What is trans healthcare?

Trans healthcare (transtervishoid), trans-specific healthcare (transspetsiifiline tervishoid), or gender-affirming care (soolist üleminekut toetav tervishoid) refers to medical and health services that trans people may seek or need in connection with gender transition (sooline üleminek).¹ According to the WPATH (World Professional Association for Transgender Health) Standards of Care,² trans healthcare is a multidisciplinary field of medicine that may include, depending on individual needs:

  • primary care services (e.g. general practitioner consultations regarding gender-affirming care and routine health check-ups),
  • endocrinological services (e.g. hormone therapy, puberty blockers, and health monitoring),
  • surgical services (consultations, operations, post-operative care, and follow-up appointments),
  • psychosocial services (e.g. psychological counselling and psychotherapy),
  • fertility-related services (e.g. fertility preservation prior to hormone therapy),
  • speech and language therapy services (e.g. voice feminization or masculinization).

The healthcare services a trans person may need are individual and depend on their personal goals and needs related to gender transition. Therefore, there is no single surgery or healthcare service that all trans people require or use. This means that gender transition does not automatically equal the use of gender-affirming healthcare services (soolist üleminekut toetavad tervishoiuteenused).

Gender-affirming services enable trans people to live fulfilling lives and feel comfortable in their own bodies. For this reason, access to services related to gender transition is essential—and in many cases, life-saving.

In 2024, Praxis conducted an in-depth study on the state of trans healthcare (transtervishoid) in Estonia, which serves as a valuable source for media coverage on the topic.

Media coverage of trans healthcare

Trans people’s lives are often portrayed in the media through a medicalized lens. However, trans people—like cisgender people—live lives that encompass far more than medical procedures related to gender transition. Each trans person’s transition journey is unique; it may include medical procedures, but it may just as well not.

Medical interventions are deeply personal and complex topics to discuss publicly. A good rule of thumb is to avoid personal questions about hormone therapy, surgeries, anatomy, or genitals unless these topics have been agreed upon in advance, are handled sensitively, and the story has a clearly defined educational purpose.

Before asking, consider: would you ask the same question of a cisgender person? If the answer is no, it’s best to leave the question unasked.

Consider whether the information could be presented in a less personal way. Could the same points be conveyed by referring to research studies or by consulting organizations that work in trans rights advocacy?

Example:
Sharing general information about the accessibility, effects, and considered risks of hormone therapy versus discussing the interviewee’s personal medical history.

Before creating a story about trans healthcare, ask yourself the following questions:

  • Is the interviewee’s personal medical history essential for conveying the message of the story?
  • Does the interviewee feel comfortable sharing details of their medical history? Which details are they willing to share, and have these been agreed upon before the interview?
  • Before publishing, have you confirmed the interviewee’s boundaries? If a trans person has said they do not wish to discuss a certain topic, it should not be mentioned at all—including noting that they declined to talk about it.
  • Have you focused only on the medical information necessary for conveying the story’s message? Leave out everything else.

A good example of responsible media coverage of trans healthcare: Aet Kuusik, “Kuidas kohtleb riik trans-inimesi? Läbipaistmatu süsteem ja hinnanguid andvad spetsialistid” [How does the state treat trans people? An opaque system and judgmental specialists], Õhtuleht, June 2021.

Depathologization

Pathologization is a process by which certain people or groups are portrayed as abnormal, placing them on a hierarchically lower level within medical or psychological frameworks.³ Depathologizing trans people and trans issues means recognizing that being trans is not a disease or mental disorder, but a normal and natural part of human diversity.

Depathologizing gender-affirming healthcare is an important step toward improving the rights and wellbeing of trans people in Estonia. The media plays a particularly crucial role in this process, as it greatly influences social values and public attitudes. The way gender minorities are represented in the media affects not only how others see them but also how they see themselves. When coverage of a specific group is incomplete or predominantly negative, it has a strong impact on self-image.

Empowering media coverage for the trans community is coverage that reflects trans people’s real experiences—representation that helps strengthen both individual and collective wellbeing.

Gender identity ≠ anatomy

Gender identity refers to a person’s internal sense of gender—how they experience, perceive, and understand their own gender in relation to identity categories such as man, woman, or non-binary. A person’s gender identity may or may not align with the sex assigned to them at birth.

When covering trans issues or broader gender-related topics—especially those related to healthcare—gender identity should not be equated with anatomy, such as genitalia.

Depending on the focus of the story, consider who the topic actually concerns: are you speaking about women, or about all people who have ovaries and/or can become pregnant?

Are you discussing men, or all people who have a prostate, for instance?

In many cases, everyday words such as “patients” or simply “people” are suitable and inclusive. It is often possible to discuss ovarian or prostate health issues without referring to gender identity at all. Think carefully about who your message is aimed at, and whom you wish to include.

The above does not mean that words like “man” and “woman” should never be used—it simply means that, when presenting gender-based information, one should consider who is actually affected by the topic. In discussions of sexual and reproductive health, phrases such as “men’s health” and “women’s health” are often used, even though sexual health affects all people, not only those whose gender identity is “man” or “woman.”

Abortion, menstruation, childbirth, and similar topics also affect non-binary people, trans men, and intersex people, and exclusionary language can feel alienating. Whenever possible, use gender-neutral language.

Instead of “women’s health” or “men’s health,” it is often more appropriate to refer simply to sexual or reproductive health.

Recommendations for writing about gender-related topics:

  1. Avoid equating gender with anatomy, including reproductive organs. When writing a story, base it on the person’s self-identification.
  2. Consider whether the topic also affects trans people. If it does, use language that includes them as well. For instance, when discussing abortion or menstruation, it is usually possible to omit gender categories without losing clarity. Avoid framing such topics as exclusively concerning women.
  3. If the topic is complex, consider involving an expert. You can find more on trans issues and expertise here.

 

¹Allikvere, E., Sepper, M., & Arumetsa, S. (2024). Mida peaksin teadma LGBTQI+ inimeste kohta? – juhendmaterjal tervishoiutöötajatele [What should I know about LGBTQI+ people? – A guide for healthcare professionals]. Think Tank Praxis.

² Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., De Vries, A. L., Deutsch, M. B., & Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259.

³ Kuusik, A. (2023, March 7). Kuidas teha sõnadega kahju [How to do harm with words]. Müürileht. Retrieved 23.03.2024, https://www.muurileht.ee/kuidas-teha-sonadega-kahju/