This educational activity is credited for 4 contact hours at completion of the activity.
The goal of this course is to offer healthcare professionals a concise overview of providing care to transgender individuals, including key definitions, psychosocial challenges experienced by this population, relevant terminology, types of hormone replacement therapy, and common surgical interventions encountered in clinical practice.
Growing awareness and acknowledgment of diverse gender identities have underscored the need for healthcare professionals to be knowledgeable and prepared to care for transgender individuals. With an estimated 2.6 million Americans—approximately 1% of the adult population—identifying as transgender, culturally competent care has become increasingly essential. This course explores key aspects of transgender healthcare, including definitions, relevant terminology, and the psychosocial challenges faced by this population. It also outlines available treatment options, such as hormone replacement therapy and gender-affirming surgical procedures, along with nursing considerations that support inclusive, respectful, and effective care in clinical environments.
Upon completion of this course, the learner will be able to:
This activity has been planned and implemented in accordance with the policies of CheapCEForNurses.com.
Cheap CE For Nurses, Inc and its authors have no disclosures. There is no commercial support.
To access Caring for the Transgender Person, purchase this course or a Full Access Pass.
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To access Caring for the Transgender Person, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
| Affordable Care Act (ACA) | Comprehensive health care reform law enacted in March 2010. The law has 3 primary goals: Make affordable health insurance available to more people. Expand the Medicaid program. Support innovative medical care delivery methods. |
| Binary | The classification of gender into two distinct forms of masculine and feminine, whether by social system, cultural belief, or both simultaneously. |
| Biological Sex | Refers to one’s status as female, male, or intersex depending on their chromosomes, reproductive organs, and other characteristics. |
| Bisexual | Sexually or romantically attracted to both men and women, or to more than one sex or gender: |
| Body Dysmorphia | A mental disorder defined by an overwhelming preoccupation with a perceived flaw in one’s physical appearance. |
| Bottom Surgery | Plastic surgical procedures that are performed on the genitals to give the look, and in some cases, functionality that matches gender identity. |
| Cisgender | A person whose gender identity corresponds with the sex registered for them at birth. |
| Conversion Therapy | Any emotional or physical therapy used to “cure” or “repair” a person’s attraction to the same sex, or their gender identity and expression. |
| DSM-5 (Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition) | A classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders. |
| Enzyme Aromatase | The enzyme responsible for the conversion of androgens to estrogen in many tissues. |
| Equal Employment Opportunity Commission (EEOC) | A federal agency that was established via the Civil Rights Act of 1964 to administer and enforce civil rights laws against workplace discrimination. |
| Estrogen | A category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. |
| Facial Feminization Surgery (FFS) | A surgery that involves the cosmetic modification of your facial characteristics. |
| Facial Masculinization Surgery (FMS) | A set of plastic surgery procedures that can transform the patient’s face to exhibit typical masculine morphology. |
| Gender | The social, psychological, cultural, and behavioral aspects of being a man, woman, or other gender identity. |
| Gender Dysphoria | A condition where a person experiences discomfort or distress because there is a mismatch between their biological sex and gender identity. |
| Gender Identity | The personal sense of one’s own gender. |
| Gender Non-Conforming | A term given to people who do not conform with the gender norms that are expected of them. |
| Gender-Affirming Care | A range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. |
| Genderfluid | A non-fixed gender identity that shifts over time or depending on the situation. |
| Genderqueer | Denoting or relating to a person whose gender identity does not correspond to conventional binary gender distinctions. |
| Gnrh Agonists | Function as agonists of the Gnrh receptor, the biological target of gonadotropin-releasing hormone (Gnrh). |
| Harassment | The act of regular and unwarranted actions against a victim, such as racial epithets, annoying remarks, or malicious acts. |
| Health Insurance Portability And Accountability Act (HIPAA) | A federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. |
| Heterosexual | Sexually or romantically attracted to people of the opposite sex. |
| Homosexual | Same-sex attraction. |
| Hormone Replacement Therapy (HRT) | Medication that contains female hormones. |
| Housing And Urban Development (HUD) | Is one of the executive departments of the the US federal government that administers federal housing and urban development laws. |
| Housing Discrimination | The historical and current barriers, policies, and biases that prevent equitable access to housing. |
| Hysterectomy | A surgical procedure to remove all or a part of the uterus. |
| Laryngoplasty | A procedure that moves the vocal fold margin medially to improve glottic closure and voice quality for patients with vocal cord paralysis. |
