their experience with harassment and discrimination. The youth also express how individuals only see them for their gender and sexuality rather than their personal traits. Many of the youth have also dropped out or experience academic decline because of the constant harassment. Victimization started on average for transgender at the age of 13, while physical abuse started at an average age 14.{{Cite journal |last1=Grossman |first1=Arnold H. |last2=D'augelli |first2=Anthony R. |date=2006-09-25 |title=Transgender Youth |url=http://dx.doi.org/10.1300/j082v51n01_06 |journal=Journal of Homosexuality |volume=51 |issue=1 |pages=111–128 |doi=10.1300/j082v51n01_06 |pmid=16893828 |s2cid=2939809 |issn=0091-8369|url-access=subscription }}

Peitzmeier and colleagues conducted a study on partner violence; they found that transgender individuals are 3 times more likely than their counterparts to experience partner violence physical and sexual. Partner violence is a risk factor for numerous health outcomes like a decrease psychological well-being, a poor sexual health, etc.{{Cite journal |last1=Peitzmeier |first1=Sarah M. |last2=Malik |first2=Mannat |last3=Kattari |first3=Shanna K. |last4=Marrow |first4=Elliot |last5=Stephenson |first5=Rob |last6=Agénor |first6=Madina |last7=Reisner |first7=Sari L. |date=September 2020 |title=Intimate Partner Violence in Transgender Populations: Systematic Review and Meta-analysis of Prevalence and Correlates |journal=American Journal of Public Health |language=en |volume=110 |issue=9 |pages=e1–e14 |doi=10.2105/AJPH.2020.305774 |issn=0090-0036 |pmc=7427218 |pmid=32673114}}

There is limited data regarding the impact of social determinants of health on transgender and gender non-conforming individuals' health outcomes. However, despite the limited data available, transgender and gender non-conforming individuals have been found to be at higher risk of experiencing poor health outcomes and restricted access to health care due to increased risk for violence, isolation, and other types of discrimination both inside and outside the health care setting.{{cite journal | last1 = Anastas | first1 = J.W. | year = 2013 | title = Policy, practice, and people: Current issues affecting clinical practice | journal = Clinical Social Work Journal | volume = 41 | issue = 3| pages = 302–307 | doi = 10.1007/s10615-013-0454-1 | s2cid = 143288898 }}

Despite its importance, access to preventive care is also limited by several factors, including discrimination and erasure. A study on young transgender women's access to HIV treatment found that one of the main contributors to not accessing care was the use of incorrect name and pronouns.{{Cite journal|last1=Dowshen|first1=Nadia|author-link1=Nadia Dowshen |last2=Lee|first2=Susan S.|last3=Castillo|first3=Marné|last4=Hawkins|first4=Linda|last5=Barg|first5=Frances K.|title=Barriers and Facilitators to HIV Prevention, Testing, and Treatment among Young Transgender Women|journal=Journal of Adolescent Health|volume=58|issue=2|pages=S81–S82|doi=10.1016/j.jadohealth.2015.10.175|date=February 2016}} A meta analysis of the National Transgender Discrimination Survey examined respondents who used the "gender not listed here" option on the survey and their experiences with accessing health care. Over a third of the people who chose that option said that they had avoided accessing general care due to bias and fears of social repercussions.{{Cite journal|first1=Jack|last1=Harrison|first2=Jaime|last2=Grant|first3=Jody L.|last3=Herman|editor-first1=David|editor-last1=Dodge|editor-first2=Eliott|editor-last2=Imse|date=2012-04-01|title=A Gender Not Listed Here: Genderqueers, Gender Rebels, and OtherWise in the National Transgender Discrimination Survey|url=http://escholarship.org/uc/item/2zj46213|journal=LGBTQ Public Policy Journal at the Harvard Kennedy School|volume=2|issue=1}}

Transgender individuals may experience distress and sadness as a result of their gender identity being inconsistent with their biological sex. This distress is referred to as gender dysphoria.{{Cite web|url=https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities|title=What Does Transgender Mean? {{!}} Gender Identification Facts|website=www.plannedparenthood.org|language=en|access-date=2019-10-23}} Gender dysphoria is typically most upsetting for the individual prior to transitioning, and once the individual begins to transition into their desired gender, whether the transition be socially, medically, or both, the distress frequently lessens.{{Cite journal|last1=Connolly|first1=Maureen D.|last2=Zervos|first2=Marcus J.|last3=Barone|first3=Charles J.|last4=Johnson|first4=Christine C.|last5=Joseph|first5=Christine L. M.|date=2016-11-01|title=The Mental Health of Transgender Youth: Advances in Understanding|journal=Journal of Adolescent Health|volume=59|issue=5|pages=489–495|doi=10.1016/j.jadohealth.2016.06.012|pmid=27544457|issn=1054-139X}}{{Cite journal|last1=Dhejne|first1=Cecilia|last2=Vlerken|first2=Roy Van|last3=Heylens|first3=Gunter|last4=Arcelus|first4=Jon|date=2016-01-02|title=Mental health and gender dysphoria: A review of the literature|journal=International Review of Psychiatry|volume=28|issue=1|pages=44–57|doi=10.3109/09540261.2015.1115753|issn=0954-0261|pmid=26835611|s2cid=207493538|url=https://biblio.ugent.be/publication/7081076/file/7081106 |url-access=subscription}}{{Cite journal|last1=Bouman|first1=Walter Pierre|last2=Claes|first2=Laurence|last3=Brewin|first3=Nicky|last4=Crawford|first4=John R.|last5=Millet|first5=Nessa|last6=Fernandez-Aranda|first6=Fernando|last7=Arcelus|first7=Jon|date=2017-01-02|title=Transgender and anxiety: A comparative study between transgender people and the general population|journal=International Journal of Transgenderism|volume=18|issue=1|pages=16–26|doi=10.1080/15532739.2016.1258352|s2cid=151463685|issn=1553-2739|url=http://eprints.nottingham.ac.uk/39670/1/Transgender%20and%20Anxiety%20second%20submission.pdf|access-date=2019-10-24|archive-date=2020-04-23|archive-url=https://web.archive.org/web/20200423232024/http://eprints.nottingham.ac.uk/39670/1/Transgender%20and%20Anxiety%20second%20submission.pdf|url-status=dead}}

Transgender individuals may be bullied as a result of the gender norm.{{Cite journal |last1=Earnshaw |first1=Valerie A. |last2=Bogart |first2=Laura M. |last3=Poteat |first3=V. Paul |last4=Reisner |first4=Sari L. |last5=Schuster |first5=Mark A. |date=December 2016 |title=Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth |journal=Pediatric Clinics of North America |language=en |volume=63 |issue=6 |pages=999–1010 |doi=10.1016/j.pcl.2016.07.004 |pmc=8941671 |pmid=27865341}} Studies revolving around the effects of bullying have shown that bullying is associated with a declining mental health. Past experience predicted more depressive symptoms and a low self-worth. A study also revealed that those who came out to school peers or staff had a greater psychological well-being despite being bullied. The effects of bullying include higher risk for substance abuse, risky behaviors like drunk driving, and higher engagement in sexual risk behaviors. Being bullied also increases absenteeism and poor grades among LGTBQ individuals. Physical symptoms can also manifest as a result including abdominal pain, poor appetite, sleeping problems, increase in blood pressure, etc. These experiences as an adolescent can have negative consequence in adulthood as well. These consequence include depression, suicide attempts, lower life satisfaction, etc.{{Citation |title=School Experiences of Gay, Lesbian, Bisexual, and Transgender Youth |date=2013-01-11 |url=http://dx.doi.org/10.4324/9780203462591-20 |work=Gay, Lesbian, and Transgender Issues in Education |pages=77–90 |access-date=2023-11-29 |publisher=Routledge|doi=10.4324/9780203462591-20 |isbn=9780203462591 |url-access=subscription }}{{Cite journal |last1=Bogart |first1=Laura M. |last2=Elliott |first2=Marc N. |last3=Klein |first3=David J. |last4=Tortolero |first4=Susan R. |last5=Mrug |first5=Sylvie |last6=Peskin |first6=Melissa F. |last7=Davies |first7=Susan L. |last8=Schink |first8=Elizabeth T. |last9=Schuster |first9=Mark A. |date=2014-03-01 |title=Peer Victimization in Fifth Grade and Health in Tenth Grade |journal=Pediatrics |volume=133 |issue=3 |pages=440–447 |doi=10.1542/peds.2013-3510 |issn=0031-4005|doi-access=free |pmid=24534401 |pmc=4530298 }}{{Cite journal |last1=Reisner |first1=Sari L. |last2=Greytak |first2=Emily A. |last3=Parsons |first3=Jeffrey T. |last4=Ybarra |first4=Michele L. |date=2014-04-17 |title=Gender Minority Social Stress in Adolescence: Disparities in Adolescent Bullying and Substance Use by Gender Identity |url=http://dx.doi.org/10.1080/00224499.2014.886321 |journal=The Journal of Sex Research |volume=52 |issue=3 |pages=243–256 |doi=10.1080/00224499.2014.886321 |pmid=24742006 |issn=0022-4499|pmc=4201643 }}{{Cite journal |last1=Russell |first1=Stephen T. |last2=Sinclair |first2=Katerina O. |last3=Poteat |first3=V. Paul |last4=Koenig |first4=Brian W. |date=March 2012 |title=Adolescent Health and Harassment Based on Discriminatory Bias |url=http://dx.doi.org/10.2105/ajph.2011.300430 |journal=American Journal of Public Health |volume=102 |issue=3 |pages=493–495 |doi=10.2105/ajph.2011.300430 |pmid=22390513 |issn=0090-0036|pmc=3487669 }}{{Cite journal |last1=Díaz |first1=Rafael M. |last2=Ayala |first2=George |last3=Bein |first3=Edward |date=2004 |title=Sexual risk as an outcome of social oppression: Data from a probability sample of Latino gay men in three U.S. cities. |url=http://dx.doi.org/10.1037/1099-9809.10.3.255 |journal=Cultural Diversity and Ethnic Minority Psychology |volume=10 |issue=3 |pages=255–267 |doi=10.1037/1099-9809.10.3.255 |pmid=15311978 |issn=1939-0106|url-access=subscription }}{{Cite journal |last1=Li |first1=Michael Jonathan |last2=DiStefano |first2=Anthony |last3=Mouttapa |first3=Michele |last4=Gill |first4=Jasmeet K. |date=2013-06-25 |title=Bias-motivated bullying and psychosocial problems: Implications for HIV risk behaviors among young men who have sex with men |url=http://dx.doi.org/10.1080/09540121.2013.811210 |journal=AIDS Care |volume=26 |issue=2 |pages=246–256 |doi=10.1080/09540121.2013.811210 |pmid=23796024 |s2cid=28910962 |issn=0954-0121|url-access=subscription }}{{Cite journal |last1=Fekkes |first1=Minne |last2=Pijpers |first2=Frans I.M. |last3=Fredriks |first3=A. Miranda |last4=Vogels |first4=Ton |last5=Verloove-Vanhorick |first5=S. Pauline |date=2006-05-01 |title=Do Bullied Children Get Ill, or Do Ill Children Get Bullied? A Prospective Cohort Study on the Relationship Between Bullying and Health-Related Symptoms |url=http://dx.doi.org/10.1542/peds.2005-0187 |journal=Pediatrics |volume=117 |issue=5 |pages=1568–1574 |doi=10.1542/peds.2005-0187 |pmid=16651310 |s2cid=13310867 |issn=0031-4005|url-access=subscription }}{{Cite journal |last1=Rosenthal |first1=Lisa |last2=Earnshaw |first2=Valerie A |last3=Carroll-Scott |first3=Amy |last4=Henderson |first4=Kathryn E |last5=Peters |first5=Susan M |last6=McCaslin |first6=Catherine |last7=Ickovics |first7=Jeannette R |date=2013-10-22 |title=Weight- and race-based bullying: Health associations among urban adolescents |url=http://dx.doi.org/10.1177/1359105313502567 |journal=Journal of Health Psychology |volume=20 |issue=4 |pages=401–412 |doi=10.1177/1359105313502567 |pmid=24155192 |issn=1359-1053|pmc=3995896 }}{{Cite journal |last1=Gini |first1=Gianluca |last2=Pozzoli |first2=Tiziana |date=2009-03-01 |title=Association Between Bullying and Psychosomatic Problems: A Meta-analysis |url=http://dx.doi.org/10.1542/peds.2008-1215 |journal=Pediatrics |volume=123 |issue=3 |pages=1059–1065 |doi=10.1542/peds.2008-1215 |pmid=19255040 |s2cid=32470703 |issn=0031-4005|url-access=subscription }}{{Cite journal |last1=Gini |first1=Gianluca |last2=Pozzoli |first2=Tiziana |date=2013-10-01 |title=Bullied Children and Psychosomatic Problems: A Meta-analysis |url=http://dx.doi.org/10.1542/peds.2013-0614 |journal=Pediatrics |volume=132 |issue=4 |pages=720–729 |doi=10.1542/peds.2013-0614 |pmid=24043275 |s2cid=2215195 |issn=0031-4005|url-access=subscription }}

