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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鈥檚 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 鈥済ender doula,鈥� but they have existed over the decades in other forms as 鈥渢ransgender transition coaches鈥� or more informal word-of-mouth mentors. With exploration of becoming more common and , people are turning to gender doulas to navigate an often unwelcoming environment.

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鈥檛 at risk of infection. The doula could also act as an advocate at doctors鈥� appointments and ensure Woods鈥� correct pronouns were being used, given that they are often misgendered at the hospitals where their clients are giving birth, though 鈥渢hey/them鈥� pronouns are clearly written on their badge.聽

鈥淲hen you鈥檝e fought for so long, and have been silenced or not seen, and are finally stepping into your body, and then someone doesn鈥檛 see or acknowledge it … it鈥檚 just a dismissal of your existence,鈥� Woods says. 鈥淎nd it鈥檚 crushing.鈥� 

According to a , 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% 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 , says medical providers are often not trained as experts in gender, which means they bring in a lot of assumptions鈥攕ometimes bias鈥攊nto their work about what they think a trans person should look or sound like.

鈥淎苍测辞苍别 who doesn鈥檛 fit that mold, providers get really concerned about opening up access to care,鈥� shuster says. 鈥淭he structure of this system is flawed because it amplifies medical authority and minimizes trans people鈥檚 autonomy.鈥�

Gender doulas help maintain autonomy, and sometimes, that looks like educating medical providers. Luigi Continenza, a gender doula in Tacoma, Washington, 鈥攍ike using the word 鈥渃hest tissue鈥� rather than 鈥渂reast tissue,鈥� or not asking patients about their top surgery scars when they鈥檙e seeking care for their ankle. 

Woods wanted a gender doula who could navigate the system, so they chose Ken McGee, a fellow birth doula who鈥檇 recently transitioned. He was also a physical therapist for a decade who鈥檇 seen how isolating gender-affirming surgeries can be and didn鈥檛 want people going through the process alone. McGee began pursuing gender doula work during the pandemic. He鈥檚 especially excited about educating clients and planning for rehabilitation post-surgery. 鈥淗ow are you going to be set up for sleeping? How do you think you鈥檙e going to wipe your bum? What鈥檚 showering going to be like?鈥� he says. 鈥淚鈥檝e never seen a surgeon鈥檚 office have a handout that covers all of that.鈥�

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

, one of the first and only full-time gender doulas, says people often seek him out when they鈥檙e 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 鈥溾�� and , but a bulk of his work is one-on-one consultations.

Lawliet holds a Ph.D. on the history of transgender medicine鈥攐ne of his clients dubbed him the 鈥渢rans librarian鈥濃�攂ut he also has lived experience. 鈥淚t took me a long time to realize that actually, I鈥檓 a gay man,鈥� he says. 鈥淚f I had had somebody just talk it through with me, I feel like I could have saved eight years of consternation, you know?鈥�

Lawliet says listening to Erica Livingston, a birth doula with Birdsong Brooklyn, on the podcast inspired him to pursue his current path. 鈥淪he said this line: 鈥榃e need a doula for every threshold.鈥� Of course, the threshold I was working with was transition,鈥� Lawliet says. 鈥淚 had a huge, thunderous, lightning moment.鈥� 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鈥攎ore than 115 of them so far with a growing waitlist. On a given day, it鈥檚 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鈥檚 the logistics鈥攊nsurance, clothing, name change鈥攁ll the complex, moving parts of being trans, he says.

There鈥檚 currently no certification process. (Birth doulas have a certification process, though it isn鈥檛 a .) 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.

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鈥檚 always thinking about the ethical considerations of the role鈥攃onfidentiality 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:聽鈥淭hat鈥檚 how it鈥檚 supposed to look.鈥� Woods and McGee are still in touch, and every now and then will go for a walk, together.聽