Transgender health care

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions which affect transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks (in relation to violence and mental health), and access to healthcare for trans people in different countries around the world. Gender-affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender-affirming care is to help a transgender individual conform to their desired gender identity.

In the 1920s, physician Magnus Hirschfeld conducted formal studies to understand gender dysphoria and human sexuality and advocated for communities that were marginalized. His research and work provided a new perspective on gender identity, gender expression, and sexuality. This was the first time there was a challenge against societal norms. In addition to his research, Hirschfeld also coined the term transvestite, which in modern terms is known as "transgender". Hirschfeld's work was ended during the Nazi German era when many transgender individuals were arrested and sent to concentration camps.

In 1966 the Johns Hopkins Gender Identity Clinic opened; it was one of the first in the US to provide care for transgender individuals, including hormone replacement therapy, surgery, psychological counseling, and other gender affirmative healthcare. The clinic required patients before a gender affirmation surgery to go through a program called "Real Life Test". The Real Life Test was a program where before a gender affirming surgery the patient was required to live with their desired gender role. In 1979 the clinic was closed by the newly appointed director of psychiatry Paul McHughs.

Gender variance is defined in medical literature as "gender identity, expression, or behavior that falls outside of culturally defined norms associated with a specific gender". For centuries, gender variance was seen by medicine as a pathology. The World Health Organization identified gender dysphoria as a mental disorder in the International Classification of Diseases (ICD) until 2018. Gender dysphoria was also listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, where it was previously called "transsexualism" and "gender identity disorder".

In 2018, the ICD-11 included the term "gender incongruence" as "marked and persistent incongruence between an individual's experienced gender and the assigned sex", where gender variant behaviour and preferences do not necessarily imply a medical diagnosis. However, the difference between "gender dysphoria" and "gender incongruence" is not always clear in the medical literature.

Some studies posit that treating gender variance as a medical condition has negative effects on the health of transgender people and claim that assumptions of coexisting psychiatric symptoms should be avoided. Other studies argue that gender incongruence diagnosis may be important and even positive for transgender people at the individual and social level.

As there are various ways of classifying or characterizing those who are either diagnosed or self-affirm as transgender individuals, the literature cannot clearly estimate how prevalent these experiences are within the total population. The results of a recent systematic review highlight the need to standardize the scope and methodology related to data collection of those presenting as transgender.

Various options are available for transgender people to pursue physical transition. There have been options for transitioning for transgender individuals since 1917. Gender-affirming care helps people to change their physical appearance and/or sex characteristics to accord with their gender identity; it includes gender-affirming hormone therapy and gender-affirming surgery. While many transgender people do elect to transition physically, every transgender person has different needs and, as such, there is no required transition plan. Preventive health care is a crucial part of transitioning and a primary care physician is recommended for transgender people who are transitioning.