Those who are transgender are significantly more likely to be diagnosed with anxiety disorders or depression than the general population.{{Cite journal|last1=Zucker|first1=Kenneth J.|last2=Lawrence|first2=Anne A.|last3=Kreukels|first3=Baudewijntje P.C.|date=2016|title=Gender Dysphoria in Adults|journal=Annual Review of Clinical Psychology|volume=12|issue=1|pages=217–247|doi=10.1146/annurev-clinpsy-021815-093034|pmid=26788901|doi-access=free}} A number of studies suggest that the inflated rates of depression and anxiety in transgender individuals may partially be because of systematic discrimination or a lack of support.{{Cite journal|last1=Trujillo|first1=Michael A.|last2=Perrin|first2=Paul B.|last3=Sutter|first3=Megan|last4=Tabaac|first4=Ariella|last5=Benotsch|first5=Eric G.|date=2017-01-02|title=The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample|journal=International Journal of Transgenderism|volume=18|issue=1|pages=39–52|doi=10.1080/15532739.2016.1247405|issn=1553-2739|pmc=5996383|pmid=29904324}}{{Cite journal|last1=McConnell|first1=Elizabeth A.|last2=Birkett|first2=Michelle|last3=Mustanski|first3=Brian|date=2016-12-01|title=Families Matter: Social Support and Mental Health Trajectories Among Lesbian, Gay, Bisexual, and Transgender Youth|journal=Journal of Adolescent Health|volume=59|issue=6|pages=674–680|doi=10.1016/j.jadohealth.2016.07.026|pmid=27707515|pmc=5217458|issn=1054-139X}} Evidence suggests that these increased rates begin to normalize when transgender individuals are accepted as their identified gender and when they live within a supportive household.{{cite journal |last1=Durwood |first1=Lily |last2=McLaughlin |first2=Katie A. |last3=Olson |first3=Kristina R. |title=Mental Health and Self-Worth in Socially Transitioned Transgender Youth |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=February 2017 |volume=56 |issue=2 |pages=116–123.e2 |doi=10.1016/j.jaac.2016.10.016|pmid=28117057 |pmc=5302003 }}

Many studies report extremely high rates of suicide within the transgender community. A United States study of 6,450 transgender individuals found that 41% of them had attempted suicide, as differing from the national average of 4.6%. The very same survey found that these rates were the most high for certain demographics, with transgender youth between the ages of 18 and 24 having the highest percent.{{Cite web|url=https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf|title=Suicide Attempts among Transgender and Gender Non-Conforming Adults|last1=Haas|first1=Ann|last2=Rodgers|first2=Philip|last3=Herman|first3=Jody|date=2017-10-08|website=The Williams Institute|url-status=live|archive-url=https://web.archive.org/web/20171008072751/https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf|archive-date=2017-10-08|access-date=2019-10-23}} Individuals in the survey who were multiracial, had lower levels of education, and those with a lower annual income were all more likely to have attempted. Specifically, transgender males as a group are the most likely to attempt suicide, more so than transgender females.{{Cite journal|last1=Toomey|first1=Russell B.|last2=Syvertsen|first2=Amy K.|last3=Shramko|first3=Maura|date=2018-10-01|title=Transgender Adolescent Suicide Behavior|url= |journal=Pediatrics|language=en|volume=142|issue=4|pages=e20174218|doi=10.1542/peds.2017-4218|issn=0031-4005|pmid=30206149|pmc=6317573}} Later surveys suggest that the rate of suicidal attempts for non-binary individuals is in between the two. Transgender adults who have "de-transitioned", meaning having gone back to living as their sex assigned at birth, are significantly more likely to attempt suicide than transgender adults who have never "de-transitioned".{{cite web |last1=Herman |first1=Jody L. |last2=Brown |first2=Taylor N.T. |last3=Haas |first3=Ann P. |title=Suicide Thoughts and Attempts Among Transgender Adults: Findings from the 2015 U.S. Transgender Survey |date=September 2019 |url=https://williamsinstitute.law.ucla.edu/wp-content/uploads/Suicidality-Transgender-Sep-2019.pdf |publisher=Williams Institute |access-date=5 November 2020}}

Several studies have shown the relation between minority stress and the heightened rate of depression and other mental illness among both transgender men and women.{{cite journal | last1 = Bockting | first1 = Walter O. | last2 = Miner | first2 = Michael H. | last3 = Swinburne Romine | first3 = Rebecca E. | last4 = Hamilton | first4 = Autumn | last5 = Coleman | first5 = Eli | year = 2013 | title = Stigma, mental health, and resilience in an online sample of the US transgender population | journal = American Journal of Public Health | volume = 103 | issue = 5| pages = 943–951 | doi=10.2105/ajph.2013.301241 | pmid=23488522 | pmc=3698807}} The expectation to experience rejection can become an important stressor for transgender and gender non-conforming individuals.{{Cite journal|last1=Rood|first1=Brian A.|last2=Reisner|first2=Sari L.|last3=Surace|first3=Francisco I.|last4=Puckett|first4=Jae A.|last5=Maroney|first5=Meredith R.|last6=Pantalone|first6=David W.|date=January 2016|title=Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals|journal=Transgender Health|volume=1|issue=1|pages=151–164|doi=10.1089/trgh.2016.0012|issn=2380-193X|pmc=5685272|pmid=29159306}} Mental health problems among trans people are related to higher rates of self-harm, drug usage, and suicidal ideations and attempts.

Trans people report multiple negative experiences in health care encounters, contributing to stigmatization of their gender identity. A systematic review conducted by researchers at James Cook University reported that 75.3% of respondents have negative experiences during physician visits when seeking gender identity-based care.{{Cite journal|last1=Heng|first1=Audrey|last2=Heal|first2=Clare|last3=Banks|first3=Jennifer|last4=Preston|first4=Robyn|date=2018-10-02|title=Transgender peoples' experiences and perspectives about general healthcare: A systematic review|journal=International Journal of Transgenderism|language=en|volume=19|issue=4|pages=359–378|doi=10.1080/15532739.2018.1502711|s2cid=150322054|issn=1553-2739|url=https://researchonline.jcu.edu.au/54712/1/JCU_54712_Heng%20et%20al_2018_accepted%20version.pdf}} Transgender patients also face obstacles to accessing health care that result in adverse effects on their health and quality of life. These include unsafe public spaces, lack of knowledgeable health care professionals, discrimination while accessing care, lack of institutional support, long distances to access treatment, and denial of health care services and health insurance benefits. These often result in trans people avoiding or delaying health care.{{Cite journal |last1=Cicero |first1=Ethan C. |last2=Reisner |first2=Sari L. |last3=Silva |first3=Susan G. |last4=Merwin |first4=Elizabeth I. |last5=Humphreys |first5=Janice C. |date=2019 |title=Health Care Experiences of Transgender Adults: An Integrated Mixed Research Literature Review |journal=ANS. Advances in Nursing Science |volume=42 |issue=2 |pages=123–138 |doi=10.1097/ANS.0000000000000256 |issn=1550-5014 |pmc=6502664 |pmid=30839332}}

Trans patients may also avoid treatment as a result of their gender identities being treated as psychological illnesses, or because they fear "discrimination and suboptimal or inappropriate care" as a result of disclosing their gender identities. For instance, after a transgender man seeking medical care in the emergency department was verbally assaulted by the hospital employees, who repeatedly referred to him as a woman, he left the hospital premises before receiving the care he needed.{{Cite journal |last1=Pinna |first1=Federica |last2=Paribello |first2=Pasquale |last3=Somaini |first3=Giulia |last4=Corona |first4=Alice |last5=Ventriglio |first5=Antonio |last6=Corrias |first6=Carolina |last7=Frau |first7=Ilaria |last8=Murgia |first8=Roberto |last9=El Kacemi |first9=Sabrina |last10=Galeazzi |first10=Gian Maria |last11=Mirandola |first11=Massimo |last12=Amaddeo |first12=Francesco |last13=Crapanzano |first13=Andrea |last14=Converti |first14=Manlio |last15=Piras |first15=Paola |date=2022 |title=Mental health in transgender individuals: a systematic review |url=https://pubmed.ncbi.nlm.nih.gov/36151828 |journal=International Review of Psychiatry |volume=34 |issue=3–4 |pages=292–359 |doi=10.1080/09540261.2022.2093629 |issn=1369-1627 |pmid=36151828}} According to a systematic review conducted by Hermaszewska and colleagues, "some transgender people are forced to migrate to countries that offer them better legal protection and wider social acceptance".{{Cite journal |last1=Hermaszewska |first1=Susannah |last2=Sweeney |first2=Angela |last3=Camminga |first3=B. |last4=Botelle |first4=Riley |last5=Elliott |first5=Kate |last6=Sin |first6=Jacqueline |date=2022-05-10 |title=Lived experiences of transgender forced migrants and their mental health outcomes: systematic review and meta-ethnography |journal=BJPsych Open |volume=8 |issue=3 |pages=e91 |doi=10.1192/bjo.2022.51 |issn=2056-4724 |pmc=9169499 |pmid=35535515}} Others may self-prescribe medication such as gender-affirming hormone therapy. More training in trans-inclusive health care principles may lead to more specialists, better standards of care in general and fewer health inequalities for trans people.{{Cite journal |last1=Dubin |first1=Samuel N. |last2=Nolan |first2=Ian T. |last3=Streed |first3=Carl G. |last4=Greene |first4=Richard E. |last5=Radix |first5=Asa E. |last6=Morrison |first6=Shane D. |date=2018 |title=Transgender health care: improving medical students' and residents' training and awareness |journal=Advances in Medical Education and Practice |volume=9 |pages=377–391 |doi=10.2147/AMEP.S147183 |doi-access=free |issn=1179-7258 |pmc=5967378 |pmid=29849472}}{{pb}}{{Cite journal |last1=Howell |first1=Jamie D. |last2=Maguire |first2=Rebecca |date=February 2023 |title=Factors Associated with Experiences of Gender-Affirming Health Care: A Systematic Review |journal=Transgender Health |volume=8 |issue=1 |pages=22–44 |doi=10.1089/trgh.2021.0033 |issn=2688-4887 |pmc=9991448 |pmid=36895311}}{{Cite journal |last1=Jecke |first1=L. |last2=Zepf |first2=F. D. |date=May 2024 |title=Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review |journal=European Child & Adolescent Psychiatry |volume=33 |issue=5 |pages=1327–1354 |doi=10.1007/s00787-023-02195-8 |issn=1435-165X |pmc=11098887 |pmid=37115277}}{{Cite journal |last1=van Heesewijk |first1=Jason |last2=Kent |first2=Alex |last3=van de Grift |first3=Tim C. |last4=Harleman |first4=Alex |last5=Muntinga |first5=Maaike |date=August 2022 |title=Transgender health content in medical education: a theory-guided systematic review of current training practices and implementation barriers & facilitators |journal=Advances in Health Sciences Education: Theory and Practice |volume=27 |issue=3 |pages=817–846 |doi=10.1007/s10459-022-10112-y |issn=1573-1677 |pmc=9374605 |pmid=35412095}}

