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The planned date to begin Gender Affirming Hormone Care across all Planned Parenthood health centers in Indiana and Kentucky is Fall of 2021.  
Sue Retzlaff, Vice President of Patient Services at Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, Kentucky (PPGNHAIK), explained that even before the merge of PPGNHI and PPINK to become PPGNHAIK, preparations were being made to introduce Gender Affirming Hormone Care (GAHC) in Indiana and Kentucky, as one of the many aspects of health care services for our patients. (PPGNHAIK health centers in Alaska, Hawai’i, Idaho and Washington began providing gender affirming hormone care in June of 2018). 

In order to offer gender affirming care in PPGNHAIK’s health centers in Indiana and Kentucky, staff underwent years of preparation work including research, collaboration with Planned Parenthood Federation of America and other Planned Parenthood affiliates across the nation, and extensive trainings for all staff.  
“We gathered a multi-disciplinary team,” said Retzlaff. In order to launch gender affirming care, teams from Clinical Services worked with Operations and organization leadership to ensure staff were trained to provide high-quality care.  
Information included current best practices and up-to-date information about gender affirming hormone care, as well as a wider range of health care information about transgender, non-binary and intersex patients.  
“One of the major milestones for training was to train all staff in Indiana and Kentucky,” said Retzlaff, noting that the training was completed June 11. The in-person training will be followed by additional sessions, including e-learning, for all clinicians and health center staff. 
“Staff are very excited to do the training,” said Retzlaff. “The response has been overwhelmingly positive, and people are excited to be doing more work with the transgender community.” 

“Of course, staff learn all about the treatment and medications involved with gender affirming hormone care,” Retzlaff said, adding that, “Some of the other things we talk about in training [in addition to medicine] is language and vocabulary.”  
Retzlaff said patient feedback, received during focus groups conducted by our research department, was one of the main drivers for focusing on inclusivity in staff training around gender affirming care.  

“We gave staff a ‘big picture’ of issues and concerns facing the transgender community, and we help inform how we can best interact with our patients.” 
She said the training helps empower staff to feel knowledgeable, which in turn puts patients at ease. “Staff learn what is inclusive versus what might be unintentionally off-putting... the training makes a big difference.” 
The difference is a confident and informed provider, instead of an apprehensive provider who may need to be educated by their patient. While the latter may be well-intentioned, the former scenario is the only one acceptable by Planned Parenthood’s standards for care. 

Retzlaff said making sure that PPGNHAIK staff could provide a great experience for transgender, non-binary and intersex patients coming to us for gender affirming hormone care was crucial to the organization. 
“We've worked really hard with staff to train soft skills,” said Bailey Boatsman, a Seattle-based Clinical Trainer. “We want to make sure that all staff feel supported and that they have access to all the education that they need.” 
Ongoing training in inclusivity and sensitivity is of paramount importance to the organization, noted Finn Kovi, PPGNHAIK Gender Affirming Patient Care Navigator. 
“While feedback from patients has been overwhelmingly positive, negative experiences still do happen, and we need continual work to improve,” they said.  
“We are looking at how to be inclusive towards trans, non-binary and intersex patients, while asking ‘how do we best serve our BIPOC [Black, Indigenous, and People of Color] patients?’” added Retzlaff. 
Boatsman explained that in trainings, “We talk about [BIPOC patients] a number of times, including at the beginning when we talk about gender messaging and stereotypes. We go into racial layers – for instance ‘how are gender expectations different for men and women of color?’ We include statistics, racial and ethnic group breakdowns, showing that every racial and ethnic group have greater barriers accessing care. We try to keep awareness throughout the training.” 
One of the ways that PPGNHAIK has been assessing inclusivity is with an “Equity Inclusiveness Tool,” or EIT, developed by the Human Resources department. 
Bert Hopkins, Equity and Inclusion Manager, explained that the tool is a series of questions and frameworks. “It’s an analytic and preventative tool that can be applied to virtually any situation, and that the goal is to avoid harm. [It helps us make decisions] based on input from groups that are furthest from the benefits of the good we’re intending to do.” 
For instance, when looking at statistics about transgender health care, many studies show that Black trans women face the most barriers and discrimination. Hopkins explained that by applying the EIT we can find ways to most include (and avoid unintentionally excluding) Black trans women in the care Planned Parenthood provides. 

Planned Parenthood is working to bring telehealth appointments for gender affirming care to the Eastern states as one of the ways to increase access and reduce barriers. Another way access has been increased is by accepting Medicaid for gender affirming hormone care. 
Hopkins called the rollout of gender affirming hormone care in Indiana and Kentucky “a year’s worth of research, a decade’s worth of advocacy.” He noted that it took years to realize gender affirming hormone care in the Western states, and much of the work done to realize that was done by Planned Parenthood staff members who were themselves transgender and non-binary. 
He emphasized that many Planned Parenthood staff members have confronted transphobia inside and outside of office settings in order to advance the timeline of gender affirming care being made available to patients. 
Hopkins, Kovi, Boatsman, and Retzlaff all agreed the need for gender affirming hormone care in the transgender community is tremendous.  
“We’ve added almost 500 patients for gender affirming hormone care in nearly a month,” Boatsman marveled at the recent figures.  
“Some patients have stated that due to COVID, they had a lot of time to reflect on their gender identity and this has resulted in an increase in Gender Affirming Care patients across affiliates,” Kovi added. 
In Twin Falls, Idaho, the Health Center Manager said that people drive great distances to access gender affirming hormone care. 

She said, “The Twin Falls Health Center is the only Planned Parenthood between parts of Idaho, Utah and Nevada. Some patients travel as much as four hours to receive care. Also, being in a very conservative area, we are usually the only health center for gender affirming hormone care. Almost every single one of our patients who are traveling from far away always express their gratitude that our doors are open for such an important service.” 
Retzlaff noted that currently, many transgender people in Indiana must travel two hours to Chicago to receive gender affirming hormone care. 
“Patients say the local provider here has a two-year wait list,” she explained. “So, there is a great need.” 
To support the expansion of gender affirming hormone care, trans telehealth expansion and trans-competence training education for clinicians and (all Planned Parenthood staff), please donate. 

A note from the author: As a transgender man, I am very pleased to report this story. Having begun my transition in southeast Ohio during 1999, I found few resources for gender affirming care and experienced heavy gatekeeping from the few that existed. I would not categorize my early transition experience as health care, but rather an elaborate and lengthy series of fees and hoops to jump through. Over the past two decades, I have watched gender affirming health care access expand and improve in some areas (albeit far too slowly), while others remain desolate of resources and restrict access solely to those with the most privilege. The issue of gender affirming health care access is deeply personal to me. I am proud to see PPGNHAIK expanding gender affirming health care, which follows the informed consent model, in a Midwestern and a Southern state. I believe that PPGNHAIK’s expansion of gender affirming health care is a step in the right direction towards transgender, non-binary, and intersex people everywhere having access to the health care they need, provided by educated clinicians who really care. 
Transgender, non-binary and intersex people across the nation report discrimination in health care on a wide scale. We desperately need good health care from educated providers who will listen, respect and take us seriously. 
Thank you for your support of Planned Parenthood. In doing so, you make it possible for many others to access vital health care and achieve a livable life.

Tags: Indiana, Kentucky, trans health, GenderAffirmingCare

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