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5 Keys to General Wellness for Gender-Diverse People

Following these tips can boost your health and overall well-being.

Keeping up with the basics of personal health can be a challenge for anyone. For many transgender, gender nonconforming and nonbinary people—particularly those on gender-affirming therapies—the complexities of treatments, screenings and preventive care can be especially daunting. But staying well doesn’t have to be stressful (and, in fact, it can help reduce stress in the long term).

Here are expert-backed tips for finding accessible and culturally competent care and staying well over the long haul.

Seek out a qualified, affirming provider or healthcare setting
One of the most important things you can do to manage your health is to establish a relationship with a knowledgeable healthcare provider (HCP) whom you can trust—ideally before you have a medical issue that needs attention. While keeping up on healthcare visits takes work, it’s worth the investment, because catching problems early can make treating them more effective and less expensive.

"Finding primary care that just fits your health insurance is hard enough as it is," says Jerrica Kirkley, MD, board-certified family medicine physician and co-founder and chief medical officer at Plume, a membership-based online network of gender-affirming providers. "But then if you have to add on this extra layer of finding somebody who can competently understand who you are, provide services that are affirming and provide very specific clinical services such as hormone therapy or surgery referrals, it gets really challenging."

Thankfully, there are resources that can help. Here are a few pointers:

  • Get recommendations from those in the know. Asking for suggestions from your friend groups or local LGBTQIA+ organizations can be a great way to find HCPs who have already been vetted by people you trust.
  • Browse online databases and health marketplaces. The provider directories from OutCare, GLMA, Included Health or WPATH can make this search easier by showing you curated options.
  • Search online. If you’re still stumped, Dr. Kirkley suggests Googling your city or state plus "LGBTQIA+ care" or "transgender care" to find options in your area.

As you go, it’s important to look for credentials and certifications. The internet is a valuable resource, but it can sometimes point to risky options, such as unregulated silicone injections or nonprescription hormones.

"We know that upwards of a third of trans folks in urban settings are probably getting their hormones from the black market in some way," says Kirkley. That’s often a result of a healthcare and insurance system that hasn’t evolved to meet the needs of patients seeking gender-affirming therapy.

Although affirming treatments are essential to maintaining one’s physical and mental well-being, taking alternatives outside of what is prescribed by a licensed HCP can be unsafe and have health risks, even if the medication itself is technically “legal.” To find safe options, stick to licensed providers rather than browsing user-generated message boards, suggests Kirkley.

When it comes to health screenings, make sure your bases are covered
A large component of primary care is getting regular preventive health screenings. But because mainstream medical guidelines have historically left out gender-diverse people, you may not be getting clear and consistent messages about what tests you need and when. That's especially the case when it comes to cancer screenings.

"The guiding principle I have is that people need and deserve cancer screening for the organs that they have—regardless of their gender," says Halley Crissman, MD, MPH, an adjunct clinical assistant professor of obstetrics and gynecology at Michigan Medicine specializing in transgender health and gender-affirming care and director of gender-affirming care at Planned Parenthood of Michigan. For transmasculine people, this typically means screening for cervical cancer if you still have a cervix and breast cancer screening if you still have breast tissue. For transfeminine people, this could mean prostate cancer screening, depending on your risk factors.

It’s also essential to keep up with general wellness screenings, including regular checks to monitor blood pressure, cholesterol and blood sugar levels, as well as screenings for STIs, including HIV, if you are sexually active.

Having an HCP you can turn to is helpful for ongoing health maintenance, but if you haven’t established a relationship with a primary care provider, you can keep up on routine checkups by tapping community resources including Planned Parenthood and your local department of health.

Remember that gender-affirming therapy may influence screening recommendations
If you've been on gender-affirming hormone therapy (GAHT) for some time, that may impact your preventive health screenings. For example, if you're a transfeminine person over 40 years of age who has been on GAHT for five years or more, you may need to be screened for breast cancer. Meanwhile, if you've had a gonadectomy (removal of the testes or ovaries) and your hormone levels have been outside of the recommended range, you may be at an increased risk for low bone density or osteoporosis, which means you should start screening for bone health earlier in life.

No doubt it can be difficult to engage in these topics with your HCP, and "there's no guarantee that a primary care provider is going to talk about these things with you," says Kirkley. But it’s important to keep up the work of finding informed, gender-affirming providers—or to guide the conversation with your existing provider toward your specific needs.

