Gender-Affirming Care

Written By: Beth Cronin, MD OBGYN, Women & Infants Hospital on July 20, 2023

About 2 million adults in the United States are transgender; meaning their gender identity differs from the body in which they were born. Many members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community face bias and, because of societal pressures, often don’t fully understand their healthcare options or how to safely access care. 

Gender Dysphoria

Gender Dysphoria is the term to describe the feeling of discomfort or distress when someone’s gender identity is at odds with their appearance and how others view them. In severe cases, it can lead to depression, anxiety, and suicidal thoughts. This is just one of many reasons gender-affirming care is so essential. 

It’s important to note that gender identity is different from gender expression and sexual orientation. 

  • Gender identity is a psychological sense of gender.
  • Gender expression is how one presents to the world in a gendered way with things that are culturally or societally considered feminine or masculine.
  • Sexual orientation is defined by the gender or genders of the people one is attracted to. 
You Have Options
Surgery is only part of the transition for many individuals and is not necessary for everyone. You can express your gender identity with your hairstyle or how you dress. You can change your name and your pronouns. 

If you are looking to physically transition, you can turn to your doctor for help. An ob-gyn, primary care physician, or another doctor might recommend hormone therapy and/or surgery. 

Hormones - estrogen and testosterone - can help change the body’s appearance to match gender identity. For transmasculine people, testosterone can deepen their voice, help grow facial hair, and possibly stop periods. People who are transfeminine can take estrogen to help breasts grow and redistribute their body fat. 

There are also surgical options:
  1. Chest surgery - removes the breast tissue and reconstructs the chest for those transitioning from female to male.  For those transitioning from male to female, you can get breast implants.
  2. Hysterectomy - removes the uterus and sometimes the surrounding organs. This would also eliminate periods and the ability to get pregnant.
  3. Genital surgery - is a series of procedures to construct genitals to match one’s gender identity.
Gender-affirming care is patient-centered and patient-driven, meaning the care chosen should meet the patient’s goals and need for how their body looks and feels. 
Seeking Care and Insurance Coverage 
I’ve had the privilege of providing gender-affirming care for countless transgender patients. It is life-changing and is different for each patient. Your healthcare provider can help connect you with local providers to provide gender-affirming hormone care if they are not comfortable. They can also refer you to local gynecologists and surgeons if you are interested in further discussing surgical care. 

Insurance coverage for gender-affirming surgery varies greatly across insurance companies, thankfully in Rhode Island it is state mandated that procedures like top surgery, hysterectomy, and vaginoplasty are covered by insurance plans. If you have questions about your insurance coverage for gender-affirming medical care, please contact your insurance company directly.

Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment. 

Dr. Beth Cronin is the Division Director of the Division of General Obstetrics and Gynecology at Women and Infants Hospital. She attended the University of Vermont Medical School and then completed her residency at Women & Infants Hospital. She has been faculty at Brown/Women & Infants since completing her residency. She serves as an Associate Program Director for the residency program and is passionate about improving care and access to care for LGBTQIA+ individuals and is working to improve the culture throughout our hospital system. She is seeing patients in need of a full range of obstetric and gynecologic services, including gender-affirming hysterectomy at our Gynecologic Specialties Clinic at 90 Plain Street. Appointments can be scheduled by calling 401-430-8380.