TABLE OF CONTENTS

What is transgender healthcare?

Transgender healthcare is any and all healthcare that supports transgender people in their health and well-being. It can include primary care, as well as specialized medical care or gender-affirming care that supports their gender transition or gender affirmation goals. 


Transgender healthcare can include gender-affirming hormone therapy (GAHT, sometimes called HRT), gender-affirming surgery including feminine facialization surgery (FFS), top surgery, breast augmentation and other surgeries, emotional support, mental health services, peer support, reproductive medicine, and other types of care.


While the language we use is still evolving, transgender healthcare is not a new field. It has been around as long as transgender people. Healthcare providers, researchers, policymakers, grassroots organizers, scientists, and people with lived experience all continue to expand our understanding of how to best serve transgender patients. This blog is an overview of what transgender healthcare is and how it helps our community.


Transgender healthcare is a complex field that may bring together many different types of medical care. Not every transgender person is the same, and not every person needs the same types of care. Just as there is no one-size-fits all definition of “transgender,” there is no one definition for transgender healthcare.


In the broadest sense, transgender healthcare is any kind of healthcare that supports a transgender individual. This may also be called or include “gender-affirming care.” Many people tend to think of transgender health as hormones and surgery, but it is more than that—because transgender patients are people, and we likely have many other healthcare needs as well.


Transgender healthcare might include:

  • Gender-affirming hormone therapy, provided by a primary care provider or endocrinologist

  • Surgeries for gender affirmation

  • Pediatric medical care for trans youth

  • Fertility support for people trying to start their families, such as by a midwife, clinic, or reproductive endocrinologist

  • Reproductive healthcare, such as pelvic exams, fertility preservation, pregnancy and postpartum support

  • Sexual health services, such as STI screenings and treatment, PrEP, and sexual function support or medications

  • Specialized elder care for our aging community members

  • Mental health support such as medications, therapy, or peer support


Why do I need transgender healthcare?

Transgender people deserve to receive the best possible care to support every phase of life. Transgender healthcare is important because it provides culturally competent care to people with unique needs. Everyone deserves to feel safe, taken care of, and seen in the clinic. When providers don’t know how to support transgender patients, healthcare needs may get overlooked.


One of the most common issues that transgender people face in mainstream healthcare is that the system does not accommodate their needs. The traditional healthcare system is designed to serve people who are cisgender. This might mean that someone with an “M” marker on their identification is not able to access a pelvic exam if they need it. It also favors people who can afford the treatments they need, either through out-of-pocket payments or insurance. Those of us with healthcare needs that are outside this spectrum tend to fall through the cracks. Or, we endure long wait lists at clinics that don’t have the capacity to see us when we need help.


Why telehealth?

Telehealth is an affordable, accessible solution to the barriers that many transgender patients face. Often, specialty clinics are difficult to access, which can be challenging for people who have limited transportation. By working with a virtual clinic, transgender patients can meet with their healthcare provider via a secure messaging app.


Telehealth patients don’t need to travel to talk to a provider who is well versed in the needs of the trans community. This helps people cope with lack of access to care. It is frustrating to work with a provider who is not familiar with the unique needs of transgender patients or able to provide the necessary culturally competent care. According to the 2015 US Trans Survey (USTS), one-third of transgender people reported having a negative experience with physicians, including having to educate them about transgender care and “being refused treatment.” Even well-meaning healthcare providers may not understand how to best help their transgender patients.


Many trans people avoid seeking medical care due to previous experiences with discrimination. According to the USTS, nearly one-quarter (23 percent) of respondents reported that they avoided seeking healthcare they needed in the past year due to fear of being mistreated as a transgender person. Telehealth has created more healthcare options for transgender people by offering the opportunity to talk to a transgender healthcare provider or another transgender healthcare expert. While not all needs can be met by telehealth, some—such as gender-affirming hormone therapy and other prescriptions—can be.


Why is culturally competent healthcare important?

Transgender healthcare ensures that patients get what they need, when they need it. The informed consent care model means that healthcare providers educate patients about types of care that might support their goals. Patients are empowered in making the healthcare decisions that feel right for them. The patient can feel safe and heard, free to focus on their gender journey.


