The term gender-affirming health care has appeared frequently in recent news headlines, most often in terms of clinical care for transgender individuals. Pundits across the social and ideological spectrum in the US have tried to politicize the term either positively or negatively. It has certainly been a focus in the ongoing culture wars in this country, with numerous laws proposed or enacted regarding access to public restrooms, school programming, and athletic eligibility. Compassionate health care for all patients at all ages should be a priority for clinicians. This crosses all sexual orientations and gender identities.

As a urologic surgeon who has a particular interest in geriatrics, I would argue that we should reconsider the term gender-affirming health care in a much broader perspective. If we think of the major urologic conditions that occur across the lifespan, many are directly influenced in some way by gender.

Pediatric urologists are experts on intersex conditions. This includes clinical evaluation, basic and translational scientific discovery, and treatments. Some of these conditions can be potentially fatal if not correctly identified and treated early in life. New research work has helped to evolve how some of these conditions are managed. Some newer paradigms involve waiting for definitive surgical treatment until patients are old enough to actively participate in their own health care decisions. Research continues to expand our understanding of how physiological and psychosocial factors interact in these conditions. There is also an increased emphasis on advocacy for affected patients and their families and loved ones.

Transitional and adolescent urology are growing disciplines within our specialty. Many of the conditions treated in this age group cross the gender spectrum. Similarly, in both adult urology and geriatrics, many of the conditions we encounter and treat have strong gender-based elements.

Men’s urologic care often focuses on andrology and fertility, benign prostatic disorders, testicular or prostate cancer, erectile dysfunction, ejaculation disorders, and conditions affecting libido. In the broadest sense, treatment of these issues is gender affirming. Testosterone replacement therapy for hypogonadal men is gender-affirming health care. Assisted reproductive technologies for couples looking to conceive are gender affirming. And treatments to assist with erectile and sexual function are gender affirming.

Female pelvic medicine and reconstruction specialists also diagnose and treat numerous conditions that are gender specific. UTIs, urinary incontinence, pelvic organ prolapse, and other pelvic floor disorders are among the most common seen in both general adult and geriatric clinical practices. Again, I would maintain that topical vaginal estrogen therapy to prevent UTIs in postmenopausal women is gender affirming. Pessary placement or surgical reconstruction for pelvic organ prolapse is gender-affirming health care.

Care for both women and men facing urologic cancers is gender affirming. Many standard treatments such as cystectomy and urinary diversion, radical orchiectomy, prostatectomy, and others can negatively influence body image and sexuality for patients. The care we provide for these conditions is indeed gender affirming. Care that helps foster and improve sexual expression and activity are gender affirming.

The population of patients who identify as transgender or nonbinary has increased exponentially in recent years. There has been a concomitant increase in the number of urologists and other clinicians offering care for these patients. This ranges from counseling and hormonal replacement therapy to gender-affirming reconstructive surgical procedures. We are starting to see more older adults identifying and seeking health care as transgender or nonbinary individuals. I have several transgender patients in my own clinical practice who are over 70 years of age. Future research and work on understanding the unique needs of transgender older adults will help improve our care across the gender spectrum.

As a member of the AUA Diversity, Equity & Inclusion Committee, I know that our group has worked diligently to represent all aspects of our specialty including both our colleagues and the patients we treat. I am honored to serve on this committee and applaud the members of AUA leadership for embracing this critically important area. As we deepen our appreciation of the vast diversity in our society and culture, I encourage us all to expand our definitions of what constitutes gender-affirming health care. It is something we as urologists offer to our patients and our communities on a daily basis.