Guidelines from the UCSF Transgender Care Center state the importance of visibility in chosen gender identity for transgender or non-binary patients. Safe environments include a two-step process in collecting gender identity data by differentiating between personal identity and assignments at birth for medical histories. Common techniques recommended are asking patients their preferred name, pronouns, and other names they may go by in legal documents. In addition, visibility of non-cisgender identities is defined by the work environment of the clinic. Front-desk staff and medical assistants will interact with patients, which these guidelines recommend appropriate training for. The existence of at least one gender-neutral bathroom shows consideration of patients with non-binary gender identities.{{Cite web|url=https://transcare.ucsf.edu/guidelines|title=Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People {{!}} Transgender Care|website=transcare.ucsf.edu|access-date=2019-08-06}}

{{Anchor|Trans broken arm syndrome}}

Clinicians may improperly connect transgender people's symptoms to their gender transition, a phenomenon known as trans broken arm syndrome.{{Cite journal |last1=Ashman |first1=A |last2=Folkers |first2=R |last3=Burns |first3=P. |date=19 October 2023 |title=How can surgeons help transgender patients and colleagues feel welcome? |journal=The Bulletin of the Royal College of Surgeons of England |volume=105 |issue=8 |pages=(epub ahead of print) |publisher=Royal College of Surgeons of England |doi=10.1308/rcsbull.2023.126 |doi-access=free }} Trans broken arm syndrome is particularly prevalent among mental health practitioners, but it exists in all fields of medicine. Misguided investigation of transition-related causes can frustrate patients and cause delay in or refusal of treatment,{{Cite book |last=Pearce |first=Ruth |date=2018 |title=Understanding Trans Health: Discourse, Power and Possibility |pages=111–112 |publisher=Policy Press}}{{Cite news |last=Payton |first=Naith |date=9 July 2015 |title=Feature: The dangers of trans broken arm syndrome |work=PinkNews |url=https://www.pinknews.co.uk/2015/07/09/feature-the-dangers-of-trans-broken-arm-syndrome/}}{{Cite journal |last1=Paradiso |first1=Catherine |last2=Arca-Contreras |first2=Karen |last3=Brillhart |first3=Susan J. |last4=Macchiarola |first4=Jennifer |last5=Curcio |first5=Danna L. |date=29 July 2022 |title=Integration of transgender health: A multi-modal approach |url=https://www.sciencedirect.com/science/article/abs/pii/S1557308722000683 |journal=Teaching and Learning in Nursing |volume=17 |issue=4 |pages=425–432 |publisher=Elsevier |doi=10.1016/j.teln.2022.06.001|s2cid=251204461 |url-access=subscription }} or misdiagnosis and prescription of a wrong treatment.{{Cite journal |last1=Freeman |first1=Lauren |last2=Lopéz |first2=Saray Ayala |date=September 2018 |title=Sex Categorization in Medical Contexts: A Cautionary Tale |url=https://muse.jhu.edu/article/707064 |journal=Kennedy Institute of Ethics Journal |publisher=Johns Hopkins University Press |volume=28 |issue=3 |pages=243–280 |doi=10.1353/ken.2018.0017 |pmid=30369506 |s2cid=53095199 |via=Project MUSE|url-access=subscription }} Misattribution of symptoms to transgender hormone therapy may also cause doctors to erroneously recommend the patient stop taking hormones.{{Cite journal |last1=Dietz |first1=Elizabeth |last2=Halem |first2=Jessica |date=November 2016 |title=How Should Physicians Refer When Referral Options Are Limited for Transgender Patients? |url=https://journalofethics.ama-assn.org/article/how-should-physicians-refer-when-referral-options-are-limited-transgender-patients/2016-11 |journal=AMA Journal of Ethics |publisher=American Medical Association |volume=18 |issue=11 |pages=1070–1080 |doi=10.1001/journalofethics.2016.18.11.ecas1-1611|pmid=27883298 |doi-access=free }} Trans broken arm syndrome may also manifest as health insurance companies refusing to pay for treatments, claiming that a mental or physical health problem is inevitable or untreatable due to the patient's transgender status or that a treatment would be too experimental because the patient is transgender.{{Cite news |last=O'Hara |first=Mary Emily |date=6 August 2015 |title='Trans Broken Arm Syndrome' and the way our healthcare system fails trans people |work=The Daily Dot |url=https://www.dailydot.com/irl/trans-broken-arm-syndrome-healthcare/}} According to The SAGE Encyclopedia of Trans Studies, trans broken arm syndrome is a form of discrimination against transgender people.{{Cite encyclopedia |title=Health Care, Discrimination |editor1-last=Goldberg |editor1-first=Abbie E. |editor2-last=Beemyn |editor2-first=Genny |date=2021 |encyclopedia=The SAGE Encyclopedia of Trans Studies |publisher=SAGE Publishing |page=356}} A 2021 survey by TransActual shows that 57% of transgender people in the United Kingdom put off seeing a doctor when they were ill.{{Cite news |last=Vinter |first=Robyn |date=10 October 2021 |title='GPs fob us off': most trans people avoid the doctor when they're sick |work=The Observer |url=https://www.theguardian.com/society/2021/oct/10/gps-fob-us-off-most-trans-people-avoid-the-doctor-when-theyre-sick}} In 2014, 43% of transgender counselling clients in the UK said their counsellor "wanted to explore transgender issues in therapy even when this wasn't the reason they had sought help".{{Cite journal |last=Hunt |first=Jane |date=2013 |title=An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK |journal=Counselling and Psychotherapy Research |volume=14 |issue=4 |pages=288–296 |doi=10.1080/14733145.2013.838597|publisher=Routledge}}

Insurance

The transgender population has faced an increased burden of disease due to the lack of gender affirming coverage by insurance. Compared to the cisgender population, the transgender community has a lower insurance rate and faces obstacles with insurance (both private and public) denying coverage for many of their healthcare needs. According to the United States Transgender Survey (USTC), 20% of the transgender community reported insurance coverage for gender affirming care being partially covered or not being covered at all. Without insurance coverage, the transgender community is left with numerous out of pocket costs. The lack of insurance coverage denies these patients their healthcare needs and creates financial insecurity.

These challenges with insurance create a decrease in healthcare outreach by the transgender community due to the costs. According to the United States Transgender Survey (USTS), 37.6% of the transgender community reported missing or avoiding preventative screenings and healthcare visits due to the costs{{Cite journal |last1=Kachen |first1=Axenya |last2=Pharr |first2=Jennifer R. |date=2020-09-02 |title=Health Care Access and Utilization by Transgender Populations: A United States Transgender Survey Study |journal=Transgender Health |volume=5 |issue=3 |pages=141–148 |doi=10.1089/trgh.2020.0017 |issn=2380-193X |pmc=7906231 |pmid=33644308}} This creates an increased burden of disease, and statistics show a higher rate of mental health conditions, poor physical health, and respiratory conditions, such as asthma.

Besides the toll on this community's health and financial stability, insurers also refuse to change their records to reflect the true nature of the patient.{{Cite web |title=WHO announces the development of a guideline on the health of trans and gender diverse people |url=https://www.who.int/news/item/28-06-2023-who-announces-the-development-of-the-guideline-on-the-health-of-trans-and-gender-diverse-people |access-date=2024-07-26 |website=www.who.int |language=en}} Many health insurance companies have refused to change the individual's name and gender on their records. This creates another obstacle for this community to receive care while feeling accepted.

Insurances Covering Gender Affirmative Care

Numerous insurances within the United States cover gender affirming care, which includes hormone replacement therapy (HRT) and surgery. However, this coverage is conditional and dependent on many factors, such as plan benefits, employer, and the state. In California most insurers are forbidden from banning gender affirming care coverage; however, insurers in other states don't have this restriction and can exclude coverage of gender affirming care.{{Cite web |last=thisisloyal.com |first=Loyal {{!}} |title=Gaps in Health Care Access and Health Insurance Among LGBT Populations in California |url=https://williamsinstitute.law.ucla.edu/publications/gaps-health-care-lgbt-ca/ |access-date=2024-07-26 |website=Williams Institute |language=en-US}} Each specific plan and policy will specify the coverage of gender affirming care. Most insurers covering gender affirming care will cover generic and FDA approved hormone replacement therapy. If a clinician recommends a brand name hormone replacement therapy, insurance will conditionally accept it based on recommendation, cost, policy, and healthcare needs.

Some insurers that cover gender affirming care include Anthem Blue Cross and Blue Shield, Cigna, Aetna, Medicare, Tricare and UnitedHealthcare.{{Cite journal |last1=Patel |first1=Heli |last2=Camacho |first2=Justin M |last3=Salehi |first3=Neeku |last4=Garakani |first4=Romina |last5=Friedman |first5=Leigh |last6=Reid |first6=Chris M |title=Journeying Through the Hurdles of Gender-Affirming Care Insurance: A Literature Analysis |journal=Cureus |date=2023 |volume=15 |issue=3 |pages=e36849 |doi=10.7759/cureus.36849 |doi-access=free |issn=2168-8184 |pmid=37123806|pmc=10142323 }}

Global access to healthcare across primary and secondary health settings remains fragmented for transgender people,{{Cite journal |last1=Arnull |first1=Liam Gary |last2=Kapilashrami |first2=Anuj |last3=Sampson |first3=Margaret |date=2021-11-30 |title=Visualizing patterns and gaps in transgender sexual and reproductive health: A bibliometric and content analysis of literature (1990–2020) |journal=International Journal of Transgender Health |volume=24 |issue=4 |pages=381–396 |doi=10.1080/26895269.2021.1997691 |s2cid=251942433 |issn=2689-5269|doi-access=free |pmid=37901061 |pmc=10601526 }} with access and services highly dependent on a political administration's support for trans health in policy as well as globally-engrained health inequalities largely shaped by financial wealth inequalities such as the Global North and Global South divide.{{Cite journal |last1=Reisner |first1=Sari L |last2=Poteat |first2=Tonia |last3=Keatley |first3=JoAnne |last4=Cabral |first4=Mauro |last5=Mothopeng |first5=Tampose |last6=Dunham |first6=Emilia |last7=Holland |first7=Claire E |last8=Max |first8=Ryan |last9=Baral |first9=Stefan D |date=2016 |title=Global health burden and needs of transgender populations: a review |journal=The Lancet |language=en |volume=388 |issue=10042 |pages=412–436 |doi=10.1016/S0140-6736(16)00684-X |pmc=7035595 |pmid=27323919}}{{Cite journal |last1=Pillay |first1=Suntosh R |last2=Ntetmen |first2=Joachim M |last3=Nel |first3=Juan A |date=2022 |title=Queering global health: an urgent call for LGBT+ affirmative practices |journal=The Lancet Global Health |language=en |volume=10 |issue=4 |pages=e574–e578 |doi=10.1016/S2214-109X(22)00001-8|pmid=35176236 |s2cid=246882513 |doi-access=free |hdl=10500/29671 |hdl-access=free }}

{{see also|LGBT rights in South Africa#Transgender rights}}

Access to transition care, mental care, and other issues affecting transgender people is very limited; there is only one comprehensive transgender health care clinic available in South Africa.{{Cite journal|last1=Wilson|first1=D.|last2=Marais|first2=A.|last3=de Villiers|first3=A.|last4=Addinall|first4=R.|last5=Campbell|first5=M. M.|date=2014-06-01|title=Transgender issues in South Africa, with particular reference to the Groote Schuur Hospital Transgender Unit|journal=South African Medical Journal|volume=104|issue=6|pages=448–449|issn=0256-9574|doi=10.7196/SAMJ.8392|doi-broken-date=2024-11-10 |pmid=26301294|doi-access=free}} Additionally, the typical lack of access to transition options that comes as a result of gatekeeping is compounded by the relatively limited knowledge of transgender topics among psychiatrists and psychologists in South Africa.

