What is Gender-Affirming Care and How does it Affect Mental Health?

Don’t be misinformed. Gender-affirming care is far broader than just hormone therapy for trans individuals.

We’ve been having enlightened conversations, haven’t we? We’ve recently discussed attacks on allies and denizens alike, orchestrated to siphon money for global dominance in our young aristocracy. Fun! One conversation, centered around gender-affirming care and how this applies to almost everyone, happened so frequently in the past week, that I feel compelled to say something here. Let’s start with a definition.

The term “gender-affirming” actually refers to any medical, psychological, or social support that helps individuals align their bodies, identities, and well-being. That’s right. Any treatments considered standard medical care for cisgender people are also gender-affirming. Here are some examples that often get overlooked.

Let’s start with medical and hormonal treatments. While many people associate hormone replacement therapy (HRT) with trans individuals, HRT is also used for menopause or hypogonadism (low testosterone). Also, not just individuals with uteruses take birth control for pregnancy prevention. Birth control is also used to regulate menstruation, which can help cis women and nonbinary individuals who have heavy cycles, debilitating cramps, and anemia. Gender-affirming care is needed for breast reconstruction & augmentation for cancer survivors or simply for aesthetic preference. Similarly labiaplasty & vaginal reconstruction is used for medical reasons or personal preference. Voice therapy helps cis women with deep voices or men with high-pitched voices.

And speaking of men, gender-affirming care helps with erectile dysfunction treatments (Viagra, Cialis, testosterone therapy), chest reduction surgery for gynecomastia, and hair restoration treatments for baldness or hair loss.

I realize that I’ve mentioned some things that might be aesthetic or cosmetic, like breast implants or mastectomies, and I want to circle back. Facial feminization or masculinization surgeries (rhinoplasty, jaw surgery, cheek implants, brow lifts) qualify as gender-affirming care. Makeup and aesthetic procedures (Botox, fillers, lip injections) and laser hair removal & electrolysis for women with PCOS or men who want a cleaner look do too.

And all of this impacts our mental health. In fact, what I do as a therapist qualifies as gender-affirming care. I help people feel at peace with their identities and experiences. I use the names and pronoun changes that my trans folks prefer and I also use the names of my cis folks after marriage, divorce, or for personal reasons. My book club provides support for people navigating gender-related experiences, including menopause or body image struggles. Should I be outlawed??

Many of you have even heard me say time and again that gender is a performance — anytime you wear a bra or binder for breast support or compression, a wig or hairpiece (for those experiencing hair loss from aging, cancer, or hormonal conditions), put on shapewear or body contouring garments to create a desired silhouette, or any other fashion or grooming choices you make, it aligns with your gender identity.

But back to the care part of the conversation. Those who have received infertility treatments (IVF, egg freezing, sperm banking), used surrogacy and assisted reproduction to affirm your role as a parent, or had pelvic floor therapy (for women experiencing postpartum or age-related issues), have engaged in gender-affirming care.

So when politicians attack gender-affirming care under the guise of targeting trans people, they fail to also tell you that so many of these treatments are widely used by cis individuals without question! This reveals a deeper issue: controlling bodies rather than supporting autonomy and well-being. Again, misinforming you and having you vote against your best interests financially benefits the aristocracy. So let’s talk about money.

The financial angle is crucial because when people hear “we’re banning gender-affirming care,” they may not immediately realize how much this could affect access to so many other services. My mind immediately goes to the impact of privatization and insurance denials. My colleagues are already talking about not using gender identity diagnoses, so that they can keep providing services under the radar. This is very real and I do not judge because when care is politicized, insurers follow suit, either raising costs or denying coverage altogether.

Many gender-affirming procedures (for both cis and trans people) are currently covered under public programs like Medicaid, Medicare, and VA benefits. Private insurers often follow government policy—if the government says “this isn’t medically necessary,” insurers have an excuse to deny claims.

So then politicians go further to argue “for their constituents” by saying things like “you don’t want your taxpayer dollars going to transgender mice!” People rarely fact-check government officials and take these comments (or opinions) as reality.

What is reality is that the government already funds gender-affirming care in many ways (e.g., covering Viagra for veterans, HRT for menopausal women, breast reconstruction for cancer survivors). Singling out trans care is a political move, not a financial necessity. If they justify cutting trans-related care under “taxpayer savings,” what stops them from denying HRT for menopause or ED drugs next?

