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The NAU library website for the Phoenix Biomedical Campus Library

Gender-affirming healthcare

 Local resources 

 Health information 

Search through the following websites to find info about healthcare options, primary care, therapists, surgeons, and other medical providers.

 Community spaces and healthcare organizations  

See below for information about support groups, meeting locations, community clinics, hospitals, and wellness centers that provide services specific to transgender and gender expansive populations in Phoenix and across Arizona.

 Guidelines 

 Professional development and health education resources 

 Policy practice and guidance 

While it doesn't at first appear that policy should fit within the context of gender-affirming healthcare, it is actually a vital component. Research shows that many of the health and healthcare disparities experienced by transgender individuals result from institutionalized harm. (Carmel & Erickson-Schroth, 2016; Klein, Paradise, & Goodwin, 2018) For that reason, health equity cannot be achieved without changes to legal and administrative structures which create barriers to inclusion. 

 

 First things first: 

​To be clear: being transgender is not an illness, or even a diagnosis! The word "transgender" is simply an adjective that describes a person who has a gender identity that is different from how they were assigned at or near birth. We know that gender and sex identity are messy, and  just because we think we know a child's gender identity based on their genitals before, at, or just after birth, science shows that gender and genitals don't always match up.

Because we place enormous expectations on gender and genitals to match, we end up over-emphasizing their connection, which can lead to significant distress, pain, and potential harm for transgender people as they grow up. Doctors call this distress "gender dysphoria". 

 Definitions: 

  • Transgender -- an umbrella term that describes a person whose gender identity may not match their sex assigned at birth
  • Gender identity -- a term that describes a person's affirmed gender
  • Sexual orientation -- a term that describes who a person loves. NOTE: sexual orientation and gender identity are NOT the same thing; however, they do inform one another. A transgender woman who loves other women might very well identify as gay. A transgender man who loves women might identify as straight. However, people can also identify as bisexual, queer, asexual, or any number of other sexual orientations.
  • Cisgender -- a term that describes a person whose gender identity "matches" their sex assigned at birth. NOTE: you are likely cisgender if you've never had to think about your gender identity!
  • Gender nonconforming, Gender expansive, Gender diverse -- catch-all terms that can refer to transgender persons, intersex persons, gender nonbinary persons, and so on
  • Genderqueer, Genderfluid, Gender nonbinary -- a person who does not adhere to traditional understandings about gender identity and expression, and may express two or more genders, no gender, or a complex fluctuation between traditional genders
  • Gender dysphoria -- the medical term used to explain the feeling of internal pain and suffering felt by transgender people. A gender dysphoria diagnosis is typically required before a transgender-identifying person can begin a treatment plan.
  • Intersex -- a term that describes a person born with sexual, hormonal, chromosomal, and/or genetic characteristics that vary from binary and traditional expectations
  • Disorders of Sexual Development (DSD) -- the medical term for diagnoses that result from diverse development of traditionally sexed body parts, including: genitals, chromosomes, and hormones
  • Transfeminine -- a term that describes a person who was assigned male at birth but identifies and expresses a gender more aligned with feminine modes of presentation
  • Transfemale (transgender female) -- a person who was assigned male at birth but identifies as female. NOTE: just because someone identifies as a transgender female, that doesn't mean they have to be or act feminine!
  • Transmasculine -- a term that describes a person who was assigned female at birth but identifies and expresses a gender more aligned with masculine modes of presentation
  • Transmale (transgender male) -- a person who was assigned female at birth but identifies as male. NOTE: just because someone identifies as a transgender male, that doesn't mean they have to be or act masculine!
  • Affirmed / asserted gender -- the gender with which a person identifies. NOTE: all people have an affirmed or asserted gender, not just transgender people!
  • Assigned sex at birth -- the sex identified (usually by a doctor) when a person is born. Sex assigned at birth typically informs what letters go onto a birth certificate (ie: M or F)
  • Transphobia -- the cultural biases, fears, stereotypes, and discrimination that is intended to harm and/or ignore the lived experiences of transgender people
  • Internalized transphobia -- the internal feelings of self-hatred, distress, and anxiety felt by transgender people concerning their own gender identity
  • Hormone replacement -- a common treatment that involves rebalancing hormones (including estrogen and testosterone) to bring them into alignment with one's felt gender identity (for instance: a transgender female might take testosterone suppressants while taking estrogen as a replacement)
  • Puberty blockers -- a generally safe method of stalling puberty and the emergence of secondary sex characteristics in pre-adolescent youth prior to hormone replacement at a later period
  • Gender-affirming surgery -- surgical treatments that bring a person's physical body into alignment with their felt gender identity. Gender-affirming surgeries are not always necessary, but they are in some cases. Typically, necessary surgeries involve genital reconstruction through: "bottom surgery" (ie: phalloplasty for transgender men and vaginoplasty for transgender women) and/or "top surgery" (mastectomy + chest contouring for transgender men and breast augmentation for transgender women)

