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It is essential for those who care for and about transgender and gender diverse (TGD) people to continue to learn about what gender affirmation means for the people they are engaging with, as well as to understand some of the more common ways TGD people pursue gender affirmation outside of a medical context. This chapter uses TGD to indicate all people who were assigned a sex at birth that is not in line with their gender identity, as well as anyone who is affirmed by aspects of gender expression that are not typically associated with someone of the same sex they were assigned at birth. A specific transgender or gender diverse identity is not necessary to benefit from the techniques and tools outlined in this chapter, and individual consideration is necessary when discussing any aspect of gender with a person, including gender affirmation.

This chapter is by no means an exhaustive list of affirming practices; it serves to introduce a variety of potential options and ideas outside of medically or surgically altering the body that TGD people may engage in. There is still a large gap in medical and academic literature describing the spectrum of strategies TGD people use to affirm their gender and sparse information addressing the medical, mental, and emotional impact of these behaviors. Therefore, this chapter includes a mixture of medical and academic sources and content created by and for TGD communities to describe their own bodies and experiences.


For most people, gender roles and gendered expectations are integral to how they choose to express their gender. Concepts and expectations of gendered expression are heavily based on a person’s cultural and social background. As one impact of cultural colonialism, predominantly white, Eurocentric ideals of femininity and masculinity are typically privileged over all others as the expected norms. Gender expression and gender affirmation are deeply personal; therefore, it is up to each individual to define what is right for them. Regardless of our personal perspectives and beliefs about what is feminine or masculine, what aspects of gender expression “go together,” or what is the most important aspect of gender affirmation to pursue, service providers must listen to the expressed needs of each individual and do whatever is possible to assist them in achieving their goals.

The gender-affirmation concepts, tools, and techniques described in this chapter are often viewed as assisting TGD people to “pass,” defined here as appearing in the world as a cisgender person, and is most often used in reference to a person being consistently seen by others as their affirmed gender. This use of gender-affirmation tools and techniques may also be described as addressing social gender dysphoria, in which individuals experience a marked and distressing incongruence between the way their gender is perceived by others and the way they see or understand themselves. It is also important ...

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