Frequently Asked Questions

In order to receive gender-affirming hormone therapy services at Planned Parenthood of the Pacific Southwest, you must be 18 or older and able to provide consent.

While patients under 18 cannot received hormone therapy, they may have a consultation with a provider to understand treatment options and to receive medications to stop their periods (if desired).

Gender-affirming medical care including hormones and surgeries must be covered in California, according to the Insurance Gender Nondiscrimination Act, AB 1586. However, if you have not met your deductible, or would have a copay for any other service, the same will apply to your gender-affirming care services and prescriptions. Additionally, Planned Parenthood of the Pacific Southwest is not contracted with every insurance provider. We will check for insurance coverage before or at the start of your visit. You can ask our biller for a cost estimate before you begin your appointment.

• Family PACT: We may be able to sign you up for Family PACT if you meet the income requirements and are receiving certain sexual health services. This will not cover your gender-affirming medical care but can cover other sexual health services.
• Sliding-scale fees: For people who are paying out of-pocket for their services, we have a sliding scale for fees based on your income. There is also a flat rate for telehealth services.
• Medications: If you do not have insurance, you can pay out of pocket for your medications. We recommend that you ask your provider about prescription discount programs to reduce the cost to you. You can search by type of medication and zip code, and the programs will show you which pharmacies have the most affordable rates, using their discounts. Some pharmacies will also be able to connect you with affordability programs.
• Lab tests: If you need lab work and do not have insurance, you can arrange to come to Planned Parenthood for your blood draw, and pay us directly, using our sliding scale. We have worked to make this service affordable.
• Losing coverage: If you lose insurance coverage, please let us know. We can help you find the most affordable approach to continuing your hormone therapy. We want you to have access to this medically necessary care.

Planned Parenthood contracts with many, but not all, insurance plans. If you have a PPO plan (preferred provider organization) you can typically choose to go wherever you wish without a referral, as long as we take your insurance. For some commercial HMO plans and some types of Medi-Cal, you’ll need a referral from your primary care provider (this is the main doctor who you’re assigned to, or your home health center). This is called a referral authorization, and is processed using your insurance company’s website. Your doctor’s office will need some basic information about the type of care you’re getting, which health center, and for how long. Sometimes they’ll want us to send them a referral request letter first. If so, please get their fax number. The referral usually lasts for 1 year.

• Remote care: If you move within the state, we may still be able to see you remotely. We can work with you to coordinate getting labs, scheduling telehealth appointments and finding a pharmacy.
• Out-of-area referrals: However, if your insurance plan is out of area, you might not be able to get a referral to come see us from your new primary care doctor. This means you’d need to pay out of pocket for your visits with us until you’re able to establish care with your new provider.
• Transferring care: We may be able to help you find a new provider. Planned Parenthood health centers throughout the country are working to expand access to gender-affirming care. If you want your medical records sent to your new provider, you’ll need to fill out a release form. It’s helpful to do this before you move, but if needed we can mail you the release form.

We are happy to help you with other aspects of gender care and gender affirmation, if these are things you’re interested in.

• Name/gender marker change letters: We recommend the Transgender Law Center’s state-by-state guide to changing legal identity documents. We can provide a letter attesting that your gender is your gender for your court process and passport application.
• Information on surgery: If you’re interested in a referral for a particular surgery, we can help you with a list of recommended surgeons and a letter of support. You will likely need to get a referral to the surgeon from your primary care provider as well. We can help you navigate those processes. For some surgeries you need a letter from a therapist and a letter from a physician. For others you’ll need 3 letters: one from a mental health professional with a PhD, PsyD or MD, one from a therapist, and one from a hormone provider or primary care provider. There may be an associated cost with this visit as the clinician needs to evaluate whether you are an appropriate candidate for surgery.
• Therapists: We maintain lists of gender-affirming therapists for a variety of insurance plans and sliding-scale payment options. Whether or not you want to talk with a therapist about gender issues, patients often prefer to see someone trans-affirming for their mental and emotional health care. We can work with you to help you find a therapist you connect with.
• Information for hair removal: We may be able to help you find an affirming and accessible hair-removal location or talk to you about avenues for hair removal.
• Fertility resources: Fertility preservation is not usually covered by insurance at this time, but we can discuss fertility with you and share options for fertility preservation.
• Vocal coaching: This is not covered by insurance at this time, but we may be able to provide you with contact information for gender-affirming vocal coaching. There is also a voice coaching app available for download.
• Community resources: We can help connect you with community-based resources, like free binder programs, support groups, food pantries, LGBTQ+ shelters, crisis lines, microgrants, and the nearest LGBTQ+ centers and trans-specific events. Just let us know what type of support and community-building you’re looking for, and we’ll try our best to connect you. Feel free to share community resources with us if you feel comfortable.
• Support for your loved ones: If your loved ones need education about trans issues, support in their learning process, or to build community, we can connect them with support circles and educational resources, and can answer questions (with respect for your privacy) if they come with you to a visit. Your loved ones can also visit PFLAG website to learn more.

Gender affirming hormone therapies (both masculinizing and feminizing) are not considered birth control. 

