Midwifery Care for Transfeminine Individuals

J Midwifery Womens Health. 2019 May;64(3):298-311. doi: 10.1111/jmwh.12957. Epub 2019 Apr 8.


This article focuses on the provision of gender-affirming care and preventive care for transfeminine individuals-those assigned male at birth who identify as female or on the feminine spectrum. To meet the learning needs of health care providers less familiar with gender-affirming care, this article begins with an overview of gender identity concepts. Initiation and management of feminizing gender-affirming hormone therapy is then covered in detail, including common gender-affirming medications and their adverse effects, diagnostic criteria, psychosocial evaluation, initial physical examination and laboratory work, and recommendations for follow-up visits and laboratory monitoring. Lastly, the article briefly reviews health care of transfeminine individuals before and after surgical gender-affirming interventions and details best practices for transfeminine preventive care.

Keywords: gender dysphoria; gender identity; gender-affirming hormone therapy; midwifery; sex reassignment procedures; sexual and gender minorities; transgender persons.

Publication types

  • Review

MeSH terms

  • Androgen Antagonists / therapeutic use
  • Estradiol / therapeutic use
  • Female
  • Gender Dysphoria / drug therapy*
  • Gender Dysphoria / nursing*
  • Gender Dysphoria / surgery
  • Gender Identity*
  • Hormone Replacement Therapy*
  • Humans
  • Male
  • Midwifery*
  • Off-Label Use
  • Practice Guidelines as Topic
  • Preventive Medicine
  • Progesterone / therapeutic use
  • Speech Therapy
  • Transgender Persons*


  • Androgen Antagonists
  • Progesterone
  • Estradiol