Reproductive justice is about more than the right to have children or not—it’s about having the resources, freedom, and safety to decide if, when, and how to build a family and to raise children in healthy, thriving communities. It also means access to sexual health, pleasure, and affirming care without stigma.

But too often, the reproductive and sexual health needs of transgender, gender-expansive, and intersex (TGI) people are ignored. Even in LGBTQ+ spaces, this care [KH1] is often sidelined or treated as an afterthought. Reproductive justice demands more: care that affirms bodies, respects choices, and honors lived experiences.

Right now, too many TGI people face systemic barriers to this care. Providers often lack training, leading to harmful assumptions, misgendering, or even denial of treatment. Insurance policies frequently exclude gender-affirming and reproductive services, leaving people to pay out of pocket — or go without care. And even with coverage, finding affirming, knowledgeable providers can be an uphill battle.

These are not isolated incidents. They reflect deeper systems of discrimination that shape who gets care and who doesn’t. The result? Many TGI people delay or avoid care until it becomes urgent, putting health and well-being at greater risk.

Reproductive and sexual healthcare is not one-size-fits-all. Transgender, gender-expansive, and intersex (TGI) people deserve access to the full range of services that support their bodies, health, and choices. This care spans prevention, treatment, family building, and gender affirmation — from contraception and abortion to pregnancy care, cancer screenings, and HIV/STI services. What matters most is that every part of this care is accurate, respectful, and affirming.

Reproductive and sexual healthcare for TGI people can include:

• Use contraception and pregnancy prevention when you want it.
  Choose from options like pills, IUDs, implants, injections, condoms, or emergency contraception. Even if you’re on hormones, pregnancy is still possible depending on your body and the kind of sex you’re having.
• Access abortion care if you need it.
  Get safe, timely options through medication abortion or in-clinic procedures. Abortion is part of reproductive healthcare, and trans people deserve full access to it without stigma.
• Preserve or build your fertility.
  Explore options like sperm banking, egg freezing, IVF, or surrogacy if you want to have biological children now or in the future. Planning around transition should never mean giving up your right to family building.
• Receive affirming pregnancy, birth, and postpartum care.
  Get prenatal checkups, labor and delivery support, and postpartum care that respects your identity. This can include chestfeeding support, mental health resources, and screenings like gestational diabetes.
• Stay on top of cancer screenings.
  Protect your health with regular screenings based on your anatomy—like pap smears if you have a cervix, chest exams if you have breast tissue, or prostate checks if you have a prostate.
• Take charge of HIV and STI testing and treatment.
  Access routine testing, treatment, and prevention tools like PrEP and PEP. You deserve care that recognizes your specific sexual practices and offers services without judgment.

TGI people face multiple barriers that make reproductive and sexual healthcare harder to access. These challenges show up in clinical settings, under insurance policies, and across broader health systems. Together, these barriers exclude TGI people from fully accessing care and lead to poorer health outcomes.

• Provider assumptions and bias
  Many providers assume all patients are cisgender. This can lead to misdiagnosis, inappropriate recommendations, or services that don’t actually meet people’s needs. Examples include assuming transgender men don’t need pregnancy prevention, or assuming trans women don’t need prostate care.
• Forms and medical records
  Intake forms, electronic medical records, and clinic systems often don’t reflect trans identities. Patients are forced to choose between inaccurate options or risk outing themselves in potentially unsafe settings.
• Disrespect and mistreatment
  Misgendering, invasive or irrelevant questioning, and outright denial of care; e small acts of disrespect — like ignoring someone’s pronouns — reinforce the idea that TGI people’s identities and needs are not to be taken seriously.
• Insurance and financial barriers
  Insurance plans frequently exclude or restrict coverage for both gender-affirming and reproductive services. This leaves patients with high out-of-pocket costs for essential care such as fertility preservation, abortion, or hormone replacement therapy (HRT).
• Geographic access
  Trans-affirming clinics may not exist in every community, especially in rural areas. Many people must travel long distances to find competent care, which can mean time off work, transportation costs, and fewer appointments overall.
• Layered inequities
  For trans people of color, immigrants, and low-income communities, these barriers stack on top of existing inequities. Language access, systemic racism, poverty, and immigration status all shape how difficult it is to find and keep care.

These barriers often cause people to delay or avoid care altogether, leading to higher rates of preventable health issues from untreated infections to missed cancer screenings.

Finding reproductive and sexual healthcare that feels safe and affirming can take work, but there are concrete steps that can make the process easier. It helps to start with providers or clinics that clearly signal they are LGBTQ+ or trans-inclusive, but it’s also okay to ask direct questions to make sure the care you’ll receive is respectful and competent.

How to Begin the Process:

• Check directories and community resources. Use tools like organizational directories or local LGBTQ+ community health centers to find providers who already work with trans patients.
• Look at clinic websites. See if they mention LGBTQ+ or trans health services, have inclusive language on their forms, or highlight staff training.
• Ask questions before scheduling. You can call and ask: “Do your forms include options for gender identity and pronouns?” or, “Do your providers have experience working with trans patients?”
• Reach out to your community. Friends, local LGBTQ+ groups, and online forums can be great places to get honest recommendations about which clinics are affirming and which to avoid.
• Trust your instincts. If something feels off or you don’t feel respected, it’s okay to look elsewhere. You deserve care where your needs and identity are affirmed.

