Surgical and hormonal gender-affirming care: cross-domain determinants and artificial intelligence-enabled expansion

Gender-affirming surgery (GAS) and gender-affirming hormone therapy (GAHT) and are evidence-based components of care that support the health and well-being of transgender and gender-diverse (TGD) individuals, with extensive evidence linking them to reduced suicidality, improved mental health, and quality of life. Whereas most studies examine isolated outcomes-often within urban populations-this review adopts a system-level, cross-domain perspective to examine how access to gender-affirming care is shaped by structural conditions, including the urban concentration of affirming services, limited clinician training, fragmented insurance coverage, and the underrepresentation of rural TGD populations in research. These intersecting barriers undermine timely initiation, continuity, and quality of GAHT and GAS across diverse care settings. A distinctive contribution of this review is its integration of artificial intelligence (AI) as an emerging dimension of gender-affirming care. By synthesizing evidence on AI-enabled decision support, training simulations, and voice therapy, the review positions AI as a promising, equity-enhancing pathway to expand access, strengthen provider competency, reduce administrative burden, and advance global TGD health equity at scale.