{{see also|LGBT rights in Thailand#Gender identity and expression}}

Sex reassignment operations (gender-affirming surgery) have been performed in Thailand since 1975, and Thailand is among the most popular destinations globally for patients seeking such operations.{{cite news|last1=Gale|first1=Jason|title=How Thailand became a global gender-change destination|url=https://www.bloomberg.com/news/features/2015-10-26/how-thailand-became-a-global-gender-change-destination|access-date=22 April 2017|work=Bloomberg|date=26 October 2015|archive-date=18 July 2019|archive-url=https://web.archive.org/web/20190718002309/https://www.bloomberg.com/news/features/2015-10-26/how-thailand-became-a-global-gender-change-destination|url-status=live}} Puberty blockers and cross sex hormones are also available to minors in Thailand.{{cite web|title=Gender affirming hormone treatment in children and adolescents|url=https://www.bumrungrad.com/en/health-blog/february-2023/gender-affirming-hormone-treatment|access-date=29 September 2024|website=Bumrungrad International Hospital|date=23 February 2023}}{{cite web|title=Gender Affirmation Surgery (Sex Reassignment Surgery)|url=https://www.yanhee.net/cosmetic-services/sex-reassignment-surgery/|access-date=29 September 2024|work=Yanhee Hospital}} Transgender people are quite common in Thai popular entertainment, television shows and nightclub performances, however, transgender people lack various legal rights compared to the rest of the population,{{cite news|url=http://www.bangkokpost.com/opinion/opinion/355011/katoey-face-closed-doors|work=Bangkok Post|title=Katoey face closed doors|department=Opinion|date=14 June 2013|access-date=2 September 2015|archive-date=18 June 2024|archive-url=https://web.archive.org/web/20240618175308/https://www.bangkokpost.com/opinion/opinion/355011/katoey-face-closed-doors|url-status=live}}{{cite web|url=http://www.bangkokpost.com/news/local/303850/sex-drugs-stigma-put-thai-transsexuals-at-hiv-risk |title=Sex, drugs, stigma put Thai transsexuals at HIV risk |work=Bangkok Post |date=23 July 2012|access-date=29 August 2015}} and may face discrimination from society.{{cite news|title=The two faces of Thai tolerance|url=https://www.bangkokpost.com/thailand/special-reports/368584/the-two-faces-of-thai-tolerance|newspaper=Bangkok Post|date=2013-09-08|author=Chaiyot Yongcharoenchai|access-date=28 June 2019|archive-date=24 February 2023|archive-url=https://web.archive.org/web/20230224062935/https://www.bangkokpost.com/thailand/special-reports/368584/the-two-faces-of-thai-tolerance|url-status=live}}{{cite news|url=http://bangkokpost.com/news/investigation/334017/ladyboys-lost-in-legal-system|archive-url=https://archive.today/20130215134042/http://bangkokpost.com/news/investigation/334017/ladyboys-lost-in-legal-system|url-status=dead|archive-date=15 February 2013|title=Ladyboys lost in legal system|date=3 February 2013|work=Bangkok Post}}

Transgender women, known as kathoeys, have access to hormones through non-prescription sources.{{Cite journal|last1=Gooren|first1=Louis J|last2=Sungkaew|first2=Tanapong|last3=Giltay|first3=Erik J|title=Exploration of functional health, mental well-being and cross-sex hormone use in a sample of Thai male-to-female transgendered persons (kathoeys)|journal=Asian Journal of Andrology|volume=15|issue=2|pages=280–285|doi=10.1038/aja.2012.139|pmc=3739151|pmid=23353716|year=2013}} This kind of access is a result of the low availability and expense of transgender health care clinics. However, transgender men have difficulty gaining access to hormones such as testosterone in Thailand because it is not as readily available as hormones for kathoeys.{{Cite journal|last1=Gooren|first1=Louis J.|last2=Sungkaew|first2=Tanapong|last3=Giltay|first3=Erik J.|last4=Guadamuz|first4=Thomas E.|date=2015-01-02|title=Cross-sex hormone use, functional health and mental well-being among transgender men and Transgender Women (Kathoeys) in Thailand|journal=Culture, Health & Sexuality|volume=17|issue=1|pages=92–103|doi=10.1080/13691058.2014.950982|issn=1369-1058|pmc=4227918|pmid=25270637}} As a result, just a third of all trans men surveyed are taking hormones to transition whereas almost three quarters of kathoeys surveyed are taking hormones.

{{see also|LGBTQ rights in China#Transgender rights|Transgender people in China}}

A 2017 report conducted by Beijing LGBT Center and Peking University showed that out of 1279 of its respondents who wanted to receive hormone treatment, 71% of them felt that it was "difficult", "very difficult", or "virtually impossible" to acquire safe and reliable information about gender affirming medications and receive hormonal replacement therapy with the guidance of a doctor. As a result, 66% of the respondents chose "online" and 51% chose "friends" as one of their sources for hormone replacement therapy medications. Gender reassignment surgeries were reported to be similarly inaccessible, with 89.1% of the respondents who have the needs for such surgeries unable to pursue them.{{Cite book |last1=Beijing LGBT Center |url=https://cnlgbtdata.com/files/uploads/2019/03/2017_%E4%B8%AD%E5%9B%BD%E8%B7%A8%E6%80%A7%E5%88%AB%E7%BE%A4%E4%BD%93%E7%94%9F%E5%AD%98%E7%8E%B0%E7%8A%B6%E8%B0%83%E7%A0%94%E6%8A%A5%E5%91%8A-%E5%8F%AF%E8%A7%86%E5%8C%96.pdf |title=2017 Zhong Guo Kua Xing Bie Qun Ti Sheng Cun Xian Zhuang Diao Cha Bao Gao |last2=Peking University |year=2017 |at=Chapter 2 |language=zh |script-title=zh:2017中国跨性别群体生存现状调查报告 |trans-title=2017 Survey Report on Survival Status of Transgender Groups in China |chapter= |author-link=Beijing LGBT Center |author-link2=Peking University}}

On December 1, 2022, the Chinese National Medical Products Administration banned online sales of cyproterone acetate, estradiol, and testosterone, which are the most common hormones and antiandrogens used in transgender hormone replacement therapy.{{Cite web |author=National Medical Products Administration |author-link=National Medical Products Administration |date=2022-11-30 |title=Guo Jia Yao Jian Ju Guan Yu Gui Fan Yao Pin Wang Luo Xiao Shou Bei An He Bao Gao Gong Zuo De Gong Gao (2022 Nian Di 112 Hao) |script-title=zh:国家药监局关于规范药品网络销售备案和报告工作的公告（2022年 第112号） |trans-title=Announcement of the National Medical Products Administration on Regulating Filing and Reporting of Online Drug Sales (2022 No. 112) |url=https://mbd.baidu.com/newspage/data/landingsuper?rs=2950361179&ruk=KZn7lJ7U6dw7NFHwgZBUAg&isBdboxFrom=1&pageType=1&urlext=%7B%22cuid%22%3A%22YuBSagOqHflfi2t3_8vZ808nH8luaH8tluSSi0aqvuKk0qqSB%22%7D&context=%7B%22nid%22%3A%22news_9839016020589811917%22%7D |access-date=2022-12-04 |website=国家药品监督管理局 |language=zh}}{{Cite news |date=2022-11-30 |title=Guo Jia Yao Jian Ju Fa Bu Wang Luo Jin Shou Yao Pin Qing Dan: Bao Kuo Yi Miao, Zhu She Ji Deng |script-title=zh:国家药监局发布网络禁售药品清单：包括疫苗、注射剂等 |language=zh |trans-title=The National Medical Products Administration Issued a List of Banned Drugs on the Internet: Including Vaccines, Injections, etc. |work=京报网 |url=https://mbd.baidu.com/newspage/data/landingsuper?rs=2950361179&ruk=KZn7lJ7U6dw7NFHwgZBUAg&isBdboxFrom=1&pageType=1&urlext=%7B%22cuid%22%3A%22YuBSagOqHflfi2t3_8vZ808nH8luaH8tluSSi0aqvuKk0qqSB%22%7D&context=%7B%22nid%22%3A%22news_9839016020589811917%22%7D |accessdate=2022-12-04}}

{{see also|LGBT rights in Spain#Transgender and intersex rights}}

Public health care services are available for transgender individuals in Spain, although there has been debate over whether certain procedures should be covered under the public system.{{Cite journal|last1=Esteva de Antonio|first1=Isabel|last2=Gómez-Gil|first2=Esther|title=Coordination of healthcare for transsexual persons|journal=Current Opinion in Endocrinology, Diabetes and Obesity|volume=20|issue=6|pages=585–591|doi=10.1097/01.med.0000436182.42966.31|pmid=24468763|date=December 2013|s2cid=36430944}} The region of Andalusia was the first to approve sex reassignment procedures, including sex reassignment surgery and mastectomies, in 1999, and several other regions have followed their lead in the following years. Multiple interdisciplinary clinics exist in Spain to cater specifically to diagnosing and treating transgender patients, including the Andalusian Gender Team.{{Cite journal|last1=Giraldo|first1=F.|last2=Antonio|first2=I. Esteva de|last3=Miguel|first3=T. Bergero de|last4=Maté|first4=A.|last5=González|first5=C.|last6=Baena|first6=V.|last7=Martín-Morales|first7=A.|last8=Tinoco|first8=I.|last9=Cano|first9=G.|date=2001-10-01|title=Andalusia (Málaga) Gender Team. Surgical experience treating transsexuals in the first and only unit in the Spanish Public Health System|url=https://www.researchgate.net/publication/289155302|journal=ResearchGate|volume=27|issue=4|issn=0376-7892}} As of 2013, over 4000 transgender patients had been treated in Spain, including Spaniards and international patients.{{Cite journal|last1=Esteva de Antonio|first1=Isabel|last2=Gómez-Gil|first2=Esther|last3=Almaraz|first3=M. ª Cruz|last4=Martínez-Tudela|first4=Juana|last5=Bergero|first5=Trinidad|last6=Olveira|first6=Gabriel|last7=Soriguer|first7=Federico|date=2012-06-01|title=Organization of healthcare for transsexual persons in the Spanish national health system|url=http://www.scielosp.org/scielo.php?script=sci_abstract&pid=S0213-91112012000300003&lng=en&nrm=iso&tlng=es|journal=Gaceta Sanitaria|volume=26|issue=3|pages=203–209|doi=10.1016/j.gaceta.2011.10.021|pmid=22402241|issn=0213-9111|doi-access=free}}

Beginning in 2007, Spain has begun allowing transgender individuals who are eighteen years or older to change their name and gender identity on public records and documents if they have been receiving hormone replacement therapy for at least two years.

