Two people hug.
Two people hug.
Two people hug.

Gender Affirmation Nonsurgical Services

Nonsurgical services are part of a holistic transgender health care program. These services are one part of the gender affirmation process for many and can vary greatly depending on a patient's individual needs and desired outcomes.

What You Need to Know Gender Affirmation Nonsurgical Services

  • Gender affirmation can include various procedures such as hormone therapy, genital reconstruction, breast reconstruction, facial plastic surgery, speech therapy, urologic and psychiatric services and primary care.
  • Patients choose only the gender-affirming nonsurgical procedures that best fit their needs as they transition.

Laser hair removal

If you are planning to undergo laser hair removal, it is best to limit other forms of hair removal for six weeks before treatment. Before the procedure, your dermatologist will trim the hair you want removed to a few millimeters in length. A dermatologist moves a low-energy beam laser over your skin. Pigments in your hair follicles absorb the energy, which results in long-term or permanent hair reduction and removal. This procedure takes several minutes to hours, depending on the area treated. Your skin may appear slightly sunburned after treatment, and your doctor may give you an ice pack or anti-inflammatory lotion. Most patients feel very little discomfort or pain and can return to regular activity immediately. Usually, a series of laser hair removal appointments are recommended for best results.

Hormone Replacement Therapy (Endocrinology)

Masculinizing hormone therapy: used to minimize undesired feminine characteristics and promote masculinization. As a result, you may notice changes in your voice and development of facial and body hair, sweat and odor patterns. You may also see an increase in your muscle mass, a redistribution of facial and body subcutaneous fat, frontal and temporal hairline recession and, possibly, male pattern baldness. Additional sexual effects may include an increase in libido, clitoral growth, vaginal dryness and cessation of menses. Talk to your doctor about any additional side effects you can expect.

Feminizing hormone therapy: used to reduce undesired masculine characteristics and promote feminization. As a result, you may notice breast development, redistribution of facial and body subcutaneous fat, reduction of muscle mass, reduction of body hair and a change in sweat and odor patterns. Additional sexual effects include reduction in erectile function, changes in libido, reduced or absent sperm count and ejaculatory fluid, and reduced testicular size. Talk to your doctor about any additional side effects you can expect.

Voice Care (Speech Therapy)

Designed to meet the individual needs of the transitioning individual, your voice therapy plan may include changes to:

  • Habitual speaking pitch
  • Resonance (the way sound is shaped to produce a vocal quality)
  • Inflection/prosody (the melodic ups and downs of the voice)
  • Rate of speech Volume/intensity
  • Articulation (how speech sounds are produced)
  • Pragmatics (social rules of communication)
  • Nonverbal communication

If voice therapy is not by itself enough to help achieve the desired voice outcome, vocal cord surgery can be considered. Many of the surgeries to help change vocal pitch can be done on an outpatient basis and without scarring. Talk to your doctor about surgical options to achieve the vocal identity that is right for you.

The Center for Transgender and Gender Expansive Health Team at Johns Hopkins

Embracing diversity and inclusion, the Center for Transgender and Gender Expansive Health provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals to provide culturally competent, evidence-based care; informs the public on transgender health issues; and advances medical knowledge by conducting biomedical research.

Mental Health

Transgender patients may have specific needs for mental health care that focus on the exploration of gender identity, coming out and social transition, preparation for gender reassignment surgery, family support systems and more. Transgender patients may also have mental health needs not specific to their gender affirmation process for which they would prefer to see a mental health expert specializing in transgender care. Discuss your individual mental health needs with your doctor. Both a primary care doctor and a mental health specialist are good places to bring up any mental health concerns you have.

Gender Dysphoria Diagnosis

Procedures related to gender affirmation are provided at different stages, typically starting with a diagnosis of gender dysphoria from a mental health professional. Gender dysphoria is not the same as being transgender, nor is it felt by all transgender individuals. Gender dysphoria is a medical condition where patients suffer psychological distress that is caused by conflicts between the assigned gender at birth not matching the patient’s mental and psychological gender identity or conflicts between societal interaction not reflecting the patient’s true preferred gender.


Some transgender individuals aspire to have biological children or be parents. Because of this, all reproductive options and future plans, such as egg banking, sperm banking and pregnancy, should be discussed with individuals prior to obtaining trans-specific medical care and surgical procedures that may reduce their future reproductive options. Additionally, it is important for transgender men, transgender women and their families to find a provider or center that understands their specific needs and offers services in a caring and compassionate environment.

LGBTQ Resources at Johns Hopkins Medicine

Johns Hopkins Medicine values and embraces the diversity of its community — neighbors, patients, families, faculty, staff, students and trainees. We are committed to ensuring that patient care, service delivery and the healing environment are designed in a way that respects the individuality of all employees, patients and visitors.

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