As trans and reproductive rights are under attack in many states, the horizon can look bleak. A major bright spot, however, is the Gender-Affirming Hormone Therapy program (GAHT) here at Planned Parenthood of the Pacific Southwest. At a time when the trans community is facing so many obstacles, it’s reassuring to see this program being expanded to offer even more care and support to our patients seeking gender-affirming hormone therapy. By increasing the availability of our services via telehealth, expanding the number of health centers that provide gender-affirming hormone therapy, creating an inclusive and non-judgmental space, and working with patients to overcome financial barriers, we are able to bridge some of these gaps that our trans and non-binary patients face when seeking hormone therapy.
The Gender-Affirming Hormone Therapy program was established in 2019 after hearing the need for these specialized services. Since then, GAHT has expanded from 7 providers to 11. Now, the program’s focus has been on expanding to all corners of the three-county region. Providers are getting certified to offer gender-affirming hormone therapy at our health centers in Escondido, Kearny Mesa, Coachella, and Imperial Valley. This will significantly improve access for our patients who can now get care in North County, Central San Diego, Riverside County, and El Centro. Furthermore, services for gender-affirming hormone therapy can now be booked online, making it even easier for patients to get care.
So what is gender-affirming hormone therapy? Just like the name suggests, this health care service uses hormones to match a person’s physical appearance to the gender that person identifies with. Feminizing (estrogenizing) hormone therapy uses estrogen and spironolactone, while masculinizing (testoronizing) hormone therapy uses testosterone. Patients will come in every three months in their first year to make sure they are able to get the appropriate dose and regimen started. After that, patients will come in at least once yearly. In 2021, Planned Parenthood of the Pacific Southwest had 821 hormone therapy visits. So far in 2022, the GAHT team has already seen 645 different patients for gender-affirming care. Director of the Gender-Affirming Hormone Therapy program, Rachel Stern, attributes part of this success to the affiliate’s diversity, equity, and inclusivity work, stating, “...we do a lot of diversity, equity, and inclusivity training across the affiliate to make sure that all of our patients, especially those that often face disparities in health care settings, can come to us and feel like they can trust us.”
There are several reasons the Gender-Affirming Hormone Therapy program is unique. Due to the smaller number of providers and the routine nature of hormone therapy, patients are often able to see the same provider over the years. This helps create a stronger provider-patient relationship. Also, because of the sensitive and life-changing nature of these services, we have very dedicated providers. In fact, almost all of the original providers are still here from the program’s inception in 2019, something that GAHT director, Rachel Stern, is especially proud of. Another distinctive feature the director points out is their informed consent model, saying, “Many of our patients prefer to come see us because we use an informed consent model”. Basically, you must be 18 or older and able to provide consent. From their Welcome Letter, “Patients are not required to provide an approval letter from a therapist to start hormone therapy. Planned Parenthood believes that when fully informed, our patients are more than capable of determining what is best for themselves and their bodies.” They trust patients to make these decisions for themselves.
Hormone therapy is just one important method for affirming one’s gender. Gender-affirming care can also look like help changing gender markers on IDs, laser hair removal, referrals for surgery, social support groups, vocal coaching, fertility resources, and other community resources. That’s where our Care Coordination program comes in. Our Care Coordinators are there for patients who need resources beyond sexual and reproductive health care. This could mean coordinating a flight or hotel for an abortion patient coming from out of state or a referral for a trans patient seeking gender-affirming care like surgery. Between the Gender-Affirming Hormone Therapy and Care Coordination programs, these teams are able to provide 360 degrees of care for our patients.
Earlier in the pandemic, our providers had to pivot to telehealth for gender-affirming care. This actually turned out to be a huge benefit for accessibility. Now, even with the return and expansion of in-person services, gender-affirming care remains one of the most in-demand telehealth services. This past year, 75% of gender-affirming hormone therapy visits were conducted via telehealth. One reason for this is because we can take patients from anywhere in California. This is helpful for patients who face barriers to getting in-person care. We know that eliminating as many barriers as possible is crucial and even lifesaving as the trans and non-binary community, especially trans and non-binary people of color, often face bias and exclusion when it comes to accessing health care. Director Rachel Stern talks about the risk of interrupted treatment saying, “I’ve definitely had a lot of my GAHT patients concerned about being able to continue to get their medications and continue to get the care that they need. If they can’t, there’s research that shows (and this is part of the informed consent model) that there is a risk for non-treatment for patients who need hormone therapy. If it’s part of their gender-affirming care and they can’t get it, there’s very high risk for depression, self-harm, and suicide”.
Where’s the Gender-Affirming Hormone Therapy program headed for the future? Director Rachel Stern hopes to increase awareness in the community that Planned Parenthood of the Pacific Southwest offers hormone therapy for gender affirmation, increase the number of providers, continue providing training on gender-affirming care, and create new partnerships that support people who are transgender as well as strengthen existing partnerships within the community. When asking the director what she’s most proud of with the Gender-Affirming Hormone Therapy program, she points to the growth of the program, the passionate providers, and of course, the patients. She says, “When I talk to patients, they’ll tell us ‘this was so much easier,’ or ‘they’ve been trying to do this for years,’ or ‘they’re finally ready and they’re really nervous.' They're just so grateful and that really makes me proud to provide the services to them. And to hear a lot of the things that patients have been through, their journey up to this point…it’s things that most people have not experienced. So if we can be there to help them be who they are, then yeah, I think that’s really great.”
To learn more about our gender-affirming care services, visit: planned.org/GAC
To learn more about our advocacy efforts and get involved, visit: planned.org/takeaction