Max Mowitz sees the effects of Iowa’s gender-affirming care ban every day in their work in Des Moines, particularly on trans minors. He also works diligently to right its negative impact as the program director for LGBTQ+ advocacy organization One Iowa, a board member of the Iowa Trans Mutual Aid Fund, and a volunteer with queer community closet Common Love DSM. There is, however, one unique role where he is able to directly give trans youth gender-affirming care directly without breaking the law — as a gender doula.
Gender doulas help people navigate gender transitions and the landscape of available resources. It’s a small but growing field without official credentialing that is exempt from many anti-trans laws. Because the Iowa law applies only to licensed health care professionals providing medical care like HRT and puberty blockers, Mowitz is allowed to provide their services even to minors. This is an important specification in many states’ anti-trans laws, allowing gender doulas to continue their life-saving, gender-affirming work legally, despite the negative hit trans healthcare has taken overall as a result of bans like Iowa’s.
“Even though that bill that was signed into law was specific to youth, it has had a ripple effect in adult access to care, too,” Mowitz says. “We’re seeing more providers that are reticent to provide surgeries, even if it’s on adults. We’re seeing pharmacies that won’t fill prescriptions for HRT. We’re seeing all of these things that are really indicative of the fact that when you see anti-LGBTQ hostility hit a state, so often we see folks — especially large organizations like a hospital, which tend to be risk-averse and risk-conservative — start to pull back on [healthcare for trans adults.]”
Like birth and death doulas, gender doulas help usher clients through a medical system and society that can feel overwhelming to traverse alone and without guidance. About half of Mowitz’s clients — who are mostly based in Iowa — are brand new to their gender discovery journey, and the other half have been out to themselves for a while but are seeking support on something specific like physical transition questions.
“In the community of people that are really just starting out, so often they are just grasping for safety,” Mowitz says. “My number one goal with those folks is to try to find an environment where they’re going to be safe, even if that’s just in our meetings or even if that’s helping them develop some coping skills if they can’t be out. Then with a lot of other folks, I’m helping them navigate a system that has gotten more and more hostile to accessing care.”
In an increasingly anti-trans political environment with growing obstacles to care, gender doulas do the necessary work that doesn’t neatly fit under the scope of another field. It’s that mounting pressure that makes their services more important than ever to understand.
What exactly is a gender doula?
Rainbow Winnike, a gender doula based in Long Beach, California, says the word “doula” is used for professionals who help with life transitions of all kinds such as birth, death, pregnancy, and gender transition.
“It’s someone who can guide someone through a gender transition or gender exploration,” Winnike says, adding that gender doulas are there to fill a gap of services that don’t have a container for them.
“What I like about ‘gender doula’ is it almost feels like that death and rebirth cycle of people releasing old selves and old ways of being and rebirthing into their newest, butterfly transformation,” Winnike says. “There’s something energetically about the term ‘doula’ that feels helpful for a gender transition.”
While doctors and therapists support parts of transition in specific ways, a gender doula works outside of systems to navigate gender-related plans like who will help you recover from surgery and if you want to start hormone therapy at all. While many birth doulas and other professionals are gender-affirming within their work, gender doulas work primarily with gender transition as the focus, rather than creating trans-affirming spaces within other concentrations.
A key piece of a gender doula’s work is to provide support on a peer-to-peer level from another trans person. Winnike says it is part of a long tradition of trans people supporting each other in their transitions, even though the term is newer.
“Being trans is natural and goes back to ancient times where it was accepted, celebrated, sometimes venerated,” says Willbliss Kim, who provides gender doula services in Phoenix, Arizona. “Treating gender-affirming transitions as an important time to incubate and celebrate, much like postpartum time, honors our divinity and our connection to ourselves and each other.”
There’s no official count of how many practicing gender doulas are scattered across the world, but there are at least a dozen who advertise their services online. Luckily, the ones who are active almost always provide their work remotely, making it an option for people all over the world.
What kind of services do gender doulas offer?
Gender doulas provide non-clinical support for those going through a gender transition by advocating within health care systems, trouble-shooting difficult interpersonal relationships, exploring gender identity and physical transition options, researching and recommending trans-affirming health care professionals and resources, navigating insurance issues, and more.
They are not therapists, but they create space in regular sessions to help a client discover what they want, how they can achieve it, and to emotionally support them through it. Some also accompany the client to medical appointments for support and advocacy or call potential providers to screen them. They may help with a slew of necessary resources: the labor of finding new clothes, selecting a surgeon, finding funding for travel out-of-state care in a state where it is legal, and so much more. A gender doula might help a client select an electrologist or a binder; provide studies on what physical transition options are most effective and safe; or help make plans for post-surgical care. Some offer public workshops or sessions with the loved ones of the client. Because gender doulas work closely with individual clients, not all doulas offer the same services as there isn’t a universal standard.
While many services take place as talk sessions over video call, in-person care is sometimes available. Though they might not self-categorize as “gender doulas,” at least two collectives of people providing gender-affirming surgical recovery support in locations across the United States: QueerCare and T4T Caregiving. A post-surgical caregiver might change bandages; help you choose what to pack for the hospital; empty drains; give medication timing reminders; accompany you to appointments; help you bathe and get dressed; and take care of cooking, laundry, and errands during recovery.
Interviewing for the right fit is critical
Unlike birth doulas, there is no certification for being a gender doula. With no standard training, education requirements, or agency oversight, anyone can use the term for themselves, so researching the individual gender doula you’re considering is key. It’s about finding the right fit for what you’re looking for.
“The first thing is if you are talking to someone you’re interested in working with, I would actually ask them about their limitations: ‘What can't you help me with? What are your boundaries in your work?’” Mowitz says.
Some gender doulas have specific specialties. Winnike specializes in serving neurodiverse clients and offers sessions in ASL or English, Ken McGee in Washington State offers gender-affirming physical therapy, and Ro Rose in Montreal offers scar care services, for example.
Cost is another factor to consider. Mowitz offers their services completely free of charge, which is rare in the industry. Most gender doula services are not covered by insurance, but some like McGee may be eligible for reimbursement by insurance as licensed a professional. Most gender doulas charge an hourly fee ($175 for Eli Lawliet in Los Angeles, for example), a custom package for services like The Rainbow Midwife in the Tampa Bay, Florida area, or by a donation of your choice like Eppchez in Philadelphia. Some offer a sliding scale.
Willbliss Kim says that the overall goal is for the healthcare system to start accepting and valuing gender doulas’ work.
“I want gender affirming healthcare teams to ask their patients if they have a doula,” Kim says. “I want my business cards to be handed out and not be thrown away when I leave their office. I want to not be treated like a medical liability when I am advocating for my client’s comfort and safety. I want cis parents of trans kids to realize having a gender worker giving compassionate care to the family is worth paying for. I want nonprofits to redistribute doula care funds along with gender-affirming medical funds. I want doulas to be paid for sharing our knowledge and lobbying at legislatures so we can have more access to vital community care. I want cis people and white folks to know that it is decolonizing and liberatory work for them to contribute to gender doula care.”
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