Gender dysphoria is characterized by significant psychological distress and a persistent feeling of incongruence between one’s deeply felt gender identity and the sex assigned at birth. This profound disconnect can affect every aspect of life, from personal relationships to daily functioning. A person experiencing gender dysphoria may feel as though they’re living in a body that doesn’t reflect who they truly are, with distressing feelings about their physical characteristics and the expectations society places upon them.
At the core of addressing gender dysphoria, medical professionals at PromiseCare in Hemet, California consider the complex interplay between psychological, social, and biological factors. Research indicates that a combination of genetic, neurobiological, and environmental elements likely contributes to its development, though the exact mechanisms are not yet fully understood.
Signs and symptoms of gender dysphoria can vary widely between individuals, but common experiences include marked distress related to one’s sex assigned at birth, a strong, persistent desire to be recognized as a different gender, and significant discomfort with one’s physical characteristics or secondary sex characteristics.
Addressing these challenges requires comprehensive, affirming support and professional guidance from experienced healthcare providers. Navigating feelings of anxiety, depression, and low self-esteem related to gender dysphoria calls for individualized care strategies that consider each person’s specific needs, experiences, and goals.
Treatment options range from psychological counseling and hormone therapy to surgical interventions and social affirmation. Healthcare providers at PromiseCare in Hemet, California may employ a combination of these approaches to alleviate psychological distress, address co-occurring mental health conditions, and improve overall well-being and quality of life.
Mental health professionals and medical specialists collaborate closely to develop personalized, gender-affirming care plans that prioritize the unique requirements and health objectives of each patient. Effective care processes emphasize informed decision-making, patient autonomy, and patient-centered strategies to nurture trust and foster open, non-judgmental communication between patients and their caregivers.
Overview
The experience of living with a significant mismatch between one’s deeply felt sense of self and the sex assigned at birth can be a source of profound psychological distress, a condition known as gender dysphoria. This persistent discomfort can lead to ongoing distress with one’s body, gender expression, and societal expectations, resulting in considerable emotional suffering and impairment in daily functioning across multiple life domains.
The distress arises from the marked incongruence between one’s gender identity (one’s internal sense of being male, female, or another gender) and assigned sex (the sex designated at birth based on physical characteristics), making everyday life challenging and sometimes overwhelming.
Research indicates that gender dysphoria can affect individuals of any age, with early signs often manifesting in childhood or adolescence. Children may express strong preferences for activities, clothing, toys, and social roles typically associated with a gender different from their assigned sex, and may persistently state their desire to be another gender.
A clinical diagnosis of gender dysphoria typically requires at least six months of marked incongruence between experienced or expressed gender and assigned sex, accompanied by clinically significant distress or impairment in social, occupational, school, or other important areas of functioning. Understanding the clinical significance of this condition, as well as evidence-based treatment and supportive interventions, is essential for the mental health and overall well-being of individuals experiencing gender dysphoria, and for supporting them through the journey to align their body, identity, and social recognition.
If left unaddressed, the psychological distress associated with gender dysphoria can escalate significantly, negatively impacting daily functioning, relationships, academic or occupational performance, and overall mental well-being. Access to appropriate, gender-affirming care is associated with improved mental health outcomes.
Symptoms
Living with a body that feels fundamentally misaligned with one’s internal sense of self can be a daily reality for individuals experiencing gender dysphoria, a condition characterized by significant psychological distress due to the incongruence between their experienced or expressed gender identity and the sex assigned at birth.
Common experiences include a strong, persistent discomfort with primary sex characteristics (such as genitals) or secondary sex characteristics (such as breasts, facial hair, or voice), and a deep, persistent desire to be rid of these characteristics because they don’t align with one’s gender identity. Many individuals also experience a strong desire to have the primary and secondary sex characteristics of their experienced gender.
A powerful desire to be treated as, and recognized by others as, one’s experienced gender rather than assigned sex is central to the experience. This may involve preferring different pronouns, names, clothing, hairstyles, and gender expression that align with one’s gender identity.
This persistent psychological distress may lead to heightened risks of mental health challenges, including anxiety disorders, depression, social isolation, and in some cases, suicidal ideation or self-harm behaviors. Social withdrawal, low self-esteem, difficulties in relationships, and neglect of self-care may become coping mechanisms for managing the distress.