Affirming care might not always be available in every community, but starting with these steps can help make the process of finding the right provider less overwhelming.

Healthcare visits can be overwhelming, especially for those with past experiences of stigma or trauma. One way to take back control is to think through your needs before, during, and after each appointment. Having a plan doesn’t remove all the stress, but it can make the process more manageable and help ensure your care is affirming and respectful.

Respectful, affirming care isn’t a special request — it’s a baseline everyone deserves.

Preparing before your appointment gives you the chance to ground yourself and set the tone for your care. This is about creating space to think through what will help you feel safe, respected, and heard. Preparation can mean reflecting on your needs, noting what past experiences you want your provider to understand, and deciding how you want to show up in the room. By taking time to prepare, you give yourself a clear plan that can guide the visit and make it easier to advocate for the care you deserve.

• Choose how you want your body and identity referred to. Decide what words feel affirming (for example, “chest” instead of “breasts”) and what terms you want your provider to avoid. Plan to tell your provider at the start of your visit.
• Define your comfort with touch. Identify which parts of your body you’re okay with being examined and which you want to avoid unless absolutely necessary.
• Reflect on past experiences. Consider how trauma or previous negative experiences affect how you might receive care. For example, past traumatic experiences may make exams like pap smears more triggering or painful. Plan how you want to bring this up with your provider.
• List your priorities. Write down the health concerns or questions you most want addressed so they don’t get lost in the rush of the appointment.
• Arrange support. Decide whether you want to bring a friend, partner, or advocate for backup.

The appointment itself is your opportunity to put your plan into action. This is the moment to speak up about what matters to you, communicate your boundaries, and make sure your priorities are addressed. It’s also a chance to notice how you’re being treated, whether your provider is listening, respecting your choices, and offering care that feels safe and affirming.

• Communicate boundaries for exams. Say things like: “Please explain each step before touching me” or “I don’t want a pelvic exam today unless it’s absolutely necessary.”
• State your pronouns. Ask for your pronouns to be recorded in your medical chart so the entire care team uses them.
• Share how you want your body and identity referred to. Tell your provider the terms that feel most comfortable and affirming.
• Correct missteps. If you’re misgendered or the wrong words are used, speak up and restate what’s right for you.
• Ask for explanations. If your provider uses confusing language or medical jargon, ask “Can you explain that in simple terms?” or “Can you please explain that again?”
• Redirect if needed. If questions feel invasive or irrelevant, ask: “I don’t see how that relates to my care, can you explain why you’re asking?”

What happens after your visit matters just as much as what happens during it. Taking time afterward to check in with yourself helps you process the experience, notice whether your needs were met, and decide what comes next. This is also the stage where you can follow up with your provider, make corrections to your records, or choose to seek care elsewhere if you weren’t treated with respect.

• Review your records. Confirm that your correct name, pronouns, and body terminology are updated in your chart.
• Follow up in writing. Use the patient portal or email to restate boundaries, clarify needs, or correct mistakes.
• Reflect on the experience. Ask yourself: Did I feel respected? Did I feel safe? Were my health priorities addressed?
• Decide next steps. If the experience wasn’t affirming, make a plan to switch providers or seek care elsewhere.

Inclusive care saves lives. When providers affirm names, pronouns, and bodies, it builds trust and makes it more likely people will come back for regular care. It also leads to more accurate treatment and better health outcomes. For health systems, being inclusive isn’t just about fairness — It’s about reducing disparities and improving public health overall. Providers who commit to affirming care play a direct role in creating healthier, stronger communities.[4] [5]

Talking with healthcare providers can feel stressful, especially if you’ve been misgendered, dismissed, or mistreated before. Preparing ahead of time can make it easier to advocate for yourself. Writing down your priorities, questions, or concerns before the visit gives you a clear guide during the appointment. Bringing a trusted friend or advocate can also make the space feel safer and help you back up your needs if something uncomfortable happens.

You also have the right to set boundaries and be specific about how you want your care delivered. That can mean telling your provider what words you want them to use for your body or avoiding terms that feel dysphoric. You can let them know what parts of your body you don’t want examined or touched unless absolutely necessary, and you can ask for explanations before, during, and after any exam.

• Bring a written list. Having notes keeps you from forgetting key questions or boundaries.
• State your pronouns. Let your provider know what pronouns you use and ask them to note it in your chart so the whole care team sees it.
• Share the language you use for your body. You can let your provider know which words feel most comfortable and affirming for you. For example, saying “chest” instead of “breasts.”
• Set boundaries for exams. You can say: “I don’t want a pelvic exam today unless it’s absolutely necessary” or “I need you to explain each step before touching me.”
• Ask for clarity. If a provider uses medical jargon, say: “Can you explain that in plain language?”
• Redirect when needed. If questions feel irrelevant or invasive, you can say: “I don’t see how that relates to my care, can you explain why you’re asking?”
• Seek support. If possible, bring someone you trust, or connect with patient advocacy services at the clinic or hospital.