Culturally competent care for transgender and nonbinary people may differ from care for cisgender people in many ways. Some examples are the language that providers use to describe certain procedures, options, medications, or other types of care. In transgender healthcare, one common treatment is gender-affirming hormone therapy (GAHT). Mainstream healthcare calls hormone treatment “hormone replacement therapy” (HRT). The name HRT is inaccurate for transgender people because the hormones we are prescribed do not “replace” anything. We are not taking hormones to “replace” estrogen or testosterone that is lower as a result of the aging process. We take them to align our bodies with our gender identity. Naming this medication correctly allows medical providers to access clinical guidelines that support transgender health, and create evidence-based standards specific to trans people’s needs.


Another example would be the intake forms that a clinic uses. In a mainstream or traditional healthcare setting, intake forms may only offer “male” or “female” as options for sex. The forms may also limit which pronouns a patient can use. In transgender-inclusive healthcare, forms use more inclusive options. Patients are referred to by their chosen names and pronouns from the moment they arrive. Making this standard practice creates an environment where folks of all gender identities can feel welcome and safe.


Another area of transgender health is gender-affirming surgery. To make healthcare trans-inclusive, we use supportive language that acknowledges different bodies and identities. For example, the tissues of the human body are not gendered. Breast tissue is not exclusive to cisgender women. People of many genders have breast tissue. In traditional medicine, however, only women—not men, intersex or nonbinary people—have breast tissue. However, this is both inaccurate and inappropriate for transgender patients.


While these variations may seem minor, they go a long way towards providing best-in-class care for transgender and nonbinary patients. Research shows that creating an inclusive treatment space that is safe and welcoming vastly improves clinical outcomes.


Transgender healthcare is important because it saves lives—and improves the quality of life for people who face high barriers to care. Everyone deserves to receive holistic and respectful care that is both supportive and culturally competent.


What gender-affirming medications does Plume prescribe?

Plume offers a number of medication options that will support you on your gender journey and help you feel like your best, most authentic self. Some of the medications our care providers prescribe include hormones (testosterone, estradiol, progesterone), hormone blockers (spironolactone, finasteride, dutasteride), hair loss medications (finasteride/dutasteride), and sexual function support medications (sidenafil, tadalafil). Your medical provider will create a customized treatment plan based on your goals and desires. 


Can I microdose?

Yes! “Microdosing” is a term that means using a less-than-standard dose of hormone therapies. Some people prefer to take smaller amounts of testosterone, estrogen, or an androgen blocker. Sometimes called a “low dose” or  “nonbinary dose”, these smaller amounts of hormones may allow for slower and/or more subtle changes in your body than the full amount. For example, taking a microdose of testosterone will affect your vocal pitch, but may not lower your voice as much as the full dose would. Some reasons to microdose is that you may want more time to determine the effects you want from GAHT, or just prefer the changes to happen more slowly. Bear in mind that microdosing does not eliminate the less-desirable side effects of some medications, such as mood changes, acne, and hair loss. Whatever your gender journey goals, Plume will support you while you find what works for you. There is no cookie-cutter answer to what is going to help you feel comfortable, so feel free to try the medications that feel right for you, ask questions, and learn more as you grow into yourself.

 

Do you prescribe syringes?

Yes, if you are prescribed an injectable medication, we will prescribe you needles and  syringes! You will get them at the pharmacy when you pick up your medications or will receive them in the mail with your prescription delivery. If you are interested in buying injection supplies in bulk, let your care team know! They will guide you through ordering them online through the proper medical supply websites, based on your current prescription. This can be a more affordable option, especially if you are not using insurance to help cover the cost of your supplies. If your pharmacy is having trouble getting the correct injection supplies in stock, you may also search for a local syringe exchange program near you as a potential alternative resource. Make sure you have enough needles and syringes on hand for your medication. You should use a new needle and syringe each time you inject.


What are the different ways I can take my medication?

For testosterone, Plume prescribes injectable testosterone, topical testosterone gel, and testosterone patches. Learn more about testosterone here.


For estrogen and E+ medications, we prescribe tablets (estradiol, progesterone, and testosterone blockers), patches, and injectable estradiol. Learn more about estrogen and E+ medications here.


For hair loss, we offer tablets and topical creams/foams. Learn more about how certain medications may affect your hair, skin, or create other changes here.