| Metoidioplasty | A surgery that uses the tissue from the clitoris to create a neophallus, a new penis. |
| Neophallus | Construction of a new penis. |
| Neovagina | Is surgery used to create a vagina. |
| Non-Binary | A term for people whose gender identity falls outside of the binary, such as man or woman. |
| Pansexual | Sexually or romantically attracted to people regardless of their sex or gender. |
| Phalloplasty | The construction or reconstruction of a penis or the artificial modification of the penis by surgery. |
| Scrotoplasty | A type of surgery to create or repair the scrotum. |
| Secondary Sex Characteristics | Physical features related to the sex of an organism that emerges during puberty, or the phase of sexual maturity. |
| Sexual Orientation | An enduring personal pattern of romantic attraction or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender, or to both sexes or more than one gender. |
| Testosterone | The primary male sex hormone and androgen in males. |
| Title VII Of The Civil Rights Act Of 1964 | A landmark civil rights and labor law in the United States that outlaws discrimination based on race, color, religion, sex, and national origin. |
| Top Surgery | A surgical procedure used to address gender dysphoria for people who identify as binary, nonbinary, or transmasculine. |
| Transgender | Someone whose gender identity differs from that typically associated with the sex they were assigned at birth. |
| Vaginoplasty | Any surgical procedure that results in the construction or reconstruction of the vagina. |
In recent years, the growing recognition and acceptance of diverse gender identities have underscored the need for healthcare professionals to be knowledgeable and competent in providing care to transgender individuals. Approximately 2.6 million adults in the United States—roughly 1% of the adult population—identify as transgender.
Transgender individuals often face distinct healthcare challenges related to gender-affirming treatments, mental health care, and preventative health services. It is essential for healthcare providers to understand these unique needs, along with the cultural and social factors that may influence patient interactions and outcomes. This course explores the core aspects of transgender care, including key definitions, psychosocial barriers, and inclusive terminology. Additionally, it covers medical options such as hormone replacement therapy and surgical procedures, as well as nursing practices designed to support respectful, inclusive, and affirming healthcare delivery.¹⁻³
Gender identity forms the foundation of the transgender experience. Traditionally, gender identity has been aligned with biological sex—defined by physical and genetic characteristics such as chromosomes (XY for males, XX for females), reproductive anatomy, and secondary sex traits.
Transgender individuals are those whose gender identity does not align with the sex assigned at birth. The origins of this incongruence have been the subject of extensive research, though no single cause has been confirmed. Some studies suggest that genetic and hormonal influences during prenatal development may contribute, while others have identified structural and functional brain differences between cisgender and transgender individuals. Although these findings offer valuable insights, further research is necessary to fully understand the biological underpinnings.
In addition to biological factors, psychological components—such as cognitive and emotional development—also shape gender identity. A person’s sense of self and their interactions with societal norms significantly impact how gender is experienced. Social and cultural influences, including family environment, peer dynamics, and broader societal attitudes toward gender diversity, play a crucial role in how individuals understand and express their gender.³⁻⁴
Gender dysphoria is a psychological term describing the emotional distress that may occur when a person’s gender identity differs from the sex assigned at birth. It is crucial to note that gender dysphoria is not synonymous with being transgender; many transgender individuals do not experience this condition. Instead, gender dysphoria refers to the psychological and emotional discomfort that can arise from this incongruence. This discomfort may present as dissatisfaction with the gender roles linked to one’s assigned sex, discomfort with physical traits—particularly secondary sex characteristics—or a desire for medical or social transition. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the distress must be persistent and present for at least six months to meet diagnostic criteria.³⁻⁴
Gender dysphoria is distinct from body dysmorphia, a different psychological condition. The distress in gender dysphoria centers specifically on gender identity and associated physical or social aspects of one’s assigned sex. In contrast, body dysmorphia involves excessive concern over perceived physical flaws that are either minor or unnoticeable to others. Individuals with body dysmorphia may engage in repetitive behaviors or intrusive thoughts unrelated to gender identity.³⁻⁴
Transgender individuals face numerous health and social disparities, often driven by systemic stigma, discrimination, and a lack of cultural competency in healthcare and society. These disparities contribute to significantly higher rates of mental health issues, substance use, and suicide attempts among transgender people compared to the general population. The risks are further amplified for transgender people of color and those living with disabilities.
