Beyond the Binary: Humanism, Gender, and the Fight for Inclusive Healthcare

Introduction: A System Designed to Erase

When Alex J., a 27-year-old nonbinary person from rural Ohio, sought primary care, they encountered more than just clinical gaps – they faced systemic invisibility. “Every intake form assumed I was male or female,” Alex remembers. “I had to explain my gender every time, only to be misgendered or dismissed. One doctor told me flat out, ‘I don’t believe in that.’”

Such erasure is widespread: according to the 2022 U.S. Transgender Survey (USTS), among those who saw a healthcare provider in the past year, 48% reported at least one negative experience—such as being refused care, misgendered, or verbally abused.

For Maya Hernandez, a 34‑year‑old Black trans woman in Texas, seeking hormone therapy meant confronting transphobia and racism. “I got turned away from three clinics in one week. One nurse told me I was ‘confusing God’s plan,’” she recalls.

Transmasculine and nonbinary individuals report invasive gatekeeping, as well: Jordan, 22 and nonbinary, remembers undergoing humiliating questioning before a hysterectomy consultation, a stark reflection of a system built only for cis bodies.

A humanist framework grounded in reason, equality, and bodily autonomy holds that denying care based on gender identity is not only a practical failure, but an ethical breach. “To deny someone care… is not just unethical, it’s inhuman,” says ethicist Casey Ruhl.

Historically, Western medicine labeled transgender identities as ‘disordered,’ appearing in the DSM until 2013. Even today, U.S. medical schools average fewer than five hours of LGBTQ+ health content across their entire curriculum.

A humanist approach demands that we treat trans health education not as an elective, but as essential. It’s not enough to add a module here and there. We need to reimagine health care education around equity, affirmation, and lived experience.

This is where humanism can make a unique impact. Unlike traditional religions that may treat gender diversity as a moral debate, humanism begins from a different premise: that every individual has inherent worth, and that self-determination is not a privilege, but a right. “Humanism allows us to honor people without pretending to know them better than they know themselves,” says Elan, a queer humanist chaplain. “It doesn’t ask trans people to prove their suffering, only to be heard.”

By foregrounding empathy, science, and justice, humanism offers a framework in which trans people are not exceptions to an ethical code, but essential examples of it.

The Quiet Crisis: Medical Mistrust and the Hidden Costs of Exclusion

For many transgender and nonbinary people, even deciding whether to seek health care is a calculation of risk. The possibility of being misgendered, denied care, or emotionally harmed often outweighs the perceived benefits of visiting a clinic.

This dynamic of what some call “anticipatory harm” leads to delayed diagnoses, untreated conditions, and avoidable suffering.“I waited six months before seeing someone about a persistent cough,” said Ren, a 30-year-old nonbinary software developer in Seattle. “By the time I went in, it had developed into bronchitis. But I just couldn’t bring myself to explain my pronouns and defend my existence again.”

Ren’s story is echoed in broader research: the 2022 USTS found that 28% of trans respondents had postponed medical care due to fear of mistreatment. This isn’t due to a lack of desire for care; it’s the result of repeated experiences where care environments become sites of trauma.

The cumulative toll of these interactions doesn’t just compromise individual health – it contributes to population-level disparities. Transgender people, especially those of color, face higher rates of HIV, depression, anxiety, suicidality, substance abuse, and chronic illness. Many of these conditions are preventable with early, affirming care, but that care remains inaccessible.

Gatekeeping in Disguise: Bureaucracy as a Barrier

Even in systems that claim to be supportive, barriers often come disguised as policy. A prime example is the requirement for a “gender dysphoria diagnosis” before receiving gender-affirming interventions. While framed as medical rigor, this practice often reinforces outdated norms, forcing trans people to conform to narrow narratives about gender.

“I had to pretend to be miserable just to qualify for hormones,” said Micah, a 22-year-old transmasculine person in Florida. “I wasn’t dysphoric, I just wanted my body to match how I experience myself. But the system didn’t accept that.”

Others describe a “hoop-jumping” experience: months-long waiting lists, multiple letters from therapists, and extensive documentation to access care that cisgender people receive without similar scrutiny. This gatekeeping disproportionately affects those already at the margins: Black and brown trans people, disabled individuals, undocumented migrants, and people without access to trans-competent therapists.

When Affirmation Is Life-Saving

It’s difficult to overstate the impact gender-affirming care can have. In a society that so often questions the validity of trans identities, being affirmed by a medical professional is more than clinical; it’s deeply humanizing.

“In my first appointment, my provider used my name and pronouns without hesitation,” recalled Avery, a 19-year-old trans woman in Massachusetts. “It sounds small, but I left the clinic crying. I had never felt so seen.”

Affirmation isn’t just emotional. It directly correlates with better mental health outcomes. A 2022 study in JAMA Network Open found that transgender youth who received gender-affirming care had significantly lower rates of depression and suicidality than those who did not. These effects persist into adulthood, with gender-affirming hormones and surgeries linked to improved quality of life and reduced psychological distress.