{{see also|LGBT rights in Sweden#Access to healthcare}}

In 1972, Sweden introduced a law that made it possible to change a person's legal gender, but in order to do that, transgender individuals were required to be sterilized and were not allowed to save any sperm or eggs. Apart from this, there were no other mandatory surgeries required for legal gender change.{{cite web

|url= https://www.rfsl.se/en/organisation/tvaangssteriliseringar-och-skadestaand/forced-sterilisation-of-trans-people-personal-stories/

|title= Forced Sterilisation of Trans People

|date= 2017-03-25

|publisher= RSFL

|access-date= 2018-05-29

|archive-date= 2020-06-13

|archive-url= https://web.archive.org/web/20200613174642/https://www.rfsl.se/en/organisation/tvaangssteriliseringar-och-skadestaand/forced-sterilisation-of-trans-people-personal-stories/

|url-status= dead

}} In 1999, people who had been forcibly sterilized in Sweden were entitled to compensation. However, the sterilization requirement remained for people who changed their legal gender. In January 2013, forced sterilization was banned in Sweden.{{cite web

|url= https://www.qx.se/samhalle/22747/tvangssterilisering-vid-konskorrigering-blir-antligen-olagligt/

|title= Tvångssterilisering vid könskorrigering blir äntligen olagligt

|author= Jessica Lundgren

|date= 2013-01-10

|publisher= QX

}}

Depending on the person's health and wishes there are several different treatments and surgeries available. Today, no form of treatment is mandatory. Although to access medical and legal transitional treatment (e.g. hormone replacement therapy, and top surgery to enhance or remove breast tissue), the person will need to be diagnosed with transexualism or gender dysphoria, which requires at least one year of therapy, during which they must live for one full year as their desired gender in all professional, social, and personal matters. Gender clinics are recommended to provide male-to-female patients with wigs and breast prostheses for the endeavor.{{Citation needed|date=June 2024}} The evaluation additionally involves, if possible, meetings with family members and/or other individuals close to the patient. Patients may be denied care for any number of "psychosocial dimensions", including their choice of job or their marital status.{{Cite journal |journal=Sexuality Research and Social Policy |title=Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare |last1=Linander |first1=Ida |last2=Lauri |first2=Marcus |year=2021 |volume=18 |issue=2 |pages=309–320 |doi=10.1007/s13178-020-00459-5|s2cid=256073192 |doi-access=free }}{{Cite web|url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/konsdysfori-vuxna-metodbilaga.pdf|title=God vård av vuxna med könsdysfori}}{{cite web

|url= https://www.1177.se/Vastra-Gotaland/Fakta-och-rad/Mer-om/Transsexualism-och-utredning/

|title= Könsdysfori och Utredning

|author= Lundströmmottagningen, Västra Götalandsregionen.

|date= 2016-11-28

|access-date= 2018-06-04

|archive-date= 2016-08-27

|archive-url= https://web.archive.org/web/20160827030723/http://www.1177.se/Vastra-Gotaland/Fakta-och-rad/Mer-om/Transsexualism-och-utredning/

|url-status= dead

}}

An individual with a transsexual or gender dysphoria diagnosis can, together with the assessment team and other doctors, decide what suits them. Medically transitioning in Sweden is covered by the high-cost protection for medications and doctor's visits, and there is no surgery fee. The fee the individual pays for a doctor's appointment or other care represents only a small fraction of the actual costs.{{cite web|url=https://www.1177.se/Blekinge/Other-languages/Engelska/Regler-och-rattigheter/Patientavgifter/|title=Patient Fees|author=Ingemar Karlsson Gadea|date=2016-11-10|publisher=1177}}

If a person would like to change their legal gender marker and personal identity number they will have to seek permission from the National Board of Health and Welfare. For non-binary persons younger than 18 years, the healthcare is limited. These individuals do not have access to a legal gender marker change or bottom surgery.{{cite web|url=https://www.rfsl.se/en/organisation/health-sexuality-and-hiv/transvaard/|title=Trans Health Care|author=RSFL|date=2015-11-27|access-date=2018-05-29|archive-date=2019-02-27|archive-url=https://web.archive.org/web/20190227072854/https://www.rfsl.se/en/organisation/health-sexuality-and-hiv/transvaard/|url-status=dead}}

In Sweden, anyone is allowed to change their name at any time, including for gender transition.{{cite web |url=https://www.skatteverket.se/privat/folkbokforing/namn.4.18e1b10334ebe8bc80004083.html |title=Namn |website=Skatteverket |language=Swedish |access-date=March 2, 2021}}

Up until January 27, 2017, being transsexual was classed as a disease. Two months earlier, on November 21, 2016, around 50 trans activists broke into and occupied the Swedish National Board of Health and Welfare (Swedish: Socialstyrelsen) premises in Rålambsvägen in Stockholm. The activists demanded that their voices be heard regarding the way the country, healthcare, and the National Board of Health and Welfare mistreat transgender and intersex individuals.{{cite news

|url= https://www.svt.se/nyheter/lokalt/stockholm/transpersoner-har-ockuperat-socialstyrelsen

|title= Transaktivister har ockuperat Socialstyrelsen

|author= Richard Ekman and Johannes Kardell

|newspaper= SVT Nyheter

|date= 21 November 2016

|publisher= SVT }}

Sweden's Karolinska Institute, administrator of the second-largest hospital system in the country, announced in March 2021 that it would discontinue providing puberty blockers or cross-sex hormones to children under 16. Additionally, the Karolinska Institute changed its policy to cease providing puberty blockers or cross-sex hormones to teenagers 16–18, outside of approved clinical trials.{{cite news |date=13 May 2021 |title=Doubts are growing about therapy for gender-dysphoric children |newspaper=The Economist |url=https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |archive-url=https://web.archive.org/web/20230810003011/https://www.economist.com/science-and-technology/2021/05/13/doubts-are-growing-about-therapy-for-gender-dysphoric-children |archive-date=2023-08-10|access-date=2 November 2021}} On 22 February 2022, Sweden's National Board of Health and Welfare said that puberty blockers should only be used in "exceptional cases" and said that their use is backed by "uncertain science".{{cite web |date=2015 |title=Care of children and adolescents with gender dysphoria: Summary |url=https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf |access-date=4 May 2023 |website=The National Board of Health and Welfare (Socialstyrelsen) |language=en-GB |archive-date=19 May 2023 |archive-url=https://web.archive.org/web/20230519163625/https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf |url-status=dead }}{{cite web |date=22 February 2022 |title=Uppdaterade rekommendationer för hormonbehandling vid könsdysfori hos unga |url=https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/ |archive-url=https://web.archive.org/web/20230803230704/https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/uppdaterade-rekommendationer-for-hormonbehandling-vid-konsdysfori-hos-unga/ |archive-date=2023-08-03 |access-date=4 May 2023 |website=The National Board of Health and Welfare (Socialstyrelsen) |language=sv}}

However, other providers in Sweden continue to provide puberty blockers, and a clinician's professional judgment determines what treatments are recommended or not recommended. Youth are able to access gender-affirming care when doctors deem it medically necessary. The treatment is not banned in Sweden and is offered as part of its national healthcare service.{{cite journal | vauthors = Linander I, Alm E |date=20 April 2022 |title=Waiting for and in gender-confirming healthcare in Sweden: An analysis of young trans people's experiences |url=https://www.diva-portal.org/smash/get/diva2:1657703/FULLTEXT01.pdf |url-status=live |journal=European Journal of Social Work |volume=25 |issue=6 |publisher=Routledge |pages=995–1006 |doi=10.1080/13691457.2022.2063799 |archive-url=https://web.archive.org/web/20220926195755/https://www.diva-portal.org/smash/get/diva2:1657703/FULLTEXT01.pdf |archive-date=26 September 2022 |access-date=11 October 2022 |s2cid=248314474}}{{cite journal | vauthors = Linander I, Lauri M, Alm E, Goicolea I |date=June 2021 |title=Two Steps Forward, One Step Back: A Policy Analysis of the Swedish Guidelines for Trans-Specific Healthcare |journal=Sexuality Research and Social Policy |volume=18 |issue=2 |pages=309–320 |doi=10.1007/s13178-020-00459-5 |s2cid=219733261|doi-access=free }}

{{see also|LGBT rights in the Netherlands#Transgender and intersex rights}}

File:2013 Rally for Transgender Equality 21166.jpg

Gender care in the Netherlands is insured under the national health care of third part insurer's, including laser hair removal, SRS, facial feminization surgery and hormones. Hormones can be prescribed by licensed endocrinologist in an academic hospital from the age 16 and older. Blockers can be prescribed from age 12 when puberty usually starts.

The Dutch Ministry of Health, Welfare and Sport publishes guidelines recommending the use of puberty blockers in transgender adolescents of at least Tanner Stage II with informed consent and approval of an endocrinologist.{{cite web | url=https://richtlijnendatabase.nl/gerelateerde_documenten/f/19927/Kwaliteitsstandaard%20Transgenderzorg%20-%20Somatisch.pdf | title=Kwaliteitsstandaard Transgenderzorg -Somatisch | access-date=10 April 2024 | archive-date=1 April 2024 | archive-url=https://web.archive.org/web/20240401073534/https://richtlijnendatabase.nl/gerelateerde_documenten/f/19927/Kwaliteitsstandaard%20Transgenderzorg%20-%20Somatisch.pdf | url-status=dead }} This guideline, published in 2016, is endorsed by the following Dutch medical organizations:

• Nederlands Internisten Vereniging (Dutch Internists Association)
• Nederlands Huisartsen Genootschap (Dutch Society of General Practitioners)
• Nederlands Instituut van Psychologen (Dutch Institute of Psychologists)
• Nederlandse Vereniging voor Kindergeneeskunde (Dutch Association for Pediatrics)
• Nederlandse Vereniging voor Obstetrie & Gynaecologie (Dutch Association for Obstetrics & Gynaecology)
• Nederlandse Vereniging voor Plastische Chirurgie (Dutch Association for Plastic Surgery)
• Nederlandse Vereniging voor Psychiatrie (Dutch Psychiatry Association)
• Transvisie (Transvision, a patient organization for transgender patients)

{{see also|Transgender rights in the United Kingdom|Cass Review}}

In 1999, the High Court ruled in favor of three transgender women in the case North West Lancashire Health Authority v A, D and G. The transgender women sued the North West Lancashire Health Authority after being denied gender reassignment surgery from 1996 to 1997. The judgement was the first time that transgender surgical operations had been tested in an open court in the United Kingdom{{cite news |last1=Finn |first1=Gary |title=Ruling backs sex change surgery |url=https://www.newspapers.com/clip/91023579/the-independent/ |work=The Independent |date=22 December 1998 |pages=7}} and was described by Stephen Lodge (the solicitor representing the three women) as a "landmark in the continuing struggle for legal recognition" of transgender rights in Britain.{{cite news |title=Landmark transsexual ruling upheld |url=http://news.bbc.co.uk/1/hi/health/407225.stm |work=BBC News |date=29 July 1999}}{{cite news |last1=Adamson |first1=Colin |title=NHS must pay for sex swaps as judges say transsexuals are ill |url=https://www.newspapers.com/clip/91023622/evening-standard/ |work=Evening Standard |date=29 July 1999 |pages=172}} The ruling means that it is illegal for any health authority in England or Wales to put a blanket ban on gender-affirming surgery relating to transgender people.{{cite web |last1=McNab |first1=Claire |title=Foreword |url=http://www.pfc.org.uk/caselaw/High%20Court%20judgment%20in%20the%20case%20of%20A,%20D%20and%20G%20v%20North%20West%20Lancashire%20Health%20Authority.pdf |website=Press for Change |access-date=21 December 2021 |page=1}}

A 2013 survey of gender identity clinic services provided by the UK National Health Service (NHS) found that 94% of transgender people using the gender identity clinics were satisfied with their care and would recommend the clinics to a friend or family member.{{Cite journal|last1=Davies|first1=Andrew|last2=Bouman|first2=Walter Pierre|last3=Richards|first3=Christina|last4=Barrett|first4=James|last5=Ahmad|first5=Sheraz|last6=Baker|first6=Karen|last7=Lenihan|first7=Penny|last8=Lorimer|first8=Stuart|last9=Murjan|first9=Sarah|date=2013-11-01|title=Patient satisfaction with gender identity clinic services in the United Kingdom|journal=Sexual and Relationship Therapy|volume=28|issue=4|pages=400–418|doi=10.1080/14681994.2013.834321|s2cid=145216924|issn=1468-1994}} This study focused on transgender people using the NHS clinics and so was prone to survivorship bias, as those unhappy with the NHS service are less likely to use it. Despite this positive response, however, other National Health Service programs are lacking; almost a third of respondents reported inadequate psychiatric care in their local area. The options available from the National Health Service also vary with location; slightly differing protocols are used in England, Scotland, Wales and Northern Ireland. Protocols and available options differ widely outside of the UK.