Surveys indicate that 39% of transgender respondents report experiencing serious psychological distress—compared to just 5% in the general U.S. population. Alarmingly, 40% have attempted suicide in their lifetime, nearly nine times the national average of 4.6%.³⁻⁶ Many transgender individuals report mistreatment in healthcare settings, with one-third encountering negative experiences related to their gender identity—such as verbal abuse or denial of care. Consequently, 23% of respondents reported avoiding needed healthcare out of fear of discrimination. Additionally, transgender women, particularly Black transgender women, are disproportionately affected by HIV. While 0.3% of the general U.S. population is living with HIV, the rate is 1.4% among transgender individuals and nearly 7% in the Black transgender population, with an estimated 19% of Black transgender women living with HIV.³⁻⁶
Discrimination also extends to housing. Approximately 24% of transgender Americans report experiencing housing discrimination, including eviction or being denied accommodation. Homeownership rates in the transgender community are strikingly low—just 16%, compared to 63% in the general population. Homelessness and poverty are pervasive, with 30% of transgender individuals experiencing at least one episode of homelessness. This is more than twice the rate seen in the general population (12%), and the disparity is even more pronounced among transgender people of color, who are three times more likely to live in poverty. These outcomes are partly driven by high unemployment rates—15% for the transgender population overall, and as high as 20% for transgender people of color, compared to 5% in the general population.³⁻⁶
Employment discrimination is widespread. About 30% of transgender individuals report being fired, denied promotion, or otherwise mistreated at work due to their gender identity. Many also face verbal, physical, or sexual harassment in the workplace, with these incidents more common among people of color.³⁻⁶
Violence against transgender individuals is also a significant concern. Surveys show that 10% of those who disclosed their identity to immediate family reported experiencing violence from relatives. Additionally, 8% have been evicted due to their gender identity. Transgender individuals experience alarmingly high rates of victimization in public spaces—86.2 incidents per 1,000 persons compared to 21.7 per 1,000 for cisgender individuals. Black and Latina transgender women make up nearly 93% of all transgender homicide victims in the U.S., a rate far exceeding that of their cisgender counterparts.³⁻⁹
In educational settings, transgender students face frequent discrimination and harassment. More than half (54%) report being verbally harassed, 24% have been physically attacked, and 13% have been sexually assaulted because of their gender identity. As a result, 17% left school due to the severity of mistreatment. These hostile environments negatively impact academic achievement and overall mental health, limiting opportunities for higher education.³⁻⁶
Legal recognition remains another significant barrier. Only 11% of transgender individuals report having all their identity documents updated to reflect their gender identity. Financial barriers are a primary factor—35% of those who hadn’t legally changed their name and 32% who hadn’t updated their gender marker cited cost as the main obstacle.³⁻⁶
Even when transgender individuals present IDs that match their gender identity, nearly one-third still face mistreatment, including verbal harassment, service denial, eviction, or physical assault. These challenges illustrate the systemic nature of discrimination and the urgent need for inclusive legal, healthcare, and social policies.³⁻⁶
The following are commonly used terms to describe gender identity. As language around gender continues to evolve, these definitions may shift over time. A person whose gender identity aligns with the sex assigned at birth is referred to as cisgender. Typically, individuals assigned male at birth use he/him/his pronouns, while those assigned female use she/her/hers.
A transgender male is someone assigned female at birth who identifies as male and may prefer male or gender-neutral pronouns (they/them/theirs). A transgender female is someone assigned male at birth who identifies as female and typically uses female or gender-neutral pronouns. The term “transsexual” was historically used to describe a transgender person undergoing medical transition. However, it is now considered outdated by many and has largely been replaced by the more inclusive term “transgender,” which acknowledges gender identity without necessarily implying medical intervention.¹²¹⁰
While cisgender and transgender identities often reflect the traditional male/female binary, other identities exist outside of this framework. These include non-binary, genderfluid, and genderqueer. A non-binary individual does not identify exclusively as male or female and may feel a blend of both, neither, or a completely different gender. Genderqueer is a broad term that may be used similarly. Genderfluid individuals experience shifts in their gender identity over time—this might vary daily, seasonally, or over years. For example, someone may identify as female one day, male the next, or alternate between non-binary and male identities. Their pronouns may change accordingly.