A clinical diagnosis of gender dysphoria requires the persistence of these symptoms for at least six months, resulting in clinically significant distress or impairment in social, occupational, academic, or other important areas of functioning. The symptoms must not be better explained by another medical condition or mental health disorder.
Individuals struggling with these feelings are not alone, and affirming support is available at PromiseCare in Hemet, California to help find a sense of congruence, authenticity, and peace in living according to one’s true gender identity.
Causes
The exact causes of gender dysphoria are not fully understood by the medical and scientific community. However, research suggests a complex combination of genetic factors, neurobiological influences, and environmental factors contribute to its development, rather than any single cause.
Individuals with a family history of gender dysphoria or those with certain medical conditions, such as differences of sex development (DSD) (previously called disorders of sex development) or traits associated with autism spectrum disorder (ASD), may be at somewhat higher risk of experiencing gender dysphoria, though most individuals with these conditions do not develop gender dysphoria.
Understanding potential risk factors and complications associated with gender dysphoria can help individuals and their families navigate their experiences more effectively and make informed decisions about treatment, support, and gender-affirming care options.
Risk factors
The development of gender dysphoria involves complex and multifaceted influences that are not yet fully understood. While the exact causes and triggers remain subjects of ongoing research, current evidence suggests a dynamic interplay of genetic, neurobiological, and environmental factors that may contribute to the development of gender identity and experiences of gender dysphoria.
Certain risk factors have been identified through research, though it’s important to note that having these factors does not mean someone will necessarily develop gender dysphoria. A history of certain mental health conditions, such as anxiety disorders or depression, may co-occur with gender dysphoria, though the causal relationship is not fully understood and these conditions may develop as a result of the distress caused by gender dysphoria itself.
Additionally, research has identified a correlation between gender dysphoria and autism spectrum disorder (ASD). Studies suggest that children and adolescents with ASD are more likely to experience gender dysphoria or gender variance compared to the general population, though the reasons for this association are not yet clear.
Biological influences, including genetic factors, prenatal hormone exposure, and brain structure and function, may play significant roles in the development of gender identity and gender dysphoria. Research on “neurobiological correlates” suggests that distinct brain activation patterns, brain structure, and connectivity patterns may contribute to the experience of gender dysphoria, though much more research is needed in this area.
Environmental and cultural influences, such as societal expectations, cultural norms regarding gender, family dynamics, and early childhood experiences, can impact how individuals understand, express, and come to terms with their gender identity, though these factors do not cause gender identity itself.
Understanding these potential risk factors and contributing elements can help individuals, families, and healthcare providers at PromiseCare in Hemet, California better navigate the complexities of gender dysphoria and seek necessary support, gender-affirming care, and treatment when needed.
Complications
Understanding the potential complications and co-occurring conditions that may arise is essential in comprehensively addressing gender dysphoria and supporting overall well-being. Navigating the complexities of the condition may involve encountering comorbidities (conditions that occur simultaneously), which can significantly impact mental health and quality of life.
The prevalence of mental health challenges among individuals with gender dysphoria is notably high. Anxiety disorders, depression, post-traumatic stress disorder (PTSD), and substance use disorders are more common in this population, often resulting from the distress of gender incongruence, experiences of discrimination, social rejection, stigmatization, and lack of access to gender-affirming care.
Suicidal ideation and suicide attempts are significantly elevated among individuals with untreated gender dysphoria, particularly among transgender youth. However, research consistently shows that access to gender-affirming care, social support, and family acceptance dramatically reduces these risks and improves mental health outcomes.
Several intersecting factors can impact the experience and severity of gender dysphoria. These factors include the interplay of biological influences, such as genetic differences, hormonal factors, and brain activation patterns, that may affect gender identity development and expression.
Environmental influences, including family dynamics, peer relationships, social acceptance or rejection, and societal expectations regarding gender, can significantly shape an individual’s experience of gender dysphoria and their ability to access support and care.
Cultural influences also play important roles in how individuals perceive, understand, and express their gender identity, and how they navigate healthcare systems and social environments.
Furthermore, research suggests a potential association between traits of autism spectrum disorder and an increased likelihood of experiencing gender dysphoria or gender variance, though the nature of this relationship requires further investigation.
