5 keys to general wellness for gender-diverse people

Keeping up with your health can be a challenge for anyone. For many transgender, gender nonconforming, and nonbinary people, the complexities of treatments, screenings, and preventive care can be especially daunting. It can feel even more difficult if you are on gender-affirming therapies.

But staying well doesn’t have to be stressful. 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, you would find this person before you have a medical issue that needs attention. While keeping up on healthcare visits takes work, it’s worth the investment. 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, or Included Health 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.

Stay current on health screenings

A large part 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. That includes regular checks to monitor blood pressure, cholesterol, and blood sugar levels, as well as screenings for sexually transmitted infections (STIs), including HIV, if you are sexually active.

Having an HCP you trust 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 using community resources including Planned Parenthood and your local department of health.

Know that gender-affirming therapy may influence screening

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. That means you should start screening for bone health earlier in life.

No doubt it can be difficult to talk about these topics with an HCP. "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 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, text, or chat 988 to the 988 Suicide & Crisis Lifeline.)

To find a mental health provider in your area, ask your HCP for a referral or try online databases such as WPATH, GLMA, or Psychology Today. 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 changes

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.

Seek healthful foods. Eating nutritious food helps support your body and mind. As much as possible, build your diet around fresh fruits and vegetables and whole grains. Try to reduce your intake of refined carbohydrates, sugar, salt, and saturated fat. As much as possible, get your fats from healthier 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. 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 you can do at home (think pushups, planks, and squats). 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. It can be easy to skimp on sleep, but it's a key part 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 electronic devices at least an hour before bed and as much as possible set up a calm, cool, dark place to sleep.

Quit smoking. Smoking can feel like a short-term stress reliever, but it harms your health in significant ways in the near and long term. Quitting is a challenge, but it’s crucial to try.

Reduce alcohol. While you might enjoy a drink on occasion, remember that every drink above a level of one to two per day increases your risk of many 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 at home.

"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.