People who reject identification with any gender may be described as gender non-conforming. This term reflects the idea that gender is a social construct, and such individuals do not identify with traditional gender roles or categories—whether cisgender, transgender, non-binary, or genderfluid. Gender-neutral pronouns are generally appropriate for these individuals.¹²¹⁰
It is important to distinguish between gender identity and sexual orientation, as they are separate aspects of personal identity. Gender identity concerns an individual’s internal sense of self in relation to their assigned sex at birth. Sexual orientation refers to the emotional, romantic, or sexual attraction a person feels toward others.
For example:
Just as cisgender individuals can have any sexual orientation, so too can transgender individuals. Gender identity does not determine or limit one’s sexual orientation.¹²¹⁰
Gender-affirming care encompasses medical, psychological, and social interventions aimed at helping transgender individuals align their physical appearance, gender identity, and overall well-being with their affirmed gender. The primary goal is to improve mental health, quality of life, and personal satisfaction by affirming and supporting gender identity. The approach is personalized and may involve several key components depending on the individual’s preferences and needs.²¹⁰⁻¹²
Maintaining Confidentiality
Transgender individuals, like all patients, are entitled to the privacy of their personal information, including gender identity and medical history. Respecting confidentiality helps to build and sustain trust between healthcare professionals and patients. This trust is essential for fostering a safe and supportive healthcare environment where individuals feel comfortable sharing concerns and seeking care.
Sensitive discussions about gender identity, dysphoria, or transition-related treatments demand a heightened level of confidentiality to protect patients from stigma, discrimination, or harassment—both inside and outside clinical settings.¹²
Protecting privacy also promotes regular healthcare engagement. When transgender patients feel confident that their identity and information are secure, they are more likely to access timely and necessary care, leading to improved outcomes in a population historically affected by healthcare disparities.
Privacy is both an ethical obligation and a legal mandate under the Health Insurance Portability and Accountability Act (HIPAA), which outlines strict rules for handling patient information. Violations can result in legal action, fines, or disciplinary consequences.¹²
Providing Support
Healthcare providers must offer inclusive, respectful care to transgender patients, free from bias. Despite growing awareness, transgender individuals still face systemic barriers to healthcare access—often worsened by insurance denials for necessary services such as hormone therapy, mental health treatment, and surgeries.
Experiences of discrimination in medical settings frequently lead transgender patients to avoid or delay care, increasing the risk of adverse health outcomes. These barriers deepen existing health inequities and contribute to higher rates of suicide and self-harm among those denied appropriate care.¹¹⁻¹²
To reduce these disparities, providers must ensure transgender patients receive holistic, gender-affirming care that addresses both physical and emotional well-being. This commitment includes advocating for equitable insurance coverage, educating staff, and fostering a healthcare culture rooted in respect, dignity, and comprehensive support.
Hormone replacement therapy (HRT) for transgender adults involves administering hormones to induce physical traits that align with their gender identity. The regimen varies depending on whether the individual is undergoing masculinizing or feminizing therapy, along with considerations for overall health and medical history. Despite HRT, some physical traits linked to the individual’s sex assigned at birth—such as height, bone structure, and fat distribution—often remain.¹⁴⁻¹⁵
Masculinizing Hormone Therapy
Masculinizing therapy primarily uses testosterone to suppress feminine characteristics and promote male secondary sex traits. In certain cases, aromatase inhibitors may be added to prevent testosterone from converting into estrogen.
Testosterone therapy leads to:
Additional long-term changes include a deepened voice, increased clitoral size, and vaginal atrophy. Male-pattern hair loss may also occur due to testosterone’s androgenic effects on hair follicles.
Common formulations include:
While generally effective and well tolerated, testosterone therapy may increase the risk of cardiovascular events and alter cholesterol levels over time.
