It’s official: Our Transgender Health Services program is very successful! Due to the COVID-19 pandemic, the program has moved largely to telehealth — but our patients seem to greatly appreciate the convenience, and also tend to feel safer and more comfortable in their own homes.
We now have approximately 253 patients in the program. In the last 12 months, we have had 451 appointments, with 268 new consultations. Most of these appointments are conducted via telehealth (87%) since we began telehealth services in May.
During an initial consultation with a new patient, we take a detailed medical history and conduct a physical if needed. We have a discussion about their personal goals and expectations of treatment.
Beyond hormonal transition care, there are many other components of a successful Transgender Health Services program, including:
- Creating a welcoming, inclusive health care experience
- Surgical care, including hysterectomy
- Creating a provider network — coming soon, in order to make processes more seamless
- Creating an advisory board
Administrative issues can be complex. There is more insurance complexity than usual: Ensuring the proper documentation of gender identity, using people’s chosen name and pronouns, and making sure these are reflected in their medical records. One hurdle we help patients overcome is figuring out what our patients’ insurance covers. It would be helpful if insurance companies made the process easier — more transparent and accessible for patients.
There are also special considerations associated with patient populations. For instance, transwomen — particularly transwomen of color — have one of the highest rates of HIV infection. Transmasculine patients can become pregnant, even if they are taking testosterone. Transmen may also want to stop their periods, and can use hormonal birth control to do so. It’s important that the health care we provide to our patients be specialized in terms of these facts.
We also give referrals for vocal coaching, laser hair removal, legal aid, Medi-Cal enrollment, behavioral health, surgical care, housing, and social services. We follow up with our patients at 3, 6, and 12 months, then annually.
We are currently partnering with Rady’s Children’s Hospital, and will refer to Rady’s if a patient lives in the area. The sooner a child identifies themselves as transgender, the sooner they can take hormones (hormones have a greater effect when taken before puberty). Planned Parenthood of the Pacific Southwest’s current threshold for gender-affirming hormone therapy is 18.
We use an Informed Consent model for gender-affirming hormone therapy: We give people the risks of treatment, the benefits of treatment, and alternatives to treatment, and ask them, “Is this something you want?” And then we trust their answer, just as we would regarding their choice of birth control or whether to have an abortion.