In 2018 Stonewall described UK transgender healthcare as having "significant barriers to accessing treatment, including waiting times that stretch into years, far exceeding the maximums set by law for NHS patients".{{cite web |title=LGBT In Britain – Trans Report |url=https://www.stonewall.org.uk/system/files/lgbt_in_britain_-_trans_report_final.pdf |access-date=5 September 2020 |website=Stonewall}} Patients have the legal right to begin treatment within 18 weeks of referral by their GP, however the average wait for patients to gender identity clinics was 18 months in 2020 with over 13,000 people on the waiting list for appointments at gender identity clinics.{{Cite news |date=2020-01-09 |title=Transgender people face NHS waiting list 'hell' |language=en-GB |work=BBC News |url=https://www.bbc.com/news/uk-england-51006264 |access-date=2022-11-13}}

As of May 2024, prescription of puberty blockers to new patients under 18 for the treatment of gender dysphoria is banned for both private medical practices (by a law in parliament in May{{Cite web |last=Barnes |first=Hannah |date=2024-05-30 |title=The government's 11th-hour ban on puberty blockers |url=https://www.newstatesman.com/politics/health/2024/05/government-11th-hour-ban-puberty-blockers-gender |access-date=2024-08-20 |website=New Statesman |language=en-US |archive-date=2 August 2024 |archive-url=https://web.archive.org/web/20240802152433/https://www.newstatesman.com/politics/health/2024/05/government-11th-hour-ban-puberty-blockers-gender |url-status=live }}) and the official state healthcare National Health Service (NHS) which stopped their use earlier, in the aftermath of the Cass Review except for use in clinical research trials.{{cite web |title=New restrictions on puberty blockers |url=https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers |website=GOV.UK |publisher=Department of Health and Social Care: Government of the United Kingdom |access-date=20 August 2024 |language=en |date=29 May 2024 |archive-date=20 August 2024 |archive-url=https://web.archive.org/web/20240820015327/https://www.gov.uk/government/news/new-restrictions-on-puberty-blockers |url-status=live }}

Previously, on 30 June 2020, the NHS changed its website, replacing the statement that puberty blockers were "fully reversible" and that "treatment can usually be stopped at any time"; with "little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.{{cite news |date=30 June 2020 |title=Women and Gaming; ICU nurse Dawn Bilbrough; Poulomi Basu; Puberty blockers |work=Woman's Hour |url=https://www.bbc.co.uk/programmes/m000kgsj |access-date=1 November 2021 |archive-date=10 November 2022 |archive-url=https://web.archive.org/web/20221110235425/https://www.bbc.co.uk/programmes/m000kgsj |url-status=live }}

The Bell v Tavistock decision by the High Court of Justice for England and Wales ruled children under 16 were not competent to give informed consent to puberty blockers, but this was overturned by the Court of Appeal in September 2021.

In 2022, the British Medical Association opposed restrictions on puberty blockers,{{cite web |title=UK doctors back trans self-ID rules and treatment for under-18s |vauthors=Savage R |work=U.S. |date=16 September 2020 |access-date=17 May 2023 |url=https://www.reuters.com/article/britain-lgbt-health-idINL8N2GD35H |quote=The BMA called for trans people to receive healthcare "in settings appropriate to their gender identity" and for under-18s to be able to get treatment "in line with existing principles of consent", which requires they fully understand what is involved. |archive-date=18 May 2023 |archive-url=https://web.archive.org/web/20230518025054/https://www.reuters.com/article/britain-lgbt-health-idINL8N2GD35H |url-status=live }} and the NHS restricted their use for children under 16 years of age to centrally administered clinical research.{{cite web |date=20 October 2022 |title=Interim service specification for specialist gender dysphoria services for children and young people – public consultation |url=https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/ |access-date=31 December 2022 |website=NHS UK |language=en-GB |archive-date=31 May 2023 |archive-url=https://web.archive.org/web/20230531102932/https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/ |url-status=live }}{{cite web |date=2022 |title=Implementing advice from the Cass Review |url=https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ |access-date=4 May 2023 |website=NHS UK |language=en-GB |archive-date=4 June 2023 |archive-url=https://web.archive.org/web/20230604080758/https://www.england.nhs.uk/commissioning/spec-services/npc-crg/gender-dysphoria-clinical-programme/implementing-advice-from-the-cass-review/ |url-status=live }}

In April 2024, the Cass Review stated that there was inadequate evidence to justify the widespread use of puberty blockers for gender dysphoria, and that more research was needed to provide evidence as to the effectiveness of this treatment, in terms of reducing distress and improving psychological functioning.{{cite web |vauthors=Cass H |date=2024 |title=Final Report – Cass Review |url=https://cass.independent-review.uk/home/publications/final-report/ |access-date=2024-04-20 |website=cass.independent-review.uk |language=en |archive-date=9 April 2024 |archive-url=https://web.archive.org/web/20240409231432/https://cass.independent-review.uk/home/publications/final-report/ |url-status=live }} This led to a de facto moratorium of the routine provision of puberty blockers for gender dysphoria within NHS England and NHS Scotland outside of clinical trials,{{cite web |vauthors=Alfonseca K |title=What the trans care recommendations from the NHS England report mean |url=https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |access-date=2024-04-20 |website=ABC News |archive-date=23 April 2024 |archive-url=https://web.archive.org/web/20240423232304/https://abcnews.go.com/Health/trans-care-recommendations-nhs-england-report/story?id=109081565 |url-status=live }}{{cite news |vauthors=Parry J |date=2024-03-12 |title=NHS England to stop prescribing puberty blockers |url=https://www.bbc.com/news/health-68549091 |access-date=2024-04-20 |work=BBC News |archive-date=21 April 2024 |archive-url=https://web.archive.org/web/20240421030249/https://www.bbc.com/news/health-68549091 |url-status=live }}{{cite web |date=19 April 2024 |title=Scotland's under-18s gender clinic pauses puberty blockers |url=https://www.bbc.co.uk/news/uk-scotland-68844119 |access-date=21 April 2024 |website=bbc.co.uk |publisher=BBC |vauthors=McCool M |archive-date=21 April 2024 |archive-url=https://web.archive.org/web/20240421043445/https://www.bbc.co.uk/news/uk-scotland-68844119 |url-status=live }} and a subsequent ban private prescription of puberty blockers in the United Kingdom.{{cite news |vauthors=Smyth C, Beal J |date=2024-04-20 |title=Private doctors who give children puberty blockers may be struck off |newspaper=The Times |url=https://www.thetimes.com/uk/article/private-doctors-who-give-children-puberty-blockers-may-be-struck-off-nf97p73l0 |access-date=2024-04-20 |language=en |issn=0140-0460 |archive-date=20 April 2024 |archive-url=https://web.archive.org/web/20240420105107/https://www.thetimes.co.uk/article/private-doctors-who-give-children-puberty-blockers-may-be-struck-off-nf97p73l0 |url-status=live }}{{cite news |date=7 April 2024 |title=NHS loophole allows puberty blockers for children |url=https://www.telegraph.co.uk/news/2024/04/07/puberty-blockers-nhs-loophole-liz-truss-dr-hilary-cass/ |work=The Telegraph |vauthors=Searle M |access-date=8 April 2024 |archive-date=8 April 2024 |archive-url=https://web.archive.org/web/20240408090851/https://www.telegraph.co.uk/news/2024/04/07/puberty-blockers-nhs-loophole-liz-truss-dr-hilary-cass/ |url-status=live }}{{cite magazine |title=Children Will No Longer Be Able to Access Puberty Blockers at England Clinics |url=https://time.com/6900330/nhs-bans-puberty-blockers-england-clinics/ |magazine=Time |access-date=16 March 2024 |archive-date=16 March 2024 |archive-url=https://web.archive.org/web/20240316040825/https://time.com/6900330/nhs-bans-puberty-blockers-england-clinics/ |url-status=live }}

Children already receiving puberty blockers via NHS England will be able to continue their treatment.{{cite news | vauthors = John T | date = 12 March 2024 | work = CNN | url = https://www.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html | title = England's health service to stop prescribing puberty blockers to transgender kids | access-date = 16 March 2024 | archive-date = 16 March 2024 | archive-url = https://web.archive.org/web/20240316040825/https://www.cnn.com/2024/03/13/uk/england-nhs-puberty-blockers-trans-children-intl-gbr/index.html | url-status = live }} In England, a clinical trial into puberty blockers is planned for early 2025.{{cite news |last1=Campbell |first1=Denis |date=7 August 2024 |title=Delayed puberty blocker clinical trial to start next year in England |url=https://www.theguardian.com/society/article/2024/aug/07/delayed-puberty-blocker-clinical-trial-to-start-next-year-in-england |access-date=8 August 2024 |work=The Guardian |archive-date=1 October 2024 |archive-url=https://web.archive.org/web/20241001004823/https://www.theguardian.com/society/article/2024/aug/07/delayed-puberty-blocker-clinical-trial-to-start-next-year-in-england |url-status=live }}

In July 2024, the Royal College of General Practitioners stated that for patients under 18, no general practitioner should prescribe puberty blockers outside of a clinical trial, and the prescription of gender-affirming hormones should be left to specialists. They affirmed they will fully implement the Cass Review recommendations.{{Cite web |last=RCGP |title=Transgender care |url=https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |access-date=2024-08-16 |website=www.rcgp.org.uk |language=en |archive-date=29 July 2024 |archive-url=https://web.archive.org/web/20240729180836/https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care |url-status=live }}