Aromatase Inhibitors (AIs)
AIs such as anastrozole and letrozole inhibit the enzyme aromatase, which converts androgens into estrogen. Although not a standard part of masculinizing therapy, they may be used when estrogen suppression is insufficient with testosterone alone.
Side effects may include:
Feminizing Hormone Therapy
Feminizing HRT typically combines anti-androgens, estrogen, and sometimes progestins. Anti-androgens are often administered several weeks prior to estrogen initiation to reduce testosterone’s masculinizing effects.
Common anti-androgens include:
These medications help reduce facial and body hair, slow or stop voice deepening, and cause testicular atrophy. They may also lower libido, reduce spontaneous erections, and impair fertility. Bone density and clotting risk may also be affected, making fertility counseling and regular monitoring essential.
Estrogen therapy results in:
These changes contribute to a more traditionally feminine body shape, though responses vary based on genetics and lifestyle.
Forms of estrogen include:
Potential side effects include:
Progestins (e.g., medroxyprogesterone acetate, micronized progesterone) may be added to enhance breast development, reduce testosterone production, and improve sleep and mood. They may also promote bone health and help manage menopausal symptoms.¹⁴⁻¹⁶
Surgical Interventions for Gender Affirmation
Transgender individuals may opt for surgical procedures to bring their physical characteristics into alignment with their gender identity. These surgeries aim to reduce the disconnect between one’s internal sense of self and outward appearance. However, as with all surgical interventions, these procedures carry risks and should be considered carefully in consultation with healthcare providers. It is important to note that not all transgender individuals choose to undergo surgery.¹⁷
Top Surgery (Chest Reconstruction or Augmentation)
For transgender men, chest masculinization involves a double mastectomy to remove breast tissue and reshape the chest for a more masculine look. Nipple grafts, resizing, and repositioning may also be part of the procedure. Techniques vary based on tissue volume and may include double incision, periareolar, or keyhole methods. Transgender women may undergo chest feminization, which involves breast augmentation with saline or silicone implants to create a more traditionally feminine chest.
Postoperatively, drainage tubes may be placed and removed within 1–2 weeks. Compression garments are worn to control swelling and aid healing, and pain management is typically prescribed. Scar care and follow-up for muscle development may be advised for transgender men. For transgender women, regular mammograms are recommended after age 50 if on hormone therapy for more than five years.¹⁸⁻¹⁹
Bottom Surgery (Genital Reconstruction)
For transgender men, masculinizing procedures include:
Recovery involves strict rest, hygiene protocols, and follow-up care. Potential revisions may be required for function or appearance.²⁰⁻²²
For transgender women, feminizing procedures may include:
Postoperative care includes wound care, hygiene routines, and regular dilation to maintain vaginal depth. Lifelong dilation is often necessary. Follow-up ensures healing and aesthetic results.²⁰⁻²²
Facial Surgery
Laryngoplasty and Hair Transplantation
Body Contouring
Body shaping procedures include:
These procedures, when chosen, are part of a highly individualized transition journey and should be guided by comprehensive medical consultation, realistic expectations, and long-term planning.
Federal and state-level policies have increasingly addressed transgender rights, particularly in healthcare. These initiatives aim to reduce discrimination and ensure equal access to necessary services. However, legal protections and their implementation can vary widely depending on the jurisdiction.³⁰⁻³¹
At the federal level, several key policies provide important safeguards. The Patient Protection and Affordable Care Act (ACA) includes Section 1557, which prohibits discrimination in healthcare based on race, color, national origin, age, disability, sexual orientation, or gender identity in federally funded health programs and activities. Additionally, the Equal Employment Opportunity Commission (EEOC) interprets Title VII of the Civil Rights Act of 1964 to protect individuals from employment discrimination based on gender identity and sexual orientation. Similarly, the U.S. Department of Housing and Urban Development (HUD) has implemented regulations that guarantee equal access to housing and related services regardless of gender identity.
As of April 2022, U.S. citizens can select “X” as their gender marker on passport applications, offering a more inclusive option for non-binary and gender-diverse individuals. This advancement reflects a broader push for gender recognition at the federal level.
