Gender-Affirming Care

Planned Parenthood of Southern New England's (PPSNE's) gender-affirming health care program strives to reduce barriers that disproportionately affect transgender, nonbinary, and gender non-conforming people. Our health centers offer services for adults across the gender spectrum. PPSNE knows our community is strong, and we are here to provide tools and resources to empower you in meeting your health goals.

We know there can be a lot of questions about what to expect as a patient. Below you'll find helpful info about our approach to gender-affirming care.

Gender-Affirming Care Services at PPSNE

Hormone-Related Lab Work

We use blood tests to monitor hormone levels to minimize the risk of complications and guide the safety and efficacy of treatment. In general, we recommend blood tests every 3 months in the first year of hormones, spacing out to once a year once you are on a stable dose.

Insurance and Cost

PPSNE provides care regardless of your insurance status. We offer a sliding fee scale for patients paying out of pocket. Patients without insurance can ask to speak with our Insurance Enrollment Care Navigator to find out if they qualify for Medicaid. We understand that some patients who have insurance may prefer not to use their insurance for privacy reasons; if this is the case please share this information with your care team so additional steps can be taken to meet your needs. These patients can also pay out of pocket, using our sliding fee scale.

Not sure if your insurance covers a service? You can call your insurance company and ask, or ask our patient navigator for assistance.

Letters of Support

You may need a letter of support from a healthcare provider if you want to amend the gender marker on your birth certificate or receive most gender-affirming surgeries. Our team can help you navigate this process and provide you with the letters of support needed for government agencies, insurance companies, and other healthcare providers.

Patient Navigator

Our care team includes an experienced patient care navigator to guide and support our patients through the complex healthcare referral system, insurance challenges, and legal name or gender marker changes. Our navigator educates and empowers patients with information so they can walk through their healthcare journey with greater knowledge and agency.

Referral Letters

If you are looking for gender-affirming services outside the scope of PPSNE, we can help connect you with the care you need. Our team can provide referral letters as well as a list of gender-affirming surgeons, therapists, and other specialists in the area.

Gender-Affirming Hormone-Therapy (GAHT)

GAHT is one of the most common forms of medical gender-affirming care. Generally, GAHT involves taking hormones, sometimes in combination with hormone blockers, to change things about your body over time. Changes resulting from GAHT differ from person to person. Your PPSNE provider will take your lead on your needs and goals, and can help you determine the best medication options for you.

Learn About Common Medications:

Estrogen

Estradiol, taken alone or with anti-androgens or testosterone blockers, can help patients with goals like breast growth, body fat redistribution, and skin and hair changes. Estradiol is most commonly taken through pills, patches and injections. Estradiol is sometimes prescribed in combination with other medications such as spironolactone, finasteride, dutasteride or progesterone as needed to help patients achieve their goals. Our team will help you figure out what medications and formulations best suit you.

What might I expect?

Breast tissue growth
Body fat redistribution towards thighs, hips, face, and chest
Mood changes
Skin softening and hair changes
Decrease in muscle mass
Changes in libido
Changes in fertility with long-term use

What not to expect:

Voice Changes: Estradiol-based therapy typically does not contribute to changing your voice if you are starting hormone therapy after going through testosterone-dominant puberty. This is because testosterone can thicken your vocal cords, which cannot be reversed by medication. Gender-affirming voicework can help where GAHT may not!
Body and Facial Hair: While estradiol, progesterone, and antiandrogens may slow hair growth on the face and body, they do not stop hair growth. Adults seeking to get rid of unwanted hair often use hair removal techniques such as shaving, waxing, electrolysis or laser hair removal together with GAHT.

Finasteride & Dutasteride

Finasteride and Dutasteride are medications used to treat hair loss, and are prescribed to people of any gender. They work by decreasing the production of an androgen called DHT. Finasteride or dutasteride can be prescribed in combination with hormones or on their own.

What might I expect?

Slowing of scalp hair loss, especially on the crown
Decrease or slowing of facial and body hair growth
Mood changes
Slight breast tissue growth
Decrease in libido and erections

What not to expect:

Radical regrowth of hair after significant hair loss

Progesterone

Progesterone is a hormone commonly used to complement the effects of estradiol for patients on long-term hormone therapy.

What might I expect?

Mood changes
Slight changes in breast tissue
Changes in libido and sexual function

What not to expect

Dramatic changes in breast tissue

Spironolactone

Spironolactone is a testosterone blocker and reduces the total amount of testosterone in a person’s body. This medication can be taken in addition to estradiol, especially if a person’s testosterone is not sufficiently suppressed by estradiol alone.