There are four NHS Scotland Gender Identity Clinics providing services to adults and a separate service for younger people.{{cite web |url=https://www.scottishtrans.org/healthcare/scottish-gender-identity-services/ |title=Scottish Gender Identity Services |author= |date= |website= |publisher=Scottish Trans |access-date=29 June 2022 |quote=}} The National Gender Identity Clinical Network for Scotland reported in 2021 that some patients had waited in excess of two years from referral for their first appointment.{{cite web |url=https://www.ngicns.scot.nhs.uk/wp-content/uploads/2021/11/2020-2021-NGICNS-Annual-Report-1.0.pdf |title=Annual Report 2020/2021 |author= |date= |website= |publisher=National Gender Identity Clinical Network for Scotland |access-date=29 June 2021 |quote= |archive-date=30 April 2022 |archive-url=https://web.archive.org/web/20220430191226/https://www.ngicns.scot.nhs.uk/wp-content/uploads/2021/11/2020-2021-NGICNS-Annual-Report-1.0.pdf |url-status=dead }} Minister for Public Health Maree Todd has stated that the Scottish Government wants to reduce "unacceptable waits to access gender identity services".{{cite web |url=https://www.gov.scot/news/supporting-nhs-gender-identity-services/ |title=Supporting NHS gender identity services |author= |date=20 December 2021 |website= |publisher=Scottish Government |access-date=29 June 2021 |quote=}} Research has indicated patient dissatisfaction with long wait times.{{cite web |url=https://www.stor.scot.nhs.uk/bitstream/handle/11289/580258/Health%20Needs%20Assessment%20LGBTQ.pdf?sequence=1&isAllowed=y |title=Health needs assessment of lesbian, gay, bisexual, transgender and non-binary people |author= |date= |website= |publisher=Traci Leven Research |access-date=29 June 2022 |quote=}} However, overall experience of treatment outcomes was largely positive, particularly for hormone therapy and surgery.{{cite web |url=https://www.scotphn.net/wp-content/uploads/2017/04/2018_05_16-HCNA-of-Gender-Identity-Services-1.pdf |title=Health Care Needs Assessment of Gender Identity Services |author= |date= |website= |publisher=Scottish Public Health Network |access-date=29 June 2022 |quote=}}

{{see also|Transgender rights in Canada#Healthcare access}}

A study of transgender Ontario residents aged 16 and over, published in 2016, found that half of them were reluctant to discuss transgender issues with their family doctor.{{cite news|title=Local access to healthcare for transgender patients lacking, one advocate says|url=http://www.cbc.ca/news/canada/kitchener-waterloo/local-access-healthcare-transgender-patients-1.3421756|access-date=January 3, 2017|publisher=CBS News|date=January 27, 2016}} A 2013–2014 nationwide study of young transgender and genderqueer Canadians found that a third of younger (ages 14–18) and half of the older (ages 19–25) respondents missed needed physical health care. Only 15 percent of respondents with a family doctor felt very comfortable discussing transgender issues with them.{{cite web|title=Canadian Transgender Youth Health Survey|url=http://www.saravyc.ubc.ca/what-we-do/lgbtq-youth/canadian-transgender-youth-health-survey/|website=Stigma and Resilience Among Vulnerable Youth Centre|publisher=The University of British Columbia|access-date=January 3, 2017}}

All Canadian provinces fund some sex reassignment surgeries, with New Brunswick being the last of the provinces to start insuring these procedures in 2016.{{cite news|author1=Daniel McHardie|title=New Brunswick will now cover gender-confirming surgeries|url=http://www.cbc.ca/news/canada/new-brunswick/gender-confirming-surgeries-1.3614766|access-date=January 3, 2017|publisher=CBS News|date=June 3, 2016}} Waiting times for surgeries can be lengthy, as few surgeons in the country provide them; a clinic in Montreal is the only one providing a full range of procedures.{{cite news|author1=Melissa Fundira|title=Arson at Montreal clinic concerns trans people awaiting surgery|url=http://www.cbc.ca/news/canada/montreal/ahuntsic-medical-clinic-arson-1.3564543|access-date=January 3, 2017|agency=CBC News|date=May 3, 2016}}{{cite news|title=Ontario expands referrals for gender reassignment surgery|url=http://www.cbc.ca/news/canada/toronto/transgender-ontario-1.3307287|access-date=January 3, 2017|publisher=CBS News|date=November 6, 2015}}{{cite news|title=Canada's health care doesn't meet the needs of transgender patients|url=http://www.cbc.ca/radio/thecurrent/the-current-for-january-15-2015-with-host-comedian-lara-rae-1.3405091/canada-s-health-care-doesn-t-meet-the-needs-of-transgender-patients-1.3405146|access-date=January 3, 2017|publisher=CBC Radio|date=January 15, 2016}} Insurance coverage is not generally provided for the transition-related procedures of facial feminization surgery, tracheal shave, or laser hair removal.{{cite web|title=Publicly Funded Transition-related Medical Care in Canada|url=http://www.ufcw.ca/templates/ufcwcanada/images/media/posters/Publicly_Funded_Transition_Posters/Publicly-funded-transition-related-medical-care-in-Canada-8.5x11-EN.pdf|website=UFCW Canada|access-date=January 3, 2017}} And in January 2024, The Alberta government of Danielle Smith announced plans to ban gender affirming surgeries for minors under the age of 18 and hormones and puberty blockers for minors under the age of 16.{{cite web | url=https://edmonton.ctvnews.ca/alberta-to-require-parental-consent-for-name-pronoun-changes-at-school-1.6750498 | title=Alberta to require parental consent for name, pronoun changes at school | date=31 January 2024 }}

According to the Canadian Pediatric Society, "Current evidence shows puberty blockers to be safe when used appropriately, and they remain an option to be considered within a wider view of the patient's mental and psychosocial health."{{cite news|work=CBC|url=https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920|title=What Canadian doctors say about new U.K. review questioning puberty blockers for transgender youth|vauthors=Johnson L|date=15 April 2024|access-date=17 April 2024|archive-date=16 April 2024|archive-url=https://web.archive.org/web/20240416185549/https://www.cbc.ca/news/health/puberty-blockers-review-1.7172920|url-status=live}}

{{see also|LGBTQ rights in Mexico#Healthcare access}}

A July 2016 study in The Lancet Psychiatry reported that nearly half of transgender people surveyed undertook body-altering procedures without medical supervision.{{cite web|author1=Mayela Sánchez|title=Transgender People in Mexico City Resort to Dangerous Unsupervised Procedures|url=https://globalpressjournal.com/americas/mexico/transgender-people-mexico-city-resort-dangerous-unsupervised-procedures/|website=Global Press Journal|access-date=January 3, 2017|date=December 18, 2016}} Transition-related care is not covered under Mexico's national health plan.{{cite web|title=Report on Human Rights Conditions of Transgender Women in Mexico|url=http://transgenderlawcenter.org/wp-content/uploads/2016/05/CountryConditionsReport-FINAL.pdf|website=Transgender Law Center|access-date=January 3, 2017|date=May 2016}} Only one public health institution in Mexico provides free hormones for transgender people. Health care for transgender Mexicans focuses on HIV and prevention of other sexually transmitted diseases.

The Lancet study also found that many transgender Mexicans have physical health problems due to living on the margins of society. The authors of the study recommended that the World Health Organization declassify transgender identity as a mental disorder, to reduce stigma against this population.{{cite news|author1=Pam Belluck|title=W.H.O. Weighs Dropping Transgender Identity From List of Mental Disorders|url=https://www.nytimes.com/2016/07/27/health/who-transgender-medical-disorder.html|access-date=January 3, 2017|work=The New York Times|date=July 26, 2016}}

In June of 2020, the Mexican federal government released "The Protocol for Access without Discrimination to Health Care Services for Lesbian, Gay, Bisexual, Transsexual, Transvestite, Transgender, and Intersex Persons and Specific Care Guidelines." The guidelines are used in healthcare facilities administered by the government. The guidelines state that the process of identifying one's sexual orientation, gender identify and/or expression can occur at early ages. Thus, the guidelines recommend that medical facilities and doctors consider the use of puberty blockers and cross-sex hormones as a treatment for transgender minors when appropriate. In addition to the guidelines, multiple Mexican states have modified their civil codes to recognize gender-affirming healthcare as a right for transgender people under the age of eighteen.{{Cite web |title=Protocolo para el Acceso sin Discriminación a los Servicios de Salud para Personas Lesbianas, Gays, Bisexuales, Transexuales, Travestis, Transgénero e Intersex y Lineamientos Específicos de Atención |url=https://www.gob.mx/cms/uploads/attachment/file/558167/Versi_n_15_DE_JUNIO_2020_Protocolo_Comunidad_LGBTTI_DT_Versi_n_V_20.pdf |access-date=2024-09-29 |website=Government of Mexico |date=June 2020 |language=es |archive-date=10 September 2024 |archive-url=https://web.archive.org/web/20240910233257/https://www.gob.mx/cms/uploads/attachment/file/558167/Versi_n_15_DE_JUNIO_2020_Protocolo_Comunidad_LGBTTI_DT_Versi_n_V_20.pdf |url-status=live }}

{{main|Transgender rights in the United States#Healthcare}}

Transgender people face various kinds of discrimination, especially in health care situations. An assessment of transgender needs in Philadelphia found that 26% of respondents had been denied health care because they were transgender and 52% of respondents had difficulty accessing health services.{{Cite journal|last1=Bradford|first1=Judith|last2=Reisner|first2=Sari L.|last3=Honnold|first3=Julie A.|last4=Xavier|first4=Jessica|date=2012-11-15|title=Experiences of Transgender-Related Discrimination and Implications for Health: Results From the Virginia Transgender Health Initiative Study|journal=American Journal of Public Health|volume=103|issue=10|pages=1820–1829|doi=10.2105/AJPH.2012.300796|issn=0090-0036|pmc=3780721|pmid=23153142}} Aside from transition related care, transgender and gender non-conforming individuals need preventive care such as vaccines, gynecological care, prostate exams, and other annual preventive health measures. Various factors play a role in creating the limited access to care, such as insurance coverage issues related to their legal gender identity status.

The Affordable Care Act (commonly known as Obamacare) marketplace has improved access to insurance for the LGBT community through anti-discriminatory measures, such as not allowing insurance companies to reject consumers for being transgender.Department of Health and Human Services, Office of Disease and Health Promotion. (2016, September). Lesbian, Gay, Bisexual, and Transgender Health. Retrieved from HealthyPeople.gov: https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health {{Webarchive|url=https://web.archive.org/web/20231225160351/https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health |date=2023-12-25 }} However, insurance sold outside of the ACA marketplace does not have to follow these requirements. This means that preventive care, such as gynecological exams for transgender men, may not be covered.Varny J. (2016). Rainbow Medicine- Supporting the Needs of Lesbian, gay, bisexual, and trans patients. Journal of Clinical Medicine.

