For two weeks, Jameson "Jay" Dunn wanted to peek under the bandages. Since 2020, Dunn had been taking testosterone and hoping for the day he could undergo top surgery. Dunn is a transgender man. While the hormone therapy helped affirm his gender, Dunn wanted to have his breasts removed to feel comfortable in his body.
“When the bandages finally came off … it was like a literal weight lifted off me,” Dunn, 37, of Kalamazoo, Michigan, told TODAY. “I wanted to get (top surgery) done and get it done as soon as possible to start creating the body that I should have had from the beginning.”
Dunn’s breast removal — performed by Dr. Amie Hop at the Spectrum Health Center Comprehensive Breast Clinic in Grand Rapids, Michigan — is considered medical transitioning.
Transitioning overall refers to the process that a person goes through to "bring their gender expression and/or body into alignment with their gender identity," according to LGBTQ advocacy group GLAAD.
Transitioning is different for everyone, and a person can be transgender without undergoing any physical changes or medical procedures, but transitioning generally includes three elements:
- Social transition, meaning coming out to family, friends and colleagues and altering how one dresses or presents oneself
- Legal, such as changing your name and sex on documents
- Medical, which often involves hormone replacement therapy and one or more surgical procedures, such as jaw contouring and breast removal
According to GLAAD, all of these steps fall under the umbrella of "gender-affirming care."
In 2022, state legislators put forward a record number of bills targeting LGBTQ rights, 315, though less than 10% of them, 29, became law. Most that passed targeted minors, NBC News reported. In March 2022, Florida Gov. Ron DeSantis signed a bill into law that bans discussing sexual orientation or gender identity in primary school, and he's seeking to expand it to all grades, Associated Press reported. An Alabama law that took effect in May makes it a felony to provide gender-affirming medical care to trans minors.
This year may set a new record for state legislation targeting LGBTQ rights, NBC News reported: As of mid-January, 120 such bills have been put forward in 22 states, such as Texas, North Dakota, Missouri and Oklahoma, majority of which focus on young trans people. As of this week, at least 11 states either ban or restrict providing gender-affirming medical care to trans youth, Associated Press reported: Kentucky, West Virginia, Alabama, Arkansas, Arizona, Georgia, Iowa, Mississippi, Tennessee, Utah and South Dakota.
Why is gender-affirming care important?
Gender affirming care is really about "caring for the whole person. It’s caring for all their needs,” nurse practitioner Dallas Ducar, CEO of Transhealth, a Massachusetts clinic that cares for trans youth and adults, told TODAY.
“We’re really working with the intrinsic nature of who someone is, how they feel deeply inside. And so gender-affirming care is a chance to really be able to care for that person’s identity, care for that person’s whole self.”
Why is gender-affirming care important for kids?
While gender-affirming care for minors looks a little different than such care for adults, it’s not dramatically different.
“Gender-affirming care can be basically anything that affirms someone’s gender identity," Dr. Juanita Kay Hodax, co-director of the Gender Clinic at Seattle Children’s, told TODAY. "Whether that is using the right names or pronouns that a person identifies with or supporting somebody with social groups and social transitions and the way they dress — that is considered gender affirming. We have options for different medical care, like hormones and puberty blockers.”
Many leading medical organizations, including the American Academy of Pediatrics, American Medical Association, the Endocrine Society and the American Psychiatric Association, support offering gender-affirming care.
Research also shows that providing access to gender-affirming care improves trans people’s mental health.
A January 2023 study, the largest in the U.S. to look at the impact of gender-affirming hormones, found that providing this treatment to trans and nonbinary youth improves anxiety and depression symptoms for at least two years, according to Northwestern Medicine, whose experts led the study. A January 2022 study in the journal PLOS One found that trans teens between ages 14 and 17 with access to gender-affirming hormones experienced better mental health as adults than peers who didn’t have access.
“It’s really important,” Hodax said. “There have been multiple research studies that have showed that kids have better outcomes, specifically mental health outcomes, from family support and also receiving gender-affirming medical care. And these outcomes are things like decreased depression and anxiety and suicidality.”
Many people misunderstand what gender-affirming care in pediatrics is, Hodax said: “One misconception that I often hear is that we are starting really young kids on hormones and doing surgery on young kids. That’s just not what’s happening.”
Before puberty, the Gender Clinic at Seattle Children’s offers “social and emotional support” for trans children and their families, Hodax said. At the onset of puberty, doctors then might prescribe puberty blockers, which suppress hormonal changes.
“We use puberty blockers, which don’t have permanent physical changes to the body,” Hodax said. “It’s not until teenager years, like mid-teenage years, that most clinics will start things like hormones like testosterone or estrogen that can have more permanent changes to the body.”
Most gender-affirming surgeries “aren’t happening until after 18," she added.
Hodax urges parents to talk to their pediatrician if their child says they are trans. Their doctor might help them identify places where their child can get gender-affirming care, though there are not enough medical professionals that understand gender-affirming care, so it can be tough, Hodax said, adding that she travels to Montana, for example, to help trans children and teens there.
“There are not as many providers that have the training or the knowledge to take care of transgender youth,” she said. In 2021, "there were a number of bills (in Montana) that were doing things like banning medical care for transgender youth, and it was really challenging for all the patients and the families.”
Why is gender-affirming care important for adults?
For years, Dunn felt like primary care doctors didn’t get him. Sometimes, doctors would understand the importance of using Dunn’s chosen name, but office staff would often use his deadname (the term some trans people use to refer to their birth name after they stop using it) or incorrect pronouns.
“I’ve gotten into a couple — not arguments — but very stern conversations with a couple of people who were choosing not to use my preferred name,” Dunn said. “It’s just not right. You don’t have to call me that.”
Hop treated him as Jay, the motorcycle loving, Lego-collecting health care worker, who needed medical care.
“Providers have to remember that affirming care has to do with everyday health care, too,” Hop told TODAY. “I have so many patients that say, ‘I just want a primary care doctor that talks to me about normal stuff when I go there and just have a question about an ear infection, and I don’t need to be asked a million questions.’ … That’s affirming care — (when) you treat the person in front of you.”
Transhealth provides a unique setting to its patients in a “wraparound care model,” Ducar explained. She added that the clinic was built on "four pillars" — research, advocacy, clinical care and education. In addition to providing medical gender-affirming care and well visits, the clinic offers social support and a welcoming safe space. Medical appointments are at least 30 minutes.
“We have built a system that tries to get health care to slow down,” Ducar said. “We’ve built a community room here, too, so after or before your appointment, you can stop by and have some snacks and check out our clothing closet.”
So often, trans people need to educate their doctor on how to talk to or care for them, Ducar said, but at Transhealth, the staff are also experts. They understand how to navigate insurance challenges and what gender-affirming care entails, from well visits to mental health services. Ducar herself has a psychiatry background.
“We're here to see you, to listen to you, to really have you guide us, which is so different than the traditional medical model, which is, ‘I’m the provider. I’m going to tell you what’s going to happen, and you have to jump through hoops,’” Ducar said. “We operate on a model that says … ‘You’re the expert of your own life, and we’re going to get you what you need, provided it's safe.’”
This type of care fills patients with joy and hope, Ducar said, recalling the trans girl she met who promptly — and happily — discovered that trans women can be CEOs. Ducar wants Transhealth to be an example to all health care providers on how to affirm all patients' life experiences.
“This is really a chance for the transgender community to be able to show health care what it can be and what it should be — and what patients deserve,” she said.