Minority stress (chronic stress from discrimination and stigma), social isolation, difficulties accessing healthcare, experiences of violence or harassment, and lack of legal protections can all contribute to poorer mental health outcomes.
These complexities highlight the critical need for a comprehensive, multidisciplinary approach to addressing gender dysphoria at PromiseCare in Hemet, California, taking into account the intricate relationships between mental health, neurobiological factors, social support, and environmental influences to provide holistic, patient-centered care.
Diagnosis
A person’s journey toward self-discovery, acceptance, and authentic living can be long and challenging, especially when their experienced gender identity doesn’t align with the sex they were assigned at birth. You may find that your internal sense of self is fundamentally at odds with what society expects of you based on your assigned sex and the gender role associated with it.
If this incongruence is causing you clinically significant distress or impairment in functioning, you might be considering seeking an evaluation and potential diagnosis related to your gender identity from a qualified healthcare provider.
To meet the diagnostic criteria for gender dysphoria as outlined in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), individuals must experience marked incongruence between their experienced or expressed gender and their assigned sex for at least six months. Among children, at least six specific indicators must be present, such as a strong desire to be of another gender, strong preferences for cross-gender roles in play, or strong rejection of toys, games, or activities typical of their assigned sex.
For adolescents and adults, the diagnosis requires at least two of several criteria, including a marked incongruence between experienced gender and primary and secondary sex characteristics, a strong desire to be rid of these characteristics, a strong desire for the characteristics of another gender, and a strong desire to be treated as another gender.
It’s important to note that some diagnostic frameworks and classification systems, such as the ICD-11 (International Classification of Diseases, 11th Revision), have shifted terminology from “gender dysphoria” to “gender incongruence” and categorize it differently, no longer requiring psychological distress as a necessary component for diagnosis. This reflects evolving understanding that the incongruence itself, rather than inherent pathology, is the clinical concern.
Receiving an evaluation and potential diagnosis related to your gender identity from a qualified mental health professional at PromiseCare in Hemet, California can be a critical step in accessing gender-affirming treatment, medical interventions, and appropriate support services. However, it’s also essential to be aware of the potential risks of stigmatization, discrimination, and marginalization as a transgender or gender-diverse individual, which is why affirming, non-judgmental care is paramount.
The prevalence of individuals experiencing significant distress related to their gender identity varies across studies, but it’s likely that these figures are underreported due to the significant challenges, barriers, social stigma, and discrimination individuals may face in seeking evaluation, diagnosis, and care.
Treatment
When you’ve received an evaluation or diagnosis related to your gender identity, you may experience a complex mix of emotions, including relief and validation at being understood, but also possibly anxiety or uncertainty about what steps come next in your journey.
As you navigate these feelings, it’s essential to start exploring your treatment options and gender-affirming care pathways with qualified healthcare providers who specialize in transgender health.
Treatment for gender dysphoria at PromiseCare in Hemet, California typically focuses on reducing psychological distress, alleviating gender incongruence, and improving overall quality of life and functioning across multiple domains.
To achieve these goals, comprehensive care may involve psychological counseling and psychotherapy to address any co-occurring mental health concerns such as anxiety or depression, process feelings related to gender identity, and support emotional well-being throughout the transition process.
Hormone therapy (also called gender-affirming hormone treatment) helps align physical characteristics with gender identity by inducing secondary sex characteristics consistent with one’s experienced gender. For transgender women (assigned male at birth), this typically involves estrogen and anti-androgens. For transgender men (assigned female at birth), this involves testosterone. Hormone therapy may begin in adolescence under careful medical supervision.
Surgical options and gender-affirming surgeries, usually recommended for adults who meet specific eligibility criteria, may include procedures such as chest surgery (top surgery), genital reconstruction surgery (bottom surgery), facial feminization or masculinization surgery, and other procedures, all performed in line with individual developmental stages, readiness, and treatment goals.
Social affirmation and social transition through changes to name, pronouns, gender expression, clothing, hairstyle, and other aspects of gender presentation allow individuals to live authentically and comfortably in their experienced gender in daily life, which is a crucial component of treatment.
Research consistently demonstrates that gender-affirming care, including these treatment modalities, is associated with significantly decreased suicidal ideation, reduced rates of suicide attempts, decreased depression and anxiety, and improved overall psychological functioning, self-esteem, and quality of life in individuals with gender dysphoria.
