Gatekeeping vs. Empowerment: Accessing Gender Affirming Care

Medically reviewed by Dr. Scott Mosser on September 13, 2024.

Trans and gender non-conforming people’s ability to access medically necessary gender affirming healthcare has historically been gatekept. Gatekeeping happens when health professionals, academic institutions, and insurance providers place unnecessary hurdles in the path of gender-affirming care. These hurdles can have significant consequences on trans people seeking medically necessary care. These consequences have included an inability to receive necessary treatments, unfair acts of discrimination, financial burdens, and emotional distress. Empowerment is when patients are able to make joyous, well-informed decisions about their care and identity. 

Examples of Gatekeeping:

The distinction between gatekeeping and reasonable precautions before surgical intervention have been a subject of controversy. Currently, some medical and insurance providers still require a letter of support from a mental health professional before performing gender-affirming surgery. This requirement was designed to prevent regret after undergoing surgical procedures, despite the exceedingly low incidence of regret after gender-affirming surgery and the lack of evidence supporting the benefits of presurgical mental health screening in lowering rates of regret. Other examples of gatekeeping include unreasonable or excessive documentation requirements and arbitrary time requirements for hormone therapy that prevent timely access to necessary care.

Providing Support:

Here at the GCC, we are committed to reducing unnecessary barriers in patients’ medical journeys, empowering individuals to have the autonomy in making an informed decision about their health. We currently do not require our patients to present a letter of support before their surgery as we follow the informed consent model. However, as mentioned previously, insurance providers often require this letter before covering the cost of surgery.