Critics often paint this care as “experimental” or “rushed,” but the data says otherwise. Multiple peer-reviewed studies, covering years of clinical outcomes, support the safety and efficacy of gender-affirming care when provided with informed consent.

The Global Context: A Widening Divide

While some countries are expanding protections and access, others are sliding backward. In the United Kingdom, the National Health Service has faced criticism for shuttering the Tavistock gender clinic and delaying the rollout of regional alternatives. In Hungary, trans people were legally erased in 2020 when the government banned gender marker changes on official documents.

Meanwhile, countries like Argentina, Malta, and New Zealand have implemented progressive gender self-determination laws, allowing individuals to change legal documents without medical intervention. These shifts show what’s possible when human dignity, not bureaucratic control, becomes the guiding principle.

In the U.S., the patchwork nature of health care coverage means that access often depends on one’s zip code. A trans teen in California may have access to comprehensive, affirming care, while another in Mississippi may be banned from accessing puberty blockers altogether. This geographic inequality reinforces a kind of medical apartheid where civil rights vary not by identity alone, but along state lines.

Care in the Crossfire: When Politics Weaponizes Bodies

One of the most alarming trends of the past five years has been the politicization of trans health care not only in conservative legislatures, but in the public consciousness. What was once a matter of private medical decision-making is now the subject of press conferences, policy battles, and social media pile-ons. Trans people have become rhetorical battlegrounds, their existence debated on television panels as though it were an abstract idea rather than the lived reality of millions.

In the U.S. alone, over 500 anti-LGBTQ+ bills were introduced in 2024, the majority of which targeted trans youth and health care access. Many of these bills borrow language from pseudoscientific narratives claiming to “protect children” by banning gender-affirming care. But behind the euphemisms lies a simple truth: these policies seek to criminalize identity and institutionalize shame.

For young people in affected states, the consequences are devastating. Families are fleeing to safer jurisdictions. Teens are losing access to puberty blockers mid-treatment. Clinics are closing or being defunded. The emotional toll, according to pediatric psychologists, is comparable to the grief associated with death.

“It felt like my entire future was taken away in one vote,” said Jules, a 15-year-old trans girl from Texas whose treatment was halted by a state ban. “I was finally starting to feel okay in my body. Now I don’t know what’s going to happen.”

The Myth of “Too Young” and the Data That Debunks It

Opponents of gender-affirming care often argue that children are too young to make life-altering decisions. But this talking point misunderstands both the process and the people it affects.

Gender-affirming care for minors doesn’t begin with surgery. It starts with listening. It involves long conversations with therapists, pediatricians, and families. Puberty blockers, often the first clinical step, are fully reversible and give young people time to explore their identity without the permanent effects of endogenous puberty.

Moreover, these decisions aren’t made lightly. Studies show that over 97% of trans youth who begin medical transition continue into adulthood with no regret. For those who do detransition, the majority cite external factors such as discrimination or lack of family support – not regret over their transition itself.

“It wasn’t that I didn’t know who I was,” said Leo, a 24-year-old who briefly stopped HRT in college. “It’s that the world made it impossible to be that person safely.”

Humanist ethics require that we examine not just the outcomes, but the context of the care we provide. If the data show that gender-affirming care reduces suicidality, improves mental health, and is largely free of long-term regret, then denying it isn’t cautious, it’s cruel.

Reimagining Education: The Future Starts in the Classroom

One of the most persistent barriers to inclusive health care is ignorance, not willful bigotry, and the absence of meaningful education.

A 2020 study in Academic Medicine found that fewer than half of U.S. medical schools offered any formal training on transgender health. Of those that did, the median time spent on the subject was under two hours.This lack of training leaves providers unprepared and patients unsafe.

“I had a doctor Google my hormone prescription during my appointment,” said Dani, a nonbinary patient in Colorado. “They said they’d never heard of ‘estradiol patches for someone assigned male at birth.’ I had to explain how it works.”

Some medical schools are working to close the gap. Institutions like UCSF, Harvard, and Vanderbilt have developed comprehensive LGBTQ+ health curricula. But without national standards, these remain exceptions rather than norms.

Invisible Labor, Unseen Cost: The Price Trans People Pay to Stay Alive

Navigating the health care system as a trans person requires a staggering amount of unpaid labor. From researching affirming providers to educating clinicians during appointments, from contesting insurance denials to coordinating referrals across hostile systems every step demands resilience. But resilience is not a sustainable health care strategy.

“For every 30-minute appointment, I spend 5 hours fighting to make it happen,” said Imara, a Black trans woman in Atlanta. “And that’s assuming the doctor even shows up informed.”

This labor takes an emotional and financial toll. Trans people are more likely to experience unemployment, housing insecurity, and lack of insurance. These challenges compound when intersecting with race, disability, or immigration status.

In many cases, care is crowdsourced. Entire communities raise money online to fund surgeries, travel to affirming clinics, or cover hormone prescriptions. While mutual aid is beautiful, it also underscores systemic abandonment. No one should have to rely on GoFundMe for basic medical care. Yet for trans people, it’s often the only option.