Also, if gender-affirming care gets removed from insurance coverage, only wealthy people will have access. This means that many cis people could lose access to care they take for granted, like hormone therapy, reconstructive surgery, and even mental health services related to gender identity. The cost of these treatments out-of-pocket can be astronomical—HRT alone can go from $30 a month with insurance to hundreds without.

That’s why politicians use vague language to create fear without explaining what they mean by “banning gender-affirming care.” Many Americans don’t realize they are already benefiting from gender-affirming care. The more this gets normalized as “frivolous” or “elective,” the easier it is for insurance companies to deny coverage across the board.

How did all of this start, you ask? It all seems to have started by banning gender-affirming care for minors. Cries of “what about the children??” are often used to project adult fears onto beings who do not have voices that people listen to or take seriously. In fact, as of today, 23 states have already banned gender-affirming care for minors, even though HRT and puberty blockers are used for many non-trans conditions. This raises a critical question: Why is the government inserting itself into parental decision-making?

Parents are typically responsible for making medical decisions for their children, from vaccinations to mental health care. If a parent, alongside medical professionals, determines that gender-affirming care is in the best interest of their child, why should the state intervene? This isn’t about protecting children—it’s about controlling families and dictating who can access care.

Lawmakers in several states have introduced bills that would prohibit Medicaid coverage of gender-transition services, prevent state or county health professionals from providing it, or bar the use of public money to pay for such care for adults who are incarcerated. How is this not unconstitutional and discriminatory, you might ask?

It is unconstitutional and discriminatory!! These laws disproportionately target low-income people, incarcerated individuals, and those on public assistance, creating a two-tiered system where only the wealthy can access gender-affirming care.

Full disclosure — I’m not a lawyer. That’s why I did some research and asked some questions. This is what I learned.

FACT: Banning gender-affirming care violates the 14th amendment. The Equal Protection Clause states that laws must apply equally to all people. When a state bans gender-affirming care for certain groups (low-income individuals on Medicaid, incarcerated people) while allowing private insurance to cover it, they are denying equal medical access based on socioeconomic status. If cis people can get HRT for menopause or erectile dysfunction under Medicaid, but trans people can’t access the same medications for transition, that’s clear discrimination. Denying gender-affirming care specifically to incarcerated individuals violates Supreme Court precedent (Estelle v. Gamble, 1976), which requires prisons to provide medically necessary care.

FACT: Banning gender-affirming care violates the Americans with Disabilities Act (ADA) & Section 1557 of the Affordable Care Act (ACA). Courts have ruled that gender dysphoria is a medical condition covered under the ADA. Banning treatment for it under Medicaid could be challenged as an ADA violation. Section 1557 of the ACA prohibits discrimination in federally funded health programs based on sex, which includes gender identity. Many of these bans directly contradict existing protections.

FACT: Banning gender-affirming care violates the 8th amendment for incarcerated individuals. The Supreme Court has previously ruled that denying medical care to incarcerated individuals is unconstitutional under the 8th Amendment. Courts have previously ruled that denying gender-affirming care in prison settings is cruel and unusual punishment (e.g., Edmo v. Corizon, 2020).

FACT: Banning gender-affirming care disproportionately impacts marginalized groups. Medicaid bans disproportionately harm Black and brown trans people, low-income families, disabled individuals, and pregnant women—groups who are already vulnerable under the law. Courts have struck down policies that disproportionately impact one group without a valid public health justification (Romer v. Evans, 1996).

So where do we go from here? We already know that there will be legal challenges—civil rights groups are already suing over some of these laws. Courts have struck down bans on Medicaid coverage of gender-affirming care before (e.g., West Virginia and Georgia cases) and public pressure matters! When people see that these laws go beyond trans care and strip access to necessary medical treatments, they push back.

If we don’t all push back, we all stand to lose. Use this article to educate others on how much they benefit from gender-affirming care. Contact legislators to tell them you oppose bans on medically necessary treatment. Support legal challenges. Organizations are already fighting these unconstitutional laws. And of course VOTE. Local and state elections matter just as much as federal ones.

I want you to make informed decisions about your life. Attacks on gender-affirming care are a direct attack on bodily autonomy and economic justice. It’s not just about gender to oligarchs—it’s about who “deserves” healthcare (e.g. people who can pay) and who is deemed undeserving (e.g. everyone else).