A strong support system, including family support, peer support groups, community resources, family therapy when appropriate, and connections with other transgender and gender-diverse individuals, can substantially enhance treatment effectiveness and improve mental health outcomes throughout the transition process.
Medications
Numerous individuals with gender dysphoria find that medications, particularly hormone therapy, play a fundamental and transformative role in their treatment journey, helping to alleviate psychological distress, align physical characteristics with gender identity, and improve their overall quality of life and well-being.
For those experiencing gender dysphoria, gender-affirming hormone therapy is often an essential component of their comprehensive treatment plan. This type of therapy involves taking hormones such as estrogen (for transgender women) or testosterone (for transgender men) to help develop secondary sex characteristics that align with their experienced gender identity.
Estrogen therapy for transgender women (assigned male at birth) typically includes estradiol combined with anti-androgen medications (such as spironolactone or cyproterone acetate) to suppress testosterone and help develop feminine characteristics such as breast development, body fat redistribution, softer skin, and reduced body hair growth.
Testosterone therapy for transgender men (assigned female at birth) helps develop masculine characteristics including deepening of the voice, increased muscle mass and strength, facial and body hair growth, cessation of menstruation, and body fat redistribution in a more masculine pattern.
For transgender youth and adolescents, pubertal suppression using GnRH agonists (gonadotropin-releasing hormone agonists) such as leuprolide or histrelin may be an important option to temporarily delay the onset of puberty and the development of unwanted secondary sex characteristics, reducing psychological distress, allowing time for exploration and decision-making, and potentially reducing the need for certain surgeries later. This is a reversible intervention that gives young people more time to explore their gender identity.
The decision to begin gender-affirming hormone therapy typically depends on comprehensive individual assessments conducted by experienced healthcare providers to determine readiness, appropriateness for treatment, and to ensure informed consent. This process involves thorough evaluation of mental health, understanding of risks and benefits, and confirmation of persistent gender dysphoria.
Research consistently indicates that access to hormone therapy and gender-affirming care can significantly decrease rates of depression, anxiety, suicidal ideation, and suicide attempts among transgender individuals, while improving quality of life, self-esteem, and overall psychological functioning.
Working closely with a qualified healthcare provider at PromiseCare in Hemet, California who specializes in transgender health to carefully monitor hormone levels, assess effectiveness, and manage potential side effects or health risks is essential for ensuring a safe, effective, and well-supported treatment journey. Regular follow-up appointments and laboratory monitoring are important components of hormone therapy management.
Surgery
For many individuals experiencing gender dysphoria, surgical interventions represent an often profoundly meaningful step in their journey towards self-affirmation, bodily autonomy, and alleviating persistent psychological distress related to physical characteristics.
Surgical options may be considered as important means to align physical appearance and bodily characteristics with gender identity. Various gender-affirming surgical interventions are available, and the specific procedures chosen depend on individual needs, goals, and circumstances.
Top surgery (chest surgery) includes mastectomy with chest contouring for transgender men or breast augmentation for transgender women, helping align chest appearance with gender identity.
Bottom surgery (genital reconstruction) includes procedures such as vaginoplasty, orchiectomy, and other surgeries for transgender women, or phalloplasty, metoidioplasty, hysterectomy, and related procedures for transgender men. These complex surgeries can help alleviate significant distress related to primary sex characteristics.
Facial surgery procedures, such as facial feminization surgery (FFS) or facial masculinization surgery, can help align facial features with one’s gender identity, addressing characteristics like brow ridge, nose, jaw, chin, and other facial structures.
Voice surgery (such as vocal cord surgery) and other procedures may be considered to feminize or masculinize voice characteristics when voice therapy alone is insufficient.
Before undergoing gender-affirming surgery, certain eligibility criteria and requirements typically need to be met to ensure safety, readiness, and optimal outcomes. This process may include a thorough mental health evaluation and documentation of persistent gender dysphoria, a period of living in accordance with one’s gender identity (sometimes called real-life experience), ongoing hormone therapy for a specified duration (typically at least one year), and capacity to provide informed consent with full understanding of risks, benefits, and expected outcomes.
Research has consistently shown that access to gender-affirming surgeries is strongly associated with significant improvements in psychological well-being, mental health, reduced gender dysphoria, decreased suicidal ideation, and improved overall quality of life for transgender individuals. The regret rate for gender-affirming surgeries is extremely low (typically less than 1%), making these among the lowest regret rates for any surgical procedures.
