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It has been just over a year since Dr. Cassy Friedrich came to the  Sacramento B Street health center as PPMM's Gender Affirming Care Program Director. During that time, even during the pandemic, we have seen a steady increase in the number of patients seeking gender affirming care, either in health centers or via telehealth.

Dr. Friedrich has launched a training program in all of PPMM's health centers  to  further  educate  staff about best practices in providing this essential care. We caught up with her to hear more about how the training is going and the latest on PPMM's gender affirming care services.

PPMM: What gender affirming care services are PPMM offering now, and what are our GAC plans for the future?

Dr. Cassy Friedrich: Five of our health centers are providing full gender affirming hormone therapy, and soon all PPMM clinicians will be trained to provide it. In April, we will be integrating gender affirming hormone therapy into services at every health center. Also, RNs and HSS (Health Service Specialist) staff will be trained to teach patients how to give themselves hormone injections.

It's our goal to provide affirming care in our health centers for people of all genders -- transgender and non-binary people also come to our health centers for all of our other services.

This is so important because a lot of communities, including many in rural parts of the Central Valley, don't have access to these services. We have telehealth appointments with patients who live really far away because they can't get this care where they live.

I'm also pleased to announce that on March 1, Patient Navigator Elliott L., at the Westside health center, became PPMM's Gender Affirming Care Coordinator as part of the Regional Reproductive Health Coordinator team.

PPMM: When did you begin the affiliate's gender affirming health care training in health centers, and what is it focused on?

Dr. F.: I started the training, with (Lead Clinician Trainer) Kelly G. and (Lead HSS Trainer) Katie G., back in November, talking about the foundations of gender affirming care, including affirming language and terminology. All Patient Services staff are receiving this training, including our call center staff. We're also discussing social determinants of health and the discrimination that so many transgender and non-binary folks have experienced when trying to access this health care.

PPMM: Can you talk a bit more about "social determinants of health?"

Dr. F.: Sure. This refers to many social factors -- such as eating healthy food, socioeconomic status, geographic location and other factors beyond health care. All of these things factor into overall physical and mental health.

PPMM: What are some of the materials you're using to explain these concepts in your training webinars?

Dr. F.: We've shown staff several videos, including two of trans youth who talk about their experiences. One trans man describes what it was like for him to develop breast cancer and then be denied treatment. There are many ways that our medical system doesn't practice gender affirming care, which means people are denied health services they need and deserve.

PPMM: What are some examples of appropriate language to use in gender affirming care?

Dr. F.: Well, for example, in general, never assume someone's gender and pronouns based on their appearance. Understand that people must be called by the name and pronouns of their choosing. Use neutral terms as much as possible, and, once you know someone's pronouns, make every effort to use them.

Also, using gendered language as a figure of speech -- like "you guys" and "girls" or "gentlemen" -- is not representative of all groups. It's affirming to use gender-inclusive terms like "folks" or "you all."

PPMM: Are there other reflections of PPMM's focus on gender affirming care in the way we provide services?

Dr. F.: We are about to launch new intake forms that include space for people to put their chosen name, pronouns and gender identity. I'm also collaborating with PPMM Education to develop trainings for other staff, and those will be available this spring.

We already have a gender affirming care page on our PPMM website: ppmarmonte.org/gac.

PPMM: In closing, what are you most proud of about the way PPMM is providing gender affirming care?

Dr. F.: The feedback from staff and patients is incredible. Staff are really enthusiastic about providing this care, and patients have definitely been showing their appreciation.

Not long ago, we heard from a patient at our Woodland health center who came in to be started on Depo. They expressed such gratitude for how they were treated, especially in comparison with their  negative  experience  at  another community clinic. At our site, the staff made an effort to ask for and use the patient's chosen name and pronouns, and the patient said it was the first time they felt like they could return to a health center for care.

You can really see the impact, and I'm so proud that we are providing it at PPMM.

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Tags: transgender, nonbinary, gender_affirming_hormone_therapy