Care for the Transgender and Gender Nonbinary Patient

The American Academy of Family Physicians (AAFP) recognizes that diversity in gender identity and expression is a normal part of the human existence and does not represent pathology.  The AAFP supports access to gender-affirming care for gender-diverse patients, including children and adolescents.  Gender-affirming health care is part of comprehensive primary care for many gender-diverse patients, and may include supportive behavioral health care, voice therapy, gender-affirming hormones, puberty blockade, surgical interventions, permanent hair removal, and other medical procedures. The AAFP supports an informed consent model rather than a diagnostic model as the preferred approach to providing gender-affirming health care to adults and emancipated minors.

Family physicians are uniquely suited to provide gender-affirming care because of their whole-person focus, ability to create care plans that meet the needs of diverse individuals, and longitudinal relationship with the patient across the entire lifespan.  Family physicians who do not provide this care should take steps to ensure that patients requiring gender-affirming services are appropriately referred.

Transgender and gender nonbinary people often face social and economic marginalization, and experience a variety of barriers to healthcare, including overt discrimination, inadequate health insurance coverage, legislative interference in the physician-patient relationship, and poor physician knowledge of appropriate treatment. The AAFP supports gender-affirming care as an evidence-informed intervention that can promote health equity for gender-diverse individuals, although wider sociopolitical efforts are necessary to further mitigate these barriers and advance equity. The AAFP asserts the full spectrum of gender-affirming care should be legal and should remain a treatment decision between a physician and their patient.

The AAFP supports education on gender diversity and gender-affirming care at all levels of medical education, including medical school, residency and continuing professional development. (October 2020) (September 2024 COD)