People who are using testosterone, have uteruses, and are having sex with pregnancy potential (sex where sperm gets near the uterus) should use birth control to prevent pregnancy. People whose periods have stopped with testosterone use have become pregnant while taking testosterone. Testosterone should not be used during pregnancy (due to effects on the fetus). 

Use of birth control by people who could get pregnant is recommended if they are having sex with pregnancy potential with someone who is using feminizing hormone therapy unless pregnancy is desired.

Using testosterone is not a contraindication to the use of any form of hormonal birth control. Use of birth control is recommended for all people using testosterone who are having sex with pregnancy potential. While research is limited, we do not think that hormonal birth control (including estrogen-containing methods) have a significant negative impact on the effects of testosterone. Said another way, this means people using testosterone can use birth control pills, patches, and rings to prevent pregnancy.

We support people of all genders in achieving their family planning goals. At this time there is limited data on the long-term impact of testosterone on fertility and pregnancy outcomes. However, the available data generally suggests that people can get pregnant and carry a healthy pregnancy after using testosterone. Testosterone should not be used during pregnancy (due to effects on the fetus). There may be some impact of long-term testosterone use on gametes (eggs) or future pregnancies, but existing data is limited. Some people pursue gamete (egg) banking (oocyte cryopreservation) prior to or during testosterone use. This process involves taking hormones to stimulate the ovaries to make eggs and then undergoing a needle guided procedure to harvest the eggs. This is not a service PPMI offers. If this is something you are considering, we are happy to provide resources for exploring these services.

We support people of all genders in achieving their family planning goals. At this time there is limited data on the long-term impact of feminizing hormones on fertility. However, the available data suggests that feminizing hormone therapy likely has a long-term negative impact on the quality and quantity of gametes (sperm). It is possible (and likely) that decreased fertility persists even after stopping feminizing hormones. Some people pursue gamete (sperm) banking (semen cryopreservation) prior to or during feminizing hormone use. This process involves banking ejaculated semen with a fertility lab. This is not a service PPMI offers. If this is something you are considering, we are happy to provide resources for exploring these services.

Masculinizing hormone therapies do not appear to increase the risk of either uterine or ovarian cancer. Studies are limited at this time, but researchers and clinicians do not think there is a link between testosterone use and uterine or ovarian cancer.

No. Removal of the uterus and/or ovaries is medically necessary for gender dysphoria for some transmasculine and nonbinary people, but use of testosterone does not mean that someone needs to proceed with any particular surgeries.

If you have a cervix (the bottom portion of the uterus) and are between the ages of 21 and 65 years old, cervical cancer screening is recommended. Use of testosterone does not change cervical cancer screening guidelines.  Depending on your age, type of screening, and your results, Pap tests may be needed every 1 to 5 years. People using testosterone should be aware that testosterone increases the risk that cervical cancer screening samples may be “unsatisfactory”; this result occurs approximately 10% of the time for people using testosterone, and repeat testing is recommended following this result. People may experience spotting (light bleeding) after a Pap test.

Yes. Currently, PPMI does not use self-swab testing technology. Cervical cancer screening at PPMI requires a pelvic exam with a speculum. If you have concerns about pelvic exams, please speak with your clinician about ways in which we may be able to best support you to facilitate an exam when you are ready.

You may. In general, breast cancer screening may be recommended for transfeminine and nonbinary people who have been on feminizing hormone therapy for at least 5–10 years and are at least 50 years old. Additionally, we always recommend letting a clinician know if you have a breast or chest concern.

Yes, people assigned male sex at birth retain their prostate tissue even if they undergo a vaginoplasty procedure (construction of the vagina). PPMI clinicians do not perform prostate exams. People using estradiol should speak with their primary care doctor about prostate cancer screening. In people who have had a vaginoplasty procedure, the prostate sits in front of the vagina and exams of the prostate are typically best performed by placing a finger in the vagina rather than the rectum.

Some sexually transmitted infection screening, such as hepatitis, syphilis, and HIV, are completed using blood samples. Other testing, like gonorrhea and chlamydia, are done using swabs or urine. The type of testing recommended depends both on the part of the body you have and how you engage in sex. Our health center staff can help recommend screening based on your specific practices. However, in general, for people who have had a vaginoplasty and use their vagina for sex, urine STI screening is recommended rather than vaginal swabs.

We encourage you to discuss any concerns you may have related to sexual pleasure or function with a clinician. 

Testosterone can increase libido, genital sensitivity, and can change lubrication; some people with uteruses also experience uterine cramps intermittently or with orgasm for reasons that are not well understood. Depending on one’s symptoms and goals, additional lubrication, dilator use, pelvic floor physical therapy, ibuprofen use for cramping, an exam, and/or resources for sex therapy may be recommended. Some people have a hysterectomy if symptoms of uterine cramping persist and cannot be well controlled and if having the uterus removed aligns with their needs and goals.

Feminizing hormones typically cause spontaneous erections to stop or decrease significantly and may decrease or change libido; erections may be less firm and orgasms may take longer to achieve on feminizing hormones. Of note, orgasms can occur without erections. Some people using feminizing hormones who desire assistance with erections may use medications marketed for erectile dysfunction; PPMI does not prescribe erectile dysfunction medications but encourages folks who are interested to speak with their primary care doctor. Sex therapy may also be helpful; we are happy to provide resources!