What might I expect?

Mood changes
Decrease in muscle mass
Changes in libido and sexual function
Changes in fertility with long-term use

Testosterone

Testosterone can help patients with goals such as voice deepening, increased body or facial hair, increased muscle mass, and cessation of monthly bleeding. It is most commonly taken through injections or topical gel. Our team will help you figure out what formulations best suit you.

What might I expect?

Skin and Hair Changes: Skin oiliness and acne early on, increased thickness and growth of facial and body hair
Mood changes
Cracking, then deepening of voice
Increased muscle mass
Redistribution of body fat away from the hips and towards the abdomen
Bottom growth (clitoral enlargement)
Pause in monthly bleeding
Increase in libido
Hairline changes (thinning hair/scalp hair loss)
Changes in fertility with long-term use

What not to expect:

Changes in height
Disappearance of chest tissue, though a slight decrease may occur
Immediate dramatic changes in facial hair growth or voice: these changes generally take years to reach full effect and also depend on your genetics

What to Expect: Your First In-Person Visit

Step 1: Check in at the Front Desk

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.

Step 2: Reason for Visit

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, 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.

Step 3: Meet Your Clinician

Next, you will meet with your clinician. They will ask questions about your transition goals. 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 same whether you are beginning or continuing hormone therapy. Before the end of your first appointment, your clinician will provide you with contact information for your Care Navigator. Please save this information.

What to Expect: Your First Telehealth Visit

Step 1: Download the App

When you make your Telehealth appointment with us you will be emailed an activation code for the MyChart app. Once you have your activation code ready, go to the link listed below. In the MyChart login box, click sign up now. You will be asked to create a username, password and security question.

Step 2: Prepare for Your Telehealth Visit

One hour before your appointment you will receive a phone call. During this call you will go over your medical history and the reason for your visit. To make sure your Telehealth visit goes smoothly, make sure you have a stable wifi connection, your are in a well lit room but not backlit by a window, and most importantly have a private room in which to take your appointment.

Step 3: Accessing Your Appointment

You will be sent a link via text or email that will connect you to a secured video chat. The invitation to your appointment will expire if it is not accepted within 15 minutes. To protect your privacy attend your appointment from a quiet and private space.

Frequently Asked Questions (FAQs)

What are the requirements for me to get hormones?

We trust you to decide whether or not hormone therapy is the right choice for you. Our providers will explain the risks, benefits and alternatives and answer any questions you may have. Our providers are trained in best practices of informed consent, so you don’t need a letter from a therapist to get a hormone prescription from us.

Do I need a Telehealth or In-person appointment?

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.

Why do I need lab work, and how often?

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 3-6 months for patients in their first year and may space out to once a year when you are on a stable dose.

What should I expect at the pharmacy?

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 help you advocate for yourself if you encounter issues.

Pharmacies may not fill your prescription until they know how you are paying. Pharmacies often 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 the name on your identification. If this name is different from 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 dispensed monthly by the pharmacy. 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, such 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.
Some 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 or reach out to your care team.
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.

Can I bring a support person to my visit?

Yes — in general, you are welcome to have one person accompany you for support. Your clinician may ask to speak to you privately about some topics, but your support person is welcome at any visits for which you’d like them present.

How soon after my visit can I start hormones?

Most patients who want to start gender-affirming hormone therapy can receive a prescription during their first appointment. If you have a pre-existing 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 prior authorization, i.e. special permission from your insurance. If a prior authorization is needed, your 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.
If needed, all medications can be paid for without insurance.

Will I have to undress to be examined for the visit?

No. Your clinician will assess your general health by looking at and talking with you during your visit. At the start of health center visits, we check your blood pressure, heart rate, and vital signs. 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.

I’ve already been prescribed hormones before, and I’m looking to resume care with a provider at PPSNE. What should I expect?

Just like with new patients, your provider will listen to you about your needs and provide options depending on how long it’s been since you last took hormones, and whether or not you need a dose adjustment. Your provider may recommend that you get some bloodwork done if recent records are not available.

I’m under 18 and seeking gender-affirming care. What are my options?

PPSNE isn’t currently able to offer GAHT for patients under 18. However, our Care Navigator is happy to work with you to identify pediatric providers that might work for you.

I’m planning on having gender-affirming surgery. How can I find a surgeon?

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 surgeon, your Care Navigator can help with referrals, letters of support, and coordinating with your surgeon’s office. You can schedule a consultation visit to meet the surgeon and discuss your goals before deciding if you want to schedule surgery with that surgeon.

Gender-Affirming Care

What is Gender-Affirming Care?