Starting in the early-2020s, as many as 13 U.S. states banned gender affirming health care for transgender youth,{{cite news |last1=Paris |first1=Francesca |title=Bans on Transition Care for Young People Spread Across U.S. |work=The New York Times |date=April 15, 2023 |url=https://www.nytimes.com/2023/04/15/upshot/bans-transgender-teenagers.html#:~:text=Ten%20states%20in%20the%20past,surgery%20for%20people%20under%2018. |access-date=May 24, 2023 |archive-date=May 24, 2023 |archive-url=https://web.archive.org/web/20230524053546/https://www.nytimes.com/2023/04/15/upshot/bans-transgender-teenagers.html#:~:text=Ten%20states%20in%20the%20past,surgery%20for%20people%20under%2018. |url-status=live }} with several states further restricting treatment for adults as well.{{Cite news |url=https://www.losangelesblade.com/2023/05/11/trans-patients-being-dropped-as-florida-law-bans-up-to-80/ |title=Trans patients being dropped as Florida law bans "Up To 80%" |work=Los Angeles Blade |date=May 11, 2023 |access-date=May 24, 2023 |archive-date=May 20, 2023 |archive-url=https://web.archive.org/web/20230520000841/https://www.losangelesblade.com/2023/05/11/trans-patients-being-dropped-as-florida-law-bans-up-to-80/ |url-status=live }}{{cite web | url=https://thehill.com/homenews/state-watch/3949521-missouri-ag-issues-emergency-order-restricting-gender-affirming-health-care/ | title=Missouri AG issues emergency order restricting gender-affirming health care | date=April 13, 2023 | access-date=May 24, 2023 | archive-date=April 21, 2023 | archive-url=https://web.archive.org/web/20230421200932/https://thehill.com/homenews/state-watch/3949521-missouri-ag-issues-emergency-order-restricting-gender-affirming-health-care/ | url-status=live }} In January 2024, several Republican legislators have expressed their desire to ban gender-affirming healthcare altogether.{{cite web|last=Reed|first=Erin|url=https://www.erininthemorning.com/p/ohio-michigan-republicans-in-released|title=Ohio, Michigan Republicans In Released Audio: "Endgame" Is To Ban Trans Care "For Everyone"|website=Erin in the Morning|date=27 January 2024|access-date=2024-01-30|url-status=live|archive-url=https://web.archive.org/web/20240130013258/https://www.erininthemorning.com/p/ohio-michigan-republicans-in-released|archive-date=2024-01-30}}

In May 2025, a two year systematic review commissioned by the state of Utah as part of a ban on trans youth healthcare concluded that "The consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric [gender dysphoria] patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer". The review's findings were thereafter dismissed by the Utah state legislature, who kept the ban in place.{{Cite web |last=Pauly |first=Madison |title=Utah study on trans youth care extremely inconvenient for politicians who ordered it |url=https://www.motherjones.com/politics/2025/05/utah-transgender-youth-affirming-care-ban/ |access-date=2025-05-28 |website=Mother Jones |language=en-US}}{{Cite web |title=Utah lawmakers’ own study found gender-affirming care benefits trans youth. Will they lift the treatment ban? |url=https://www.sltrib.com/news/politics/2025/05/22/utah-lawmakers-own-study-found/ |access-date=2025-05-28 |website=The Salt Lake Tribune |language=en-US}}

{{main|LGBTQ rights in Colombia#Gender identity and expression}}

Transgender women sex workers have cited financial difficulties as barriers to accessing physical transition options.{{Cite journal|last1=Bianchi|first1=Fernanda T.|last2=Reisen|first2=Carol A.|last3=Zea|first3=Maria Cecilia|last4=Vidal-Ortiz|first4=Salvador|last5=Gonzales|first5=Felisa A.|last6=Betancourt|first6=Fabián|last7=Aguilar|first7=Marcela|last8=Poppen|first8=Paul J.|date=2014-01-24|title=Sex Work Among Men Who Have Sex with Men and Transgender Women in Bogotá|journal=Archives of Sexual Behavior|volume=43|issue=8|pages=1637–1650|doi=10.1007/s10508-014-0260-z|issn=0004-0002|pmc=4110190|pmid=24464550}} As a result, they have entered sex work to relieve financial burdens, both those related to transition and those not related to transition. However, despite working in the sex trade, the transgender women are at low risk for HIV transmission as the Colombian government requires education about sexual health and human rights for sex workers to work in so-called tolerance zones, areas where sex work is legal.

{{See also|Suicide among LGBT youth}}

Transition options for transgender adolescents and youth are significantly limited compared to those for transgender adults. Prepubescent transgender youth can go through various social changes, such as presenting as their gender and asking to be called by a different name or different pronouns.{{Cite journal|last1=Chen|first1=Diane|last2=Hidalgo|first2=Marco A.|last3=Leibowitz|first3=Scott|last4=Leininger|first4=Jennifer|last5=Simons|first5=Lisa|last6=Finlayson|first6=Courtney|last7=Garofalo|first7=Robert|title=Multidisciplinary Care for Gender-Diverse Youth: A Narrative Review and Unique Model of Gender-Affirming Care|journal=Transgender Health|volume=1|issue=1|pages=117–123|doi=10.1089/trgh.2016.0009|pmid=28861529|pmc=5549539|year=2016}} Medical options for transition become available once the child begins to enter puberty. Under close supervision by a team of doctors, puberty blockers may be used to limit the effects of puberty.

Discrimination has a significant effect on the mental health of young transgender people. The lack of family acceptance, rejection in schools and abuse from peers can be powerful stressors, leading to poor mental health and substance abuse.{{cite web|last1=Taylor|first1=Mark|title=An Insight into the Life of a Transgender Child|url=https://www.linkedin.com/pulse/insight-life-transgender-child-mark-taylor|website=LinkedIn|access-date=28 June 2017}} A study done on transgender youth in San Francisco found that higher rates of both transgender-based and racial bias are associated with increased rates of depression, post-traumatic stress disorder, and suicidal ideation.{{Cite journal|last1=Wilson|first1=Erin C.|last2=Chen|first2=Yea-Hung|last3=Arayasirikul|first3=Sean|last4=Raymond|first4=H. Fisher|last5=McFarland|first5=Willi|date=2016-04-26|title=The Impact of Discrimination on the Mental Health of Trans*Female Youth and the Protective Effect of Parental Support|journal=AIDS and Behavior|volume=20|issue=10|pages=2203–2211|doi=10.1007/s10461-016-1409-7|issn=1090-7165|pmc=5025345|pmid=27115401}} The Swiss National Advisory Commission on Biomedical Ethics (NCE) has suggested that research into treatments for gender-incongruent and gender-diverse young people should routinely consider the impact of social factors, including discrimination and social support, when analyzing their results.{{Cite web |date=16 December 2024 |title=New CNE opinion paper on the medical treatment for minors with gender dysphoria |url=https://www.nek-cne.admin.ch/en/about-us/news/news-details/die-nek-veroeffentlicht-stellungnahme-zur-medizinischen-behandlung-von-minderjaehrigen-personen-mit-einer-geschlechtsdysphorie |access-date=2025-03-04 |website=National Advisory Commission on Biomedical Ethics (NCE) |pages=18–9, 25 |quote=differences in social support and discrimination experiences should be systematically included in the analysis" (p. 18) "The prospects of success of medical treatment for a minor with gender dysphoria demonstrably depend not only on the treatment protocol itself, but also on the social support received by the person treated. Because of this close interaction, it is therefore recommended that, in the context of gender dysphoria, differences in social support and discrimination experiences should be systematically included in the analysis when the effectiveness of particular treatment methods is studied.}} (p. 25)

In a 2018 review, evidence suggested that hormonal treatments for transgender adolescents can achieve their intended physical effects. The mental effects of GnRH modifiers are positive with treatment associated with significant improvements in multiple psychological measures, including global functioning, depression, and overall behavioral and/or emotional problems.{{Cite journal|last1=Chew|first1=Denise|last2=Anderson|first2=Jemma|last3=Williams|first3=Katrina|last4=May|first4=Tamara|last5=Pang|first5=Kenneth|date=2018-04-01|title=Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review|journal=Pediatrics|volume=141|issue=4|pages=e20173742|doi=10.1542/peds.2017-3742|pmid=29514975|doi-access=free}} In a two-year study published in January 2023, Chen et al. found that gender-affirming hormones for transgender and non-binary youth "improved appearance congruence and psychosocial functioning".{{Cite journal |last1=Chen |first1=Diane |last2=Berona |first2=Johnny |last3=Chan |first3=Yee-Ming |last4=Ehrensaft |first4=Diane |last5=Garofalo |first5=Robert |last6=Hidalgo |first6=Marco |last7=Rosenthal |first7=Stephen |last8=Tishelman |first8=Amy |last9=Olson-Kennedy |first9=Johanna |title=Psychosocial Functioning in Transgender Youth after 2 Years of Hormones |journal=The New England Journal of Medicine |doi=10.1056/NEJMoa2206297 |date=19 January 2023|volume=388 |issue=3 |pages=240–250 |pmid=36652355 |pmc=10081536 |s2cid=255969323 }} Another study analyzing Dutch transgender youth completed by Catharina van der Loos et al. found that 98% of participants who started gender-affirming hormone treatment in youth continued using said treatment into adulthood.{{Cite journal |last=Catharina van der Loos |first=Maria Anna Theodora |date=October 20, 2022 |title=Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands |url=https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/fulltext# |journal=The Lancet}}

In February 2024, the American Psychological Association approved a policy statement supporting unobstructed access to health care and evidence-based clinical care for transgender, gender-diverse, and nonbinary children, adolescents, and adults, as well as opposing state bans and policies intended to limit access to such care.{{Cite web |date=February 2024 |title=APA Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science |url=https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care |access-date=2024-02-29 |website=American Psychological Association}}{{cite news |last1=Reed |first1=Erin |title=World's largest psych association supports trans youth care |url=https://www.advocate.com/news/apa-gender-affirming-care |access-date=29 February 2024 |work=www.advocate.com |language=en}}

Transgender older adults can encounter challenges in the access and quality of care received in health care systems and nursing homes, where providers may be ill-prepared to provide culturally sensitive care to trans people.{{Cite web|url=https://transequality.org/issues/aging|title=Aging|website=National Center for Transgender Equality|access-date=2019-03-24}} Trans individuals face the risk of aging with more limited support and in more stigmatizing environments than heteronormative individuals.{{Cite journal|last1=de Vries|first1=Brian|last2=Gutman|first2=Gloria|last3=Humble|first3=Áine|last4=Gahagan|first4=Jacqueline|last5=Chamberland|first5=Line|last6=Aubert|first6=Patrick|last7=Fast|first7=Janet|last8=Mock|first8=Steven|date=2019-03-14|title=End-of-Life Preparations Among LGBT Older Canadian Adults: The Missing Conversations|journal=The International Journal of Aging and Human Development|volume=88|issue=4|pages=358–379|doi=10.1177/0091415019836738|pmid=30871331|s2cid=78094482|issn=0091-4150|url=http://archipel.uqam.ca/12470/3/Vries%20et%20al.%20Missing%20Conversations_publi%C3%A9.pdf}} Despite the rather negative picture portrayed by medical literature in relation to the depression and isolation that many transgender people encounter at earlier stages of life, some studies found testimonies of older LGBT adults relating feelings of inclusion, comfort and community support.{{Cite journal|last1=Reygan|first1=Finn|last2=Henderson|first2=Neil|date=2019-03-21|title=All Bad? Experiences of Aging Among LGBT Elders in South Africa|journal=The International Journal of Aging and Human Development|volume=88|issue=4|pages=405–421|doi=10.1177/0091415019836929|pmid=30897921|s2cid=85446146|issn=0091-4150|hdl=10566/6338|hdl-access=free}}

For transgender older adults seeking gender-affirming hormonal therapy, data on the health impacts of masculinizing and feminizing therapies in the older population is limited. Testosterone and estrogen levels reduce with age, and sex hormone levels and advanced age have each been identified as risk factors for cancers, cardiovascular disease, and other disease states. Further investigation is needed to assess the risks and benefits of GAHT in older adults.{{Cite journal |last1=Iwamoto |first1=Sean J. |last2=Defreyne |first2=Justine |last3=Kaoutzanis |first3=Christodoulos |last4=Davies |first4=Robert D. |last5=Moreau |first5=Kerrie L. |last6=Rothman |first6=Micol S. |date=2023-04-19 |title=Gender-affirming hormone therapy, mental health, and surgical considerations for aging transgender and gender diverse adults |journal=Therapeutic Advances in Endocrinology and Metabolism |volume=14 |pages=20420188231166494 |doi=10.1177/20420188231166494 |issn=2042-0188 |pmid=37113210|pmc=10126651 }}

{{Portal|Medicine}}

• Detransition
• {{slink|Transgender#Healthcare}}
• Healthcare and the LGBT community
• Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People
• Transgender clinic
• European Network for the Investigation of Gender Incongruence (ENIGI)
• Study of Transition, Outcomes, and Gender (STRONG)

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