who deserves gender-affirming care?
aka: cisgender people experience gender dysphoria too. why are we punished for trying to alleviate ours?
TRIGGER WARNINGS: mentions of suicide and transphobia.
Last summer, my mother relayed to us that she'd been diagnosed with cervical cancer. Thankfully, it had not yet progressed to a stage that would threaten her life, but she required chemotherapy and a surgical procedure to completely remove her reproductive organs.
When someone's ovaries are removed, as my mother's were, sudden onset menopause typically occurs. Usual symptoms include mood swings, hot flashes, and what many people describe as feeling disconnected from their own bodies. As a result, my mother was prescribed estrogen patches to alleviate and prevent these symptoms. Nobody--not healthcare professionals, family members, or colleagues--questioned whether she "really" needed it, whether she was making it up, or whether treating her discomfort was medically necessary. The potential of severe distress about her changing body was taken seriously, treated with compassion, and resolved quickly.
Meanwhile, as a transmasculine person, I've spent years fighting for access to the same basic medical care. Social rejection from people I knew who insisted I was "confused." Healthcare professionals who dismissed my distress as a phase or suggested I try therapy instead. Months-long waitlists just for the first appointment.
Today, I am 17 and still waiting to receive care since, without my mother's approval and insurance coverage, I as a minor cannot access HRT. All of these barriers were so overwhelming that I attempted suicide twice, unable to reconcile the disconnect between my identity and my body.
Same symptoms, same treatment--and yet a completely different standard of care.
This isn't just a story about healthcare inequality--it's about how we've created an artificial distinction between "legitimate" and "illegitimate" gender distress. Gender dysphoria gets talked about like it's some exotic disease that only affects transgender people, but cisgender people experience identical symptoms all the time. We just treat it differently and pretend it's unrelated.
yeah dude, that's gender dysphoria.
Gender dysphoria, as per the textbook definition, is distress caused by incongruence between your gender identity and physical characteristics. But these experiences are incredibly common among cisgender people--we just don't pathologize and stigmatise them.
Take gynecomastia, which affects roughly two-thirds of the male population, when cisgender men develop breast tissue due to hormonal changes or medical conditions. Men describe feeling "less masculine" and report significant negative effects on their well-being, self-esteem, and mental health [1]. Insurance companies routinely approve surgical removal, recognizing the distress as legitimate and treatment-worthy.
Cis women who undergo mastectomies (typically due to cancer) often choose reconstruction not for medical necessity but because they feel incomplete without breasts--their sense of themselves as women tied to having certain feminine physical characteristics [2]. This isn't vanity; it's gender identity seeking alignment with physical reality.
Hormonal changes during menopause trigger profound distress about changing bodies. Women describe feeling "less feminine" and report sexual dysfunction as estrogen drops [3]. Hormone replacement therapy for these conditions is considered standard medical care, not experimental treatment.
Cisgender men experiencing low testosterone levels routinely receive the same hormone therapy that transgender men are systematically denied. The global testosterone replacement therapy market is worth over $1.9 billion annually [4], driven largely by cisgender men seeking treatment for symptoms like decreased muscle mass, mood changes, and feeling "less masculine". These men describe their distress in terms nearly identical to transgender experiences--disconnection from their bodies, anxiety, social withdraw, and depression [5].
None of these people are considered mentally ill. None require psychological evaluation to prove their distress. Their feelings about their bodies are taken at face value.
the gatekeeping game.
When transgender people experience identical distress, suddenly it becomes pathological. The same feelings that warrant immediate intervention for cisgender people become evidence of mental illness requiring extensive scrutiny.
In Canada, transgender people face wait times from 180 days to 5 years for gender-affirming surgery, with some regions lacking any surgical services at all [6]. The Canadian Professional Association for Transgender Health notes that 43.9% of trans people reported unmet healthcare needs in the past year compared to 10.7% of the cisgender population [7].
The situation is even worse in the UK, where the NHS requires extensive psychological evaluation before any medical intervention, and referrals to gender identity clinics can take 3-5 years. Some clinics report wait times exceeding 6 years [8].
In the US, more than half of transgender respondents were denied health coverage for transition-related surgery [9]. A 2021 study found that 25-34% of transgender Americans were denied gender-affirming care by their healthcare providers entirely [10].
These barriers have measurable consequences. The 2015 U.S. Transgender Survey found that 40% of transgender respondents had attempted suicide--nearly nine times the national average [11]. The Trevor Project's 2024 survey on the mental health of LGBTQ+ youth found that 46% of transgender and nonbinary young people seriously considered attempting suicide in the past year [12]. Access to gender-affirming care reduces this risk by 44% [13].
In contrast, cisgender people typically don't face the same systemic barriers when seeking treatment for gender-related distress. The extensive gatekeeping, psychological evaluations, and years-long wait times that characterize transgender healthcare are notably absent from standard medical care for comparable conditions.
the pathologization trap.
This double standard isn't about medical caution--it's cultural bias dressed as clinical standards.
When transgender people, particularly youth, receive appropriate treatment and support, mental health outcomes improve dramatically [14], [15]. The "disorder" disappears when the incongruence is resolved--exactly like it does for cisgender people receiving identical interventions.
We don't question cisgender motivations for body modifications aligning with gender identity. A woman getting breast augmentation after a mastectomy isn't scrutinized about her "real" motivations. A man taking testosterone for low T isn't forced to prove he's "masculine enough" to deserve it.
But transgender people face entirely different systems: multiple letters from mental health professionals, lengthy evaluation periods, requirements to "live as" their gender identity before accessing medical care--a catch-22 making such living impossible without the very interventions being withheld.
who deserves to live or die?
People die waiting for this care [16]. I've had friends whose lives could have ended because of these delays by design; whether it's disapproval from their parents/guardians, dismissals from healthcare professionals, and/or years-long waitlists that treat transgender distress as less urgent than any other form of medical suffering.
Why have we decided that some forms of gender-related distress are more legitimate than others? Why is a cisgender woman's desire to feel feminine through hormone therapy unquestionable, while a transgender woman's identical desire requires years of justification and proof? The term "gender-affirming care" itself reveals our biases. We don't call estrogen therapy for menopause "gender-affirming". It's only when transgender people seek identical outcomes does it become a separate category requiring special justification.
These are life-and-death decisions that politicians, lawmakers, and anti-trans activists want to frame as a debate, a controversy, a matter of public opinion rather than medical necessity. They turn our bodies into battlegrounds for their ideological wars and our existence into something that requires democratic approval.
When you treat someone's medical care as debatable, you're denying their humanity. You're saying their suffering is theoretical, their need for treatment optional, and their right to exist conditional on winning a popularity contest. My mother's hormone therapy was never put to a vote. No politician campaigned on restricting access to menopause treatment. No one demanded public hearings about whether cisgender women "really" need estrogen.
But transgender healthcare gets treated like a luxury item society can choose to provide or withhold based on political winds. Every day that care is delayed, we're telling transgender people that their lives matter less, that their suffering is less real, that their humanity is conditional on proving themselves worthy of basic medical compassion.
So here's the question that keeps me up at night: why do cisgender people deserve to live while we don't?