A comprehensive mental health assessment conducted by a qualified mental health professional is essential in determining readiness for surgery, ensuring appropriate expectations, and confirming that surgery aligns with the individual’s treatment goals and overall well-being.
Meeting eligibility criteria and completing necessary preparatory steps are important to ensure a smooth, successful surgical experience and optimal recovery. Working closely with experienced surgeons and the healthcare team at PromiseCare in Hemet, California throughout the process is crucial for achieving the best possible outcomes.
Lifestyle and home remedies
Navigating the complexities of gender dysphoria can be challenging on a daily basis, but incorporating supportive lifestyle practices and self-care strategies into daily life can provide essential emotional support, reduce psychological distress, and promote overall well-being.
Creating a personal space and environment that authentically reflects one’s gender identity can foster comfort, safety, and a crucial sense of belonging and affirmation, all of which are important for mental health and well-being. This can be achieved by surrounding oneself with decor, clothing, accessories, and personal items that align with and affirm one’s true gender identity and gender expression.
Engaging in self-affirmation practices, such as consistently using preferred names and pronouns in all settings where safe to do so, can significantly boost self-esteem, reduce feelings of distress related to gender incongruence, and promote a stronger sense of authentic identity.
Connecting with supportive peer groups, transgender community organizations, LGBTQ+ support groups, or online communities provides a safe, affirming platform for sharing experiences, learning effective coping strategies, receiving validation, and alleviating feelings of isolation and loneliness that many transgender and gender-diverse individuals experience.
Incorporating mindfulness and relaxation techniques, such as meditation, deep breathing exercises, yoga, progressive muscle relaxation, or other stress-reduction practices, can help manage anxiety, reduce emotional distress, and promote overall emotional regulation and well-being.
Establishing a consistent daily routine that includes regular physical activity or exercise, nutritious eating habits, adequate sleep, and engagement in enjoyable activities can positively impact mood, mental health, physical health, and energy levels, ultimately supporting the management of gender dysphoria symptoms and promoting resilience.
Building and maintaining strong social connections with supportive family members, friends, and community members who affirm and respect your gender identity is crucial for emotional well-being and reducing minority stress.
Seeking professional counseling or psychotherapy from therapists experienced in working with transgender and gender-diverse individuals can provide valuable support in processing emotions, developing coping strategies, and navigating challenges.
These lifestyle practices and self-care strategies, combined with appropriate medical care from PromiseCare in Hemet, California, can significantly improve daily functioning and overall quality of life for individuals experiencing gender dysphoria.
Preparing for your appointment
Preparing thoroughly for an appointment with a healthcare provider at PromiseCare in Hemet, California requires some thoughtful groundwork to ensure a productive, meaningful, and affirming conversation about your gender identity and related concerns.
Gathering relevant medical history, including any previous mental health treatments, counseling experiences, current and past medications, and any previous discussions about gender identity with healthcare providers, helps create a comprehensive understanding and facilitates development of an appropriate care plan.
When discussing gender dysphoria and gender identity concerns, being prepared to discuss your treatment goals, specific symptoms or experiences of distress, timeline of when you first became aware of gender incongruence, and how these feelings have evolved over time is essential. This information guides the assessment process and helps develop a personalized, gender-affirming care plan tailored to your specific needs.
Some key things to consider and prepare before your appointment include clarifying your treatment goals and which treatment options are of particular interest (such as counseling, hormone therapy, surgery, or social transition support), identifying your coping mechanisms and existing support systems (such as supportive family members, friends, or community connections), documenting specific symptoms or challenges related to gender dysphoria (including how they impact daily functioning, relationships, and well-being), and noting any previous experiences, trauma, discrimination, or significant events related to your gender identity that may be relevant to your care.
Understanding your overall physical health, any existing medical conditions, current medications, and health concerns helps healthcare providers create an effective, safe, and comprehensive care plan that addresses all aspects of your well-being.
Preparing specific questions about what to expect from treatment, timeline for various interventions, potential risks and benefits, insurance coverage, and referrals to specialists can help you feel more informed and empowered in making decisions about your care.
Bringing a trusted friend, family member, or support person to your appointment can provide emotional support and help you remember important information discussed during the visit.
