What to Do If You’ve Been Denied Gender-Affirming Care Because You Don’t Fit Into the Binary Gender Cis-Tem
If you identify as nonbinary, gender diverse, expansive, or nonconforming and have felt overlooked or disregarded by a binary-focused medical system, you are not alone.
Navigating a healthcare world that often expects people to fit neatly into “male” or “female” categories can be exhausting and invalidating.
Many traditional trans medical models have operated under the assumption that everyone’s transition is from one binary gender to the
other. This leaves little room for the beautiful and sacred diversity of gender experiences.
It’s a shame that so many nonbinary, genderqueer, and gender-expansive folks have felt misunderstood or even outright told “no” when seeking care.
Unfortunately, research continues to show that nonbinary people often feel less respected by providers and are more frequently misgendered in healthcare settings.
You deserve so much better. You deserve care that honors you, in all your uniqueness, without asking you to conform to someone else’s idea of gender.
As a nonbinary therapist, I want you to know: I see you, and I affirm you.
My name is Edgar Fabián Frías, LMFT, and I am deeply committed to supporting gender-diverse communities.
Not only do I have years of professional experience in LGBTQ+ advocacy and therapy, but I also carry the personal experience of living as a nonbinary person every day.
I know what it’s like to move through spaces that just don’t get it. I’ve dedicated my career and my heart to changing that experience for others.
Every day, I work with people across the gender spectrum, from binary trans folks to genderfluid, agender, Two-Spirit, and nonbinary people, helping them feel heard, validated, and empowered.
Edgar Fabián Frías, LMFT, a nonbinary, gender-expansive therapist offering affirming, trauma-informed care for those navigating their gender journey.
A Therapist Who Truly Understands and Cares
A calm and open space can make all the difference. I strive to create an atmosphere where you can relax and be your authentic self, knowing you are fully accepted and supported.
I became a therapist to provide the kind of safe, affirming space I craved in my own journey.
I understand the frustration and pain that come from being turned away or misunderstood by providers who follow outdated models.
Many of my clients have come to me after hearing responses like “you don’t fit our criteria” or “I’m not sure how to help you.”
If you’ve ever been told you’re not trans enough or felt you had to educate your doctor about your identity, I want you to know that you’re not the problem; the system is.
Here, with me, you never have to prove or hide who you are.
My role is to meet you wherever you are on your gender journey and support your goals, rather than imposing a predetermined path.
My commitment runs deep. I’ve spent years involved in advocacy and education around gender diversity, working to broaden understandings of what gender can look like.
As a therapist in California’s LGBTQIA+ community, I’ve participated in trainings, workshops, and grassroots efforts pushing for more inclusive care and community support.
But most importantly, I truly listen to the people who seek my care. Your story, your feelings, and your definition of who you are matter to me.
I bring both my professional expertise and my personal heart to each session. When we work together, you have someone on your side who gets it on multiple levels and who will never question the validity of your identity.
An Affirming, Holistic Approach to Healing
Feeling seen and understood is a vital start, but you also deserve therapy that helps you heal and flourish.
I use a holistic, somatic, and trauma-informed approach to ensure our work together honors both your mind and body.
Somatic therapy involves recognizing the body's inherent knowledge and wisdom. We aim to foster gentle connections with our bodies through mindfulness, movement, breathing, or grounding exercises, as long as these practices resonate with you.
My approach is mindfulness-based, offering tools to help you remain present and discover tranquility in times of anxiety or stress.
I integrate parts therapy, which means that if it’s useful, we can explore the different “parts” of you (for example, parts that protect you or parts that carry hurt) to foster inner transformation and self-compassion.
Additionally, I incorporate creative and artistic elements for those who are interested. I believe that growth and healing can be both creative and playful—we might use art, writing, or visualization during sessions to help you express yourself in new and innovative ways.
Last, I welcome spiritual exploration in our time together: whether that’s connecting with ancestral traditions, meditation, or simply finding meaning in your journey, all of you is welcome here.
My approach is always affirming and non-judgmental. I’m here to support your truth, not to push any agenda or “correct” you.
In our work, you are the expert of your own experience, and my job is to offer tools, guidance, and steadfast support as you navigate life’s challenges and joys.
This blend of approaches means our therapy is flexible and personalized. You are a whole person, not a diagnosis, not a letter on a form, and certainly not a box to check off.
Our sessions will honor all of you: your intellect, body, identity, culture, creativity, and spirit.
Helping Those Who’ve Been Told “No”
One of the greatest joys in my work is seeing someone realize that the problem was never them; it was the limitations of the system they were in.
I have helped many people who initially heard “no” from other professionals or felt like they didn’t fit the traditional mold of what it means to be trans.
For example, some of my clients are nonbinary folks who were told by clinics that they could only access hormones if they identified as either a trans man or trans woman.
Others have been gender-expansive folks who were denied surgery consults because their gender presentation didn’t match what a provider expected.
These experiences can be heartbreaking and infuriating. If something like this has happened to you, I am genuinely sorry that you went through that.
Please know that it is absolutely possible to get the care and respect you deserve.
When clients come to me after these upsetting experiences, our first steps are often about healing from that gatekeeping trauma.
We spend time validating just how real and wrong those dismissals were.
It’s amazing how liberating it can be to hear someone say, “I believe you. You shouldn’t have been treated that way.”
From there, we focus on your truth and your needs.
Maybe you want to try a low dose of HRT to see how it feels, or pursue a surgery that doesn’t align with a binary transition narrative – that’s okay!
Your goals are valid. My job is to help you clarify what you want for your body and your life, and then support you in making it happen.
