This article originally appeared in Yes! Magazine.

Before Ash Woods got gender-affirming top surgery last January, they stapled together a zine-like booklet filled with all sorts of delicious smoothie recipes. On the front cover, Woods drew a T-Rex in a self-effacing nod to how the surgery was going to render their arms virtually useless for at least one week after they received a more masculine-looking chest. Before their surgery, they set the booklet down next to the blender in their kitchen so it was ready to go when they got home from the hospital.

Woods, who is trans and nonbinary, works as a birth doula in the Seattle area. As part of their job, Woods extensively plans for a client’s post-labor recovery, and they wanted a similar level of care after their surgery. Top surgery was going to be vulnerable and challenging, Woods knew, and rather than rely solely on a partner or friends, they decided to hire an expert: a gender doula.

Similar to birth doulas, gender doulas are non-clinical companions who provide advocacy, knowledge, and support. These days, you can count on two hands the number of people who have assumed the formal title of “gender doula,” but they have existed over the decades in other forms as “transgender transition coaches” or more informal word-of-mouth mentors. With exploration of gender-nonconforming identities becoming more common and gender-affirming surgeries on the rise, people are turning to gender doulas to navigate an often unwelcoming environment.

A person with a clipboard supportively puts a hand on another person's arm.
A gender doula might offer guidance about how a patient can communicate with their doctor, though they will not offer medical advice. Credit: Media_Photos / Shutterstock

The gender doula could remind Woods to take their medication, supervise them on a walk in case they started feeling dizzy, or record how much fluid was draining into their post-surgical plastic bulbs to ensure they weren’t at risk of infection. The doula could also act as an advocate at doctors’ appointments and ensure Woods’ correct pronouns were being used, given that they are often misgendered at the hospitals where their clients are giving birth, though “they/them” pronouns are clearly written on their badge.

“When you’ve fought for so long, and have been silenced or not seen, and are finally stepping into your body, and then someone doesn’t see or acknowledge it … it’s just a dismissal of your existence,” Woods says. “And it’s crushing.”

According to a 2020 Center for American Progress survey, nearly half of the 1,500 transgender adults surveyed reported experiencing mistreatment or discrimination with a health provider. This includes misgendering, care refusal, and verbal or physical abuse. The rates are higher for transgender respondents of color, with 68 percent reporting a negative interaction. This in turn leads to health avoidance and delay, which can further exacerbate chronic health problems.

stef shuster, author of the 2021 book Trans Medicine: The Emergence and Practice of Treating Genders, says medical providers are often not trained as experts in gender, which means they bring in a lot of assumptions — sometimes bias — into their work about what they think a trans person should look or sound like.

“Anyone who doesn’t fit that mold, providers get really concerned about opening up access to care,” shuster says. “The structure of this system is flawed because it amplifies medical authority and minimizes trans people’s autonomy.”

Gender doulas help maintain autonomy, and sometimes, that looks like educating medical providers. Luigi Continenza, a gender doula in Tacoma, Washington, coaches health care providers to be trans-competent — like using the word “chest tissue” rather than “breast tissue,” or not asking patients about their top surgery scars when they’re seeking care for their ankle.

Ken McGee.
Ken McGee. Credit: Danielle Barnum

Woods wanted a gender doula who could navigate the system, so they chose Ken McGee, a fellow birth doula who’d recently transitioned. He was also a physical therapist for a decade who’d seen how isolating gender-affirming surgeries can be and didn’t want people going through the process alone. McGee began pursuing gender doula work during the pandemic. He’s especially excited about educating clients and planning for rehabilitation post-surgery. “How are you going to be set up for sleeping? How do you think you’re going to wipe your bum? What’s showering going to be like?” he says. “I’ve never seen a surgeon’s office have a handout that covers all of that.”

For those who decide to medically transition — not a requirement for a transgender identity — a gender doula might offer guidance about how a patient can communicate with their doctor. But they won’t dish out medical advice. Gender exploration can be delicate, and many doulas are there to listen and help people process, though it’s important to note they are not trained therapists.

Eli Lawliet, one of the first and only full-time gender doulas, says people often seek him out when they’re exploring their gender and feeling scared or confused. Like McGee, he started during the pandemic and much of his practice is online. He hosts virtual workshops such as “Love Your Trans Self” and monthly breath work circles, but a bulk of his work is one-on-one consultations.

Eli Lawliet.
Eli Lawliet. Credit: Abby Mahler

Lawliet holds a PhD on the history of transgender medicine — one of his clients dubbed him the “trans librarian” — but he also has lived experience. “It took me a long time to realize that actually, I’m a gay man,” he says. “If I had had somebody just talk it through with me, I feel like I could have saved eight years of consternation, you know?”

Lawliet says listening to Erica Livingston, a birth doula with Birdsong Brooklyn, on the Tarot for the Wild Soul podcast inspired him to pursue his current path. “She said this line: ‘We need a doula for every threshold.’ Of course, the threshold I was working with was transition,” Lawliet says. “I had a huge, thunderous, lightning moment.” Eventually, Livingston and her partner, Laura Interlandi, became his mentors, teaching him the skills to guide people through their most vulnerable and tender moments.

From his apartment in Los Angeles, surrounded by Dolly Parton art and tarot decks, Lawliet meets his clients over Zoom, which allows him to see people anywhere in the country — more than 115 of them so far with a growing waitlist. On a given day, it’s not uncommon for Lawliet to discuss everything from the spiritual aspects of transitioning and not feeling trans enough to the current political climate. Then there’s the logistics — insurance, clothing, name change — all the complex, moving parts of being trans, he says.

There’s currently no certification process. (Birth doulas have a certification process, though it isn’t a legal requirement.) However, Lawliet is continually receiving requests for mentorship, so he is planning to offer a structured mentorship program in the future. For now, he has only taken on one mentee, who is Filipinx and Yaqui, which gives clients of color an option for someone with more shared experience.

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Given the lack of official training, Lawliet strongly believes a deep interrogation of self needs to happen before someone assumes the title of gender doula. He’s always thinking about the ethical considerations of the role—confidentiality for one, or not trying to force people to grow or heal in a way that he thinks they need. He also created an online community with other gender doulas, including McGee, Luigi Continenza, Bowie Winnike and Ro Rose, where they share resources, troubleshoot and refer clients to one another.

In the end, McGee worked with Woods for a month. He taught them the signs of abnormal swelling and of course, made smoothies. When Woods wanted to step out into the world, McGee was right there alongside them, reminding them to take pauses when they felt winded, filling in the awkward silences, and stopping when they wanted to admire the exuberant branches of their favorite monkey puzzle tree.

Eventually, Woods healed. The first time they slipped their favorite black hoodie over their head and looked in the mirror, they cried and thought: “That’s how it’s supposed to look.” Woods and McGee are still in touch, and every now and then will go for a walk, together.

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