Beyond the Binary: Expanding the Language of Healing

One of the most significant blind spots in trans health care is its continued centering of binary narratives. Much of medical literature, institutional policy, and public discourse still treats “transgender” as synonymous with transitioning from male to female or vice versa. Nonbinary, intersex, and gender-fluid people are frequently erased from policy, data collection, and clinical care models.

“Forms don’t have my gender. Providers don’t know how to talk to me. Even my insurance rejects coverage for my care because I’m not ‘trans enough,’” said Harper, a genderqueer person in Chicago.

This erasure isn’t just rhetorical. It creates gaps in access and outcomes. Nonbinary people often face additional scrutiny when seeking care because their transitions don’t follow the expected scripts. They may want some medical interventions but not others or none at all. These choices are just as valid, but systems built on binary thinking fail to accommodate them.

Humanist care must recognize that gender diversity isn’t a detour from normal, it is normal. Our medical systems must evolve to reflect the full spectrum of human experience, not just the narrow lanes inherited from outdated science.

Toward a Humanist Health Care Revolution

What would a truly inclusive, humanist health care system look like? It would start with patient-led policies, where trans and nonbinary people co-create standards of care. It would mandate comprehensive provider training, create robust feedback systems for accountability, and eliminate gatekeeping procedures that infantilize patients.

Insurance would be restructured to cover all medically necessary gender-affirming interventions, including electrolysis, voice therapy, and reproductive services. Clinics would use inclusive intake forms, and electronic health records would accommodate diverse gender identities. But more than anything, it would involve a cultural shift – a new kind of medicine rooted not just in treatment, but in trust: trust that patients know themselves, trust that identity is not pathology, and trust that care is not conditional.

This is the kind of transformation humanism calls for: not one limited to political cycles or institutional reforms, but a deeper change in how we relate to one another.

Every day, trans and nonbinary people must navigate a health care system that too often denies their reality, pathologizes their identity, or disappears them entirely. This is not just a failure of policy, it’s a failure of morality. But it doesn’t have to be.

We can choose a different path, one lit by compassion, shaped by reason, and grounded in the shared belief that every person deserves care that affirms who they are. Humanism gives us the tools. Now we must build the system.

The Right to Be Well: A Moral Framework for Trans Health

What does it mean to live a good life? For many humanists, this question sits at the heart of ethical inquiry. It’s a question that transcends doctrine and asks us to imagine systems that allow all people, not just the majority, to flourish.

In the context of trans health care, this means shifting the conversation away from what is legally permissible toward what is morally necessary. A world in which trans people merely survive is not enough. We must build a world in which they can thrive.

This requires more than inclusion. It requires transformation. Not just adding a pronoun question to intake forms, but changing how care is conceptualized and delivered. Not just hiring a DEI consultant, but embedding equity into every layer of institutional practice. Not just tolerating trans existence, but celebrating trans joy, resilience, and wisdom. Humanist health care isn’t about ticking boxes, it’s about rewriting the contract between society and its people, one that affirms that everyone, regardless of gender, deserves to be well.

Stories as Survival: Why Trans Narratives Matter

In the absence of structural support, storytelling has become a survival tool for many trans people. Personal essays, TikToks, zines, and podcasts offer space for authenticity that clinical records cannot. These narratives are more than catharsis; they are blueprints for belonging.

“I wrote about my top surgery recovery not to educate others, but to remind myself I made it through,” said Riley, a transmasc artist whose blog has reached thousands. “Now people tell me it helped them decide to pursue care. That means everything.”

Mainstream media often reduces trans people to their traumas, focusing on pain, discrimination, and medical transition. While these realities are important, they are not the whole story. Trans people are also thriving, innovating, building families, creating art, and changing the world. Centering those narratives is itself a form of care. It shifts the narrative from pathology to possibility. It tells young trans people that their futures are not only viable but luminous.

Intersectional Care: The Importance of Community-Led Models

Some of the most effective and affirming trans health care models aren’t found in hospitals or private clinics, but in grassroots spaces. Across the country, trans-led organizations are creating community clinics, mobile care units, mutual aid networks, and healing circles. These initiatives reflect a radical truth: care doesn’t need to be clinical to be real.

Groups like The Okra Project, Folx Health, TGIJP, and QueerDoc are redefining what it means to provide trans-affirming care. They often operate on sliding scales, integrate culturally-specific healing practices, and foreground consent and autonomy in every interaction.

These models deserve not just recognition, but resourcing. Funding grassroots health efforts is not charity, it’s strategy. It’s investing in the people who are closest to the problem and best positioned to create lasting solutions.

A Call to Action

If you’re a health care provider, it starts with listening. Seek out trans-led training. Audit your biases. Don’t wait for the system to catch up. If you’re a policymaker, fight for parity. Make gender-affirming care not just legal, but accessible. Fund clinics. Protect providers. Learn from what’s working and replicate it.

If you’re part of a humanist or secular community, advocate loudly. Let trans people know they are not merely tolerated but celebrated. Offer support not as allies, but as co-conspirators in the fight for dignity.