Imagine needing to see a doctor but hesitating—not because you don’t care about your health, but because the exam room doesn’t feel safe. For many LGBTQ+ individuals, that hesitation is a daily reality. It’s not about being careless or stubborn; it’s about trying to avoid being misgendered, misunderstood, or dismissed.
I recently appeared on the news to talk about this issue, and I’m including the clip below. But let’s unpack what we mean when we say we need more affirming care—and why it’s not just a nice idea. It’s a public health imperative.
The Hidden Cost of Avoiding Care
The data is stark: LGBTQ+ individuals are more likely to delay medical care—even when they’re sick or injured—due to fear of discrimination. This avoidance doesn’t come from nowhere. It comes from lived experiences where “care” didn’t feel like care at all.
Maybe it was the intake form that didn’t have an accurate gender option.
Maybe it was the provider who made assumptions about sexual activity or parenting status.
Maybe it was the quiet discomfort in the room when a patient disclosed their identity—and the provider didn’t know how to respond.
These moments add up. And over time, they erode trust in a system that was never built with LGBTQ+ people in mind.
What Is Affirming Care, Really?
Affirming care isn’t about rainbow logos in June or performative gestures. And it’s not just for LGBTQ+ patients—it’s for everyone.
Affirming care means creating clinical environments where all patients feel safe, respected, and understood. It means showing up with curiosity, humility, and a commitment to treating each person as a whole human being—not a list of symptoms or a stereotype.
In this post, we’re focusing on LGBTQ+ patients because their experiences highlight where the healthcare system often falls short—but the principles of affirming care benefit every single person who walks through a clinic door.
Here’s what that looks like in action:
- Using a patient’s correct name and pronouns without hesitation, just as you would with any name or title
- Recognizing health disparities that affect different communities—not as side notes, but as essential clinical knowledge
- Offering trauma-informed care that makes no assumptions and never puts the burden of explanation on the patient
- Creating physical and cultural spaces that invite trust, not guardedness
Affirming care is about meeting people where they are—with respect for their identities, their stories, and their goals. Whether someone is navigating chronic illness, mental health struggles, menopause, gender transition, or none of the above, the need is the same: to be seen, heard, and treated with dignity.
That’s not “special” care. That’s real care.
Why So Many Providers Fall Short
It’s easy to assume this is a matter of prejudice, but often the problem is more insidious: it’s educational. Most providers—including well-meaning ones—were never trained in LGBTQ+ health. Medical education has historically centered white, cisgender, heterosexual male bodies. That bias is baked into the textbooks, the case studies, and the lab ranges.
So when a nonbinary patient shows up with symptoms that don’t “fit,” or when a lesbian couple asks about fertility options, some providers simply don’t know what to do. And instead of saying “I don’t know, but I’ll find out,” too many default to deflection or dismissal.
That’s where the gaslighting begins—not always out of malice, but out of medical indoctrination.
And patients feel it.
When someone walks into a clinic and feels unseen, unheard, or invalidated, it doesn’t just damage that one encounter. It shapes how they see the entire system. It becomes another reason to skip the next appointment or delay that important test.
The Role of the Nurse Practitioner
As a nurse practitioner, I believe we have a unique responsibility—and opportunity—to shift this culture. Nurse practitioners are trained with a holistic, patient-centered model that often prioritizes relationships over protocols. We spend more time with our patients. We’re trained to listen. And that gives us a head start when it comes to providing affirming care.
But even with that advantage, we still need to do the work. We need continuing education. We need to challenge outdated assumptions. We need to look critically at our forms, our language, and even our unconscious reactions. Because affirming care isn’t something you check off once and move on from. It’s a mindset. A practice.
I’ve heard from so many LGBTQ+ patients that the first time they felt safe in a medical setting was with a nurse practitioner. That matters. But it also means the bar is too low if “not being misgendered” is what qualifies as great care.
We can—and must—do better.
Small Changes. Big Impact.
If you’re a provider reading this, here’s where you can start:
- Review your forms. Do they include inclusive gender and relationship options?
- Audit your space. Are there visible signs that say “you’re safe here”—not just in marketing materials, but in how staff are trained?
- Practice affirming language. Don’t wait until a patient calls you out. Learn now.
- Educate yourself. Don’t put the burden of your learning on your LGBTQ+ patients.
If you’re an ally but not in healthcare, you still play a role:
- Go to appointments with LGBTQ+ friends or loved ones if they want support
- Speak up when someone is being ignored, misnamed, or talked over
- Share stories, like the one in the clip below, to help normalize affirming care and raise awareness
Because affirming care isn’t just about clinical protocol—it’s about humanity.
Becoming the Expert We Shouldn’t Have to Be
Here’s the hardest part: many LGBTQ+ folks have become their own health experts out of necessity. They’ve had to research their own conditions, correct their providers, and advocate fiercely—often while feeling unwell, scared, or both.
It’s exhausting. It’s unfair. And it’s not how healthcare should work.
When the system fails to learn how to care for you, you start to blame yourself. You wonder if you’re too sensitive. Too complicated. Too much.
But you’re not. You’re just not being cared for properly.
Affirming care is about reversing that narrative. It’s about telling every LGBTQ+ person: You are not the problem. The system is.
Where We Go From Here
We can’t fix everything overnight. But we can start by calling things what they are. We can start by acknowledging that too many people avoid healthcare because they don’t feel safe. And we can commit—not just in theory but in practice—to making affirming care the standard.
Not just for Pride Month. Not just in progressive clinics. But everywhere.
Because care that isn’t affirming isn’t really care at all.