 Statistics: 

 Myths, debunked: 

The following myths are common to discussions regarding transgender identities in the United States. Each one is followed by a rationale explaining why the myth does not reflect the reality of transgender experience.

Nobody is born in the wrong body. Every person’s body is unique in its own way. This goes for transgender people, just like everyone else. That said, many transgender people experience gender dysphoria, which results in varying levels of body dissatisfaction, discomfort, or distress. In many cases, these words fail to describe the internal, psychological turmoil felt by persons with gender dysphoria, with transgender adults sometimes using intense language associated with “hatred or dissociation” to describe their bodies. 

A more recent study found that adolescents with gender dysphoria experienced self-criticism, social distress, hyper-awareness of their bodies, and dissociation from undesirable body parts. This is especially concerning since puberty exacerbates such feelings.

Simply put, transgender persons may not be “in the wrong body”, but many transgender people do experience having a body that does not work in conjunction with their asserted gender identity and their brain function, which can be deeply painful, and leads to intense psychological and emotional distress.

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First, we need to define delusion...a term which is often misunderstood.

Delusion is defined in the DSM as irrational and fantastic beliefs that do not correlate with reality. Delusions are often associated with psychotic disorders like schizophrenia, but they can occur in persons with body dysmorphic disorder and anorexia nervosa, both of which involve delusions about body image and "dysphoric feelings" (these are feelings of discomfort or dissociation from oneself). Importantly, we aren't sure what causes delusions, but we do know a few things, like:

  • persons suffering from delusions tend to believe with certainty in their delusion;
  • a delusion is not the same as lying. People with delusions experience the delusion as a real thing;
  • there is a fine line between "delusion" and "insight". Some persons who have been called "delusional" were instead very "insightful";
  • not all delusions are the same, and not all delusions should be treated in the same way;

Now that we know a bit more about delusions, let's take schizophrenia out of the equation, since schizotypal disorders can involve distinct types of delusions, and are different from disorders like body dysmorphic disorder (BDD) and anorexia nervosa (AN), which involve feelings about own-body perception. We can also add gender dysphoria (GD) to this mix, because a key part of gender dysphoria involves similar feelings about having something wrong with your body. BUT, just because all three of these are similar, that doesn't make them the same! In fact, all three have different diagnostic criteria, and unsurprisingly, they all require different treatment.

For persons with BDD, that typically means rounds of therapy paired with antipsychotic medications like SSRIs. Through that process, the brain’s visual processing networks can be brought into alignment with the rest of the body. When that happens, delusional thinking tends to lessen or disappear.

For persons with AN, counseling and psychotherapy might involve "visual realignment", where persons are slowly helped to "see" and "recognize" their bodies. It also can include therapies that help persons overcome trauma and recognize individual agency, since adverse experiences and loss of agency may be a trigger for AN.

There is growing evidence that individuals with gender dysphoria also have irregularities in visual processing regions of the brain. However, in AN and BDD, realignment occurs by bringing the brain into alignment with the body. For persons with gender dysphoria, treatment works best when the rest of the body is brought into alignment with the brain's expectations about one’s own gender identity (remember: the brain is just as much a part of the body as anything else). We are not entirely certain why this works, but since there are many different regions of the brain, it is possible that gender identity and awareness are more strongly correlated with parts of the brain governing "gendered behavior". This also means that people with gender dysphoria are not at all delusional about their gender; instead, they probably have deep insight that the rest of us cannot see!

