For years, transgender and gender-expansive people have reported bad experiences in healthcare. Many have said they had to explain their identities just to get basic care or ran into problems with health insurance. Common issues included being misgendered, dismissed, or made to feel exposed or unsafe—no matter the type of provider or clinic (McLaughlin, et al., 2025).

25% of transgender patients have experienced issues with insurance denying coverage for gender transition-related services

These negative experiences have made many transgender people feel afraid of seeking care, and some even avoided it altogether (Katta, et al., 2025). These stories often point to providers who don’t understand gender diversity or who hold narrow views about gender. 

We’ve seen firsthand how transformative GAC can be: reduced suicide risk, improved mental health, and young people finally feeling at home in their bodies (Fallin-Bennett, et al., 2024). Despite the fear, legal risk, and growing waitlists, we remain committed to offering this care because we’ve witnessed its life-saving power again and again. 

Demand for gender-affirming care (GAC) has grown, but the number of trained providers remains critically low (Fallin-Bennett, et al., 2024). 

In the last several years, state bills have been passed (and many more have been proposed) prohibiting medical providers from offering puberty blockers, hormone therapy, or surgery to transgender minors—a move that has had a devastating impact on providers’ work and the health of our most vulnerable patients (Fallin-Bennett, et al., 2024). Unfortunately, significant gaps remain in providers’ understanding of gender diversity, cultural sensitivity, and inclusive communication (McLaughlin, et al., 2025).

The work of gender competent providers has become even more urgent as fewer provider trainees report plans to provide GAC, especially in politically restrictive states (Fallin-Bennett, et al., 2024). 

33% of transgender patients have reported at least one negative experience with a healthcare provider in the past year related to being transgender, including verbal harassment, refusal of treatment, or having to teach the provider about transgender people in order to obtain proper care (James, et al, 2016).

As a provider, you may be open to supporting clients along their journey as they seek gender-affirming care, but what is your level of gender competency?

  • A gender competent provider works directly with trans and gender-expansive clients. Therapists at this stage must provide affirming, accurate diagnoses while navigating misinformation from media and politicians. Common myths—like the idea that rising trans visibility is a trend—must be debunked with facts and historical context. Therapists are also challenged to identify co-occurring conditions like eating disorders, as well as depression or anxiety as results of gender dysphoria, and must avoid gatekeeping behaviors that invalidate a client’s identity and could perpetuate further harm.
  • Being a gender competent provider also means using inclusive, up-to-date language, respecting names and pronouns, and understanding the mental health importance of social, legal, and medical alignments. Writing referral letters for treatment can be daunting due to external pressures, but the solution lies in thorough, timely assessments—not delays or dismissiveness. Providers must balance ethical responsibility with affirming care, gaining confidence to work with families and other professionals to ensure comprehensive support for trans clients.

Understanding the facts and sorting out myths from the truth are key skills for a gender-competent therapist. Inclusive forms and referrals are a baseline—not a full expression of gender-affirming care. 

Providing GAC has deepened our sense of purpose and restored trust in healthcare for communities that have long been marginalized. We need more research, better training, and clear definitions of what GAC entails. But most of all, we need more providers who are willing to learn and commit, even when the politics are tough. Because in the end, this work is not just ethical—it’s joyful, necessary, and deeply human.

Learn more about using inclusive language with your clients — Download our free Glossary of Gender & Sexual Identity Terminology for Professionals

 

Sources:

  • Fallin-Bennett, K., Arterburn, M., & Marks, S. T. (2024). Training in Gender Affirming Care is Medically Necessary. The Journal of the American Board of Family Medicine, 37(5), 976–978. https://doi.org/10.3122/jabfm.2024.240266r1
  • James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
  • Katta, S., & Davoody, N. (2025). Exploring health care professionals’ perspectives on education, awareness, and preferences for digital educational resources to support transgender, nonbinary, and intersex care: interview study. JMIR Medical Education, 11, e67993. https://doi.org/10.2196/67993
  • McLaughlin, A. J., Nonoyama, S., Glupe, L., & Bosse, J. D. (2025). Systemic transphobia and ongoing barriers to healthcare for transgender and nonbinary people: A historical analysis of #TransHealthFail. PLOS digital health, 4(3), e0000718. https://doi.org/10.1371/journal.pdig.0000718

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