Trans affirming healthcare and best practices

This month our SECU Public Fellows intern, Matti Kauftheil, spoke with Dr. Jennifer Abbott about providing gender affirming care and creating trans affirming health care spaces. Dr. Abbott is family practice physician, who works at the Minnie Jones Health Center, commonly known as Western North Carolina Community Health Services (WNCCHS). She is also a valuable member of the WCMS Board of Directors in her role as a Director-at-large.?

The Minnie Jones Health Center has low barriers to hormone therapy and practices an informed consent model that centers the patient. In 2020, they created?TAP?(Transition Assistance Program) that helps to cover the costs of hormone therapy (HRT) for patients who are uninsured or underinsured.?

Dr. Abbott explained that many of the center’s patients have been turned away from hormone therapy by other providers. One reason providers may be turning patients away is from a lack of training on providing hormone therapy. Access to HRT can be increased by training other providers and encouraging providers to reach out and learn more about providing hormone therapy.?

A barrier to health care for everyone, but especially for patients seeking gender affirming care, is insurance. Of the roughly 500 active Trans and nonbinary patients at WNCCHS, 36% of those patients within the last year were uninsured, and many more are under-insured. WNCCHS is a federally funded health center making the care provided there more accessible, however when patients are referred out for specialist care they utilize?Project Access?to support their patients.

To access gender affirming surgery, most patients either need insurance coverage or the capacity to pay out of pocket. Some patients can raise the money for top (chest) surgery out of pocket, but genital surgeries are nearly impossible to pay for out of pocket. For patients who do have insurance, they will need support navigating the various necessary letters of support and referrals that insurance companies require to cover gender affirming care. WNCCHS has a LGBTQ health coordinator who helps with letters of support and referrals, an essential aspect of navigating gender affirming care.?

Regarding gender affirming surgery, there are very limited surgeons near WNC that specialize in gender affirming surgery. Additionally, the?Trans Health Program?at UNC Chapel Hill is the only place that takes Medicaid for surgeries and has a long wait list. Dr. Abbott identified a need for more experienced providers, and for surgeons to have training specific to gender affirming surgery. The?WPATH?(World Professional Association for Transgender Health) annual conference has time set aside for surgeons to learn from one another about best practices in gender affirming surgery.?

WPATH is also responsible for standards of care that insurance companies utilize to identify what services they are going to cover. They are quite controversial and can aid in the gatekeeping of Trans health care. The much-anticipated Version 8 will be released shortly this year:?https://www.wpath.org/soc8

For primary care providers and specialists not specializing in Trans-specific care, it is still vital to receive training on how to be Trans affirming and create office spaces that are Trans affirming. There is a training initiative with the Campaign for Southern Equality to support providers and offices in their pursuit of being affirming and welcoming to Trans patients. Reach out to CSE for this training:?https://southernequality.org/our-work/community-health-project/?or contact Ivy Hill at?[email protected]

For providers specializing in Trans-specific care, WPATH offers educational courses through their Global Education Institute:?https://www.wpath.org/gei

An important way to create an affirming, safe, and welcoming space for Trans patients (and all patients) is constant and ongoing training of every person who comes to work in your office. For all incoming staff, providing inclusive patient care training and ensuring proper training will result in the best care for patients. Patients that are misgendered or referred to by the wrong name (birth name/dead name) are likely to not want to seek medical care in spaces where that occurs. It is a harmful and gender dysphoria inducing experience to not be fully welcomed and affirmed in a medical space.

Providers and medical practices that are open to receiving patient feedback can learn and continue to improve care.

This Pride month, we welcome you to learn and take the next steps to learn and grow the access to Trans-affirming care and the gender affirming services that your practice offers. Happy pride month to all LGBTQ+ patients and providers in WNC!