Gender Affirming Care

At PPSNE, we take a team-based approach to care. At the front desk, our clinic assistant will ask you to confirm your identity using two identifiers. This can be your legal name or chosen name, if you have provided this, your date of birth, or your medical record number. If not already provided, you will be asked to share your chosen name and pronouns. If you have insurance, you will be asked to show your insurance card and ID so we can place a copy in your electronic health record. 

Next, you will meet with another clinic assistant, to review your reason for visit and health history, including any medical conditions, surgeries and your family’s health history, as this information will allow your clinician to better understand your unique health history to, helping them provide more tailored counseling. You will also be asked to list any medications you take (including doses), so have this information handy. If you are looking to start hormones, we will review a consent form that goes over the expected changes and risks. 

Next, you will meet with your clinician. They will ask questions about your transition goals. Although we follow the same general guidelines for all our patients, we understand that every individual’s goals and gender expression are unique, so you can work with your clinician to decide what medications and doses are best for you.  

At the end of the first visit, most patients who are starting hormones will be asked to get blood tests done. These can be drawn at the health center, or at any Quest lab. This process is approximately the same for those who are starting gender affirming hormone therapy for the first time, and those already on hormone therapy looking to switch their care to PPSNE. 

Before the end of your first appointment, your clinician will provide you with contact information for your Care Navigator. Please save this information.

No. Your clinician will assess your general health by looking at and talking with you during your visit. At the start of your visit, we will also ask to perform vital signs, to check your blood pressure and heart rate. You can choose whether or not you would like to be weighed. In general, patients are not required to undress for any of the physical examinations required to start hormones. If you have a specific medical condition or concern that requires a more detailed exam, your clinician will discuss this with you to determine what you are comfortable with. 

Whichever option feels more comfortable for you. The same information is reviewed and a similar process is followed for both telehealth and in-center visits. Patients must be physically in the state of Rhode Island or Connecticut during their telehealth visit. We anticipate that the legal requirements may change in November 2023, which may require patients to have at least ONE in-person visit on record to be able to receive testosterone prescriptions (or other controlled substances). We advise all patients seeking testosterone to schedule an in-person if they have not had one in the past. 

Yes—in general you are welcome to one person for support, barring the need to restart social distancing requirements in the event of a new COVID spike or other extenuating circumstance.

Most patients who want to start gender affirming hormone therapy can receive a prescription during their first appointment.  If you have a preexisting medical condition that would impact or be impacted by starting hormone therapy, your clinician will work with you to address these concerns before moving forward with new prescriptions. Depending on your insurance coverage, you may require a prior authorization, ie. special permission from your insurance. If a prior authorization is needed, our Care Navigator can help you by contacting your insurance company. This process commonly results in an approval from the insurance provider within a week, though individual insurance plans may vary.

All medications can be paid for without insurance. 

Pharmacy issues are not uncommon and can be difficult to understand. The following tips can help reduce your chances of complications at the pharmacy as well as ... 

Pharmacies will not start to fill your medication until they know how you are paying. Pharmacies assume all patients will be using insurance. If a pharmacy does not have an insurance listed for you, they generally will not begin to fill the medication until you contact the pharmacy to supply insurance, or inform them that you will be paying out-of-pocket. All medications with a prescription can be paid for out of pocket if you choose. 

Prescriptions will be prescribed to your legal name. If this name is different than the one your insurance has listed, please note this to your clinician. 

During the first year of hormone therapy, most patients will be prescribed a three-month supply at a time, often being broken up into one- month supply at a time. Check the label of your medication to see how many refills are listed. 

If medication refills are available, the pharmacy will usually automatically refill them until you have 0 refills remaining. However, non-medication prescriptions, just as injection supplies, often are NOT automatically refilled. In this case you will need to speak with pharmacy staff and request they dispense a refill of your prescribed supplies.  

Many insurance plans do not cover the cost of injection supplies. This can cause confusion at the pharmacy, especially if the insurance covers the rest of the prescriptions. 

Sometimes pharmacy staff will substitute injection supplies based on what they have in stock. All supplies should be dispensed as written by your clinician. If you experience issues, please ask the pharmacy staff to contact your prescriber for clarification. 

Before leaving the pharmacy, view your medication list on MyChart and double-check that all dispensed prescriptions match what your clinician prescribed.  

Calling a pharmacy before visiting can reduce your overall wait time and save you a trip in the event that your medication is not yet ready. 

Hopefully your pharmacy experience goes smoothly, but if there is an issue, reach out to your Care Navigator. Please do this even if the pharmacy has said they will contact us. 

If you have not already, please check your health insurance plan’s Evidence of Coverage (EOC). This is a document that outlines services covered or not covered by your plan. This can often be accessed by logging into your insurance’s website or app. If this is not an option, please call the customer service number listed on the back of your insurance card and ask for an emailed copy of your EOC. Once found, you can use a key word search (ctrl+F) to search for “transgender” or “gender affirming.” This should bring you to relevant sections outlining your covered benefits. 

We bill all gender affirming hormone therapy visits as general office visits and therefore your insurance should treat them the same as any other PPSNE office visit.  Currently, it is uncommon for insurance to not cover labs and prescriptions related to gender affirming hormone therapy. Some plans may require prior authorization for some prescriptions.; this requirement is often not known until the pharmacy tries to fill the prescription. The pharmacy does not always relay this message to our team. If you find that your insurance requires a prior authorization, please contact the Care Navigator. 

No problem. We provide care regardless of insurance status and offer a sliding fee scale for patients paying out of pocket. Patients without insurance who may qualify for Medicaid can ask to speak with our insurance enrollment Care Navigator to apply for Medicaid. We understand that some patients who have insurance may prefer not to use their insurance for privacy reasons. These patients can also pay out of pocket, using our sliding fee scale.

For patients taking hormones, we use blood tests to guide the safety and efficacy of treatment and avoid complications. We want to ensure the doses prescribed are safe, so if your levels are too high, your clinician will recommend decreasing your dose. In general, we recommend blood tests every 3 months for patients in their first year, spacing out as long as once a year once you are on a stable dose. 

You can ask your care team for a list of surgeons in the area, but determining which surgeon is right for you is a very individualized decision. Some factors to consider include: cost/insurance coverage, location where the surgeon operates, type of surgery offered, the surgeon’s reputation/portfolio, wait times, and bedside manner. Once you decide on a desired surgeon, you can typically schedule a consultation visit to meet the surgeon and discuss your goals before deciding if to schedule a surgery with that surgeon.