Prioritize your mental health
Thirty-nine percent of respondents in the 2015 U.S. Transgender Survey said they were experiencing serious psychological distress, compared to 5 percent of the U.S. population. Meanwhile, 40 percent of respondents said they had attempted suicide in the past, compared to 4.6 percent of Americans overall. Data like these demonstrate the urgent need for accessible mental care tailored to the gender-diverse community. (If you or someone you know is considering suicide or having thoughts of suicide, call the National Suicide Prevention Lifeline at 800-273-8255.)

To find a mental health provider in your area, ask your HCP for a referral or try online databases such as WPATH, GLMA and Psychology Today, or teletherapy options like Pride Counseling. Look for providers or platforms that price services on a sliding scale depending on income to help make therapy as affordable as possible.

Your emotional self-care can also get a boost from membership in a local LGBTQIA+ organization or other online or in-person groups. "If you don't feel like you have the power or the autonomy to be visible, that can be really crushing," says Kirkley. Finding spaces where you feel seen and heard can improve both your mental and physical health.

Make healthy lifestyle modifications that can have a lasting impact
While having regular check-ins with a trusted HCP is a key component of your overall health plan, there are steps you can take in your day-to-day life to boost your physical and mental well-being.

Set your plate. Eating nutritious food goes a long way toward fortifying your body and mind. Start by building your diet around fresh produce and whole grains. Try to reduce your intake of refined carbohydrates, sugar, salt and saturated fat and get your fats instead from sources like olive oil, nuts and avocados. Opt for lean proteins like chicken, fish or beans and legumes instead of red or processed meat.

Build your body. When you move more, you lower your risk of a range of conditions, from heart disease to diabetes to cancer—and you may even develop a deeper level of comfort with your body. Aim to get at least 30 minutes of moderate-intensity physical activity each day.

If you’re uncomfortable working out in group settings, search for trans-friendly gyms in your area or consider solo outdoor activities (like running, walking, cycling or hiking) or body-weight workouts (think pushups, crunches and squats) you can do at home. Transmasculine people who wear binders or compression shirts should consider skipping binders during workouts or wearing a size up to allow for greater mobility. If you wear a binder, start with low-intensity moves, stay attuned to any discomfort you might feel and adjust as necessary.

Get the rest you need. Though it can be easy to skimp on sleep, it’s a cornerstone of wellness, keeping your body and mind in balance. Try to establish a schedule with regular bedtimes, wake-up times and a consistent winding down routine. Unplug from devices at least an hour before bed and as much as possible set up a calm, cool, dark place to slumber.

Kick the habit. Smoking can feel like a short-term stress reliever, but it harms your health in significant ways over the long haul. Quitting is a challenge, but it’s crucial to try. Sharecare’s Craving to Quit program can help.

Reduce alcohol. While you might enjoy a drink on occasion, remember that every drink above a level of 1 to 2 per day increases your risk of a slew of conditions, from heart disease to certain cancers. If you don’t drink now, don’t start, and if you do, limit your intake. If you’re having trouble sticking to a moderate amount or experiencing side effects from reducing your intake, consult with an HCP.

Try to tame stress. Exercise is a great stress buster, but sometimes you need a little more help. You can do calming practices like yoga or tai chi in groups or solo or start a simple meditation practice.

"We encourage our gender-expansive patients to limit tobacco use, to exercise, to have a healthy diet—all of the things that we recommend to our cisgender patients," says Christina Milano, MD, a family physician and co-founder and medical director of the Transgender Health Program at Oregon Health & Science University.

Lastly, remember that gender-affirming care can have benefits for all aspects of your life. Research suggests that gender affirmation benefits your physical and mental health and improves health behaviors overall.

Medically reviewed in July 2021.

Sources:

Costa MCB, McFarland W, Wilson EC, et al. Prevalence and correlates of nonprescription hormone use among trans women in São Paulo, Brazil. LGBT Health. 2021;8(2):162-166.
Sandy E. James, Jody L. Herman, Susan Rankin, Mara Keisling, Lisa Mottet, Ma’ayan Anaf. The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality. December 2016.
Office of Disease Prevention and Health Promotion. Lesbian, Gay, Bisexual, and Transgender Health. Accessed July 21, 2021.
Jamie Moffa. Chest Binding: A Physician’s Guide. PrideInPractice. April 6, 2019.
Centers for Disease Control and Prevention. Know Your Risk for Heart Disease. Page last reviewed December 9, 2019.
Centers for Disease Control and Prevention. What Are the Risk Factors for Breast Cancer? Page last reviewed September 14, 2020.
Centers for Disease Control and Prevention. Diabetes Risk Factors. Page last reviewed April 23, 2021.

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