Massage Therapy Journal Summer 2025

Summer 2025 • 63

Massage and Gender Dysphoria Your client may disclose their gender dysphoria as it relates to receiving a massage. For example, a transgender male may feel dysphoric about his chest but not his back. Use this as a starting point for discussing where he would and wouldn’t feel comfortable receiving massage. Be mindful of hand placement during massage. For example, body areas associated with dysphoria are not only sensitive and a source of anxiety, but the areas surrounding them may be also. Acknowledge and verbalize safe touch by statements such as, “I am coming around into your waist but going no higher there. Does that feel okay?” Secondly, clients may be experiencing physical pain in response to attempts to reduce gender dysphoria. For example, clients may be using binders to compress the chest muscles (mentioned previously). Another example is clients who may alter their body posture to accentuate their femininity or masculinity, which may lead to pain in the back, neck or shoulders. Transgender Transitional Care Transgender individuals may seek medical and surgical gender-affirming procedures, including hormone therapy, facial hair removal, surgery, speech modification, genital tucking and chest binding. The current medical standards of care allow transgender individuals to determine what interventions they need to affirm their gender identity. 45 Apply the hormone and surgical massage modifications to all your clients who use hormone therapy or have undergone surgery. 46 Hormone Therapy: The Basics Gender-affirming hormone therapy is a common medical intervention used by transgender individuals. This allows secondary sex characteristics to match an individual’s gender identity. For example, gonadal hormones are used to suppress male secondary sex characteristics in favor of developing female secondary sex characteristics. Gonadal hormones are hormones

people with gender dysphoria use hormones and other gender-affirming care like surgery. Gender identity and gender expression are different. Gender identity is the psychological sense of gender, but gender expression is the way a person presents themselves to the world in a gendered way. For example, in much of the United States and Canada, wearing a dress is considered a “feminine” expression and wearing a tuxedo is considered a “masculine” expression. Gender expression does not always coincide with gender identity. And gender identity and expression are not indicators of mental disorders. Gender identity and sexual orientation are also different. Sexual orientation refers to the types of people one is sexually attracted. As with people who are cisgender (people whose gender identity is the same as the sex they were assigned at birth), people who are transgender have a diverse range of sexual orientations. No one knows what causes gender dysphoria. Some experts believe that hormones in the womb, genes, and cultural and environmental factors may be involved. People with gender dysphoria show various signs of discomfort or distress, including low self-esteem, withdrawing or socially isolating, and/or becoming depressed or anxious. They may also take unnecessary risks and/or neglect themselves. The main goal of treatment is to reduce distress and to support the person in whatever way they choose to transition, and may include individual counseling to help them better understand their feelings or couples/family counseling to help reduce conflicts, create understanding and provide a supportive environment. Various forms of gender-affirming procedures may be used, including chest binding (to minimize the appearance and feel of undesired chest tissue), gender-affirming hormones (estrogens, testosterone), and/ or gender-affirming surgery (facial, top or

bottom). Massage can positively impact gender dysphoria through empathetic, nonjudgmental touch.

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