Despite these federal protections, transgender rights and healthcare access differ significantly across states. Some states have enacted laws that explicitly require health insurance providers to cover gender-affirming treatments, while others offer no such mandates. This results in considerable disparities in access to hormone therapy, surgeries, and related care.
States also vary in their adoption and enforcement of non-discrimination laws in employment, housing, and public services. The processes for updating legal documents like names and gender markers also differ, affecting how easily a transgender person’s identity can be legally recognized. In addition, while some states have banned conversion therapy targeting sexual orientation or gender identity, the presence and enforcement of these bans are inconsistent.
These legal differences highlight the need for healthcare providers to be aware of both federal and local regulations to support transgender patients effectively and advocate for equitable care.
Nursing care for transgender patients requires a comprehensive approach that incorporates both medical and psychosocial elements. Creating a culturally sensitive and nonjudgmental environment is essential. Nurses can enhance inclusivity by using patients’ affirmed names and pronouns, respecting their gender identity, and safeguarding confidentiality. Implementing gender-neutral language and applying the two-step method—which separately asks about gender identity and sex assigned at birth—can help patients feel more comfortable. These practices foster trust and encourage open communication, allowing patients to express their healthcare needs and preferences.²⁴¹¹
Clinically, nurses should be knowledgeable about gender identity and the scope of gender-affirming care, including hormonal and surgical treatments. Familiarity with treatment plans, side effects, monitoring needs, and follow-up protocols enables the delivery of competent and compassionate care. Routine health evaluations should assess both physical and mental well-being, recognizing the challenges associated with gender dysphoria and the broader psychosocial stressors that transgender individuals often face. This includes screening for depression, anxiety, PTSD, eating disorders, substance abuse, intimate partner violence, self-harm, bullying, truancy, homelessness, high-risk sexual activity, and suicidal thoughts. It’s essential not to automatically link health issues solely to the person’s transgender status.²⁴¹¹
Physical exams may trigger discomfort due to past trauma or ongoing gender dysphoria. Nurses can ease this experience by maintaining awareness of the patient’s comfort and asking for consent throughout the exam. This attentiveness also extends to advocacy, where nurses support the development of inclusive institutional policies, address implicit biases, and commit to continuous education to deepen cultural competence. Recognizing and responding to barriers such as limited insurance coverage for gender-affirming care is also crucial. Nurses may need to work collaboratively with the healthcare team to navigate these obstacles.²⁴¹¹
Offering emotional support and connecting patients with community-based services or support groups can enhance their overall care experience. A holistic approach to nursing includes understanding and addressing the unique social and emotional aspects of transgender health. Creating affirming, respectful, and inclusive healthcare settings is key to improving outcomes. Nurses play an important role in upholding the dignity and rights of transgender patients through sustained education, communication, and advocacy within the healthcare system.²⁴¹¹
Delivering holistic care to transgender individuals demands an approach that goes beyond medical procedures to include a deep understanding of gender identity, respect for personal autonomy, and acknowledgment of the diverse ways individuals may pursue gender affirmation. Medically, hormone replacement therapy, surgical interventions, and other gender-affirming treatments help align physical traits with gender identity. However, it is equally important to recognize the social, emotional, and systemic factors that influence the overall health of transgender individuals.
This population is disproportionately affected by health disparities, including elevated rates of mental health conditions, substance use, and exposure to discrimination and violence. Addressing these issues requires collaboration among healthcare professionals, educators, and policymakers to foster inclusive, equitable environments. While federal legislation offers protections against healthcare discrimination, variations in state-level policies create a complex legal framework that directly impacts access to care for transgender individuals.
To effectively support transgender patients, healthcare providers must engage in continuous education to improve cultural competence and create spaces where patients feel validated and supported. Nurses, in particular, play a crucial role in advocacy, patient education, and maintaining environments that encourage open communication. Promoting inclusivity not only reflects the values of patient-centered care but also helps close gaps in health equity by ensuring that transgender individuals receive care that affirms their identity and meets their specific needs. A healthcare system grounded in respect, knowledge, and empathy enhances the health and well-being of transgender patients while advancing a more inclusive model of care.
To access Caring for the Transgender Person, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
To access Caring for the Transgender Person, purchase this course or a Full Access Pass.
If you already have an account, please sign in here.
