By: Jerry P. Abraham, MD MPH CMQ
Photo by: Praewphan Olij | Dreamstime.com
If you’ve turned on the news lately, you’ve probably noticed that “transgender healthcare” has become one of the loudest and most polarizing topics in American politics. In more than half of the nation, lawmakers have proposed or passed legislation that limits access to medically-necessary, gender-affirming care, especially for minors. Many such bills single out access to puberty blockers, hormone therapy, and surgeries that are backed by major medical organizations, including the American Medical Association (AMA) and the American Academy of Pediatrics (AAP).
Thankfully, California stands apart. In 2023, Governor Gavin Newsom signed legislation that reinforced the state’s safeguards for transgender people, including those who come here from other states in search of medical treatment. California now regards itself as a “refuge state” for people seeking gender-affirming treatments–something that has become increasingly important as other regions slam their doors shut.
Even in supportive states, though, transgender patients still confront very real barriers like insurance challenges, a lack of available providers, and stigma, both in and outside of the exam rooms. For Latinx trans and gender-diverse people, those obstacles can be multiplied: language barriers, immigration concerns, and family pressures often make it more difficult for them to access care or feel safe doing so.
Let’s take a step back from politics and talk about what really matters: staying healthy, feeling supported, and building respectful, compassionate care for everyone across the gender spectrum.
The Basics: What “Gender-Affirming Care” Really Means
Before we get into the specifics, it’s important to clear up a common misunderstanding: gender-affirming care isn’t just surgery or hormones. It’s actually an umbrella term for all the medical, psychological, and social supports that help a person live authentically in their chosen gender.
That includes everything from routine checkups to mental health care, reproductive counseling, voice therapy, and sometimes hormone or surgical interventions. Some trans and gender-diverse people pursue all of these options, while others choose none. The goal is not to “change” anyone, it’s to align a person’s body, mind, and daily life with who they truly are.
Every patient’s journey looks different. My role as a doctor is to meet each person where they are, help them make informed choices, and walk with them through that process with respect and honesty.
Trans Men
For people on testosterone, monitoring is important. Testosterone can alter cholesterol, red blood cell count, and liver function, so regular blood testing every 3 – 6 months in the first part of treatment and yearly thereafter is a good practice. Many trans men find their voices deepen and their body hair increases within the first year, along with redistribution of fat and acne. These are all normal changes, but they can be managed by specialists like dermatologists if you find them uncomfortable. Testosterone can also stop menstruation, though that doesn’t mean pregnancy is impossible. It’s important to discuss birth control if sexually active with partners who could cause a pregnancy.
Some trans men might retain their reproductive organs, others may seek out hysterectomy or chest surgery. Regardless, routine care counts. Cervical and breast cancer screening should continue based on anatomy, not gender marker.
Trans Women
Estrogen therapy can be delivered as pills, patches, or injections. In combination with anti-androgens, such as spironolactone, it serves to lower testosterone levels and thus promotes changes like softer skin, breast development, and reduced body hair. What is relevant here is safe dosing and regular follow-up. Too much estrogen can increase the risk of blood clots, especially if combined with smoking or certain medical conditions. There are safer alternatives, like transdermal patches, with patients over 40 or those with a family history of cardiovascular disease. It’s not about gatekeeping, it’s about partnership and prevention.
Trans women often think that transitioning means being unable to be fertile anymore, but this is not necessarily so. In instances where the possibility of having biological children in the future exists, sperm preservation should be discussed prior to starting hormones. Sexual health, too, deserves open conversation about pleasure, safety, and intimacy. Estrogen can change libido and sexual function, so doctors should talk honestly about what’s normal and what can help. Lubrication, pelvic floor exercises, and open communication with partners all make a difference.
Even after surgery, some prostate tissue remains, and the risk of prostate cancer, though reduced, isn’t zero. Mammograms should start once breast tissue has developed for at least five years, or at least after you have turned 50 years old.
For Gender Non-Conforming & Nonbinary Patients
Not everyone identifies strictly as male or female, and not every gender-diverse person wants or needs hormones or surgery. Healthcare can be a maze for nonbinary people; so often, forms and pronouns assume a gender binary, even lab reference ranges. The first step toward good care is recognition: your health is valid, your needs are specific, and you deserve providers who listen without assumptions.
Some nonbinary individuals may use low-dose hormones (“micro-dosing”) to achieve subtle changes that better fit their identity. Others focus on social transition-changing name, presentation, or pronouns. Either way, prevention counts. Depression, anxiety, and stress from social stigma can affect sleep, cardiovascular health, and substance use patterns. Ask your patients what support they desire, do not assume.
How Physicians Can Be Better Allies
If you’re a healthcare provider reading this, here’s the truth: trust is the most powerful medicine we have, and it has often been denied to transgender patients. One bad encounter–being misgendered, dismissed, or questioned about their identity-can keep someone from seeking care for years.
We can do better as clinicians through small changes in our everyday practice. Names and pronouns aren’t “preferred”, they’re correct. Ask once, note it in the chart, and use it consistently. If you make a mistake, correct yourself briefly and move on. Over-apologizing can make the patient more uncomfortable than the slip itself. Instead of saying “ladies and gentlemen,” say “everyone.” Instead of saying “women’s health,” say “reproductive health.” These little changes send a big message. Also, gender-neutral restrooms, and intake forms with “transgender” and “nonbinary” options tell patients they’re welcome before you even say a word.
The World Professional Association for Transgender Health, or WPATH, puts out regularly updated guidelines. But that’s not where learning needs to stop, attend workshops, consult gender specialists, and most importantly listen to your patients. If there’s a need for a patient to be on estrogen, treat it as seriously and professionally as you would insulin. If someone wants a surgery letter, do not make it a moral debate. Frame care in medical terms, not political ones.
Transgender patients age, catch colds, and get high blood pressure like anyone else. Don’t let gender overshadow the rest of their health. Encourage cancer screenings, dental care, vaccinations, and regular checkups.
Ultimately, transgender health is not a political issue; it’s a human one. It’s about making sure everyone, regardless of identity, can walk into a doctor’s office and be treated with dignity. It’s about reminding our patients, our colleagues, and ourselves that medicine is not just about curing disease but also caring about people. California continues to lead with compassion and courage, but laws alone don’t make care inclusive-people do. Every conversation, every appointment, every small gesture of respect helps create a culture where everyone can live healthy, fulfilled lives. So to my trans siblings: keep taking care of yourselves. To my fellow physicians and health professionals: keep showing up, keep listening, and keep learning. Because when we care beyond the headlines, we form a kind of health no law can remove.
Resources for Transgender and Gender-Diverse Individuals in California
Los Angeles LGBT Center – Comprehensive transgender health and legal services
TransLatina Coalition TLC – Advocacy and support for trans Latinx women
Gender Health SF – Public access to Gender-Affirming surgeries and care
The Trevor Project – Crisis and suicide prevention for LGBTQ+ youth
Planned Parenthood California – Gender-Affirming hormone therapy and primary care
Remember, you can visit Dr. Jerry Abraham and the whole JWCH-Wesley HIV Street Medicine Team at Tempo Nightclub every Sunday night. Come get HIV-tested, PrEP’d, and all your LGBTQ+ health questions answered. Happy Holidays, y’all!