The Importance of Inclusive, Gender Affirming Care: Building Strong Communities
The Importance of Inclusive, Gender Affirming Care: Building Strong Communities
Our Current Health System Could Use a Revamp
Early in my career, I worked on an adult inpatient psychiatric unit. The unit was covered by an attending physician: an older white cisgender male. One may have considered his belief system outdated. After daily rounding on the clients on the unit, the respective treatment team (physician, social workers, music therapist, and unit nurse) met for our daily treatment team meeting. Here, we discussed each client’s progress while being hospitalized and any barriers or concerns for their hospital discharge. The attending physician presented his case for a newly admitted, transgender female. I don’t remember the client’s preferred name, but I do remember how the physician spoke about the client.
The physician completely disregarded the client’s identity and made it clear he did not support the client’s gender transition. He spoke about the client as if they were a disgrace and didn’t deserve the same respect as any other cisgender-presenting client. At the time, the culture of an inpatient psychiatric unit was this: what the attending physician says, went! I often think about this interaction and how I, a lowly nurse, could have challenged that physician and instead, created a culture where the client could fully be themselves and we, as professionals, could be the ones to support them in that journey!
I can’t change the past, but I can work to make the present more inclusive. The question is: where do I begin? Do I work to educate my community or advocate for broader healthcare reform to better support my clients? In today’s medical system, medical treatment for gender dysphoria or gender incongruence is considered elective by insurance companies, which fail to provide coverage for physician-prescribed treatment (Pediatric Endocrine Society, 2020). This reinforces a system where health insurance companies make all the calls. How can I, as the healthcare provider, empower my clients to have more autonomy and say in their care? I don’t have all the answers, but I know I want to gather key insights to better support my community.
Outlining What it Means to Be a Transgender Female in America
Like I said, I don’t recall the preferred name of the client in my earlier story, but I can imagine how rigorous her journey was to become who she wanted to be: androgen suppression, estrogen therapy, top AND bottom surgery…oh my! In layman’s terms, the client required suppression of the hormones associated with their sex assigned at birth and took female hormones to present in a more feminine way. Medications such as spironolactone or finasteride may be prescribed to suppress testosterone and reduce male characteristics such as excess body or facial hair. In contrast, estradiol may be taken to promote feminizing features including softer skin, decreased muscle mass, and changes in body fat distribution (Tangpricha & Safer, 2025b).
Feminizing surgical procedures may include breast augmentation, vaginoplasty, vulvaplasty, and orchiectomy. Estrogen therapy often results in breast development, with augmentation available for additional enhancement. For transgender women choosing only to remove their testes, an orchiectomy is undergone. Vaginoplasty often involves inversion of penile tissue to create an aesthetic and functional vaginal, vulvar, and clitoral anatomy. Lastly, vulvoplasty is performed for women who desire exclusively external female genitalia (Tangpricha & Safer, 2025b).
Outlining What it Means to Be a Transgender Male in America
For transgender males, testosterone therapy is often prescribed to promote masculinizing effects, such as deepening of the voice, reduced fatty tissue, and a decrease in breast tissue. To address excess breast tissue, transgender men may bind their breasts or opt for surgical removal. Chest surgery may be undergone to remove breast tissue, reposition and resize the nipple-areola complex, and contour the pectoral muscles. Surgery for transgender men can vary in complexity depending on the individual’s goals. Some may opt for extirpative procedures that remove female organs, while others pursue reconstructive surgery to create masculine functions. Extirpative surgeries include hysterectomy, oophorectomy, and vaginectomy, which involve the removal of the uterus, ovaries, and vaginal tissue, respectively. Reconstructive procedures include metoidioplasty, which creates a penis from a hormonally enlarged clitoris, and phalloplasty, which constructs a penile shaft using grafts or flaps from other parts of the body (Tangpricha & Safer, 2025a).
Why Inclusion Is Important in Our Healthcare System and How to Achieve It
As healthcare providers, it’s important to foster inclusive spaces for our clients to promote safer, more attentive communities. According to the Journal of Adolescent Health (2020), transgender individuals, particularly youth, are at high risk for physical and verbal harassment in schools, detention facilities, foster care, and shelters. For healthcare providers, this may be achieved by pursuing continuing education in transgender care to ensure the use of appropriate language and to better meet the needs of this vulnerable population. Websites such as Violet and the National LGBTQIA+ Health Education Center offer free training for healthcare providers.
Additionally, it’s essential for healthcare providers to acknowledge and address any personal biases. Biases involve our preconceived thoughts and attitudes that influence our judgement and interactions with clients. According to Carroll and Siegel (2025), biases in healthcare are associated with poorer health-related outcomes and decreased access to care. For clients, this may cause increased stress, discrimination in care, stigmatization, reduced access to insurance coverage, and delays in seeking care or obtaining necessary medication. If we fail to recognize and manage our personal biases, we’ll be doing our clients a great disservice.
How to Create an Inclusive Community
Communities are strongest when they are well-informed and supported. The Journal of Adolescent Health (2020) emphasizes that caregiver support is crucial for a child’s life satisfaction and serves as a protective factor against depressive symptoms, substance use, and suicidality. Environments that invalidate a child’s identity can contribute to strained familial relationships and risky behaviors. Parents should acknowledge their child’s humanity rather than framing sexuality in terms of “right” or “wrong.” Communities can further support LGBTQ+ youth by promoting participation in and the formation of PFLAG chapters (Parents, Families, and Friends of Lesbians and Gays), which provide education and advocacy resources at local and legislative levels.
According to the Pediatric Endocrine Society (2020), increased funding is essential to ensure an informed community. While compiling research for this section, I came across an article by the Department of Health and Human Services that had been archived. Further investigation highlighted the current political climate: under the Trump administration, over $125 million of LGBTQ research funding was eliminated (Ryan & Bendix, 2025). The archived article detailed behavioral health integration, a collaborative approach among healthcare disciplines designed to address all aspects of a client’s health. These funding cuts have prompted lawsuits from multiple states and health organizations. At the local level, individuals can make an impact by contacting their state senators and representatives; their information can be found on www.house.gov and www.congress.gov.
Where Change Begins
To summarize, the healthcare industry is becoming a more inclusive place, but progress is slow and often met with setbacks. The world needs more trained, culturally sensitive providers to ensure transgender clients receive appropriate treatment across all aspects of the healthcare system. The culture of the healthcare system is shaped by each provider and their ability to ensure clients feel seen and respected. As the saying goes, Rome wasn’t built in a day. However, when we come together as a society, we build a stronger foundation and healthier communities.
References
Carroll & Siegel (2025). Reproductive health care for lesbian, gay, bisexual, queer, and other
sexual minority individuals assigned female at birth
Congress. https://www.congress.gov/members
House. www.house.gov/representatives/find-your-representative
Journal of Adolescent Health (2020). Promoting health equality and nondiscrimination for
transgender and gender-diverse youth.
National LGBTQIA+ Health Education Center.
Pediatric Endocrine Society (2020). Position statement on transgender health.
PFLAG. https://pflag.org/resource/legislative-advocacy/
Ryan & Bendix (2025). Trump administration axes more than $125M in LGBTQ health funding,
upending research field.
Tangpricha & Safer (2025a). Transgender men: Evaluation and management.
Tangpricha & Safer (2025b). Transgender women: Evaluation and management.
