Blog Post

Transgender patients need more than surgery-only care. Here's how to meet their needs.

May 7, 2019

    When systems think about gender-affirming services, surgery is often the first thing that comes to mind—and given that payers have started covering these surgeries, provider interest in these programs has spiked.

    Hospitals are building gender affirmation health programs—here’s how to decide which services to offer

    However, the 2015 U.S. Transgender Survey found that only 25% of respondents had undergone some form of transition-related surgery, either because of health or financial barriers (55% of respondents who sought coverage for transition-related surgery in the past year were denied), or because they don't want to undergo these procedures. Conversely, almost 50% of respondents had received hormone therapy, pointing to the value of medical services.

    Taken together, these factors clearly point to a need for transgender services—but surgery-only programs may miss the mark. Read on to learn how to build a comprehensive gender affirmation health program that meets the needs of your community.

    1. Provide wraparound medical and social services

    The pathway to gender affirmation has been described by many transgender people as a journey, as every experience and choice is different. Not everyone who is transgender desires a full medical transition.

    Comprehensive programs should offer the wraparound services sought out by the transgender community, such as medical services (specifically, hormone and voice therapy), hair removal, and behavioral health consults. These services are often required as pre-requisites for surgery by payers, but also to a degree by surgeons, who must make judgment calls with their multi-disciplinary care teams—and with patients themselves—about the surgical readiness of each patient.

    If you do not offer the medical services necessary in advance of surgery, you must be prepared to refer your patients to an external partner to meet those requirements, such as a clinic for hormone therapy, a behavioral health facility for psychotherapy, or a rehabilitation facility for physical therapy as needed.

    In addition to medical services, all programs should offer social services such as social workers for case management and insurance navigators to help patients move through their chosen care pathway. Comprehensive programs may also help patients join support groups to ensure they have the support they need during their transition, especially post-surgery.

    2. Offer universal cultural competency training on the unique needs of the transgender community

    The same 2015 U.S. Transgender Survey found that 33% of respondents who had seen a health care provider in the past year had at least one negative experience related to being transgender. Because of these damages to patient trust, the onus is on the provider organization to prove that your program is capable of providing care in an affirming and friendly environment.

    To adequately serve this patient population and provide affirming care, leaders must invest in facility-wide education. Not only do the physicians involved need to be educated, but so do all staff who may interact with patients (e.g., nurses, administrative staff). Some programs hire consultants to lead cultural competency trainings, while other organizations use resources from programs like the National LGBT Health Education Center to own training in-house.

    In addition to educating staff, many organizations create connections and partner with local and state LGBTQ+ centers or other community-based organizations to drive volumes and engender trust. These partnerships and connections help reaffirm your organization's commitment to providing affirming and friendly care through your participation in them.

    Not sure if wraparound gender-affirming services are possible at your organization?

    Although most of the organizations we spoke with opted for offering comprehensive care to their transgender patients, some emphasized the importance of offering as much as is feasible, rather than nothing at all. This approach may mean mostly surgical services for some organizations, and various medical services for others. Regardless of how robust your service offerings are, the education and training of all staff members remains imperative in providing high quality care.


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