Frequently asked questions

Most gender-affirming hormone care is provided at PPMI by advanced practice providers (physician assistants, certified nurse midwives, and nurse practitioners) in our family planning clinics which offer a wide range or reproductive and sexual health services, including STI screening, cervical and breast/chest exams, contraception, etc. Clinicians are trained on our medical standards and guidelines and work with patients to determine a plan for their hormone care based on patients’ medical history, embodiment goals, and the bounds of our medical standards and guidelines. Our gender-affirming care program is overseen by the Director of Gender Affirming Care, with whom clinicians consult as needed.

There may be protesters in public areas outside our health centers. They can carry signs and approach you to offer you pamphlets or try to talk to you. They are not allowed to touch you or block your way into the health center or the parking lot. You do not have to talk to them or take their literature. The safest strategy is to ignore them. As long as the protestors do not break the law and are on public property, they have the right to protest. If you feel a protester has acted inappropriately, please let us know immediately. At some locations there may be clinic escorts available to walk you into the health center.

Yes, all PPMI health centers have gender-neutral bathrooms. All people are supported in using whatever restroom they feel most comfortable with.

PPMI will always make every effort to communicate with you using your name and pronouns if different from your legal name. Name and pronouns can be recorded in our electronic health records and can be updated using your MyChart portal or at your visit. Unfortunately, if your legal name with your insurance company differs from your affirmed name, when submitting insurance claims or lab orders we will be required to use your legal name which may result in your deadname being used with various types of billing communication. Please know we are working to educate those around us in hopes of eliminating instances of deadnaming in the future.

If you experience deadnaming or misgendering and you feel the situation is not appropriately handled or corrected, or if you have other concerns about your experience of care, you can call a patient representative at 734-926-4799 or toll free at 855-440-8022 to communicate your concern. The concern may also be emailed to the patient representative at [email protected] (please do not send confidential information to this address).

You can update your legal name when you call to schedule an appointment or when you arrive at the health center for an appointment.

In order to meet the needs of most insurance companies and patients, we typically use the codes F64.0 (gender identity disorder in adolescence and adulthood) and E34.9 (endocrine disorder, unspecified). We recognize that much of the language around billing for gender affirming care is troublesome; we recognize this is medically necessary care and will work to decrease barriers to getting folks the care they need. If you have concerns about the specific billing claims being used with your care, please speak with your clinician.

At this time, PPMI does not offer social work or mental health services. We can provide a letter documenting use of gender affirming hormones by our patients if requested, but cannot provide a letter of mental health support for surgeries. We are happy to provide patients with resource lists for mental health services and surgeries.

Unless a change is being recommended based on follow-up of lab results by a nurse or clinician due to lab concerns, you will need to have a follow-up visit to change your medications. Changing medication doses or hormone routes can only be made at PPMI at an appointment with a clinician. Unfortunately, we cannot accommodate medication adjustment requests made via the portal or phone. Please note that changes may require additional lab work.

The complete list of gender-affirming hormone medications we can prescribe is as follows:

• spironolactone
• finasteride
• estradiol intramuscular injections
• estradiol patches
• estradiol pills (swallowed or dissolved under the tongue)
• progestin medications (prometrium pills, Depo-Provera injections)
• testosterone intramuscular or subcutaneous injections
• testosterone gels

Estradiol pills dissolved under the tongue do lead to higher estradiol blood levels than swallowed pills, as well as a different profile of hormone highs and lows than swallowed pills. However, to avoid levels that are too high, dosing is adjusted (approximately in half) when transitioning from oral to sublingual estradiol. Please do not change the route by which you are taking your estradiol tablets without speaking to a clinician to ensure appropriate dose adjustment and lab follow-up.

We follow Planned Parenthood Federation of America (PPFA) Medical Standards and Guidelines. Based on these guidelines, we cannot offer bicalutamide or selective estrogen receptor modulator (SERM) prescriptions.

Yes, we can prescribe testosterone auto-injectors.

We do not have hormone pellets or implants for gender-affirming care.

We cannot provide prescriptions through compounding pharmacies.

Yes. If you are already being seen by a medical provider for hormone treatment or have been self-managing hormones and wish to transfer your care to PPMI, we would be happy to see you. If applicable, please bring the records of your most recent care to your first appointment, including details regarding dosing and any recent labs.

We encourage all people not to smoke or vape tobacco or nicotine products for their general health. We can provide smoking cessation resources, including prescriptions for nicotine replacement therapy and other smoking cessation medications. Among other risks, nicotine use increases the risk of blood clots in the lungs or the legs. Estrogen can also increase blood clot risks. Nicotine use may also make estrogen-based therapy less effective. Estradiol patches (transdermal) have the best data to suggest little to no increased risk of blood clots. Estradiol can be prescribed by PPMI to people who are vaping or smoking nicotine; however, working toward nicotine cessation is recommended. Depending on your risks for blood clots and heart disease, if you use nicotine, your clinician may recommend estradiol patches instead of another route of estradiol.

No. Unfortunately, due to restrictions regarding the administration of medications and controlled substances, PPMI cannot administer your hormone medications for you. We can troubleshoot injection techniques, ways to decrease discomfort, and any questions you may have about injections. You can also consider having a support person perform your injections for you.