For transgender people, treatments like hormone replacement and gender confirmation surgery help to alleviate the distress resulting from internal conflicts.

In short, it can be said that gender dysphoria, body dysmorphic disorder, and anorexia nervosa all exhibit similarities, but for persons with BDD and AN, treatment involves aligning the brain with the rest of the body, and for persons with GD, treatment involves aligning the rest of the body with the brain.

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Transgender people are far more likely than the general population to experience suicidal behavior at a rate of 9 - to - 1, or 40% compared to 4.6%.

Additionally, a famous 2011 study showed that suicidal behavior is higher in transgender people compared to the general population, even after hormone-replacement and surgical intervention. However, follow-up studies have shown that transitional medicine does increase quality of life and well-being.

You could argue that the research is divided, but if you dig deeper, you'd find that suicidal behavior is more closely associated with discrimination and transphobia, which do not go away even after medical intervention. In fact, a 2016 review by the same author who wrote the 2011 study finds that social stigma, discrimination, transphobia, sexual abuse, gender abuse, lack of access to healthcare and social services, loneliness, and fear of abandonment contribute the most to mental illness among transgender people. The same 2016 review found that medical interventions like hormone replacement therapy and surgery combined with competent counseling and psychotherapy are “protective factors” against all forms of transphobia and discrimination mentioned above. 

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No one age group "owns" transgender identity. In fact, an even balance of people from every age group identify as transgender in the United States.

Still, the percentage of young people who identify as transgender is slightly higher than that of adults. An estimated 0.58% of U.S. adults between 25 and 64 are transgender-identifying. That is 967,000 out of about 208 million. The number is slightly higher for 18 - 24 year-olds, at 0.66% (205,850 out of about 39 million). 0.73% of 13 - 17 year-olds are transgender-identifying (149,750 out of 26 million). There is a lack of data for transgender-identifying children under 13, but a recent sample study conducted in San Francisco put the number at 1.3%. 

For the most part, these data are stable, and the growth in numbers is more than likely a good thing! Scientists believe that the higher numbers are due to a combination of: increased visibility, more informed diagnoses, and increases in general safety.

Put another way, it was a lot more difficult (not to mention dangerous!) for a 10-year-old to identify as transgender 50 years ago. Taking into consideration the effects of gender dysphoria when left untreated, it is not surprising that there are less transgender-identifying 60-year-olds than there are transgender-identifying 10-year-olds today.

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As most of us know, puberty is challenging for young people! It also tends to invite questions and curiosity surrounding identity and self-expression.

Consider the feelings of transgender kids, though. Concerns about body image, changes in sex characteristics, and development of reproductive organs are all potential triggers for gender dysphoria. In a small number of cases, the shift is so sudden, that is has been given the label, “rapid-onset gender dysphoria”. Very little is known about rapid-onset, but we do know that gender dysphoria exists on a spectrum.

For some adolescents, symptoms can be minor whereas for many transgender youth, symptoms can lead to severe feelings of fear and anxiety leading to poor mental health. Gender dysphoria can persist, grow, or diminish at different stages of childhood, including in adolescence.

 All that’s to say, it may be tempting to connect a sudden onset of gender dysphoria with puberty, but we need to keep in mind that mental health is at stake either way, and the treatments for gender dysphoria can help adolescents develop a health and holistic body image whether they continue to identify as transgender or not.

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 Research shows that children know their gender identity just as well as do adolescents. By 12 months, children begin to adopt gendered behaviors, and between the ages of 2 and 5 years, develop a knowledge that gender is stable, and start to label themselves as girl or boy.

This is just as true for transgender children as it is for any other child. In fact, we rarely even notice when a cisgender child expresses their gender identity to us because it doesn’t seem out of the ordinary. But what if we were to make cisgender children “wait” to live their gender identity like we often do with transgender children? We may not be able to answer this question, but we do know that transgender children who are affirmed in their gender identity are more likely to develop a healthy sense of self and less likely to experience mental illness.

Click here for a list of citations used in this section.