Gatekeeping

For trans and gender diverse people, medical gender affirmation almost always requires interaction with some kind of health professional or medical body. When a health professional uses a model of informed consent, and takes a patient-led approach to facilitating medical affirmation, there is a balance of medical care and oversight, with patient needs, wishes, and hopes.

Gatekeeping happens when health professionals place unnecessary and unfair hurdles in the path of affirmative care, and require trans and gender diverse patients to prove who we are and that we really want or need access to medically affirming care.

For those who seek it, gender affirming medical interventions can be a critically important part of how we affirm our gender. Interventions are not only medically necessary, but life saving.

All gender affirming care must be inclusive, self-determined and rights-based. Barriers to timely, culturally safe and accessible medical gender affirmation can result in tragic consequences.1

Gatekeeping can look like:

• Refusing to take on trans or gender diverse patients and clients

• Requiring unnecessary steps in order to access gender affirmation, eg. Mandating a psychiatrist or endocrinologist is assessment for all patients

• Delaying gender affirming care without a clear health-based reason, or for reasons of “watchful waiting”, a well-established conversion practice

• Not providing all the information or answers as to why a particular decisions has been made

• Requiring trans and gender diverse people to adopt a binary identity, or refusing to accept or learn about non-binary identities

• Requiring invasive and unnecessary examinations or testing in order to access care

• Engaging in conversion or aversion therapy (or Gender Identity Change Efforts)

• Any discussion of ‘Rapid Onset Gender Dysphoria’

• Over-inflation of regret rates

You have a right to safe and considered affirmative care, free from experiences of gatekeeping or disrespect.

If you feel that a health professional is acting as a gatekeeper to your care, providing resources to them might assist their learning and strengthen their practice, or you can find a different health professional. If you feel you’ve been discriminated against or otherwise treated unlawfully, head to our rights and justice page.

Everyone deserves health care that is affirmative and rights-based, and this means being able to find the doctor for you.