What you can do
Taking the first proactive steps toward healing from the discomfort and psychological distress of gender dysphoria involves actively seeking support and care through therapy or counseling with mental health professionals experienced in working with transgender and gender-diverse individuals, which focuses specifically on your gender identity, experiences, and treatment goals. This specialized support helps you navigate your feelings and experiences more effectively, leading to improved mental health outcomes and greater clarity about your path forward.
Exploring your gender identity and practicing self-advocacy through social affirmation steps, such as adopting preferred pronouns and names, experimenting with clothing and gender expression, and coming out to trusted individuals, fosters a crucial sense of acceptance, authenticity, and belonging that can significantly reduce psychological distress.
Accessing support groups for transgender and gender-diverse individuals, whether in-person at PromiseCare in Hemet, California or through online communities, can provide invaluable guidance, shared experiences, practical resources, emotional validation, and a sense of community that reduces isolation.
Educating yourself and your loved ones about gender dysphoria, gender identity, and transgender experiences is vital in creating a supportive, affirming environment, reducing feelings of isolation, misunderstanding, and distress. Providing educational resources to family members can help them better understand and support your journey.
Staying informed about your legal rights, anti-discrimination protections, and medical guidelines regarding gender-affirming care is also important for advocating for yourself and ensuring you receive appropriate, affirming treatment. Understanding insurance coverage, legal name and gender marker changes, and workplace protections empowers you to navigate systems more effectively.
Developing healthy coping strategies for managing minority stress, discrimination, and challenging situations, such as practicing self-compassion, setting boundaries, and seeking support when needed, protects your mental health and resilience.
Taking these proactive steps empowers individuals to effectively manage their gender dysphoria, advocate for their needs, access appropriate gender-affirming care, and improve their overall mental health and well-being. Community support, self-advocacy, professional guidance, and family acceptance are key components of the journey toward healing, self-acceptance, and authentic living.
When to see a doctor
When seeking medical attention at PromiseCare in Hemet, California, a qualified healthcare provider will typically create a safe, affirming, and non-judgmental space to discuss your feelings, experiences, and concerns openly without fear of stigmatization or discrimination.
They’ll conduct a comprehensive assessment of your overall well-being by inquiring about your mental health, experiences with gender identity and gender expression, timeline of gender incongruence, any feelings of distress or discomfort related to your assigned sex or physical characteristics, and how these experiences impact your daily functioning and relationships.
This thorough information gathering will help them determine the best course of action to support your individual needs, whether that involves counseling, hormone therapy, referrals to specialists, support groups, or other appropriate interventions.
What to expect from your doctor
Consulting a doctor about persistent feelings of distress or incongruence between your gender identity and the sex assigned at birth is an essential and courageous step towards addressing discomfort, accessing appropriate care, and improving your overall well-being and quality of life.
During the consultation at PromiseCare in Hemet, California, you can and should expect a non-judgmental, respectful, and empathetic attitude from your healthcare provider. Affirming, competent care is your right, and healthcare providers should approach gender identity concerns with sensitivity, respect for your autonomy, and commitment to your well-being.
They’ll likely start by asking thoughtful questions about your feelings regarding gender identity, your medical history, any previous experiences with mental health treatment, experiences of gender dysphoria throughout your life, when you first became aware of gender incongruence, and how these experiences have evolved over time.
A healthcare provider will assess your overall physical and mental health and provide guidance on the appropriate next steps in your care journey. They can provide referrals for specialized care and support services, which may involve an initial comprehensive evaluation to assess the nature and severity of your distress and its impact on functioning, a thorough review of your mental health, including screening for symptoms of anxiety, depression, trauma, or other co-occurring conditions that may require treatment, detailed discussion of potential treatment options available to you, including psychological counseling, hormone therapy, surgical options, support groups, and social transition support, and collaborative development of a personalized treatment plan tailored to your specific needs, goals, circumstances, and readiness for various interventions.
Early consultation with a knowledgeable, affirming healthcare provider can significantly improve mental health outcomes, reduce psychological distress, decrease risk of suicidal ideation and self-harm, and help address concerns associated with gender dysphoria, such as anxiety, depression, social isolation, and impaired functioning. Access to gender-affirming care is associated with dramatically improved outcomes and quality of life for transgender and gender-diverse individuals.