This might involve practical guidance, like discussing how to navigate medical systems or providing resources from my network of gender-affirming providers (I’ve connected with many trans-friendly doctors and organizations over the years).
It can also involve building up your own sense of self and confidence, so that external doubting voices don’t shake your knowing of who you are.
You are the expert on your identity, and I will always treat you as such. Over and over, I’ve witnessed the transformation as folks who once felt hopeless about getting care finally get what they need and thrive.
It’s often a journey, but you will not be on that journey alone.
Gender-Affirming Letters of Support – On Your Side
In a world that sometimes puts up hoops for transgender and nonbinary people to jump through, I aim to make the process of getting gender-affirming care as smooth as possible for you. Part of my gender-affirming therapy services includes providing letters of support when needed.
These are the letters that medical providers often require from a therapist in order to access hormones, surgeries, or other gender-affirming treatments.
Frankly, I wish your word about who you are could be enough. Since that’s not always the case, I’m here to advocate for you and provide any documentation necessary to help you move forward.
Here’s how it works: we’ll meet for a number of therapy sessions (by secure video or phone) to get to know each other and ensure I understand your history, needs, and goals.
I require at least five therapy sessions before writing an official letter of support.
This isn’t about gatekeeping you – it’s the opposite. Those sessions enable me to genuinely listen to your story and collaborate with you on what the letter should convey.
As part of the process, I complete a diagnostic assessment, and we’ll talk together about what that means—contextualizing it within your lived experience, not reducing you to a label.
By the time we’ve met for five (or more) sessions, I will have a comprehensive understanding of you that allows me to write a strong, personalized letter that reflects your authentic self and meets the requirements of medical providers or insurance companies.
The letter will highlight your truth clearly and confidently, so that it can help open the doors to the care you’re seeking.
I do not charge any extra fees for writing gender-affirming letters.
This service is built into our work together because I see it as part of providing holistic support. When the day comes that you need that documentation, you can trust that I’ll handle it with the utmost care and urgency.
I’ve composed numerous letters for procedures like top surgery, HRT, hysterectomy, and name/gender marker changes, always focusing on empowering you and affirming your identity.
Clients have told me that even reading their letter was affirming, because it reflected them accurately and respectfully (and sometimes, it just feels good to see a medical document that gets it right!).
Remember, any requirement for a letter doesn’t mean you are questionable; it just means we need to navigate the system, together.
I’ll be right there with you, making sure that bureaucratic step becomes an opportunity to celebrate who you are.
You Deserve Support: Take the Next Step
Your journey – your very existence – is proof that there is no one “right” way to be. You deserve a therapist and a care team that celebrates that fact. I am here to offer you warm, wholehearted support every step of the way.
Whether you’re just starting to explore your gender or you’ve been out for years and are feeling worn down by the medical gatekeeping, my door (or rather, my screen – since I offer telehealth across California) is open to you.
Together, we can navigate the challenges, celebrate your victories (big and small), and help you build a life where you feel truly at home in yourself.
I invite you to reach out and schedule a free 15-minute consultation with me. This no-pressure phone call is a chance for you to ask questions, share a bit about what you’re looking for, and see if I feel like the right fit for you as a therapist.
Finding a therapist who truly understands can be a game-changer, and you deserve that.
You can schedule your free consult or learn more about my services by visiting edgarfabianfrias.com.
I know it can be scary to take that first step, especially if you’ve been let down before. But here is my promise to you: with me, you will be respected, believed, and affirmed just as you are.
It would be an honor to accompany you on your journey toward healing and becoming your most authentic self. You are not alone, and you never have to settle for anything less than care that celebrates you.
You are worthy. You are whole. And I am here to help.
Let’s embark on this journey together. Your magical, authentic, and expansive self is always welcome here 💖
📚 Sources & Further Reading
James, S. E., et al. (2016). The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.
https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
– One of the largest studies on the experiences of trans and nonbinary people in the U.S. Documents barriers to medical care and mental health disparities.Lindley, L., & Witten, T. (2021). Barriers to health care access for gender-expansive people: A critical review. Transgender Health, 6(2), 60–67.
– Explores the systemic, interpersonal, and institutional challenges faced by gender expansive and nonbinary individuals in healthcare.Jones, B. A., et al. (2021). Health and healthcare disparities experienced by transgender and gender nonconforming older adults: A narrative review. Health & Social Care in the Community, 29(6), e258–e270.
– Highlights the specific ways gender nonconforming people experience erasure, misgendering, and inadequate care in health settings.Kattari, S. K., et al. (2019). “It’s very hard for me to have a good relationship with healthcare”: Barriers to healthcare engagement among transgender and nonbinary people. Social Work in Health Care, 58(8), 740–757.
– Discusses the emotional and logistical toll of navigating non-affirming systems and the importance of gender-competent providers.Puckett, J. A., et al. (2018). Barriers to gender-affirming care for transgender and gender nonconforming individuals. Sexuality Research and Social Policy, 15(1), 48–59.
– Looks specifically at the trans medical model and how gatekeeping disproportionately impacts nonbinary individuals.Scheim, A. I., & Bauer, G. R. (2015). Sex and gender diversity in the DSM-5: Progress in the right direction, but not enough. Canadian Journal of Psychiatry, 60(11), 505–507.
– A critique of diagnostic frameworks that rely heavily on binary definitions of gender.WPATH Standards of Care Version 7 & 8 (World Professional Association for Transgender Health).
https://www.wpath.org/publications/soc
– The international guidelines often referenced by healthcare providers when assessing eligibility for gender-affirming treatments.