Serious About Gender Exploration? There’s a Doula for That.

Gender doulas assist individuals at all stages of their gender journey, much like birth doulas.

A zine-like paper with all kinds of delicious milkshake recipes was stapled together before Ash Woods underwent gender-affirming chest surgery in January of last year. Woods made a self-effacing smile to how the operation would render their arms almost useless for at least a week after giving them a more masculine-looking chest on the front cover. Before their surgeries, they placed the booklet in their kitchen next to the blender so it was set when they returned from the hospital.

Woods, who is transgender and nonbinary, works as a birth doula in the Seattle area. As part of their job, Woods heavily plans for a client’s post-labor treatment, and they wanted a comparable level of care after their operation. Major surgery was going to remain resilient and hard, Woods knew, and rather than depend solely on a partner or friends, they decided to hire a professional: a gender doula.

Similar to birth doulas, gender doulas are non-clinical companions who provide advocacy, understanding, and support. There are more than a lot of people who have taken the formal name of “gender doula” today, but they have also taken the role of “transgender change instructors” or other less formal word-of-mouth mentors over the years. People are turning to gender doulas to navigate an often unwelcoming environment as gender-nonconforming identities become more prevalent and gender-affirming surgeries are becoming more common.

The gender doula could record how much fluid was leaking into Woods’ post-surgical plastic bulbs to make sure they weren’t in danger of getting infected, advise them to take their medication, or take them on a walk if they started to feel dizzy. Given that Woods is frequently mispronounced at the hospitals where their clients are giving birth, even though the “they/them” pronouns are clearly written on their badge, the doula could act as an advocate at doctors’ appointments and ensure Woods’ correct pronouns were being used.

“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.”

Almost half of the 1,500 trans people surveyed reported experiencing abuse or prejudice with a health service, according to a 2020 Center for American Progress study. This includes misgendering, care refusal, and verbal or physical mistreatment. The rates are higher for transgender responders of color, with 68% reporting a bad conversation. This, in turn, causes wellness pause and mitigation, which can exacerbate chronic health issues.

Stef Stern, author of the 2021 book Trans Medicine: The Emergence and Practice of Treating Genders, says health services are often not trained as specialists in gender, which means they bring in a lot of assumptions—sometimes bias—into their labor about what they think a trans person should look or sound like.

“Anyone who doesn’t fit that casting, companies get really anxious about opening up access to care,” Stern says. The construction of this system is flawed because it limits trans people’s freedom and amplifies health expert.

Gender doulas help preserve autonomy, and occasionally, that looks like educating health providers. Luigi Continenza, a gender doula in Tacoma, Washington, instructs health care providers to become trans-competent—like using the word “chest tissue” more than “breast tissue,” or not asking people about their top surgery scars when they’re seeking care for their knee.

Woods wanted a gender doula who could navigate the system, so they chose Ken McGee, a fellow birth doula who’d recently transitioned. He also worked as a physical therapist for ten years and had seen how difficult gender-affirming procedures can be for people who didn’t want to go through the procedure alone. McGee began studying gender doula work while the pandemic was occurring. He is particularly interested in educating and organizing rehabilitation plans after surgery. “How are you going to be set up for sleeping? How do you anticipate having your bum wiped clean? 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.”

A gender doula can provide advice on how to communicate with their doctor for those who choose to transition medically, which is not necessary for a transgender identity. 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 began his practice while battling the pandemic, which is now largely done 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.

A Ph.D. is held by Lawliet. D. 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?”

According to Lawliet, Erica Livingston, a birth doula with Birdsong Brooklyn, inspired him to pursue his current career. “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.

Lawliet meets his clients over Zoom, which allows him to see people anywhere in the country, with more than 115 of them so far and a growing waitlist, from his apartment in Los Angeles, which is surrounded by Dolly Parton artwork and tarot decks. On a typical day, it is not uncommon for Lawliet to discuss everything from the spiritual aspects of changing one’s mind 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.

Due to the lack of formal training, Lawliet is of the opinion that a thorough examination of one’s self is required before one can hold the position of gender doula. He is constantly considering the ethical ramifications of the job, including confidentiality, or not trying to force people to grow or recover in a way he believes 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. McGee was right there with Woods and them when they were attempting to leave the world and take pauses when they were feeling worn out, awkward silences, and stops when they wanted to admire the exuberant branches of their favorite monkey puzzle tree.

Eventually, Woods healed. They cried and pondered their feelings when they first slipped their favorite black hoodie over their heads and looked in the mirror. Woods and McGee are still in touch, and every now and then will go for a walk, together.